C - Scientific and Educational Exhibits - myESR.org

CScientific andEducational ExhibitsAbdominal Viscera (Solid Organs) .............. 338Breast ......................................................... 353Cardiac ....................................................... 364Chest .......................................................... 378Computer Applications ............................... 393Contrast Media ........................................... 398Genitourinary .............................................. 401GI Tract ....................................................... 418Head and Neck ........................................... 434Interventional R adiology ............................. 443Molecular Imaging ...................................... 454Musculoskeletal .......................................... 457Neuro .......................................................... 475Pediatric ...................................................... 490Physics in Radiology .................................. 497Radiographers ............................................ 502Vascular ...................................................... 504S337

Scientific and Educational Exhibitsand hepatic arterial thrombosis, hepatic venous outflow obstruction, hepatic infarction,hereditary hemorrhagic telangiectasia and peliosis hepatis) will be performed.Vascular pseudo-lesions shall also be discussed.Conclusion: Vascular disorders of the liver may not only mimic but also concealfocal liver lesions. Awareness of the imaging spectrum and knowledge of the underlyingmechanisms of vascular hepatic disorders can help avoid a substantialamount of interpretative pitfalls, thereby increasing the diagnostic accuracy of CTin this group of conditions.C-011Clinical application of Gd-EOB-DTPA enhanced T1-weighted MRCPN. Lee, S. Kim, J. Yeom, J. Lee, D. Kang, G. Kim, H. Seo; Busan/KRLearning Objectives: To understand pharmacokinetics of Gd-EOB-DTPA. To listdisease entities that cause absent or delayed filling of the gallbladder and biliarytract. To describe clinical applications of hepatobiliary MR using Gd-EOB-DTPA.Background: Gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a newly developed hepatobiliary MR contrast agent. Gd-EOB-DTPAis gradually taken up by the hepatocyte and eventually excreted via the biliarysystem, where it causes T1 shortening of bile. Because of these characteristics,addition of Gd-EOB-DTPA enhanced T1-weighted MRCP may havepotential toimprove diagnostic limitations of standard MRCP.Imaging Findings: We will illustrate clinical applications of Gd-EOB-DTPA enhancedT1-weighted MRCP. Clinical applications of Gd-EOB-DTPA include: 1)visualization of biliary anatomy, 2) differentiation of biliary lesion from extrabiliarylesion, 3) diagnosis of cholecystitis, 4) evaluation of filling defects in the biliarytract and the degree of bile duct obstruction, and 5) post-operative complicationand post-procedure evaluation.Conclusion: Gd-EOB-DTPA enhanced T1-weighted MRCP can increase diagnosticperformance for anatomical and functional biliary disorders.C-012The application of single direction diffusion gradient DW-MRI in hepaticmetastasesY. Cui, X. Zhang, Y. Sun, L. Tang, K. Cao, J. Li; Beijing/CN (tjbjcui@yahoo.com.cn)Purpose: To evaluate the possibility of thin slice DW-MRI of whole liver in hepaticmetastases patients within one breath-hold via applying single direction diffusiongradient sequence.Methods and Materials: 30 locally gastro-intestinal cancer metastases patients (M/F=19/11, mean age 57.5 years) were scanned by GE 1.5 T MR system. Transverseplane DW-MR images were obtained by using single direction diffusion gradients(diffusion gradients were applied in the S/I direction with b=0 and 800 sec/mm 2 ;slice thickness/slice gap=6/1 mm; slice number=28, scan time 22 sec) and threedirection diffusion gradients echo planar imaging sequence (diffusion gradients wereapplied in the S/I, R/L and A/P direction with b=0 and 800 sec/mm 2 ; slice thickness/slice gap=6/1 mm; slice number=15, scan time 48 sec) separately. ADCs of lesionswere measured and artifact and distortion scale of lesions were evaluated.Results: All the 30 patients acquired whole liver DW-MRI images within one breathholdby using single direction DW-MRI. At least two breath-holds were appliedwhen using three direction DW-MRI and the scan range could not cover the wholeliver. The ADCs of lesions obtained by single direction DW-MRI (mean =1.16×10 -3mm 2 /s) were correlated significantly (P=0.000) with ADCs acquired by DW-MRIwith three direction (mean =1.11×10 -3 mm 2 /s). The scale of artifact and distortionof lesions were significantly different between the two sequence (F arti=31.39,P arti=0.000; F dist=35.01, P dist=0.000). Better DW-MR images were acquired by usingsingle direction DW-MRI.Conclusion: By using single direction DW-MRI we can obtain whole liver thin sliceimages as well as lesser artifact and distortion images.C-014Prevalence and significance of hypoattenuating hepatic lesions deemedtoo small to characterise: How are we following up these lesions and whatare the outcomes?G.M. Jonathan Albuquerque, H. Khosa, P. McCarthy; Galway/IEPurpose: To retrospectively determine the prevalence and significance of smallhypoattenuating hepatic lesions, in which follow-up imaging had been done, andhow this contributed to the diagnosis.Methods and Materials: The authors retrospectively reviewed 1192 CT scans andreports of patients undergoing CT thorax, abdomen and pelvis scans. The initialand final CT scans were reviewed for hypoattenuating lesions less than 15 mmthat were reported as too small to characterise (TSTC). The primary diagnosis,treatment, number and size of lesions and their interval change were also reported.Any additional investigations, such as ultrasound and MRI and their findings weredocumented.Results: Of 1192 CT scans, 564 (47%) patients were with multiple contrastedscans. Of 564 patients, 96 (17%) patients had lesions deemed TSTC. 6 (6.3%) ofthe 96 patients were excluded due to a short scan interval of 12 weeks. Follow-upimaging of 90 (15.9%) patients revealed lesions were unchanged in 71 (78.9%),increased size in 5 (5.6%), decreased in 3 (3.3%), and not seen in 9 (10%). 2(2.2%) patients with multiple lesions, each had 1 lesion unchanged with the resteither decreasing in size or not visualised.The 5 enlarging lesions represented metastatic breast cancer in 3 (3.3%), dilatedhepatic ducts, and a simple cyst in 1 patient each (1.1%).Conclusion: The prevalence of small hypoattenuating lesions in our study is 15.9%with 3.3% proving to be metastases. Additional imaging with ultrasound or MRI didnot characterise the lesions in 69.6 and 40%, respectively, of the cases imaged.C-015Motionless T2 weighted magnetic resonance liver imaging using functionalresidual capacity breath-holdA. Tabuchi 1 , T. Katsuda 2 , R. Gotanda 1 , T. Gotanda 1 , M. Mitani 1 , Y. Takeda 1 ;1Okayama/JP, 2 Hyogo/JP (a-tab@po1.oninet.ne.jp)Purpose: T2 weighted (T2W) liver images are often plagued by poor-image qualitydue to respiratory motion artifact. The diaphragm moved during data acquisitionin spite of breath-hold (B-H). To reduce the motion artifact, the functional residualcapacity B-H technique was used and the diaphragmatic movement during B-Hwas compared with voluntary expiration B-H.Methods and Materials: Diaphragmatic movement during B-H were assessedamong three types: voluntary expiration without explanation and training beforehand(VE-NEx B-H), VE B-H with explanation and training beforehand (VE-Ex B-H) andfunctional residual capacity with explanation and training beforehand (FRC B-H)in 25 healthy volunteers (12 males and 13 female, age 21 - 46, median age 24). Inclinical study, the qualitative analysis of the incidence rate of the respiratory motionartifact was assessed in 60 patients (31 males and 29 female, age 37 - 88, medianage 65.5) between T2W whole liver images using VE-Ex B-H and FRC B-H.Results: Diaphragmatic movement of VE-NEx, VE-Ex, and FRC B-Hs were4.2 2.2, 3.4 1.6, and 1.6 1.2 (mm), respectively, (p 0.001). Diaphragmaticmovement of the FRC B-H was significantly smaller than the other B-H methods(p 0.05). In clinical study, the incident rate of the motion artifact with FRC B-H wassignificantly smaller than that of VE-Ex B-H (p 0.05).Conclusion: The FRC B-H was a significantly effective method to reduce themotion artifact during B-H. The FRC B-H should be applied to improve the imagequality of HCC diagnosis.C-016Characterisation of diffusion-weighted magnetic resonance imaging offocal hepatic lesionsA. Pinardo Zabala, L. Gorospe Sarasus, M. Valle de Frutos,T. Gómez San Roman, A. Palomar Estrada, V.R. Lara Mazenett; Puertollano/ES(pinarcis@yahoo.es)Purpose: To analyse diffusion weighted magnetic resonance (DWMRI) in differentialdiagnosis of focal hepatic lesions, by using two b values, and determine anapparent diffusion coefficient (ADC) threshold value to differentiate benign frommalignant lesions.Methods and Materials: DWMRI was performed in 77 hepatic lesions, includinghepatocellular carcinoma (4 cases), hepatic metastases (9 cases), hemangioma(30 cases), hepatic cyst (32 cases). Apparent diffusion coefficient (ADC) valueswere evaluated using four different b values in different sequences. The ratio ofADC values of lesion/liver in hepatocellular carcinoma and hepatic metastaseswas also calculated.Results: The mean ADC values of hepatic lesions were as follows: hepatocellularcarcinoma (0.91 0.22)×10-3 mm 2 /s, hepatic metastasis (1.14 0.12)×10-3 mm 2 /s,hemangioma (1.64 0.42)×10-3 mm 2 /s, and hepatic cyst (3.18 0.21)×10-3 mm 2 /s. The ratio of ADC values in lesion/liver in hepatocellular carcinoma was0.87 0.42, being significantly different from that in hepatic metastasis (1.41 0.17,P 0.05).Conclusion: Diffusion-weighted MR imaging can help differentiate benign frommalignant hepatic lesions. The use of two b values in one direction could be sufficientfor the design of MR sequences in the liver.CS340 A B D E F FG H

Scientific and Educational ExhibitsC-017Evaluation of hepatic lesions using diffusion-weighted echo-planarimaging at 3 T MRIT. Namimoto, K. Awai, T. Nakaura, Y. Yanaga, Y. Yamashita; Kumamoto/JPPurpose: The purpose of this study was to determine apparent diffusion coefficients(ADCs) of focal liver lesions on the basis of a diffusion-weighted single-shot echoplanarimaging (DWI) at 3 T magnetic resonance imaging (MRI) and to evaluatewhether ADC measurements can be used to differentiate between malignant andbenign masses in the liver.Methods and Materials: One hundred forty-nine consecutive patients with focalliver lesions (75 hepatocellular carcinomas (HCCs), 23 metastases, 15 cholangiocellularcarcinomas (CCCs), 17 hemangiomas and 19 cysts) were evaluated inthis retrospective trial. DWI parameters at 3 T MRI were b values of 0 and 800 s/mm 2 , TR/TE= 2200/68 ms, FA of 90° in the axial plane with chemical shift selectivefat suppression technique. Quantitative measurement of ADC was performed foreach liver lesion and liver parenchyma. Statistical analysis was applied to checkwhether differences in mean ADC values were significant (p 0.05).Results: The mean ADC values of HCCs, metastases, CCCs, hemangiomasand cysts, were 1.08 0.24, 1.27 0.35, 1.43 0.42, 2.17 0.54, 3.06 0.29× 10 -3 mm 2 /s, respectively. Mean ADC values of normal and cirrhotic liver parenchymawere 1.33 0.27, 1.29 0.36 ×10 -3 mm 2 /s, respectively. The mean ADCsof malignant liver lesions were significantly lower than those of hemangiomas andcysts (p 0.01), whereas no significant difference was seen for that of normal andcirrhotic liver parenchyma.Conclusion: Our preliminary results indicate that the ADC value has good potentialfor differentiation between malignant and benign masses in the liver at 3 T MRI.C-018Progress in diagnosis of hepatic metastases in patients with colorectalcancer: A prospective study of diffusion-weighted MR imaging combinedwith gadolinium-enhanced dynamic studyY. Kuroki 1 , K. Nasu 2 , S. Kuroki 3 , R. Sekiguchi 1 , Y. Yoshida 1 , Y. Yamabe 1 ,T. Yamamoto 1 ; 1 Utsunomiya/JP, 2 Tsukuba/JP, 3 Tokyo/JP(ykuroki@tcc.pref.tochigi.jp)Purpose: We prospectively examined the detectability of hepatic metastaseson diffusion-weighted images (DWI) in combination with Gadolinium-enhanceddynamic (Gd-dynamic) study.Methods and Materials: 24 patients with 60 metastatic nodules in all underwentDWI and Gd-dynamic study prior to the resection of hepatic metastases of colorectalcancer. We used a 1.5 Tesla MR scanner (Gyroscan Intera Master 1.5 T, Philips) andSENSE-body coil. DWI was performed applying b factor 500 and then proceededto T2WI, T1WI, and Gd-dynamic study. The nodules that fulfilled all the following 3conditions were diagnosed as hepatic metastases: nodules that showed high signalintensity on DWI, nodules that were detected on T2WI or T1WI, and nodules thatshowed a different contrast enhancement pattern from cavernous hemangiomasand cysts on Gd-dynamic study. We analyzed the following 4 details: sensitivity,positive predictive value (PPV), false positive (FP), and false negative (FN).Results: 60 nodules, whose median diameter was 17 mm, were confirmed asmetastases pathologically. Of these, 13 nodules were 10 mm or under in diameter.Overall sensitivity was 95%, PPV was 93%, FP was 4 nodules, and FN was 3nodules. In cases of 10 mm or under, sensitivity was 85%, PPV was 73%, FN was2 nodules, and FP was 4 nodules.Conclusion: A combination of DWI with Gd-dynamic study accurately detectedhepatic metastases and showed its efficacy in preoperative diagnosis.C-019The mathematical model of chronic diffuse liver diseases differentialdiagnosis based on 31 P-MRS dataS.S. Bagnenko, G.E. Trufanov, V.A. Fokin, A.P. Kretsu; St. Petersburg/RU(bss_1979@mail.ru)Purpose: To design the mathematical model of chronic diffuse liver diseases differentialdiagnosis based on 31 P-MRS data.Methods and Materials: Ninety-four patients with diffuse liver diseases wereexamined with 31 P-MRS (1.5 T), which was performed in the right hepatic lobe.Forty-three of them were with chronic viral hepatitis, 31 with cirrhosis and 20 withsteatosis of the liver. Reference data were acquired from 30 healthy volunteers. Wecalculated the relative part of each metabolite (phosphomonoesters, inorganic phosphate,phosphodiesters and adenosine triphosphate) in total volume of phosphoruschemical compounds and on the basis of acquired data designed the mathematicmodel of differential diagnosis discussing pathological states.Results: The variance analysis showed the relative parts of PME, PCr, Y-ATPin total volume of phosphorus chemical compounds and the PDE/Pi index werethe most informative criteria. On the assumption of equal probability the patient’sbelonging to all studying groups we received four linear classification discriminators:F1 (hepatitis)= -29.53+361.68* Y-ATP+66.23*PME+173.14*PCr+0.79*PDE/Pi, F2 (cirrhosis)= -38.75+325.32* Y-ATP+146.39*PME+203.89*PCr+0.87*PDE/Pi, F3 (steatosis)= -27.43+345.4* Y-ATP+31.5*PME+132.34*PCr+1.17*PDE/Pi,F4 (control group)=-20.6+301* Y-ATP+58.76*PME+120.13*PCr+0.73*PDE/Pi. Thefunction with the largest value indicated the type of pathological process. Our modeldemonstrated the total sensitivity for all kind of pathologies - 91%, differentiatingsensitivity - 77.6%, specificity - 78.3% and diagnostic efficacy - 77.8%.Conclusion: As a result, we designed the efficient model of chronic diffuse liverdiseases differential diagnosis with satisfactory characteristics of sensitivity andspecificity. This model can assist in making decision when traditional MR-signsare not obvious.C-020Hepatic dysfunction: Evaluation by MRI with Gd-EOB-DTPAY. Nakamura 1 , T. Ohmoto 1 , E. Nishimaru 2 , T. Kajima 1 , K. Itoh 2 ; 1 Kure/JP,2Hiroshima/JP (nakamura_yuk@kure.hiroshima.med.or.jp)Purpose: Gd-EOB-DTPA exhibits high hepatic uptake and high T1 relaxivity in theliver tissue. MRI with Gd-EOB-DTPA had the potential to evaluate hepatic dysfunctionin animal studies. Our aim was to determine the potential of Gd-EOB-DTPAfor the evaluation of liver dysfunction clinically.Methods and Materials: Between March 2008 and July 2008, 65 patients (39men, 26 women; mean age 68.8 years, range 38 to 86 years) were examinedprospectively with abdominal MR imaging, using a 1.5 T MR imager (Hi-Speed;General Electric Medical Systems, Milwaukee, WI) and torso phased array coil.Fat-suppressed T1-weighted image was performed in the axial plane, before andafter (10 min, 20 min) administration of Gd-EOB-DTPA. The signal intensity (SI)of the liver was measured by using a monitor-defined region of interest. Relativeenhancement (RE) of the liver was calculated with the following equation: RE (%)= (SI postcontrast- SI precontrast)/SI precontrast× 100. Hepatic dysfunction was classified withChild-Pugh class.Results: RE of the liver was on the decline with liver dysfunction. Also, there wasdifference in RE increase pattern depending on the degree of liver dysfunction.Conclusion: MRI with Gd-EOB-DTPA has the potential to evaluate liver dysfunctionclinically.C-021Hepato-mesenteric index: A new Doppler index in the hepatic perfusion’sstudy - comparison with Doppler perfusion indexP.V. Foti, R. Farina, M. Coronella, S. La Scola, R. Minardi, G. Riva, F. Pennisi,G.C. Ettorre; Catania/IT (pietrofoti@hotmail.com)Purpose: To evaluate the diagnostic capabilities of a new Doppler index, thehepato-mesenteric index (HMI), in the study of hepatic metastases from large boweltumours and to compare it with Doppler perfusion index (DPI).Methods and Materials: HMI is calculated from the ratio between the hepaticartery’s flow and the mesenteric artery’s one. 130 patients affected by colorectalcarcinoma, with or without hepatic metastases, underwent hepatic ultrasonographicexamination. HMI and DPI were obtained and compared. 50 patients without intestinaland hepatic disease represented the control group.Results: Indexes analysis enabled identification of three groups of patients.Group A: 41/130 patients (31.5%) with hepatic metastases showing HMI and DPIhigher than 0.50 and 0.30, respectively. Group B 24/130 patients (18.5%) withouthepatic lesions showing HMI and DPI higher than 0.50 and 0.30, respectively.Group C 65/130 patients (50%) without hepatic metastases showing HMI and DPIlower than 0.50 and 0.30, respectively. Control group’s patients showed HMI andDPI lower than 0.50 and 0.30, respectively. These results show a perfect matchbetween DPI and HMI. HMI is easier to calculate than DPI. DPI evaluation showssome difficulties owing to portal vein’s elliptic section and its movements withrespiratory excursion.Conclusion: HMI is easy to perform; owing to its reproducibility it could replaceDPI in the hepatic evaluation of patients with colorectal cancer.Abdominal Viscera (Solid Organs)ACB D E F G HS341

Scientific and Educational ExhibitsC-022The role of imaging in the preoperative assessment of potential donors inliving donor-liver transplantation (LDLT)S.E. Mc Sweeney, M. Staunton, T. Kim, K. Khalili; Toronto, ON/CA(drsemcs@yahoo.com)Learning Objectives: 1) To discuss the role of imaging in the preoperative assessmentof potential living donor-liver transplantations (LDLT). 2) To review andillustrate with appropriate examples the role of cross-sectional imaging in donorassessment.Background: Liver transplants were originally obtained from cadevaric liver donorsbut can now be harvested from living donors. This technique, called living-donorliver transplantation (LDLT), expands the donor pool providing an effective alternativemeans of liver transplantation when the supply of organs for transplant fromcadevaric donors is inadequate. This procedure demands careful preoperativeevaluation to minimize morbidity to the healthy donor and recipient of the transplantand cross sectional imaging is central to achieving this.Procedure Details: There are relative and absolute contraindications to LDLT thatare primarily based on minimizing potential risk to the donor, but also ensuringadequate graft survival. Exact preoperative anatomical knowledge required andsurgical technique varies between centers. Multidetector CT and MRI can assessthe liver parenchyma, relative and absolute lobar volumes and hepatic vascularanatomy. Biliary anatomy can be determined with MRCP or CT cholangiography. Inthis educational exhibit, the preoperative imaging evaluation of hepatic parenchymal,biliary and vascular anatomy is described and illustrated in detail and the variousimaging protocols are reviewed.Conclusion: Imaging plays a crucial role in living donor liver transplantation assessmentand allows accurate evaluation of potential donors. This ensures selectionof only anatomically suitable donors without significant co-existing pathology andallows detailed preoperative planning.C-023Ultrasound quantification of tissue strain properties: A way to overcomesubjectivity?M. D’Onofrio, R. Malagò, F. Principe, R. Pozzi Mucelli; Verona/IT(mirko.donofrio@univr.it)Learning Objectives: To show the possibilities of Virtual touch Tissue imaging(Siemens, Germany) in studying normal and pathological conditions of liver, pancreas,spleen and kidneys.Background: Acoustic radiation force impulse (ARFI) imaging is a new and promisingimaging modality that uses sound beams to evaluate the tissue strain properties.Virtual touch Tissue imaging gives quantification of the responses.Imaging Findings: The normal values found in 40 volunteers were: mean value of1.37 m/s (1.02-2.63) in the liver; mean value of 1.2 m/s (0.90-1.42) in the pancreas;mean value of 2.4 m/s (1.98-3.00) in the spleen; mean value of 2.2 m/s (0.80-3.47) in the kidney. In solid tumor, high values were found in hard tumors suchas pancreatic adenocarcinoma with mean value of about 4.5 m/s. Hepatocellularcarcinoma revealed value of about 3 m/s. In homogeneously fluid liquid structure(gallbladder, simple cysts, serous lesions) no value (X-X-X-X) was obtainable owingto very high tissue motion. This was confirmed by testing ex vivo the probe inthe water with no value (X-X-X-X) obtainable. In inhomogeneous fluid structures(mucinous lesions), the scanner measured a value from 1.39 to 3.93, owing toviscous content. This was confirmed by testing ex vivo the probe in a gel-fluidobtaining a value from 0.65 to 1.5m/s.Conclusion: Tissue characterization could be possible with this new ultrasoundimage method thus allowing differentiation between normal and pathologic tissuesor discrimination between different cystic content on the basis of fluid analysis. Thepossibility of quantification should lead to an overcoming of subjectivity.C-024Ferucarbotran-enhanced diffusion-weighted MRI for assessment of smallhepatocellular carcinomas (HCCs) in the cirrhotic liverD. Kim, J. Yu, J. Lim; Seoul/KRPurpose: To retrospectively compare diffusion-weighted images (DWI) beforeand after SPIO injection during MRI for assessment of small HCCs in the cirrhoticliver.Methods and Materials: Small HCCs (52 lesions, 29 patients) were detected at1.5 T unit. Confidence score of each lesion on pre-contrast DWI (pre-DWI) andSPIO-enhanced DWI (SPIO-DWI) were rated by two independent radiologists, using5-grade scales. Lesions depicted on the SPIO enhanced T2* weighted images(SPIO-T2) were also scored by same method. All HCCs were divided to two groups(Group 1, 1 cm; Group 2, 1-2 cm in maximum dimension). Cohen kappa test andWilcoxon signed rank test were used for statistical analysis.Results: Comparing to pre-DWIs, SPIO-DWIs revealed no significantly differentconfidence scores (p 0.05) in all small HCCs. Comparing to SPIO-T2, both ofpre-DWI and SPIO-DWI showed no significantly different confidence scores, regardlessof b values (p 0.05), except SPIO-DWI with b value of 800 s/mm2 (p 0.05).For group 1 lesions, SPIO-DWIs (mean = 4.28, 4.22, 4.11 for b = 50, 400, 800 s/mm2, respectively) revealed higher confidence scores than pre-DWI (mean = 3.94,3.89, 3.61 for b = 50, 400, 800 s/mm2, respectively) (p = 0.06, 0.08 and 0.02). Alsocomparing to SPIO-T2 (mean = 3.83), SPIO-DWI with b value of 50 and 400 s/mm2showed higher confidence scores (p = 0.05 and 0.09, respectively). Interobserveragreement was substantial (k= 0.54-0.69).Conclusion: SPIO-DWI is an easily applicable method and is superior to DWI fordetection of HCCs smaller than 1 cm.C-025Double contrast (DC) enhanced magnetic resonance imaging (MRI) of theliver: Where do we stand today?A.T.B. Almeida, K. Ganesan, Y. Lee, C. Sirlin; San Diego, CA/US(atbalmeida@sapo.pt)Learning Objectives: After reviewing this exhibit, the participants will know: 1.What is DC MRI? 2. What are the indications? 3. How is it performed? 4. How is itinterpreted? 5. What are the advantages, disadvantages, and pitfalls?Background: DC MRI consists of the sequential use of superparamagnetic ironoxide (SPIO) and gadolinium (Gad) chelates. DC MRI techniques are based on thefollowing basic concepts: 1. SPIO and Gad have a synergistic effect on increasinglesion-to-background contrast. The synergistic effect of SPIO and Gad is mainlyemployed to evaluate hepatic fibrosis: SPIO selectively accumulates within Kupffercells, thereby reducing normal hepatic signal intensity while Gad accumulatesand enhances fibrotic hepatic tissue. 2. SPIO and Gad provide complementarybiological information: SPIO evaluates phagocytic function, while Gad evaluatesvascularity. In combination, SPIO and Gad increase sensitivity and specificity forthe diagnosis of focal hepatic lesions.Imaging Findings: Combined contrast images exploit: 1. Synergist effects: on aheavy T1W and T2*W sequence fibrosis appear as hyper-intense reticulations in abackground of dark liver. 2. Complementary biological information: SPIO-enhancedT2*W images can be used to characterize lesions with atypical or indeterminategadolinium enhanced features, while Gad-enhanced dynamic acquisitions can beused to detect and characterize lesions with preserved phagocytic function.Conclusion: DC MRI exploits synergistic and complementary biological effects ofSPIO and Gad, and provides accurate identification, characterization and stagingof liver diseases.C-026Diffusion-weighted images of the liver at 3 T MRI: Comparison of apparentdiffusion coefficient before and after contrast enhancement with Gd-EOB-DTPAT. Namimoto, K. Awai, T. Nakaura, Y. Yanaga, Y. Yamashita; Kumamoto/JP(namimottoo@yahoo.co.jp)Purpose: To compare the apparent diffusion coefficient (ADC) of the liver lesionson diffusion-weighted images (DWI) before and after the administration of Gd-EOB-DTPA for shortening the complete examination time.Methods and Materials: Fifty-eight consecutive patients with focal liver lesions (25hepatocellular carcinomas (HCCs), 11 metastases, 5 cholangiocellular carcinomas(CCCs), 8 hemangiomas and 9 cysts) and liver parenchyma were evaluated in thisprospective trial. DWI with b values of 0 and 800 s/mm 2 was performed before andafter the administration of Gd-EOB-DTPA at 3 T MRI. The ADC maps were derivedautomatically pixel-by-pixel basis from the DWI. Quantitative measurement of ADCwas performed for liver lesions at each pre- and post- contrast. The paired Student’st-test was used to evaluate the difference between these two methods.Results: The mean ADC values of liver parenchyma, HCCs, metastases, CCCs,hemangiomas and cysts, were 1.16 0.19, 1.11 0.32, 1.27 0.42, 1.35 0.46,2.25 0.50, 2.92 0.33 at pre-contrast, 1.23 0.21, 1.13 0.28, 1.27 038,1.34 0.49, 2.18 0.537, 2.89 0.38 × 10 -3 mm 2 /s at post-contrast, respectively.The mean ADC of the liver parenchyma at post-contrast was significantly higherthan that of pre-contrast (p 0.01). However, no significant difference was seen forthe mean ADCs of all liver lesions between pre- and post-contrast.Conclusion: Our preliminary results indicate that the ADC value of the liver lesionsat post-contrast of Gd-EOB-DTPA was comparable with that of pre-contrast.CS342 A B D E F FG H

Scientific and Educational ExhibitsC-027T2-weighted images of the liver on 3 T MRI: Comparison of contrast beforeand after the administration of Gd-EOB-DTPAT. Namimoto, K. Awai, T. Nakaura, Y. Yanaga, Y. Yamashita; Kumamoto/JP(namimottoo@yahoo.co.jp)Purpose: To compare the T2-weighted image of the liver lesions before and after theadministration of Gd-EOB-DTPA for shortening the complete examination time.Methods and Materials: Fifty-eight consecutive patients with focal liver lesions(25 hepatocellular carcinomas (HCCs), 11 metastases, 5 cholangiocellular carcinomas(CCCs), 8 hemangiomas and 9 cysts) were evaluated in this prospectivetrial. T2-weighted imaging was performed before and after the administration ofGd-EOB-DTPA at 3 T MRI. The imaging parameters were TR/ TE=3354/75 ms, FA90 degrees, ETL 25, SENSE factor of 2 with chemical shift selective fat suppression.The signal intensity (SI) of tumor on T2-weighted images was quantified asthe lesion-liver-contrast-ratio (CR) between lesion and liver by using the followingformula: (SI lesion- SI liver)/SI liver. Quantitative measurement of CR was performed forliver lesions at each pre- and post- contrast. The paired Student’s t-test was usedto evaluate the difference between these two methods.Results: The mean CRs of HCCs, metastases, CCCs, hemangiomas and cystswere 1.67 0.47, 2.28 0.79, 2.58 1.86, 2.45 0.75, 3.27 0.79 at pre-contrast,1.74 0.53, 2.37 0.71, 2.80 1.91, 2.81 0.87, 2.99 0.97 ×10 -3 mm 2 /s at postcontrast,respectively. The CR of hemangiomas at post-contrast was significantlyhigher than that of pre-contrast (p 0.01). However, no significant difference wasseen for the CRs of all other liver lesions between pre- and post-contrast.Conclusion: Our preliminary results indicate that the T2-weighted imaging of theliver lesions at post-contrast of Gd-EOB-DTPA was comparable with that of precontrast,except for hemangiomas.C-028Focal nodular hyperplasia (FNH) or hepatic adenoma (HA)? How MRI canhelp us using liver-specific contrast agentsP. Paolantonio, R. Ferrari, M. Rengo, F. Vecchietti, P. Lucchesi, D. Bellini, A. Laghi;Latina/IT (paolantoniopasquale@hotmail.com)Learning Objectives: To illustrate pharmacodynamic and pharmacokinetic propertiesof Gd-BOPTA, Gd-EOB-DTPA and ferucarbutran. To show pathological featuresof FNH and HA with imaging correlation. To show typical and atypical featuresof FNH and hepatic adenoma at MRI using different classes of hepatospecificcontrast agents.Background: Differential diagnosis between FNH and HA is crucial for patientmanagement. An accurate and non-invasive differential diagnosis using MRI ispossible based on both dynamic imaging and functional information of liver-specificcontrast-agents.Procedure Details: The identification and characterization of FNH and HA requiresan accurate dynamic study of the liver for the assessment of lesion vascularity.Unfortunately, a definite differential diagnosis on the basis of morphology and lesionvascularity is not always possible. Functional information offered by liver specificcontrast agent may help us in this diagnostic challenge.Conclusion: The use of liver specific contrast agents offers functional informationon lesion cellularity that is extremely useful in differentiating FNH by HA. Informationon lesion bile ducts offered by hepatobiliary agents represents an accurate markerof FNH nodule with respect to HA.C-029Value of mutlti-slice spiral CT in the diagnosis of manners of hepatic veinreconstruction in adult living donor liver transplantationW. Shen, C. Xie, J. Qi; Tianjin/CN (shenwen66happy@163.com)Purpose: To discuss the value of MSCT CTA in the diagnosis of hepatic veinreconstructive manners in adult living donor liver transplantation (LDLT).Methods and Materials: From May 2007 to August 2008, 84 recipients who hadunderwent the LDLT with right lobe grafts did enhanced CT scan using MSCT afteroperation, CTA of the hepatic veins were reconstructed with MPR, MIP and VRtechniques. All hepatic vein reconstructive manners were assessed. The resultsof CTA were compared with that of surgical manners.Results: CT images can display hepatic vein reconstructive manners. Bridge veintransplant was used to reconstruct the tributaries of the middle hepatic vein andinferior right hepatic vein (IRHV). Reconstructive types and numbers were listed:RHV+MHV (n=22), RHV+MHV+ IRHV (n=5), RHV (n=22), RHV + IRHV (n=8), RHV+ V5 (n= 3), RHV + V8 (n= 1), RHV + V5 + V8 (n= 23), among them 4 developedthin, 2 became narrow, 4 cases (among RHV + V5 + V8) only showed right hepaticvein and the tributaries (V8), the others displayed hepatic vein reconstructive mannersand were correlated with that of surgical manners.Conclusion: MSCT can clearly detect hepatic vein reconstructive manners, appearbridge vein transplant used to reconstruct the tributaries of the middle hepatic veinand inferior right hepatic vein, detect the track and distribution of vessels.C-030Dynamic contrast-enhanced ultrasonography with quantification for theearly evaluation of response to bevacizumab in advanced hepatocellularcarcinoma: A phase II studyL. Chami, M. Chebil, S. Koscielny, B. Benatsou, A. Roche, N. Lassau; Villejuif/FR(chami@igr.fr)Purpose: To evaluate the efficacy of bevacizumab in patients with advanced hepatocellularcarcinoma (HCC) using standard endpoints (i.e. objective response,progression-free survival [PFS]), and to investigate whether there is any correlationbetween these endpoints and tumor perfusion parameters measured using dynamiccontrast-enhanced Doppler ultrasonography (DCE-US).Methods and Materials: Forty-two patients were enrolled and received intravenousbevacizumab every 2 weeks. CT scans were performed before treatment and every2 months thereafter. DCE-US was performed before treatment, on days 3, 7 and15, at 2 months and every 2 months thereafter. Tumor perfusion parameters wereestimated quantitatively from contrast uptake curves constructed from raw lineardata. They were compared to CT-scans at 2 months and PFS. The ethics committeeapproved the study and all patients gave written informed consent.Results: A total of 262 DCE-US examinations were performed including 242 rawlinear data. Twenty-two patients were classified as good responders (i.e. partialresponse/stable disease). Median PFS was 3 months. At day 3, total area under thecurve (AUC), AUC during wash-in (AUWI), and AUC during wash-out (AUWO) significantlycorrelated with response (p=0.03, p=0.03 and p=0.02, respectively), and AUCand AUWO correlated significantly with PFS (p=0.02 and p=0.01, respectively).Conclusion: DCE-US can be used to detect and quantify dynamic changes intumor vascularity as early as 3 days after initiation of bevacizumab therapy inpatients with HCC. These early changes in tumor perfusion are predictive of tumorresponse and PFS and may be potential surrogate measures of efficacy for antiangiogenictherapy.C-031Neoplastic and non-neoplastic disorders of the periportal space: CTimaging findingsS. Yeom, H. Kim, S. Lee, S. Park, P. Kim, M.-G. Lee; Seoul/KR(pagoda20@hanmail.net)Learning Objectives: 1. To illustrate the spectrum of neoplastic and nonneoplasticconditions that involve the periportal space and correlate them with histopathologicfindings. 2. To assess the differential diagnosis of periportal lesions according totheir origins and imaging features.Background: Periportal region is an anatomic and potential space surroundingportal vein, hepatic artery, bile duct, nerve and lymphatics. A variety of pathologicconditions can occur in the periportal space via hematogenous, biliary, lymphatic,and peritoneal routes and can be demonstrated with CT imaging. In this exhibit, wedescribe the imaging features of a heterogeneous group of neoplastic and nonneoplasticperiportal lesions and correlate them with histopathologic findings. We alsoassess the differential diagnosis according to their origins and imaging features.Imaging Findings: Periportal lesions may be classified on the basis of theirorigins and imaging features as neoplastic iso-attenuating soft-tissue masses(metastasis, direct tumor invasion, lymphoma, and inflammatory pseudotumor),neoplastic low-attenuating soft-tissue masses (Langerhans’ cell histiocytosis),nonneoplastic biliary and vascular lesions (congenital or acquired), and nonneoplasticlow-attenuating lesions (periportal edema, hemorrhage, and inflammation).Although the overlap of imaging findings among these diverse periportal lesionsexists, knowledge of the imaging features of periportal lesions may be helpful inreducing the differential diagnosis.Conclusion: Familiarity with the wide spectrum of pathologic conditions involvingthe periportal space may facilitate making the differential diagnosis.Abdominal Viscera (Solid Organs)ACB D E F G HS343

Scientific and Educational ExhibitsC-033Liver tumour segmentation using contrast enhanced multidetector CTdata: Performance benchmarking of three semi-automatic methodsJ. Zhou, Y. Qi, Q. Tian, S.K. Venkatesh, D.W.K. Wong, W. Xiong, T. Han, J. Liu,W.-K. Leow, S.-C. Wang; Singapore/SG (dnrskv@nus.edu.sg)Purpose: To quantitatively benchmark the performance of three semi-automaticalgorithms for 3D liver tumor segmentation.Methods and Materials: We evaluated three segmentation methods in this study: (M1)2D region growing with knowledge-based constraints, (M2) 2D voxel classification andpropagational learning, and (M3) Bayesian rule-based 3D region growing. The segmentationmethods were tested on contrast enhanced multi-detector CT images of 30liver tumors comprising of HCC and metastases. All tumors were manually segmentedby an experienced radiologist and confirmed by another radiologist, as the referencefor evaluation purposes. Data from 10 tumors were used for algorithm training and theremaining 20 were used for testing. By calculating a set of complicated measures (volumetricoverlap error, relative absolute volume difference, average symmetric absolutesurface distance, symmetric RMS surface distance and maximum symmetric absolutesurface distance) from reference and results, a score (ranged from 0 for total missingto 100 for perfect matching) was assigned to each testing case. The total score of amethod was obtained by averaging the scores of all testing cases.Results: The overall scores for the three methods were 64 for M1, 69 for M2 and57 for M3. Major errors appear in tumors with poorly defined outline or isodenseto liver and in those with irregular shape.Conclusion: Compared to expert’s recognition and interpretation, semiautomaticliver tumor segmentation methods did not perform well in difficult cases; however,the overall performance is promising. Further development and validation is neededbefore it can be potentially used in clinical practice.C-034Gadoxate disodium-enhanced MRI of hepatic hemangiomasS.-E. Baek, M.-J. Kim, J.-Y. Choi, J. Lim, Y.-E. Chung; Seoul/KR(songi100@yuhs.ac)Purpose: To determine whether the dynamic enhancement pattern of hemangiomason gadoxate disodium enhanced magnetic resonance imaging (MRI) are differentfrom conventional extracellular agents enhanced MRI.Methods and Materials: After reviewing gadoxate enhanced MRI image from2007.12 to 2008.03, 16 from 21 proven hepatic hemangiomas were included.Multiphasic dynamic gadoxate enhanced T1W images were obtained in hepaticarterial, portal, venous, equilibrium (5-min), 10-min and 20-min delayed phases.The enhancement pattern of lesion was classified to homogeneous-high, isoor hypo signal intensity (SI) to surrounding liver, rim enhancement, peripheralnodular enhancement, and fill-in pattern. We also analyzed SI change of lesionROI in precontrast, 5 min, 10 min and 20 min delayed phases. Dynamic imagesusing a gadolinium-based extracellular agent was also obtained in two patientsone day ago.Results: 14 lesions showed peripheral nodular enhancement in arterial phase,and delayed fill-in, centripetal enhancement pattern at portal, venous, equilibriumphases. 1 lesion showed rim enhancement in portal phase and 1 lesion washomogenous-highly enhanced from arterial phase. 5 hemangiomas presented isoSI in equilibrium phase. In ROI analysis, 15 hemangiomas depicted increasing SIvalue at 5-min delayed phase and decreasing SI values at 10-min delayed phase.Only 1 hemangioma showed slightly increased SI value at 10-min delayed phasebut, decreased SI value in 20-min delayed phase.Conclusion: Early dynamic enhancement pattern of hemangiomas with gadoxateenhanced MRI is similar to that with extracellular agent enhanced MRI, but centralpooling on the equilibrium phase images may be obscured by strong enhancementof the surrounding liver.C-036Contrast-enhanced ultrasound versus gadolinium-enhanced magneticresonance for the evaluation of the response of hepatocellular carcinomato radiofrequency therapy: A concordance studyA. Sanchez-Montanez, D. Gil, J. Puig, J. Martin, A. Malet, A. Darnell; Sabadell/ES(asanchez-montanez@tauli.cat)Purpose: To compare contrast-enhanced ultrasound (CEUS) and gadoliniumenhancedmagnetic resonance imaging (Gd-MRI) for assessing the response toradiofrequency (RF) treatment of hepatocellular carcinoma (HCC) and high-gradedysplastic nodules (HGDN).Methods and Materials: We retrospectively studied 89 percutaneous therapeuticprocedures with RF in 50 patients. We treated 86 HCCs and 3 HGDNs diagnosedby imaging or biopsy. CEUS and Gd-MRI were performed 4-5 weeks after treatment.Signs of tumor persistence were: enhanced foci in the arterial phase and thewash-out in the late phases. Neither CEUS nor Gd-MRI was considered the “goldstandard”. Imaging findings were classified into three categories: tumor persistence,complete ablation, and undetermined. We distributed the results in concordancetables, calculating the kappa statistic to eliminate random effects.Results: From the total of 89 lesions, CEUS and Gd-MRI coincided in the diagnosisof complete ablation in 66 cases, and of tumor persistence in 4. In 9 cases,CEUS diagnosed complete ablation and Gd-MRI tumor persistence. In 2 cases,CEUS diagnosed tumor persistence and Gd-MRI complete ablation. CEUS wasinconclusive in 3 cases and Gd-MRI in 5. The techniques agreed in 86.4% of casesand the kappa statistic was 0.36.Conclusion: Agreement between the two techniques is only fair. We think Gd-MRI is better for assessing the response to RF treatment in HCC and HGDNbecause it enables evaluation of the whole liver and all hepatic nodules with asingle contrast dose; CEUS has a secondary role when Gd-MRI is unable to reacha definite diagnosis.C-037Multi-step changes of drainage vessels during hepatocarcinogenesis:Imaging-pathological correlationA. Kitao, Y. Zen, O. Matsui, T. Gabata, Y. Nakanuma; Kanazawa/JP(kitao@rad.m.kanazawa-u.ac.jp)Purpose: To clarify the changes occurring in drainage vessels of dysplastic nodule(DN) and hepatocellular carcinoma (HCC) during hepatocarcinogenesis.Methods and Materials: This study focused on 46 surgically resected hepatocellularnodules. According to the findings of CT during arterial portography (CTAP)and CT during hepatic arteriography (CTHA), we classified each nodule into threetypes: type A (n=18), having equivalent or decreased portal perfusion comparedwith background liver (CTAP), decreased arterial perfusion, and no corona enhancement(peri-nodular drainage of contrast material) (CTHA); type B (n=13), havingno portal perfusion, increased arterial perfusion, and thin corona enhancement (2 mm); type C (n=15), having no portal perfusion, increased arterial perfusion, andthick corona enhancement ( 2 mm). We compared the histopathological featuresand microangioarchitecture among these three types.Results: Type A nodules histologically consisted of DN and well-differentiatedHCC; in contrast, type B/C nodules were moderately-differentiated HCC. Replacinggrowth was commonly observed in type A, whereas compressing growth wasmore frequent in type B/C. Fibrous capsule was observed in 60% of type C nodules.Serial pathological sections demonstrated continuity between intra-nodularcapillarized sinusoids and hepatic veins in type A, and intra-nodular capillarizedsinusoids to surrounding hepatic sinusoids in type B. In type C, intra-nodular capillarizedsinusoids were connected to extra-nodular portal veins directly, or via portalvenules within a fibrous capsule. Intra-nodular hepatic veins were significantlydecreased in type B/C.Conclusion: Drainage vessels of DN and HCC change from hepatic veins to hepaticsinusoids, and then to portal veins during multi-step hepatocarcinogenesis.C-038Ultrasound non-invasive methods for assessing liver cirrhosis in chronichepatitis C patientsH. Stefanescu, R.I. Badea, M. Lupsor, M. Grigorescu, Z. Sparchez, A. Serban,H. Branda, A. Maniu; Cluj-Napoca/RO (hstefanescu@umfcluj.ro)Purpose: Liver lobes diameters, platelets to spleen size index (PSI) and liverstiffness measurement (LSM) were validated as non-invasive liver cirrhosis (LC)predictors in chronic hepatitis C (CHC) patients. The aim of this study was tocompare their diagnostic/prognostic performances.Methods and Materials: 273 consecutive CHC patients - mean age 47.62 years,63.4% females - were prospectively included. All of them underwent percutaneousLB (METAVIR scoring system), LSM and ultrasound (US) examination. Left, caudateand right lobe diameter, and spleen area were US measured and included into aformula: liver size index (LSI)=[LL+CL]/RL, respectively, PSI=platelets count/spleenarea. The performance of LSI, PSI and LSM in diagnosing LC was assessed andcompared using sensitivity (Se), specificity (Sp) and AUROC using SPSS 15.0.Results: The fibrosis stage distribution was: F1 -95 (34.8%), F2 -106 (38.8%), F3-35(12.8%), F4 - 37 (13.6%). When LSI 0.96, LC patients were detected with Sn 47.2%,Sp 91.9% and AUROC 0.705. When PSI 2.66, LC patients were detected with Sn71.4%, Sp 86.3% and AUROC 0.816. When LSM 13 Kpa, LC patients were detectedwith Sn 83.3%, Sp 91.9% and AUROC 0.943. Comparing AUROCs, FibroScan provedto be more accurate in diagnosing LC than LSI (p 0.001) and PSI (p=0.002), whilebetween LSI and PSI there was no significant difference (p=0.188).CS344 A B D E F FG H

Scientific and Educational ExhibitsConclusion: LC can be accurately diagnosed using ultrasound derived non-invasivemethods in CHC patients. Among them, LSM is the best in identifying LC, whileLSI and PSI can be used in absence of FibroScan.C-039The diagnosis performance of ultrasonic transient elastography fornoninvasive assessment of liver fibrosis in 537 chronic hepatitis C patientsM. Lupsor, R.I. Badea, H. Stefanescu, Z. Sparchez, H. Branda, M. Grigorescu,A. Serban, A. Maniu; Cluj-Napoca/RO (mmlupsor@yahoo.com)Purpose: The golden standard for fibrosis assessment in chronic hepatitis C (CHC) isliver biopsy (LB), an invasive procedure with several limitations. We aim to assess theperformance of liver stiffness (LS) measurement through ultrasonic transient elastography(UTE) in quantifying liver fibrosis in a cohort of consecutive CHC patients.Methods and Materials: 537 CHC patients were referred to LS measurement by UTE(FibroScan®, EchoSens, Paris, France) 1 day before biopsy (which was interpretedaccording to the METAVIR scoring system). Statistical analysis was performed usingSPSS 15.0 for Windows. The diagnostic performance of LS was assessed usingsensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictivevalue (NPV) and receiver operating characteristic curves (AUROC).Results: LS values ranged from 2.90 to 75 kPa. Although there were a small correlationwith steatosis (r=0.19, p 0.0005) and a medium one with necroinflmatoryactivity (r=0.38, p 0.0005), LS values were significantly and strongly correlatedwith fibrosis (r=0.73, p 0.0005).The diagnostic performances of LS in quantifyingeach fibrosis stage was: for fibrosis stage F1 prediction AUROC= 0.890 (cutoff value4.9 KPa, Se 83.77%, Sp 84.62%, PPV 99.07, NPV 20.96%); for F2 AUROC=0.829(cutoff 75 KPa, Se 72.19%, Sp 80.90%, PPV 85.95%, NPV 64.24%); for F3 AU-ROC=0.915 (cutoff 9.1 KPa, Se 84.27%, Sp 87.98%, PPV 78.08%, NPV 91.66%)and for cirrhosis (F4) AUROC=0961 (cutoff 13.2 KPa, Se 90%, Sp 93.40%, PPV78.37%, NPV 97.23%)Conclusion: Ultrasonic transient elastography is a promising noninvasive methodfor detection of different fibrosis stages in CHC patients.C-040Gd-EOB-DTPA (Primovist®) MRI in evaluating residual liver tumor afterradiofrequency ablation (RFA)S.V. Setola, A. Petrillo, O. Catalano, E. de Lutio di Castelguidone, M. Petrillo,M. Mattace Raso, A. Siani; Naples/IT (antonellapetrillo2@gmail.com)Purpose: The aim of the study is evaluate the diagnostic efficacy of magneticresonance imaging (MRI) using the new liver-specific contrast agent gadoxetic-acid(Gd-EOB-DTPA, Primovist ® ) after radiofrequency ablation (RFA) in the diagnosisof residual liver tumor (hepatocellular carcinoma, HCC).Methods and Materials: Twenty patients with known HCC (histologically proven)underwent RFA after two diagnostic methodics: A contrast-enhanced triphasicMDCT (Philips Brillance 16s, performed with pre-contrast, arterial, venous, interstitialand 5-min delayed phase) and a Gd-EOB-DTPA MRI (Siemens Symphony 1.5 T,performed using dynamic phase and another acquisition, 20’ min delayed, duringthe hepatocytic phase). Gd-EOB-DTPA MRI and MDCT were evaluated separatelyby 2 blinded radiologists. All patients were followed up with both methodics at the1 st month and every 3 months during one year.Results: MDTC detected 22 HCC lesions and after performing twenty-one RFAtreatments, 7 residual tumors and 3 new HCC foci were demonstrated. Dynamic-MRIbefore RFA treatments detected 28 HCC and after RFA 10 residual tumors; delayedMRI acquisition 5 new HCC foci; thus Gd-EOB-DTPA (Primovist ® ) MRI showed 3residual tumor and 2 new HCC more than MDCT. In a patient, delayed phase (hepatocytic),acquired 20’ min after Gd-EOB-DTPA administration, showed a growinglesion in its trasforming into an undifferentiated HCC, histologically proven.Conclusion: The administration of Gd-EOB-DTPA (Primovist ® ), using both phases,early (arterial) and delayed (hepatocytic) made we were able to identify at the sametime more residual HCC post-RFA and new undifferentiated HCC than MDCT.C-041Multiparametric MRI [diffusion-weighted imaging (DWI) and dynamiccontrast enhanced-MRI (DCE)] in liver fibrosis quantification in patientswith chronic hepatitis CD. Olivié 1 , P.-a. Eliat 1 , P. Audet 2 , L. Lepanto 2 ; 1 Rennes/FR, 2 Montreal, QC/CA(damien.olivie@chu-rennes.fr)Purpose: To quantify the liver fibrosis in HCV+ patients by a multiparametric approachincluding diffusion weighted imaging and dynamic contrast enhanced MRIwith BOPTA-Gd.Methods and Materials: We present the results of a pilot prospective study including29 patients who had a recent liver biopsy (less than 3 months) and an MRI(Avanto 1.5 T, Siemens). Each examination included DCE 3D VIBE acquisitions.A late sequence was performed 1 hour after injection. DWI sequences were performedin breathold for different b values. ADC was measured on maps generatedby the Siemens console and with the Image J software based on the native DWIsequences. Relative perfusion parameters were calculated from a dual-input onecompartmentalmodel as proposed by the Van Beers group.Results: Patients were classified according to Ishak. We found a significant difference(p 0.05) for the relative arterial perfusion between the different low gradesand for the other constants between patients with or without cirrhosis. Using bvalues of 150 and 400 s/mm 2 , ADC measured with Image J in large ROIs wasmore discriminant than with the other methods. We found that b values of 150 s/mm 2 are more significant for low grades discrimination and that b values of 400 s/m 2 are better for discrimination of cirrhosis from lower grades.Conclusion: It seems possible to assess different grades of liver fibrosis usingDWI and DCE MRI (relative arterial perfusion and b=150 s/mm 2 for low grades;others perfusion parameters and b=400 s/mm 2 to differentiate patients with cirrhosisor not).C-042Preoperative detection of colorectal liver metastases in fatty liver: MDCTor MRI?V. Kulemann, W. Schima, D. Tamandl, K. Kaczirek, T. Gruenberger, M. Weber,A. Ba-Ssalamah; Vienna/ATPurpose: To compare the sensitivity of MDCT and MRI in preoperative detectionof colorectal liver metastases after neoadjuvant chemotherapy resulting in diffusefatty infiltration of the liver.Methods and Materials: Twenty preoperative tri-phasic MDCT (4-64-row, Siemens).and dynamic contrast-enhanced MRI (1.5 T or 3.0 T, Siemens) examinationsof patients with colorectal cancer and liver metastases in diffuse steatosiswere retrospectively evaluated. All patients underwent surgical resection of livermetastases (time interval 1- 60 days). The grade of fatty infiltration of the liver washistopathologically proven and ranged from 25-75%.Results: Overall, 51 metastases were found by histopathologic results of theresected liver segments/lobes. The size of the metastases ranged from 0.4-13 cm;with 18 (35%) being up to 1 cm in diameter. In overall rating, MDCT detected 33/51lesions (65%) and MRI 45/51 (88%). For lesions up to 1 cm, MDCT detectedonly 2/18 (11%) and MRI 12/18 (66%). One false positive lesion was detected byMDCT. Statistical analysis showed that MRI is markedly superior to MDCT with astatistical significant difference (p .001), particularly in detection of small lesions(1 cm; p .004). There was no significant difference between the two modalitiesin detection of lesions 1 cm.Conclusion: In the detection of colorectal liver metastases after neoadjuvantchemotherapy and consecutive diffuse fatty infiltration of the liver, MRI is superiorto MDCT, especially for detection of small lesions.Abdominal Viscera (Solid Organs)ACB D E F G HS345

Scientific and Educational ExhibitsAbdominal Viscera (Solid Organs)PancreasC-043Accessory pancreatic duct and minor duodenal papilla: Visibility,examination technique and imaging findings at secretin-enhancedmagnetic resonance cholangio-pancreatographyG. Restaino, M. Occhionero, M. Missere, E. Cucci, M. Ciuffreda, G. Sallustio;Campobasso/IT (gennares@hotmail.com)Learning Objectives: Many variants exist of accessory pancreatic duct (APD)and minor duodenal papilla (MIP). Proper S-MRCP examination provides goodconspicuity of these structures. Morphological and functional evaluation of APDand MIP adds important information regarding patients evaluated with S-MRCPfor pancreatic disease.Background: APD, due to harder visibility and presumed lower clinical significancethan main pancreatic duct, is usually disregarded by radiologists reporting MRCP.Nevertheless, beside its role in pancreas divisum (PD), its patency lowers the riskof developing acute pancreatitis either spontaneous and after ERCP. MIP is difficultto locate radiologically, but may host disease, like several type of endocrine tumors,and its function is crucial in PD.Procedure Details: We reviewed 300 S-MRCP performed at our institution from2004 to 2008 and focused on APD with regard to: visibility, type (long, intermediate,short, ansa), morphology of distal end (stick, branch, saccular, spindle, cudgel),caliber and patency; on MIP with regard to visibility, location, size and morphology.We also assessed the APD and MIP conspicuity in various S-MRCP sequences:T2w-SSFSE, b-SSFP, 2D-MRCP w/o secretin, 3D-MRCP (with MIP, MPR) and3D-LAVA (with minIP, MPR).Conclusion: Morphological and functional evaluation of APD and MIP adds importantinformation to those provided by S-MRCP. Newer MR sequences allow goodconspicuity of these structures. Knowledge of normal and variant morphology ofAPD and MIP is crucial to correct image interpretation.No Material Submitted to EPOSC-044Malignant intraductal papillary mucinous neoplasm of the pancreas: Acomparison of the likelihood of invasiveness between 18 F-FDG PET/CTand contrast enhanced MDCT findingsK. Takanami, T. Kaneta, M. Tsuda, S. Takahashi; Sendai/JP(pfpmf6212000@yahoo.co.jp)Purpose: To evaluate the capability of 18 F-FDG PET/CT in determining thelikelihood of invasiveness of malignant intraductal papillary mucinous neoplasm(IPMN) of the pancreas.Methods and Materials: Sixteen patients with malignant IPMN (in situ carcinoma,7; invasive carcinoma, 9) proved by a pathologic examination of surgically resectedspecimens underwent surgery after both PET/CT and CE-CT were performed.A nuclear medicine physician retrospectively evaluated the PET/CT images forSUVmax of the lesions and a radiologist evaluated the CE-CT images for characteristicsof the lesions. The results were compared between the in situ and invasivecarcinomas using Student’s t-test. Invasiveness was suspected when SUVmax 2.5 was observed with PET/CT. Meanwhile, invasiveness was suspected when asolid mass, or dilated main pancreatic duct (MPD 10 mm diameter) was observedwith CE-CT.Results: The SUVmax, the diameters of cystic tumor, and the diameters of MPDof the in situ and invasive carcinomas were 2.18 0.66 vs. 5.68 3.27 (p .05),31.1 8.63 vs. 34.4 8.08, and 4.88 2.30 vs. 8.67 3.84 (p .05), respectively.Solid masses were observed in 0/7 and 5/9 patients with in situ and invasivecarcinomas, respectively. The sensitivity, specificity and accuracy for detectinginvasiveness were 1, 0.85 and 0.83 with PET/CT and 0.88, 1.00 and 0.75 withCE-CT, respectively.Conclusion: PET/CT provides useful information regarding the likelihood of invasivenessfor malignant IPMN, which is almost equivalent to those provided by CE-CT.C-045Pancreatic-duodenal junction: Review of pathology by means of CT and MRD. Hernandez, J. Pernas, C. Gonzalez Junyent, S. Gonzalez, J. Monill,I. Corcuera, C. Perez-Martinez; Barcelona/ES (cgonzalezj@santpau.cat)Learning Objectives: To review by means of CT and MR, the different pathologicconditions tumoral, inflammatory or congenital origin in this specific anatomic areathat involve the pancreatic head, duodenum, duodenal ampulla, distal pancreatobiliarytract junction and retroperitoneum.Background: Pancreato-duodenal junction is a very small anatomical areawhere pathologic processes converge that involve pancreatic head, duodenum,distal pancreatobiliary tract, duodenal ampulla and retroperitoneum. Differentialdiagnosis includes a spectrum of entities that ranges from anatomical variantsto malignancies.Imaging Findings: CT and MR help us to identify specific radiologic signs that allowto divide the pancreato-duodenal junction abnormalities into three cathegories: 1.Normal variants and congenital anomalies (pancreas divisum, santorinicele, annularpancreas, duodenal duplication cyst, choledocal cyst). 2. Acquired non tumoral:traumatic, iatrogenic, inflammatory (duodenal hematoma, duodenal iatrogenicperforation, groove pancreatiitis, gastroduodenal artery pseudoaneurysm). 3. Tumoral(pancreatic head adenocarcinoma, periampullary tumors, neuroendocrinepancreatic tumors, duodenal adenocarcinoma). CT and MR images illustratemorphologic aspects of these entities.Conclusion: CT and MR are the most appropriated imaging modalities to evaluatepancreato-duodenal junction. Knowing the imaging features is crucial to reach the rightdiagnosis and treatment of the different entities that involve this anatomic area.C-046The postoperative residue or recurrence of pancreatic cancer: Comparisonof multi-detector row CT perfusion and PET-CTL. Yu Bao; Guangzhou/CN (ybliu28@yahoo.com.cn)Purpose: To evaluate the postoperative residue or recurrence of pancreatic cancerby MDCT perfusion and PET/CT, to analyze whether any of the CT perfusionparameters correlated with the postoperative residue or recurrence.Methods and Materials: Perfusion CT of the postoperative patients with pancreaticcancer was performed with 64-Detector row CT in 38 patients. A dynamic study (cinemode) was acquired through the lesion following intravenous contrast administration(100 ml; 4-5 ml/s), and the data were analyzed using commercial software tocalculate tissue, BV, MTT, and vascular permeability surface area product (PS). Allthe postoperative patients underwent fluorodeoxyglucose (FDG) positron emissiontomography CT (FDG-PET/CT) examinations and analyzed whether any of theperfusion parameters correlated with the postoperative residue or recurrence ofpancreatic cancer. Perfusion parameters of the residue or recurrence and normalpancreas tissue were compared.Results: Thirty-two patients with postoperative residue or recurrence of pancreaticcancer were detected by PET/CT. The mean BF, BV, MTT and PS of postoperativeresidue or recurrence of pancreatic cancer were 226.47167.38 ml/min/100 g,16.5714.32 ml/100 g, 8.034.16 s, 48.8527.31 ml/min/100 g, respectively. Themean BF, BV, MTT and PS of normal pancreas tissue were 362.47142.31 ml/min/100 g, 28.4816.58 ml/100 g, 5.973.85 s, 26.3321.42 ml/min/100 g, respectively.The mean BF, BV and PS between postoperative residue or recurrenceof pancreatic cancer and normal pancreas tissue were statistically significant(p=0.015, p=0.006, p=0.002). The mean MTT between postoperative residue orrecurrence of pancreatic cancer and normal pancreas tissue were not statisticallysignificant (p=0.09).Conclusion: MDCT perfusion can evaluate the postoperative residue or recurrenceof pancreatic cancer with significant BF, BV, and PS values, which can make differentialdiagnosis with postoperative residue or recurrence and normal tissue.No Material Submitted to EPOSC-047Characteristic MR features that are useful in differentiating between focalautoimmune pancreatitis and pancreatic cancerY. Sugiyama, Y. Fujinaga, M. Kurozumi, K. Ueda, M. Kadoya, H. Hamano,S. Kawa; Matsumoto, Nagano/JP (ysgym@shinshu-u.ac.jp)Purpose: Autoimmune pancreatitis, especially its localized form, has been frequentlymisdiagnosed as pancreatic cancer; this has led to unnecessary pancreaticresections. We aimed to identify magnetic resonance (MR) imaging characteristicsthat would be useful for differentiating between focal autoimmune pancreatitis andpancreatic cancer.Methods and Materials: We identified 27 patients with a focal pancreatic massfrom a patient database between 2002 and 2007. Thirteen of these patients hadautoimmune pancreatitis and 14 had pancreatic cancer. MR images were comparedbetween patients with focal autoimmune pancreatitis and those with preoperativepancreatic cancer. MR imaging consisted of a respiratory-triggered fat-suppressedT2-weighted turbo spin echo sequence, a breath-hold precontrast, and a dynamiccontrast-enhanced fat-suppressed T1-weighted gradient echo sequence, performedon either a 1.5-T or a 3.0-T MR system.Results: For differentiation between focal autoimmune pancreatitis and pancreaticcancer, we found that the following MR image characteristics are useful: (1)speckled hyperintensity in a hypointense area on precontrast and arterial dominantCS346 A B D E F FG H

Scientific and Educational Exhibitsphase contrast-enhanced T1-weighted images, and (2) homogenous isointensity orhyperintensity on equilibrium phase contrast-enhanced T1-weighted images. Thesefindings were observed significantly more frequently in autoimmune pancreatitisthan in pancreatic cancer, with a high accuracy of 74.1-85.2%. This suggested thatthese characteristics would comprise a valuable diagnostic tool.Conclusion: We identified two characteristic MR findings that are useful for thedifferentiation between focal autoimmune pancreatitis and pancreatic cancer.C-048Pancreatic metastases: An imaging challengeC. Triantopoulou, P. Maniatis, Z. Touloumis, E. Kolliakou, I. Siafas, C. Avgerinos,J. Papailiou, C. Dervenis; Athens/GR (ctriantopoulou@gmail.com)Learning Objectives: To describe the imaging features of pancreatic metastasesand present differential diagnostic criteria from other pancreatic tumors.Background: Unlike primary pancreatic carcinoma, metastatic lesions of the pancreasare uncommon and account for approximately 2% of pancreatic malignancies.A variety of extrapancreatic tumors can involve the pancreas secondarily and maymanifest with different clinical and imaging characteristics. Although many patientshave widespread disease, isolated metastases can be found. Surgical managementseems to be associated with improved survival in these cases.Imaging Findings: Synchronous and metachronous cases were encountered. Hypovascularand hypervascular solitary or multiple lesions were found. In most cases, imagingappearance was related to the primary tumor. Metastases from renal cell carcinomaand melanoma were hyperdense after contrast administration, while metastases fromlung, gastric and colon cancers appeared as hypodense lesions with a peripheral rim ofcontrast enhancement in most patients on CT imaging. MRI was performed in a smallnumber of patients presenting diagnostic dilemmas and the enhancement pattern wasthe same. Pancreatic duct showed no dilatation in all the cases. All surgical candidatesunderwent partial pancreatectomy or enucleation of metastatic lesions. Imaging findingscorrelated well with pathology results. Accurate diagnosis of metastases was possibleby imaging in all the patients. No surgical candidates received chemotherapy withpromising results in cases of colon and renal cancer metastases.Conclusion: Preoperative diagnosis of a secondary pancreatic tumor is essentialfor proper patient management. Radiologists should be familiar with the differentimaging appearance of pancreatic metastases.C-049IgG4-related sclerosing disease: Imaging findings of pancreatic andextrapancreatic abnormalitiesH. Irie, T. Nakazono, J. Nojiri, N. Kamochi, Y. Egashira, M. Nishihara, Y. Okajima,S. Kudo; Saga/JP (irie@cc.saga-u.ac.jp)Learning Objectives: To recognize the concept of IgG4-related sclerosing disease.To review imaging findings of IgG4-related sclerosing disease of various organs. Tolearn diagnostic clues of IgG4-related sclerosing disease of various organs.Background: IgG4-related sclerosing disease is a systemic disease that is characterizedby extensive IgG4-positive plasma cells and T-lymphocyte infiltration ofvarious organs. Autoimmune pancreatitis (AIP) is thought to be pancreatic involvementof IgG4-related sclerosing disease. Besides pancreas, IgG4-related sclerosingdisease may affect bile duct, gallbladder, salivary gland, retroperitoneum, kidney,lung, and prostate. Most IgG4-related sclerosing diseases have been found tobe associated with AIP, but also those without pancreatic involvement have beenreported, and diagnosis of such cases is often difficult.Imaging Findings: This disease includes AIP, sclerosing cholangitis, cholecystitis,sialadenitis, retroperitoneal fibrosis, tubulointerstitial nephritis, interstitialpneumonia, prostatitis, inflammatory pseudotumor and lymphadenopathy, allIgG4-related. T2-weighted MR images and dynamic study are essential to diagnosethis disease, since fibrosis with obliterative phlebitis is a characteristicpathologic finding of this disease.Conclusion: Since malignant tumors are frequently suspected on initial presentation,IgG4-related sclerosing disease should be considered in the differential diagnosisto avoid unnecessary surgery. Although the nomenclature differs, radiologistsshould recognize this disease entity and its imaging findings.C-050Differentiation between autoimmune pancreatitis and other pancreaticdisorders on CT and MRIH. Irie, T. Nakazono, J. Nojiri, N. Kamochi, Y. Egashira, M. Nishihara, Y. Okajima,S. Kudo; Saga/JP (irie@cc.saga-u.ac.jp)Background: AIP is characterized by diffuse or segmental enlargement of thepancreas with irregular narrowing of the main pancreatic duct, and fibrotic changewith lymphocyte infiltration histopathologically. Diagnosis of AIP is very important,since it can be treated by steroid therapy. AIP can show various CT and MRI findingsand it is often difficult to differentiate AIP from other pancreatic disorders.Imaging Findings: We reviewed CT and MRI findings of 39 cases of AIP, andclassified AIP to three types: diffuse, segmental, and multifocal type. The importantdifferential diagnosis of diffuse type AIP is mild acute pancreatitis and lymphoma.Differentiating clues are main pancreatic duct change and enhancement pattern ondynamic study. Differentiation between segmental type AIP and mass-forming pancreatitisor pancreas cancer is often difficult or may be almost impossible. Althoughrare, AIP may show multifocal delayed enhanced masses within the pancreas.Recognition of this type of AIP is mandatory in diagnosing pancreatic abnormalities.The important differential diagnosis is lymphoma and metastases.Conclusion: A capsule-like rim can play an important role in diagnosing AIP. Asmooth contour of the lesion without circumference fat tissue change is also consideredto be characteristic for AIP. Differentiation between segmental type AIPand pancreas cancer requires clinical information such as IgG4.C-05164-MDCT imaging of the pancreas: Scan protocol optimisation by differentscan delay regimesM.S. Juchems, A.S. Ernst, H.-J. Brambs, A.J. Aschoff; Ulm/DEPurpose: The purpose of this study was to compare different MDCT protocols tooptimize pancreatic contrast enhancement.Methods and Materials: Forty patients (18 male, 22 female; 68.25y) underwentbiphasic CT (arterial and portal venous phase) using a 64-slice MDCT (Brilliance64, Philips Medical Systems) after the injection of 1.2 ml/kg bodyweight of Iomeron400 (Bracco) at rate of 4 ml/s. In 20 patients the scan protocol was adapted froma previously used 40x CT scanner (Brilliance 40) with arterial phase scanninginitiated 11.1 s after a threshold of 150 HU was reached in the descending aortausing automatic bolus tracking (protocol 1). This 11.1 s delay was changed to 15s in the other 20 patients to reflect the shorter scanning times on the 64-channelCT compared to the previous 40x system (protocol 2). Hounsfield-units (HU)were measured in the head and the tail of the pancreas in the arterial and portalvenous phases.Results: Using a 11.1 s delay, 74.2 HU (head) were measured on average in thearterial phase, while 111.2 HU (head) were measured using a 15 s delay (p=0.0001).For the pancreatic tail, 76.73 HU (11.1s) and 99.89 HU (15s) were measured onaverage (p=0.0002). HU values were also significantly higher in the portal venousphase (pancreatic head: 67.5 HU (11.1 s) and 84.0 HU (15 s), p=0.0014; pancreatictail: 69.4 HU (11.1 s) and 99.9 HU 15 s), p=0.0071) using protocol 2.Conclusion: In this study, we were able to demonstrate that the concept thatlonger scan delays are required for faster CT scanners can be used to optimizeimaging of the pancreas.C-052Typical and atypical manifestation of serous cystadenoma of the pancreasJ.-Y. Choi, M.-J. Kim, J. Lee, J. Lim, J. Kim, H. Ko; Seoul/KR (gafield2@yuhs.ac)Learning Objectives: 1. To review the typical imaging features of serous cystadenomaof the pancreas. 2. To discuss atypical manifestations of serous cystadenomaand correlate with histopathology. 3. To discuss the differential points to diagnoseserous cystadenoma and its clinical significance.Background: With the widespread use of cross-sectional imaging, cystic massesin the pancreas are being detected with greater frequency. Among cystic pancreatictumors, serous cystadenomas (SCA) have characteristic imaging and histologic featuresthat may differentiate them from other potentially malignant cystic tumors, suchas mucinous cystic tumors and intraductal papillary mucinous neoplasms. However,various atypical features of SCA found on cross-sectional imaging may lead to incorrectdiagnosis. Therefore, we illustrate in detail the various appearances of SCA.Imaging Findings: 1. Imaging findings and histopathologic features of typicalserous cystadenoma-CT/EUS/MR. 2. Review of atypical manifestations of serouscystadenoma-giant tumor with ductal dilatation, intratumoral hemorrhage, a solidvariant, unilocular cystic tumor, interval growth, and disseminated form. 3. Differentialdiagnosis of SCA.Conclusion: Pancreatic SCA exhibit a wide range of imaging findings. Knowledgeof the spectrum of varied features observed in SCA is useful for differentiating thislesion from other pancreatic tumors.Abdominal Viscera (Solid Organs)Learning Objectives: To review various CT and MRI findings of autoimmunepancreatitis (AIP) and to classify AIP to three types: diffuse, segmental, andmultifocal type. To learn the crucial CT and MRI findings in differentiating AIP fromother pancreatic disorders.ACB D E F G HS347

Scientific and Educational ExhibitsC-053Abdominal disease in an adult population with cystic fibrosis: A pictorialreviewC.A. Ridge, S. McDermott, V. Chan, C. Hegarty, D.E. Malone; Dublin/IE(c.ridge@st-vincents.ie)Learning Objectives: To illustrate the broad spectrum of abdominal imaging findingsin an adult population with cystic fibrosis.Background: With improvements in the management of the respiratory complicationsof CF, life expectancy in this population has increased. The abdominal manifestationsof CF are common and may not present until adulthood. Consequently,radiologist familiarity with the expected imaging appearances of CF abdominaldisease is paramount.Imaging Findings: This pictorial review demonstrates the broad spectrum ofabdominal imaging findings in CF including: a. fatty infiltration of the liver, b. multinodularcirrhosis, c. portal hypertension and its complications, d. cholelithiasis, e.microgallbladder, f. pancreatic cystosis, g. pancreatic atrophy and h. a rare case ofbiopsy-proven hepatocellular carcinoma with underlying cirrhosis.Conclusion: Abdominal disease in CF can be successfully evaluated by ultrasound,CT and MRI.C-055Computed tomodensitometry severity index of Balthazar or Mortele inacute pancreatitis: From theory to practiceA.B. Faye, O. Craciun, M. Ben Hajmor, A.H. Tyazi, P. Etessami, M. Nowakowski,A. Boruchowicz, P. Cuingnet; Valenciennes/FR (abfaye5@hotmail.com)Learning Objectives: To review the best indications and technique of MDCT in theearly assessment of acute pancreatitis by using both classifications of Balthazarand Mortele. To give the basic interpretation while assessing acute pancreatitis.To describe and illustrate the spectrum of the radiological semiology of each statein both classifications and to demonstrate the main difficulties encountered whileassessing acute pancreatitis, based on a series of 200 patients selected betweenFebruary 2005 and September 2008 in a general hospital.Background: According to the best guidelines in Europe and America, computedtomodensitometry is the gold standard in the early assessment of acute pancreatitisby using Balthazar’s CTSI. It describes well inflammatory spectrum, early commonand uncommon complications. There is a good correlation between CTSI ofBalthazar and the others clinical classifications like Ranson’s score. Nevertheless,controversies persist between radiologists while assessing acute pancreatitis.Recently, because of the complexity of the classification of Balthazar, Morteleinvented a new CTSI that seems to be interesting and more easy to practice butneeds further evaluations.Imaging Findings: The author will illustrate the iconographic spectrum of theradiological semiology of each stage in both classifications and demonstrate difficultiesand limits by exciting examples.Conclusion: CTSI of Balthazar needs to be well known in daily practice for eachradiologist in the early assessment of acute pancreatitis. The CTSI of Mortele is lesscomplex to use and seems to be more complete but needs furthers studies.C-056Hypotonic-MRCP combined with lava dynamic enhanced MRI in diagnosisof periampullary diseasesX. Lin, N. Li; Jinan/CN (linxt@sdu.edu.cn)Purpose: To analyze the image features of the periampullary diseases by hypotonic-MRCP and Propeller LAVA multi-phase dynamic enhanced sequence of the 3.0 TMR, and the value of this technique in diagnosis and in preoperative evaluationof excisability of tumors.Methods and Materials: Forty-three patients suspected of periampullary diseasesunderwent routine MRI including axial T1WI/T2WI and FS-T1WI/T2WI, coronal FIESTAand 2D or 3D hypotonic-MRCP scanning. The maximum intensity projection (MIP) andmulti-planar reformation (MPR) were reconstructed and the time-signal curve wasdrawn. The direct and indirect signs, diagnosis of the origin, feature, size and range of thelesions were observed and compared with the clinical and histopathology findings.Results: For calculus, inflammation and tumor lesions, the sensitivity and specificityof hypotonic-MRCP combined with Propeller LAVA multi-phase dynamic enhancedscan were 100 and 100%, 60 and 97.4%, 96.7 and 76.9%, respectively. In all the30 tumors, the diagnostic accuracy rate of tissue origin was 93.3, 90.0 and 86.7%,respectively. The diagnostic accuracy of tumor invasion was 83.3%. The accuracyof preoperative evaluation of tumor excisability of pancreatic carcinoma, cholangiocarcinomaand ampullary carcinoma was 76.9, 85.7, and 88.9%, respectively.Conclusion: Hypotonic-MRCP combined with Propeller LAVA multi-phase dynamicenhanced scan can display the direct and indirect signs of periampullary lesions. Itis useful in identifying the origin and range of small periampullary lesions.C-057Autoimmune pancreatitis with multifocal mass-like lesionsY. Fujinaga, M. Kadoya, K. Ueda, M. Momose, M. Kurozumi, S. Yanagisawa,H. Hamano, S. Kawa; Matsumoto/JP (fujinaga@shinshu-u.ac.jp)Purpose: Autoimmune pancreatitis (AIP) with multifocal mass-like lesions is arare form of AIP and only a few authors have been reported. The aim of this studyis to clarify the frequency and to analyze imaging findings of this unique form forcorrect diagnosis.Methods and Materials: We systematically reviewed CT, MRI, or gallium-67(Ga-67) scintigraphy for 90 patients with AIP, 75 men and 15 women (median age,63.1 years old), at Shinshu University Hospital. Diagnosis of AIP was based on thediagnostic criteria for AIP proposed by the Japanese Pancreatitis Society. Amongthese patients, we reviewed the diagnostic imaging, and analyzed frequency andimaging findings of multifocal mass-like lesions of the pancreas.Results: We identified 5 of 90 (5.6%) patients, 5 men (median age, 66.8 years old),with multifocal mass-like lesions in the pancreas. MRI was performed in all patientsand fat saturated-T1-weighted images obviously showed all localized lesions ashypointense lesions. MRCP was performed in 4 patients and showed irregularmain pancreatic duct narrowing in all patients, but multifocal lesions were unclear.Dynamic contrast-enhanced CT was performed in 4 patients and all lesions but onelesion showed hypovascular lesions. Ga-67 scintigraphy was performed in 4 patientsand all but one lesion that was unclear on dynamic contrast-enhanced CT, showedincreased uptake. All lesions disappeared after corticosteroid therapy.Conclusion: A multifocal mass-like lesion was a rare form of AIP. It seems to beimportant to know this unique form for differentiation of AIP from other focal lesionssuch as pancreatic cancer.C-058Incidental pancreatic cysts are a frequent finding in livertransplanted patients (LTPs) addressed to magnetic resonancecholangiopancreatography (MRCP)R. Girometti, L. Cereser, G. Como, M. Del Pin, A. Furlan, M. Bazzocchi, C. Zuiani;Udine/IT (rgirometti@sirm.org)Purpose: To determine the prevalence of previously undiagnosed pancreatic cystsin LTPs addressed to MRCP for suspected biliary complications.Methods and Materials: 75 MRCPs performed on 49 LTPs over a 3-year periodwere retrospectively reviewed by two radiologists, to assess the presence of pancreaticcysts, as far as their number, size (minimum detectable dimension=3 mm),location (head/body/tail), relation with main pancreatic duct (MPD) (close/far, with/without communication), and evolution over a minimum 6-month delay in 13 patientswith multiple examinations. Presence of cysts was also assessed in a control groupof 106 patients who underwent MRCPs for suspected biliary disease.Results: Prevalence of pancreatic cysts was significantly higher in LTPs (61.2%)compared to controls (30.2%) (p=0.0005; test of comparison of proportions). InLTPs a total of 99 cysts were detected (per-patient mean=3.3), prevailing in thehead (43.4%), and ranging up to 16 mm in diameter. The majority of cysts (65.6%)was close to MPD, only 24.2% showing evident communication. Four cases werestrongly suspected for intraductal-papillary-mucinous-tumors, including the onlypatient showing cysts increase over a maximum 31-month follow-up. Cysts were notassociated (p=0.38-1.00; Fisher exact test) with pre- or post-transplantation factors(including sex, age, type of bilio-pancreatic channel/biliary anastomosis, distance ofMRCPs from transplant, presence/type of biliary complications), except for alcoholicetiology of cirrhosis (p=0.002) (Odds Ratio 9.71; 95% C.I. 1.90-49.6).Conclusion: Incidental pancreatic cysts are frequent in LTPs. Clinical significance,relation to liver transplant, and impact on patients’ management before and aftertransplant are matters for debate.CS348 A B D E F FG H

Scientific and Educational ExhibitsC-059Interventional radiologic management of severe acute pancreatitisD. Leiva Pedraza, L. Martínez Carnicero, C. Valls Duran, S. Ruiz Osuna,E. Alba Rey, F. García Borobia, A. Gumà Martínez; L’Hospitalet de Llobregat/ES(d_leiva29@yahoo.es)Purpose: To evaluate indications and results of interventional radiologic techniquesin the management of complications related to severe acute pancreatitis (SAP).Methods and Materials: Twenty patients with SAP who required CT or US guidedFNA of necrotic tissue or drainage of fluid collection were reviewed over a 1-yearperiod (2006-2007). All patients were admitted to an intensive care unit and indicationsfor percutaneous management were sepsis or organ failure.Results: 40 procedures were performed in 20 patients: puncture of necrotic tissuein 26 cases (11 patients), puncture of fluid collection in 7 (5 patients) and drainageof collection in 7 (4 patients). The procedures were performed under US-guidancein 11 cases and CT-guidance in 29. FNA of necrosis showed a sensitivity of 100%and a positive predictive value of 87.5% (8/11 patients). Patients with positive cultureunderwent surgery. Mean time of infection was 18.9 d. One culture positive forStaphylococcus aureus was not proved at surgery. In 5 patients acute fluid collectionsin the initial period (11-20 days) were suspected to correspond to abscesses.Needle aspiration was positive for infection in 4 cases, and surgical debridementwas performed. Four patients presented distant fluid collections (mean: 215 d)consistent with infected pseudocysts and were treated percutaneously (n=3) orsurgically (n=1). Procedure-related complications were not observed.Conclusion: FNA is useful for microbiological study of necrosis to detect infection,with a sensitivity of 100% and a positive predictive value of 87.5%. Infectedpancreatic necrosis must be managed surgically. Infected fluid collections may besuccessfully managed percutaneously.No Material Submitted to EPOSC-060Relative accuracy of CT and MRI for the characterization of cystic lesionsof pancreasH.-J. Lee, M.-J. Kim, J.-Y. Choi, H.-S. Hong, K.-A. Kim; Seoul/KRPurpose: To define the relative performance of CT and MRI for the characterizationof cytstic lesions of pancreas.Methods and Materials: We retrospectively analyzed 67 patients (M: F = 40:27,age range, 12 - 79 years; mean, 55.2 years) with pancreatic cystic lesions whounderwent both multidetector CT and MRI. Three radiologists reviewed the CT andMR images in random order and independently and recorded their confidence forthe benignity and malignancy of the lesions, the leading specific diagnosis for thelesions. Area [Az] under receiver operating characteristic (ROC) curve was calculatedto compare the diagnostic accuracy between CT and MRI.Results: 6 lesions that were borderline lesions were excluded in the ROC analysis.35 lesions were benign (57.4%), 26 lesions were malignant (42.6%). Az for differentiatingbenign from malignant lesions were comparable between two modalities ineach reviewer ([Az]=0.651, 0.764, 0.772 for reviewers 1, 2 and 3 at CT and 0.736,0.762, 0.800 at MRI (p 0.05)). The leading diagnosis given by reviewers showedno remarkable significance difference between the two modalites (Chi-square testwith Yates correction for continuity p 0.05; reviewers 1, 2, 3 were correct in 56.1,71.2, and 59.1% at CT and 48.5, 71.2, and 57.6% at MRI, respectively).Conclusion: CT and MRI were comparable for the characterization of benign andmalignant lesions.C-061Lymphoepithelial cyst of the pancreas: Morphologic features andcomparison with other cystic diseases of pancreasW. Kim, J. Lee, H. Park, S. Kim, S. Kim, B. Choi; Seoul/KR(greenoaktree9@gmail.com)Purpose: To evaluate CT findings of lymphoepithelial cyst of pancreas (LEC) andfind differential points between LEC and other pancreatic cystic lesions.Methods and Materials: Nine patients with surgically proven LECs and 39 patientswith pathologically confirmed cystic lesions including mucinous cystic neoplasms(MCN, n=11), serous oligocystic adenomas (SOA, n=18), and chronic pseudocysts(n=10) were included in this study. Two radiologists analyzed CT images in terms ofsize, location, shape, exophytic degree, presence of wall thickening and enhancement,internal septum, mural nodule, calcification, pancreatic duct dilatation, andinternal debris. Comparative analysis was performed using 2 test.Results: LECs occurred predominately in male patients (88.9%) and varied in size(38.217 mm). Most LECs were unilocular or multilocular and had smooth or slightlylobulated margin. A few LECs had peripheral calcification, wall thickening, internalseptum, internal debris, and pancreatic parenchymal lining of exophytic portion. TheNo Material Submitted to EPOSmost significant differential point of LEC from MCN and SOA was exophytic degree(p=0.002 in MCN, p=0.000 in SOA). Most LECs were "mainly exophytic" (77.8%) or"partially exophytic" type (22.2%), whereas no MCN and just one SOA was "mainlyexophytic" type. There was no statistical difference in other features. There wasalso no significant difference between LEC and pseudocysts in exophytic degree.However, there were ancillary findings to favor LEC such as absence of calcificationand presence of pancreatic parenchymal lining of exopytic portion.Conclusion: LECs appear as unilocular or multilocular, smooth or slightly lobulated,exophtyic cystic lesions with male predominance. Most LECs revealed moreexophytic features than other cystic lesions.No Material Submitted to EPOSC-062Contrast-enhanced ultrasound in the staging of acute pancreatitisE. López-Pérez, T. Ripollés, M.J. Martínez-Pérez, F. Delgado, C. Leiva-Salinas,I. Castelló; Valencia/ES (azulena@msn.com)Purpose: To determine the diagnostic value of contrast-enhanced ultrasound(CEUS) in the assessment of the severity of acute pancreatitis in comparison withCT and clinical outcomes.Methods and Materials: The study included 39 consecutive patients with a diagnosisof acute pancreatitis and clinical CT indication admitted to our hospital betweenAugust 2006 and June 2008. Balthazar´s grading system and the modified severityindex of Mortelé were used to evaluate acute pancreatitis. Clinical variables were:Ramson score, levels of C-reactive protein and duration of hospitalisation. Correlationbetween CEUS and CT severity indexes and between CEUS and clinicalparameters were tested by Spearman´s rank correlation coefficient. Based on CTfindings as the gold standard, the sensitivity, specifity, positive predictive valueand negative predictive value of CEUS were calculated for detecting severe acutepancreatitis and pancreatic necrosis.Results: 35 patients were analyzed (17 men, 18 women, median age 60.89 years,range 23-87). A significant correlation between CT and CEUS was found for Balthazar(r= 0.894, p 0.01) and Mortelé severity indexes (r=0.957 p 0.01) andfor the detection of necrosis (Balthazar r= 0.851, p 0.01 and Mortelé r= 0.850,p 0.01). The sensitivity, specifity, positive predictive value and negative predictivevalue for detecting severe acute pancreatitis was 100% and for detecting pancreaticnecrosis were 73, 100, 100, and 89%, respectively.Conclusion: Contrast-enhanced ultrasound is comparable to CT in the assessmentof severity of acute pancreatitis. It is a cheap, safe and portable method that couldbe an alternative when CT is contraindicated.C-063Distinctive imaging features of solid pseudopapillary tumor of thepancreas in male patients: Comparative study with CT and MR imagingfindings in female patientsJ. Lee 1 , T. Kim 1 , J. Kim 1 , J.-S. Yu 2 , M.-S. Park 2 ; 1 Suwon/KR, 2 Seoul/KR(radljh@ajou.ac.kr)Purpose: The purpose of this study was to describe the CT and MR imagingfeatures of solid pseudopapillary tumor (SPT) of the pancreas in male patientsand to compare with SPT in female patients.Methods and Materials: Preoperative CT or MR images of pathology-proven36 patients (men:women = 6:30) with SPT of the pancreas were retrospectivelyreviewed. Images were retrospectively reviewed, including location of the tumor,size, shape (round, oval, lobulated), capsule thickness, proportion of solid andcystic component, and morphology of calcifications. Contrast enhancement patternswere also evaluated. Statistical differences of the imaging features betweenmale patients and female patients were analyzed.Results: Mean age was higher in male SPT patients (male:female = 43.2:31.1years) than in female patients with statistical significance (P=0.015). Lobulatedshape was comparably seen in both male SPT (50%) and female SPT (20%)(P=0.438). Completely solid lesion was significantly more frequent in male SPTpatients (83.3%) than in female patients (26.7%) (P=0.049). Contrast enhancementof progressive fill-in pattern was seen in all male SPT patients (100%), whereas itwas found in less than half of female SPT patients (44.8%) (P=0.044). No statisticaldifferences were found with respect to tumor size, location, capsule thickness,and shape of calcification.Conclusion: In conclusion, completely solid pancreatic mass lesion with lobulatedshape and progressive fill-in contrast enhancement pattern in a middle-aged manmay suggest SPT in male patients. These imaging features may help distinguishSPT from other pancreatic neoplasms, such as islet cell tumors or ductal adenocarcinoma.Abdominal Viscera (Solid Organs)ACB D E F G HS349

Scientific and Educational ExhibitsC-064Cross-sectional imaging of pancreas transplants and their complicationsJ.R. Dillman, K.M. Elsayes, J.D. Nadig, R.O. Bude, J.F. Platt, I.R. Francis;Ann Arbor, MI/US (jnadig@med.umich.edu)Learning Objectives: To discuss the recent advances in cross-sectional imagingfor the evaluation of pancreas transplants. Illustrative examples of the normalpancreas transplant, as well as a wide variety of transplant-related complications,will be presented.Background: Pancreas transplantation is currently performed for treatment ofinsulin dependent diabetes mellitus. Therefore, radiologists must be familiar withthe normal imaging appearances of pancreas transplant and the wide variety oftransplant-related complications.Imaging Findings: The exhibit begins with a brief explanation of the indicationsand surgical techniques involved in pancreas transplantation. We then discuss thevarious imaging modalities and parameters used in imaging pancreas transplants,as well as indications for when to use a specific modality. The appearance of thenormal pancreas graft and complications will be discussed, including parenchymalcomplications, vascular complications, various fluid collections, duodenal complications,and urethral complications, as well as post-transplant lymphoproliferativedisorder. Representative imaging examples are provided for each entity.Conclusion: Pancreas transplantation has become much more commonplace overthe past several decades. Pancreas transplant grafts can be successfully evaluatedusing multiple cross-sectional imaging modalities, including ultrasound, CT, andMRI. Radiologist familiarity with the expected post-operative graft appearance andpossible transplant-related complications is of increasing importance.C-065Pictorial review of aggressive solid pseudopapillary tumours of thepancreasJ. Lee 1 , T. Kim 1 , J. Kim 1 , M.-S. Park 2 , J.-S. Yu 2 , K. Kim 2 ; 1 Suwon/KR, 2 Seoul/KR(radljh@ajou.ac.kr)Learning Objectives: The purpose of this exhibit is to discuss pathologic characteristicsof aggressive solid pseudopapillary tumours (SPT) of the pancreas and toillustrate imaging features of aggressive SPT compared with benign SPT.Background: SPT of the pancreas are rare neoplasms, which mainly occur inyoung woman. However, malignant behaviour does occur in 10-15% of cases.Because of its rarity, there have been few reports about the imaging findings ofaggressive SPT.Imaging Findings: Preoperative CT or MR images for 26 patients (8 patients withaggressive SPT and 18 patients with benign SPT) were retrospectively reviewedand imaging features were comparatively assessed. There were no significant differencesbetween aggressive SPT and benign SPT with respect to the tumor size,location, capsule thickness, internal composition, and pattern of calcification. Pancreaticduct dilatation was present in 4 of 8 aggressive SPT patients, while absentin all benign SPT patients (p = .005). Vascular encasement by the tumor (n = 2)and hepatic metastases (n = 2) were also exclusively demonstrated in aggressiveSPT patients. Multivariate logistic regression analysis showed that pancreatic ductdilatation (p = .001), vessel encasement (p = .027) and metastasis (p = .027) werethe variables that can differentiate aggressive STP from benign SPT.Conclusion: Aggressive SPT of the pancreas may show the imaging features ofaggressive behaviour of pancreatic duct dilatation, and vessel encasement withor without extrapancreatic metastases. Recognition of the imaging features of aggressiveSPT may help correct diagnosis and treatment planning.C-066Magnetic resonance cholangiopancreatography through the administrationof ilex paraguariensisE.E. Martin, P. Battezzati, M. Bruno, D.F. Sarroca, M.A. Borensztein, C.H. Bruno;Lomas de Zamora/AR (mcprincich@hotmail.com)Results: Ilex was well-tolerated by all patients. Gastrointestinal signal was annulled(p 0.001) in all patients; mean ratings with and without contrast agent were 2.0and 3.95, respectively. Depictions of the common bile duct (p 0.01) and of thepancreatic duct (p 0.001) were markedly improved, their mean scores being, respectively,2.5 and 2.97 for the former, and 1.9 and 2.95 for the latter. Interobserveragreement was high (k= 0.65) in the post-contrast images.Conclusion: The elimination of the gastroduodenal signal was statistically significant(p 0.001) and all biliopancreatic structures were visually improved afteradministering Ilex, proving to be an efficient and convenient alternative to negativeoral contrasts known.C-067Usefulness of MDCT perfusion measurement in patients with acutepancreatitisJ.M. Pienkowska, E. Szurowska, J. Wierzbowski, M. Studniarek; Gdansk/PL(jpienkowska@amg.gda.pl)Purpose: Severe acute pancreatitis (AP) is a significant clinical problem, which isassociated with a highly mortality. The aim of this study was the analysis of usefulnessof MDCT regional perfusion measurement in assessing the severity of acutepancreatitis and its using for therapy planning.Methods and Materials: 45 patients with clinical symptoms indicative of acutepancreatitis underwent perfusion CT on 64-row MDCT scanner within 48 hours afteronset of symptoms of the AP. The follow-up examinations were performed after 4-6weeks to detect progression of the disease. Dynamic perfusion CT was performedafter intravenous injection of a 40 ml bolus of contrast medium (injection rate 4 ml/sec) at a 12-second scanning delay. Blood flow (BF), blood volume (BV), meantransit time (MMT) and permeability-surface area product (PS) were calculated inthe three anatomic pancreatic subdivisions (head, body and tail).Results: Perfusion parameters were significantly lower in 16 patients with acutepancreatitis due to pancreatic ischemia. In 14 of these patients, severe complications(as pancreatic necrosis) would develop. There were no significant changesin regional perfusion in patients with mild acute pancreatitis.Conclusion: MDCT perfusion is a very useful indicator for selected patients in earlystages of acute pancreatitis who are at risk of developing severe complications andcan be used for therapy planning.C-068Intraductal papillary mucinous tumors of the pancreas (IPMTP): Assets ofMRI and 3D image reviewC. Cotereau Denoiseux, L. Huwart, M. Louvet, I. Boulay-Coletta, M. Zins;Paris/FR (celine@denoiseux.com)Learning Objectives: 1. Knowing the elements of a positive diagnosis of IPMTP.2. Understand the contribution of 3D MR imaging of the pancreas. 3. Evaluate MRarguments of degeneration and knowing how to monitor an IPMTP. 4. Knowing thedifferential diagnosis of cystic tumor of the pancreas.Background: The diagnosis of IPMTP is affirmed by the identification of a communicationbetween the secondary dilated duct and the main pancreatic duct.Pancreatic 3D MR facilitates the identification of those communications. It is usedto monitor the IPMTP, search criteria of degeneration (pancreatic mass with endocanalarbud, majoration of the duct dilatation, calcifications, biliary fistula), andevaluate recurrence or post-op complications.Procedure Details: 1. The diagnosis of IPMTP is based on the identification of acystic dilatation of the pancreatic secondary ducts, communicating with the mainpancreatic duct. 2. 3D MR of the pancreas contains cholangio-wirsungographysequences, T1 sequences with and without injection, and T2 sequences. 3. 3DMR of the pancreas affirms cysts communication with the main pancreatic duct,eliminating differential diagnoses (serous cystadénoma, false pancreatic cyst,mucinous cystadénoma).Conclusion: 3D MR is the method of choice for monitoring IPMTP.Purpose: To show the capability of Ilex paraguariensis as a negative oral contrastagent to improve the quality of magnetic resonance cholangiopancreatography.Methods and Materials: In the in-vitro preliminary phase, Ilex shortened T2relaxation time and signal in SSh-TSE 2D, similar to the action of ferumoxil. Ilex isa herb consumed as an infusion with 5.5 mg/dl manganese, responsible for theseproperties. In this study, 30 consecutive patients were imaged with SSh-TSE 2Dsequences before and 10 minutes after administering Ilex. Two radiologists blindlyrated the contrast effect on the gastroduodenal signal using a scale from 1 (present)to 4 (null); and on image quality of the biliary ductal system sections grading 1 (notdiscernible) to 3 (wholly discernible). Results were analyzed statistically, with ANOVAfor repeated measures, with Friedman test for differences before and after thecontrast, and with weighted kappa coefficient values for interobserver variation.CS350 A B D E F FG H

Scientific and Educational ExhibitsAbdominal Viscera (Solid Organs)MiscellaneousC-069Unusual extramedullary hematopoiesis sites shown by CT and MRI-scanM. Albrizio, C. Peroni, C. Reduzzi, V. Piazza, A. La Fianza; Pavia/IT(mailbox@mauroalbrizio.eu)Learning Objectives: The purpose of the exhibit is to present CT and MRI imagesshowing examples of extramedullary hematopoiesis (EMH).Background: EMH is a peculiar condition that occurs in response to an insufficienterythrogenesis in case of myelofibrosis, long standing anemia or chronic leukemia.EMH can rarely be detected with CT or MRI-scan, the latter being able to showerythropoietic activity only in very few cases.Imaging Findings: From January 2004 to June 2008, 174 patients affected byidiopathic myelofibrosis underwent a CT followed by an MRI examination at ourhospital. An IV contrast medium was always used (iodinated contrast medium forCT and gadolinium for MRI). Only 14 patients presented EMH sites. EMH lesionnumber, size and shape were evaluated. In case of MRI investigation, the presenceof contrast enhancement within a lesion was considered to be a sign of erythropoieticactivity. EMH was found in peritoneal space, pelvicaliceal system, periportalspace, and extraperitoneal non lymphnodal sites. Imaging findings were confirmedby CT-guided biopsy, follow-up or post-mortem examination. Only in 4 cases MRIwas able to detect evidences of erythropoietic activities.Conclusion: CT and MRI can be successfully used to show EMH. In addition, gadoliniumenhanced MRI scans can be useful in detecting erythropoietic activity.C-070Errors of a first year consultant radiologistH.M. Imalingat, J. Smith; Leeds/UK (himalingat@doctors.org.uk)Learning Objectives: Self reflection and documentation of errors is recommendedby the General Medical Council and the Royal College of Radiologists as a part ofgood clinical practice. We aim to demonstrate the important lessons that can belearnt from reflection on one’s recorded practice.Background: An observational prospective study of a number of errors made bya first year consultant radiologist between January 2007 and December 2007 wasperformed. Errors, either self observed or informed by consultant colleagues, weredocumented. Details of error detection and patient impact were also recorded.Imaging was reviewed with knowledge of the final diagnosis and correlated withtheir pathological or operative findings and follow-up. Important learning pointswere identified.Imaging Findings: 8965 radiology studies were reported. 15 errors were observed,incidence 0.2% (15/8965). 11 errors were recorded on imaging modalities and 4errors occurred during interventional procedures. The impact of the errors observedon patients included a negative laparotomy, delay in diagnosis and treatment plusinstigation of further imaging. 16 significant learning points were identified.Conclusion: Recording one’s errors plays an important role in documenting performance.Learning from one’s mistakes is an important aspect of any individual’sdevelopment.C-071Imaging response patterns of malignant tumors treated with themultitargeted tyrosine-kinase inhibitor (TKI) SorafenibO. Maksimovic, J.P. Pintoffl, J.T. Hartmann, C.D. Claussen, M. Horger; Tübingen/DE(Olga.Maksimovic@med.uni-tuebingen.de)Learning Objectives: To illustrate usual therapy-related imaging changes ofdifferent tumors during therapy with Sorafenib as regarded by different imagingmodalities (contrast-enhanced ultrasound-CEUS, dynamic contrast-enhancedCT-dynCECT, contrast-enhanced MRI with additional diffusion-weighted imaging-DWI). To outline the advantages of the assessment of functional data contrary toclassical morphological therapy monitoring.Background: Sorafenib demonstrates profound anti-tumor activity in differenttumors (e.g. hepatocellular carcinoma-HCC, renal cell carcinoma-RCC and others).Since TKI inhibit angiogenesis, imaging tumor vascularization may allow assessmentof treatment response. On the contrary, standard criteria in evaluating therapyresponse are based on changes in size as defined by RECIST and do not addressfunctional parameters like tumor perfusion.Imaging Findings: Examination of 35 patients and 76 lesions showed that tumorsize monitoring is unreliable as TKI generally do not induce tumor shrinkage. Tumorsize variations can occur and range from partial remission up to pseudo-progressiondue to increased volume secondary to tumor liquefaction. Perfusion imaging withaid of both CEUS and dynCECT enable early assessment of therapy-inducedreduction in tumor perfusion. Additional abnormalities in tumor echogeneity andattenuation (CT) reflecting accompanying necrosis can occur and be helpful fordiagnosis. On MRI, signal abnormalities generally occur early after therapy onsetand are supposed to reflect intratumoral hemorrhage and secondary necrosis.Tumor necrosis can also be evaluated with the aid of DWI.Conclusion: The use of functional imaging is beneficial and outclasses standardresponse criteria and should therefore be implemented in response monitoringprotocols of TKI therapies irrespective of the modality to be used.C-072Diffusion weight imaging (DWI) in body district: From physics principles toimage interpretationP. Paolantonio 1 , R. Ferrari 1 , M. Rengo 1 , F. Vecchietti 1 , P. Lucchesi 1 , F. Vasselli 2 ,A. Laghi 1 ; 1 Latina/IT, 2 Rome/IT (paolantoniopasquale@hotmail.com)Learning Objectives: To illustrate basic physics principles of DWI from imageacquisition to apparent diffusion coefficient calculation. To discuss peculiar technicalfeatures of DWI in body applications To review the spectrum of potential clinicalapplication of DWI in body district. To show basics principles of qualitative andquantitative image interpretations using DWI.Background: DWI is a routinely used technique of neuro-MRI. DWI has showngreat chance in oncologic applications of body-MRI. DWI offers unique functionalinformation on water molecules diffusion; this information can be used study cellularityand integrity of cell’s membrane. Therefore, DWI can be used in a widespectrum of MR applications from lesion identification to characterization. Moreover,DWI offers an unique chance to predict tumors response to therapy and to followneoadjuvant treatment.Procedure Details: We will show how to optimize a DW sequence for body applications.In our experience, we used a SE-EPI-DWI sequence (TR 9000 msec;TE: 87 msec; matrix 128x128 Fov 350x350 mm; slice thickness 5 mm; Nex 8 acq.Time 2 min, 50 sec. b values: ranging 0-1000) acquired on a 1.5 T MR platform(Signa Hde; GE, USA). We will show a spectrum of finding of DWI of liver lesions,lymphnodes and neoplastic disease of abdomen and pelvis.Conclusion: DWI is a feasible technique in body district. DWI offers a new parameterwith respect to conventional T1 and T2 signal and contrast-enhancements.Information of water diffusibility offered by DWI may be useful in tumor detectionand characterization as well as in prediction of tumor response to therapy andtumor follow-up during neoadjuvant treatment.C-073Quantitative MR imaging in assessing the effect of different chelationprotocols in beta-thalassemic patients: A prospective long term trialE.E. Drakonaki, S. Maragaki, A. Papadakis, T.G. Maris, A.H. Karantanas; Iráklion/GR(drakonaki@yahoo.gr)Purpose: To compare different chelation protocols on liver, spleen and bone marrowsiderosis in beta-thalassemic patients using quantitative MRI studies.Methods and Materials: The study included 34 transfusion-dependent betathalassemicpatients (age 25+7 years, 13/34 splenectomized) undergoing chelationtherapy (subcutaneous deferoxamine-DFX in 21/34 patients and combined therapywith DFX and oral deferiprone in 13/34 patients). Liver, spleen and bone marrowwere prospectively assessed on two abdominal MR studies (time between scans614.35+89 days) using T1GRE (120/4/90), PDGRE (120/4/20), T2*GRE (120/9/20)and T1TSE (700/6.5/90) sequences. The signal intensity ratios of liver, spleen andbone marrow to the paraspinous muscle (L/M, S/M, B/M, respectively) were calculated.The change (D) in ferritin (F), L/M, S/M, and B/M values were calculated in theT1TSE sequence using the formula D=[(2d value-1 st value)/1 st value] x 100%.Results: L/M, S/M and B/M correlated with ferritin values in all sequences (Pearson’sr-0.371, p~0). A reduction in iron load (negative DL/M, DS/M, DB/M value)was found in 14/34 (41.17%), 7/21 (33.3%) and 14/34 (41.2%) patients, respectively,greater in patients under combined therapy (t-test, p 0.05). A reduction in serumferritin (positive DF value) was found in 22/34 (95.6%) patients, greater in patientsunder combined therapy (t-test p=0.03). Increased siderosis (positive DL/M, DS/M,and DB/M value), was greater in the DFX group (t-test, p 0.05).Conclusion: Ferritin values are an indicator of liver, spleen and bone marrow ironload. Combined therapy is more effective than DFX alone in chelating liver, bonemarrow and spleen iron in transfusion-dependent beta-thalassemic patients.Abdominal Viscera (Solid Organs)ACB D E F G HS351

Scientific and Educational ExhibitsC-074Spontaneous abdominal hemorrhage: Causes, CT findings and clinicalimplicationsA. Furlan 1 , S. Fakhran 2 , M. Federle 3 ; 1 Udine/IT, 2 Pittsburgh, PA/US, 3 Stanford, CA/US(ali.furlan@gmail.com)Learning Objectives: To review the most common causes and imaging manifestationsof spontaneous abdominal hemorrhage (SAH). To describe CT signs usefulfor diagnosis and implications for patient’s management.Background: SAH is defined as the presence of intra-abdominal hemorrhage froma non-traumatic and non-iatrogenic cause. The clinical presentation is usually nonspecific,thus frequently the diagnosis is made on the basis of radiologic findings.Because of its speed and widespread availability, CT plays an important role in theassessment of presence and location of hemorrhage.Imaging Findings: We will present the most common imaging manifestations ofthe various etiologies of SAH. The following structure will be used: appearanceof hemorrhage on CT, coagulopathy related SAH, rupture of an abdominal aorticaneurysm, visceral (hepatic, splenic, renal, adrenal and gastrointestinal) causes(rupture of underlying tumor, infection, vasculitis) and gynecological causes (rupturedovarian cyst or ectopic pregnancy, HELLP syndrome). For each point, we willprovide multiple images demonstrating the most typical and unique findings to aidthe radiologist in arriving at the correct diagnosis. In particular, we will discuss thekey CT findings to distinguish SAH due to coagulopathy from rupture of abdominalaortic aneurysms or underlying visceral pathology, as well as the implications forpatient management.Conclusion: CT is highly accurate for detection, quantification and localizationof SAH, having a direct impact on the clinical management and patient morbidityand mortality. Radiologists should be familiar with the CT appearances of variousetiologies of SAH, as they may be life-threatening, requiring prompt diagnosisand treatment.C-075Comparison of central and site review of RECIST data in an openrandomised phase II trial in advanced melanomaD.C. Ghiorghiu 1 , K. Kemsley 1 , N. Schmitt 1 , D.J. Wilson 1 , H. Young 1 , O. Bohnsack 2 ,J.M. Kirkwood 3 , M. Cantarini 1 ; 1 Macclesfield/UK, 2 Berlin/DE, 3 Pittsburg, PA/US(Dana.Ghiorghiu@astrazeneca.com)Background: The diaphragm constitutes a striking boundary between chest andabdomen. Some anatomic structures cross this border through anatomical orifices.Several lesions also can cross from one cavity to another by using those orificesor by direct invasion. We review 82 patients with lesions crossing the diaphragm.Patients were evaluated by upper gastrointestinal series, ultrasound, sixteenchannelMDCT and 1.5 T-MRI.Imaging Findings: Imaging findings were variable according to etiology of thelesions and include diaphragmatic hernias, congenital or traumatic; infectiouslesions, with and without fluid collections; mass lesions either from thoracic orabdominal organs.Conclusion: Several lesions can extend through the diaphragm. The exquisiteanatomic details provided by MDCT and MRI, especially in sagittal and coronalplanes are essentials for correct diagnosis and planning surgical approach.C-077Imaging of the spleen: More than just size measurementJ. Ash-Miles, S. Morgan, M. Callaway, H. Roach; Bristol/UK(huwroach@doctors.org.uk)Learning Objectives: To describe the various anatomical anomalies and pathologiesthat can affect the spleen. To outline the imaging features of these conditionsin the common imaging modalities.Background: Imaging assessment of the spleen is often limited to measuring itssize, and the spleen is often spared by many pathological conditions. There arehowever several processes that can affect the spleen with characteristic imagingfeatures. It is important for the radiologist to recognise these.Imaging Findings: In this presentation, we describe the imaging features of avariety of anomalies and pathologies affecting the spleen, including anatomicalvariations, cysts, haemangiomas, infections, abscesses, trauma, metastases, lymphomaand haematological disorders such as sickle cell disease. We also outlinesome of the imaging guided interventions applicable to the spleen.Conclusion: The spleen is an important organ, which can be affected by a varietyof anomalies and pathologies, with characteristic imaging features that aredescribed here.Purpose: A 200 patient, Phase II multi-centre, open-label, randomised study wasconducted to compare the efficacy of AZD6244 (ARRY-142886) versus temozolomide(TMZ) in patients with advanced melanoma, assessed by progression-freesurvival (PFS).Methods and Materials: Scheduled tumour assessments were performed usingRECIST criteria until objective progression. All available radiological data wascollected by an independent review (IR) facility. Double read with adjudicationin case of discrepancies was performed in a blinded fashion for each subject.Agreement between site measurements and independent central review of PFSwas assessed.Results: Images were available for IR from 180 patients. Discordance was seenbetween central and site data and on further investigation of these discrepancies,imbalance was seen in favour of AZD6244 by the sites. Of the 22 patients whoseprogression was recorded earlier by site than central review, 14 were on the TMZarm and of the 32 patients whose progression was recorded later by site than centralreview, 20 were on the AZD6244 arm. In 20% of cases, discrepancy was due todifferent assessments of % change of target lesions alone and 31% were due tothe identification of new lesions alone. There was large variability in the choice ofanatomical location of target lesions.Conclusion: PFS using standard RECIST needs to be treated with caution inadvanced melanoma and consideration needs to be given to optimally definelesion selection and radiological criteria. The potential for site bias in open labeltrials supports use of central review of imaging data.C-076Crossing diaphragmatic lesions: Imaging findings with emphasis on MDTCand MRIV.F. Muglia, H.S. Trad , M. Nader, M.K. Santos, R.R. Rosalen Jr,M.H. Nogueira-Barbosa, J. Elias Jr.; Ribeirão Prêto/BRLearning Objectives: To review the pertinent anatomy from diaphragm. To reviewthe spectrum of diseases that can grow through the diaphragm, either by anatomicorifices or by invasion. To illustrate how MDCT and MRI can be used to assessthese lesions. To review imaging findings of 83 patients, with emphasis on MDCTand MRI.CS352 A B D E F FG H

Scientific and Educational ExhibitsBreastDigital MammographyC-078Computer-based generation of masses in digital mammogramsM.A. Berks, S. Astley, S. Caulkin, C. Rose, R. Rahim, C. Boggis; Manchester/UK(michael.berks@postgrad.man.ac.uk)Purpose: Synthetic abnormalities provide a cost-effective substitute for real datawhen testing and training radiologists or CAD software. A method of generatingsynthetic masses based on learning the statistical variation in appearance of realdata is described.Methods and Materials: A set of regions, each containing a biopsy-proven malignantmass, was sampled from a population of digitised screening mammograms.Adaptive filtering and thin-plate spline interpolation were used to separate themasses from the underlying breast tissue. Wavelet-decomposition was used tobuild a hierarchical texture model of the breast tissue and a statistical appearancemodel fitted to the separated masses. For synthesis, a normal mammogram regionis modified using the tissue model to match the appearance of a region associatedwith a mass. A new mass is then generated from the mass model and superimposedin the modified region.Results: When 15 breast radiologists attempted to distinguish between 25 real andsynthetic masses, the mean area under the ROC was 0.690.13 (the goal being0.5). The models used in this initial analysis have subsequently been optimised(significantly reducing model fit error from 3.109 to 1.262; p 0.0001) and thetraining set doubled. Preliminary results indicate masses generated by the newmodels appear more realistic; an observer study is in progress.Conclusion: Statistical appearance models successfully generate mammographicmasses that are indistinguishable from real examples. Unlike other methods, userinput is not required to synthesise each new mass. This allows large datasets to begenerated automatically, maximising the advantages of using simulated data.C-079Comparison between digital and screen-film mammography in a screeningprogram in Cantabria/ESP. Merino, S. Sanchez, M. Sanchez, A. Vega, P. Alonso, E. Ortega; Santander/ES(paulamerino@seram.org)Purpose: To compare results between the 4 th (2003-2004) and 5 th (2005-2006)round of the screening program from Cantabria, Spain, after the introduction ofdigital mammography.Methods and Materials: The screening program studied women aged 50-65 yearswith double projection. In the 4 th round, only conventional mammography was used.In the 5 th round, women were studied with conventional mammography and digitalmammography, both direct (with soft copy reading) and indirect with CR (withscreen-film reading); the radiologists changed, having at least one year of trainingin screening mammography reading. We compared these outcomes: participation,recall for complementary projections and detection rates and percentage of in situand invasive carcinomas, pT1ab tumors, axillary lymph node involvement andconservative surgeries.Results: Rates of participation, recall for complementary projections and breastcancer detection for 4 th and 5 th rounds were: 56.89 vs 64.53%, 7.2 vs 6.9% and 2.39vs 4.69/1000 (p 0.001), respectively. The percentage of ductal in situ carcinomas,invasive carcinomas, pT1ab tumors, tumors without axillary lymph node involvementand conservative surgeries were 14 vs 18.71%, 86 vs 81.29% (p 0.001), 29.23vs 34.35% (p 0.05), 75 vs 78.07%, and 76 vs 79.33%, respectively.Conclusion: The introduction of digital mammography and the changes in thescreening program reading is supposed to double breast cancer detection rate inthe 5 th round and specially an increase in the detection of ductal carcinoma in situin the counties where direct digital mammography was used.C-0803-mega versus 5-mega liquid-crystal displays for digital mammography: Acomparison of observer performance in the detection and characterizationof microcalcifications and massesJ. Cha, W. Moon, S.-Y. Chung, Y. Koh; Seoul/KR (jhcha@radiol.snu.ac.kr)Purpose: To compare observer performances using 3- and 5-megapixel (M)liquid-crystal display (LCD) monitors for the detection and characterization ofmicrocalcifications and masses in digital mammograms.Methods and Materials: Six radiologists assessed the 100 digital mammograms.Of these, 28 mammograms depicted clustered microcalcifications (12 benign, 16malignant), 18 depicted masses (10 benign, 8 malignant), and 54 depicted noapparent abnormality. The images were stored uncompressed as DICOM filesand randomized for two sessions of soft copy reading. The readers independentlyread all cases displayed on two 3-M and two 5-M LCD monitors with an interval ofthree months. Observers were asked to rate using a five-point scale the presenceor absence, and the probability of malignancy of microcalcifications and masses.ROC analysis, the sensitivities and specificities were used to analyze results.Results: For the detection of lesions, the mean Az was 0.986 for the 3-M, and0.978 for the 5-M LCD session. The mean sensitivity and specificity was 97.1 and80.8% for the 3-M, and 97.8 and 81.5% for the 5-M LCD session (p 0.5). For thecharacterization of lesions, the mean Az was 0.954 for the 3-M, and 0.953 for the5-M LCD session. The mean sensitivity and specificity was 94.4 and 67.1% for the3-M, and 95.2 and 66.4% for the 5-M LCD session (p 0.5).Conclusion: The 3-M and 5-M LCD monitors are comparable in terms of detectionand characterization of microcalcifications and masses in digital mammograms.C-081Computer-aided detection (CAD) in screening mammography: Analysis offindings overlooked by the radiologistS. Sanchez Gomez 1 , M. Torres-Tabanera 2 , A. Vega Bolívar 1 , M. Sainz Miranda 3 ,A. Baroja Mazo 3 , M. Ruiz Diaz 3 , P. Martinez-Miravete 3 , E. Lag Asturiano 3 ;1Santander/ES, 2 Madrid/ES, 3 Logrono/ES (smsanchezg@seram.org)Purpose: To analyze malignant lesions marked by CAD and overlooked in mammographyinterpretation.Methods and Materials: We prospectively applied a CAD system to 21,855screening mammograms for a 2-year period. Mammograms were interpreted byone of six radiologists (two general and four breast radiologists). One hundred andfive cancers were detected in 94 women. After completing the series, we addeda 12-month follow-up period. Twenty-four additional carcinomas (false negativeinterpretations by radiologists) were diagnosed during the follow-up period. Mammogramsand CAD marks of these 24 cases were retrospectively analyzed by abreast radiologist.Results: General radiologists interpreted 15 (62.5%) of the 24 false-negativemammograms. False-negative rates were 73.3% for general and 55.5% for breastradiologists. Classification by lesion type was: 14 masses, 7 calcifications and3 masses with calcifications. CAD system correctly marked 6 of the 24 lesionsoverlooked by radiologists (2 minimal signs and 4 false negatives). CAD systemcould have increased the detection rate of 4.65% if appropriate attention had beenpaid to the marks.Conclusion: Appropriate attention to CAD marks can reduce false negatives inscreening mammography, although more prospective studies and follow-up arerequired.C-082Digital mammography self-assessment workshopR. Holland, H.J.T.M. Rijken, J.H.C.L. Hendriks †; Nijmegen/NL(holland.roland@gmail.com)Learning Objectives: Participants should be more familiar with reading andmanipulating screening digital mammography cases and will have assessed theirreading skills to detect cancers in their early stage and to maintain a good balancebetween recall- detection- and false-positive rates.Background: A Dutch study (JNCI May 2005) on the review of advanced intervaland screen-detected cancers showed that a delicate balance exists betweenrecall-, detection-, and false-positive rates. At a low recall rate (i.e., 1%), whenonly women with obvious mammographic abnormalities are recalled, a number ofcancers will surface as interval cancers or late screen-detected cancers at a moreadvanced tumour stage. By lowering the threshold for recall by focusing on moresubtle mammographic abnormalities, a substantial number of cancers could bedetected earlier.Procedure Details: This workshop gives participants the opportunity for hands-onexperience with digital mammography systems. Fourteen one-hour sessions will beoffered during two days. Each session starts with an introduction that includes thelearning objectives of the workshop, the method of reading and self-assessmentand instruction on how to use the system. Participants can read up to 10 differentmodules, each one containing 30 selected screening mammography cases with amix of negatives and biopsy proven positives. At the end of each session, participantscan assess their detection and false positive rates.Conclusion: An optimal balance between detection- and false-positive rate canbe achieved with a recall rate of about 2 to 4%.BreastACB D E F G HS353

Scientific and Educational ExhibitsC-083Digital breast tomosynthesis: Approaching mammographic challengesC. Malhaire 1 , F. Thibault 1 , C. Dromain 2 , A. Tardivon 1 , C. Balleyguier 2 ,A. Athanasiou 1 , C. El Khoury 1 , L. Ollivier 1 ; 1 Paris/FR, 2 Villejuif/FR(caroline.malhaire@curie.net)Learning Objectives: To learn the basic principle of digital tomosynthesis. Tounderstand the expected advantages and current clinical issues. To illustratethese through a panel of clinical cases investigated in a research study in thediagnostic setting.Background: A limitation of mammography comes from the overlaid breast tissueon projection views of the breast where a lesion may be obscured. Obtaining 3Dimaging of the breast may help visualize abnormal findings. A series of 150 patientswas prospectively investigated using one MLO-view digital breast tomosynthesis.Diagnostic performance was compared with that of standard digital mammographyand breast ultrasound.Imaging Findings: Tomosynthesis best helped characterize masses’ margins.Asymmetric densities were well identified. Multiple, as well as one-view only, lesionswere more easily localized. Microcalcifications were correctly detected with perceptionof their distribution within the breast. As a limitation, lesion detection could beimpaired in very dense breast parenchyma with almost no fatty contrast.Conclusion: Digital tomosynthesis offers a detailed 3D visualization of the breast,thereby gaining useful information relative to standard mammography. Wider clinicalevaluation will define the situations best served by this new tool.Results: The introduction of DM meant a reduction in tumour size at diagnosis forcarcinomas T1 (p = 0.02). This was also the case following the addition of CAD.There were no statistically significant differences between the three diagnosticimaging techniques for the distribution of imaging findings, although a 9% increasein the detection rate for microcalcifications was noted.Conclusion: The digitalisation of mammography and the later introduction of CADmeant a non significant improvement in breast cancer detection rate (p=0.06) atour Unit. Nevertheless, a significant reduction in tumour size upon diagnosis wasobserved with an overall increase in T1 carcinomas (p = 0.02).C-084Mammographic density estimation: Comparison among BI-RADScategories - a semi-automated software and a fully automated oneA. Tagliafico, G. Tagliafico, C. Martinoli, S. Tosto, M. Calabrese; Genoa/IT(alberto.tagliafico@tele2.it)Purpose: Although breast density is considered a strong predictor of breast cancerrisk, its quantitative assessment is difficult. The aim of our study is to calculate breastdensity with a semi-automated and a fully automated software and compare it withquantitative BI-RADS standardsMethods and Materials: A data set of 180 mammograms was evaluated withthe semi-automated software, the fully-automated one and BI-RADS quantitativeassessment. Intra- and inter-observer variability of three readers who used thesemi-automated software was calculated. The mean of these values was usedas a reference standard and correlated with BI-RADS evaluation made by twoblinded radiologists. Comparison between the semi-automated software and thefully automated was studied with Bland-Altman statistics.Results: Intra- (reader 1: k=0.73; reader 2: k=0.75; reader 3: k=0.65) and interobserver(reader 1 vs reader 2: k=0.75; reader 2 vs reader 3: K=0.81; reader 3 vsreader 1: k=0.75) variability for the semi-automated software among three readerswere good and correlated with BI-RADS evaluation made by the two radiologists(r=0.65 p 0.01). The fully automated software eliminated intra- and inter-observerdifferences, correlated with BI-RADS categories (r=0.61 p 0.01) and can replacethe semi-automated one.Conclusion: Our study demonstrates that automated estimation of breast densityis feasible, eliminates subjectivity and is more accurate than BI-RADS quantitativeevaluation. CLINICAL RELEVANCE/APPLICATION: A fully-automated estimationof breast density is feasible, eliminates subjectivity and can be used not only forresearch purposes but also in the daily practice.C-085Impact of the introduction of digital mammography and a computer-aideddiagnosis system (CAD), on a multidisciplinary breast unitC. Romero, M. Gª-Hidalgo, C. Varela, A. Almenar, I. Herrera, J. Pinto; Toledo/ES(mabelgha@gmail.com)Purpose: To evaluate the impact that the introduction of digital mammography (DM)first, and a computer-aided diagnosis (CAD) system later, had on breast cancerdiagnostic rate at a multidisciplinary breast unit.Methods and Materials: We conducted a retrospective study that looked at 4164,4204, and 4315 mammograms for 3180, 4034, and 4117 women for the first sixmonths of 2003, 2006, and 2007, respectively. We reviewed the images and reportsfor all cases in the study. Only cases with diagnostic imaging features suggestiveof malignancy were included. 2 tests were carried out using SPSS after thesample’s homogeneity was proved. We calculated total number of carcinomas(including in situ carcinomas), their histological patterns and size, and interventionalprocedures´ rate. We describe the comparative results for each of the three studyperiods, which relate to diagnostic imaging by conventional mammography, DM,and CAD with DM, respectively.CS354 A B D E F FG H

Scientific and Educational ExhibitsBreastMRIC-086Predictive value for malignancy of suspicious breast masses of BI-RADScategory 4-5 using ultrasound elastography and MRI diffusion-weightedimagingH. Satake, A. Nshio, M. Ikeda, S. Ishigaki, M. Kawamura, K. Shimamoto,H. Kawai, S. Naganawa; Nagoya/JPPurpose: To evaluate the predictive value for malignancy of ultrasound elastography(USE) and MRI diffusion-weighted imaging (MRI-DWI) regarding breast mass ofBI-RADS category 4-5.Methods and Materials: The subjects were consecutive 63 suspicious breastmasses classified as BI-RADS category 4 or 5. All patients were recommendedfor biopsy and were confirmed pathologically (19 benign, 44 malignant). In additionto the routine clinical examinations of mammography, ultrasound, and dynamiccontrast-enhanced MRI, USE and MRI-DWI were also obtained. Two radiologistsretrospectively evaluated elasticity score of USE, and calculated apparent diffusioncoefficient (ADC) values on MRI-DWI. According to the several reports, thecut-off levels of elasticity score was defined as between scores 3 and 4. Optimalcut off levels of continuous ADC values were determined by estimating the receiveroperating characteristic curves. The diagnostic abilities to differentiate malignantfrom benign lesions were analyzed by using univariate and multivariate logisticregression analyses.Results: The sensitivity, specificity, and accuracy were 84.0, 68.0, and 79.3% forelasticity score and 75.0, 74.0, and 74.6% for ADC values, respectively. All fourcases with elasticity score 1 were proved to be benign pathologically. Althoughboth elasticity score and ADC values were shown to provide the significant criteriafor differentiating malignancy from benign in the univariate analysis, only elasticityscore was the significant predictor in the multivariate analysis.Conclusion: Our results show that USE is the examination that can add morereliable information to a recommendation for biopsy in the breast masses classifiedas BI-RADS category 4-5, compared with MRI-DWI.C-087Evaluation of neoadjuvant chemotherapeutic effects of breast cancer byMRI: Accuracy of MRI in predicting pathological complete responseN. Gomi, A. Khono, Y. Yamamoto; Tokyo/JPPurpose: The importance of the evaluation of pathological complete response(pCR) has been confirmed by the fact that there is a close correlation between pCRto neoadjuvant chemotherapy (NAC) and prognosis for breast cancer. The objectiveof our study was to evaluate the accuracy of MRI in predicting CR after NAC.Methods and Materials: 305 women with stage IIB-III palpable solid breast cancerunderwent dynamic contrast-enhanced T1WI of the entire breast, before andafter NAC. On imaging, complete response (iCR) was defined as no enhancedtumor on all serial images. All patients underwent radical or conservative surgerybetween Jan. 2005 and Dec. 2007, and imaging findings were compared withpathologic findings.Results: 43 out of 305 patients had iCR after NAC. 23 out of the iCR (53%) wereidentified correctly with pCR (no histological evidence of invasive tumor cells). Yetin 20 out of iCR patients (47%), MRI underestimated the residual tumor. In 17 outof the 20 patients who were underestimated on MRI, resected specimens showedmarked response to chemotherapy and only a small amount of residual tumorwas detected. In 3 out of 20 patients who were underestimated on MRI, resectedspecimens showed mild response to chemotherapy, and considerable amount ofresidual tumor among fibrotic change was detected.Conclusion: MRI seems to reflect pathological conditions after neoadjuvant chemotherapyeffectively, and appears to provide good correlation with pCR. 53% ofthe patients who were evaluated as iCR were pCR.C-088Morphological and kinetic characteristics of dynamic CE-MRI correlatedwith histopathological factors of breast cancer: A potential prognostic roleof breast MRI?T. Kanavou, M. Vlychou, A. Poultsidi, E. Athanasiou, M. Ioannou, I. Fezoulidis,K. Vassiou; Larissa/GR (kanavou@freemail.gr)Purpose: To explore the correlation of morphological and kinetic DCE-MRI featureswith histopathological prognostic factors of invasive breast cancer.Methods and Materials: Fifty-one women with 57 cancerous lesions underwentDCE-MRI prior to surgery. DCE-MRI findings were interpreted with a multifactorialclassification system that included morphological (shape, margins and pattern ofenhancement) and kinetic characteristics (initial signal increase and postinitialbehaviour of the time-signal intensity curve). Each morphological and kinetic parameterwas scored with 0, 1 or 2 points and the total score was estimated. Finally,each lesion was classified into one of the five categories that correspond to the fiveACR BI-RADS categories. Statistical analysis was performed to correlate DCE-MRimaging parameters and histopathological findings using Fisher’s exact test andstepwise multiple regression analysis.Results: Increase of the signal intensity at the initial phase 100% was stronglycorrelated with positive lymph nodes (p=0.008, OR 0.054). Types I and II time-signalintensity curves at the postinitial phase were associated with a 4-fold increase inthe likelihood of progesterone receptors positivity (p=0.022, OR 4). Finally, hightotal score was positively correlated with affected lymph nodes (p=0.033, OR0.29). There was a statistically significant trend regarding ill-defined margins ofthe tumor (p=0.08) and vascular infiltration and also high score and neural infiltration(p=0.072).Conclusion: A multivariate interpretation model for DCE-MRI that includesmorphological and kinetic characteristics has prognostic value for invasive breastcancer. Early initial contrast agent uptake and a high overall score are associatedwith poor prognostic factors.C-089The factors influencing perifocal high signal intensity surrounding breastlesions on T2-weighted images of breast MRIK. Nakashima 1 , H. Ishimaru 1 , I. Isomoto 2 , K. Ishimaru 3 , T. Koshiishi 1 , N. Taura 1 ,S. Maeda 1 , H. Toyama 1 , M. Ito 1 , Y. Matsuoka 1 ; 1 Omura/JP, 2 Nagasaki/JP,3Isahaya/JP (marimori@v101.vaio.ne.jp)Purpose: Breast MRI often demonstrates perifocal high signal intensity (PH)surrounding contrast-enhanced lesions, especially in breast carcinomas, on T2-weighted images (WI). Some authors speculated that PH reflects edema due tolymphatic involvement and one of the indicators of malignancy. However, the otherfactors that may influence PH have not been established. Our purpose is to clarifythe factors influencing PH.Methods and Materials: 131 patients with breast cancer and 48 patients withbenign lesion examined by MRI at 1.5 T were included. Coronal fat-suppressedT2WI (section thickness 2-4 mm, matrix 512×512, field of view 25 cm), Gd-enhanceddynamic T1WI, and postcontrast 3D T1WI were retrospectively evaluated to determinethe presence of PH. Candidate factors including patient’s age, lesion’s signalintensity on T2WI, homogeneity of enhancement, dynamic time course of enhancement,size, shape, margin, histopathology, and peritumoral lymphatic invasion (LI)were evaluated with univariate and multivariate logistic regression analyses to findthe independent factors influencing PH.Results: 2 of 9 factors (patient’s age and lesion’s margin) showing P 0.20 inunivariate analysis were excluded in multivariate analysis. LI [observed in 26/35(74%) of lesions with PH vs 53/144 (37%) of lesions without PH; odds ratio, 3.6]was the only valuable predictors for PH at multivariate analysis (p=0.006).Conclusion: In 9 factors analyzed here, LI was the only valuable factor influencingPH.BreastACB D E F G HS355

Scientific and Educational ExhibitsC-090Correlation of breast ultrasound (US) elastography and MR imaging:correlation of elastography score (ES) with short Tau inversion recovery(STIR) MR images, enhancement ratio, apparent diffusion coefficient (ADC)and fibrotic changes of breast diseaseR.N. Matsubayashi, M. Imanishi, K. Yasumori, T. Muranaka, S. Momosaki;Fukuoka/JP (radmad311@yahoo.co.jp)Purpose: US elastography provides information regarding tissue hardness, andis expected to become a novel diagnostic tool for breast disease. On the otherhand, MR images reflect the tissue characteristics. Fibrosis of the stroma of breastdiseases may affect the hardness of them. We investigated the correlation betweenES and signal-intensity (SI) of STIR MR images, enhancement ratio, ADC, and thefibrosis in the breast lesions.Methods and Materials: We reviewed the findings of US elastography and MRIfrom 41 consecutive patients with breast lesions (25 invasive ductal carcinoma,3 fibroadenoma, 1 phyllodes tumor, 2 ductal hyperplasia, 2 primary malignantlymphoma, 3 mastopathy, 1 metastasis, 1 tubular adenoma, 1 ductal carcinomain situ, 1 diabetic matopathy and 1 intraductal papilloma). In each patient, elastographyimages were classified based on Tsukuba ES. We calculated the ratio ofSI of the lesion to muscle on STIR images (L/M ratio), enhancement ratio of earlyto pre-contrast (E/P) and early to delayed (E/D) images and ADC for each lesion.The ES and MR findings were correlated with the degree of fibrosis (based onMasson trichrome stain).Results: The ES significantly correlated with the L/M ratio (p=0.0306) and the ADC(p=0.0256). The stromal fibrosis also correlated with ES (p=0.0023), the L/M ratio(p=0.0344) and the E/D ratio (p=0.049).Conclusion: The ES and L/M ratio are correlated significantly each other, andthey are correlated with the fibrosis. These results suggest that they will providethe information of fibrosis, and may help the diagnosis of breast lesions.C-091Usefulness of diffusion-weighted imaging for detecting breast tumors asscreening modality: Comparing with breast US and dynamic contrastenhancedMRIJ.E. Lee, J.H. Lee, H.Y. Choi, S.Y. Baek; Seoul/KRPurpose: To evaluate the usefulness of diffusion-weighted imaging (DWI) fordetecting breast tumors, as compared with breast ultrasound and dynamic contrastenhancedMRI.Methods and Materials: Eighty-two patients who received mastectomy or breastconserving surgery for breast cancer between February 2007 and April 2008 wereincluded. They had preoperative breast US and breast MRI within one month beforebreast surgery. Dynamic contrast-enhanced images of MR were used as a referenceimage for detecting tumor. We compared the detectability of breast lesions on DWIwith that of US. We also compared the detectability of coincidental probable benignbreast lesions for screening tool.Results: Among 82 histopathologic proved malignant lesions, 80 lesions weredetected on DWI (detectability 97.6%) and 80 lesions were detected on US (detectability97.6%). Of nine suspicious lesions for DCIS such as segmental or linearclumped enhancement on dynamic contrast-enhanced images, 8 lesions (88.9%)were found on DWI and 5 lesions (55.6%) were found on US. 35 lesions were notedas coincidental probable benign lesions and 24 lesions were histopathologic provedas benign lesions such as fibrocystic disease (12), fibroadenoma (5), fibrosis (4),sclerosing adenosis (3) and the others are not confirmed by histopathology. Ofthese, 34 lesions (97.1%) were detected on US, but only 18 lesions (51.4%) weredetected on DWI.Conclusion: DWI had a high sensitivity for detecting malignant breast tumorssimilar to US and dynamic contrast-enhanced images. However, benign lesionson DWI were found with lower sensitivity than US. Then, DWI is not more sensitivethan US to detect breast tumors. We concluded that DWI is not useful for additionalscreening modality.C-092Does breast MRI help us differentiate uncommon malignant breast tumorsfrom invasive ductal carcinoma?O. Woo, S. Huh, A. Yi, K. Cho, B. Seo, A. Kim, E.-Y. Kang; Seoul/KR(huhsik@gmail.com)Learning Objectives: To describe MRI findings of uncommon malignant breasttumors, focusing on both the morphologic and dynamic enhancement patternswith pathologic correlation. To identify MRI characteristics that aid in making acorrect diagnosis.Background: Although it is a challenging task for the radiologist to differentiatepathologic subtypes of breast cancers owing to the overlap of radiologic findingsbetween them, certain types of uncommon malignant breast tumors have characteristicradiologic features that may help in the diagnosis of a specific subtype. Thisexhibit illustrates the MRI findings of pathologically confirmed uncommon malignantbreast tumors of the breast and axilla.Imaging Findings: We reviewed a wide spectrum of uncommon malignantbreast tumors: papillary carcinoma (n=13), mucinous carcinoma (n=7), medullarycarcinoma (n=3), tubular carcinoma (n=3), metaplastic carcinoma (n=4), apocrinecarcinoma (n=8), malignant phyllodes tumor (n=5) and primary breast lymphoma(n=2). Mucinous, medullary, intracystic papillary carcinoma and metaplastic carcinomashowed benign morphologic characteristics. Mucinous and tubular carcinomapresent type I persistent enhancement pattern on MRI. Especially, internal cysticportion of papillary carcinoma and mucinous carcinoma showed characteristichigh signal intensity on T2WI.Conclusion: Breast MRI can help in the interpretation of specific pathologicdiagnosis, combining T2 high signal intensity, morphologic features and dynamicenhancement pattern. Several subtypes of carcinomas may show persistentenhancement pattern (tubular carcinoma) or benign morphologic characteristics(mucinous and medullary carcinoma) on MRI, giving rise to possible diagnosticpitfalls. Familiarity with radiologic findings of these tumors can aid in making thecorrect diagnosis and avoiding misinterpretation of MRI findings.C-093Impact of the arterial input function assessment on the kinetic parametermeasurements and on the final response evaluation of breast cancer tochemotherapy at contrast-enhanced MR imagingC. de Bazelaire, C. Brunon, C. Farges, M. Albiter, L. Fournier, N. Siauve,E. de Kerviler, O. Clément, C.A. Cuenod; Paris/FR(cedric.de-bazelaire@sls.aphp.fr)Purpose: To determine whether calculated or measured arterial-input-function(AIF) at low-temporal-resolution dynamic-contrast-enhanced MRI (DCE-MRI)yielded kinetic parameters that could be used to predict final pathologic responseto neo-adjuvant chemotherapy in breast cancer.Methods and Materials: DCE-MRI were performed in women with breast cancerbefore (n=35) and after treatment (n=24). High-spatial-resolution DCE-MRI included 8series of 1.11 minute-acquisitions. Kinetic parameters (transfer constant, K trans ; leakagespace, V e) were calculated for tumors using measured or calculated-AIF. Differencesbetween the two AIFs and kinetics parameters issued from both AIFs were analyzed.Changes in kinetic parameters after treatment obtained with both AIFs were correlatedwith final pathologic response and accuracies to identify non responders werecompared with area under receiver operating characteristic curves.Results: Low-values of calculated-AIFs were overestimated whereas high-valueswere underestimated. With calculated-AIF, similar errors were observed for K transvalues whereas V ewas globally overestimated. With measured-AIF, significantchanges in K trans and V ewere noted between non-, partial-, and complete responders(Kruskal-Wallis test, P=0.0317 and P=0.0220, respectively). No differences in kineticparameters using calculated-AIF were seen with respect to response. A decreasein V eof less than -85% and less than -90% for K trans with measured-AIF resulted in91% sensitivity for identifying non-responders (specificity=54%, area=0.83 for V e;specificity= 61%, area=0.80 for K trans ). With calculated-AIF, these cutoff values hadlower accuracy (sensitivity=84%, specificity=23%, area=0.74 for V e; sensitivity=55%,specificity=46%, area=0.48 for K trans ).Conclusion: The use of measured-AIF rather than calculated-AIF tends toimprove accuracy in kinetic parameter measurements and treatment responseevaluation.C-094Molecular breast cancer subtypes: Accuracy of breast magnetic resonanceimaging predicting response to neoadyuvant chemotherapyF. Jimenez Aragon, C. Bernal Lafuente, C. García Mur, M. Beltrán Marín,L. Martínez Comín, R. Gomez Pereda; Zaragoza/ES (fatima-jimenez@hotmail.com)Purpose: Breast cancer is a clinically heterogeneous disease. A new molecularclassification based on gene expression studies divides it into three major subtypes:triple negative (TN), HER2+, and luminal. Each one has shown different prognosisand response to neoadjuvant chemotherapy (NAC). The objectives of this studyare: - To evaluate with magnetic resonance imaging (MRI) the response to NACof the three molecular subtypes of breast cancer. - To compare the radiologicalresponse (RR) in MRI with the pathological response (pR), calculating the correlationindex.CS356 A B D E F FG H

Scientific and Educational ExhibitsMethods and Materials: A total of 160 patients in whom core biopsy had confirmedthe presence of breast cancer underwent breast MRI prior to beginning NAC andbefore surgical excision. Based on the MRI findings, patients were divided intofour groups: Non Response (NR), Major Parcial Response (MPR), Minor PartialResponse (mPR), and Complete Response (CR). The pR was based on the Miller& Payne Scale, which divides the response into five categories (G1-G5).Results: Of the 161 patients, 91 were into the luminal subtype, 39 HER2+ and31TN. The MRI results showed 51.3% of RC in the HER2+ subtype and 41.9% inthe TN. The correlation index between the pR and RR was bigger in the TN (0.901Pearson coefficient, p 0.0001).Conclusion: There is a high correlation between PR and RR in all molecular breastcancer subtypes. HER2+ and TN subtypes have the best rates of RC to NAC inspite of their worse prognosis.C-095Apparent diffusion coefficient value and correlation with tumor gradingand histology in breast cancer patients undergoing DWIE. Bufi, M. Costantini, P. Belli, C. Ierardi, R. Lombardi, L. Bonomo; Rome/IT(reagandus@alice.it)Purpose: To investigate the predictability of tumor grade, histology and invasivity inbreast cancer patients by means of the apparent diffusion coefficient (ADC) valuesobtained with the DWI sequence.Methods and Materials: From April 2005 to June 2008, 133 patients (a total of160 breast lesions) with proven breast cancer underwent breast MRI including theDWI sequence. For each breast lesion, the ADC value was calculated. Grading wasassessed by the Nottingham system. Kendall’s rank-correlation coefficient (tau) wasused to analyze the correlation between ADC and grading.Results: Pathological analysis revealed invasive ductal carcinoma (CDI) in 123cases (76.9%), invasive lobular carcinoma (CLI) in 14 cases (8.8%), in situ ductalcarcinoma in 16 (1%), invasive tubular carcinoma in 2 (1.3%) and mixed tubular andlobular invasive carcinoma in 6 (3.8%). There were 20 (12.5%) grade 1, 68 (42.5%)grade 2 and 72 (45%) grade 3 lesions. We observed a trend towards lower meanADC value for invasive carcinomas vs. in situ lesions (p=0.42, t-test) and a statisticallydifference between CDI and CLI (p=0.01, t-test). Mean ADC value for grade1, 2 and 3 tumours was 1.17x10 -3 mm 2 /s, 0.99x10 -3 mm 2 /s and 0.89x10 -3 mm 2 /s,respectively (p 0.001 at one-way ANOVA). A statistically significant (p 0.001)inverse correlation (Kendall's tau -0.279) was disclosed between the ADC valueand the tumor grading.Conclusion: DWI and ADC provide consistent information to support MRI diagnosisof breast cancer and are therefore promising parameters in the evaluation of thetumor grading and histology.C-096The value of MR and MR-guided vacuum biopsy of the breast in selecteddiagnostically difficult casesS.D.F. Rego 1 , S.H. Heywang-Köbrunner 2 , A. Heinig 3 , B. Amaya 3 ;1Rio de Janeiro/BR, 2 Munich/DE, 3 Halle/DE (regosal@hotmail.com)Purpose: To determine the value of MR in the diagnostic problem resolution incases that cannot be adequately solved by conventional imaging (mammographyand ultrasound) and clinical findings.Methods and Materials: Between 1997 and 2001, 262 patients with alterationsthat became evident in a mammography and without a correlation with additionalscans or ultrasound underwent breast contrast-enhanced MR.Results: Among 262 patients, 145 did not show alterations; 27.5-month follow-upwas performed through MR (30 patients), MR/MM (14), MM (40), MM/US (35), US(2), obit (3) and no control in 21 patients. In 117 patients with alterations, biopsywas indicated in 73 cases (23-month follow-up), control through MR in 10 patients(11.6-month follow-up) and through MM in 34 patients (27-month follow-up). Amongthe 73 cases in which the histopathologic study was indicated, 58 patients did theprocedure (25 malignant, 1 LCIS, 32 found benign), in 3 patients the lesions werenot visible at the time of the biopsy and 12 did not undergo the procedure.Conclusion: MR and MR-guided vacuum biopsy of the breast contributes towardsa correct diagnosis in problematic cases, which could not be clarified with onlymammography and ultrasound, 10% of these cases having been found to bemalignant.C-097Texture analysis of breast lesions enhancement kinetics in dynamiccontrast enhanced MRI: Correlation with histologyA. Karahaliou 1 , K. Vassiou 2 , T. Kanavou 2 , M. Vlychou 2 , N. Arikidis 1 ,S. Skiadopoulos 1 , L. Costaridou 1 ; 1 Patras/GR, 2 Larissa/GR(karahaliou.a@med.upatras.gr)Purpose: To investigate correlation between texture features extracted fromenhancement kinetics feature maps and histopathological prognostic factors ininvasive breast cancer.Methods and Materials: 37 women with invasive breast cancer (40 lesions)underwent preoperatively DCE-MRI, with 1.5 T system. Coronal 3D T1-weightedspoiled gradient echo sequence was acquired before and five times after intravenousadministration of gadopenate dimeglumine (0.2 mmol/kg). For a selected slice, mostrepresentative of the lesion, a bilinear model was fitted pixel-wise to correspondingtime series and fitted parameters were used to create 3 kinetic feature maps:peak-enhancement (PE-map), time-to-peak-enhancement (TPE-map) and wash-out(W-map). 12 second order statistics texture features were extracted from each lesionkinetic map and correlated with histopathological and immunohistochemical factorsemploying univariate (Spearman rank-order correlation, binary logistic regression)and multivariate (binary logistic regression and multiple regression with forwardselection) statistical analysis.Results: Inverse-different-moment (W-map) was found to be a significant andindependent predictor of both histological grade (p=0.034) and estrogen receptors(p=0.031). Difference-entropy (W-map) was independently associated with in situcomponent (p=0.021). Sum-entropy (W-map) was found to be a significant andindependent predictor of both Her2/neu overexpression (p=0.046) and estrogenreceptors (p=0.044). Entropy (PE-map) and Sum-entropy (PE-map) were independentlyassociated with tumor size (p=0.002) and progesterone receptors (p=0.046),respectively. Information-measure-of-correlation-1 (TPE-map) and sum-entropy(TPE-map) were found to be significant and independent predictors of lymph nodestatus (p=0.011) and neural infiltration (p=0.041), respectively.Conclusion: These preliminary results suggest that texture analysis of breast lesionsenhancement kinetics may contribute in preoperatively identifying malignantlesions with different biological behaviour.C-098Pitfalls in breast MRI imagingG. Argento, F. Capparella, C. Porcari, W. Calandro, E. Iannicelli, B. Sessa,V. David; Rome/IT (gargento@sirm.org)Learning Objectives: MRI imaging of the breast has evolved into an importantadjunctive tool in breast imaging with multiple and ever increasing indications forits use. As with other types of MRI imaging, there are a number of technical artifactsand pitfalls that can potentially limit interpretation of the images by maskingor simulating disease.Background: Between Oct 2007 and Sept 2008 we studied 106 Pt, age 30-60 aa.All of them came with a mammography and US imaging and a confirmed biopsydiagnosis of breast cancer.Imaging Findings: Most common pitfalls were: breast with BIRADS IV pattern withhigh representation of fibroglandular tissue with poor adipose component; breastvolume exceeding breast coil dimension with tissue outside FOV; errors in contrastvenous administration: poor quantity or incorrect timing; poor fat saturation; badbreast positioning inside coil; ipervascularity pattern in post-radiotherapy examsor surgical granulation tissue.Conclusion: A correct approach breast MRI imaging interpretation as to considerpitfalls as potential causes of incorrect diagnosis or staging.BreastACB D E F G HS357

Scientific and Educational ExhibitsBreastTumorsC-099Metaplastic breast carcinoma: Radiologic findings with pathologiccorrelationJ. Hernández Gañán, A. Gumà Martínez, R. Ortega Martínez, M. Lerin Martos,M. Soler Monsó, L. Prieto Álvarez; L’Hospitalet de Llobregat/ES(jb_hdez@hotmail.com)Learning Objectives: To review mammographic, ultrasonographic and magneticresonance findings in 26 cases of metaplastic carcinoma of the breast (MCB). Tocorrelate the radiological features with clinical and histopathologic findings.Background: MCB accounts for less than 5% of breast carcinomas. It is a rapidlygrowing, palpable mass with mixed epithelial and mesenchymal differentiation. Wereviewed 26 metaplastic carcinomas diagnosed between 1996 and 2008. Patients’sage ranged from 31 to 93 years (mean 53.2). Mammography was performed toall 26, ultrasound to 23 and magnetic resonance to 6 cases. Radiologic findingswere classified according to the ACR BIRADS classification. Pathologically, size,tumor type and presence of necrosis and osteoclast-like cells were assessed, andimmunostains for oestrogen and progesterone receptors, HER2, and markers ofmesenchymal, epithelial and myoepithelial cells were performed.Imaging Findings: At mammography, 69% of tumors were round or lobular,76.9 % had circumscribed or indistinct margins and only five had calcifications.At ultrasound, 86.9% of tumors had circumscribed or microlobulated margins andheterogeneous echogenicity with both solid and cystic areas and posterior acousticenhancement were seen in 56.5%. At MR, all tumors had type 2 or 3 enhancementand four had cystic areas. At pathology, adenocarcinoma with squamous metaplasia,pure squamous carcinoma, spindle differentiation, chondroid elements andosteoclast-like giant cells were seen.Conclusion: Radiologists must be aware of these imaging findings, becausemetaplastic carcinoma tends to show benign imaging features, such as round orlobular shape with circumscribed margins, but biologically it is an aggressive tumorwith poor prognosis.C-101Benign breast lesions mimicking breast cancer: What do you need to knowA. Silva 1 , R. Sinnatamby 2 , P.D. Britton 2 , J. Venancio 1 , M. Ribeiro 1 ; 1 Matosinhos/PT,2Cambridge/UK (catarina.silva.hph@gmail.com)Learning Objectives: Describe the various causes of benign breast lesions thatmay mimic carcinoma on mammograms. Highlight the importance of an integratedapproach to these lesions that includes clinical presentation, imaging and cytology/histologyto get to the correct diagnosis and prevent unnecessary surgicalintervention.Background: Many benign breast lesions pose diagnostic challenges. It is importantfor radiologists to be familiar with these benign lesions to avoid unnecessary surgeryon one hand or to plan the appropriate surgical procedure if needed.Imaging Findings: This exhibit aims to do a pictorial review of the imaging featuresof carcinoma-mimicking benign lesions with pathologic correlation. These lesionsinclude abscess, hematoma, radial scar, postsurgical scar, diabetic mastopathy, fatnecrosis, focal fibrosis, sclerosing adenosis, granular cell tumor, extraabdominaldesmoid tumor, medial insertion of pectoralis muscle or sternalis muscle, and axillarylymphadenopathy for different causes other than breast disease.Conclusion: Benign breast lesions are common and sometimes assume an aggressiveappearance. Familiarity with its imaging findings and pathological correlationis important to plan the appropriate plan of action.C-102Breast cancer in young women: Clinical, radiological and pathologicalfeaturesR. Lombardi, M. Costantini, P. Belli, M. Romani, G. Franceschini, L. Bonomo;Rome/IT (rlombardi0@sirm.org)Purpose: To study clinical, radiological and pathological findings of breast cancerin women aged 40.Methods and Materials: We studied all the young women with pathological diagnosisof breast cancer who underwent radiological examinations and surgicaltreatment in our hospital from March 2000 to June 2007. We describe clinical andradiological patterns and we correlate imaging findings to histology and biologicalmarkers.Results: We enrolled in this study 161 female patients 40 years with breast cancer.We obtained a prevalence of 10.76%. An increase of breast cancer cases duringthe considered period was noted. Mean age of our patients was 35.1 years. 24.3%of patients had breast cancer familial history. At diagnosis, 96.27% of patients weresymptomatic: palpable mass or breast hardening was present in most cases. Meansize of cancer at diagnosis was 26.10 mm. Diagnostic accuracy in breast cancerdetection and characterization was higher in ultrasonography than in mammography(sensitivity, respectively, 67.08 and 90.06%). Histology revealed 77.64% cases ofIDC and most cases of grade 2 and 3 carcinomas. 55.3% of patients were lymphnodes positives; 9 patients had metastases at diagnosis. Biological evaluationrevealed a high frequency of estrogen and progesterone receptor negatives andfrequent Ki67, c-erbB-2 and p53 positives. Statistical tests showed significant correlationsbetween biological findings and radiological features.Conclusion: Our study confirms the significant incidence and the high aggressivenessof breast cancer in young women. Our experience led us to reaffirm the importanceof clinical examination and prompt imaging evaluation in young women.C-103Cancer detection in early recall patients in the all Wales breast screeningprogram (breast test Wales)S.H. Bolt, P. Young; Cardiff/UK (sally.bolt@btopenworld.com)Learning Objectives: To analyse the cancer detection rate and associated imagingfeatures in patients placed on early recall in the Welsh screening program. Toreview their management at the first assessment clinic.Background: A search was made for all early recall episodes from 01/04/02 to31/03/08. This yielded 754 women, 27 of whom developed breast cancer. NHSBSP target standard requires less than 0.25% of women screened to be put onearly recall. Our rate was 0.14%.Procedure Details: Of the 27 women with cancer, 17 were diagnosed within 12months of the initial assessment. At the first visit, only 13 of the 27 had an attemptat biopsy. Six of these were inadequate or technically difficult. Of the fourteen whodid not undergo biopsy at this first visit, thirteen had normal ultrasound scans; onehad neither. The mammographic appearances were varied with no trend identified.Six of the 27 cancers required open surgical biopsy for diagnosis; four of these werefor calcification. Eighteen of the cancers were invasive, nine were DCIS.Conclusion: Early recall can induce anxiety. It is therefore important to minimisethe number referred this way and optimise assessment at first visit. The cancerdetection rate was 3.6% in this cohort, compared with 0.8% for the general screeningpopulation. Early recall therefore remains a valid management option. Werecommend biopsy is attempted in all women, even if the ultrasound is normal,before using early recall.C-104Flat epithelial atypia (FEA): Clinical-radiological and pathologicalcorrelationM. Cara García, M. Alvarez Benito, E. Fuentes Vaamonde, M. García Ortega,J. Raya Povedano, B. Cajal Campo; Córdoba/ES (jolumoga@hotmail.com)Purpose: Assess in patients with FEA: the clinical and radiological manifestations,the accuracy of percutaneous biopsy, its association with other high-risk lesions orcarcinoma, and its prognosis, for the purpose of registering its management.Methods and Materials: Retrospective study based on reviews of clinical historiesof patients with result of FEA in percutaneous breast biopsy (PB) and/or surgicalbiopsy (SB) in the period April 05-May 08. The results of percutaneous biopsy andsurgical biopsy are correlated in order to calculate the rate of underestimation ofthe percutaneous biopsy.Results: 30 patients have been detected with result of FEA in mammary biopsy:20 patients with result of FEA in PB. The SB confirmed the diagnosis of FEA in allof them, demonstrating in addition another high-risk lesions in 8, and carcinomain 3. 4 with result of FEA and carcinoma in PB. 6 with diagnosis of FEA in SB (5of them with percutaneous diagnosis of carcinoma). The majority of the patients(83.33%) were `asymptomatic` at the moment of the diagnosis. The most frequentradiological manifestation has been microcalcifications (80%). FEA has been associatedwith other high-risk lesions in 33.33%, and with carcinoma in 40%. Rateof underestimation for patients with result of FEA in PB of 15%.Conclusion: In patients with result of FEA in percutaneous mammary biopsy, surgicalbiopsy should be carried out. A specific monitoring is recommended for thesepatients, some authors proposing prophylactic measures (chemoprevention).CS358 A B D E F FG H

Scientific and Educational ExhibitsC-105Metastatic disease to the breastA. Salgado, F. Pires, J. Loureiro, A. Aguiar, A. Guimarães, M. Gouvêa; Porto/PTLearning Objectives: To recognize the clinical and imaging features of breastmetastasis from extramammary malignancies.Background: Metastatic lesions to the breast are unusual. The most commonsource is melanoma, but a wide variety of other tumors may secondarily involvethe breast. Although breast involvement occurs late in malignant disease, imagingstudies are indicated to reinforce the clinical suspicion of metastasis, to exclude aprimary breast tumor and to serve as a baseline for evaluation of therapy.Procedure Details: We evaluated 17 cases of metastatic lesions of nonbreast originfrom our pathology database. The clinical and imaging features were retrospectivelyreviewed and findings were correlated with pathology.Conclusion: The radiologist is sometimes asked to evaluate breast masses discoveredin patients with known extramammary malignancy. Thus, it is importantto recognize the clinical and radiographic distinctions between a metastasis anda primary breast cancer.BreastUSC-106Mammographic and ultrasonographic findings after oncoplastictechniques and breast reconstruction for breast cancerA. Valdivielso Ortiz, P. Vera Aguila, A. Gumá Martinez, A. Lopez Ojeda,A. Lopez Martinez, L. Prieto Alvarez; Barcelona/ES (alaznev@hotmail.com)Learning Objectives: To describe mammographic and ultrasonographic findingsin patients treated for breast cancer with oncoplastic techniques in conservativesurgery and with breast reconstruction techniques in mastectomy. We review normaland pathologic findings and signs of recurrence.Background: Oncoplastic techniques after breast-conserving therapy and breastreconstruction techniques after mastectomy are a treatment choice for women withbreast cancer, being an alternative treatment to conventional surgery in specializedcenters. Both techniques include tissue expanders, prosthesis and autologoustissue (latissimus dorsi, rectus abdominis, gluteus maximus myocutaneous flaps),as well as remodeling and breast reduction in oncoplasty. We review exams performedin 355 patients treated between 2004 and 2007; 243 patients were treatedwith mastectomy and breast reconstruction, and 112 with conserving therapy (20hemimastectomy). Sixty-one patients had bilateral reduction mammoplasty, 17tumorectomy and remodeling, 196 reconstructions with myocutaneous flaps only,51 autologous flaps with implant, and 25 patients only implant.Imaging Findings: Fat density surrounded by dense band and muscle fibers insideis a normal finding of myocutaneous flaps. Implant wrinkles are seen with salineimplants. Parenchymal redistribution inferiorly, distortion and elevation of nippleare normal findings in reduction mammoplasty. Abnormal findings are fat necrosis,dystrophic calcifications, epidermal inclusion cysts and recurrent carcinoma.Conclusion: Treatment of breast cancer with oncoplastic techniques has increasedin popularity. Mammography and ultrasound provide excellent visualization ofnormal and pathologic findings in reconstructed breasts. For a better follow-up ofthese patients, radiologists dedicated to breast pathology need to be familiarizedwith these radiologic findings.C-107Automated breast ultrasound: A valid diagnostic tool in breast evaluationD. Miranda 1 , R. Duarte 2 , J. Costa 3 ; 1 Matosinhos/PT, 2 Vila Nova de Gaia/PT,3Viana do Castelo/PTLearning Objectives: To evaluate the accuracy of automated breast ultrasound(ABUS) based on the literature review. To outline the advantages and limits of thetechnique. To illustrate the spectrum of imaging findings of benign and malignantbreast disease.Background: The ABUS provides 3D ultrasound images of breast tissue. Theintegrated workstation allows the operator to select individual diagnostic planes,including a high-resolution coronal view, not achievable on 2D ultrasound. Handheldbreast ultrasound is significantly operator dependent and scanning practices arehighly variable. This technique allows a consistent and uniform approach of breastscanning in reducing operator variability. Exact comparisons of ultrasonographybreast images between different patients can be made, as well as managementand follow-up of breast disease of the same patient over time. Additionally, ABUSpermits a confident full coverage of the breast.Imaging Findings: The imaging findings obtained with ABUS presented a goodcorrelation with conventional sonography. In this exhibit, we will illustrate thespectrum of breast abnormalities (benign and malignant) acquired with ABUSwith 3D rendering.Conclusion: The ABUS permits a uniform and consistent evaluation of breasttissue, which adds confidence to ultrasound breast analysis. The quality of thehigh-resolution images as well as 3D rendering images correlate well with the findingsobtained with handheld ultrasonography. Based on this, ABUS is a valuablediagnostic tool in evaluating breast abnormalities.No Material Submitted to EPOSBreastACB D E F G HS359

Scientific and Educational ExhibitsC-108Mimickers of malignancy and pitfalls in breast ultrasoundK.J. Jayapragasam, A. Yang Faridah; Kuala Lumpur/MY (drkasthoori@hotmail.com)Learning Objectives: To identify benign lesions that share malignant ultrasoundimaging features and to identify malignant lesions with atypical appearance.Background: Analysis of the sonomorphology of breast nodules can permit theirclassification into benign, malignant, and indeterminate categories. Nodules thatdo not fulfill the strict criteria for benignity are considered either indeterminate ormalignant and biopsied. It is important for radiologists and clinicians to understandthe spectrum of imaging features to establish decision criteria for managing patientsHistopathology of indeterminate lesions was compared to the general sonographicappearance based on its shape, margins, width-AP ratio, echogenicity, posterioracoustic artifact, pseudocapsule and vascularity.Imaging Findings: Presence of regular margins, gentle lobulations, posterioracoustic enhancement, thin boundary and homogenous echo texture increasesthe diagnostic confidence of a benign lesion. Atypical fibroadenomas, granulomatousmastitis radial scar, fat necrosis, papilloma, fibrocystic changes, sclerosingadenosis, fibrosis, pseudoangiomatous stromal hyperplasia, show heterogeneousinternal echogenecity, microlobulations, thick boundary and posterior shadowingmimicking breast carcinoma On the contrary, mucinous carcinoma with posteriorenhancement can mimic fibroadenoma or cyst. While echogenic or spherical breastcarcinomas are rare, such tumours do exist. Sonographic differentiation betweenpapillomas, papillary DCIS, and carcinomas are challenging when intraductal softtissue mass is seen. Color-flow or power Doppler imaging does not help distinguisha cancer from benign lesions.Conclusion: There is increased diagnostic confidence in using the sonographic features,when dealing with a typical lesion. For differentiation of malignant masses andtheir mimikers, an objective sonographic criteria and core biopsy is warranted.C-109Relation of breast cancer vascularization pattern depicted by ultrasound toaxilary nodes statusF. Todua, T. Changelia, T. Daraselia; Tbilisi/GE (radiag@mail.ru)Purpose: The aim of the study was to assess possible correlation between powerDoppler sonographic data concerning vascularization pattern of the tumor andhistopathology results after lymphadenectomy in case of breast cancer.Methods and Materials: 105 females with breast cancer were studied preoperativelyby power Doppler sonography. Tumor size and number of tumor arterieswere correlated with axillary nodal status. Sonographic findings were comparedwith tumor arteries with a diameter larger than 350 µm and with the density andarea of microvascularization.Results: Good correlation of ultrasonographic and histopathologic results regardingnumber of tumor arteries (k=0.66, P 0.001) and tumor size (P=0.012) wasobserved. Multivariate analysis showed an independent relationship between probabilityof axillary metastasis, number of tumor arteries (P=0.016), and sonographictumor size (P=0.035). A predictive model of axillary status was developed. Thereceiver operating characteristic curve was used to determine 0.2324 as the scoreto classify axillary nodal status. This score indicated high sensitivity (93.1%), lowspecificity (49.4%), and high negative predictive value (96.1%).Conclusion: The number of arteries in invasive breast carcinoma detected withpower Doppler sonography and sonographic tumor size are independent predictorsof axillary nodal status; these variables could contribute to reliable prediction ofabsence of axillary involvement on the basis of a mathematic model.C-110Imaging aspects of papillary breast proliferations: From mammography tofree hand elastographyA.G. Maglas, A. Chiorean, M. Duma, T.S. Serb, S.M. Dudea, S. Sfrangeu;Cluj Napoca/RO (anca_maglas@yahoo.com)Learning Objectives: To present imaging aspects encountered with breast papillaryproliferations. To highlight features that raise malignancy suspicion.Background: A retrospective analysis of cases diagnosed between a 4 year interval(2004-2008) in our radiology department was performed. Pathology was obtainedusing core or excision biopsies. 58 cases were included. 33 were benign papillarylesions and 25 were papillary carcinomas. Imaging examinations were carried outin accordance with the ACR guidelines. Galactography was performed in 6 casesand elastography in 12 cases.Imaging Findings: The most frequent mammographic appearance of invasive papillarycarcinomas was that of an opacity with imprecise deliniation. On ultrasound,these tumours appeared as solid lesions (19), complex cysts (4) or intraductalproliferations (2). On ultrasound, the most frequent aspect of benign papillary lesionswas that of dilated ducts with solid, intraductal component (21), followed bythe nodular solid appearance in 8 cases and intracystic proliferations in 4 cases.Galactographically, there were visualized ductal obstruction, lacunary images orparietal irregularities. All elastographically assessed papillary proliferations provedto be more rigid than neighbouring breast parenchyma.Conclusion: Ultrasound may enable us to detect and appreciate the extent ofdisease in symptomatic and asymptomatic patients with negative standard mammographies.Differential diagnosis between benign or in situ papillary proliferationsand the invasive ones is often impossible from an imaging point of view. A closeappreciation of lesion’s delineation and degree of vascularization may up-gradeour level of suspicion. However, pathologic proof is mandatory for all papillaryproliferations.C-1113D and 4D ultrasound of the breast: What kind of additional informationcan it provide over conventional 2D ultrasound in the diagnosis andintervention of breast lesions?O. Woo, K. Lee, A. Yi, Y. Kim, K. Cho, B. Seo, E.-Y. Kang; Seoul/KR(wokhee@unitel.co.kr)Learning Objectives: 1. To present variable techniques and differences in 3D and4D ultrasound of the breast. 2. To demonstrate various breast lesions with pathologiccorrelation. 3. To evaluate the diagnostic accuracy of 3D and 4D ultrasoundin comparison with 2D ultrasound.Background: 3D and 4D ultrasound may provide new perspectives in the fieldof breast ultrasound. Consequently, we look forward to offering new diagnosticinformation and potentially improved characterization of breast lesions.Imaging Findings: 1. 3D and 4D ultrasound: techniques and differences. 2. 3D and4D ultrasound images related normal anatomy. 3. Overview of 3D and 4D breastultrasound imaging. 1) Benign tumor: morphology, volume calculation. 2) Papillaryneoplasm: in association with adjacent duct. 3) Malignant tumor: morphology, extentincluding adjacent duct involvement, staging. 4) Additional information provided over2D ultrasound that aids in the diagnosis and intervention of breast lesions.Conclusion: Major advantages of 3D and 4D ultrasound of the breast is itscapability to generate multi-sectional planes and provide volumetric data of thelesion. Furthermore, the coronal plane provides additional information that assistsin differentiating benign and malignant tumors and in 3D targeting; it can provideprecise location of biopsy needles in all planes thus providing reassurance to theradiologist.C-112Usefulness of sonographic findings for detection of extensive intraductalcomponent (EIC) around invasive breast cancer: Correlation with nucleargrade of histopathologyK. Kim, H. Han, Y. Park, C. Hwang, Y. Cho, H. Yoo, D. Yoon, H. Seol, K. Kim;Taejon/KR (lizkim1@hanmail.net)Purpose: To investigate the efficacy of ultrasound in the detection of extensiveintraductal component (EIC) around invasive ductal cancer (IDC) and correlationwith histopathologic findings.Methods and Materials: From January 2007 to September 2008, we retrospectivelyevaluated 140 malignant confirmed breast nodules by operation. We classifiedas IDC without EIC and IDC with EIC by histopathologic evaluation. Sonographicfinding were classified as hard finding (spiculation, thick halo, angulation, shadowing),mixed finding (microlobulation, taller than wide, hypoechogenecity) and softfinding (calcification, duct extension and branching). We analyzed sonographicfeatures between IDC without EIC and IDC with EIC. EIC lesions were evaluatedpathologically and classified using the nuclear grade of DCIS.Results: Among 140 lesions malignant confirmed lesions, 69 lesions were confirmedas IDC without EIC and 49 as IDC with EIC. As comparison of sonographicfindings between IDC with EIC and without EIC, calcification, duct extension, branchpatterns were statistically significant. In IDC with EIC, odds ratio of calcification(32.3), duct extension (7.4) and branching patern (13.3) were high. Odds ratio ofthick echogenic halo (0.2), angulation (0.4) and microlobulation (0.2) were low.Among 23 EIC lesions, 12 were classified as high nuclear grade, 10 as intermediategrade, and 1 as low grade. Ductal extension and branch patterns were associatedwith a high nuclear grade (p 0.05).Conclusion: Soft suspicious findings were helpful findings for detection of EICaround IDC. More ductal extension and branch patterns were associated withhigh nuclear grade. High resolution US is useful in detection of EIC, especiallyhigh grade.No Material Submitted to EPOSCS360 A B D E F FG H

Scientific and Educational ExhibitsC-113Definition of tumor margins by high frequency ultrasound examination ofcancer tissue during breast conserving surgeryA. Hushmand Nia 1 , B. Dohmen 2 , F. Jahn 1 , E. Jung 3 , K. Scherer 1 , R. Kubale 1 ;1Pirmasens/DE, 2 Kaiserslautern/DE, 3 Regensburg/DE (reinhard@kubale.net)Purpose: To assess the feasibility of high resolution ultrasound (US) examinationfor defining free margins of tumour tissue during breast conserving surgery usinga novel tissue transfer and X-ray system (T-TRAX).Methods and Materials: In 49 consecutive patients with malignant breast tumours(0.4 to 2.2 cm) the specimens were examined, during surgery, using a 17 MHz USprobe with spatial compounding (SC) of different settings and THI i (Siemens Acuson512 17L5) and compared to specimen mammographs (Hologic Lorad) measuringthe cranial, caudal, medial, lateral and dorsal free margins. For 3D correlation, thespecimens were fixed on T-TRAX.Results: 41/49 of the tumours could be identified in mammographs, 47/49 in USbest seen with speckle reduction filters and a medium SC-level. In 3 cases, satellitemetastases were seen and resection of the correlating margins was performed.In 19 patients, close margins (less than 5 mm) were identified and the correlatingmargins were consequently removed. Compared to the pathological findings therewas a correlation of 0.86 to 0.91 in lateral, medial, caudal and cranial directions.No second operation was necessary. Due to compression there was a sonographicunderestimation of the dorsal distance.Conclusion: High-frequency US of surgically removed specimens is a valuabletool for identifying tumour, microcalcifications and free margins avoiding repeatedsurgery. In small tumours without calcifications it was superior to the specimenmammograph.BreastMiscellaneousC-114Prospective multicentric observational registry on 900 ultrasound guidedvacuum-assisted breast biopsies: Towards a more wide-spread use of thetechnique in daily medical practiceC.A.S. Labbe-Devilliers 1 , P. Meingan 1 , P. Lebas 2 ; 1 Nantes/FR, 2 Orléans/FR(c-labbe@nantes.fnclcc.fr)Purpose: The purpose of this national registry is to bring together professionalsusing the Mammotome ® EX breast biopsy system (Ethicon Endo-Surgery Cincinnati,OH, USA) according to their type of practice and experience, and to demonstratethe feasibility of the technique together with its impact on management of mastologypatients.Methods and Materials: The study is multicentric, prospective and non-randomised.Between June 2006 and April 2008, 900 Mammotome ® EX procedures were carriedout under ultrasound guidance in 25 different centres in France classed accordingto their experience of breast biopsy and their type of practice: 17 private structures,4 public establishments and 4 anti-cancer centres.Results: We used an electronic registry to collect clinical data (age, past historyand risk factors), patient management prior to the procedure, type of lesion (Bi-Rads classification, size), prior cytology or histology results, indication chosen(for diagnostic purpose: discrepancy between radiology and pathology results,technical reason; for strategic reasons: BI-RADS 5 lesion; or in order to excise abenign lesion). Details of each procedure are given: 8 or 11 Gauge probe, numberof samples taken, tolerance (pain, anxiety) and any complications. The impact ofthe Mammotome ® EX was assessed using post-biopsy histology and the numberof surgical operations avoided.Conclusion: The Mammotome ® EX is a recent tool for mastology managementto be used as a complement to microbiopsy, and for which the indications havebeen validated. Covering 900 procedures carried out in France, the EX registry isa means for federating practices and demystifying the technique.C-115Imaging features of granulomatous mastitisM.U. Manzoor, Z.S. Faruqui, N. Din; Lahore/PKLearning Objectives: To highlight the clinical presentation and pattern of involvementin granulomatous mastitis and to review the imaging features of granulomatousbreast disease based on our case series.Background: Granulomatous mastitis is a benign breast disease, which presentsas a breast mass in most of the cases. The clinical presentation and imagingfeatures of this benign breast disorder often mimics breast cancer. The purposeof this educational exhibit is to highlight the key imaging features.Imaging Findings: The most common presentation of granulomatous masttisis an irregular hypoechoic mass. Breast abscess is the second most commonpresentation. Axillary lymphnodes are enlarged in most of the cases and presentwith thickened cortex. In some cases, isolated enlarged axillary lymphnodes arethe sole presentation, without any breast mass or abscess. Calcification can alsobe seen in a few cases. Overall, the imaging features alone cannot distinguishbetween granulomatous mastits and breast carcinoma. Clinical history, examinationand histological assessment are definitely required for the distinction.Conclusion: Clinical presentation and imaging features of granulomatous mastitiscan mimic breast carcinoma in many cases and it is imperative to have fine needleaspiration and/or core breast biopsy for definite diagnosis of the disease. Hunt formalignant cells should continue in the presence of granulomatous picture, as theco-existence has been documented in literature.BreastACB D E F G HS361

Scientific and Educational ExhibitsC-116Mammographic appearance of CAPSS and columnar cell lesions in ascreening populationK. Rahmat 1 , E. Wylie 2 ; 1 Kuala Lumpur/MY, 2 Perth/AU (katt_xr2000@yahoo.com)Purpose: Columnar alteration with prominent apical snouts and secretions(CAPSS), a recently recognised breast pathology, is a spectrum of lesions boundby columnar alteration at the low end and low grade ductal Ca in situ at the highend. These lesions are being detected with increasing frequency in breast biopsiesperformed for microcalcifications in the breast assessment centre in WesternAustralia. The spectrum of mammographic and ultrasound appearance of columnarcell lesions and CAPSS lesions are reviewed.Methods and Materials: We retrospectively reviewed our institution for recordsof breast pathology obtained for columnar cell lesions performed for core needlebiopsies and surgical excisions from 2002 to 2006. A total of 65 patients were foundto have various types of columnar cell lesions. We identified 11 patients with CAPSSlesions with a variety of histologies coexisting within the specimens.Results: All 11 patients with CAPSS lesions underwent mammograms with andwithout ultrasound. Of the 11 lesions, 10 lesions appeared as clusters of microcalcificationsand 1 with a palpable non calcified mass. All patients underwentdiagnostic open biopsy following core biopsy.Conclusion: CAPSS lesions usually present as non palpable suspicious clustersof microcalcifications on mammograms. These lesions are indistinguishable fromother suspicious microcalcifications such as atypical ductal hyperplasia (ADH) orductal carcinoma in situ (DCIS). Current recommendation suggest that patients withcore needle biopsy showing CAPSS lesions with atypical features should undergosurgical biopsy as they are more likely to be associated with a cancerous lesion.C-117Value of double reading and arbitration: Results based on 140944screening mammograms, double read in 2005S.H. Heywang-Köbrunner, A. Crispin, D. Hölzel, D. Möhrling; Munich/DEPurpose: To assess the value of double reading and arbitration for QA in apopulation-based screening project.Methods and Materials: The Bavarian mammography screening program startedin 2003. Prior to being accepted as a reader, first readers had to have experiencewith 1000 4-view mammograms performed/yr, second and third readers with morethan 2500 view mammograms performed/yr. Third reading was only performed bythe most experienced reader (s) per county.Results: In 2005, a first reading was performed in 140944 women, a second readingwas performed in 138224 women in 2005, almost all remaining cases were doubleread in 2006 (delay in first vs. second reading). When the first and second readersrated the mammogram as BIRADS 1 or 2, the case was considered normal. Athird reading (abnormality reported by at least one reader) was performed in 9544cases. The sensitivities and PPVs achieved by the first, second and third readers(based on the initial evaluation of the 3 readers and histology confirmation in casesrated suspicious by reader 3) were: 85 and 24% versus 91 and 17% versus 99.5and 23%. Per county the gain in additional cancers from first reader to third readermay be 25%. For single readers it may be even higher.Conclusion: Double reading and arbitration allows to significantly increase thedetection rate, but does not lead to an increased rate of recalls.C-118Micro-CT as a tool to evaluate breast microcalcifications in 3DI. Willekens 1 , T. Lahoutte 1 , A. Schiettecatte 1 , C. Breucq 1 , C. Bourgain 1 ,R. Deklerck 2 , A. Bossuyt 1 , J. de Mey 1 ; 1 Jette/BE, 2 Etterbeek/BE(inneke.willekens@vub.ac.be)Purpose: The detection of microcalcifications on mammography is a unique signindicative of the presence of a breast lesion. The shape is of great importance forthe probability of malignancy. The purpose of this study was to evaluate the 3Dshape of breast microcalcifications using micro-CT in comparison with the anatomopathologicalanalysis.Methods and Materials: In this study, breast biopsy samples of 5 female patientswho showed suspicious microcalcifications on routine mammography were used.The samples were imaged using a micro-CT (Skyscan 1076 micro-CT system;Skyscan, Aartselaar, Belgium) at a resolution of 9 µm. Images were reconstructedusing filtered backprojection and viewed in 3D using CT-Volume software. Thesamples were subsequently analyzed by the pathology service.Results: Anatomopathological analysis showed that 3/5 patients had a ductalbreastcarcinoma in situ. The micro-CT scans of the patients with no carcinomashowed microcalcifications that were regularly shaped like tea cups. The 3Danalysis of the microcalcifications of the patients with carcinoma showed irregularand angular shaped volumes.Conclusion: This is the first analysis of microcalcifications in 3D using micro-CT.The initial evaluation shows that benign and malign lesions could be distinguishedvisually. This application opens up the possibility of 3D quantitative analysis andautomated detection of malign lesions.C-119Ultrasound and core needle axillary biopsy in patients with probablemalignant breast lesionsM. García Ortega, M. Alvarez Benito, M. Cara García, E. Fuentes Vahamonde,P. Contreras Puertas; Córdoba/ES (rserranogan@telefonica.net)Purpose: To assess the diagnostic accuracy of axillary percutaneous core needlebiopsy (CNB) in probable malignant breast lesions. To evaluate its impact on patientmanagement.Methods and Materials: From October 2006 to July 2007, 257 patients (261lesions) were evaluated retrospectively. CNB was performed in dominant orsuspicious lymph nodes. Patients with a malignant result in CNB were excludedfrom the sentinel node procedure (SLNP) and treated with surgery or neoadjuvantchemotherapy, but a benign result in CNB was treated with surgery and SLNP oraxillary dissection (AD). Results obtained with US and axillary CNB were correlatedwith those obtained with SLNB and/or AD.Results: 113 CNB were performed: negative in 63 patients, breast cancer metastasesin 45, and metastases from other primaries in 5. The therapeutic approachin patients with a positive result was: neoadjuvant chemotherapy in 15 patientsand surgery with AD in 29 patients (20 mastectomies and 9 tumorectomies). In44 patients with a benign result in CNB, SLNP was performed, as well as 28 tumorectomies,13 mastectomies with immediate reconstruction and 3 mastectomieswithout reconstructive surgery. Diagnostic accuracy of axillary US: sensitivity 63%,specificity 86%, positive and negative predictive values 75 and 78%. Diagnosticaccuracy of CNB: sensitivity 73%, specificity 100%, positive and negative predictivevalues 100 and 77%, respectively.Conclusion: CNB allows for a more precise therapeutic approach. 37% of thepatients have been spared from the SLNP and 60% of the patients treated withmastectomy have been treated with immediate breast reconstruction.C-120The role of the radiologist in the planning of the oncoplastic surgeryJ.J. Mosquera Osés, J.R. Varela Romero, C. Fernández da Ponte García,A. Iglesias López, D. Fernández Alonso, A. Ríos Reboredo; A Coruña/ESLearning Objectives: To review the different patterns of oncoplastic surgeryand the role of radiologist in delimitation of tumoral extension, multifocal or multicentricdisease and postoperative results of surgery, particularly in case of widemicrocalcifications.Background: Oncoplastic surgery refers to several surgical conservative techniquesfor which segments of malignant breast tissue are removed to achievewide surgical margins whereas the glandular remaining tissue is modified to obtainthe best possible cosmetic outcome simultaneously that looks for the symmetryin another breast.Procedure Details: We described the use of bracketing wires as markers foroptimal excision margins and to plan the surgical pattern, especially in troubledcases. The number of bracketing wires to be used is determined by consultationbetween the radiologist and the surgeon.Conclusion: Oncoplastic surgery techniques improve the possibilities of breast conservativesurgery in wide tumors. Bracketing wires may assist the surgeon to achievecomplete excision but do not ensure clear histologic margins of resection.CS362 A B D E F FG H

Scientific and Educational ExhibitsC-121Mammography infection control: Should this be part of quality assuranceprogrammes?D. O’Leary 1 , J. McCrann 1 , S. Lewis 2 , A. Poulos 2 ; 1 Dublin/IE, 2 Sydney/AU(desiree.oleary@ucd.ie)Purpose: The human skin has become reservoirs for exotic viruses and antibioticresistant bacteria and this is an increasing worldwide problem. During mammography,patients’ friable skin is in close contact with both equipment and handsduring positioning and the possibility of infection spread is highest where immunityhas been lowered by disease process. This research collaboration investigatedwhether mammography units within New South Wales, Australia (NSW) and theRepublic of Ireland (ROI) have dedicated mammography-specific infection controlprotocols and the extent of cleaning and disinfection. Possible vectors for increasedbio-load on hospitals/outpatient facilities specifically due to these mammographyunits were also examined.Methods and Materials: A questionnaire underpinned by worldwide infectioncontrol guidelines was formulated and circulated to mammographers in symptomatic/asymptomaticmammography units within ROI and NSW. Observationaltriangulation was also performed.Results: Whilst mammography-specific infection control protocols were availablein fewer ROI (25%) than NSW (32%) units; NSW mammographers (43%) hadless access to documented protocols (vs. 94% ROI units). Significant variationin cleaning methods, consistency and procedures resulted and was observed inboth regions. Infection control is not routinely included in the quality assurance(QA) process of all units.Conclusion: Many aspects of infection control procedures are less than satisfactory.These procedures should be regulated with specific mammography infection controlprotocols within the QA process to prevent patient cross-infection with a consequentlowering of biological burden on hospitals and outpatient facilities.C-122Incidental 18 F-FDG uptake in breast tissue in PET/CT: A case seriesC.S.H. Ng, T. Lynch; Belfast/UK (u9310665@hotmail.com)study. Women with both blue dye and radio-isotope underwent ANC as a secondprocedure only if the SLNB was positive.Results: Blue dye alone vs. blue dye and isotope, % SLN found: 90 vs. 99, % SLNpositive: 14 vs.16, % SLN negative: 86 vs. 83, % false negative: 3 vs. 0, averageno nodes: 2.3 vs. 2.13, range: 1-7 vs. 1-7.Conclusion: Using blue dye alone it is possible to achieve the targets set by thenew UK start program, but there is a higher incidence of failure to find the sentinelnodes than when used in combination with radio-isotope (90 vs. 99%). The useof combined blue dye with radio-isotope is recommended as the best way to findsentinel lymph nodes in women with breast cancer.C-124Breast screening assessment clinics: As easy as ABCN.T.F. Ridley, S. Taylor, N. Gilhespy, S. Brown; Swindon/UK(nicholas.ridley@smnhst.nhs.uk)Learning Objectives: To illustrate the introduction of a simple ABC classificationsystem for recall screening mammograms. A is the least and C the most suspicious.To describe the results of an audit of this and demonstrate how this canimprove clinic efficiency.Background: There is an increasing workload in the UK National Breast Screeningprogramme. We have devised a simple ABC classification of recall mammogramsdone at consensing. The classification correlates with the degree of suspicion ofsignificant pathology on the mammogram. We postulated that the time taken in theclinic would relate to this. By allocating these patients evenly throughout our clinicsbased on the ABC, grading efficiency has been improved.Imaging Findings: We audited 30 of these patients to see if the ABC classificationcorrelated with number of biopsies, extra mammograhic views and final pathology.Films per patient: A: 0.7, B: 1.9, C: 2.2; Biopsy rate per patient: A: 0, B: 0.27, C. 0.7;Cancer diagnosis per patient: A: 0, B: 0.18, C: 0.44.Conclusion: The results confirm that our grading system correlates with finaldiagnosis, number of films and biopsy rate. A simple ABC grading method can beintroduced easily within the screening programme to improve assessment clinicefficiency.Learning Objectives: To recognise the importance of appropriate investigation andfollow-up of abnormal activity in breast tissue using 18 F-FDG PETCT.Background: 18 F-FDG PETCT is increasingly being used to diagnose, stage,restage and monitor malignant diseases. 18 F-FDG is a radioactive positron emitter,which mimics cellular glucose utilization. Tumours such as lung cancer andhigh grade lymphoma have a high glucose metabolic rate and are well identifiedby PETCT. The role of PETCT in breast cancer is more limited as many malignantbreast lesions have relatively low glucose uptake and consequently show onlylowgrade uptake of radioactive tracer. 18 F-FDG PETCT has been shown to be effectivein differentiating postoperative fibrosis from malignant change in patients with ahistory of breast cancer. In this exhibit, we will illustrate and describe the incidentalPETCT breast findings in patients with no previous history of breast cancer. Weconsider the benefits of appropriate investigation and follow-up in such cases.Imaging Findings: We illustrate and describe a series of cases where incidentalFDG activity was demonstrated in breast tissue in patients with no previous historyof breast cancer. Final diagnoses ranged from the benign (incidental fibroadenoma)to malignant breast carcinomas.Conclusion: Reporters of PETCT studies should be made aware of the malignantpotential of asymmetric, often low grade, increased FDG uptake in breast tissueand should recommend appropriate investigation and follow-up.C-123Comparison of blue dye alone with blue dye and radioisotope combinedin the detection of axillary sentinel lymph nodes in women with invasivebreast cancerD.J. Dasgupta, P. Jones, S. Jones, D. Fish, A.R. Sever, P. Mills, J. Donaldson;Maidstone/UK (ali.sever@nhs.net)Purpose: Sentinel lymph node biopsy (SLNB) is established as a reliable method ofassessing the axillary nodal status in women with breast cancer. It can be performedwith blue dye or radio-isotope alone or in combination. This study compares theblue dye alone with the combined blue dye and radio-isotope method.Methods and Materials: 200 women with histologically confirmed invasive breastcancer, and negative axillary assessment (ultrasound/FNA) underwent sentinellymph node biopsy. 100 had a sub-areolar injection of blue dye after induction ofanaesthesia, and 100 had an additional sub-areolar injection of radio-isotope theday before surgery. Women receiving blue dye only went on to undergo a level 3axillary node clearance (ANC) under the same anaesthetic as part of a validationBreastACB D E F G HS363

Scientific and Educational ExhibitsCardiacCardiomyopathiesC-125Cardiomyopathies: The role of cardiac MRIN. Galea, I. Carbone, E. Algeri, H. Grazhdani, D. Cannata, G. Cannavale,C. Catalano, R. Passariello; Rome/IT (nicogale2000@yahoo.it)Learning Objectives: 1. To review classification and the main MR imaging findingsof various cardiomyopathies. 2. To explain the usefulness of cardiac MRI in thediagnosis and proper management in patients with cardiomyopathy.Background: Cardiomyopathies are an important and heterogeneous group ofmyocardial diseases, including a large spectrum of different severity degree thatcan lead to cardiovascular death or progressive heart failure. Cardiac MRI canprovide a lot of important information for the recognition and identification of theCMP form, and for a proper patient management: morphological analysis of themyocardium, evaluation of the impact on ventricular function, valvular dysfunction,characterization of pathological myocardium with an estimate of myocardialdamage extension.Procedure Details: After a brief classification of non-ischemic cardiomyopathies,we will illustrate a pictorial review of the various forms mainly focusing on dilated,hypertrophic, restrictive and non-compaction cardiomyopathy, arrhythmogenic rightventricular dysplasia and Tako-Tsubo disease. We will also describe MR strategiesemployed to study different CMPs with particular emphasis on b-SSFP cine MRI,T2w-STIR and DE-IR sequences, correlating with clinical data.Conclusion: Cardiac MRI is a very useful imaging modality to assess variouscardiomyopathies, evaluating the degree of severity and giving important informationfor patient management.C-126Non-compaction of the myocardium: A distinct cardiomyopathyR.J. Perea Palazon, T.M. de Caralt Robira, J.T. Ortiz Perez, M. Sitges Carreño,C. Pare, J. Ramirez Ruz, P. Arguis Gimenez, M. Sanchez Gonzalez; Barcelona/ES(rjperea@clinic.ub.es)Learning Objectives: To present the MRI protocol for studying patients with noncompactioncardiomyopathy (NCC). To describe the MRI appearance of the NCC.To review the embryology of the heart.Background: Non-compaction of the myocardium is a recently recognized congenitalcardiomyopathy. It may be an isolated finding or may be associated withother congenital heart anomalies. Its diagnosis, however, is sometimes missed,most often as a consequence of ignorance of the condition. NCC is diagnosedaccurately with MRI.Imaging Findings: In this exhibit we describe and illustrate: 1.The new AmericanHeart Association (AHA) classification of cardiomyopathies. 2. The embryologyof the heart (focusing on the endomyocardial morphogenesis). 3. The clinicalpresentations of NCC. 4. The MRI protocol for studying patients with NCC. 5. TheMRI diagnostic criteria of NCC. 6. Other imaging modalities to diagnose NCC:echocardiography and multidetector computed tomography.Conclusion: MRI morphologic findings and characteristic delayed enhanced imagesallow an accurate diagnosis of NCC.C-127Origin of ventricular arrhythmias by 12-Lead ambulatory ECG andrelationships with late enhancement cite in left ventricle by MRI andmultislice CT in hypertrophic cardiomyopathy and myocardial infarctionN. Funabashi, M. Ueda, T. Murayama, M. Uehara, H. Takaoka, I. Komuro; Chiba/JPPurpose: We estimated the origin of ventricular-arrhythmias (VAs) from the morphologyrecorded by 12-lead ambulatory ECG and examined relationships to hypertrophicor late enhancement (LE) cite in the left ventricle by MRI or MSCT in subjects withhypertrophic-cardiomyopathy (HCM) or old myocardial infarction (OMI).Methods and Materials: 30-subjects (24-male, 17-79 yrs, 20 with HCM and 10 withOMI) underwent 12-lead ambulatory ECG-monitoring (24 hours), and MRI, and/or MSCT. VAs were classified into 4-categories; right-superior (RS), left-superior(LS), right-inferior (RI), and left-inferior (LI) axes. Furthermore, VAs with an RI or LIaxis-pattern without S-wave more than 0.1mV in the V6 lead were recognized as aspecial-type of outflow (OF). If there were VAs in the same categories except OFtype,but obviously different configurations in a subject, this subject was recognizedas having multi-morphological VAs in one restrictive axis pattern.Results: Among 20-HCM-subjects, multi-morphological VAs in RI or LI categorieswere observed in 11-subjects (Maron classification II or III) either with LE (5-subjects)or without LE (6-subjects) in MRI or MSCT. Nine subjects (Maron classificationI or V) had no multi-morphological VAs in one-restrictive-axis-pattern. Among 10subjects with OMI, multi-morphological VAs in RS or LS categories were observedin 6 subjects with extensive LE (5 antero-septal-apical and one lateral-posteriorinferior)exclusively. All MSCT-findings were coincident with MRI.Conclusion: Multi-morphological VAs in one-restrictive-axis-pattern are relatedto abnormal-myocardial-findings, i.e. broad-hypertrophy or extensive LE in the LV.Presence of multi-morphological VAs in one-restrictive-axis pattern may suggestabnormal findings in the LV myocardium, and MRI or MSCT should be taken intoconsideration.C-128Cardiac magnetic resonance imaging of myocarditisN. Galea, I. Carbone, E. Algeri, F. Ciolina, D. Cannata, A. Cannavale,H. Grazhdani, C. Catalano, R. Passariello; Rome/IT (nicogale2000@yahoo.it)Learning Objectives: To illustrate the most relevant anatomo-pathologic featuresof myocarditis. To be aware of cardiac MRI findings in patients with myocarditis. Tounderstand the role of cardiac MRI in patients with a suspicion of myocarditis.Background: The clinical features of myocarditis are varied; so, the diagnosis ofmyocarditis could be difficult at initial presentation. Cardiac MRI has the potentialityto assess in the same session ventricular function, myocardial oedema and, usingcontrast enhanced inversion-recovery late sequences, to evaluate the presenceend extent of myocardial injury. Knowledge of clinical, anatomo-pathological andcardiac MRI technique and findings is essential when evaluating patients with asuspected or known myocarditis. A precise knowledge of T2-w findings and especiallyof enhancement patterns observed in myocarditis is necessary to differentiateit from other myocardial disease.Procedure Details: In this exhibit, we will describe and illustrate: 1. The principalclinical and anatomo-pathologic features of myocarditis. 2a. MRI techniquethat should be used in patients with a suspicion of or a known myocarditis. 2b.T2-weighted sequences findings. 2c. Most frequent pattern of enhancement atcontrast-enhanced inversion recovery sequences.Conclusion: Cardiac MRI plays a crucial role in diagnostic path, proper managementand follow-up in patients affected by myocarditis.C-129Cardiac sarcoidosis: No longer “a hesitant art, an imperfect science”Z.A. Khan, I. Barros D’Sa, A. Shimal; Birmingham/UKLearning Objectives: To illustrate the range of the multi-modality imaging findingsfor cardiac sarcoidosis. To emphasize the role of modern imaging techniques giventhe crucial importance of early diagnosis of this illness.Background: Traditionally difficult to diagnose, cardiac sarcoidosis has historicallybeen labelled as “a hesitant art, an imperfect science”. The first published death dueto cardiac sarcoidosis was in 1937. The disease is usually subclinical manifestingonly in 2-10% of cases of sarcoidosis. Cardiac involvement may be the sole or initialpresentation of the disease. It may involve any cardiac structure and hence canpresent as arrhythmias, conduction defects, myocardial hypokinesia or ventricularfailure. Sudden cardiac death has also been described in up to 16% of patients.We will describe the findings on plain film radiography, echocardiography, nuclearcardiology, chest CT and cardiac MRI.Imaging Findings: Plain films can show a spectrum of cardio-pulmonary findings.Echocardiography provides both morphologic and functional data. Myocardialperfusion studies show “reverse distribution” and left ventricular function. CardiacMRI can show myocardial or pericardial abnormalities with characteristic patchylate gadolinium enhancement. CT supplements with abnormalities related to bothlungs and the heart.Conclusion: Early diagnosis of cardiac sarcoidosis is possible allowing vital earlytreatment initiation, profoundly affecting prognosis. New imaging techniques allowbetter structural and functional cardiac assessment and a low index of suspicionis required for investigation of symptoms.CS364 A B D E F FG H

Scientific and Educational ExhibitsC-130Recreational and doping drugs induced cardiomyopathiesE. Algeri, I. Carbone, N. Galea, D. Cannata, F. Ciolina, C. Catalano,R. Passariello; Rome/IT (emanuela_algeri@yahoo.com)Learning Objectives: To review the principal recreational and doping drugsresponsible for cardiac damage and to describe their effects. To illustrate the roleof MRI in evaluating cardiac morphological, structural and functional damage indrug consumers.Background: Most frequently used recreational and doping drugs are responsiblefor cardiac structural and functional damage and should be considered especiallyin young patients presenting with chest pain. Cardiac MRI has the potentiality toassess in the same session right and left ventricular function, myocardial perfusionand oedema and, using contrast enhanced inversion-recovery late sequences, toevaluate the presence end extent of myocardial injury.Procedure Details: In this exhibit, we describe and illustrate: 1a. The principalrecreational and doping drugs that can be responsible for cardiac damage (alcohol;cocaine; amphetamines; heroin and other opiates; dopes used by athletes).1b. Pathophysiology and anatomic pathology of their cardiac effects. 2a. The MRItechnique that should be used in patients with a history of drug or dope abuse. 2b.Most frequent MRI findings in patients with drug addiction.Conclusion: Knowledge of cardiac side-effects of the most frequently used recreationaland doping drugs and awareness of the role of MRI in the evaluation of theimpact of these substances on cardiac function and myocardial structure is essentialwhen evaluating patients with a known or suspected drugs and/or dope abuse.C-131Patterns of delayed-enhancement in MRI of ischemic and non-ischemiccardiomyopathiesM. Natrella, D. Furfaro, E. Muraro, M. Cristoferi, M. Alessi, G. Fanelli, T. Meloni;Aosta/IT (m.natrella@tiscali.it)Learning Objectives: We describe characteristic enhancement pattern of variouscardiomyopathies.Background: Myocardial diseases of varying etiology result in myocardial changes,such as necrosis, fibrosis, edema and metabolite deposition, which can be visualizedby DE-MRI. Acute and chronic ischemic diseases based on a coronary arterydisease as well as non-ischemic cardiomyopathies display DE. Cardiomyopathiesoften show a characteristic enhancement pattern.Imaging Findings: While ischemic lesions are localized in the subendocardium,non-ischemic cardiomyopathies often display an intramyocardial or subepicardialpattern. The typical pattern for dilated cardiomyopathies is band-like and intramyocardialwith septal involvement. Arrhythmogenic right-ventricular dysplasias/cardiomyopathies are frequently associated with right-ventricular DE. In the caseof amyloid cardiomyopathies that are often restrictive cardiomyopathies, subendocardialand circular DE is typically observed. Hypertrophic cardiomyopathies displaypatchy intramyocardial DE usually in the anteroseptal region. Acute myocarditis istypically accompanied by intramyocardial or subepicardial DE affecting the lateralwall. In the case of chronic myocarditis, intramyocardial or subepicardial DE isobserved most frequently. Cardiac sarcoidosis typically entails patchy subepicardialDE with right- and left-ventricular involvement. Since there is an overlap betweenthe enhancement patterns of cardiomyopathies, the diagnostic accuracy of DE-MRI is limited and the diagnosis must be based on additional clinical and MRIfindings. The amount of DE often corresponds with cardiac functional parametersas well as with the frequency of cardiac events so that DE-MRI may be useful forrisk stratification.Conclusion: Furthermore, DE-MRI can be helpful in the planning and evaluationof myocardial biopsies and electrophysiological examinations.CardiacCTC-132Clinical significance of fat replacement in the moderator band of theright ventricle in multislice CT in comparison with abnormal conductionsystemsN. Funabashi, M. Uehara, H. Takaoka, I. Komuro; Chiba/JPPurpose: In MSCT, fat-replacement (FR) in the moderator-band (MB) of theright-ventricle (RV) can often be observed. As the right-bundle-branch courses inthe MB, we evaluated the relationship of FR in the MB of the RV and conductionabnormalities in ECG retrospectively.Methods and Materials: 132 subjects (58-male, 5927 years) who underwentMSCT and without any findings of organic myocardium diseases in MSCT norechocardiogram were retrospectively analyzed. ECGs were also retrospectivelyanalyzed.Results: FR in the MB was detected in 42-subjects (Group 1) and was not detectedin 90-subjects (Group 2). Complete and incomplete right-bundle-branch block(RBBB) and complete left-bundle-branch-block (LBBB) were detected in 6, 8, and1 subject, respectively. There were no significant differences about incidence ofcomplete or incomplete RBBB (9.6 versus 11.1%), mean QRS width (93.49.5versus 94.517.7 msec), mean QRS axis (28.6 versus 33.2 degree), and standarddeviation of QRS axis (32 versus 34 degree) suggesting presence of hemiLBBB, among both groups. But age (64 versus 58 years) and ratio of female (66versus 51%) were significantly higher in Group 1. In a logistic-model, only agewas associated with increased incidence of FR in the MB (relative-risk and 95%confidential-interval were 1.03 and 1.001~1.053, respectively).Conclusion: FR in the MB of the RV may not influence complete RBBB andhemi LBBB, suggesting comprehensive abnormalities in myocardial conductionsystems but may be influenced by age. FR in the MB of the RV by MSCT may notindicate organized abnormal myocardial conduction but only indicate degenerationby aging.C-133Usefulness of cardiac multidetector row CT (MDCT) before percutaneouscoronary intervention (PCI) as a treatment strategy for chronic totalocclusionD. Kim 1 , E. Suk 2 , J. Seo 1 ; 1 Bucheon/KR, 2 Seoul/KR (dhk0827@naver.com)Learning Objectives: 1. To review the non-invasive imagings and pathophysiologyof chronic total occlusion. 2. To demonstrate the various imaging characteristics ofchronic total occlusion. 3. To explain the usefulness of multi-detector row CT (MDCT)in the diagnosis and planning treatment of chronic total occlusion.Background: In chronic total coronary occlusion (CTO), a common problem occursin 10-15% of patients undergoing coronary angiography. Despite the developmentof interventional techniques, many clinicians prefer not to recanalize theCTO because of the difficulty and low clinical success of percutaneous coronaryintervention. Under this circumference, MDCT is very useful to plan approach routeand to evaluate functional improvement after PCI.Procedure Details: 64-slice CT (Siemens, Sensation 64, Erlangen, Germany)was used for the evaluation of CTO. We included contents in this exhibit as follows:1. Pathophysiology of chronic total occlusion; 2. Imaging findings and points thatshould be checked on cardiac MDCT: a) site and detailed anatomy of occludedstump, b) length of involved segment, c) amount of calcification within wall or occludedlumen, d) angulation of involved vessel, e) anatomy of collaterals, etc.; and3. Review of imaging findings and discussion.Conclusion: 1. Cardiac MDCT is a good image modality to assess the chronictotal occlusion. 2. Understanding of different imaging check points for chronic totalocclusion is important for accurate diagnosis and proper management.C-134Positive influence of aging on the occurrence of fat replacement in theright ventricular myocardium determined by multislice-CT in subjects withatherosclerosisN. Funabashi, Y. Hori, M. Uehara, H. Takaoka, M. Ueda, I. Komuro; Chiba/JPPurpose: We evaluated predictors of fat replacement (FR) in the right-ventricularmyocardium(RVM) determined by MSCT in atherosclerotics not receiving antiarrhythmiadrugs and evaluated the relationship between the presence of FR inthe RVM and the occurrence of ventricular premature beats (VPB).CardiacACB D E F G HS365

Scientific and Educational ExhibitsMethods and Materials: 120-consecutive-atherosclerotics (101-males, 11-85years) not receiving anti-arrhythmia drugs for VPB, who underwent MSCT (LightSpeed Ultra 16, GE) for evaluating atherosclerosis and Holter-ECG within onemonthwere retrospectively analyzed for FR in the RVM and its relationship withage, body mass index (BMI), and occurrence of VPB.Results: 31-subjects had FR in RVM (18-males; median 67 years), and 89 did not(53-males, median 56 years). Median age was significantly higher in subjects withFR in RVM (P 0.01). The median BMI was 23.0 in subjects with FR and 23.0 inthose without (not significant). Average number of VPB by Holter-ECG was 1445in 31 subjects with FR. Without FR, the average number of VPB was 995. The differencein the numbers of VPB was not significant (P=0.73). A logistic-regressionmodelusing age, male sex and BMI indicated that age was associated with anincreased incidence of FR in the RVM (relative risk=1.055, 95% CI 1.019-1.092,P 0.05).Conclusion: Age but not BMI is significantly associated with the presence of FRin the RVM. Aging might have a positive influence on the occurrence of FR in theRVM as determined by MSCT in atherosclerotics, but FR in the RVM had no influenceon the occurrence of VPB.C-135Comprehensive imaging of the heart in coronary artery disease by dualenergy CTA: Reconstruction and postprocessing strategiesF. Schwarz, B. Ruzsics, G. Bastarrika, J. Abro, R. Brothers, U. Schoepf;Charleston, SC/US (schwarz@musc.edu)Learning Objectives: To provide a step-by-step guide for the reconstruction andpostprocessing of ECG-gated dual energy datasets of the heart aiming at optimizingthe visualization of coronary artery lumen, myocardial perfusion and regionalmyocardial function.Background: The principle of dual energy CT is that information about the absorptionof X-rays with distinct energy spectra allows for the computation of averageatomic numbers for every voxel and iodine concentrations during steady states oforgan perfusion with iodine-containing contrast agents. Transfer of this technique tocardiac CTA acquisitions permits a comprehensive diagnostic evaluation of the heartin coronary artery disease: coronary artery stenoses, resulting perfusion defects ofthe myocardium and myocardial function can be assessed based on a single CTscan. With three primary datasets reconstructable from one CT scan, one for eachtube and a merged one, and specific myocardial perfusion series, reconstructionand postprocessing have become confusing for inexperienced users.Procedure Details: In this exhibit, we describe and illustrate based on our retrospectiveanalysis of over 40 dual energy CTA acquisitions: 1. How the series for theevaluation of coronary artery lumen, resulting perfusion defects of the myocardiumand myocardial function can be reconstructed from the same dual energy raw data.2. How reconstruction and postprocessing parameters can be setup in a standardizedand reproducible way to maximize gain of clinical information, reduce artifactsand maximize reproducibility and oberserver-independence.Conclusion: Knowledge of appropriate reconstruction and postprocessing parametersis most essential for a reproducible and observer-independent readoutof cardiac dual energy CTA datasets.C-136Characteristic cardiac MDCT findings of acute non-ST elevated myocardialinfarction (NSTEMI) without cardiac enzyme elevation in patients withacute chest painD. Kim 1 , E. Chun 2 , S. Choi 2 , E. Suk 3 ; 1 Bucheon/KR, 2 Bundang/KR, 3 Seoul/KR(dhk0827@naver.com)Purpose: To evaluate the characteristic imaging findings on ECG-gated MDCT inpatients with acute NSTEMI.Methods and Materials: Among the consecutive 213 patients with acute chestpain who underwent ECG-gated 64-slice MDCT, we retrospectively reviewed in15 patients (13 men, 2 women, 64 9 years) with acute NSTEMI proved by ECG,cardiac enzymes, and conventional angiography. We evaluated MDCT findings interms with plaque composition and density, lesion length, remodeling index (RI),enhancement of vessel wall, density of infracted and remote normal myocardium,regional wall motion abnormality (RWMA), and associated perfusion defect (PD).Results: Initial ECG abnormality showed in 4 patients with ST-depression and5 patients with T-inversion. Initial elevation of cardiac enzyme was seen in only2 patients, even though all patients had elevated cardiac enzyme on follow-upexam after MDCT. All patients showed intraluminal filling defect within coronarylumen. Imaging findings of culprit coronary lesion on MDCT were as follows:plaque composition (noncalcified: mixed = 13:2), plaque density (3212 HU),lesion length (8.26.9 mm), RI (1.460.16), type of enhancement at vessel wall(partial slight (n=5); concentric slight (n=6); concentric strong (n=4)). The densityof myocardium at infarct area and remote normal area is 3819 and 11515 HU,respectively. RWMA and PD on corresponding vascular territory of culprit lesionshowed 13 in 15 patients (86%).Conclusion: The characteristic imaging findings on MDCT in patients with acuteNSTEMI is discrete intraluminal filling defect with density of thrombus, severepositive remodeling, and enhancement of vessel wall.C-137Cardiac assist devices at computed tomography and conventionalradiographyH. Scheffel, P. Stolzmann, M. Wilhelm, M. Lachat, L. Desbiolles, A. Plass,S. Leschka, B. Marincek, H. Alkadhi; Zurich/CH (Hans.Scheffel@usz.ch)Learning Objectives: To learn about the imaging appearance of various cardiacassist devices (CAD) using computed tomography and conventional radiographyand to learn about associated complications following their implantation.Background: Circulatory support systems are able to act as a left ventricular assistdevice (LVAD) supporting the left ventricle, as right ventricular assist device (RVAD)supporting the right ventricle, or as biventricular assist device (BVAD) supportingboth ventricles. Patients receive mechanical circulatory support by implantation ofa CAD system for one of the three following intentions: (a) as a bridge-to-transplantthat provides circulatory assistance for the patient awaiting heart transplant; (b) as abridge-to-recovery that provides circulatory assistance allowing the heart to recoveror (c) as a long-term and permanent circulatory assistance being an alternative toheart transplantation (so-called ‘destination therapy’). Because of the increasinguse of CAD systems, radiologists are confronted more and more often with suchdevices in their daily clinical practice.Imaging Findings: A thorough understanding of the cardiac anatomy and themorphological features of various devices is a prerequisite for correct imageinterpretation. Conventional radiography and computed tomography (CT) are themost commonly used radiological techniques for imaging patients with a CAD. CTis very useful to evaluate CAD systems and complications by using both two- andthree-dimensional reconstructions of the volumetric data sets.Conclusion: Conventional radiography and CT allow for the comprehensiveassessment of patients with CAD by imaging the in- and outflow cannulae, theanastomoses, the position of the pump, as well as associated complications.C-138Radiation dose and image quality using prospective electrocardiographtriggeredcoronary 64-MSCT angiography with different KVG. Guo, C. Zhou, H. Cao, Y. Shen; Beijing/CN (huizhi.cao@ge.com)Purpose: To evaluate radiation dose, image quality using prospective electrocardiograph(ECG)-triggered coronary 64-slice CT angiography (CTA) with differentKV and the clinical application of 1 mSv coronary scan.Methods and Materials: 224 consecutive patients underwent 64-slice CTA usingprospective ECG-triggered axial scan protocol (mA tailored to Body Mass Index:180~800 mA). 38 patients with low BMI were divided into two groups: 20 were ingroup A (BMI 21.5, 100 KV); 18 were in group B (BMI 21.5, 120 KV). The other 186patients were divided into group C (21.5BMI25, 120 KV), group D (25BMI30,120 KV) and group E (BMI 30, 120 KV). The radiation dose was recorded andthe image quality (excellent: 5; bad: 1) was blindly evaluated.Results: The radiation dose of groups A, B, C, D, E was 0.88 mSv (0.49~1.17 mSv),1.47 mSv (0.91~2.02 mSv), 2.40 mSv (1.10~3.39 mSv), 3.44 mSv (2.20~5.78 mSv)and 4.45 mSv (3.82~5.68 mSv), respectively. There was no significant differencebetween image quality of group A with 100 KV (4.32) and that of groups B, C, D andE with 120 KV (4.5). And radiation dose of the patient using axial scan protocol at100 KV was decreased by 40% contrasted with that of group B at 120 KV.Conclusion: Prospective ECG-triggered axial scan in 64-slice coronary CTA hasthe ability to significantly reduce radiation exposure. For low-BMI ( 21.5) patients,super low dose ( 1 mSv) at 100 KV using prospective ECG-triggered axial scancould be selected and the image quality can fulfil clinical diagnostic needs.No Material Submitted to EPOSCS366 A B D E F FG H

Scientific and Educational ExhibitsC-139The use of R-peak edit technique to improve image quality of 64-row MSCTcoronary artery angiographyB. Lv 1 , H. Cao 1 , Y. Zhou 2 ; 1 Beijing/CN, 2 Hefei/CN (huizhi.cao@ge.com)Learning Objectives: To demonstrate the value of R-peak edit technique on highheart rate with fluctuation during the scanning in coronary artery angiographyusing 64-row MSCT.Background: Using application-specific ECG edit technique can improve imagequality of CCTA. GE VCT provides R-peak edit technique that radiologists cancorrect wrong ECG trigger position manually. This study evaluates this techniquethrough both phantom and patient experiments.Procedure Details: Helical scan of pulsating cardiac phantom on the 70-110 bpmheart rate (10 bpm step) and different arrhythmia plan was performed using ECGgated 64-row 40 mm volume computed tomography. And 50 patients who underwentcoronary artery CTA on high heart rate were selected in this study. The imagequality of volume rendering (VR) and multiplanar reformation (MPR) with/withoutR-peak edit technology were analyzed using 5 point scoring (5: Excellent; 1: poor;3: accepted diagnosis) in a blinded fashion. For simulated coronary arteries ofcardiac phantom, mean scoring values (MSV) of the images with/without R-peakedit including all heart rate is 4.030.45 and 3.090.7, respectively. The MSV onthe fluctuation of heart rate 10/min were significantly different with/without R-peakedit (p 0.01). Coronary arteries of 50 patients were analyzed: MSV with/withoutR-peak edit is 3.720.6 and 3.061.1 and MSV of 90% patients using R-peak edittechnique is larger than 3.0 (accepted diagnosis scoring).Conclusion: The phantom experiment and patient’s analysis demonstrate R-peakedit technique can reduce motion and stair-step artifacts and provide good imagequality on the high heart rate with fluctuation.No Material Submitted to EPOSC-140The evaluation of image quality using optimized low-dose contrastinjection protocols on 64-row MSCT in coronary artery angiographyY. Wang, H. Cao, C. Zhou; Beijing/CN (huizhi.cao@ge.com)Purpose: To compare the effect of a fixed contrast material injection dose protocoland a dose tailored to patient body weight injection protocol on 64-row MSCT incoronary artery angiography.Methods and Materials: Two contrast material injection protocols were appliedin this study: protocol 1 - a fixed contrast material dose (69 mL of iopamidol 370)with an injection rate of 5.0 mL/sec; protocol 2 - a dose tailored to the patient’sbody weight (0.8 mL/kg) with an injection rate of dose/12 mL/sec. ProspectiveECG-triggered cardiac CTA was performed in 52 patients (26 patients in eachprotocol). The image quality of multiplanar reformation (MPR) was analyzed using5 point scoring (5: Excellent; 1: poor;), and the mean cardiac artery enhancementwas also measured. Statistical t test analysis on image quality score, enhancementand dose of contrast material was performed.Results: The mean image quality scores of protocol 1 and protocol 2 were 4.130.23and 4.240.18, respectively. There was no statistically difference (p 0.05). Themean enhancement was 41552 Hu with protocol 1 and 35031 Hu with protocol 2,indicating significant statistical difference. The mean contrast material dose showedstatistical difference between protocol 1 (69 mL) and protocol 2 (51.3 mL).Conclusion: The dose and rate tailored to patient body weight injection protocolcan provide satisfactory quality and has the potential to significantly reduce contrastmaterial injection dose compared with fixed contrast material injection doseprotocol. And it is very useful for obtaining better, homogeneous and consistentcontrast enhancement.No Material Submitted to EPOSC-141Dual-source coronary CT angiography: Radiation dose estimates indifferent protocols tailored to patient specific parametersS. Leschka, P. Stolzmann, H. Scheffel, S. Baumüller, L. Desbiolles, B. Marincek,H. Alkadhi; Zurich/CH (sebastian.leschka@usz.ch)Purpose: To examine radiation dose estimates and image quality of different dualsourcecomputed tomography coronary angiography (CTCA) protocols tailored toheart rate (HR) and body mass index (BMI).Methods and Materials: 200 consecutive patients (age 619 years) underwent eitherhelical CTCA (retrospective ECG-gating) or sequential CT (prospective ECG-triggering).CTCA protocols were tailored to HR and BMI: n=50 (any BMI, any HR) wereexamined with a non-tailored CTCA protocol (helical CTCA, 120 kV/330 mAs), group A(n=40, BMI25 kg/sqm, HR70 bpm) with sequential CTCA (100 kV/220 mAs ref), groupB (n=43, BMI25 kg/sqm, HR 70 bpm) with helical CTCA (100 kV/220 mAs), group C(n=28, BMI 25 kg/sqm, HR70 bpm) with sequential CTCA (120 kV/330 mAs ref), andgroup D (n=39, BMI 25 kg/sqm, HR 70 bpm) with helical CTCA (120 kV/330 mAs).The radiation dose was calculated for each patient. Image quality was classified asbeing diagnostic or non-diagnostic in each coronary segment.Results: No significant differences in image quality were found among all five CTCAprotocols (p=0.78). Using the non-tailored CTCA protocol resulted in a radiation doseof 9.01.0 mSv. This dose was significantly higher compared to that at sequentialCTCA (group A: 1.30.3 mSv, p 0.001; group C: 2.90.6 mSv, p 0.001), andhelical CTCA at reduced tube voltage and tube current (group B: 4.20.6 mSv,p 0.01), but not significantly higher as compared to the non-tailored CTCA protocolin patients with HR 70 bpm (group D: 8.50.9 mSv, p=0.51).Conclusion: Dual-source CTCA is associated with average radiation doses between1.3 and 9.0 mSv, depending on the protocol used. Tailoring of the protocol to the HRand BMI results in dose reductions of up to 86%, while maintaining image quality.C-142The application of 64-section MSCT in diagnosing the coronaryatherosclerotic heart diseaseL. Guo, W. Zhang; Suzhou/CN (ilguoliang@sohu.com)Purpose: To evaluate the diagnostic performance of 64-MSCT in detecting differentgrades of coronary artery stenosis as well as the influence of image qualityin diagnosis.Methods and Materials: A total of more than 600 patients underwent 64-MSCT,out of which 78 patients who had undergone both MSCTA and selective coronaryangiography were taken into consideration. The sensitivity, specificity, positivepredictive value and negative predictive value of the 64-MSCT in detecting differentgrades of coronary artery stenoses were calculated. The coronary segments weredivided into three groups according to the image score, followed by analyzing itsinfluence of the image quality on diagnosing stenosis in coronary segments. Thenthe diagnostic performance of MSCT was compared with QCA in diagnosing thestenosis of coronary artery quantitatively and qualitatively.Results: Overall sensitivity, specificity, positive predictive value and negative predictivevalue of the 64-MSCT in detecting coronary artery stenosis were 93, 98, 88,and 99%. The sensitivity in diagnosing mild, moderate and severe stenosis were75, 77, 81, and specificity was 98%. There were 999 coronary segments that canbe assessed and 17 coronary segments could not be assessed due to poor imagequality. The kappa index was 0.7856, which indicated excellent agreement between64-MSCT angiography and QCA. The correlation coefficient was 0.661.Conclusion: Sixty-four MSCT angiography is an effective noninvasive diagnostictool for the detection of coronary artery stenosis, and the grade derived by CTcorrelated well with QCA.C-143Coronary stenosis diagnosis accuracy and radiation dose of 64-rowcardiac CT with prospective ECG-triggered scan protocol andretrospective ECG-gated scan mode: A pulsating cardiac phantom studyH. Cao, C. Zhou, Y. Shen; Beijing/CN (huizhi.cao@ge.com)Purpose: To evaluate the accuracy of coronary stenosis measurement and radiationdose of prospective ECG-triggered and retrospective ECG-gated scan modesusing a pulsating cardiac phantom.Methods and Materials: Simulated coronary arteries of 5 mm diameters withthree different stenosis rates (25, 50, and 75%) were scanned with both prospectiveECG-triggered (Axial) and retrospective ECG-gated (Helical) modes. Differentheart rate plans were used: 1. 40~90 bpm, step 5 bpm; 2. 60 bpm2, 60 bpm5,60 bpm10 to simulate fluctuation of heart rate. During axial scan, dynamic paddingtechnique was applied at irregular heart rate. ECG-driven X-ray current modulationand multi-sector reconstruction were utilized on helical scan. Accuracy of coronarystenosis measurement and radiation dose was compared.Results: There was no significant difference on the measured stenosis ratesbetween axial and helical scan at heart rate below 70 bpm and at 60 bpm2 heartrate. But radiation dose of axial protocol (2.4 mSv) was lower than that of helicalscan (8.0 or 13 mSv with/without ECG-driven current modulation). Helical scanwith multi-sector reconstruction had better stenosis measurement at high heartrate ( 70 bpm). At irregular heart rate, there was significant difference with/withoutdynamic padding technique on measured stenosis rates and radiation dose.Conclusion: Axial protocol can significantly reduce radiation exposure. This protocolis better used on stable heart rate up to 70 bpm and dynamic padding techniqueis suitable for slightly irregular heart rate. ECG-driven current modulation helicalscan with multi-sector reconstruction is a better choice in cases of high heart ratefor both image quality improvement and radiation dose reduction.No Material Submitted to EPOSCardiacACB D E F G HS367

Scientific and Educational ExhibitsC-144Development of heart dynamic phantom usable with CT, MRI, nuclearmedicine and angiography (new type of phantom with ventriclemyocardiumbicameral composition and artery valve movement)K. Tsujioka, T. Goto, T. Sekitani, K. Asano, S. Shimizu, M. Tanase; Toyoake/JP(tsujioka@fujita-hu.ac.jp)Purpose: In this report, we will discuss about our new type of phantom, the heart dynamicphantom, which can be used with CT, MRI, nuclear medicine, and angiography.With our new heart dynamic phantom, we have succeeded in recreating the movementof an actual human heart by making the myocardial pumping movement take place.Methods and Materials: The phantom is made up of four segments: the drivingpart, the transmitting part, the balloon, and the pool. The driving part, based on alinear motor, can recreate actual human heart movement with computer-guidedassistance. The transmitting part allows this movement created by the driving partto communicate with the balloon, which has a dual composition of cardiac muscleand cardiac ventricle. A series of these movements appropriately imitates theactual heart movement.Results: We used the new phantom to conduct experiments on heart functions withCT, MRI, and nuclear medicine scan. Our experiments found that ejection fraction(EF), of which the true value is 55%, varied according to the type of scanning:55% with CT, 54% with MRI, and 34% with nuclear medicine. As for myocardialischemia diagnosis, no difference was shown among all the modalities, resultingin the accurate rate.Conclusion: The new phantom we used was developed under a completelynew concept; it generates a movement closely resembling that of a human heart,allowing the heart circulation and coronary artery movement. We believe thatthe development of this type of phantom encourages further advances in thecardiovascular field.C-145Role of CT angiography and cardiovascular magnetic resonance in theselection of patients suitable for percutaneous aortic valve replacementA. Rossi 1 , S.W. Kirschbaum 1 , F. Pugliese 1 , A. Moelker 1 , M.A. Cova 2 , P. de Feyter 1 ,P. de Jaegere 1 , G.P. Krestin 1 , R.J. van Geuns 1 ; 1 Rotterdam/NL, 2 Trieste/IT(alexia.rossi0@aliceposta.it)Learning Objectives: To illustrate the role and the advantages of CT angiography(CTA) and cardiovascular magnetic resonance (CMR) in the selection of patientsfor percutaneous aortic valve replacement (PAVR).Background: In the past, surgical aortic valve replacement was the only effectivetherapy for severe aortic stenosis (AS). Nowadays, a PAVR technique has beenin development. Important measurements before treatment are aortic valve area,aortic annulus diameter, absence of severe peripheral arterial disease and favorablecoronary anatomy. CTA and CMR are useful tools in the evaluation of the selectioncriteria for PAVR and one of them should be used in the preoperative screening ofpatients who are candidates for PAVR.Procedure Details: In this poster, we are going to describe the acquisitions protocolsfor CT and CMR in the evaluation of patients with aortic stenosis who arecandidates for PAVR, how to choose the best aortic annulus imaging plane for theprocedure, the anatomic relation between coronary ostia and annulus calcificationsin relation to different types of percutaneous aortic valve prothesis and howto evaluate proximal peripheral vessels by CTA and MRI.Conclusion: CTA and CMR have an important role in the selection of patients forPAVR giving important information to the execution of the procedure.C-146Congenital heart disease in adults: Role of MDCTP. Orenes, M. Navallas, M. Sánchez Nistal, R. Cano, C. Jiménez López-Guarch,T. Velázquez; Madrid/ES (paulaorenes@hotmail.com)Learning Objectives: 1. To show the role, clinical applications and advantages ofMDCT in the evaluation of adults with congenital heart diseases. 2. To illustrate theradiological features and most representative findings of different CHD.Background: Although echocardiography is the initial diagnostic modality for patientswith suspected congenital heart disease, MDCT is a helpful complementaryimaging modality that overcomes the limitations of echocardiography, MRI andheart catheterization.Procedure Details: The most outstanding CT findings in congenital heart diseasesin adults are shown: atrial and ventricular septal defects, transposition of the greatarteries, solitary heart ventricle, tetralogy of Fallot, patent ductus arteriosus, anomalouspulmonary venous connection, Ebstein’s anomaly, pulmonary artery agenesis,truncus arteriosus, etc. In some patients, more than one CHD are associated. Postsurgicalfindings are shown too. All patients were imaged on a sixteen-row MDCTscanner without cardiac gating after the administration of iodinated contrast media.A fast and simple postprocessing with MIP and VR reconstructions was performed.Findings were compared with those of echocardiography, MRI and catheterism.Conclusion: CT has become a useful imaging modality for the pre- and postsurgicalevaluation of a wide variety of cardiac defects in adults. It is complementary toechocardiography and heart catheterization, and can become a good alternativeto MRI because: spatial resolution, multi-phasic and functional studies, very fast,availability, safe and effective in presence of metallic coils, pacemaker wires, valvularprostheses, aneurysm clips, detection of extracardiac abnormalities (simultaneousevaluation of airways and lung parenchyma).C-147Prognostic value of multislice computed tomography coronaryangiography and calcium scoring in patients without known coronaryartery diseaseF. Cademartiri 1 , E. Maffei 1 , S. Seitun 2 , A.A. Palumbo 1 , C. Martini 1 , C. Saccò 1 ,A. Aldrovandi 1 ; 1 Parma/IT, 2 Genoa/IT (filippocademartiri@hotmail.com)Purpose: To determine the prognostic value of multislice computed tomographycoronary angiography (MSCT-CA) and coronary artery calcium scoring (CACS) inpatients without known coronary artery disease (CAD).Methods and Materials: 511 patients (316 men, 61.511.2 years), who werereferred for suspected CAD, underwent MSCT-CA for CAD detection (normal vs.non significant vs. significant CAD). CACS was categorized as normal/minimal(0-10), mild (11-100), moderate (101-400), and severe/extensive ( 400). Patientsunderwent follow-up for cardiac events.Results: Normal coronary arteries were detected in 40%, non significant CAD(50% luminal narrowing) in 40%, and significant CAD ( 50%) in 20% of thepatients. Prevalence of significant CAD was 3.5% in the normal/minimal CACS,21.5% in the mild CACS, 40% in the moderate CACS and 57% in the severe/extensive CACS. At follow-up (194 months), 60 total events occurred (9 major).In patients with normal coronary arteries on MSCT-CA, the major event rate was0 vs. 1% in patients with non significant CAD, and 7.8% in patients with significantCAD (p 0.0001). 1 major event occurred in a patient with normal/minimal CACS;1 major event occurred in a patient with mild CACS. In multivariate analysis, CACSwas an independent outcome predictor over traditional risk factors, but when CADanalysis by MDCT-CA were included into the model, significant predictors of eventsremained the presence of diabetes (p 0.05), and obstructive CAD (p 0.01).Conclusion: An excellent prognosis was noted in patients with a normal MSCT-CA (0% major event rate). Importantly, normal/minimal CACS did not exclude thepresence of CAD and future events.C-148How to perform and to look at myocardial delayed enhancement with CT:Impact of X-ray beam voltage/energy and contrast material volumeC. Martini 1 , E. Maffei 1 , A.A. Palumbo 1 , C. Saccò 1 , M.L. Dijkshoorn 2 ,A.C. Weustink 2 , N.R. Mollet 2 , F. Cademartiri 1 ; 1 Parma/IT, 2 Rotterdam/NL(cmartini@ao.pr.it)Learning Objectives: 1. To evaluate myocardial viability in myocardial infarctionusing delayed-enhancement CT imaging. 2. To provide interpretation and scanhints for the best visualisation of DE and no-reflow zone. 3. To show the effect ofdifferent X-ray beam voltage/energy and contrast material volume.Background: Myocardial infarct size is a predictor of clinical outcome in patientssuffering from AMI. We propose the delayed-enhancement CT imaging (DE-CT)as non-invasive imaging modality for the detection of myocardial infarction. We usedifferent algorithms of dose and contrast material volume to evaluate the best wayto depict DE and no-reflow, in relation to remote myocardium.Procedure Details: In domestic pigs (mean weight: 24 kg), an AMI was inducedand DE-CT imaging was performed 5 days later after administration of iodinatedcontrast. Four scan protocols were performed in spiral cardiac mode at two tube currentvalues (350/900 mAs) with two iodinated contrast material volume (30/100 ml).The scans performed were: ART (CTA first-pass), DE 1(15 mAs/kg-1.25 gI/kg), DE 2(37.5 mAs/kg-1.25 gI/kg), DE 3(15 mAs/kg-3.75 gI/kg), DE 4(37.5 mAs/kg-3.75 gI/kg). Also in humans, different protocols have been performed and different imagingprotocols are displayed.Conclusion: The amount of contrast material is far more important than radiationdose for the assessment of DE-CT.CS368 A B D E F FG H

Scientific and Educational ExhibitsC-149Optimization of cardiac ECG-gated dose modulation techniques forpatients with high heart ratesT. Inoue 1 , K. Oosawa 2 , T. Nishida 2 , F. Uto 1 ; 1 Tenri/JP, 2 Sakurai/JPPurpose: Some of the major limitations in performing cardiac CTA examinations onpatients with high heart rates are challenges in obtaining consistent image qualityand implementing dose modulation techniques. An optimized scan technique thatwill help better image these patients at lower radiation exposures is introduced.Methods and Materials: Retrospective investigations of 571 cardiac CTA examinationswere performed for physiological parameters and optimal cardiac phasesrequired for imaging of coronaries. Phantom tests were performed at different heartrates (70, 80, 90 and 100 BPM) to compare performance between four differentdose modulation protocols (55% phase, combination of 50 & 60% phases, combinationof 45 & 65% phases, and combination of 40 & 70% phases). Subsequently,acquisitions were performed on patients to validate the optimized technique foundthrough phantom investigations.Results: Evaluation of clinical scans indicated that optimal phases for coronaryvisualization were between 30-50% and 70-80%, depending on heart rate. Detailedanalysis of phantom data for different heart rates revealed that the optimal phaseswere 40 & 70% at 70 BPM, 45 & 65% at 80 BPM, 50 & 60% at 90 BPM, and 55% at100 BPM. The radiation exposures when compared to those without dose modulationtechniques were 20.1, 19.5, 18.8 and 18.4%, respectively. Overall, assessmentof clinical cases show an average heart rate of 84 BPM, resulting in dose of 18.7%compared to that required without dose modulated techniques.Conclusion: Optimized scanning techniques can enable considerable reductionsin X-ray radiation exposure for patients with high heart rates, while providing consistentdiagnostic image quality.C-150Diagnostic performance of low-dose CT coronary angiography in the stepand-shootmodeH. Scheffel, P. Stolzmann, S. Leschka, L. Desbiolles, A. Plass, T. Krauss,B. Marincek, H. Alkadhi; Zurich/CH (Hans.Scheffel@usz.ch)Purpose: The purpose was to investigate the performance of low-dose dual-sourcecomputed tomography (DSCT) coronary angiography in the step-and-shoot (SAS)mode for the diagnosis of significant coronary artery stenoses in comparison withconventional coronary angiography (CCA).Methods and Materials: 120 consecutive patients (71 males, age 689 years, BMI26.23.2 kg/m 2 ) underwent both DSCT in the SAS mode and CCA within 14 days.Twenty-seven patients were given IV beta-blockers for heart rate reduction prior toCT. Patients were excluded if a target heart rate 70 bpm could not be achieved bybeta-blockers or when the patients were in non-sinus rhythm. Two blinded readersindependently evaluated coronary artery segments for assessability and for thepresence of significant ( 50%) stenoses. Sensitivity, specificity, negative (NPV)and positive predictive value (PPV) were determined with CCA being the standardof reference. Radiation dose values were calculated.Results: DSCT coronary angiography in the SAS mode was successfully performedin all 120 patients. Mean heart rate during scanning was 596 bpm (range44-69 bpm). 1773/1803 coronary segments (98%) were depicted with a diagnosticimage quality in 109/120 patients (91%). The overall patient-based sensitivity,specificity, PPV, and NPV for the diagnosis of significant stenoses were 100, 93,94, and 100%. The mean effective dose of the CT protocol was 2.50.8 mSv(range 1.2-4.4 mSv).Conclusion: DSCT coronary angiography in the SAS mode allows in selectedpatients with a regular heart rate the accurate diagnosis of significant coronarystenoses at a low radiation dose.C-151Dynamic visualization of the pulmonary valve at cardiac CTE. Gassner 1 , Y.-S. Lee 1 , J. Abro 1 , W. Jaschke 2 , P. Costello 1 , U.J. Schoepf 1 ;1Charleston, SC/US, 2 Innsbruck/AT (gassner@musc.edu)Learning Objectives: To demonstrate the feasibility, display techniques, and limitationsof pulmonary valve imaging with retrospectively ECG-gated CT.Background: Accurate visualization of the pulmonary valve remains challengingfor cross sectional imaging modalities. Recent developments in cardiac CT provideunprecedented spatial and temporal resolutions for imaging rapidly moving structures,providing new opportunities for diagnosing valvular disease. This exhibit isspecifically aimed at CT diagnosis of pulmonary valve morphology and functionbased on dedicated imaging planes. The current capabilities, limitations, and futurepotential of cardiac CT for imaging the pulmonary valve are illustrated.Imaging Findings: Imaging the pulmonary valve: current status and challenges.Cross sectional anatomy of the right ventricular outflow tract, pulmonary valve, andthe pulmonary root. CT post-processing techniques and imaging planes for pulmonaryvalve display. Performance of dynamic CT imaging for visualizing pulmonaryvalve anatomy and leaflet motion. CT imaging features of normal and diseasedvalves. Current role of cardiac CT is compared to standard clinical modalities - advantagesand disadvantages. Limitations: Anatomic conditions, technical pitfalls,image noise, contrast medium delivery, heart rate, and temporal resolution.Conclusion: High spatial and temporal resolution capabilities of cardiac CTcombined with postprocessing by interactive manipulation of 4D data sets allowfor high quality dynamic imaging of the pulmonary valve.C-152Characteristics of early coronary artery plaque in Korean young adultsunder 40 years: Findings of screening coronary CT angiography andcomparison with angiographic findings of acute coronary syndromepatientsE. Ha, J. Cheung, Y. Kim, S. Shim; Seoul/KR (cheery-eun@hanmail.net)Purpose: We evaluated the characteristics of atherosclerotic plaque of earlycoronary artery disease (CAD) in Korean young adults under 40 years old byanalysis of CT findings of coronary plaques detected on screening coronary CTangiography (CCTA).Methods and Materials: We analyzed screening CCTA obtained in 144 patientswho were younger than 40 years old in terms of the location, degree of stenosis,and type of plaques and compared the results with angiographic findings of patientswho had acute coronary syndrome. We also compared the patients with CAD andwithout CAD on CCTA in coronary risk factors.Results: Eighteen patients had 22 coronary plaques on CCTAT,which werelocated in proximal left anterior descending (LAD) (n=16), left main (LM) (n=4),right (RCA) (n=2) coronary artery with the most common location of proximal leftanterior descending coronary artery (n=14). All patients had mid stenosis andtypes of plaque included non-calcifying (n=7), mixed (non-calcifying component calcifying) (n=4), mixed (non-calcifying component calcifying) (n=6), calcifying(n=5) plaque. Patients presented with acute coronary syndrome had 37 plaqueslocated in LAD (n=21), RCA (n=9), left circumflex (n=6), and LM (n=1) coronaryartery. The presence of obesity, smoking, hypertension, hypercholesterolemia,and fatty liver was significantly higher in patients with CAD compared with patientswithout CAD on CCTA.Conclusion: In young adults, plaque of early coronary artery disease most commonlyoccurs in LAD, particularly in proximal segment, and non-calcifying plaqueis common.C-153Anatomy and variations of the arterial supply to the sinuatrial node:Imaging with dual-source cardiac multidetector CT angiographyD. Yildirim, A. Agildere, S. Akpek, T. Gumus, M. Ucar; Istanbul/TR(yildirimduzgun@yahoo.com)Purpose: Our basic aim was to describe the sinus node artery (SAN) and to definethe typical anatomy and rare variations at this junction.Methods and Materials: We retrospectively examined cardiac CT images of 98patients (male: 85, female: 13, mean age: 48 years) acquired with dual sourcemultidetector system. Using the special software; three-dimensional and maximumintensity projection and curved multiplanar images were generated. After depictionof the sinuatrial node arterial supply: firstly, the trace of the artery was defined; secondly,calibration at the origin measured and then percentages were calculated.Results: A single SAN arter originated from the proximal 35 mm of the rightcoronary artery (RCA) in 89 (91%), from the proximal 40 mm of the left circumflexartery in 4 (4%), directly from the RCA sinus in 3 (3%) and from the conal branchof the RCA in 2 (2%) patients. Also, a typical trace of the SAN arterial supply wasdetected in 43 patients who have similar anatomy.Conclusion: The arterial blood supply to the SAN can be imaged easily withdual-source multidetector CT examination by processing the routine cardiac CTsections. Comparing with the literature reports, we can say that there is high variabilitybetween different races concerning the percentages of the different typesof arterial supply to the SAN.CardiacACB D E F G HS369

Scientific and Educational ExhibitsC-154Quantitative analysis of the impact of nitroglycerin on coronary arteryimaging with 64-row CTY. Miao 1 , B. Wang 1 , Y. Shen 2 , J. Li 2 , Y. Guo 2 , H. Cao 2 ; 1 Hangzhou/CN, 2 Beijing/CN(yingmiao6588@sina.com)Purpose: Quantitatively evaluate the impact on image quality of using nitroglycerinin coronary artery imaging with 64-row CT.Methods and Materials: 100 patients who underwent 64-row CT coronary arteryimaging were divided into two groups of 50 each. Nitroglycerin was applied topatients in one group (A) before the CT scans. CPR reconstructions of the anteriordescending, circumflex and right coronary branches were performed at their bestcardiac phases. Two experienced radiologists selected the middle points of theproximal section of right coronary, left anterior descending, and circumflex branches,and measured their diameters for the two groups of patients.Results: The measured diameters of the proximal section of the right coronary,left anterior descending, and circumflex branches were 3.920.72, 3.900.56,3.590.81 mm and 3.410.99, 3.520.86, 3.280.56 mm for the groups of patientswith and without the use of nitroglycerin, respectively. The diameters increased by15, 10.7 and 9.4%, respectively, for the three vessels with the use of nitroglycerin.The mean values for these vessels were 3.830.52 and 3.400.72 mm, respectively,with and without the use of nitroglycerin. The perceived image quality had markedincrease with the use of nitroglycerin.Conclusion: The use of nitroglycerin is effective in increasing the diameters ofcoronary arteries. It may improve the visualization of small coronary arteries andtheir branches with the limited spatial resolution of the current CT system.C-155Imaging of left ventricular assist devices and possible device relatedcomplicationsB. Greiner, K. Wiebe, P. Heiss, C. Schmid, S. Feuerbach, O.W. Hamer;Regensburg/DE (ba_greiner@gmx.at)Learning Objectives: 1. Learn the imaging appearance of different types ofleft ventricular assist devices (LVAD) on chest radiographs (CR) and computedtomography (CT). 2. Learn which complications are associated with LVADs andhow to identify them on imaging.Background: LVADs are increasingly used for the management of patients withacute or chronic heart failure of various origins. The devices provide circulatorysupport and are used as “bridge to transplant”, “bridge to recovery”, or permanentalternative to transplant (“destination therapy”). LVADs are frequently associated withdevice related complications that contribute to morbidity and mortality. Radiologistsshould be aware of the normal imaging appearance of LVADs on CR and CT andshould be able to recognize device related complications.Imaging Findings: Mechanical circulatory support is generally accomplished byinserting cannulas in the heart and great vessels to divert blood from the failingleft ventricle back to the arterial circulation via a pump. Schematics as well as CRand CT imaging findings (including multiplanar reformations) of different types ofLVAD are outlined. Potential device related complications, the most frequent beinghemorrhage, thrombembolism and air embolism, are discussed and illustrated.Conclusion: LVADs are increasingly used in modern heart surgery. Radiologistsare required to recognize normal postoperative imaging appearances of the variousdevices and to reliably identify potential complications.C-156Relative influence of plaque composition, arterial diameter and technicaladequacy on diagnostic performance of 64-row coronary CT angiography(cCTA) using conventional quantitative coronary angiography (QCA) asreferenceA. Ascarelli, A. Napoli, M. Francone, F. Zaccagna, D. Geiger, P. Di Paolo,C. Catalano, R. Passariello; Rome/IT (adrianoasca@libero.it)Purpose: Relative plaque composition, along with coronary diameter and imagequality, may affect the ability of cCTA in detecting significant stenoses. Thus, theaim of our study was to determine whether composition of atherosclerotic plaques,segmental coronary diameter and technical adequacy influence diagnostic performanceof cCTA.Methods and Materials: Seventy-eight patients underwent cCTA (64x0.6 mm[Siemens]; 70 mL of 400 mgI/mL [Iomeprol; Bracco] at 4.5 ml/s) prior to QCA,performed within 3 days. Data were analyzed using semi-automated quantitativestenosis software (Vitrea 2). All segments 1.5 mm were analyzed. Two radiologistsevaluated all cCTAs datasets concerning diagnostic image quality, presenceof significant coronary stenoses (validated against QCA), plaque composition andsegmental location.Results: In 77 of 78 patients, 64 cCTA enabled the visualization of the entirecoronary tree with diagnostic image quality in 925 segments. The overall sensitivityfor the detection of stenosis 70% was 93% (156-169), and specificity was 92%(697-756). cCTA diagnostic accuracy (sensitivity, specificity[%]) was dominantlydependant on plaque composition and progressively decreased with parallel increaseof compositional density: 1, (soft plaque) 97-99; 2, (mixed) 97-96; p 0.01;3, (predominantly calcified) 61-85; p 0.001. Inversely, diagnostic accuracy waslargely independent of image quality and segmental location (both p .05).Conclusion: Plaque composition, and specifically high density lesions, significantlyaffects diagnostic accuracy. In presence of soft plaque, the diagnostic accuracyis consistently high irrespectively of coronary diameter and, at a lesser extent,image quality.C-157How to assess various cardiac findings on non-gated routine chest CT:Correlation with ECG-gated 64-slice MDCT - more to know, better tounderstand!S. Kim, E. Chun; Seoul/KRLearning Objectives: Significant cardiac findings are common and it might beeasily-overlooked on non-gated routine chest CT. Therefore, systemic approach isrequired for the evaluation of cardiac structure on non-gated CT. Also, radiologistsshould know the significance and limitations for the assessment of various cardiacfindings on routine chest CT comparing with ECG-gated 64-slice MDCT.Background: With recent advances of MDCT technology, temporal and spatialresolution has been markedly improved. Therefore, cardiac structure on non-gatedCT is well visualized and it needs tailored evaluation for the accurate diagnosis ofvarious cardiac diseases.Imaging Findings: 1. How to assess various cardiac findings on routine chest CT;2. To demonstrate the various easily overlooked cardiac findings with significanceon routine chest CT correlated with ECG-gated 64-slice MDCT: 1) Myocardialabnormality - acute or chronic myocardial infarction, DCMP, HCMP etc. 2) Valvularheart disease - aortic, mitral, and pulmonary valvular heart disease. 3) Chambermorphology such as ASD, D-shaped LV, and septal inversion. 4) Space occupyinglesions at heart structure - tumor or thrombus 5) Significant coronary atherosclerosisincluding left main and proximal segment disease. 6) Pericardial disease such asTbc and tumor mimicking effusion; and 3. Limitation and Remedies of routine chestCT for the assessment of cardiac findings.Conclusion: Understanding of various cardiac findings on non-gated CT is importantfor the evaluation of chest pain or dyspnea as well as detection of subclinical,but significant findings.C-158Diverticula of the heart in cardiac MSCT examinationE. Czekajska-Chehab, K. Rosinska-Bogusiewicz, E. Siek, S. Uhlig, A. Drop,G. Staskiewicz, E. Wysokinska, J. Kobayashi; Lublin/PL(katarzynabogusiewicz@wp.pl)Purpose: Evaluation of the incidence, localization and morphology of heart diverticula(HD) in patients hospitalized in tertiary cardiology centre.Methods and Materials: The study included 3266 ECG-gated MSCT examinationsof the heart in patients with acute or chronic heart diseases (8- and 64-row GEMedical System LightSpeed).Results: HDs were incidentally found in 46 (1.4%) patients aged from 10 to 76years. Diverticula more frequently localized in the left ventricle (35 cases), especiallyin its periseptal part. Nine lesions were discovered in the left atrium, one in theright atrium and in one case both in the left atrium and ventricle. In 7 patients HDswere seen multifocally. The size of HDs ranged from 4 to 30 mm (mean 7 mm). In19 cases, diverticula were visible only in diastolic phase and almost completelyemptied during the systolic phase. In two cases, thrombus inside the diverticulumwas observed. HDs were associated with heart enlargement or hypertrophy in 34patients, cardiac muscle hypokinesis or pathological mobility in 10 patients, othercongenital or acquired anomalies of the heart, cardiac or pulmonary vessels in 19patients. Moreover, HDs coincided with cardiac focal lipomatosis in 14 patients.Conclusion: The ECG-gated MSCT is an efficient method for detection and evaluationof both diverticula and other associated anomalies of the heart.CS370 A B D E F FG H

Scientific and Educational ExhibitsC-159Evaluation of MDCT for the assessment of aortic disease: Pitfalls andremediesS. Kim, E. Chun; Seoul/KRLearning Objectives: Rapid advances of MDCT technique have enabled correctdiagnosis of aortic disease. However, the proper understanding of the techniqueand optimal enhancement is important for correct detection or characterizationof aortic disease. Therefore, it is necessary to understand the various pitfalls andremedies of aortic disease on MDCT and to know the correct scanning protocols,the optimal contrast enhancement, how to adjust the scan timing and appropriatepost processing method.Background: The purpose of this exhibit is: 1. How to evaluate and measure variousaortic diseases using MDCT. 2. To demonstrate the various pitfalls and remediesof aortic disease on MDCT. 3. To understand usefulness of state of art technologyand post-processing for the assessment of aortic disease.Procedure Details: 1. Recent advances of techniques for the evaluation of aorticdisease on MDCT and post processing; 2. How to evaluate and measure variousaortic diseases; and 3. Common various pitfalls and remedies of aortic diseaseon MDCT: 1) Acute aortic syndrome - technical factors, streak artifacts, periaorticstructures, aortic wall motion, and normal aortic sinuses. 2) Suboptimal enhancementof contrast media in patients with aortic dissection or aneurysm, 3) Accuratemeasurement of maximum diameter before and after procedure in patient withaortic aneurysm 4) Detection of impending or ruptured aneurysm. 5) Differentiationcommon aortic disease from unusual disease such as mycotic aneurysm,vasculitis, and tumor.Conclusion: Understanding of various pitfalls and remedies for the assessmentof MDCT is essential for accurate diagnosis and management in patients withaortic disease.C-160Accuracy of 64-slice CT in assessment of coronary artery bypass graftsand distal anastomosesA. Arjmand Shabestari, M. Fatehi, S. Akhlaghpoor, M. Tehrai, M. Hashemian;Tehran/IR (abarjshabestari@yahoo.com)Purpose: This study was performed to determine diagnostic accuracy of MSCTin assessment of patency of coronary artery bypass grafts (CABGs) and theiranastomoses.Methods and Materials: Seventy-three patients with previous CABG who underwentboth coronary CT angiography using 64-slice CT scanner and invasive coronaryangiography were enrolled. Arterial and venous CABGs patency was gradedas: a-normal, b-insignificant ( 50% diameter reduction) stenosis, c-significant(50% diameter reduction) stenosis or d-totally occluded. Distal anastomoses weregraded as normal, stenotic or totally occluded. Negative results were consideredas either normal findings or presence of insignificant stenosis and positive resultswere regarded as presence of 50% diameter reduction stenosis, together withtotal occlusion.Results: In 73 patients (51 male, 22 female; mean age 64.9 8.6 years) totally 223grafts (48 arterial and 175 venous) with the same number of distal anastomoseswere evaluated. In MSCT, 5 out of 223 bypass grafts (2.2%) patency could not beevaluated; hence, finally 218 grafts (97.8%) were assessable. Assessability was93.7 and 98.9% for arterial and venous grafts, respectively. Both normal patencyand total occlusion of SVGs in CTA were correctly reported in all venous grafts(100%). Positive Predictive Value: General: 92.2%, Arterial: 84.6%, Venous: 94.1%;Negative Predictive Value: General: 96.1%, Arterial: 93.8%, Venous: 96.7%.Conclusion: Diagnostic accuracy of 64-slice MSCT in detecting normal patency,non-significant stenoses, significant stenoses and total occlusion of arterial andparticularly venous CABGs is extremely high so that ICA may be eventually substitutedby CTA in the near future.C-161Temperature monitoring in ablation procedures using computedtomographyT.R. Fleiter, T. Dickfeld, K. Read; Baltimore, MD/US (tfleiter@umm.edu)Learning Objectives: Understanding the correlation of absorption changes incorrelation to temperature changes in CT imaging.Background: Cardiac EP procedures are currently utilized using fluoroscopy and3D mapping systems to visualize and control the positioning of the ablation catheterin the heart dung the procedure. These imaging systems do not provide visualizationor control of ablation procedures and are strictly limited to catheter guidance andpositioning control. But a real time imaging of the developing tissue damage duringthe ablation procedure would be helpful to modulate ablation in order to maximizethe destruction of the targeted structure such as electrophysiologic active scars andto minimize the damage of healthy tissue. Monitoring the temperature changes inthe effected tissue during the ablation would provide such information.Procedure Details: The X-ray absorption of soft tissue varies with temperature.Increasing temperature leads to decreased X-absorption and therefore decreasingHU values in CT. There is almost a linear correlation of temperature and HUdecrease in the typical EP ablation induced changes in the soft tissue. Measuringthe density changes over time using repeated CT scans therefore allows the monitoringof temperature changes and the size of the affected area in real time. Themeasurements are relative and results depend on the content of the soft tissue.Typical changes will be demonstrated in cardiac (swine model) and liver tissue - thetwo main targets of interventional procedures.Conclusion: CT monitoring of temperature changes has the potential to providereal time monitoring of ablation procedures.C-162Dual source computed tomography angiography for detecting coronaryostial lesions: Superior to conventional coronary angiography?L.A. Neefjes 1 , E. Neoh 1 , M. Rengo 2 , S. Kyrzopoulos 1 , A.C. Weustink 1 ,N.R. Mollet 1 , G.P. Krestin 1 , P.J. de Feyter 1 ; 1 Rotterdam/NL, 2 Latina/IT(l.neefjes@erasmusmc.nl)Purpose: To evaluate the diagnostic performance of dual source multi-slicecomputed tomography coronary angiography (CTCA) in detecting coronary ostiallesions in symptomatic patients, in comparison with conventional coronaryangiography (CAG).Methods and Materials: 480 patients with CAG and CTCA were evaluated by anindependent observer. Of this group, 43 patients were suspected to have a coronaryostial lesion. The CAGs and CTCAs of these patients were reviewed by, respectively,a cardiologist and a radiologist. Afterwards, the cardiologist and radiologist formeda consensus diagnosis by re-evaluating the CAG and the CTCA together. Theconsensus diagnosis, considered as the standard of reference, was compared tothe first diagnosis made by the cardiologist and the radiologist separately.Results: According to the consensus diagnosis, 26 ostial lesions were present in24 patients. CTCA missed none of the severe ostial lesions and missed 1 moderatelesion. CAG missed 5 lesions; 2 severe and 3 moderate ostial lesions. CTCA showeda sensitivity of 96% up to 100% (depending on the stenosis degree; moderate/severe and severe) in detecting coronary ostial lesions. Sensitivity of CAG was75% up to 86% in detecting these ostial lesions.Conclusion: CTCA appears to be an accurate imaging modality to detect coronaryostial lesions. Compared to CAG, CTCA is more accurate in evaluating the coronaryostium because of better 3D visualization of the ostia and no catheter related problemsas passing the lesion with the cathetertip and catheter induced spasms.C-163ECG-CT: A perfect diagnostic tool for detection and evaluation of coronaryartery aneurysmsS. Uhlig, E. Czekajska-Chehab, G. Staskiewicz, E. Siek,K. Rosinska-Bogusiewicz, A. Drop; Lublin/PL (uhlig.s@eranet.pl)Purpose: Coronary artery aneurysm (CAA) is a rare complication of atherosclerosisor vasculitis, occurring in 1.5% of population. Initial symptoms are notspecific and the lesion may lead to serious clinical implications, including suddendeath. The aim of the study was to present possibilities of ECG-CT in detectionand evaluation of CAA.Methods and Materials: ECG-CT examinations of 1700 patients were analyzed inrespect to detect CAA. The examinations were performed with 64-row scanner in theyears 2006-2008, in typical cardiac CT protocol. Multiplanar and 3D reconstructionswere used to evaluate coronary arteries. Localization and morphology of aneurysms,as well as concomitant lesions of coronary arteries, were evaluated.Results: CAA were detected in 25 patients (1.47% of investigated group; age41-80, median 54.5), more frequently in males - 19 cases (76%). In 22 cases,CAA was diagnosed for the first time. In 21 patients, one coronary artery was affected.Two and four arteries were involved in two cases each. CAA were revealedin following vessels (number of aneurysms in brackets): RCA (14), LAD (5), LCX(4), OM1 (4), LM (2), DIA1 (2), IM (1), posterolateral branch (1), (total number ofaneurysms - 33).Diameter of aneurysms ranged from 3.8 to 15 mm (median 6.2) and the lengthwas 4-36 mm (median 11). In three cases, aneurysm contained thrombus. Theatherosclerosis was detected in 21 cases, and in 11 of them (44%) the stenoseswere hemodynamically significant.Conclusion: ECG-gated CT, apart from being the valuable method of detection of atheroscleroticlesions in coronary arteries, enables an accurate diagnosis of CAA.CardiacACB D E F G HS371

Scientific and Educational ExhibitsC-164Artifacts in MDCT coronary angiography: How to recognize and avoid themJ.A. Fernandez Villameytide, P. Catalán Sanz, R. Gómez Illán, J. Longo Areso,D. Barettino Coloma, J. Richard Rodriguez; Oviedo/ES (villameytide@hotmail.com)Learning Objectives: To illustrate the potential artifacts and pitfalls in MDCT coronaryangiography and describe the potential solutions and tips to avoid them.Background: MDCT coronary angiography is rapidly developing and its use isbecoming more prevalent, but artifacts and other pitfalls can cause significantproblems for the accurate diagnosis of coronary artery disease. Therefore, it isimportant for the observers reporting these studies to be aware of the potentialartifacts and pitfalls and the different methods to minimize false-positive and falsenegativeinterpretations of coronary artery stenosis. We reviewed 285 64-MDCTcoronary angiography studies performed between September 2006 and September2008 to illustrate the potential artifacts and pitfalls. Available solutions for avoidingthem are presented.Imaging Findings: The pitfalls and artifacts are classified in: a) Motion relatedartifacts caused by cardiac, respiratory or body motion; b) Partial volume averagingeffect; c) Streak artifacts; d) Technical artifacts, either during adquisition or reconstruction;e) Postprocessing artifacts and f) Artifacts derived from contrast materialenhancement and body habitus. Examples that may help to recognize these artifactsare shown. Available solutions and tips to avoid them are presented.Conclusion: Artifacts and other pitfalls can cause significant problems for theaccurate diagnosis of coronary artery disease. The most common artifacts aremotion-related.C-16564-CT angiography for whole-body vascular imaging: In vivo quantificationof atherosclerotic burden and relation to traditional cardiovascular riskindex and 2-year follow-upA. Napoli, M. Anzidei, D. Geiger, F. Zaccagna, C. Catalano, R. Passariello; Rome/IT(alessandro.napoli@uniroma1.it)Purpose: Determine the value of whole-body CT angiography (WBCTA) for quantificationof atherosclerosis burden and individual risk stratification.Methods and Materials: Coronary and extra-coronary CTA was performed in asingle session using an adapted contrast injection protocol (70 + 50 mL at 4 and3 mL/s [Iomeprol-400; 400 mgI]). The vascular system was evaluated on a segmentalbasis. An atherosclerosis burden score (ABS) was generated for each individualand correlated to traditional cardiovascular (CV) risk (Framingham risk index; FRI).The prognostic value was determined on the basis of two years’ follow-up.Results: 268 patients underwent WBCTA (190 with diabetes; 78 with metabolicsyndrome [MetS]). 113 patients were classified as high risk (FRI) and had higherABS (p=0.005); 155 patients were considered at mild risk for CV events; the ABSvaried between 5 and 63 (p 0.05). For ABS values greater than 35, the relativerisk for nonfatal myocardial infarction or coronary death was 2.2 (95% CI 1.4-3.6)and the relative risk for any coronary event was 3.1 (CI 2.1-4.5) (P35 experiencedincident CV events.Conclusion: WBCTA allows non-invasive, robust assessment of coronary andextra-coronary vascular disease. ABS has a quantitative measure of whole-bodyvascular pathology that compares with FRI for high risk individuals. ABS wassuperior to FRI for risk stratification in patients at intermediate risk according to 2year’ follow-up findings.C-166What every radiologist should know about pharmacological managementin MDCT coronary angiographyJ.A. Fernandez Villameytide, P. Catalán Sanz, R. Gómez Illán, J. Longo Areso,D. Barettino Coloma, J. Richard Rodriguez; Oviedo/ES (villameytide@hotmail.com)Learning Objectives: To outline the pharmacological preparation of MDCT coronaryangiography and the management of eventual complications.Background: Best results in MDCT coronary angiography are obtained with lowand regular cardiac rhythm. In many cases drugs are needed to reach optimalheart rhythm, mainly using beta-blockers. On the other hand, nitrates are frequentlyused to improve the diameter of proximal coronary arteries. Therefore, radiologistsmust be familiarized with these drugs, their contraindications and interactionsand the management of eventual complications. Between September 2006 andSeptember 2008, 285 MDCT coronary angiography studies were performed inour department. The pharmacological preparation used and the complicationsreported are described.Procedure Details: Patient’s history and vital signs are obtained on arrival. Potentialcontraindications for the use of beta-blockers, nitrates and iodinate contrast arespecifically asked. Heart rhythm below 65 bpm is attended to optimize the resultsof MDCT-coronary artery angiography. The determination to give beta-blockers,their dosage and the way of administration to be used are individualized for eachpatient on the basis of clinical setting and possible contraindications. Pharmacistand referring physician consultation are done if alternative drugs are considered, ascalcium-channel blockers. None complication was described with the use of betablockersor with the alternative drugs used. Nitrates are used if heart rhythm is below60 bpm. One case of hypotension and bradycardia was derived from its use.Conclusion: The pharmacological preparation for MDCT coronary angiography onan individualized basis and with awareness of potential complications is safe.C-168Acute chest pain and patent coronary arteries: What’s the next step?V. Pineda, X. Merino, J. Rodriguez, H. Cuellar, S. Gispert, R. Domínguez-Oronoz;Barcelona/ES (victor.pineda@idi-cat.org)Learning Objectives: 1. To present a diagnostic algorithm in patients with acutechest pain and patent coronary arteries. 2. To describe the usefulness of MRI insuch patients.Background: The main cause of acute chest pain in patients with ECG changes andelevated cardiac enzymes is coronary artery disease. However, some patients haveno coronary obstruction on angiography or MDCT, causing diagnostic uncertainty.There are a number of potential causes for this situation and cardiac MRI helps toclarify this diagnostic dilemma.Imaging Findings: A broad spectrum of cardiovascular pathologies are consideredin the differential diagnosis of this scenario, including myocardial infarction, acutemyocarditis, tako-tsubo cardiomyopathy, apical hypertrophic cardiomyopathy,coronary vasospasm, cardiac syndrome X, pericardial disease and acute aorticsyndrome. In these pathologies, cardiac MRI provides useful information to suggestthe correct diagnosis. The morphological and functional appearance in MR imagesof these conditions will be described.Conclusion: Cardiac MRI is a non-invasive powerful and clinically relevant toolto distinguish between different cardiovascular aetiologies of acute chest pain inpatients with unobstructed coronary arteries.C-169Radiologic-pathologic correlation of imaging features of congenital heartdiseases using an ultra high-resolution flat-panel volume-CT: PictorialintroductionB. Reichardt 1 , C. Lang 1 , A. Juraszek 2 , P. Vock 1 , R. Gupta 2 ; 1 Berne/CH,2Boston, MA/US (Benjamin.Reichardt@insel.ch)Learning Objectives: 1. To demonstrate anatomical changes associated withcongenital heart disease. 2. To recognize the unique and novel imaging featureson ultra high resolution digital flat-panel CT that permit distinction among theseentities. 3. To demonstrate correlation between radiologic findings of congenitalheart disease and macroscopic pathological specimens.Background: This educational exhibit will describe the morphologic changes of20 excised and preserved hearts of children with congenital heart disease fromthe cardiac registry of the Children´s Hospital Boston.Procedure Details: Ten formalined excised hearts with common defects and tenwax-fixated hearts with rare congenital heart defects were imaged on a prototypeof a digital flat-panel detector CT scanner with ultra high resolution (~200 µm) andvolumetric coverage.Conclusion: We were able to demonstrate the benefits of the ultra high resolution CTimaging features in observing the major types of congenital heart disease. We wereable to demonstrate clinically important relationships between the imaging findingsand macroscopic pathological findings even in small defects down to 0.2 cm.C-170Incidental findings noted on calcium scoring CT scansM.D.B.S. Tam 1 , T. Latham 1 , W. Howard 2 , A.B. Tanqueray 2 ; 1 Norwich/UK,2Southend/UK (matthewtam2005@gmail.com)Purpose: To determine the number of incidental non-cardiac abnormal findingson calcium scoring cardiac CTs.Methods and Materials: Triple-reading of 199 consecutive calcium scoring CTscans was conducted. A consensus meeting was then held to review the detectedabnormalities, define the nature of the abnormalities, and to determine whetherpatient recall for further investigations was required.CS372 A B D E F FG H

Scientific and Educational ExhibitsResults: 55 out of 199 CT scans (27.6%) were abnormal. 67 abnormalities weredetected across the 55 scans. Significant abnormalities included a squamouscarcinoma of the lung and indeterminate pulmonary nodules requiring follow-up.Parenchymal lung abnormalities included a tumour, nodules, consolidation, emphysemaand bronchiectasis. Pleural plaques and pleural effusions were identified.Mediastinal abnormalities included lymphadenopathy and pericardial effusions.Upper abdominal abnormalities were also detected and included ascites andgallstones.Conclusion: 28% of unenhanced calcium scoring CT scans show non-cardiac abnormalities.The interpretation of a large number of abnormalities is dependent uponthe clinical scenario. These findings raise the question whether these investigationsshould be read by non-radiologists or specialists with no training in general CT.C-171Correlation of effective radiation dose and heart rate in dual-source CTcoronary angiographyF. Laspas, D. Tsantioti, A. Roussakis, N. Kritikos, R. Efthimiadou, D. Kechagias,D. Savidou, V. Filippi, T. Georgiou, J. Andreou; Athens/GR (arkrous@hol.gr)Purpose: To evaluate the relationship between radiation exposure and heart rate(HR), in dual-source CT coronary angiography (CTCA).Methods and Materials: Data from 187 CTCA examinations, performed with adual-source 64-slices scanner (Siemens Definition), were statistically evaluated.Effective radiation dose (ERD), expressed in mSv, was calculated as the productof the dose-length product (DLP) times a conversion coefficient for the chest(mSv=DLPx0.017). Heart rate range and mean heart rate, expressed in beats perminute (bpm) of each individual during CTCA, were also provided by the system.Statistical analysis of ERD and HR data was performed by using Pearson correlationcoefficient, analysis of variance (AnOVa) and two-sample t-test.Results: Mean HR and ERD were found to have a linear correlation. Each additionalheart beat per minute was found to increase the total ERD by 0.138 mSv.Individuals with a mean HR 70 bpm turned out to receive a statistically significanthigher ERD as compared to those with HR70 bpm.Conclusion: Dual-source CT scanners are considered to have the capability toprovide diagnostic examinations even with high HR and arrhythmias. However, it isdesirable to keep the HR below 70 bpm in order to reduce the ERD.CardiacMRIC-172A modified rabbit model of reperfused myocardial infarction for cardiac MRimaging researchY. Feng, Y. Xie, H. Wang, F. Chen, G. Marchal, Y. Ni; Leuven/BE(fengyuanbolxm@hotmail.com)Purpose: We sought to obtain a rabbit myocardial infarction (MI) model for researchwith cardiac magnetic resonance imaging (cMRI) by overcoming a few technicaldifficulties.Methods and Materials: After systemic anesthesia, a newly developed endotrachealintubation method was applied for ventilation. Fourteen rabbits were dividedinto group-1 (n=8) with open-chest occlusion of left circumflex coronary artery andclose-chest reperfusion, and group-2 (n=6) of non-ischemic control; all animalsreceived ECG-triggered cMRI at a 1.5 T clinical scanner. Left ventricular (LV)functions were compared between two groups using two-tailed paired t-test. Theareas of MI in group-1 were morphometrically compared between delayed contrastenhancement (DE-cMRI) and triphenyltetrazolium chloride (TTC) histochemicallystained specimens using Bland-Altman test and linear correlation analysis.Results: The total success rate of intubation and reperfused MI was 14/14 and6/8, respectively. Both global and regional LV functions significantly decreasedin group-1 as evidenced by significant hypokinesis of the lateral LV-wall andstatistical difference in wall thickening (P 0.001). In group-1, mean MI-area was19.4121.92% on DE-cMRI and 19.1022.61% with TTC staining (r=0.985). GlobalMI-volume was 17.927.42% on DE-cMRI and 16.627.16% with TTC (r=0.994).Bland-Altman data showed a good agreement between DE-cMRI and TTC stainedspecimens. The usefulness of this model was successfully tested for assessing anew contrast agent.Conclusion: We have introduced a practical rabbit model of reperfused MI, whichmay offer a platform for more translational research using clinical MRI facilities.C-173Comparison with myocardial perfusion MRI and myocardial perfusionSPECT in the diagnostic performance of coronary artery disease: A metaanalysisK. Iwata 1 , M. Kubota 1 , K. Ogasawara 2 ; 1 Asahikawa/JP, 2 Sapporo/JP(kiwata@asahikawa-med.ac.jp)Purpose: To compare the diagnostic abilities of stress myocardial perfusion MRIand myocardial perfusion SPECT, using a meta-analysis method.Methods and Materials: We investigated the diagnostic abilities of MRI and SPECTin the similar subject groups in reports written in English and Japanese. Thesereports to be used for analysis were selected according to a “screening standard,”which was established in advance. After consolidating the data from the selectedreports, we compared: (1) the integrated odds ratio, (2) the point estimation valuesof sensibility/specificity, and (3) the summary ROC curve.Results: For the analysis, six reports were selected (subjects: 153, coronary-arterytarget sites: 447). Meta-analysis revealed that the diagnostic ability of myocardialperfusion MRI was superior to that of myocardial perfusion SPECT regardingthe parameters (1)-(3): (1) the integrated odds ratio of MRI was 24.8 (95% CI14.4-42.6) and SPECT was 9.2 (95% CI 5.6-15.1), (2) sensitivity were 75% (95%CI 68-81%) and 64% (95% CI 57-71%), specificity were 89% (95% CI 85-93%)and 83% (95% CI 77-88%), and (3) the summary ROC curve indicated statisticalsignificant difference (p 0.001).Conclusion: The result of meta-analysis supports the previous reports concerningthe diagnostic abilities of the myocardial perfusion MRI and myocardial perfusionSPECT are equal above. This is considered to be supportive evidence of theusefulness of myocardial perfusion MRI.C-174Noninvasive measurement of cardiac high-energy phosphate metabolitesusing 31P-spectroscopic chemical shift imagingA. Hansch, R. Rzanny, J. Reichenbach, W.A. Kaiser; Jena/DEPurpose: Cardiac diseases are commonly accompanied by structural abnormalitiesand impaired cardiac energy metabolism. Aim of this study was to investigatewhether the phosphocreatine/adenosine-triphosphate (PCr/ATP) ratio is reduced inpatients with different heart diseases by using spectroscopic chemical shift imaging(CSI), and whether this ratio is a suitable indicator of disease severity.CardiacACB D E F G HS373

Scientific and Educational ExhibitsMethods and Materials: 59 patients were included: 20 patients with dilatedcardiomyopathy (DCM); 35 patients with hypertensive heart disease (HHD); and 4patients with myocarditis (MyoC). Cardiac 31P-MR spectroscopy was performedwith a 1.5 T whole body scanner. Peak areas and ratios of different metabolites wereevaluated, including high-energy phosphates (PCr, ATP), 2.3-diphosphoglycerate(2.3-DPG), and phosphodiesters (PDE). Correlation analyses were performedbetween the metabolite ratios and the left ventricular ejection fraction (LVEF), anestablished prognostic factor of heart failure.Results: Spectral resolution and signal-to-noise ratio (SNR) of the CSI spectra weresufficient to detect the multiplet structures of ATP and 2.3-DPG in all spectra andto estimate the peak areas of 2.3-DPG+Pi, PDE, PCr and ATP in the myocardiumof all subjects. Patients with DCM, HDD and MyoC showed decreased PCr/ATPratios compared to healthy volunteers.Conclusion: Magnetic resonance spectroscopy with standard CSI sequences is avaluable tool for the non-invasive evaluation of myocardial structural alterations indifferent cardiac diseases. The PCr/ATP ratio is a helpful parameter to evaluate theseverity of structural impairments of the myocardium in DCM, HDD and MyoC.C-175The role of transthoracic echocardiography and magnetic resonance imagingfor evaluation of heart echinococcosisF. Todua, M. Razmadze, S. Kakhadze; Tbilisi/GE (razmadzemarika@yahoo.com)Purpose: Analyze the role of transthoracic echocardiography (TE) and MRI in theassessment of heart echinococcosis (HE).Methods and Materials: 16 patients with HE were examined. The age of patientsvaried from 11 to 55 years. The diagnosis of HE is based on serological reactions,TE and MRI. TE was done in all cases followed by MRI to confirm TE data. Presentingsymptoms have a wide variety, but the main symptom was precordial pain. 7Patients had isolated heart echinococcosis, but most had concomitant damage ofother organs (lungs, liver, brain).Results: The cysts were localized in the different sites of the heart: ventricularseptum-4 (the mean diameter of cystic mass 5.8 cm), LV apical segment (meandiameter - 4.5 cm)-6, LV anteriolateral wall - 6 (mean diameter 8.7 cm). All massesby TE presented either as solitary or multi-chambered cystic lesions with sharpoutlines. 11 patients underwent surgical treatment. During the operation wasfound complete coincidence with TE data. Most of patients underwent multistephydatidectomy from heart, lungs, brain; in 3 patients was performed one-momentcystectomy from heart and liver or lung. After the operation, all patients underwentthree or more courses of chemotherapy. 5 patients underwent conservative therapydue to general condition; 3 of them died within 11 months.Conclusion: TE is the primary modality for imaging of HE. It provides highresolution,real-time images. MRI is a useful method in differential diagnosticsof cysts providing additional information concerning relation of the cysts to theadjacent structures.C-176MR imaging of “no-reflow” phenomenon after PCI for acute myocardialinfarctionL. Natale 1 , A. Meduri 1 , A. Bernardini 2 , C. Liguori 1 , R. Marano 1 , L. Bonomo 1 ;1Rome/IT, 2 Teramo/ITLearning Objectives: To demonstrate the appearance of no reflow with delayedenhancement and with first pass perfusion imaging. To demonstrate differencesbetween the above mentioned techniques. To demonstrate the different impact onprognosis of the two techniques.Background: Even the complete restoration of epicardial blood flow could result inan incomplete reperfusion of microvascular bed, causing hypoperfused zones withinthe previously ischemic myocardial infarction. These phenomena were described as“no-reflow”. New imaging modalities (such as myocardial contrast echocardiography,magnetic resonance or scintigraphic techniques) allow to precisely assess perfusionat microvascular level confirming the presence of myocardial areas with impairedperfusion even with completely restored epicardial flow. Moreover, the amount ofno-reflow was found to significantly predict left ventricular segmental wall motiondysfunction, ventricular remodeling and clinical outcome.Imaging Findings: After introducing the pathophysiology of the “no-reflow phenomenon”,its impact on left ventricle remodeling is underscored. The appearanceof no-reflow is shown in both first pass and delayed enhancement MRI, with abrief mention to other current techniques (other than MRI). Finally, differencesbetween first pass and delayed enhancement MRI in no-reflow assessment arescrutinized.Conclusion: No-reflow reflects microvascular damage due to both infarction andreperfusion. In segments with non transmural delayed enhancement, the presenceof no-reflow is a negative prognostic factor for functional recovery. No-reflowrepresents the major prognostic factor predicting left ventricle remodeling. Mild tomoderate rest perfusion defects at first pass MR represent no reflow phenomenanot visible at delayed enhancement, but significant for prognosis.C-177MR assessment of myocardial delayed hyperenhancement in hypertrophiccardiomyopathy for stratificationO. Larina, O. Stukalova, V.E. Sinitsyn, M. Smirnova, S. Ternovoy, F. Ageev;Moscow/RU (Larina-Olga@yandex.ru)Purpose: To estimate the extent and distribution of focal myocardial hyperenhancementdetected with delayed contrast-enhanced MR imaging (DCE MRI) inpatients with severe left ventricle hypertrophy caused by hypertrophic cardiomyopathy(HCP) and compare their occurrence with presence of clinical risk factorsof sudden death.Methods and Materials: 18 patients with HCP were studied using 1.5 T MRscanner.Cine-MR was done using TrueFISP sequence. First-pass myocardialperfusion assessment during bolus injection of Gd-DTPA-BMA (0.1 mmol/kg) wasfollowed (after 15 min) with studies of delayed contrast enhancement (DCE) usingsegmented IR sequence.Results: Three types of myocardial hyperenhancement were found: isolated focuses(21%), multiple focuses (50%) and diffuse hyperenhancement (29%). There wassignificant difference in myocardial end-diastolic thickness between hyperenhancingand non-enhancing segments (19.06.4 vs. 10.64.7 mm, p 0.001). Significantcorrelations were observed between end-diastolic segment's thickness and extentof DCE (r=0.26, p 0.05), maximum values of hyperenhanced area were found insegments with thickness 25 mm. Four patients (22%) had episodes of syncope,and there was moderate correlation between volume of DCE and presence ofsyncopes (r=0.53, p=0.04). No patient had episodes of ventricular tachycardia. Inthe group studied, no correlation was found between extent of myocardial enhancementand presence of genetic markers of HCM.Conclusion: In the group of HCM patients studied, correlation between the extent andpresence of DCE from one side, and extent of myocardial hypertrophy and presenceof syncopes from other side (possible risk factors of sudden death) was found.C-178Evaluating the enhancement of atherosclerotic plaque on contrastenhancedMRA: Comparison with CTAT. Li, J.-h. Gao; Beijing/CN (zyf0627@yahoo.com.cn)Purpose: To evaluate the enhancement of coronary atherosclerotic plaque revealedby CTA using pre- and post-contrast navigator-gated 3D-SSFP sequence and therelationship between plaque enhancement and CT value of the plaque.Methods and Materials: Nineteen patients with non-calcified plaques on theproximal or middle segments of coronary artery detected by MDCT were studied.The coronary MRA was acquired before and after Gd-DTPA administration usingnavigator-gated 3D-SSFP sequence. The cross-section images perpendicular tothe long axis of coronary artery were reformatted on MRA. Plaque enhancementwas assessed using CNR. 50% increase of CNR was defined as enhancement.The relationship between CNR increment and CT value was analyzed.Results: Twenty-four plaques of 14 patients were identified on both pre- and postcontrastMRA. 11 plaques showed enhancement. 13 plaques showed no enhancement.CNR between 24 plaques and surrounding fat tissue were 10.294.28 and14.085.8 in pre- and post-contrast MRA and there was a significant difference(P 0.01). CNR was significantly increased from 8.433.59 to 17.556.18 in 11enhanced plaques and no significant change (11.864.3 versus 11.153.48) in 13non-enhanced plaques. There was no significant difference of CT value betweenthe enhanced plaques (68.4424.72) and non-enhanced plaques (57.8224.13).There was no relationship between CNR increase of coronary atheroscleroticplaque on MRA and CT value.Conclusion: Enhancement of plaques can be demonstrated on CEMRA. Theenhancement of plaques on MRA has no relationship with CT value.No Material Submitted to EPOSCS374 A B D E F FG H

Scientific and Educational ExhibitsC-179The diagnostic role of cardiac 31P-MRS combined with transmitral MR-flowmeasurements in patients with hypertensive heart disease without overtsystolic dysfunctionT. Burkhard, C. Herzog, F. Huebner, T.J. Vogl; Frankfurt a. Main/DEPurpose: To evaluate the diagnostic role of 31P-MRS combined with transmitralMR-flow measurements in hypertensive patients compared to echocardiographyand tissue Doppler.Methods and Materials: 20 subjects (16 men and 4 women, mean age 57 13years) were studied with echocardiography and 31P-MRS at 1.5 Tesla using anECG-gated CSI sequence with nuclear Overhauser effect. 12 subjects had adiastolic dysfunction, 8 subjects served as control group in the following statisticalanalysis. All patients underwent phase encoded MRI to obtain transmitral flow patternsto calculate E/A ratio and deceleration time of the early filling curve DT (E).Comparison to echocardiographical results was performed. Statistical analysis wasmade by using mean SD for description of the data, Spearman correlation, Bland-Altman- and Lin-correlation and 2-tailed student-t test for independent samples.Results: No differences were found in weight, age, LVEF, endsystolic volume,enddiastolic volume, cardiac output and BNP levels between patients and controlgroups. Myocardial PCr/ATP-ratio in patients was significantly decreased comparedto controls (1.21 0.22 versus 1.54 0.24; p=0.006). Significant correlation existedbetween echocardiographical and MR assessment of diastolic function. Bland-Altman correlation was r=0.29, p=0.03, 95%-CI for r:[0.03; 0.52]; Lin-concordancewas: r=0.29, p=0.03, 95%-CI for r:[0.03; 0.52].Conclusion: Cardiac 31P-MRS combined with MR assessement of transmitral flowpatterns correlate well with echocardiographical findings and could be a non invasivemeans for detecting early states of heart failure in hypertensive patients.C-180Usefulness of cardiac magnetic resonance (CMR) in the non-invasiveevaluation of the Fontan procedure (FP)S. Navarro Herrero, P. Serrano Gotarredona, F.J. Jimenez Barros,J.J. Cordones Guerrero; Seville/ES (silvianavarroherrero@gmail.com)Learning Objectives: To illustrate the FP and its variants in the univentricular heart.To outline the advantages of CMR as a non-invasive technique in its evaluation. Todescribe the postsurgical follow-up and our results in a series of 30 patients.Background: The FP has achieved excellent results in patients with a univentricularheart, though it can lead to several late complications. CMR proves to be essentialfor excluding some of them, as pulmonary venous obstruction, ventricular outflowobstruction, collateral vessels, stenosis and thromboembolic events. It is also apriority to assess the ventricular contractile function, the competence of its inflowvalve and the width of its outflow tract.Imaging Findings: CMR allows describing the congenital cardiopathy and associatedanomalies. It depicts clearly the FP and its variants. CMR evaluates theventricular function and pulmonary perfusion. Contrast-enhanced 3D angiographyshowed the cardiopulmonary flow paths and the 3D structure of the vascularbranches. CMR shows collateral vessels, stenosis, and anatomical study of pulmonaryarteries. Cine-imaging allows to visualize the presence of flow in all thepostsurgical paths of FP.Conclusion: CMR is an advanced technique in the non-invasive evaluation of FP.Whichever the variant used, it is crucial to confirm the patency of the cavopulmonaryflow paths and to rule out stenosis. CMR gives us relevant information about thepulmonary anatomy and perfusion, the ventricular function and the postsurgicalevaluation of FP.C-181Role of cardiac magnetic resonance imaging in evaluation of hypertrophiccardiomyopathy (HCM): A single-center experienceN. Galea, I. Carbone, E. Algeri, H. Grazhdani, G. Cannavale, C. Catalano,A. Cannavale, R. Passariello; Rome/IT (nicogale2000@yahoo.it)Purpose: As HCM is a genetic disease whose initial manifestation can be suddendeath (SD), it is essential to establish an early diagnosis, to proceed with riskstratification and implementation of SD and cardiac failure prevention strategies.CMR provides not only morphologic and functional information, but also detectsedema and, after gadolinium injection, perfusion defects and areas of fibrosis.The aim of our study is to correlate MRI findings with clinical signs in patientsaffected by HCM.Methods and Materials: Thirty-five patients with a previous echocardiographicdiagnosis of HCM underwent CMR. They performed a cine study to assess freewall and septal thickness, volumes, myocardial mass and outflow tract area in theleft ventricle and evidence of systolic anterior motion (SAM) of the anterior mitralleaflet. CMR protocol included also T2-weighted sequences, First-pass perfusionand DE-IR sequences. All data were correlated with clinical signs as chest painand ECG anomalies (atrial fibrillation, branch block, episodes of sustained VTand/or VF).Results: Delayed enhancement has been detected in 26/35 patients (74%). Edemawas present in 15/35 patients (43%) and perfusion defects in 8/35 (23%). 26 ptspresented outflow tract obstruction and in 14 cases there was SAM. Chest painand arrhythmias were significantly more frequent in pts with LV outflow obstruction,SAM, edema and LE areas.Conclusion: Cardio MRI offers a complete assessment of HCM in a one-stopshopprocedure. CMR, with its capability to detect potentially arrhythmogenicmyocardial scarring, could provide additional information for the risk stratificationin selected patients.C-182Utility of T2 weighted short-tau inversion recovery (STIR) sequences incardiac MRI: Clinical applications in acute ischemic (AI) and non-ischemic(NI) heart diseaseM. Francone, F. Calabrese, I. Iacucci, F. Vasselli, C. Catalano, R. Passariello;Rome/IT (francescaantonella@interfree.it)Learning Objectives: To become aware of the basic MRI design of a T2w-STIRsequence and with possible edema artifact. To understand the pathophysiology andsignificance of myocardial edema in different AI and NI settings. To correlate differentpatterns of late enhancement with distribution and extent of T2w hyperintensity inthe clinical scenario of myocardial disease.Background: To illustrate clinical use and spectrum of applications in cardiac MRIof T2 weighted imaging using a short-tau inversion recovery technique (T2w-STIR)in pts with AI and NI diseases.Imaging Findings: Heart can be involved in a variety clinical disorders in whichheart muscle is preferentially involved or in which is a part of systemic diseases(infectious, ischemic, tako-tsubo, pulmonary hypertension, myocardial hypertrophy).Diagnosis is based on a clinically and compatible presentation, and technical investigations.Cardiac MR is an important tool for differential diagnosis, evaluationof morphologic patterns of AI and NI diseases. MR can be useful in evaluatingactivity of disease and determine treatment planning.Conclusion: T2 weighted STIR represents an appealing and versatile techniquethat can be applied in a wide variety of ischemic and non-ischemic conditions allowingdetection of segmental or global increase of myocardial free water contentwith high contrast difference between edematous myocardium and surroundingtissues. Detection of edema is clinically relevant because it not only representsan indicator of acute injury but should also be considered a prognostic marker innumerous clinical settings potentially affecting ventricular contraction and relaxation,initiating arrhythmias and inducing additional necrosis.C-183Inflammatory whole heart diseases (IWHD): Cardiac MR role inclassification and differential diagnosis of infective non-infective heartdiseaseF. Calabrese, M. Francone, I. Iacucci, F. Vasselli, C. Catalano, R. Passariello;Rome/IT (francescaantonella@interfree.it)Learning Objectives: To review the pathophisiology and clinical cardiac presentationof various IWHD. To understand the diagnostic role and strategies techniqueof CMR in the evaluation of IWHD. To discuss morphological, functional and hyperenhancementfindings and correlate them to clinical situations.Background: To evaluate the advantages and limitation of cardiac MR in patientswith clinical diagnosis of IWHD (endocardial, myocardial and pericardialdiseases).Imaging Findings: Heart can be involved in a variety inflammation disorders inwhich heart muscle is preferentially involved (myocardities) or in which is a partof systemic diseases (infectious, metabolic or hymmunitary disorders). Symptomonset is usually gradual but may be sudden and severe. Diagnosis is based ona clinically compatible presentation, ECG, physical and technical investigations(cardiac imaging, laboratory investigations). Cardiac MR is an important tool fordifferential diagnosis, evaluation of morphologic patterns of IHD.MR can be usefulto evaluate activity of disease and determine treatment planning.CardiacACB D E F G HS375

Scientific and Educational ExhibitsConclusion: MR demonstrates different imaging findings in patient in acute(edema) or chronic phase. DE can demonstrate osmotic alterations of heart cellsin acute phase and the size, location and extent of fibrosis process in the chronicphase. In conclusion, MRI is characterized by high tissue characterization and theknowledge of location of CE delayed, of functional and clinical parameters canallow a differential diagnosis of IWHD. Only in the valve leaflets evaluation caseMRI is inferior in morphologic analysis, but is superior in quantification of flow andvelocity in valve apparatus.C-184Cardiac tumorsI. Santiago 1 , M. Portilha 2 , B. Gonçalves 2 , H. Rodrigues 2 , P. Donato 2 ,F. Caseiro-Alves 2 ; 1 Aveiro/PT, 2 Coimbra/PTLearning Objectives: To illustrate the CT and MR imaging findings of various typesof cardiac tumors diagnosed at our institution. To discuss the pertinent literature ondistinguishing clinical and imaging features of each type of cardiac tumor. To outlinethe advantages and disadvantages of CT and MR for cardiac tumor diagnosis.Background: Cardiac tumors are rare, often clinically non-specific and potentiallylife-threatening. Early diagnosis is of utmost importance, since some are surgicallycurable. CT and MR can accurately image the heart and surrounding structureson multiple planes, providing important information regarding size, extension andcomposition of heart tumors. In this exhibit, we will depict the CT and MR imagingfindings of selected cases of cardiac tumors from the pathology records of ourinstitution.Imaging Findings: We selected histologically confirmed cases of benign and malignantheart tumors from the pathology records of our institution for which CT and/or MR were performed, such as pericardial cysts, myxomas, hamartomas,fibromas,metastasis and sarcomas; gathered and summarized the patients’ relevant clinicalinformation; depicted and described the differentiating imaging findings, namelylocation, size, composition, patterns of enhancement, invasiveness and associatedfindings; and overviewed the pertinent literature on each type of tumor describedand the main advantages and disadvantages of CT and MR.Conclusion: CT and MR imaging findings help differentiate benign from malignantcardiac tumors, sometimes even further narrowing the differential diagnosis;therefore, influencing their management.C-185Cardiac cine MRI at 3 Tesla (comparision of SSFP and FLASH sequence)J. Suyama, N. Seino, Y. Ohgiya, M. Hirose, T. Gokan; Tokyo/JP (jcarl_s@yahoo.co.jp)Purpose: The aim of this study was to compare cardiac cine MRI using steadystatefree precession (SSFP) and Fast Low Angle Shot (FLASH) at 3 T MRI aboutcontrast to noise ratio (CNR) and visual image quality assessment.Methods and Materials: All images were acquired on a 3 T Siemens MAGNETOMtrio. Seven healthy volunteers underwent magnetic resonance imaging using SSFPand FLASH sequence on the same day. For both SSFP and FLASH imaging,8-mm thick short axis view and long axis view were acquired with equal matrix size(192×192). CNR calculations were performed on the short axis images acquiredat end systole time point when myocardium has maximum thickness between leftventricular blood and myocardiums, and compared between 2 sequences. Andvisual image quality was assessed by three radiologists.Results: In the CNR, SSFP images were better than FLASH images (SSFP:7.142.16, FLASH: 3.571.83). Visual image quality also revealed that SSFP weresuperior to FLASH in both short and long axis views. Although SSFP images containeddark blood artifact in 2 cases, these were improved by frequency offset.Conclusion: SSFP sequences provided higher quality image than FLASH sequenceand would be available for cardiac cine MRI at 3 T.C-186Sequential changes of myocardial microstructure in patients postmyocardial infarction by diffusion-tensor cardiac MR: Correlation with leftventricular structure and functionM.-T. Wu 1 , M.-Y. Su 2 , W.-Y. Tseng 2 ; 1 Kaoshiung/TW, 2 Taipei/TW(wu.mingting@gmail.com)Purpose: To investigate the sequential changes of microstructure from recent tochronic myocardial infarction (MI) using diffusion-tensor cardiac MR (DT-CMR).Methods and Materials: Institutional review board approval and informed consentwere obtained. Seventeen patients from our previous study participated (age=55.111.5years, all men). Myocardial microstructure, including tissue integrity (mean diffusivity[MD], fractional anisotropy [FA]) and fiber architecture (helix angles [HA]), together withmyocardial viability by late gadolinium-enhancement and wall function by cine fast gradientecho image were measured at recent and chronic MI (interval=19159 days).Results: As compared to the remote zone, the infarct-adjacent zone showed overallincrease of MD (two-way MANOVA, F 1.16=36.3, P 0.001), decrease of FA (F 1.16=5.8,P=0.029) and decrease of mean HA (F 1.16=62.0, P 0.001). From recent to chronicMI, the differences of wall thickness and wall thickening between the remote zoneand infarct-adjacent zone progressed (P 0.001, P=0.020, respectively). Therewas overall sequential decrease of MD (F 1.16=22.6, P 0.001) and increase of FA(F 1.16=7.8, P=0.013). Multiple linear regression showed the improvement of wallthickening in the infarct-adjacent zone correlated with decrease of MD in the infarctadjacentzone (r=-0.70, P=0.002) and increase of mean HA (i.e., more right-handedhelical myofiber reorientation) in the remote zone (r=0.60, P=0.011). Likewise, wallthickening in the remote zone correlated with MD in the remote zone (r=-0.72,P=0.001) and mean HA in the infarct-adjacent zone (r=0.72, P=0.001).Conclusion: DT-CMR showed that zonal improvement of tissue integrity and fiberarchitecture remodeling both contributed to zonal wall thickening recovery fromrecent MI to chronic MI.C-187MR imaging in endomyocardial fibrosisS.N. Patro, T.R. Kapilamoorthy, N.K. Bodhey, A.K. Gupta, W. Sumnyan;Trivandrum/IN (drsatyanpatro@gmail.com)Purpose: 1. To study the extent and pattern of myocardial involvement in theexclusive tropical endomyocardial fibrosis with delayed contrast enhancement.2. To assess the feasibility of endocardiectomy and subsequent follow-up. 3. Todifferentiate EMF from other non-ischemic cardiomyopathies.Methods and Materials: 30 patients of EMF planned for endocardiectomy & valvereplacement on the basis of echocardiography were selected for MRI. Cine images,SE T1WI, velocity-encoded MR and postprocessing on Argus were done to assessthe morphology, ventricular functions and vascular velocities. Pattern of enhancementwas studied with phase shift IR scans performed at 10 - 60 mts.Results: Myocardium involvement was seen with partial obliteration of ventricular cavitypredominantly in ventricular apex or in the inflow regions. Ventricular cavity showed characteristiccrevices and outpouchings in cine images. AV valve incompetence was seen in73% of cases due to plastering of leaflets. The LV ejection fraction (varied from 30 to 50%)was a effective tool to suggest improvement in postsurgical cases. There was associatedthrombus (in 10%) and pericardial thickening/effusion (in 30%). The enhancement wasseen later (25-45 minutes) than that is seen in the cases of ischaemic heart disease. Thepattern of enhancement was irregular and bizarre unlike in ischaemic myocardium.Conclusion: Due to the possible involvement of the RV also in EMF, MRI than justechocardiography best studies this pathology. The timing and pattern of delayedenhancement is different from other diseases. MRI gives a comprehensive assessmentof the myocardial involvement.C-188Role of cardic magnetic resonance (CMR) in the diagnosis and evaluationof sinus venosus defect (SVD)P. Serrano Gotarredona, S. Navarro Herrero, J. Cordones Gerrero,B. Sobrino Guijarro, J. Jiménez Barro; Seville/ES (mpserranogot@gmail.com)Learning Objectives: To depict morphologic findings of SVD with anomalous rightupper pulmonary venous connection (RUAPVC), by illustrating six such casesreferred for CMR in our institution. To describe study protocol, which also includedventricular volumes and function quantification, as well as flow measurements toassess pulmonary-to systemic flow ratio.Background: SVD account for only 2 to 10% of atrial septal defects. High occurrenceof presentation in adult age has been reported. The more common SVDoccurs in the upper atrial septum and is contiguous with the superior vena cava(SCV). It is almost always associated with anomalous pulmonary venous drainageof the right upper pulmonary vein (RUPV) to the SVC. Preoperative recognitionof the extraseptal nature of the interatrial communication is essential for surgicalplanning. Echocardiography usually is sufficient for demonstrating RUAPVC inyounger children but may be missed in adolescent or adult patients.Imaging Findings: This anomaly is recognized as a deficiency in the wall thatnormally separates the left atrium and RUPV from the SCV, so that the pulmonaryvein is left unroofed, compelling it to drain into the SCV or into the superior domeof the right atrium (RA) at the level of the caval atrial junction.Conclusion: Cardiac MRI has to be considered as an adequate alternative methodfor surgical planning of SVD repair, because it is able to accurately depict SVDanomaly and associated RUAPVD, as well as to provide accurate quantitativeinformation on the hemodynamic burden.CS376 A B D E F FG H

Scientific and Educational ExhibitsC-189Systemic vasculitis with cardiac involvement: Cardiovascular magneticresonance (CMR) findingsD. Piotrowska-Kownacka, L. Kownacki, D. Gawryluk, O. Rowinski; Warsaw/PL(dpiotrowska@tlen.pl)Purpose: The aim of our study was CMR evaluation of cardiac function, rest perfusionand delayed enhancement pattern in patients with systemic vasculitis.Methods and Materials: In the study, we included 13 patients with systemic vasculitis:9 with Churg-Strauss syndrome (CSS) and 4 with Wegener’s granulomatosis (WG).Cardiac involvement was suspected based on clinical symptoms and echocardiographicfindings. All patients underwent CMR examination including function assessment,rest perfusion and delayed enhancement imaging. Perfusion defects anddelayed gadolinium enhancement were assessed using 17 segments model.Results: Left ventricular (LV) ejection fraction ranged from 17.9 to 61.7% (mean41.6 14%). LV dysfunction was observed in all patients with Churg-Strauss syndrome(mean 34.411.2%, ranged from 17.9 to 48.9%) and in 1 with Wegener'sgranulomatosis. In all studied patients delayed enhancement was observed 10-20 minutes after Gd-DTPA administration (0.1 mmol/kg b.w). In CSS, delayedenhancement was subendocardial (9/9 pts) or/and transmural (6/9 pts). The numberof affected segments ranged from 5 to 17 (median 10). In WG delayed enhancementwas intramural or/and subepicardial. Perfusion deficits were detected in 3/9patients with CSS and in 1 with WG.Conclusion: CMR revealed crucial information in patients with systemic vasculitis.Delayed enhancement pattern was typically subendocardial or partially transmuralin Churg-Strauss syndrome opposite to intramural and subepicardial in Wegener’sgranulomatosis.C-190Cardiac MRI: A survival guideG. Tardaguila de la Fuente, F. Tardáguila Montero, R. Varela Ponte,C. Trinidad López, G. Fernández Pérez; Vigo/ES (gonzatar@gmail.com)Learning Objectives: The objective of this exhibit is not to make a deep revision ofphysics and specific pathology but to make a schematic and easy to understand reviewof most common cardiac pathology that could be diagnosed with cardiac MRI.Background: On one hand MRI physics is complicated. On the other, many radiologistsare not familiarized with cardiac pathology as it is a relatively new field for them.These two premises make cardiac MRI a subject that sometimes frightens radiologistswho are not used to it. But the knowledge of the basic sequences, cardiacplanes and contrast enhancement patterns will allow non-specialised radiologistsand residents to diagnose the most prevalent cardiac pathologies.Imaging Findings: We will illustrate and explain how to obtain the basic cardiacplanes (short axis, long axis, four chambers and left ventricle outflow tract). Wewill use basic morphologic sequences to explain the most prevalent structuralcardiopathies. Cine sequences will be shown to explain valvular disease and contractilitydefects. T2 weighted images, first pass perfusion (with and without stresswith adenosine) and late enhancement (viability) will be explained to illustrateischemic cardiopathy and how to differentiate acute from chronic ischemic heartdisease including hibernated myocardium.Conclusion: It is necessary for radiologist to be familiarized with terminologyand sequences used in cardiac MRI. Cardiac MRI is not as complicated as it isoften thought.C-191Is there a role for coronary MR angiography for the follow-up of patientswith Kawasaki disease?E. Algeri, I. Carbone, N. Galea, G. Cannavale, D. Cannata, C. Catalano,R. Passariello; Rome/ITResults: Coronary-MR-angiography produced diagnostic images in 13/15 patients.Information provided by coronary-MRA in the 13 diagnostic exams correlated wellwith SCA and MDCT findings.Conclusion: Coronary-MRA is a very useful diagnostic tool for the follow-up of ptswith KD. In order to reduce radiation dose, the decision to perform SCA or MDCTcan be based on coronary-MRA findings.C-192Cardiac planes in tomography and magnetic resonance imaging in theevaluation of double outlet right ventricleL.M. Pabón, N. Pedreañez, C. Ng, M. Carrillo; Caracas/VE(luzmpabon@hotmail.com)Purpose: Defining the planes by magnetic resonance imaging (MRI) and computedtomography (CT) in the double outlet right ventricle (DORV) diagnosis.Methods and Materials: Cardiac CT and MRI revision with DORV diagnosis todetermine the planes characterizing the location of the ventricular septal defect(VSD), the relationship of the great arteries and the outflow tract permeability,confirming the findings with the echocardiogram.Results: The total studies reviewed with DORV diagnosis by TC and IRM, included3 CT and 12 MRI. The axial slices defined the relationship of the great arteries hadas result- according to GAR classification (great arteries relationship): 1 (GAR 1),3 (GAR 2), 1 (GAR 3), 5 (GAR 4), 3 (GAR 5). The four-chamber planes and theshort axis in multiple slices determined the VSD type: they were 4 subaortic VSD,3 subpulmonic and 2 doubly committed and 4 noncommitted. The short multiphase- multislice permitted the evaluation of the ventricular function by MRI. The fourchamberplanes and the long horizontal or vertical axis allowed to evaluate theoutflow, showing 7 pulmonary obstructions; 1 subaortic obstructions, 2 pulmonaryand subaortic obstruction, 2 cases with no obstruction and 3 pulmonary atresias.The presence of associated anomalies was determinated with the vascular reconstructionby CT and the MRI-angio.Conclusion: The MRI and the CT are complementary methods that not only allowto make a diagnosis of vascular abnormalities associated to DORV but also areuseful to confirm intracardiac findings that determine in the surgical decision.C-193Realistic visualization of DTI tractography of healthy and ischemic heartsT.H.J.M. Peeters, A. Vilanova, G.J. Strijkers, B.M. ter Haar Romeny;Eindhoven/NL (B.M.terhaarRomeny@tue.nl)Purpose: We use DTI to improve the understanding of the structure of the musclefiber orientation in the heart wall, and how this changes with ischemia. Becausethe heart wall is built from a vast amount of fibers, visualization is challenging.We present a new photo-realistic rendering method, which greatly improves thevisual appearance.Methods and Materials: Inspired by hair rendering methods, we use line illuminationand shadowing of fibers to improve the perception of the shape of the fibersand their mutual coherency. Color encodes the out-of-plane components of thefibers, and fractional anisotropy.Results: The new visualization methods are applied to a series of mouse models (9Tesla small bore MRI) of healthy and ischemic hearts (7 days after the infarct). Theinsight in the fiber structure becomes much better visible, in an intuitive way.Conclusion: Proper illumination of lines improves the perception of fiber shapes.Shadows improve the perception of coherencies among fibers. Our slice visualizationallows for combined visualization of structure and function, and extra propertiessuch as fractional anisotropy.Purpose: Kawasaki disease (KD) is an acute systemic vasculitis, often involvingcoronary arteries with the development of aneurysms that may evolve to rupture,thrombosis, up to complete occlusion. Since patients with KD need to be periodicallyfollowed-up from the time of diagnosis to evaluate the evolution of CA disease, anon invasive method, without any ionizing radiation employment is highly desirable.The aim of our study was to test the ability of coronary-MR-angiography to identifyand follow-up CA lesions in patients with KD.Methods and Materials: 15 patients with a previous diagnosis of KD underwent acoronary-MRA. First a whole heart bSSFP acquisition was performed, then, after theintravenous injection of 8 mL of a blood-pool contrast agent (Vasovist 0.25 mMol/mL,Schering), a further steady state whole heart acquisition was performed. Imageswere reconstructed on a dedicated software, using MPR, curved MPR and MIP.Results were compared with findings at previously performed selective coronaryangiography (SCA) and/or multi detector computed tomography (MDCT).CardiacACB D E F G HS377

Scientific and Educational ExhibitsC-194Three methods for quantification of mitral regurgitation fraction bycardiovascular magnetic resonanceE.A. Mershina, V.E. Sinitsyn, G.A. Shiriaev; Moscow/RU(elena_mershina@mail.ru)Learning Objectives: To remind the three methods for quantifying of mitralregurgitation fraction (RF) with cardiovascular magnetic resonance (CMR) anddemonstrate their comparability.Background: Velocity-encoded MRI has been reported to provide accuratemeasurement of the volume of blood flow in the ascending aorta and through themitral annulus. 1. Biventricular volumetric analysis: RF (VOL) = [LVSV - RVSV],where LVSV is left ventricular stroke volume and RVSV is right ventricular strokevolume. 2. RF (FLOW) = [LVSV - aortic flow volume]. 3. RF (in/out) = [LV inflow- aortic flow volume]. This method calculates the difference between LV outflowand inflow. LV inflow is assessed by velocity mapping at the mitral valve annulusduring diastole.Imaging Findings: We examined 10 healthy volunteers without cardiac valvulardisease confirmed with echocardiography. All subjects underwent LV and RVvolumetry, aortic flow and LV inflow measurements. There was good agreementbetween aortic flow volume and RVSV (mean difference 3.5 1.8 ml), LVSV andLV inflow (mean difference 2.8 3.2 ml).Conclusion: All three methods are applicable. The most time-consuming andsensitive to errors in RVSV visualization and regurgitation of other heart valves isbiventricular volumetric analysis. LV inflow calculation was the most difficult partof this study because it acquires the flow at a fixed location during the cardiaccycle, which is not necessarily the location of the mitral valve during the wholecycle. Subtracting aortic flow volume from LVSV is the optimal CMR technique toquantify mitral regurgitation.ChestLungC-195Imaging of lymphatics in the lung: From past to presentN. Nitta 1 , M. Takahashi 1 , Y. Nagatani 1 , H. Otani 1 , K. Shimoyama 2 , Y. Murakami 1 ,K. Murata 1 ; 1 Otsu/JP, 2 Fukuchiyama/JP (r34nitta@yahoo.co.jp)Learning Objectives: To give an overview by describing research history oflymphatics in the lungs. To learn about distribution of lymphatics and systematicclassification. To discuss anatomical problems of lymphatics. To review various lungdiseases invading the lymphatic system.Background: Lymphatics are invisible to CT when there are no abnormalities. Itis important to know the distribution of lymphatics in the lungs.Imaging Findings: Analysis of inflated, fixed lungs after contrast medial injection tovisualize lymphatics. Introduction of the two systems of lymphatic flow in the lungswith a scheme: 1) Interstitium-pulmonary veins system and 2) Bronchi-pulmonaryarteries system. Exploration of anatomical problems of lymphatics in the lungs: 1)Presence or absence of lymphatics in the alveolar regions; 2) Higher distribution oflymphatics around pulmonary artery than bronchi and 3) Association of subpleuralwith deep lymphatics. Studying how lung lesions invade the lymphatics, based onHRCT findings and the discussions about concerning conditions, such as lymphangitiscarcinomatosa, pulmonary edema, sarcoidosis, malignant lymphoma, acuteeosinophilic pneumonia and so on.Conclusion: To enhance understanding of the complicated lymphatic system inthe lungs. To identify keys to solutions of anatomical problems based on previousreports and our experience. To promote better understanding of lung lesions invadingthe lymphatic system based on anatomical findings.C-196Revision of the lung cancer TNM staging: Pictorial review of the proposedchanges and its limitationsJ.V. Raj, A. Bajaj, J.J. Entwisle; Leicester/UK (drvimalraj@googlemail.com)Learning Objectives: 1. Review (pictorial) the proposed changes to the T, N andM descriptors in the forthcoming (seventh) edition of the TNM classification of lungcancer. 2. Highlight limitations of the proposed system.Background: Non small cell lung cancer is the leading cause of cancer relateddeaths. TNM staging of lung cancer plays a critical role in determining the therapyand the prognosis of the disease. In 1996, the international association for the studyof lung cancer launched a worldwide TNM staging project to inform the next editionof the staging system, which is due to be published in early 2009.Imaging Findings: Changes to the T stage of the tumour: table and images. For ex:T1 and T2 subclassified into a and b subgroups, nodule in the same lobe classifiedas T3 instead of current T4. N stage of the tumour: table and images. Changes tothe M stage of the tumour: table and images. For ex: Subclassification of M1 into1a and 1b. Limitations of the proposed system: lymphangitis carcinamatosa notincluded. Different bulk of N2 disease not given sufficient importance.Conclusion: The TNM staging is evolving to reflect the changing algorithms inpatient management worldwide. It is vital for all the radiologists to be well versedwith these proposed changes in the current system and appreciate its limitations.C-197Imaging findings of malignant pleural mesothelioma (MPM) in JapanK. Kato 1 , T. Kishimoto 1 , K. Genba 1 , Y. Takeshima 2 , K. Inai 2 , S. Kanazawa 1 ;1Okayama/JP, 2 Hiroshima/JP (kato-rad@cc.okayama-u.ac.jp)Purpose: Our purpose is to evaluate the radiological findings of MPM by reviewingthe images of MPM cases in Japan.Methods and Materials: Among 2742 mesothelioma death cases extracted by“Vital Statistics of Japan 2003 to 2005”, we reviewed 211 MPM cases (182 men, 29women; mean age, 69 years) in which the chest CT, XP and pathologic specimenswere obtained. 1. We reviewed whether there was pleural plaque, pleural effusionand asbestosis or not on images. 2. Abnormal CT findings of the pleura werecategorized as follows: Category 1 (Cat-1), no thickening; Cat-2, smooth thickening;Cat-3, irregular thickening and Cat-4, mass formation. The categories of eachcase were compared with T-stage according to IMIG. 3. We reviewed localizationof the pleural irregularity. We focused on three places as follows: mediastinal, fissuraland basal pleura.Results: 1. In all 211 cases, pleural plaque was present in 37% cases on CT andin 12% cases on XP. Each pleural effusion and asbestosis was present in 93 and3% cases on CT. 2. The ratio of each category was as follows: Cat-1 5%, Cat-2CS378 A B D E F FG H

Scientific and Educational Exhibits17%, Cat-3 35% and Cat-4 43% cases. As for correlation with T-stage, the majorityof patients of Cat-1 and Cat-2 were T1-2 (91%) and Cat-3 and Cat-4 were T3-4(85%). 3. Location of pleural thickening was mediastinal in 78% cases, fissural 47%cases and basal in 73% cases.Conclusion: For early diagnosis of the MPM, it is necessary to pay attention toslightly pleural irregularity, especially mediastinal pleura in persistent pleural effusioncase with unknown cause.C-198Various imaging findings of pulmonary alveolar proteinosisK. Kato, Y. Okumura, H. Hayashi, H. Yamamoto, S. Kanazawa; Okayama/JP(kato-rad@cc.okayama-u.ac.jp)Learning Objectives: To demonstrate the wide spectrum of imaging findings ofpulmonary alveolar proteinosis (PAP) on CT/HRCT. To know imaging findings ofPAP on various stage (from early to advanced). To recognize the importance of thefinding “crazy-paving” to make a correct diagnosis of PAP.Background: PAP presents various imaging findings on CT. On this exhibit weshow various cases from a typical to atypical and rare imaging findings of PAPespecially focusing on CT (including HRCT).Imaging Findings: We show plain X-P and CT/HRCT images of the followingvarious impressive cases of PAP proven by pathological specimen: Subpleural andapical distribution. We show localized ground-glass opacity and diffuse centrilobularopacities. We follow, from very early to advanced stages, the course of showingreticular opacities coexisting with ground-glass opacities, which is the so called“crazy-paving”. We have migration of a lesion that underwent prone positioned CT.We also show typical cases of PAP.Conclusion: We will show the spectrum of disease in PAP by showing variouscases and emphasize the patterns most frequently associated with PAP. We couldfind various degrees of “crazy-paving” like appearances in most PAP cases. Weshould suspect PAP when we see such findings as “crazy-paving” like appearances,which is therefore GGO with reticulation.C-199Imaging characteristics of the solitary pulmonary noduleY.M. Jones 1 , A.J. Clark 2 ; 1 Liverpool/UK, 2 Stoke-on-Trent/UK(yvonnejones25@hotmail.com)Learning Objectives: To describe and illustrate the salient imaging appearancesof a solitary pulmonary nodule that can aid the radiologist in differentiating benignand malignant nodules.Background: The incidental finding of a solitary pulmonary nodule is a frequentclinical occurrence. With the advent of improved CT scanners and the possibilityof introducing screening for lung cancer it is becoming increasingly common, andis likely to continue to do so. Until fairly recently, it had been widely accepted thatnon-calcified pulmonary nodules should be considered to be malignant until provenotherwise; however, current thinking has evolved from this.Imaging Findings: Nodule contour, location, cavitation, attenuation, presence offat or calcification, size, volume doubling time, enhancement properties on CT andMRI and metabolic activity on 18 F-FDG PET are all valuable features in evaluatingthe likelihood of malignancy within a solitary pulmonary nodule. We review theseimaging characteristics with illustrative examples.Conclusion: The SPN often causes a clinical dilemma. Early detection and correctmanagement of malignant nodules is crucial, with the aim of minimising unnecessaryintervention and follow-up of benign lesions, while detecting malignant nodules atthe earliest opportunity. This review demonstrates, with examples, the key imagingappearances that can assist the radiologist in determining whether a solitarypulmonary nodule is more likely to be benign or malignant.C-201Lymphoid lesions of the lung: Multidetector CT (MDCT) features andpathologic correlationsC. Nedelcu, A.-L. Gourdier, S. Abi Khalil, M.-C. Rousselet, C.-M. Singeorzan,C. Aubé; Angers/FRLearning Objectives: To know the MDCT features of various lymphoid lesionsof the lung. To illustrate the etiologic diagnostic with clinical radiologic-pathologiccorrelations.Background: There is a large spectrum of lymphoid lesions of the lung: benignreactive infiltrates as lymphoid interstitial pneumonia, follicular bronchiolitis, Castelmandisease and intrapulmonary lymph nodes; malign primary lesions as lymphoidgranulomathosis and primary lymphoma (most frequently MALT); secondary malignlesions as lung dissemination of a nodal lymphoma and neoplasic lymphangitis.Imaging Findings: The MDCT scan features of those lesions are highly polymorphic,and clinical, biological and pathological correlations are necessary to reachthe diagnosis. The opportunist infections especially in immunosuppressed patientsare an important differential diagnostic and a classical pitfall.Conclusion: The lymphoid lesions of the lung have various MDCT aspects anddifferent etiologies. The low of specificity of CT scan signs impose a clinical, biologicaland pathological correlation for a right diagnostic. Not to forget the opportunistinfections in immunosupressed patients.C-202A computed tomography (CT) score for sarcoidosis: Observer variationand correlation with lung functionP.A. de Jong 1 , M. Nagtegaal 2 , H. de Jong 1 , J.C. Grutters 2 , J.M. van de Bosch 2 ,V. Karthaus 2 , H.W. van Es 2 , J.P. van Heesewijk 2 , S. Braak 2 , B. van Ginneken 1 ,M. Prokop 1 ; 1 Utrecht/NL, 2 Nieuwegein/NL (pimdejong@gmail.com)Purpose: Chest CT can be used for obtaining prognostic information and phenotypingfor genetic studies in sarcoidosis. A detailed CT-score for this purpose islacking. We developed such a CT-score and tested its reproducibility and correlationwith lung function.Methods and Materials: For a cohort study that correlates genotypes, phenotypesand prognosis, we obtained HRCT, positron-emission-tomography, lung functiontests, blood samples, and broncho-alveolar-lavage in 135 sarcoidosis patients. Inorder to perform detailed mapping of the CT phenotype, we established a CT-scorethat included nodules, parenchymal, bronchial, air space, lymph node and pleuralinvolvement. The parameters were scored per lobe (except lymph nodes). Oneobserver scored 135 cases to correlate CT-scores with lung function (Spearman); asecond observer scored 50 scans to estimate reproducibility of the scoring system(intraclass correlation).Results: Patient age at HRCT was 4412 yrs; the interval between HRCT and lungfunction was 425 days. FVC, FEV 1/FVC and DCLO were 9619% pred, 7710 and7815% pred, respectively. The most frequent findings on HRCT were lymphadenopathy(84%), nodules (61%), bronchial disease (46%) and parenchymal distortion(44%). Intraclass correlation was excellent for the CT-score (R=0.89) and decreasedfrom 0.79 (septa and consolidations) to 0.44 (ground glass and mosaic pattern) forthe individual items. Significant negative correlation with lung function was found forCT-score (0.44R 0.54, p 0.0001) and most CT items (0.22R 0.42, p 0.01)except for nodules, ground glass and mosaic pattern.Conclusion: In this pilot study, we found excellent reproducibility for our total CTscoreand good reproducibility for most CT items. Total CT-score was significantlyrelated to lung function.C-203Disease-modifying antirheumatic drugs (DMARDs)-induced lung disease inpatients with rheumatoid arthritis: Chest radiographic and high-resolutionCT findingsS. Sakai, H. Yabuuchi, Y. Matsuo, T. Kamitani, T. Setoguchi, H. Honda;Fukuoka/JP (sakai@shs.kyushu-u.ac.jp)Learning Objectives: To know the kinds of disease-modifying antirheumatic drugs(DMARDs) causing lung diseases. To know the clinical criteria of drug-inducedlung disease. To demonstrate the image findings in patients with DMARDs-inducedlung disease.Background: Recent progress in the development of DMARDs has greatlyimproved the status of rheumatoid arthritis (RA) patients. However, adverse lungreactions to DMARDs are potentially life-threatening. The diagnosis of DMARDsinducedlung disease is difficult because the clinical and radiological findingsare nonspecific and periods between the introduction of a drug and the onset ofsymptoms are various in each patient. The recent studies reported that potentialpredisposing factor for acute lung disease is pre-existing interstitial lung disease. Theaim of this educational exhibit is to show the chest radiographic and high resolutionCT (HRCT) findings in the patients with DMARDs-induced lung diseases.Imaging Findings: Among DMARDs, injectable and oral gold, bucillamine, methotrexate,and leflunomide are able to cause potentially the adverse lung reaction.Main histological types of these drugs-induced lung diseases are nonspecificinterstitial pneumonia, organizing pneumonia, and diffuse alveolar damage. However,these histological conditions are also seen as RA-related lung diseases.Furthermore, DMARDs-induced lung diseases in rheumatoid arthritis patientsneed to be differentiated from opportunistic infection because almost DMARDshave immunosuppression effect.Conclusion: DMARDs-induced lung disease shows various imaging findings.HRCT for baseline examination is important for diagnosis of DMARDs-inducedlung disease on RA patients.ChestACB D E F G HS379

Scientific and Educational ExhibitsC-204Imaging findings in associated thoracic and renal adult diseasesM. Herraiz, R. Saiz, A. García-Layana, J. Bondia, J.J. Noguera, A. Villanueva,J. Broncano; Pamplona/ES (mjherraiz@unav.es)Learning Objectives: Recognize the findings of thoracic and renal associateddiseases in various imaging techniques (chest radiographs, MDCT, ultrasoundand MRI).Background: Some findings in thoracic radiology are not specific. Knowing that apatient has a specific renal disease is useful in the diagnosis of thoracic disease.Imaging Findings: The imaging findings in thoracic and renal associated diseasesare shown. Cases of diseases that affect the kidneys and the lung, the mediastinum,the skeletal system or the heart are shown. Cases are classified in: 1) chronic renalfailure (interstitial edema, metastatic pulmonary calcification, coronary disease); 2)tumours: lung neoplasm spreading to the kidney and kidney neoplasm spreadingto the thorax; 3) kidney transplantation (infection, adverse drug reaction) and 4)non-tumor-related systemic diseases with renal and thoracic affections (Wegener’sdisease, tuberous sclerosis).Conclusion: Unspecific findings in the pulmonary parenchyma with CT (groundglass opacities, “crazy-paving” pattern, interstitial pattern, pulmonary calcifications)might prove easier to diagnose if it is known that the patient has a specifickidney disease (kidney failure, renal transplantation with opportunistic infection orEverolimus side effect). Bone changes (increased vertebral density, erosions ofvertebral bodies) could be interpreted more effectively in oncology patients with renalfailure. Infrequent diseases of the heart or great vessels (myocardial hamartomas,pulmonary artery stenosis) can be diagnosed more easily if it is known that renaldisease is present (tuberous sclerosis, Wegener’s disease).C-205Normal variants in the chest: Mimickers of diseaseJ.F.G.M. Costa, J. Brito, A. Costa, F. Caseiro-Alves, A. Bernardes; Coimbra/PTLearning Objectives: 1. To review the most frequent normal anatomic variants inthe thorax. 2. To correlate them to the characteristic imaging findings of possibledifferentials.Background: There are innumerable anatomic variants involving the chest wall,bronchi, lung and fissures, and systemic and pulmonary vessels. Familiarity withthese findings is essential to prevent errors in the interpretation of CT images.Imaging Findings: In this exhibit, we review the imaging appearances of the mostcommon variants involving the chest wall, bronchi, lung and fissures, and systemicand pulmonary vessels. Imaging modalities include chest X-rays, angiography,CT and MRI. Anatomical correlation is also presented when possible. Each caseis accompanied by a brief history, an explanation of the findings and a list of theappropriate differential considerations.Conclusion: By reviewing this exhibit, users will be able to recognize both thenormal anatomy and anatomic variants of the chest, which is essential to avoidmisdiagnosis.C-206Bronchial carcinoid tumors: Factors that influence the rate of recurrenceand outcomeR. Duarte 1 , D. Miranda 2 , T. Pereira 1 , S. Gomes 1 , R. Couto 1 , P. Portugal 1 ;1Vila Nova de Gaia/PT, 2 Matosinhos/PTPurpose: 1. To review the most common clinical symptoms and imaging findingsat radiography and computed tomography (CT) of bronchial carcinoid tumors. 2. Tocorrelate the imaging findings with the histologic features. 3. To determine how theextent and histologic features of disease influence recurrence rate after surgery.Methods and Materials: Bronchial carcinoid tumors are neuroendocrine neoplasmsthat have a broad spectrum of clinical and histologic features. They arerare primary thoracic neoplasms, representing only 1-2% of all lung tumors. Weretrospectively reviewed the imaging and pathologic findings of bronchial carcinoidtumors in 29 patients who underwent surgical resection of bronchial carcinoid tumorat our institution between 2000 and 2006. Tumor size, histologic findings and nodaldisease status were evaluated and their influence in the recurrence of disease inthese patients was determined.Results: Patients with bronchial carcinoid tumors submitted to surgical resectionhave excellent outcome, with an overall survival rate near 90%. In our groupof patients, atypical histologic pattern was the factor that most influenced localrecurrence.Conclusion: Typical and atypical bronchial carcinoids have similar imaging features.Patients submitted to surgical resection of bronchial carcinoid tumor with atypicalhistologic findings were associated with higher rates of local recurrence than thosewith typical histologic findings.No Material Submitted to EPOSC-207Imaging the lungs in lymphomaH. Vargas, F.A. Hampson, J.L. Babar, A.S. Shaw; Cambridge/UK(vargas@doctors.org.uk)Learning Objectives: 1. Illustrate the thoracic imaging findings of lymphoma andthe consequences of lymphoma treatment, including radiotherapy, chemotherapyand bone marrow transplantation. 2. Highlight distinguishing features to aid differentiationbetween the types of lymphoma and other chest pathologies. 3. Provideguidance on when, how and why tissue sample should be obtained.Background: Pulmonary abnormalities are a frequent finding in patients withlymphoma. Abnormalities may be due to the lymphoma itself, or a consequenceof the treatment regime. As radiologists, we are commonly asked to differentiatebetween tumour, infection, drug reactions and post-radiotherapy changes. Patientsare also at increased risk of pulmonary emboli and, following transplantation, maydevelop obliterative bronchiolitis.Imaging Findings: Thoracic involvement is three times more common in Hodgkins(HL) than non-Hodgkins (NHL) lymphoma. It is almost always associated withmediastinal lymphadenopathy. In HL pulmonary involvement is most commonlythe result of direct extension from affected nodes; the parenchymal pattern may benodular, alveolar, bronchovascular or miliary. In NHL, pulmonary or pleural lesionsmay present in the absence of mediastinal lymphadenopathy. Infective changesmay present with ground glass opacification, nodules, consolidation or cavitation,whilst drug hypersensitivity may manifest in a number of ways.Conclusion: Radiological evaluation of the lungs in lymphoma is a common andpotentially difficult problem. We will review the radiological features of these diseasesin order that the radiologist will be in a better position to aid clinical colleagues.C-208Slowly growing malignant nodules and rapidly growing benign nodules:Evaluation of the value of volume doubling timeY. Zhao, Y. Wang, P.M.A. van Ooijen, M. Oudkerk; Groningen/NLLearning Objectives: 1. To review the volume doubling time (VDT) of someslowly growing malignant nodules and rapidly growing benign nodules on thoracicCT images. 2. To outline other factors that should be taken into account in differentiationbetween malignant and benign lesions. 3. To discuss the benefits andlimitations of VDT.Background: The VDT of lung nodules has been widely accepted as an index oftumour growth rate. The prognosis of lung cancer correlates well with the tumourVDT. The VDT of most benign pulmonary nodules is more than 450 days, whereasthe VDT of malignant lesions is usually less than 400 days. But a 2-year stabilitydid not always imply a benign state as it might also indicate malignant growth witha long VDT.Imaging Findings: We will present representative cases of slowly growing malignantnodules and rapidly growing benign nodules as found in a lung cancer screeningsetting. We will discuss the characteristics of these lesions. We will analyzethe pathologic results of slowly growing malignancies. We will also discuss how tomanage them in the follow-up and the benefits and limitations of VDT.Conclusion: Evaluation of pulmonary nodules based on VDT alone sometimesis complicated because the different natural histories. Malignant lesions can growfast, but may also have a long VDT. Malignant nodules may be stable for a longperiod, and benign nodules may have rapid growth; the concept of lead-time shouldbe considered in managing these lesions.C-209Usefulness of the reversed halo sign on CT for the diagnosis of theorganizing pneumoniaV. Pérez Dueñas, I. Torres Sánchez, A. Bravo Soberón, L. Figueroa Nasra,M. Pardo Rodríguez, M. Parrón Pajares; Madrid/ES (virpedue@gmail.com)Purpose: The reversed halo sign has been recently described on lung CT as aninfrequent finding although specific for the diagnosis of organizing pneumonia (ON).This exhibit will evaluate the prevalence of this sign in ON, describe its featuresand its association with other ON findings.Methods and Materials: High-resolution CT of 37 patients with histologicaldiagnosis of ON was reviewed by two experienced thoracic radiologist. 28 cases(75.7%) were idiopathic and 9 (24.3%) were secondary (2 postchemotherapy ofbreast cancer, 2 rheumatoid arthritis, 2 bone marrow transplantation, 1 polymyositis,1 polymyalgia rheumatica, and 1 secondary to carbamazepine herpes zostertreatment). HRCT was performed with a standard protocol (1 mm slice thickness,10 mm table movement, high resolution reconstruction algorithm, and kV and mAsadjusted to patient’s weight).CS380 A B D E F FG H

Scientific and Educational ExhibitsResults: Reversed halo sign was seen in 5 cases (prevalence 13.5%), 3 were cryptogenic,and 2 secondary (1 to chemotherapy for breast cancer and 1 to rheumatoidarthritis). In 1 patient, the sign was identified in the superior lobes and in 4 in theinferior lobes. It was unilateral in 1 case and bilateral in 4. Reversed halo sign wasthe unique CT finding in 3 patients. In the other 2, additional ON signs were present(peribronchovascular consolidations, bronchial dilatations, and multiple noduleswith halo sign in one case and centrilobular nodules in the other).Conclusion: The reversed halo sign is not an exceptional lung CT finding in ON,and so its knowledge and presence is a very useful imaging clue in the diagnosisof this entity.C-210CT appearance of radiation injury of the lung after stereotactic bodyradiation therapy (SBRT) for lung cancers: A pictorial reviewA. Linda 1 , M. Tro vo 2 , C. Javidan-Nejad 3 , J. Bradley 3 ; 1 Udine/IT, 2 Aviano/IT,3St.Louis, MO/US (annalinda33@gmail.com)Learning Objectives: To review the serial CT manifestations of radiation injury tothe lung after stereotactic body radiation therapy (SBRT) for lung cancers.Background: SBRT is a recently introduced technique that allows the delivery of avery high radiation dose to the target volume, while minimizing the dose to the adjacentnormal tissues. SBRT has been shown to be highly effective in the treatment of nonoperablestage I lung cancer or lung metastases. Considering its excellent results, itis expected that an increasing number of patients will be treated with SBRT for lungcancer. Therefore, an understanding of the SBRT-induced lung changes and CT findingsis very beneficial to the radiologist, in particular in making the distinction betweenradiation-injury and disease recurrence, and in the assessment of tumor response.Imaging Findings: The complex distribution of radiation dose of SBRT and the veryhigh dose per-fraction result in patterns of lung injury that are different from thoseof conventional radiation therapy (CRT). The most common early ( 6 months) CTpatterns are linear or diffuse consolidation, patchy consolidation and ground-glassopacity (GGO), diffuse GGO, patchy GGO, no findings. The most common late ( 6months) CT patterns are the "modified" conventional pattern (consolidation, volumeloss, bronchiectasis), mass-like pattern (focal consolidation), scar-like pattern (linearopacity and volume loss), no findings. Infrequent complications of SBRT includelobar collapse, parenchymal infection, rib fracture.Conclusion: Lung injuries following SBRT are less evident than those followingCRT and have variable CT appearances according to the timing from treatment.C-211Postoperative bronchial stenosis in lung transplanted patients: Earlydiagnosis with thoracic CT with multiplanar and 3D reconstructionM. Martinez-Sapiña, P. Fernandez Suárez, O. Vazquez Muiños,C. Fernandez Da Ponte, A. Iglesias Lopez, M. Delgado Roel; La Coruña/ES(martinez_sapina@canalejo.org)Purpose: Lung transplant is the elective treatment in end-stage pulmonarydiseases. Advances on surgical techniques, donor organ preservation and immunosuppressanttherapies have improved surveillance and lowered postoperativecomplications. Stenosis of bronchial anastomosis is considered an importantmorbidity. Its early detection allows an effective treatment.Methods and Materials: Since January 1999 until May 2008, thoracic CT withbronchial reconstruction was performed in 220 lung transplanted patients. CTscans were realized between first and third month post-transplant. We have reviewed320 anastomosis using thoracic CT with axial slides, multiplanar and 3Dreconstructions.Results: Bronchial stenosis were minimal in 36 anastomosis, moderate in 3 and 12were considered critical, appearing in these cases airway complications. All stenosiswere studied by broncoscopy and results were concordant with CT findings. Criticalstenosis was treated with balloon dilatation and bronchial stenting.Conclusion: The use of thoracic CT with multiplanar and 3D reconstruction in lungtransplant follow-up protocol has supposed a great advance. It supports informationabout longitudinal extension of bronchial narrowing area and distal airway spaceorientation. It also allows higher clarity than axial slides and adequate calibrationof stenosis grade, which helps anastomosis dilatation and stenting planification.Multiplanar and 3D reconstruction will permit us early bronchial stenosis detectionwithout the use of bronchoscopy.C-212Blunt chest trauma: A review with MDCTP. Olmedilla, S. Hernandez, D. Exposito, V. Cuartero, S. Alonso, A. Sanz; Madrid/ES(polmedillaa@gmail.com)Learning Objectives: Our purpose is to review the spectrum of imaging findingsin patients with blunt chest trauma evaluated with MDCT.Background: MDCT is a relatively new modality that has come to occupy an importantrole in the evaluation of severely injured patients. Although isolated chestinjuries are not common, they are responsible for a high proportion of morbidity andmortality. Therefore, a rapid and proper diagnosis is mandatory in these patients,and contributes to the immediate treatment plan. After chest radiography, usedas initial tool for rapid triage, CT is the next most used imaging method. Technicalcapabilities of new generation MDCT scanners allow a prompt and accuratediagnosis of major organ system disruption as well as subtle injuries.Imaging Findings: In this exhibit we classify blunt-chest traumatic injuries, and weshow different cases of lung, pleura, mediastinum, diaphragm, aorta and thoraciccage lesions. We also review the imaging findings in cardiac trauma, illustratedwith two additional examples. As this traumatic pathology is unusual and difficult toidentify, we emphasize its radiological presentation and clinical management.Conclusion: Radiologist plays an important role in the evaluation of chest injuriesdue to the development of MDCT. This modality allows an accurate and promptdiagnosis, contributing to patient treatment. However, diagnosis of chest injuries isnot always easy. We review the spectrum of imaging findings in MDCT, especiallythe more subtle ones. We believe that the reviewing of this topic will help us toreduce overlooked lesions.C-213Role of MDCT in the management of blunt chest traumaM. Febrer, M. Teixidor Viñas, L. Valls Masot, E. Gómez Roselló,M. Osorio Fernández, S. Pedraza Gutiérrez; Girona/ES (marinafebrer@yahoo.es)Purpose: Thoracic injuries are frequent lesions in traumatic patients. The purposeof our study is to review the spectrum of lesions in chest trauma and its associationwith traumatic injuries in other locations using multidetector computed tomography(MDCT).Methods and Materials: We retrospectively reviewed whole-body MDCT studiesperformed in our institution to polytraumatized patients over a 21 month period.The analysis of the CT included multiplanar reformation (MPR) and two- or threedimensionalpostprocessing techniques of the entire data set at the workstation.Results: 397 polytraumatized patients underwent standardized whole-body MDCTscan. There were 305 males and 92 females with a median age of 38 years (range:4-93). In 187 out of 397 patients (142 males and 45 females), a thoracic traumaticinjury was diagnosed (47%). The most frequent lesion was pulmonary contusion(58.3%) associated or not with pulmonary laceration, followed by pneumothorax(43.9%) and costal fractures (42.3%). Less prevalent injuries were hemothorax(29.4%), athelectasis (17.1%), thoracic wall lesions (including subcutaneousemphysema, hematoma and contusion) (11.2%), mediastinal hematoma (11.2%),sternal fractures (including condrosternal articulations), clavical and scapular fracturesand pneumomediastinum. Vascular, diaphragmatic and esophageal injurieswere infrequent findings.Conclusion: Chest lesions are common injuries in polytraumatized patients. CTis the election technique in clinical suspicion of severe trauma. MDCT improvesvascular injury assessment. The most frequent lesions are pulmonary contusions(with or without associated laceration), pneumothorax and costal fractures. Radiologistsplay an important role in the management of traumatic patients, as anaccurate diagnosis will lead to proper therapeutic decisions.C-214Focal lung lesions that all radiologists should recognize as benign on CTM. Seco, A. Canelas, B. Graca, L. Curvo-Semedo, F. Caseiro-Alves; Coimbra/PT(migseco@sapo.pt)Learning Objectives: To know and illustrate the benign focal lung lesions whosediagnosis can be specifically made by CT.Background: The radiographic assessment of patients with a solitary or multiplelung nodules, masses or cavities is a common clinical problem, which may requirefurther characterization by CT. Primary or metastatic tumors usually are themain diagnoses in patients with these findings. However, some other diseases orabnormalities present with focal lung abnormalities, many of which have specificappearances on CT that may suggest the correct diagnosis.ChestACB D E F G HS381

Scientific and Educational ExhibitsImaging Findings: A systematic review with proper illustration of several entitiesthat have specific appearances on CT, including healed granulomas, hamartoma,exogenous lipoid pneumonia, bronchocele, pulmonary arterio-venous malformations,sequestration, rounded atelectasis and loculated fluid collections, will beperformed.Conclusion: The radiologist must be able to recognize the specific CT findingsof a wide spectrum of benign lung lesions, in order to avoid lung biopsies or otherinvasive procedures in a considerable proportion of patients who present with focalabnormalities on the chest plain film.C-215Upper lobe emphysema and concomitant lower lobe interstitial fibrosis:The role of HRCT in the assessment of this distinct entityE. Testempassi, S. Kopanakis, E. Lazaridou, M. Kalomenopoulou, D. Chondros;Athens/GRPurpose: Concomitant pulmonary fibrosis and upper lobe emphysema is a uniqueentity that was recently characterized. This disorder is usually found in men who aresmokers. The purpose of this study is to present the imaging findings in patientswith combined pulmonary emphysema and fibrosis.Methods and Materials: We analysed the chest HRCT findings in a retrospectiveseries of 30 men patients ranged in age from 55 to 73 years. All patients haddyspnea but they had almost normal spirometry. All patients had marked reductionon pulmonary function tests.Results: Lung volumes were preserved in almost all patients. All patients hadextensive upper lobe emphysema and diffuse interstitial fibrosis of the lower lobe.All patients had dilatation of the central pulmonary vessels. The emphysema was ofbullous type in the 19 patients and of centrilobular type in 11 patients. All patientshad subpleural reticular abnormalities and honeycombing of lower lobes. Ninepatients had also ground glass opacities in the lower lobes.Conclusion: The radiologist must be aware of this unique entity of combinedemphysema and interstitial fibrosis, which has almost normal spirometry. The earlydiagnosis of the above syndrome affects the treatment, prognosis and outcomeof the disease.C-216The abnormality is on the lateral chest X-ray: What does the frontal chestradiograph look like?D.Y.F. Chung 1 , R.R. Misra 2 ; 1 Oxford/UK, 2 High Wycombe/UKLearning Objectives: To present a pictorial review of ‘abnormalities’ present ona lateral chest X-ray (CXR), asking the question, ‘What does the abnormality looklike on the frontal radiograph?’ This is to emphasize the importance of the lateralview in problem solving, without having to automatically recourse to CT, therebyminimising patient dose wherever possible.Background: The frontal CXR is an extremely commonly requested investigation.By comparison, requests for lateral CXRs are in decline. The reasons can only besurmised, but rapid access to CT, for a ‘CXR abnormality’, is likely the main drivingfactor. We have a duty of care to minimize patient doses wherever possible, andthe Ionizing Radiation Regulations (UK) and media attention have made patients’acutely aware of this. We present many examples where CT can be avoided, if alateral view is initially considered.Imaging Findings: Firstly, we review the normal radiological anatomy of the lateralCXR. We then review several ‘abnormal’ lateral views, asking the question ‘whatdoes the abnormality look like on the frontal view?’ Finally, we review the correspondingfrontal CXR for each case, highlighting the lateral view appearances,thereby demonstrating why diagnostic CT may be avoided.Conclusion: This review should help the viewers reacquaint themselves with theclinical usefulness of the lateral CXR, and to appreciate its value in dealing with an‘abnormal’ frontal radiograph, thus avoiding unnecessary CT radiation exposure.C-217Hemoptysis assessment with multidetector CTA. Sierra Vinuesa, M. Sanchez, I. Real, M. Burrel, P. Arguis, R. Perea,T. De Caralt; Barcelona/ES (asierravinuesa@gmail.com)Learning Objectives: To describe the anatomy of the pulmonary and systemicvasculature of the lungs. To assess the usefulness of multidetector CT (MDCT)for the initial diagnostic evaluation in cases of acute hemoptysis and of recurrenthemoptysis following embolization. To suggest a hemoptysis managementguideline.Background: Massive hemoptysis has been defined as the expectoration of anamount of blood ranging from 100 mL to more than 1000 mL over a period of 24hours or any amount sufficient to cause a life-threatening condition. In 90% ofcases of hemoptysis, the bronchial arteries are responsible for the bleeding, andnonbronchial systemic arteries and other pulmonary vessels the remaining 10%.Imaging Findings: MDCT for initial evaluation of acute hemoptysis allows: (a)the assessment of the severity of the hemorrhage and localization of the bleedingsite; (b) the identification of the origin and trajectories of the bronchial, systemic orpulmonary vessels that may require embolization; (c) the detection of the underlyinglung parenchima or mediastinic disease as potential sources of hemoptysis.MDCT study of the bronchial arteries and pulmonary and systemic vasculatureincreases the effectiveness of arterial embolization and decreases the extensionof the intervention by showing the precise hypertrophic or pathologic vessels. Italso studies underlying pathology in lung parenchima and mediastinum that mightbe the primary cause of the hemoptysis.Conclusion: MDCT improves the endovascular treatment procedures by providingan accurate vascular map prior to embolization and allowing the correct identificationof the pathologic vessel or other underlying causes of hemoptysis.C-218Pulmonary abnormalities in HIV infected patients: An imaging reviewA. Roque, T. Saldanha, C. Vasconcelos; Lisbon/PT (andreiaroqu@gmail.com)Learning Objectives: The aim of this pictorial essay is to review computed tomography(CT) pulmonary abnormalities in human immunodeficiency syndrome(HIV) infected patients.Background: Worldwide estimates suggest that, by November 2007, about 33.2million people were HIV infected with 2.1 million deaths resulting from AIDS.Pulmonary complications of AIDS that depend on the immunological competenceand CD4 level represent major causes of morbidity and mortality in HIV infectedpatients and despite the advent of highly active antiretroviral therapy (HAART), thelung continues to be the most frequently involved organ, although accompaniedby changes in frequency and nature of pulmonary findings. Imaging, mainly CT,is an essential key in the diagnosis of pulmonary conditions (both infectious andnon-infectious), which occur at a higher rate in those patients.Imaging Findings: Radiological features of infectious aetiologies such as fungal,bacterial, mycobacterial (typical and atypical), viral and parasitic will be reviewed.Non infectious conditions including Kaposi sarcoma, AIDS related lymphoma,non specific interstitial pneumonitis, lymphocytic interstitial pneumonitis will bediscussed. The authors suggest a systematic approach of CT findings in HIVpatients based on imaging patterns and immunological parameters.Conclusion: Pulmonary disorders are the most prevalent complication of HIVinfection, and it is imperative for the physician reporting CT studies to know fullpulmonary imaging spectrum enrolled since these conditions are associated withhigh morbidity and mortality. Interpretation of imaging studies should integrateclinical and laboratory information with radiographic pattern recognition.C-219Pneumomediastinum: Old signs in a refresher perspectiveL.F.P. Gonçalves, S.C. Dias, P. Covas, C. Pina Vaz, V. Mendes; Braga/PT(l.f.p.goncalves@gmail.com)Learning Objectives: We review imaging of pneumomediastinum and of the variousconditions that can lead to it.Background: Pneumomediastinum may constitute a diagnostic challenge due toits wide spectrum of intra and extrathoracic causes and to similitude of its radiologicfindings with those of others entities. Good understanding of mediastinal anatomyand of pneumomediastinum pathophysiology is crucial in this behalf. Althoughpneumomediastinum is often asymptomatic, it may lead to chest pain, dyspnea,and seldom hypotension due to impairment of venous return to the heart. Carefulexamination of radiographic findings is of utmost importance in the diagnosisof pneumomediastinum. Computed tomography corroborates the diagnosis andprovides rapid and accurate evaluation of the organs involved, frequently leadingto a specific diagnosis. Correct assessment of the radiologic signs of pneumomediastinumstrongly contributes to appropriate treatment planning.Imaging Findings: We describe the radiographic signs of pneumomediastinum aswell as the imaging spectrum of its various intra and extrathoracic sources. Emphasisis given to related diagnostic challenges, imaging pitfalls and differential diagnosis,namely medial pneumothorax, pneumopericardium and spurious causes. The radiologicalfindings were confirmed by reviewing clinical and pathological records.Conclusion: Diagnosis of pneumomediastinum can be challenging and stronglybenefits from radiographic and tomographic findings, leading to accurate orientation.CS382 A B D E F FG H

Scientific and Educational ExhibitsC-220Pulmonary and abdominopelvic imaging manifestations of complicationspost haematopoetic stem cell transplantationR. Dunne, P. Beddy, G. Murphy, R. Mc Dermott, G. Wilson, J.F. Meaney; Dublin/IE(ruthdunne@yahoo.co.uk)Learning Objectives: To outline the temporal relationship between immune statusof the recipient and the development of complications post haematopoetic stem celltransplantation (HSCT). To recognise the imaging patterns of such complicationson cross-sectional imaging of the thorax and abdomen.Background: HSCT is frequently performed to restore immunologic and haematologicfunction in neoplastic conditions after myelosuppressive chemotherapyand radiation therapy and in non-neoplastic conditions in which such function isinadequate. Complications post HSCT are numerous and can be divided into threephases based on the immunocompetency of the recepient: the pre-engraftmentor neutropenic period (days 0-30 after HSCT), the early post-engraftment period(days 30-100), and the late post-engraftment period (after day 100). We performeda retrospective 3 year review of all cross-sectional thoracic and abdominopelvicimaging post HSCT patients with clinical and pathological correlation.Imaging Findings: Acutely, the commonest complications were infection, iatrogenicand idiopathic pneumonitis and neutropenic enteero-colitis. In the late postengraftment period, hepatic veno-occlusive disease, multisystem graft versus hostdisease and secondary malignancy were most prevalent. CT was found to be themost useful imaging modality in these patients with MRI and ultrasound aidingdiagnosis in certain situations.Conclusion: With increasing use of and survival after HSCT, the prevalence ofcomplications related to HSCT is likely to increase, particularly in the adult population.Complications post HSCT are numerous and potentially devastating; therefore,prompt recognition of their radiological features is essential.C-221Lymphoproliferative thoracic diseaseS. Tripathi 1 , Y. Jones 1 , J. Curtis 1 , P. Janousek 2 , E. Marchiori 3 ,A. Soares Souza Junior 4 , M. Bertoni 5 , J. Gosney 1 , K. Irion 1 ; 1 Liverpool/UK,2Manchester/UK, 3 Niteroi/BR, 4 Sao Jose do Rio Preto/BR, 5 West Yorkshire/UKLearning Objectives: To review the key lymphoproliferative diseases of the thorax,with pathological and imaging examples.Background: The lymphoid tissue of the thorax is located in the lungs and mediastinum,including the thymus gland. Lymphoproliferation occurs in multiple andvaried conditions, for example, Castleman’s disease, infectious mononucleosis,plasma cell granuloma and lymphoid interstitial pneumonia, and may involve lungparenchyma, intra-thoracic lymph nodes or the thymus. The pathology of reactiveand neoplastic proliferations of thoracic nodal lymphoid tissue is essentiallyequivalent to that of extra thoracic lymph nodes; however, proliferations of thoraciclymphoid tissue, particularly within the thymus, display various unique characteristics.Lymphoproliferative disorders are relatively infrequent findings within the thorax;however, once identified clinical and radiological findings may allow distinctionbetween benign or malignant lymphoproliferative disorders, and also distinctionbetween these groups and lymphomas.Imaging Findings: Lymphoproliferative disease of lung parenchyma, thymic tissueand intra-thoracic lymph nodes are presented. We present the current radiologicaltrends for diagnosis and staging, including PET imaging, and pathological featuresof a range of thoracic lymphoid diseases.Conclusion: We present a comprehensive review of thoracic lymphoproliferativedisease, including current diagnostic strategies, staging, imaging trends andpathological features.C-222Cardiac silhouette findings and mediastinal lines and stripes: X-ray andcomputed tomography correlationR. Marano, G. Savino, C. Liguori, A. Meduri, L. Natale, L. Bonomo; Rome/IT(riccardo.marano@rm.unicatt.it)Learning Objectives: To illustrate the CXR and CT imaging correlation of the mediastinallines and stripes and cardiac silhouette concepts. The knowledge and the capabilityto recognize the thickening, displacement or deletion of one of these mediastinal linesor stripes as well as the presence/absence of the cardiac silhouette finding support theappropriate request of CT examination. To help identify the CXR abnormal appearancesto perform differential diagnosis prior to obtaining information with chest CT.Background: Chest X-ray (CXR) still represents the first diagnostic tool in patientwith suspected lung or mediastinal disorders, providing useful information. Mostof this information is mostly based on the compositions and relationships of theanatomic structures in mediastinum, pleura, and lungs determining the so calledmediastinal lines and stripes and cardiac silhouette concepts, which may play animportant role in establishing or ruling-out a diagnosis before proceeding to CT. Theknowledge and the capability to recognize the thickening, displacement or deletionof one of these mediastinal lines or stripes as well as the presence/absence of thecardiac silhouette finding support the request of valuable CT examination.Imaging Findings: CXR and CT anatomy of mediastinal lines and stripes andcardiac silhouette. Relationship of lung and mediastinal diseases to mediastinallines and stripes and cardiac silhouette. Sample cases and differential diagnosis.Conclusion: Radiologists must be familiar with these anatomical concepts andbe able to identify their normal and abnormal appearances to perform differentialdiagnosis prior to obtaining additional information with chest CT.C-223Diverticula of trachea vs main bronchus: MDCT with 1.25 mm thin sectionW.-H. Lee, Y. Kim, S. Jou, W. Bae; Cheonan/KR (ssmri@naver.com)Purpose: To evaluate the incidence, size, number, location, and relation withemphysema of tracheal and main bronchial diverticula on MDCT.Methods and Materials: Consecutive 967 patients (mean age: 54 years, M:F=600:367) underwent chest CT during 2 months were included. We reviewed CTimages reconstructed with 1.25 mm thickness, 1.25 mm interval. The incidence,size, number and location of diverticula in trachea (group 1) and main bronchus(group 2) were analyzed. The incidence of combined emphysema and diverticularsize with/without emphysema were analyzed.Results: Of 967 patients, group 1 was 5.1% and group 2 was 5.2%. The diverticularsize was 6.4 mm (1.2-30 mm) in group 1, and 2.17 mm (1-15 mm) in group 2. Ingroup 1, all diverticula were in right posterolateral aspect of the trachea. In group 2,91 of 94 diverticula were in inferior wall and 72 diverticula were in left main bronchus.Diverticular number was one in group 1 and 1.8 (1-9) in group 2. 20 patients hadtwo or more diverticula. Emphysema was in 13 patients of group 1 and 18 patientsin group 2. Diverticular size in patients with emphysema was larger than withoutemphysema in two groups (p 0.05).Conclusion: On thin section MDCT, tracheal and main bronchial diverticula wereabout 5%. The main bronchial diverticulum is smaller. All tracheal diverticula arein right posterolateral aspect of the trachea, and most main bronchial diverticulaare the inferior wall of left main bronchus with one or more number. Diverticularsize is related with emphysema.C-224Cryptogenic organizing pneumonia: Typical and atypical imaging featureson high resolution computed tomographyC. Dornia 1 , D. Manos 2 , J.L. Babar 3 , S. Feuerbach 1 , O.W. Hamer 1 ;1Regensburg/DE, 2 Halifax, NS/CA, 3 Cambridge/UK (dornia@gmx.net)Learning Objectives: 1. Learn the pathophysiological basis and clinical backgroundof cryptogenic organizing pneumonia (COP). 2. Learn the classical HRCT appearanceof COP. 3. Learn how to recognize unusual patterns and avoid diagnosticpitfalls. 4. Learn how to work up difficult cases.Background: Organizing pneumonia (OP) occurs without any identifiable cause(“cryptogenic organizing pneumonia”, COP) as well as secondary to a multitude ofdisorders of various origins (“secondary organizing pneumonia”). Possible triggersare infections, drugs, collagen vascular disease, transplantations and radiationdirected to the chest. Common symptoms include cough, fever, and dyspnea. In thevast majority, OP shows an excellent response to corticosteroid treatment with rapidclinical improvement and resolution of radiological findings. Radiologists shouldbe aware of the typical and atypical imaging features of OP to prevent diagnosticerrors and guide appropriate work-up and management.Imaging Findings: High resolution computed tomography (HRCT) is the modalityof choice if OP is suspected. The classical HRCT features of OP are consolidationsand ground glass opacities in a predominantly peripheral or peribronchovasculardistribution; an air bronchogram is common. Less common or atypical findingsinclude perilobular opacities, crazy paving, nodules, linear opacities and thereversed halo sign. Cryptogenic and secondary OP cannot be distinguished onthe basis of imaging.Conclusion: The classical HRCT features of OP are well known. However,numerous atypical patterns have meanwhile been described. A profound knowledgeof the various appearances of OP is a prerequisite for an accurate imageinterpretation.ChestACB D E F G HS383

Scientific and Educational ExhibitsC-225Density-based MDCT quantification of lung volumes: An inter and intraoperatorreproducibility studyF. Molinari 1 , M. Amato 1 , A. Macagnino 1 , G. Serricchio 1 , T. Pirronti 1 , M.U. Puderbach 2 ,L. Bonomo 1 ; 1 Rome/IT, 2 Heidelberg/DE (fmolinari@rm.unicatt.it)Purpose: Density-based MDCT quantification (q-MDCT) of lung volumes can berelevant in patients undergoing surgery for severe emphysema or lung cancer. Theinter- and intra-observer variabilities of q-MDCT were assessed in this study.Methods and Materials: From the institution database, we identified 23 chest examinationsobtained on a 16-MDCT scanner (slice thickness and interval = 1.25 mm;pitch = 1.5) and showing signs of emphysema. After applying a semi-automaticprocedure for lung segmentation and delimiting manually the lobes through thefissures, mean densities (MD) and volumes (V) were calculated for both lungsand each lobe. A threshold of -950 HU was used to obtain mean densities andvolumes of the areas of emphysema (MDE; VE). All four parameters were calculatedindependently by two operators in two sessions one month apart. Inter- andintra-observer differences were expressed as percentages over the means. Meanpercent differences with confidence intervals were assessed.Results: Inter-observer mean percent differences for both lungs were: MD=0.041.1;V=-0.193.4; MDE=-0.10.5; VE=-4.417.9; intra-observer mean percent differenceswere: MD=0.081; V=-0.173.45; MDE=-0.080.5; VE=3.616.4. Confidenceintervals ranges () obtained from each lobe were MD=1.4-3.9; V=13.3-98.3;MDE=0.6-1.4; VE=29.6-137.6 for the inter-observer, and MD=0.4-0.7; V=3.7-10.6;MDE=0.4-0.8; VE=17.3-32.9 for the intra-observer analyses.Conclusion: Very accurate assessment of mean density and volume of normaland emphysematous parenchyma can be obtained applying q-MDCT to both lungs.Results are less reproducible if the analysis is performed lobe-wise using manualdelimitation along fissures.C-226Side effects of chest radiotherapy: MDCT findingsA.F.L. Carneiro, P.G.F. Sousa, A.S. Preto, J.M.T. Campos; Porto/PT(alexandrelimacarneiro@gmail.com)Learning Objectives: To describe the most common CT findings complicationsafter chest radiotherapy.Background: Radiotherapy is a widely used curative or palliative technique andrecent advances have rendered it progressively more effective and less aggressive.Still, unwanted ill-effects are still commonly found in follow-up chest examinationsof irradiated patients. Their differential diagnosis can be a challenge.Imaging Findings: The different structures and tissues of the chest have differentradiation tolerances and are affected accordingly, in more or less characteristicpatterns, over time. Lung damage may be evident as early as six weeks aftertreatment with standard doses as acute radiation pneumonitis, which presents asair-space consolidation with geometric boundaries. This may resolve successfullyor progress over 12 to 18 months to a more chronic, organized and fibrotic form,with lung volume loss and retraction. Both forms of injury are characteristic in thatthey conform to the radiation field and in their timing. Pneumothorax and pleuraleffusion are rarely seen. Airways are inevitably included in the radiations ports andmay be affected as well. Irradiation of the heart may cause pericardial effusions orthickening or scarring of the myocardium. Bone may become osteoporotic or developosteoradionecrosis. Soft tissue calcifications are common. Acute esophagitis isfrequent and may be followed by stricture or fistula formation.Conclusion: Awareness of the possible CT findings allows correct recognition ofthese radiation-associated entities and better management of irradiated patients.No Material Submitted to EPOSC-227Thoracic CT in the intensive care unit: Does it alter the management?Z.H. Aldin, N. Tunariu, J. Hollway; London/UK (nazaldin@hotmail.com)Purpose: To determine the clinical value of thoracic computed tomography (CT) incomparison with conventional in patients in a general intensive care unit (ICU).Methods and Materials: We retrospectively reviewed the thoracic CT studiesand the associated bedside chest radiographs in 108 ICU patients scanned over4 year period (age range 23- 87 years). The time interval between the CT scanand the chest radiograph was not more than 24 hours. We analyzed the additionalinformation provided by CTs and the diagnostic and therapeutic relevance ofthese findings.Results: CT revealed new findings in 47 of the 108 patients (43.4%). However,CT provided unsuspected significant diagnostic information that changed themanagement of the patient in only 19 of the 108 patients (17.5%). Examples ofcorrectable lesions include malpositioned or occluded chest tube, unsuspectedlarge pleural effusion, empyema, pneumothorax, lung abscess, and postoperativemediastinal collections. There were no significant complications during transportfor CT-examination.Conclusion: Our experience suggests that although chest CT does not change themanagement significantly in the majority of ICU patients, it is tremendously helpfulin patients whose clinical course is not explained by the available information orwhose chest radiographs are difficult to interpret. Therefore, careful selection ofpatients who require CT examination can reduce time and cost incurred by transferringpatients to and from radiology department.C-228Inflammatory pseudotumor: Radiological manifestations from head to toeJ. Quintero 1 , G. Valderas 2 , I. Guasch 1 , S. Ruiz 2 , I. Urra 1 , M. Pujol 2 ; 1 Badalona/ES,2Hospitalet de Llobregat/ES (jcquintero.germanstrias@gencat.net)Learning Objectives: To describe to spectrum of clinical and radiologic featuresof inflammatory pseudotumor. To identify the various treatment options for inflammatorypseudotumor.Background: Inflammatory pseudotumor is a quasineoplastic lesion that mostcommonly involves the lung and the orbit, but it has been reported to occur in nearlyevery site in the body. Because inflammatory pseudotumors mimic malignant tumorsboth clinically and radiologically, the radiologist should be familiar with this entityand help avoid unnecessary radical surgery when possible. Clinically, patients withinflammatory pseudotumor tent to have varying degrees of fever, growth impairment,iron deficiency anemia, thrombocytosis, and hypergammaglobulinemia.Imaging Findings: We presented thirteen cases with histological proven or clinicaldiagnosed of inflammatory pseudotumor: lung (2), spleen (2), liver (4), gastrointestinaltract (2), orbit (2) and adrenal gland (1). But in the literature also described in:heart, pancreas, gastrointestinal tract, kidney, retroperitoneum, mesentery, urinarytracts. Inflammatory pseudotumor is the most common primary lung mass seen inchildren (50% of benign intrapulmonary tumors seen in pediatric patients). Orbitalpseudotumor is a common cause of unilateral proptosis in adults (constitutes about6% of all orbital lesions).Conclusion: Inflammatory pseudotumor can both radiologically and clinicallymimic a malignant process. They involve many anatomic sites. If this diagnosis isconsidered, unnecessary radical surgery may be avoided. The treatment optionsare varied and consist of surgery, high-dose steroids, irradiation, and chemotherapeuticagents.C-229Acute and chronic cardiothoracic manifestations of illicit useS. Akers, H. Litt; Philadelphia, PA/US (scott.akers@va.gov)Learning Objectives: To review the common cardio-pulmonary effects of illicitdrug abuse. To illustrate the common imaging findings of pathology related to illicitdrug abuse. To discuss interactions between drug-related and non-drug relateddiseases.Background: Illicit drug use is a major societal problem worldwide. Many of themost commonly used illicit drugs have acute and chronic cardiopulmonary effectswith imaging manifestations. In this exhibit, we will demonstrate many of the mostcommon conditions related to drug use which affect the heart, lungs, and otherintrathoracic structures, and discuss the effects of drug-related disease on nondrugrelated pathology. This is particularly important in the acute setting, where thepsychomotor effects of drug use may mask underlying disease.Imaging Findings: Conditions to be illustrated include: cocaine related acute andchronic lung disease, IV drug related talcosis, emphysema, and vanishing lung, aswell as cocaine induced coronary vasospasm, IV drug related valvular disease,among others. These conditions may cause acute and chronic symptoms, which caninteract with and mask other underlying diseases, for example causing or worseningacute coronary syndrome in patients with underlying coronary artery disease.Conclusion: Illicit drugs have wide ranging effects on the cardiopulmonary system,with a myriad of imaging manifestations. Appreciating these manifestationscan lead the radiologist to the appropriate diagnosis and suggest other potentialclinical findings.No Material Submitted to EPOSC-230CT halo sign: Differential diagnosisN.J.F.P. Silva 1 , M. Castro 2 , L. Melão 2 , B. Viamonte 2 , R. Cunha 2 ;1V.N. Famalicão/PT, 2 Porto/PT (nunopsi1@gmail.com)Learning Objectives: Learn differential diagnosis of the entities associated withthe CT “halo sign”. Learn clinical characteristics and other imaging features thathelp narrowing the differential diagnosis.CS384 A B D E F FG H

Scientific and Educational ExhibitsBackground: The halo sign refers to a CT finding of ground glass opacity areasurrounding a nodule or a mass. It is commonly present in leukemic patients withinvasive aspergilosis as a sign of perilesional hemorrhage; however, its presence isnonspecific and has been demonstrated in several other clinical entities associatedwith pulmonary hemorrhagic nodules like hypervascular tumor metastases, Kaposisarcoma, Wegener granulomatosis or in patients submitted to a transbronchialbiopsy. It is also documented in patients with other infections (like tuberculosisor mycobacterium avium complex), chronic eosinophilic pneumonia, cryptogenicorganizing pneumonia and in some tumors, particularly adenocarcinoma or bronchioloalveolarcarcinoma.Procedure Details: A didactic format will be used and organized based on imagingfindings and clinical features. Differential diagnosis with a discussion of specificentities will follow.Conclusion: Understanding the imaging findings and the clinical spectrum of thediseases associated with the CT halo sign may allow a more precise diagnosis,optimizing patient management, particularly in the setting of severely immunocompromisedpatients.C-231Lipoid diffuse lung disease: A pictorial reviewR.M. Maia, M. Gomes, R. Themudo, L. Sousa, J. Reis, M. Ribeiro; Oporto/PTLearning Objectives: To illustrate the imagiologic spectrum of lipoid diffuse lungdisease (pulmonary alveolar proteinosis and exogenous lipoid pneumonia) anddescribe the classic radiographic and HRCT findings based on a series of patientsdiagnosed in our institution.Background: Pulmonary alveolar proteinosis is a very rare condition that is characterizedpathologically by filling of the alveoli with a PAS-positive proteinaceousmaterial rich in lipid. It is considered idiophatic. Exogenous lipoid pneumonia is anuncommon condition resulting from aspirating or inhaling fatlike material that elicitsa foreign body reaction and proliferative fibrosis in the lung. Because symptoms areabsent or nonspecific and the roentgenographic findings simulate other diseases,exogenous lipoid pneumonia is often unrecognized.Imaging Findings: Radiographic manifestations of pulmonary alveolar proteinosisinclude bilateral, patchy, diffuse or para-hilar air-space consolidation or hazyground-glass opacity that is more severe in lung bases and resembles pulmonaryedema. HRCT shows bilateral areas of ground glass opacity, smooth interlobularseptal thickening in lung regions showing ground-glass opacity (crazy paving), consolidationand a patchy or geographic distribution. Radiographic manifestations ofexogenous lipoid pneumonia include consolidation, ill-defined masses with variableamounts of low attenuation fat and sometimes fibrosis, with a typical lower-lobedistribution. HRCT shows well or ill-defined masses or areas of consolidation ina dependent location.Conclusion: Staining of BAL fluid can be diagnostic if the radiologist has consideredclinical information and imagiologic patterns of lipoid diffuse lung diseaseand alerts the pathologist.C-232HRCT features of ATRA syndromeE.M. Di Maggio, M.C. Inserra, M. Floridia, M. Russo, M. Raimondo, P. Romeo;Taormina/IT (c.inserra@yahoo.it)Learning Objectives: To discuss and to illustrate the occurrancy of pulmonaryhemorrhage in all trans retinoic acid syndrome even without haemoptysis as strictlyrelated clinical finding. To understand the HRCT aspects of this syndrome.Background: ATRA syndrome is a complication (16%) of the use of all transretinoic acid, which may develop 5-21 days after the accepted treatment of acutepromyelocytic leukaemia. Diagnosis can be made by the presence of three of thefollowing symptoms: fever, dyspnea, weight gain, hypotension, renal failure, pulmonaryinfiltrates, pleural effusion, and pericardial effusion; anaemia with haemoptysiswhen pulmonary haemorrhage occurred.Imaging Findings: Out of 3 cases of ATRA syndrome observed during the lastyear, one occurred also with anaemia and pulmonary haemorrhage but withouthaemoptysis. Diagnosis was made by HRCT that showed diffuse alveolar damage:poorly defined centrilobular nodules, coalescent nodules associated to bilateraldiffuse air space consolidation of posterior lung zones with relatively sparing ofthe anterior lung fields and patchy zone of GGO. At complete remission on bonemarrow examination, final HRCT after treatment showed no evidence of pulmonarydamage.Conclusion: Early recognition of ATRA syndrome is important: tempestive interventionwith high doses of corticosteroid appeared in fact to abort the progressionof this syndrome.ChestPathologyC-233IgG4-related lung disease: CT findings with pathological correlationsD. Inoue 1 , Y. Zen 1 , H. Abo 2 , T. Gabata 1 , H. Demachi 2 , T. Kobayashi 1 , J. Yoshikawa 3 ,S. Miyayama 3 , Y. Nakanuma 1 , O. Matsui 1 ; 1 Kanazawa/JP, 2 Toyama/JP, 3 Fukui/JP(d-inoue@lake.ocn.ne.jp)Purpose: To retrospectively analyze radiological findings of IgG4-related lungdisease as correlated with pathological specimens.Methods and Materials: This study focused on 13 patients with IgG4-relatedlung disease (nine males and four females; age, 43-76 years). We retrospectivelyanalyzed CT images with regard to the characteristics, shapes and distribution ofradiological findings and correlated them with surgically resected or biopsied lungspecimens in seven patients.Results: IgG4-related lung disease manifested a variety of radiological features.Pulmonary lesions could be classified into four types based on the presence ofmajor radiological abnormalities: solid nodular type having solitary mass formingor discrete nodules resembling primary lung cancer in four cases, local groundglassopacity (GGO) type characterized by multiple round-shaped GGO resemblingbronchioloalveolar carcinoma in two patients, alveolar interstitial type showinghoneycombing, bronchiectasia, and diffuse GGO resembling interstitial pneumoniain two patients, and bronchovascular type showing thickening of bronchovascularbundles and interlobular septa in five patients. Pathologically, solitary nodules consistedof diffuse lymphoplasmacytic infiltration with fibrosis. GGO was histologicallycharacterized by inflammatory cell infiltration in thickened alveolar interstitium. Inthe advanced lesions, alveolar structures were disrupted and peri-pleural air spaceswere dilated. These histological findings corresponded to the radiological findingsof honeycombing. Thickened bronchovascular bundles or interlobular septa on CThistologically showed lymphoplasmacytic infiltration with fibrosis along peribronchiolaror interlobular connective tissue.Conclusion: IgG4-related lung disease manifested four types of radiological featureson chest CT. Radiological findings corresponded to IgG4-related sclerosinginflammation along the intrapulmonary connective tissue.C-234Diagnosis of malignant pleural mesothelioma on CTS. Haque, M. Singh, B. Rajashanker, P.M. Taylor; Manchester/UK(sairahaque@doctors.org.uk)Purpose: Computed tomography (CT) is the primary imaging modality used for thediagnosis of malignant pleural mesothelioma (MPM). We carried out a review todetermine the appearances of MPM on CT in 15 histologically confirmed cases.Methods and Materials: CT performed prior to biopsy was retrospectively reviewedusing a grading system ranging from 0 - 4, depending on the degree ofsuspicion of MPM. Initial CT reports were assessed to determine whether MPMwas suspected prior to biopsy.Results: All cases were proven MPM on histology; 6/15 cases also diagnosedon cytology. A third of cases had no suspicious features (Grade 0) or a low indexof suspicion (Grade 1). 3/15 patients had borderline appearances (Grade 2) withminor pleural thickening. 3/15 patients had a high degree of suspicion (Grade 3)including nodular, circumferential pleural and interlobar fissure thickening. 4/15patients had typical findings of MPM with local invasion (Grade 4). Unilateral pleuraleffusion demonstrated in 11/15 and pleural plaques in 20%. 6/15 had lymph nodeinvolvement. 2/15 patients had originally been suspected of MPM prior to biopsyand 6/15 were presumed pleural metastases.Conclusion: There is a wide spectrum of findings on CT in MPM and the initialdiagnosis was only suspected in two cases. Despite retrospective review, 5/15 casesdid not demonstrate any suspicious features. However, the presence of a unilateralpleural effusion with nodular pleural and interlobar fissure thickening should raisethe suspicion of MPM and requires careful assessment for local invasion.ChestACB D E F G HS385

Scientific and Educational ExhibitsC-235A great unknown diaphragm call: Normal anatomy and pathologyJ. Quintero, S. Mourelo, E. Barluenga, D. Hernández, I. Guasch, C. Pozuelo;Badalona/ES (jcquintero.germanstrias@gencat.net)Learning Objectives: To describe the normal anatomy, variants of normality andpathology of the diaphragm and peridiaphragmatic structures, emphasizing CT.Illustrating the importance and advantages of the reconstructions with multidetectorCT and magnetic resonance imaging in the evaluation of the diaphragm.Background: For the role of the diaphragm is generally regarded as a structureintrathoracic albeit for their integration across the diaphragmatic crura also areregarded as a structure intraabdominal. Become familiar with the embryologicaldevelopment of the diaphragm will facilitate know the anatomy, pathology andperiprhagmatic processes.Imaging Findings: Normal anatomy: diaphragmatic hiatuses and inserts.Variants of normalcy: diaphragmatic pillars, pseudotumor diaphragmatic, archedlateral ligaments, retrocrural air. Diaphragmatic defects: Bochdalek hernia, herniaMorgagni, hiatus hernia and traumatic hernia. Peridiaphragmatic pathology: yuxtadiaphragmaticand retrocrural. Transdiaphragmatic processes: subphrenic, liver(hydatid cyst, amebian abscess, iatrogenic) and lymphatic channels. Diaphragmatictumors: they are very rare, most of those are malignant sarcomas, while the highlightof benign lipoma. Diaphragmatic elevation: unilaterally or bilaterally.Conclusion: Given the shape and thinness of the diaphragm it is difficult to visualizea structure in its entirety. For its structural complexity anatomical structures withmultiple ligaments and connections to the chest and abdomen is more than just aborder between the two cavities. Technological advances with teams’ multidetectorCT with multiplanar reconstructions have improved markedly display normaldiaphragm and the pathology of the area and diaphragmatic peridiaphragmatic.ChestPETC-236PET/CT depiction of ATS mediastinal nodal stations: What everyradiologist should know - diagnostic strategies and potential pitfallsJ.V. Raj 1 , J. Birchall 2 ; 1 Leicester/UK, 2 Derby/UK (drvimalraj@googlemail.com)Learning Objectives: To understand the importance of using ATS (AmericanThoracic Society) nodal stations in staging lung cancer. Appreciate PET/CT depictionof these nodal stations and be aware of diagnostic strategies and potentialpitfalls of the technique.Background: Accurate staging of lung cancer is critical due to its therapeutic andprognostic implications. It is vital that radiologists, nuclear medicine physicians,pulmonologists, thoracic surgeons and the oncologists speak the same languagewhen it comes to nodal staging. This can only be achieved by universal use of ATSsystem. Recent advances in PET/CT have led to its increased use in staging, butit has its own advantages and limitations which we will address.Imaging Findings: Pictorial depiction of: ATS nodal stations on PET/CT. Diagnosticstrategies: Normal vs abnormal node characteristics. Importance of PET and CTintegration. Pitfalls: Differential diagnosis of PET positive node. Implication of N3positive node on PET/CT without N1/N2 disease-radical therapy should not be deniedwithout exploring these nodes. Spatial resolution of PET component of CT.Conclusion: As time goes by, PET/CT and ATS nodal staging will become part andparcel of lung cancer staging. Every radiologist therefore should be well versed withATS nodal stations and appreciate the importance and limitations of PET/CT.C-237Evaluation of the accuracy of PET/CT in determining the size of theprimary tumour in T1 and T2 non-small cell lung cancersD. Pawaroo 1 , N. Cummings 2 , P. Musonda 1 , R. Rintoul 2 , C. Beadsmoore 1 ;1Norwich/UK, 2 Cambridge/UK (davina.pawaroo@nnuh.nhs.uk)Purpose: To compare measurements of T1 and T2 primary non-small cell lungcancer tumours (NSCLC) on CT and PET and determine which modality correlatesmost accurately with histological tumour size.Methods and Materials: Retrospective study of 58 patients with surgical resectionof T1 and T2 NSCLC at Papworth Hospital between 2005 and 2007 in whompre-operative PET/CT scanning was performed. The maximum measurement ofthe primary lung tumour was recorded on the PET scan and unenhanced CT (softtissue and lung windows) in whichever plane was largest. Comparison was madewith the maximum dimensions of the histological specimen.Results: Linear correlation with the histology specimen maximum dimension wasgreatest for PET (0.82), followed by CT soft tissue (0.70) and CT lung (0.67). Thegreatest linear correlation was between measurement on CT soft tissue and lungwindows indicating these can be used interchangeably. The Bland and Altmanmethod showed CT soft tissue window measurements demonstrated highestconcordance with histology (mean -0.225; standard deviation 1.5) but PET had alower standard deviation (mean -0.29; standard deviation 0.99). PET measurementswere discordant with histology in 3 patients, CT in 5.Conclusion: PET is better at delineating the primary tumour volume in NSCLC ifthere is surrounding collapse/consolidation; otherwise, CT using either soft tissueor lung windows is accurate. PET tumour volume measurements can be inaccuratein alveolar cell carcinoma and atypical adenomatoid hyperplasia due to low FDGaccumulation. CT is more accurate in these cases.C-238Detection of second primary malignancies with integrated PET/CT in thestaging of non-small-cell lung cancer (NSCLC)D. Leiva Pedraza, C. Gámez Cenzano, S. Guirao Marín, E. Andía Navarro,Á. Fernández León, I. Puig Povedano, F. Martínez Torrens, I. Martínez Ballarín,S. Padrones Sánchez; Hospitalet de Llobregat/ES (d_leiva29@yahoo.es)Purpose: To assess retrospectively the additional value of PET/CT in the detectionof unsuspected second primaries in the staging of patients diagnosed withnon-small-cell lung cancer and other extrathoracic lesions including metastaticdisease and physiologic variants.Methods and Materials: 379 patients with a pathological proven lung tumourunderwent conventional staging work-up and PET/CT with FDG from August2003-February 2006. TNM metabolic staging was established. All extrathoracichypermetabolic lesions were recorded and compared with the final diagnosisobtained from the medical records (follow-up 12 mo).No Material Submitted to EPOSCS386 A B D E F FG H

Scientific and Educational ExhibitsResults: Extrathoracic hypermetabolic lesions were detected in 23% of the patients(88/379) and 75% of these lesions (66/88) were proved to be malignant: 51 patientswith metastasis (77%) and 15 patients with second primaries (23%). Simultaneousmalignancies, observed in 4% of the patients (15/379), were more frequentlycolorectal tumours in an early stage (10/15) and 1 of those patients presented adouble synchronous colorectal cancer. Other primaries included head and neckcancer (1), renal cancer (1), pancreatic cancer (1) and lymphoma (1). Extrathoracicbenign foci observed in the remaining 25% of the patients (22/88) were localizedmainly in colon and corresponded to physiologic variants and adenomas.Conclusion: PET/CT for staging non-small-cell lung cancer patients was able toassess local involvement and detect unsuspected distant metastases and secondprimaries in a single study. Most extrathoracic hypermetabolic lesions resultedmalignant (75%): metastasis (77%) and second malignancies (23%). The resultsof our study suggest that second primary tumours can be detected in 4% ofpatients with primary lung cancer (most of them are detected as an early stagecolorectal tumor).No Material Submitted to EPOSC-239Solitary pulmonary nodule: Role of combined morphological andmetabolic imagingA. Reginelli, M. De Rimini, M.G. Pezzullo, A. Russo, F. Lassandro, P. Muto,A. Rotondo; Naples/ITPurpose: To determine the complementary diagnostic value of morphological andmetabolic studies obtained with 18 F-FDG-PET/CT and contrast enhanced MDCTin solitary pulmonary nodule (SPN) characterization.Methods and Materials: 34 patients with SPN from 10 to 30 mm in size werestudied with 18 F-PET/CT and MDCT with iv contrast. Data analysis on dedicatedworkstations provided the semi-quantitative parameter of 18 FDG uptake (standardizeduptake value-SUV) and morphological, volumetric and densitometric data ofMDCT with iv contrast. The results so obtained were compared with histologicaland citological responses.Results: Of the 34 SPN, 23 were malignant and 11 were benign at histopathologicalexamination. 18 F-FDG-PET/CT correctly identified 21 (91%) malignant lesions(SUV 3) and 10 (90%) benign lesions with 2 false negative and 1 false positive.MDCT with morphological and densitometric evaluation identified 19 (82.6%)malignant lesions and 11 (100%) benign lesion with 4 false negative.Conclusion: Combined study with 18 F-FDG-PET/CT and MDCT with iv contrastoptimizes the global information with morphological and metabolic parameters andso it improves the specificity in SPN characterization.ChestTechnical AspectsC-241Multi-detector row CT (MDCT) and post-processing techniques in thediagnosis of diffuse lung diseaseJ. Ciampi, J. Alarcón, J. de la Torre, M. Santillana, A. Aguado, F. Pla; Madrid/ES(juanciampi@hotmail.com)Learning Objectives: To illustrate the multi-detector row CT (MDCT) and postprocessingtechniques in the diagnosis of diffuse lung disease. To demonstrate thebenefits of MDCT versus high-resolution CT of the chest (HRCT).Background: HRCT is the imaging technique widely accepted for evaluation ofdiffuse lung disease. However, the main limitations of HRCT are that only 10%of lung parenchyma is scanned, and the difficulties to obtain high quality imagesin severely dyspneic or non collaborative patients. The generation of isotropicvolumetric high-resolution data obtained with MDCT has supposed the possibilityof visualizing the lung parenchyma in contiguous high quality images, with theoption of creating two-dimensional (2D) and three-dimensional (3D) reformattedimages. These studies are obtained at much shorter scanning times without losingspatial resolution.Procedure Details: In this exhibit we describe the different reconstruction techniquesavailable with MDCT, and their application to the different patterns of diffuselung disease. In the first part we discuss the wide spectrum of post-processing tools,including 2D reformation (multiplanar reconstruction, maximum intensity projection(MIP), minimum intensity projection (minIP)) and 3D reformation (volume intensityprojection (VIP) and volume rendering (VR)). In the second part we illustrate theMDCT findings in the major patterns of infiltrative lung disease (reticular, nodular,and increased-decreased lung attenuation), with special emphasis in the mostfrequent pathological entities.Conclusion: The numerous reformation tools and the shorter scanning times ofMDCT suppose an actual benefit over HRCT in the evaluation of infiltrative diffuselung disease.C-242The preliminary study on 64-detector CT perfusion imaging in guidingbiopsy of pulmonary lumpsL.-Q. Kang, Z.-W. Song, Y.-F. Chen; Cangzhou/CNC-240Standardized perfusion value (SPV): A semi-quantitative approach betweenMSTC and 18 f-FDG pet in evaluating solitary pulmonary nodules (SPN)A. Reginelli, S. Cappabianca, G. Rossi, M. Petrillo, C. Varelli, R. Muto,A. Rotondo; Naples/ITPurpose: In order to correlate MSCT standardized perfusion value (SPV) andobtain 18 F-FDG PET standardized uptake value (SUV) in the characterization ofsolitary pulmonary nodules.Methods and Materials: We studied 29 patients (52 - 74 years old) with provensolitary pulmonary nodule (SPN) (n = 21) or in follow-up for previously identifiedSPN of unknown nature (n=8). In all patients, both CT scan after intravenousadministration of contrast medium and PET-CT were performed. In all SPN perfusionalvalues quantified with semi-quantitative method and elaborated as SPVand SUV were calculated and the obtained values were matched and correlatedwith cytological specimens.Results: Seventeen patients with SPN had malignant lesions while in four, benignnodules were found. They were computed, respectively, a specificity SPV/SUV of75% and 83%, a sensitivity SPV/SUV equal to 88% and an accuracy of 85%. BothSPV and SUV had the same positive predictive value (PPS) (94%) but differentnegative predictive value (NPV) (60 vs. 67%). The relationship among the specificity,sensitivity and accuracy was 90% (r=0.90), 100% (r=1) and 100% (r=1).Conclusion: Being histological bioptic evaluation the only certain response, theSPV is potentially able to offer, with a single MSCT acquisition, an information datapool easy to be compared with both routine studies, made by MSCT and 18 F-FDGPET, gaining a lower global patient exposition to the radiant doses.Purpose: To explore the value of 64-detector CT perfusion imaging in guidingbiopsy of pulmonary lumps.Methods and Materials: CT guided biopsy was performed on 147 patients withpulmonary lumps between February 2005 and June 2007. The patients were dividedinto 3 groups: 33 cases guided by CT perfusion imaging as group I, 45 cases guidedby contrast-enhanced CT as group II, and 69 cases guided by plain CT as groupIII. The achievement ratio of biopsy, the accuracy in grouping and grading of lungcancer and the incidence of complication were compared.Results: The achievement ratio of biopsy from group.i. to III was 100% (33/33),91.1% (41/45), and 79.7% (55/69), respectively, and the difference was statisticallysignificant between group.i. and III (P 0.05). The accuracy in grouping and gradingof lung cancer from group.i. to III were 100% (27/27), 91.2% (31/34), and 71.7%(33/46), respectively, and the difference was statistically significant between group.i.and III and between group II and III (P 0.05). The incidence of complication fromgroup.i. to III was 15.2% (5/33), 26.7% (12/45), and 43.5% (30/69), respectively, andthe difference was statistically significant between group.i. and III (P 0.01).Conclusion: CT perfusion imaging guided biopsy of pulmonary lumps using 64-detectorCT has a potential to improve the accuracy of histopathological diagnosiswith lower risk and higher achievement ratio, but more research and technicalimprovements are needed before it is widely used.C-243Feasibility of in vivo proton magnetic resonance spectroscopy of lungcancerC. Park, C. Lee, I. Song, J. Goo, H. Lee; Seoul/KR (cmpark@radiol.snu.ac.kr)Purpose: To investigate the feasibility of in vivo proton magnetic resonance spectroscopy(MRS) for assessment of lung cancer.Methods and Materials: In this prospective study, 10 consecutive patients (7men and 3 woman; mean age, 64.4 years) with pathologically-proven lung cancer(mean size, 56.8 mm, range, 44-77 mm), were subjected to MRS using PRESS inbreath hold and continued respiration-triggered acquisition. All MRS examinationswere performed using a 1.5 T scanner. We assessed technical success rate andChestACB D E F G HS387

Scientific and Educational Exhibitsinvestigated the reason of the technical failure in those cases. The peak areasof the choline (Cho) and lipid were measured in the lung mass and expressedthe relative signal-to-noise ratio (SNR) of Cho to the background noise level. TheCho-to-lipid ratio was measured by dividing the peak area of Cho at 3.2 ppm bythe peak area of lipid at 1.3 ppm.Results: Of the 10 lung cancers, spectra of analyzable quality were obtained from8 tumors (technical success rate, 80%). Two MRS data sets from tumors had poorspectroscopic resolution or impaired signal-to-noise ratio for analysis. The meanCho SNR of lung cancers was 1014.43 (range, 0-31.2). The mean Cho-to-lipidratio of lung cancers was 0.20.34 (range, 0-0.96).Conclusion: In vivo proton MRS in breath hold and continued respiration-triggeredacquisition is technically feasible for the evaluation of lung cancer.C-244Ground-glass nodule volume - influence of the tube current on automatedmeasurements: A chest CT phantom studyL. E, D. Ma; Beijing/CN (elinning@163.com)Purpose: The purpose of our study was to evaluate the effect of various tubecurrents on the accuracy of volumetric measurement of ground-glass nodules byusing a chest phantom.Methods and Materials: A chest phantom containing 13 artificial ground-glassnodules (8~15 mm in diameter) with known volume was scanned using a 64-sectioncomputed tomography (CT) scanner at different tube currents (210, 180, 150,120, 90, 60, 30 mA). All data were reconstructed with slice thickness of 0.625 mmand bone algorithm. Automated nodule volume measurements were performed byusing computer-assisted volume measurement software. The relative percentageerror (RPE) and the absolute percentage error (APE) between the CT measuredvolume and the reference-standard volume of ground-glass nodules was measured.RPEs and APEs obtained at each current were compared respectively by the useof two-way ANOVA.Results: There was substantial underestimation of volume of ground-glass nodulesmeasured at 30, 60, 90 mA, the mean RPE of the software-calculated volume ofground-glass nodules were -5.638.60, -6.077.49, and -5.508.31%, respectively.And there was substantial overestimation of volume at 120, 150, 180 and 210 mA,the mean RPE were 2.328.05, 3.068.18, 4.717.63, and 3.057.79%, respectively.But there was no statistically significant difference in APEs across the seventube currents (p=0.876).Conclusion: Computer-assisted volume measurement is a promising method forquantification of ground-glass nodule volume. It is important to know the effectof different tube currents on the accuracy of volumetric measurement during thefollow-up of ground-glass nodule volume.C-245Low dose chest CT in the preoperative evaluation in patients with pectusexcavatum: Clinical utility for surgical planK. Lee, M.-Y. Kim, H. Park, E.-Y. Kang, Y. Oh, B. Seo, S. Lee, B. Je; Ansan/KR(kiylee@korea.ac.kr)Purpose: Individual patients with pectus excavatum (PE) may have chest characteristicsthat impact the result of repair. This study was conducted to assessthe usefulness of low-dose multidetector row computed tomography (MDCT)depiction of various deformities that would have an impact on the choice of pectusbar shaping.Methods and Materials: This study included 185 consecutive patients (135 menand 50 women; age, 3-30 years; mean age, 10 years) who underwent low doseMDCT and had surgical correction of their PE between March 2007 and March 2008.All the patients underwent low dose multidetector (MDCT) before surgical procedure.MDCT scans were obtained by using a sixty four-channel MDCT with 120 kVp and30-35 mAs. Morphological variations of chest wall deformity were evaluated basedon symmetricity of deformity and broad or deep focal depression.Results: 105 (56.8%) patients had the typical deep symmetrical depression ofthe lower sternum (focal type; 74, broad type; 31). 80 (43.2%) patients had asymmetricaldepression, which is the maximal depression is in the cartilage off to oneside (focal type; 33, broad type; 20). 27 patients (14.6%) revealed the unbalancedtype (variant of asymmetric depression), which describes the center of the depressionis in the midline but one side of the wall of the depression is more severelydepressed than the other.Conclusion: Low dose chest CT is useful in the identification of morphologicalvariations of PE that is helpful in the preoperative shaping of the pectus bar priorto surgical repair.C-246Whole-lung xenon ventilation CT using a dual energy technique with dualsourceCTY. Watanabe 1 , T. Nakazawa 2 , M. Higashi 2 , T. Itoh 3 , K. Ohtani 3 , S. Sase 3 ,Y. Ohnishi 2 , H. Naito 2 ; 1 Chuo/JP, 2 Suita/JP, 3 Tokyo/JP (yowatana@luke.or.jp)Purpose: To evaluate whether whole lung xenon-ventilation CT by dual energy (DE)CT is a useful diagnostic tool for regional lung ventilation evaluation.Methods and Materials: Six healthy volunteers inhaled 30% stable xenon for2 min. Whole-lung CT (baseline native and dynamic enhanced) was performedduring wash-in (7 times) and wash-out (2 times) by dual-source CT (SOMATOMDefinition; Siemens, Germany) in the low-dose DE mode (140 kV, 6 eff.mAs and80 kV, 26 eff.mAs). Xenon images were obtained using commercial DE software(Siemens, Germany) to extract lung perfused blood volume images and xenonventilation analysis software (Anzai, Japan). Time-attenuation curves were fittedby non-linear least square curve fitting to a single-compartment exponential model.K (rate constant of enhancement), A (amount of enhancement) and EMS (errormean square) maps from xenon images or combined images (140 kV and 80 kVdata) were obtained. The lung was divided into upper, middle, and lower fields andK-values of these fields were compared.Results: Xenon images and whole lung ventilation maps from DE CT data weresuccessfully obtained in all volunteers. Average EMS from the xenon images(77.59.0) was significantly lower than those from the fused images (133.514.1).K-values from the xenon images were significantly larger in the lower lung fields,but this difference was not detected in K-values from the combined images.Conclusion: The xenon ventilation map was calculated more accurately from xenonimages extracted from DE CT data than from combined images. Whole-lung regionalventilation function can be displayed with DE xenon ventilation CT.C-247Comparison of STIR turbo SE imaging and diffusion-weighted imaging ofthe lung: Capability for detection and subtype classification in pulmonaryadenocarcinomasH. Koyama, Y. Ohno, N. Aoyama, M. Nogami, D. Takenaka, Y. Onishi,K. Matsumoto, S. Matsumoto, K. Sugimura; Kobe/JP(hisanobu19760104@yahoo.co.jp)Purpose: To evaluate the capabilities of DWI for detection and differentiation ofsubtype classification in patients with pulmonary adenocarcinoma, and to directlycompare those capabilities with STIR.Methods and Materials: Thirty-two patients (14 men and 18 women; mean age,65.2 years) with 33 adenocarcinomas were enrolled in this study. All MR examinationswere performed on a 1.5 T scanner. To determine the capability for detection,detection rates of both sequences were compared by using McNemar’s test.ADC values on DWI and contrast ratio between cancer and muscle (CR) on STIRwere measured for comparison with histological subtypes, and these values werecompared with subtype classifications by using ANOVA. Finally, ROC-based positivetests were performed to differentiate subtype classifications, and differentiatecapabilities were compared with each other by using McNemar’s test.Results: Detection rate of DWI (85% [28/33]) was significantly lower than that ofSTIR (100% [33/33], p 0.05). There were no significant differences between ADCvalues and subtype classifications; however, CRs of BAC were significant lowerthan other types (p 0.05). When threshold values for differentiating BAC fromothers (ADC=0.0012, CR=0.8) were adapted, sensitivity (56.5% [13/23], p 0.05)and accuracy (63.6% [21/33], p 0.05) of DWI were significantly lower than thoseof STIR (sensitivity: 95.7% [22/23] and accuracy: 90.9% [30/33]). When thresholdvalues (ADC=0.0014, CR=1.2) for differentiating adenocarcinoma with mixedsubtypes from that except BAC component, there were no significant differenceamong two sequences.Conclusion: The capabilities of DWI for detection and subtype classification werelower compared with STIR.C-248Virtual bronchoscopy-guided transbronchial lung biopsy in the diagnosisof peripheral lung cancerS. Iwano, K. Imaizumi, T. Okada, Y. Hasegawa, S. Naganawa; Nagoya/JP(iwano45@med.nagoya-u.ac.jp)Purpose: Multidetector computed-tomography (MDCT) with 0.5 mm x 64 detectorrows enables the high quality virtual bronchoscopic (HQVB) image of whole bronchialtrees. Therefore, we have applied HQVB for the navigation of transbronchialbiopsy in the diagnosis of lung cancer since 2006. The aim of this study was toevaluate the clinical value of HQVB for the assistance of peripheral lung cancerdiagnosis by transbronchial lung biopsy (TBLB).CS388 A B D E F FG H

Scientific and Educational ExhibitsMethods and Materials: Eighty patients of peripheral lung cancer (50 males and 30females, mean age 67; range from 38 to 84) confirmed by pathology were reviewed.For all patients, an experienced radiologist planned one or two suitable HQVBpaths on a workstation before the real bronchoscopy and the expert physicians ofrespiratory internal medicine underwent TBLB navigated by them. The factors for theperformance in the HQVB-guided TBLB (character of patients, CT reconstructionprotocols, feature of tumor) were analyzed by logistic regression analysis.Results: In 62 patients, specimens obtained by HQVB-guided TBLB showedpathologic findings and sensitivity was 78%, which is at least concordant withthe previously reported value in the literature. Furthermore, the size (13-55 mm),location, the leading bronchial generation (4 th - 8 th ), internal opacities (Solid orGGO) and the pathology of the lesion were independent of performance of HQVBguidedTBLB.Conclusion: HQVB-guided TBLB could contribute to accurate diagnosis of peripherallung cancer regardless of feature of tumor.C-249Small animal imaging of lung cancer: Comparison of different imagingmodalities exemplified by SPC-myc and SPC-raf transgenic mouse modelsT. Rodt, C. von Falck, R. Halter, C. Boehm, C. Tillkorn, J. Lotz, M. Galanski,J. Borlak; Hannover/DE (rodt.thomas@mh-hannover.de)Learning Objectives: To present different small animal imaging modalities forimaging of lung cancer. To compare the advantages and disadvantages of thedifferent modalities.Background: Small animal imaging allows in-vivo assessment of lung cancer. Itcan be used for further examination of molecular carcinogenesis mechanisms andevaluation of novel treatment strategies. Different modalities including microCT,microPET, MRT and optical imaging have been applied. As in human imaging, theindividual modalities have different advantages and disadvantages for particulardiagnostic questions. Furthermore, the specific requirements that come along withthe changes in physiological parameters and spatial dimension in small animalimaging have to be taken into consideration.Imaging Findings: Exemplified by SPC-myc and SPC-raf transgenic mousemodels, microCT, microPET, MRT and optical imaging techniques are presented.Imaging findings are correlated to necropsy and histology findings. Technical considerationssuch as anesthesia, gating and the choice of tracers are addressed.The advantages and disadvantages of the different modalities are further discussedby the literature on small animal imaging in lung cancer.Conclusion: Small animal imaging of lung cancer can be obtained using differentimaging modalities that have specific advantages and disadvantages. Morphologyis best appreciated by microCT while microPET and optical imaging allow obtainingfunctional and metabolic information. MRT bridges the gap allowing imagingof morphology as well as function or metabolism.C-250Role of dual energy subtraction in the detection of bone abnormalities:Looking beyond the conventional chest radiographyD. Castellon, J. Calatayud, G. Tardaguila, J. Aguilar, R. Prada, E. Santos,F.M. Tardaguila; Vigo/ES (danielcastellon@gmail.com)Learning Objectives: 1. To review the basic principles of dual energy subtraction. 2.To illustrate the broad spectrum of skeletal pathology and their radiological imagingpatterns. 3. To discuss the role of dual energy subtraction chest radiography in thedetection and characterization of bone lesions.Background: Skeletal abnormalities are common findings on chest radiography.Despite recent advances in MDCT, chest radiography remains the most commontool used to make an initial diagnosis approach of many thoracic diseases. In itsconventional form, anatomic features overlay each other and anatomical noisecan reduce the capacity of observer to detect abnormalities of concern. In dualenergy, tissue-selective images are generated removing overlying structures,which may help the radiologists to detect lesions that could not be identified onconventional X-ray.Imaging Findings: Representative cases of thoracic bone diseases found on dualenergy chest radiography are shown and classified into five groups to facilitate learning:1) congenital abnormalities, 2) inflammatory/infectious pathology, 3) bone neoplasms(primary tumors and metastases), 4) extension by contiguity and 5) traumaticlesions. Imaging features are illustrated using a multimodality approach (plain film,dual energy chest radiography, ultrasound and MDCT). Usefulness of bone-selectiveimage in the identification of chest wall abnormalities is emphasized.Conclusion: Dual energy subtraction chest radiography has been recognized as apromising technique in the evaluation of cardiothoracic disease and bone-selectiveimage is a helpful modality in the detection and characterization of thoracic bonelesions, especially in the diagnosis of metastastatic bone disease.C-251Dynamic contrast-enhanced 3D magnetic resonance with automaticsubtraction in the follow-up of lung tumors treated with radiofrequencyablationP. Arguis, M. Sánchez, L. Bianchi, A. Borrat, R.J. Perea, T.M. De Caralt;Barcelona/ES (32369pag@comb.es)Learning Objectives: To describe the dynamic contrast-enhanced 3D magneticresonance with automatic subtraction in the follow-up of lung tumors treated withradiofrequency ablation (RFA). To illustrate the MRI findings of lung tumors afterRFA.Background: RFA is a treatment option for nonsurgical patients with primaryand metastatic lung tumors. The follow-up is important because some of treatedpatients will demonstrate local residual viable tumor with potential reintervention.CT is the technique for follow-up. The enhancement pattern and the size of thechange in the ablated lesion are the most important CT findings of lung tumorsfor determining whether a complete ablation has been achieved. As at MRI imagesthe ablation zone is usually seen with high signal on T1, it may be difficult torecognize enhanced areas.Imaging Findings: On immediate MRI images, the ablation zone is iso/hypointenseon T1 and the reactive rim is hyperintense on T2 with peripheral enhancementpost-gadolinium administration. On follow-up, the central part of the lesionbecomes hyperintense on T1. Treated areas without contrast enhancement onpost-gadolinium enhanced T1-weighted images are suggestive of complete ablation.Subtraction, obtained between noncontrast and contrast enhanced imagesat dynamic gadolinium-enhanced MR imaging, may be more sensitive detectingvery small enhanced areas representing viable residual tumor.Conclusion: Dynamic contrast-enhanced 3D magnetic resonance with automaticsubtraction may be useful in the follow-up of lung tumors treated with RFA.C-253The impact of post-processing of chest DR on detection of simulated lunglesions: A phantom studyL. Zhao, W. He, K. Wang; Beijing/CN (zhaolqzr@sohu.com)Purpose: To compare three parameters sets of post-processing in DR chest radiologyfor the detection of simulated lung lesions (nodules, reticular, ground-glass,linear and miliary patterns).Methods and Materials: Simulated nodules, including ground-glass, linear andreticular patterns were superimposed over a authropomorphic chest phantom(KAGAKU, Kyoto, Japan). DR radiography was performed with different three postprocessingparameters sets (default, low pass and high pass enhanced, DigitalDiagnost, Release 1.3, Philips Medical Systems, Hamburg, Germany). Screenreading was performed by four radiologists. The detection performance of threeparameter sets was compared by using receiver operating characteristic (ROC)analysis involving 36,000 observations.Results: By using default, high and low pass enhanced processing parameter sets,the Az value for detection of ground-glass were 0.780, 0.737 and 0. 865, better atlow pass, p 0.05; linear pattern: 0.898, 0.935, 0.912, better at high pass, p 0.01;and nodule pattern: 0.826, 0.825, 0.840, better at low pass, p 0.01.Conclusion: The diagnostic performance of chest DR was changed in differenttypes of post-processing. The low pass image was better for detection of groundglassand nodule patterns whereas high pass image better for linear and reticularpatterns. This study is helpful to define some post-processing protocols to increasedetection of certain chest lesion patterns, such as nodule, reticular, ground-glass,linear and miliary patterns.C-255Clinical applications and diagnostic role of dual energy subtraction in theevaluation of thoracic disease: A pictorial essayD. Castellon, J. Calatayud, J. Aguilar, G. Tardaguila, R. Prada, C. Delgado,F.M. Tardaguila; Vigo/ES (danielcastellon@gmail.com)Learning Objectives: 1) To review the basic principles of dual energy subtraction.2) To illustrate the spectrum of diseases that can be demonstrated by this technique.3) To provide a practical approach to clinical applications. 4) To highlight technicallimitations and imaging pitfalls.Background: Chest radiography still represents the most common tool in diagnosticradiology due to its simple application, low dose and low cost. Dual energy subtractiontakes advantage of the difference in the energy dependence of attenuationbetween soft tissue and bone. These differences are used to generate tissueselectiveimages. This ability of dual energy technology to remove overlying bonystructures has markedly improve the detection of pulmonary nodules. Although theChestACB D E F G HS389

Scientific and Educational Exhibitsmajority of the published literature on dual energy subtraction chest radiographyhas focused on the improved detection of lung nodules, we will illustrate many otherdual energy clinical applications in this pictorial essay.Imaging Findings: Representative cases are shown in this exhibit to illustratethe expanded diagnostic role in the assessment of cardiothoracic disease withdual energy subtraction digital chest radiography. These are classified into differentgroups to facilitate learning: 1) calcified and noncalcified nodules, 2) pleuraldisease, 3) pneumothorax, 4) hilar and mediastinal masses, 5) airway pathology,6) bone abnormalities, 7) cardiovascular disease and 8) indwelling devices andforeign bodies.Conclusion: Dual energy subtraction chest radiography improves the radiologist’sability to diagnose a wide variety of cardiothoracic pathology. Major teaching pointis familiarizing the viewer with dual energy subtraction images of different abnormalitiesbeyond lung nodules.C-256Patent foramen ovale and expiratory scans: Importance in CT pulmonaryangiographyR.S. Kashyape, H. Choudhury, A. Kohli, D. Rajput; Mumbai/IN(drhimanshu@hotmail.com)Purpose: Evaluation of expiratory scans for adequate opacification of pulmonaryarteries during CT pulmonary angiography of patients with intra-cardiac shunts.Methods and Materials: 30 patients who underwent CT pulmonary angiographyfor suspected pulmonary embolism during a period of six months were evaluatedretrospectively. In all patients, the scan was taken after inspiration using standardrecorded API. A second scan was performed with the patient holding his breath inexpiration if adequate opacification of pulmonary arteries was not obtained in thefirst scan, due to a suspected right to left intra-cardiac shunt.Results: Out of a total of 30 patients, in 4 patients adequate opacification of pulmonaryarteries could not be achieved in the first run. In two of these, there weretechnical problems including failure of injector in one and extravasation of contrastin another patient. In the remaining two, a patent foramen ovale was suspected dueto simultaneous dense opacification of superior vena cava and ascending aortawith relative non opacification of pulmonary arteries. In these two patients, repeatscans taken in expiration with all other parameters remaining the same yieldedadequate pulmonary artery opacification. These two patients were later proved tohave a patent foramen ovale on 2D echo studies.Conclusion: Since the prevalence of patent foramen ovale has been estimated tobe about 25% in the general population, additional scans in expiration should betaken in all patients suspected to have patent foramen ovale.C-257Needle image plates compared to conventional CR in chest radiography:How much dose reduction is possible?V. Kulemann, S. Pötter-Lang, M. Gruber, R. Berger, K. Vonbank, M. Weber,M. Uffmann; Vienna/ATPurpose: To compare image quality of standard-dose computed radiography anddose reduced needle-technology CR for supine CXR in a clinical setting.Methods and Materials: We prospectively evaluated 128 radiographs of 32 immunocompromisedpatients. For each patient, four clinical CXR were performedwithin one week, two with powder image plates (PIP; Fuji ST-V) and two withneedle image plates (NIP; Agfa DXS) at standard and half doses, respectively.One experienced radiologist and two residents blinded to dose level and kind ofimaging system rated different anatomical structures, image noise, tubes/linesand abnormalities on a image quality scale from 1 to 10 (1=poor, 10=excellent).The rating scores were tested for statistical differences using analysis of variancewith repeated measures.Results: A statistical difference (p 0.05) was found for the two systems as well asfor the two dose levels. Overall rating scores were 6.5 for PIP with full dose, 6.2 forPIP with half dose, 7.6 for NIP with full dose and 7.4 for NIP with half dose. Therewas a significant difference in favour of the NIP system at the same dose level. Also,the NIP images obtained at half dose were ranked significantly better compared tothe PIP images at standard dose. The differences in ranking of anatomical structuresand abnormalities were more pronounced in low absorption areas (pulmonary vessels,parenchyma) than in high absorption areas (mediastinum, spine).Conclusion: For supine chest radiographs, the NIP technology allows for a dosereduction of 50% compared to PIP while providing higher image quality.ChestVascularC-258Clinical attitudes to diagnosis of PE: The unknown unknowns!N. Askari Haider 1 , S. Haider 2 , S. Kennish 1 , M. Darby 1 ; 1 Leeds/UK, 2 Hull/UK(askari_nazia@yahoo.co.in)Purpose: Diagnosis of pulmonary embolism (PE) requires clinical suspicion andappropriate investigation. This audit determines junior doctors’ awareness of andadherence to British Thoracic Society (BTS) guidelines for PE.Methods and Materials: Review of all CTPA request cards over a 45 day period todetermine the indications and results. Junior doctors in two big teaching hospitalsresponded to an online survey exploring whether clinical suspicion of PE translatedto appropriate investigations.Results: Request cards: 237 CTPA were performed; 16% were positive for PE. Only36% of request cards provided adequate details. Survey response: 115 doctorsresponded, 92% were confident that they could competently assess the clinicalprobability of PE, still 62% do not always assess it. 75% correctly identified that D-dimers should be performed in intermediate/low clinical probability patients. Despitethis, 57% would still consider performing CTPA in patients with negative D-dimer.The majority of doctors would inappropriately request V/Q scans for patients withsignificant cardio-pulmonary disease. 51% believed that normal V/Q scan did notreliably exclude PE. 70% of junior doctors have not read BTS guidelines.Conclusion: A low positive pick-up rate for CTPA and poor understanding of appropriateinvestigative pathways for PE amongst junior doctors suggests that manypatients are being imaged inappropriately. This has important radiation protectionand financial implications. We propose to: 1. Introduce PE teaching into juniordoctor’s induction and e-learning modules. 2. Display summary of BTS guidelinesin CT department. 3. Introduction of request cards specific for CTPA/VQ involvingtick boxes for appropriate clinical details and D-dimer result.C-259CT angiography in suspected pulmonary embolism: Impact of patientcharacteristics and different venous lines on vessel enhancement andimage qualityC.M. Heyer, D. Roggenland, S.P. Lemburg, S.A. Peters, V. Nicolas; Bochum/DE(christoph.heyer@rub.de)Purpose: To compare image quality, patient characteristics, and different types ofcontrast application in pulmonary CT angiography (pCTA) in patients with suspectedpulmonary embolism.Methods and Materials: 126 patients were investigated with pCTA including bolustracking and automated tube current modulation (ATCM). Patient characteristics,type (peripheral or central venous line), position (cubital vein or vein on forearm/hand), size (18- or 20-gauge), and side of venous access were documented.Pulmonary vessel enhancement and image noise were quantified; signal-to-noiseratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective vesselcontrast was assessed by two radiologists in consensus.Results: Patient age showed a significant positive correlation to mean (Pearson’scoefficient=.266; p=.003) and peak vessel enhancement (PC=.244; p=.006), CNR(PC=.178; p=.046), and subjective image quality (PC=.344; p .001), whereas patientweight revealed a significant negative correlation to mean (PC=-.473; p .001)and peak vessel enhancement (PC=-496; p .001), SNR (PC=-.446; p .001), CNR(PC=-.425; p .001), and subjective image quality (PC=-.422; p .001). In univariateanalysis, SNR and CNR were significantly higher in patients who received contrastmedium through a peripheral catheter (3013 and 2713, respectively) comparedto those in whom contrast agent was applied via a central line (228 and 197;p=.041 and p=.029, respectively). Sex, size, position, or side of venous access hadno significant impact on vessel enhancement or image quality.Conclusion: Patient age and weight showed significant impact on vascular attenuationand image quality in pCTA, whereas sex and different peripheral venous routesdid not significantly influence image parameters. Contrast injection through centralcatheters carries the risk of sub-optimal pulmonary artery contrast.CS390 A B D E F FG H

Scientific and Educational ExhibitsC-260Pulmonary hypertension: Role of MDCTM. Navallas, M. Sánchez Nistal, E. Álvarez Moreno, A. Arenas de Pablo,C. Jiménez López-Guarch, T. Velázquez; Madrid/ES (mnavallas@gmail.com)Learning Objectives: To show the role, clinical applications and advantages ofMDCT in the evaluation of pulmonary hypertension. To distinguish primary fromsecondary PH. To illustrate the radiological features and most representative findingsof different causes of PH, with a special mention of chronic thromboembolicpulmonary hypertension (differentiation of chronic from acute pulmonary embolismand evaluation of the extension and distribution of thrombi to select candidatesfor surgery).Background: It is important to be aware of the different causes of PH becausesome of them are treatable like chronic thromboembolism. Thromboendarterectomyimproves symptomatology, increases survival, improves the clinical condition ofpatients, and diminishes the quantity of drugs for maintenance.Procedure Details: The utility of MDCT to evaluate other causes of PH suchas congenital heart diseases, Rendu-Osler syndrome, veno-occlusive disease,connective tissue disorders, pulmonary fibrosis, and chronic thromboembolismis shown. The most outstanding CT findings in chronic thromboembolism are illustrated.A comparison between acute and chronic pulmonary embolism is done.Our findings are compared with those of classical techniques: echocardiographyand catheterism.Conclusion: MDCT is an easy to perform technique that helps in diagnosing PHwhile it makes a differential diagnosis of its causes. Chronic pulmonary embolismis an uncommon cause of pulmonary hypertension. An important difference withother causes of pulmonary hypertension is that it has a surgical treatment. MDCTis useful in the diagnosis, location and extension evaluation of the thrombi, aswell as to assess thromboendarterectomy results. MDCT is complementary toechocardiography and right heart catheterization.C-261Role of computed tomography after pulmonary endarterctomyP. Diez, A.M. Sanchez Nistal, R. Cano, M. Navallas, L. Ibañez, M.J. Ruiz-Cano,P. Escribano Subias; Madrid/ES (patriciadiezm@yahoo.es)Purpose: To evaluate the potential of multidetector-CT and search for new signsin the assessment after pulmonary thromboendarterectomy (PTE) in patients withchronic thomboembolic pulmonary hypertension (CTEPH).Methods and Materials: We analyzed hemodynamic parameters (PVR, right atrialpressure (RAP)), and we correlated it with MDCT findings (mosaic parenchyma,pattern score (MPP), pericardial and pleural changes, collateral systemic circulation(CSC), pulmonary artery (PA) to aorta artery ratio (PAR) PA score (PAS), rightand left ventricles diameter ratio and interventricular septum position) before and6 months after PTE. PAS was obtained by giving, to every affected PA, n points(x2 if completed obstruction) according to the number of branches that originatefrom it (max score (100%)= 40).Results: 10 patients were studied (4815 years, 7 males). 6MWT (345138 vs50289 meters), hemodynamic paramenters (PVR (968386 vs 351229 dinas/cm-5)), and CT findings (PAR (1.30.2 vs 1.00.2) and PAS (4218% vs 2119%))significantly improved (p 0.05) after surgery. There were changes but not significantchanges in other CT variables (CSC and MPP).Conclusion: PTE is the primary treatment of CTPH. From our knowledge, there isno compendium that shows the radiological parameters after PTE. We think that thewhole study of these parameters in MDCT is helpful before and after PTE, mainlypulmonary artery/aorta ratio and pulmonary artery score. Future works in this directionmay get that CT is an indispensable tool to evaluate these patients.C-262Can CT parameters predict clinical course in patients with pulmonaryembolism? A retrospective analysis of 152 patientsD. Roggenland, S.P. Lemburg, S.A. Peters, V. Nicolas, C.M. Heyer; Bochum/DE(daniela.roggenland@rub.de)Purpose: To establish CT parameters in patients with pulmonary embolism (PE)predictive for clinical course and mortality.Methods and Materials: Between 5/2004 and 10/2007, all patients with CT diagnosisof PE were retrospectively identified and included in the study. Analysis ofaxial 16-slice CT scans was performed by two radiologists in consensus includingdocumentation of diameter of RV, LV, SVC, Ao, PA, ventricular septal bowing andcontrast reflux into IVC and/or azygos vein. Pulmonary obstruction index (POI)and RV/LV- and Ao/PA-ratio were calculated. Patient characteristics and clinicalcourse including ICU treatment, mechanical ventilation, thrombolysis, days ofhospitalization, and mortality were documented. Multivariate logistic regressionwas performed with a p-value of 5%.Results: 152 patients (6217 years, 55% male) were enrolled in the study. Meanduration of hospitalization was 2124 days. 66 patients (42%) were treated on ICUand mechanical ventilation was necessary in 20 patients (13%). 11 patients receivedthrombolysis. Mortality rate was 8%. Significant positive correlations between bothPOI (p=.037; OR=1.020) and IVC reflux (p=.018; OR=2.894) and ICU treatment werepresent. Furthermore, significant positive correlation between IVC reflux (p=.005;OR=10.494) and mechanical ventilation could be documented. POI revealed apositive correlation to necessity of thrombolysis (p=0.037; OR=1.114). RV/LV-ratiosignificantly correlated to mortality rate (p=.042; OR=6.275). No other imagingparameter showed significant impact on the clinical course of affected patients.Conclusion: RV/LV-ratio is a predictive parameter for mortality in patients with PE.POI and IVC reflux are predictive for necessity of ICU treatment and mechanicalventilation. Length of hospital treatment cannot be predicted by CT parameters.C-263Diagnosis of chronic pulmonary embolism with dual source dual energy CTY. Nishimoto, S. Miura, S. Kitano, J. Takahama, N. Marugami, K. Kichikawa;Kashihara/JPPurpose: To investigate the usefulness of dual source dual energy CT in thediagnosis of chronic pulmonary embolism (CPE).Methods and Materials: Nine patients with clinical suspicious of CPE underwenta dual energy CT angiogram of the lung (SOMATOM Definition, Siemens) usingthe following acquisition parameters (140 and 80 kV tube voltage, 1:4 tube currentratio, 64x0.6 mm collimation and 0.5 sec gantry rotation time). Contrast agent(100 ml@370I 65 kg and 300I 65 kg for patients, respectively) was injected ata rate of 4 ml/s. Perfusion defects were evaluated with lung perfused blood volumealgorism (Lung PBV). Lung PBV images were generated with commercial software(Siemens, Germany). We evaluated: (a) the depiction of endoluminal clots ontransverse CT scans (contiguous 1-mm thick composite images from both tubes)and (b) the pattern of perfusion defects on Lung PBV images.Results: (a) Two patients showed CT features of PE with depiction of clots withintrunk (n=2), lobar (n=1), segmental (n=1). All clots were identified as incompletefilling defects. 3 patients had lobar artery stenosis. (b) The pattern of perfusiondefects: segmental perfusion defect and shift to upper lung field (n=3), segmentalperfusion defect (n=2), shift to upper lung field (n=1), decrease for whole lung field(n=1) and no perfusion defect except emphysema/honeycombing (n=2).Conclusion: Dual source dual energy CT is useful for the diagnosis of CPE. Itenables detection of the endoluminal clots, perfusion defects and redistributionat the same time.C-264Role of multidetector CT pulmonary angiography in the diagnosticalgorithm of pulmonary hypertensionV.M. Suárez-Vega, I. Torres Sánchez, J. Ríos Blanco, S. Alcolea Batres,A. Alonso Torres, C. Fernández Capitán; Madrid/ES (proksua1@hotmail.com)Purpose: To describe the prevalence of right ventricular dysfunction signs. Toestablish the usefulness of MDCT angiography versus ventilation/perfusion (V/Q)scintigraphy in the diagnostic algorithm.Methods and Materials: Between November 2006 and May 2008, the MDCTangiographies of 47 patients were recorded. The inclusion criterion was a thresholdof systolic main pulmonary artery (MPA) pressure of 40 mm Hg or higher at rest.Moreover, in 23 of these patients (48.9%) the V/Q scintigraphies were available.MDCT pulmonary angiographies were evaluated for right ventricle (RV) dysfunctionsigns (RV/LV ratio 1, left bowing of interventricular septum) and vascular prognosticratios. Patients were divided into two groups (A pulmonary artery 29 mm andB 29 mm) for the statistical analysis. The non-parametric test of U Mann-Whitneywas used. V/Q scintigraphies were classified according to high, medium or lowprobability for pulmonary thromboembolic disease.Results: The mean and standard deviations of MPA and RV were recorded, beinghigher on the B group. The RV/LV and the MPA/Aorta ratios were significantly higheron the B group (p 0.001). Sixteen patients (69.5%) presented a correct matchbetween the MDCT angiography and the V/Q scintigraphy. Four negative V/Q scintigraphiespresented signs of chronic thromboembolism in the MDCT angiography,which also made the alternative diagnosis of interstitial disease.Conclusion: MDCT angiography is an accurate tool depicting RV dysfunction signs.It has also proven signs of chronic thromboembolism in patients with negative V/Qscintigraphies and made the alternative diagnosis of parenchymal diseases. Hence,it might be a first-line-tool in the diagnostic approach of PH.ChestACB D E F G HS391

Scientific and Educational ExhibitsC-265Contribution of MDCT and transthoracic contrast echocardiographygrades in the screening of pulmonary arteriovenous malformations(PAVMs) in patients with hereditary hemorrhagic telangiectasia (HHT): Anongoing studyJ. Parra 1 , J. Bueno 2 , J. Zarauza 2 , J. Cuesta 2 , R. Zarrabeitia 2 , M. Fariñas Alvarez 2 ;1Santander/ES, 2 Torrelavega/ES (japarra@humv.es)Purpose: To compare the results obtained with MDCT and TTCE grades in thescreening of PAVMs in patients with HHT.Methods and Materials: 84 patients (45% males; mean age 46 years) with HHTstudied with MDCT and TTCE. MDCT scans were performed with 3 mm collimationand 1.5 mm reconstruction thickness. TTCE was performed by IV injection of 5 mlof agitated saline. The test was considered positive when contrast was visualizedin the left atrium after a delay of at least 4 cardiac cycles. The studies were classifiedinto grade 1 to 4 according to ventricular opacification. Positive predictivevalues (PPV) and 95% confidence intervals (CI) of TTCE using CT as the referencestandard were calculated.Results: 17 of 84 patients had PAVMs on MDCT. All patients with negative TTCEhad a negative MDCT for PAVMs. 65.5% patients had a positive TTCE, 44% wereconsidered as grade 1, 31% grade 2, 18% grade 3, and 7% grade 4. There wasa significant association between TTCE grades and detection of PAVM on MDCT(p 0.0001). None of the patients with grade 1 had PAVM on the MDCT. PPV were0% for grade 1, 24% (95%CI 5-46%) for grade 2, 90% (95%CI 70-100%) for grade3, and 100% for grade 4.Conclusion: TTCE grades are useful to select patients for MDCT in the screeningof PAVMs in patients with HHT. These findings suggest that in the presence ofTTCE grade 1, further MDCT studies may not be necessary.C-266Pre-operative evaluation for the interventional treatment of hemoptysispatients using 64-slice computed tomography angiographyL. Liu 1 , H. Yang 1 , X. Wang 1 , H. Cao 2 ; 1 Changchun/CN, 2 Beijing/CN(huizhi.cao@ge.com)Learning Objectives: To demonstrate the clinical value of multi-slice computedtomography angiography (MSCTA) in pre-operative evaluation for the interventionaltreatment of hemoptysis patients.Background: CTA techniques based on dynamic enhancement CT exams couldeffectively promote the specificity and accuracy diagnosis. This study evaluates thevalue of CTA in diagnosis and treatment of hemoptysis patients.Procedure Details: Twenty-one hemoptysis patients underwent MSCTA before thedigital subtraction angiography (DSA) and intervention treatment. The parameters ofthe CT scan protocol were: 64x0.625 collimation, 120 Kv, rotation time 0.4s. Volumerendering, maximal intensity projection, and multiplanar reformation were used to depictthe lesion. The findings of CT angiography were compared with those of DSA. Feedingarteries and their origin in 19 of 21 patients were revealed clearly by CTA. There wasno statistically significant difference in detecting abnormal arteries between CTA andDSA (P 0.05). All of the feeding arteries were treated by interventional methods andthe interventional treatment time was shortened guided by the information of CTA. Inthe reexamined CTA images, the abnormal arteries were seen embolised.Conclusion: From the comparative study between CTA and DSA on examinationof hemoptysis patients, it was proved that CTA had a high sensitivity in revealingthe feeding arteries. It can help doctors to make more confirmable diagnosis andto promote the success rate of the operation.No Material Submitted to EPOSC-267Thoracic vascular anomalies detected on CT scan: A pictorial reviewY. Kim, S. Song, O. Woo, H. Yong, E.-Y. Kang; Seoul/KR (akaeuny@hanmail.net)Learning Objectives: 1. To discuss embryogenesis of vascular structures in thorax.2. To classify developmental vascular anomalies detected on thoracic CT scan.3. To recognize the imaging characteristics of pulmonary and systemic vascularanomalies in adult.Background: Various congenital anomalies may affect the pulmonary and systemicvessels in adult thorax. These are usually found incidentally at chest radiographyor CT. An awareness of various pulmonary and systemic vascular anomalies canbe helpful for making precise diagnosis.Procedure Details: 1. Embryology of thoracic vessels 2. Incidence and category ofdevelopmental vascular anomalies in thorax. 3. Imaging characteristics of pulmonaryand systemic vascular anomalies.Conclusion: An awareness of various pulmonary and systemic vascular anomaliescan be helpful for making precise diagnosis.C-268Systemic arterial supply to the lungP. Serrano Gotarredona, S. Navarro Herrero, E. Merchante García,J. Manzanares Vargas, B. Sobrino Guijarro; Seville/ES (mpserranogot@gmail.com)Learning Objectives: To review the potential sources of systemic arterial supply(SAS) to the lung and the spectrum of associated congenital or acquired conditions.To present CT, MR, conventional angiography or chest X-ray images from casesof our experience that illustrate the imaging findings that allow the recognition ofthese vessels and associated processes.Background: SAS may take place through hypertrophied normal systemic arteries,most commonly bronchial arteries, or through abnormal vessels, alreadypresent at birth, such as major aortopulmonary collaterals (MAPCs), also calledaberrant arteries. These are more frequently related to congenital lung processes(sequestration syndrome), although they can also be a source of collateral flowin some congenital heart disease (CHD). Hypertrophied systemic arteries supplythe lung also in some cases of CHD as well as in acquired lung diseases such usbronchiectasis, tuberculosis and other lung infections, pulmonary thromboembolismand other causes of chronic pulmonary arterial obstruction.Imaging Findings: Hypertrophied bronchial or other systemic arteries are usuallyrecognized as tubular, tortuous enhancing structures originating from descendingthoracic aorta or its branches. Aberrant vessels take their origin directly from theaorta apart from the normal origin of bronchial arteries.Conclusion: SAS to the lung may be associated to congenital cardiac and lungdiseases or to acquired disease, and can be the source of significant hemoptysis.MR and CT angiography are non-invasive techniques that allow accurate recognitionof aberrant vessels and hypertrophied bronchial or other systemic arteries, aswell as cardiac and lung associated anomalies.C-269When to suspect pulmonary vasculitis: Radiologic and clinical cluesA. Alguersuari 1 , E. Castaner 1 , E. Ballesteros 1 , M. Andreu 1 , X. Gallardo 1 ,Y. Pallardo 2 , J.M. Mata 1 ; 1 Sabadell/ES, 2 Alzira/ES (ecastaner@tauli.cat)Learning Objectives: To review the causes of diffuse pulmonary hemorrhageand the types of vasculitis that most frequently affects the respiratory system. Tofamiliarize radiologists with CT findings and clinical features that can help in thedifferential diagnosis.Background: The diagnosis and management of a systemic vasculitis affectingthe lungs is difficult. The vasculitis are rare and their signs and symptoms are nonspecific.Although the clinical presentation can be highly variable, the identificationof particular combinations of findings (radiological and clinical) should suggest thepossibility of vasculitis.Procedure Details: We reviewed the CT findings and clinical features of 35 patientswith pulmonary vasculitis. We classified vasculitis in: 1) Small-vessel (ANCA-associatedWegener granulomatosis, microscopic polyangiitis, Churg-Strauss Syndrome).2) Medium vessel (polyarteritis nodosa). 3) Large-vessel (Takayasu, Behçet). 4)Primary immune complex-mediated vasculitis. 5) Secondary vasculitis (systemiclupus erythematosus). We classified radiological findings in: 1) Pulmonary signs:cavitary or nodular disease; infiltrates (consolidation, ground-glass); centrilobularnodules; bronchial disease; 2) Vascular signs: vessel wall thickening; aneurysm;stenosis; pulmonary hypertension. We will also review the clinical scenarios suggestiveof vasculitis (i.e. sinous troubles, mononeuritis).Conclusion: The diagnosis of vasculitis is often delayed because a number of otherdisorders can mimic the clinical manifestations. CT is valuable in the non-invasivediagnosis of patients with pulmonary vasculitis; certain CT signs in combinationwith clinical features enable an earlier diagnosis.C-270Does widening of coronary sinus indicate right ventricular dysfunctionin patients with acute pulmonary embolism assessed with multislicecomputed tomography?G.J. Staskiewicz, E. Czekajska-Chehab, J. Przegalinski, A. Tomaszewski,S. Uhlig, K. Torres, A. Torres, A. Drop; Lublin/PL(grzegorz.staskiewicz@am.lublin.pl)Purpose: Right ventricular dysfunction (RVD) may occur in the course of acutepulmonary embolism (PE). Patients with RVD need more intensive treatment, andthe prognosis is more severe. Radiological parameters of RVD assessed in MSCTare not satisfactory at present. The aim of the study was to evaluate usefulnessof measurement of coronary sinus (CS) in assessment of RVD in patients withacute PE.CS392 A B D E F FG H

Scientific and Educational ExhibitsMethods and Materials: Retrospective assessment of 55 MSCTPA examinationswith signs of acute PE (8- and 64-row scanner) was performed. Quantification ofpulmonary vascular obstruction was performed according to Mastora et al. Pulmonaryartery systolic pressure (PASP) was echocardiographically assessed inall patients. Width of CS was measured in axial plane in a standardized location.Specificity and sensitivity of CS measurement were calculated.Results: Median width of CS in patients with increased PASP was 16 mm (range: 12- 24 mm) and 10 mm (range: 7 - 22 mm) in patients with normal PASP (p=0.001). Bestcutoff value was assessed at 12.5 mm, with sensitivity of 0.94 and specificity of 0.75.Conclusion: Width of CS seems to be a promising parameter for identification ofRVD in patients with acute PE. A prospective study of this parameter should beundertaken to further assess its accuracy.C-271Clot burden score at CT angiography predicts short-term mortality riskafter acute pulmonary embolismE. Kamel, E. Rizzo, G. Adler-Etechami, P. Schnyder, S. Qanadli; Lausanne/CH(Mohamed-ehab.kamel@chuv.ch)Purpose: To investigate the potential prognostic value of quantifying the clot burdenat CT angiography in patients with acute pulmonary embolism (PE).Methods and Materials: Six hundred ninety patients were enrolled. For eachpatient, the arterial obstruction index (OI) was quantified. Three month mortalityrate was requested for the entire study population that was sub-divided into 2groups according to the presence (group A) or absence (group B) of pre-existingcardiopulmonary diseases (CPD). A threshold value of 40% for the arterial OI wasset to stratify patients into high (40%) or low ( 40%) risk; then, mortality rateswere compared accordingly for both groups.Results: The mean arterial OI for the whole study cohort was 2319% (range, 2.5to 67.5%). Mortality rate at 3 month was 5% (34/690 patients). Of those 34 patients,19 (56%) were in group A, whereas, 15 (44%) belonged to group B. Arterial OIthreshold of 40% failed to predict the risk of mortality from acute PE in group Apatients since 16 (84%) out of 19 deaths occurred in patients with a relatively low( 40%) arterial OI. On the other hand, there was a significant difference of mortalityrisk between group B patients who had high (10 deaths) and those who presentedwith relatively lower (5 deaths) arterial OI.Conclusion: In patients without pre-existing CPD, quantifying the clot burdenupon CT angiography has the potential to predict the risk of short-term mortalityfrom acute PE.C-272CT pulmonary angiography for evaluation of pulmonary embolus inpatients with elevated BMI: Predicting and preparing for the “habituslimited”study based upon evaluation of body mass indexS.M. Brannan, V. Ramakrishnan, N. Naveed, M.A. Berner, Q.A. Rao,S.C. Williams, G. Marinan; Bridgeport, CT/US (brannanscott@hotmail.com)Purpose: CTPA for evaluation of pulmonary embolism is frequently limited in obesepatients, due to issues of beam attenuation and scatter. Using chart review, weattempted to determine a cut-off range of body mass index at or above which theeffects of scatter and attenuation render the diagnostic utility of standard protocolCTPA predictably limited.Methods and Materials: Charts of 1000 recent CTPA studies were reviewed.BMI was calculated based on admission height and weight. Those with BMI 25were excluded. Studies limited by technical factors other than beam attenuationand scatter were excluded. Final study group comprised 208 patients (BMI 25-46).Reports and images for the 208 study members were reviewed by two BC radiologists,blinded to BMI calculations.Results: Patients with BMI 38 were more likely to have an exam interpreted as"habitus-limited" than those patients with BMI 38 (odds ratio = 12). Beginning atBMI 34, there is a direct relationship between increased BMI and risk of "habituslimited"interpretation.Conclusion: CTPA for evaluation of pulmonary embolism utilizing standard imagingprotocol in our institution is frequently limited in obese patients. Standard protocolCTPA studies performed on patients with a body mass index 38 have a high likelihoodof "habitus-limited" interpretation, which may result in subsequent utilizationof alternative diagnostic modalities. Clinical application: establish a BMI at whichmodifications to standard protocol must be made to optimize CTPA. Assist referringphysicians to optimize diagnostic algorithm for PE in morbidly obese patients andmanage expectations for CTPA in the morbidly obese.Computer ApplicationsC-273Robust modeling of time intensity curvesA. Maciak 1 , D. Mayer 2 , A. Kronfeld 1 , K. Mayer-Wiethe 3 , G. Seidel 3 , T. Vomweg 2 ;1Mainz/DE, 2 Ingelheim/DE, 3 Lübeck/DE (am@avallia.com)Purpose: This abstract shows a robust and fast method of describing TICs inutrasound-based BHI and CE-MRI based on a physical model. The model has similarrobust properties to a gamma-variate function, but an accurate bolus flow shape.Methods and Materials: The model is based on the physical behavior of bolusfluids. It is data driven and does not require any further knowledge about tissuecompartments. It describes pharmacokinetics qualitatively. The model consists ofthree parts. The first one describes the signal baseline and the second parameterdescribes the uptake behavior of the contrast agents by a logistic function. The thirdparameter gives the wash-out characteristic by an exponential term.Results: The model has been validated in two different types of clinical settings.Perfusion sonography is heavily affected by noise, movement and low SNR. Themodel substituted a gamma variate function in a software system for automaticallydetecting perfusion reduced brain tissue. This setting was validated on 26 patients.In MR-mammography the challenges are to describe the uptake and washout ofcontrast agents with few data points. In this setting, the model has substituted atwo-compartment model. This setting was validated on 142 patients. The Akaikeinformation-criterionhas shown an improvement in modeling TICs comparing togamma-variate functions.Conclusion: The advantages of the presented model are the simplicity, the behaviorof modeling TICs having only very few data and the models accuracy even if thedata is strongly affected by noise. The model can be computed very fast and givesa robust estimation of the kinetic of contrast agents.C-274“Virtual projection radiography”: A novel teaching tool to improveunderstanding of radiology basicsC. von Falck, T. Rodt, S. Waldeck, M. Galanski, H.-O. Shin; Hannover/DE(c.v.falck@gmx.de)Learning Objectives: To demonstrate a novel teaching tool for improved understandingof projection effects based on post-processed CT-datasets.Background: The accurate interpretation of plain-film radiographs demands notonly a profound knowledge of normal anatomy and typical pathologic changes butalso a conceptional understanding of projection effects. In radiological student andresident education, direct correlation of plain-film radiographs and cross-sectionalimages in the same patient is helpful to facilitate the understanding of basic projectionprinciples. Based on this cross-modality teaching approach, we proposethe use of “virtual projection radiographs” based on post-processed CT datasets.These virtual radiographs are interactively created in a step-by-step approach andthus help to develop a conceptional model of image generation. In this exhibit, weillustrate the possible use of this technique in the various pathologies of the chest,the wrist and the ankle.Procedure Details: The CT datasets were retrospectively chosen from the hospital’sPACS archive. CT scans were acquired on a 64-slice MDCT (GE Lightspeed VCT)with a slice collimation of 0.625-1.25 mm. “Virtual projection radiography” imageswere interactively created using thick-slab and ray-sum post-processing techniqueson a dedicated multi-modality workstation (GE Advantage Workstation 4.4). TheCT datasets were aligned according to the standard radiographic projections andthe “virtual radiographs” were created step-by-step. For evaluation purposes, theresulting images were compared to true radiographs of the same patient.Conclusion: Post-processing of CT-datasets using thick-slab techniques can bereadily applied to create “virtual radiographs” that facilitate the understanding ofprojection effects.C-275Development of software for automatic measurement of Cobb angle andquantitative assessment method for follow-up in radiographs of patientswith scoliosisE. Omoto 1 , O. Wakamatsu 1 , S. Sanada 2 ; 1 Tokyo/JP, 2 Kanazawa/JP(ab00451@yahoo.co.jp)Purpose: Cobb’s method is a standard technique for measurement of the degreeof scoliotic curvature in patients with scoliosis. However, some error is introducedin the manual procedure. Cobb’s method and observation of the whole-spine morphologyare required at periodic follow-ups. In the present study, we developeda computer-aided algorithm for automatic measurement of the Cobb angle and amethod for quantitative assessment of radiographs.ACB D E F G HS393Computer Applications

Scientific and Educational ExhibitsMethods and Materials: In manual analysis, the Cobb angle was measured asthe degree of scoliotic curvature in original images. In automatic analysis, theoriginal images were processed by median filter, Gaussian filter, subtraction andbinarisation. Automatic measurement of the Cobb angle was performed using afourth-order multinomial equation. In addition, the whole-spine morphology curvewas obtained by connecting the central point of the adjacent spine in the processedimage for observation of interval changes on whole-spine radiographs in ten patients.To avoid positional changes of the spine induced by tilting, Y-axis adjustment ofthe curve was performed.Results: A good correlation (r=0.9724, P 0.01) between the manual and automaticmeasurements was found, especially in the processed images. In the tenpatients, the interval changes were observed quantitatively by superimposition ofeach whole-spine morphology curve.Conclusion: Computer-aided automatic measurement of the Cobb angle is a reliablemethod for clinical evaluation of patients with scoliosis, and the whole-spinemorphology curve is useful for quantitative observation of interval changes.C-276www.PubmedReader.com: A custom-defined tool for instant literatureupdatesR. Talanow 1 , I. Timofte 2 , F. Giesel 3 ; 1 Cleveland, OH/US, 2 East Cleveland, OH/US,3Heidelberg/DE (roland@talanow.info)Learning Objectives: To provide a program that provides immediate and easyaccess from PubMed to specific medical topics, independent from location, andwithout the need to redefine search criteria repeatedly to accelerate the physician’sworkflow in research and daily work.Background: PubMed is the most used literature database for researching newestknowledge in Medicine. However, it does not provide the possibility to customizethe search to the individual user’s needs.Procedure Details: The information is obtained via RSS feed on-the-fly from thePubMed database and provided to the user as HTML code in the form of a customdefinedwebsite. The user may create multiple search criteria and save them in apersonal profile. The inividualized information is stored on the server. The programmay be used in different modes for a broad overlook about all defined search criteriawith access to the PubMed information and another mode for on-the-fly accessto the information directly from the user’s computer. By using the latter mode, theuser receives an instant access to custom defined search criteria with literally aclick of the mouse.Conclusion: This web-based program provides PubMed information to specificmedical topics on-the-fly without need for reentering frequent search criteria. Itoffers individualized user accounts, easy to use and is free of charge. The userstays always up-to-date and by individualization of the search criteria, access andlayout of information presentation, the user is provided with a flexible and practicaltool to facilitate the physician’s workflow in research and daily work.C-277RadLex for dummies: A how-to tutorial and practical example forintegrating RadLex for individual needsR. Talanow; Cleveland, OH/US (roland@talanow.info)Learning Objectives: To provide a tutorial for even less computer experiencedusers to understand how to implement a RadLex interface for individual purposessuch as integration into websites.Background: RadLex is a lexicon for uniform indexing and retrieval of radiologyinformation resources. It offers users and developers to share the information viaseveral ways. One way is the possibility to retrieve the information directly from theuser’s website. However, for less computer experienced users this may becomea difficult task to perform.Procedure Details: We provide a tutorial on how to create an interface to use theRadLex information from the user’s own website. Step by step, the tutorial explainsthe requirements that are needed to perform this task and explains the individualsteps with explanatory text and images. This tutorial demonstrates also a workingand useful example. After this tutorial, even a not well experienced computer usershould be able to integrate a RadLex interface into the own website.Conclusion: This tutorial explains in an - even for a less computer experienceduser - understandable way how to create a working RadLex interface for individualpurposes such as integrating into the own website.C-278Evaluation of availability of radiology e-learning material in the internetand concepts for improvementR. Talanow 1 , D. Ketelsen 2 , M. Grunewald 3 ; 1 Cleveland, OH/US, 2 Tübingen/DE,3Erlangen/DE (roland@talanow.info)Learning Objectives: The aim of the study was to analyze the availability of publishedradiological e-learning tools and to find solutions for quality assurance.Background: Multiple (not) peer-reviewed websites exist, which offer links to onlineradiologic-educational material. However, not uncommonly, websites changelocation, contents or shut down completely. Consequently, these link lists containincreasingly dead links, which deteriorate the value of these resource link lists.Procedure Details: Two educational resource link databases were evaluated (Compare,n=435 links and TNT-Radiology, n=1078 links). 56.4% (102/181) of links wereaccessible. A subgroup analysis of programs published 5 to 8 years ago showedsignificantly inferior availability to programs published 3 to 5 years ago (p 0.01).The analysis of external links showed between 49.2 and 61.0% accessible links.As a consequence, a solution is needed, which allows near-automatic evaluationand control of existence and quality of educational resources. Authors should beable to submit their educational programs and users themselves should be able toevaluate these programs depending on several criteria including existence of thelinks. Furthermore, the program has to check validity of resources to guaranteehigh quality and reliability of the provided resources.Conclusion: More than 50% of investigated radiological e-learning tools on theInternet were not accessible after a period of 5 to 8 years. It is not feasible for singleproviders of educational resource lists to guarantee the availability of the links. Asa consequence, an independent and peer-reviewed tool for quality assurance isnecessary to shift this responsibility to the users themselves.C-279Three radiology workflow changes over three years and the resultantradiology report turnaround times (RTAT)M.M. Conlon 1 , M. Mc Entee 2 ; 1 Galway/IE, 2 Dublin/IE(mary.conlon@galwayclinic.com)Purpose: This study investigates the effects of outsourced transcription, paperrequest scanning and voice recognition on report turnaround times (RTAT) in aradiology department over a 3 year period.Methods and Materials: A customised report named ‘Elapsed times report’extracted study data from the RIS. This report captured significant times in thereporting process. Each workflow change resulted in a new phase and data foreach of the 4 phases was analysed using a student t-test.Results: In phase 1, radiology reports were typed in-house and the RTAT was22:33:49 hours (SD 38:51 Hrs). A change to outsourced transcription in Phase 2resulted in a RTAT of 95:58:40 hours (SD 108:19 Hrs). In Phase 3, all requestswere scanned to PACS (picture archive and communication system) and RTAT was62:59:17 hours (SD 51:26 Hrs). Phase 4 introduced VR (voice recognition) andsaw a decrease in RTAT to 10:09 hrs (SD 8:51 Hrs).Conclusion: Outsourcing of report transcription resulted in an increase of +325%in the RTAT as it increased the times taken to input draft reports and the time takenfor radiologists to sign reports. The scanning of paper request saw a decreasein the RTAT (p 0.001). The RTAT was decreased by 45% on the original RTATfollowing implementation of voice recognition. In phase 4, radiologists generateand sign reports concurrently thus eliminating the elapsed time between draftand signed states. Of the three workflow changes, VR had the greatest positiveimpact on RTAT.C-280Computer-aided-diagnosis (CAD) for brain, breast, and eye diseases: Three‘knowledge cluster’ projects in JapanH. Fujita 1 , G.N. Lee 1 , Y. Uchiyama 1 , D. Fukuoka 1 , Y. Hatanaka 2 , T. Hara 1 , Y. Ikedo 1 ,C. Muramatsu 1 , T. Morita 3 , T. Endo 3 ; 1 Gifu City/JP, 2 Shiga/JP, 3 Aichi/JP(gobert@fjt.info.gifu-u.ac.jp)Learning Objectives: To introduce 3 CAD systems that are dedicated to: (a)brain MRI for the detection of cerebral diseases; (b) breast ultrasound for womenwith dense breast; (c) retinal fundus images for the early detection of some oculardiseases.Background: The above 3 CAD projects are part of the ‘Knowledge ClusterInitiative’ project, which is a national wide, multi-project, multi-center initiative bythe Japanese government. The projects emerged as a respond to the Japanesehealth care needs.CS394 A B D E F FG H

Scientific and Educational ExhibitsProcedure Details: The following three CAD systems are presented: (1) The brainCAD system detects cerebral vascular diseases on MRI images featuring the novelselMIP technique; recognition of the eight neuro arteries; and diagnosis of unrupturedaneurysm, arterial occlusion and lucunar infarct. (2) The breast CAD systemdetects breast cancer on 3D full-breast ultrasound images acquired with the use ofa prototype scanner. (3) The eye CAD system detects ocular diseases on retinalfundus images, which enables diagnosis of glaucoma with stereo imaging.Conclusion: Three CAD systems for the Japanese health-care needs are introducedwith the following features: (1) novel selMIP introduced in the brain CADsystem, which enables the visualization of interested-vessels-only and facilitatesthe diagnosis of many cerebral vascular diseases; (2) 3D full-breast ultrasounddata in the breast cancer CAD system, which enables breast ultrasound screening;(3) stereo images and 3D analysis of the optic nerve head, which improves theaccuracy in glaucoma diagnosis.C-281E-NUCS: Online evaluation and skills development in nuclear medicinewith a focus on hybrid modalities such as PET/CT and SPECT/CTM. Grunewald 1 , R. Talanow 2 , R. Heckemann 3 , D. Ketelsen 4 , M. Middendorp 5 ,T. Kuwert 1 ; 1 Erlangen/DE, 2 Cleveland, OH/US, 3 London/UK, 4 Tübingen/DE,5Frankfurt/DE (roland@talanow.info)Learning Objectives: Creation of an internet resource of cases and assessmenttools in nuclear medicine, with a focus on hybrid modalities including PET-CT andSPECT-CT.Background: Case reports were selected for educational value as part of the reportingroutine and entered into a database structured by modality, pathological entity andanatomical region. Cases are presented as multiple choice questions with brief clinicalinformation and three or more images. Answer choices vary according to three levelsof difficulty, targeting senior undergraduates, junior residents in nuclear medicine, andcertified nuclear medicine/radiology practitioners, respectively. Configurable time limitssimulate realistic pressure. In addition to in-house cases, teaching cases publishedelsewhere were added with authors’ permission. Hyperlinks lead to explanations onthe originating sites and to other sources of relevant in-depth material.Procedure Details: Approximately 500 cases have been peer-reviewed and publishedin E-NUCS. Learners can choose between a textbook learning mode and aquiz mode. After solving a block of 5, 10 or 20 questions, brief explanatory notesare presented for each case. A full history of users’ answers and performance isgathered for later analysis and plotting as “learning curves”.Conclusion: E-NUCS (http://nuk.elera.de/) combines existing teaching and learningresources from the internet with cases collected at our institution and presentsthem in a multifunctional fashion, emphasizing hybrid modalities and addressinglearners of various experience levels and disciplines. Learners can assess theirown and others’ expertise in nuclear medicine and plot learning curves that evaluatetheir progress.C-282Public web-version of an anatomical-radiological structured database forstandard values in structured reportingM. Simon 1 , A. Bischof 1 , K. Ziehe 2 , J. Klueter 1 , J. Barkhausen 1 ; 1 Lübeck/DE,2Rostock/DE (martin.simon@uk-sh.de)Learning Objectives: It can be difficult for radiologists to determine whether anatomicalstructures are normal, anatomical variations, or pathological. The result isoften an inconclusive report providing a non-specific finding.Background: We consider it essential to have a reference database accessiblewhilst report writing in order to identify whether a finding is normal, a variationor pathological. A comprehensive literature and internet search could not offercomplete papers addressing standard values. Only individual regions or organswere discussed and available overviews did not confirm the origin and validity ofthe value or they originate from the early time of diagnostics.Procedure Details: The “iQ-ANATOMY” database is PostgreSQL based andavailable in German and English; access without registration. The web-databasecan search for anatomical patterns structured by region or functionality as well asregions based on CT/MRI and US examination. The user-friendly search criteriamake finding any value easy, e.g. “Show all standard values for CT Abdomen”. Allvalues reference original literature and where available, information pertaining topatient numbers, age and sex variations and the range is also provided. Currently,it contains around 450 referenced standard values. The application is available viaour intranet and offers all departments involved in diagnostic imaging a quick toolassisting in the decision of whether a finding is normal or abnormal.Conclusion: By using the web-database, we significantly improved the quality ofradiology reports and assist radiologists in providing more definite findings andconclusions. The public web-version will be available in 2009.C-283Semi-automated assistant system of chest CT diagnosis using contentbasedretrieval of CT images with structured reportM. Endo 1 , A. Osawa 2 ; 1 Shizuoka/JP, 2 Tokyo/JP (m.endo@scchr.jp)Purpose: To evaluate the system that assists a radiologist in the diagnosis of chestCT, using content-based retrieval of CT images with structured report.Methods and Materials: With the approval of the IRB, we prepared a server clientsystem with a database containing 247 lung cancers and 60 pulmonary inflammations,each consisting of CT images, structured radiologic diagnostic reportsand definitive diagnosis based on pathology and/or clinical follow-up. This systemautomatically calculates quantitative characteristics of the lesion when a radiologistclicks on an abnormal pulmonary lesion on CT images, and retrieves CT imagesof four cases most similar to it. And then the system semi-automatically creates anew diagnostic report using the structured report of the most closely matched CTimage selected by the radiologist in four cases. One radiologist read 30 cases (23lung cancers and 7 inflammations) and evaluated the accuracy rate of differentialdiagnosis, confidence of malignant/benign discrimination, and report creation timewith or without our system.Results: The accuracy rate of differential diagnosis changed from 86.7 (26/30)to 90.0% (27/30) with the use of this system. Az value of malignant/benign differentiationhad no significant difference. Furthermore, the radiologist requiredless time to create the 27 reports, (average time 106.9 sec) compared to withoutthe system (142.2 sec).Conclusion: We have considered that this system is clinically useful as it reducesreport creation time without compromising accuracy of image diagnosis or confidenceand improves the efficiency of radiologist workflow.C-284A new image processing filter for the automatic extraction of organs’internal structures: Application to liver tumorsF. Pizzorni Ferrarese 1 , N. Moretto 1 , D. Botturi 1 , A. Choudhary 2 , G.A. Zamboni 1 ;1Verona/IT, 2 Kharagpur/IN (gzamboni@hotmail.com)Purpose: To propose a new image filter for the detection and extraction of theinternal structure of organs from liver CTs, and to assess its accuracy.Methods and Materials: Our approach is based on automatic multi-thresholdingof images obtained through the minimization of the relative entropy between theoriginal and the thresholded image, i.e., the system extracts only the structuresthat convey information, maintaining the overall content. We applied the proposedfilter on 10 CT datasets with 20 metastatic lesions to be segmented.Results: We evaluated filter accuracy by comparing the segmentation results withthe manual segmentation by 2 experienced radiologists. We used state-of-the-artimage processing filters evaluation parameters, analyzing both volume and surfacedifferences, errors and mismatches. The filter is capable to accurately extract bothhypo- and hyper-attenuating lesions. From the quantitative analysis, the accuracyis greater (84%, with 9.52% of volume difference and 0.77 mm of average surfacedistance between the segmented region and the gold standard) for homogeneousand small tumors ( 3 cm), whereas for larger tumors the accuracy is lower (70%)mainly due to their wider range of attenuation.Conclusion: We developed a new filter that extracts both hypo- and hyperattenuatingtumors using minimum cross entropy multi-thresholding. Since multithresholdingtechniques could be computationally expensive, we will optimize oursystem using genetic algorithms. We are investigating the use of textures modelingto better discriminate the liver from other organs. Furthermore, we are currentlystudying the application of our approach to the segmentation of other abdominalstructures, such as the pancreas.C-285Computer-aided detection (CAD) applied to chest X-rays: Radiologiccharacterization of false positive markersA. Malich 1 , M. Klima 1 , D. Hentrich 1 , P. Hannemann 2 ; 1 Nordhausen/DE, 2 Neustadt/DE(ansgar.malich@shk-ndh.de)Purpose: Recently, CAD-systems were developed to analyze conventional chestX-ray being the most common imaging performed to detect lung cancer. Its clinicalapplication is limited by the number of false positives (FP)/image. The study isaimed to characterize FP and their most characteristic locations.Methods and Materials: X-rays from 205 patients (171 malignant cases, 23 provenbenign cases, 11 CT-proven unsuspicious cases) were retrospectively analyzedby CAD (OnGuardEurope4.0, Riverain, USA). CAD-marks were matched to CT/histology in consensus by two radiologists. Analysis included total number of placedmarkers and characteristics of FP and its location.Computer ApplicationsACB D E F G HS395

Scientific and Educational ExhibitsResults: 541/777 set markers (69.6%) were FP. 146/171 (85.4%) conventionallydetected malignant cases were correctly highlighted by CAD (some BC werehighlighted more than once). Most common FP-markers were on vessels (218/541;40.3%), bone crossings (140/541; 25.9%) and hilar structures (75/541; 13.9%).Pneumonic structures were highlighted 9 times, periphrenic structures 22 times,hypoventilated areas 38 times, external materials 11 times, whereas nipple waswrongly highlighted 9 times, effusion 3 times. Other FP were uncharacteristicand occasionally off the thorax. Most common FP-location were bone crossingsof the clavicle, hilar/perihilar region ( 75%). Detection rate was nearly perfect inperipheral nodules sized 15 mm. The FP-rate varied (malignant: 2.57/image;benign: 3.13/image).Conclusion: Among those nodules of conventional imaging being visible, CADdetected a sufficiently high number to be clinically useful. The detection of nodulesin the lung periphery is highly sensitive and sufficiently specific using CAD. Furthersoftware upgrades should focus on a reduction of FP-markers especially on vesselsand bone crossings.C-286CT based texture analysis of the lung parenchymaW. Recheis 1 , R. Huttary 1 , A. Ruiu 2 , N. Sverzellati 2 , M. Zompatori 2 , W. Jaschke 1 ;1Innsbruck/AT, 2 Parma/IT (wolfgang.recheis@i-med.ac.at)Purpose: Texture analysis of the lung parenchyma, based on CT imagery, is a newmethod to detect and quantify various disease patterns. The purpose of this studywas to test whether texture analysis based software can discriminate betweenmultiple pulmonary patterns occurring in the main interstitial lung diseases.Methods and Materials: Two experienced thoracic radiologists retrospectively and independentlyanalyzed 25 thorax CT datasets (0.5 mm slice thickness, low-dose protocol,native, Siemens Sensation 64, 17 male, 8 female, 52 11.7 years) with different lungdiseases such as emphysema and fibrotic interstitial lung disease. Subsequently, thesame records were examined by the texture analysis algorithm 3D-AMFM (AdaptiveMultiple Feature Method, University of Iowa, Iowa City) concerning currently 4 diseasespecificpathological parenchymal textures (normal, groundglass, honeycombing,emphysema, nodular). This system had been previously trained by the same radiologistsdefining over 2000 regions of interest with specific pathologic patterns.Results: 93% of known lung pathologies, measured in volumes of interest(15x15x15 voxel), were clearly identified by the software. In 22 out of 25 cases,texture analysis provided relevant additional information such as mixtures ofemphysema and ground glass opacity. In 5 cases, mixtures of honeycombing andground glass were clearly discriminated.Conclusion: The mixtures of pathologies can be differentiated and were confirmedby a second analysis of the radiologists. The disadvantage of the methodpresented is the absence of a “ground truth”. Nevertheless, the method seemsto be capable of being employed in the separation and differentiation of severalpathological patterns.C-287A new concept of interactive journal publication: The journal of radiologycase reportsR. Talanow; Cleveland, OH/US (roland@talanow.info)Learning Objectives: To develop an interactive journal that is able to increasethe educational and practical value of case reports by resembling the “real life” atthe radiologist’s workstation.Background: Traditionally, case reports provide only selected images, which demonstrateonly the pathology or pertinent findings. This has limited educational andpractical value, because users only receive selected information and cannot “findout” the answer on their own. It does not resemble the “real life” at the radiologist’sworkstation where the entire stack of images needs to be scrolled through andthe examiner has to find the pathology himself. Furthermore, scrolling through thestack of images helps to obtain an overview of the entire environment, includingthe anatomical relationship.Procedure Details: The peer review and editorial process conforms to internationalstandards of peer reviewed, scientific journals. Peer review is blinded andexceptional by taking usually no more than 7 days. Each article receives a DOIand is fully citable. Interactivity is unique and allows viewing the cases as seen onworkstations - with scroll functions and the ability to window and level. The articlesare available in multiple formats (Abstract, HTML, PDF, Interactive) to allow interactivityas well as printing as hardcopy. This journal is dedicated to radiology casereports but also accepts review articles and original research.Conclusion: The “Journal of Radiology Case Reports” (www.RadiologyCases.com)is a new generation of interactive journals, which is dedicated to radiology casereports and offers unique interactivity as known from radiological workstations.C-288Guidelines for diagnostic imaging: The initiatives and the issuesM. Reed; Winnipeg, MB/CA (mhreed@shaw.ca)Learning Objectives: To familiarize radiologists with: 1. The reasons for diagnosticimaging (DI) guidelines. 2. The available guidelines. 3. The issues related to DIguidelines.Background: The utilization of diagnostic imaging (DI) is increasing rapidly in manycountries, and there is growing concern that a significant number of DI studiesare not contributing to the management of patients. These inappropriate studiesoften subject patients to unnecessary radiation. There may be unexpected findings(incdentalomas) which subject patients to additional investigations. They also addfurther strain to the already strained resources of many health care systems.Procedure Details: In response to this situation several radiological associations,including the Royal College of Radiologists, the American College of Radiology andthe Canadian Association of Radiologists, have developed guidelines for DI. Otherorganizations are also developing DI guidelines, usually as part of clinical practiceguidelines. Although the development of guidelines for DI is essential, there are fourimportant issues related to their development: 1. Difficulties in finding the evidencefor evidence-based guidelines. 2. Fostering interspeciality collaboration, which isessential for their development. 3. The development of two separate streams of DIguidelines: guidelines incorporated into clinical practice guidelines and guidelinesproduced by radiological societies and the necessity of merging these. 4. Theirimplementation in a way that they will be used.Conclusion: The development of guidelines is imperative to control the inappropriateuse of DI. However, there are important issues related to their development.Radiologists need to be aware of these and the available guidelines.C-289Computed radiography implementation: A statewide experience fromAustraliaT.J. Oliver; Brisbane/AU (tanya_oliver@health.qld.gov.au)Purpose: Queensland Health (QH) provides public health services to a highlydecentralised population base across the state of Queensland. Medical imaging isprovided at 130 facilities; Licensed X-ray operators perform the image acquisition at77 sites in rural and remote locations where there are no diagnostic radiographersavailable. In July 2008, QH successfully completed the ‘j.net’ project and in doingso became the first state health service in Australia to provide digital acquisition ofgeneral radiographic examinations at all of its medical imaging facilities.Methods and Materials: The aim of the j.net project was to establish a minimumlevel of digital image capture and processing equipment at all 130 facilities. Thisinvolved installation or upgrade of computed radiography (CR) equipment at atotal of 86 sites.Results: The project was completed within the proposed timelines. A follow-upsurvey of CR users indicated a high satisfaction rate (90% of respondents). This is areflection of the quality of the project processes and the attention paid to the changemanagement aspects associated with the introduction of this new technology.Conclusion: Rural and remote image acquisition sites in QH are now well positionedto employ the advantages of the digital imaging paradigm. As QH’s RadiologyInformatics Program continues to establish full wide area network connectivityfor these sites, all of QH’s image acquisition facilities will have equitable accessto specialist services and the consequent improvement to healthcare delivery fortheir communities.C-290Efficiency of DICOM image compression algorithms for reducing filetransfer time for teleradiologyD. Ustyuzhanin, O. Pianykh, V.E. Sinitsyn, S. Ternovoy; Moscow/RU(d-ust@yandex.ru)Purpose: To assess applicability of ZIP, JPEG-LS, JPEG2000, JPEG image compressionalgorithms (time of image transfer, size of image files) for DICOM imagetransfer in teleradiology.Methods and Materials: Brain MR images of 30 patients with different pathologies(vascular white matter lesions, multiple sclerosis) were included in the study.MRI scans of each patient contained 175 slices. Images were transferred viathe Internet (by DICOM protocol) between two medical centers in the same city(Moscow). Internet speed at both sites was 2.8-3.0 Mbit/sec. Images of each patientwere transferred 5 times with different compression algorithms integrated inDICOM format (without compression, lossless ZIP, JPEG-LS, JPEG2000, JPEG).Image quality loss for lossy JPEG-LS, JPEG2000, JPEG algorithms was chosento maintain diagnostic image quality.CS396 A B D E F FG H

Scientific and Educational ExhibitsResults: Use of lossless compression (ZIP) leads to 55% reduction of imagestransfer time (203.16.9 vs. 92.42.2 sec) and 63% reduction of files size (63.20.1vs. 23.70.4 MB). Lossy image compression algorithms provided shorter imagestransfer times and decreased file size (66 and 74% for JPEG-LS, 69 and 81% forJPEG-2000, 79 and 79% for JPEG, respectively). All differences were statisticallysignificant (p 0.01).Conclusion: Using of lossless DICOM images compression (ZIP) algorithm allowed2.2-fold reduction of image transfer time. Lossy compression algorithmscan provide shorter transfer time (3.0-4.7 fold) and can be used for slow satelliteInternet and transfer of large studies.C-291Advent of 3D printing based on MDCT dataP.M. Berman, J. Sosna; Jerusalem/IL (phillipb@hadassah.org.il)Learning Objectives: To introduce the concept of 3D printing in image postprocessingand to demonstrate useful applications for this technology.Background: While 3D printing (3DP) is widely used in industrial design, it hasenjoyed only limited use in the medical field and in radiology. Despite having welldocumentedbenefits, certain technical and cost issues have effectively prevented3DP from enjoying wider use. However, recent developments have paved the wayfor 3DP to become a viable component in medical imaging.Procedure Details: While standard imaging workflow consists of MDCT scannersfor the acquisition of source data and dedicated post-processing workstations forgeneration of 2D and 3D reconstructions, we have added 3D printing capabilitiesfor improved visualization of complex anatomical structures. The 3D printerproduces highly-accurate, physically three-dimensional plastic models that canbe held in one’s hands, examined from all angles, and even dissected. This allowsone to interact with imaging data in a way that was difficult, unlocking a wealth ofinformation that is contained in our everyday CT exams.Conclusion: 3D printing is a compelling technology, which is now technicallyfeasible and has a potential role in state-of-the-art 3D visualization.C-292Custom implant design and surgical pre-planning using rapid prototypingand anatomical models for the repair of orbital floor fracturesM.T. Elgalal, M. Kozakiewicz, M. Olszycki, B. Walkowiak, L. Stefanczyk; Lodz/PL(telgalal@yahoo.co.uk)Purpose: Orbital floor fractures are a common complication of facial trauma. Surgicalrepair is challenging due to complex anatomy of the orbit and limited operatingfield. Rapid prototyping can provide virtual and physical anatomical models basedon MDCT imaging for accurate surgical pre-planning and fabrication of patientspecific 3 dimensional preformed implants.Methods and Materials: 12 patients with facial trauma and orbital floor fractureswere included in the study. DICOM data sets from MDCT were prepared and exportedto specialist software. 3D virtual models of the unaffected orbit were created andmirrored onto the contralateral side; producing models that represented premorbidanatomy of the fractured orbit. Physical models were built using a photopolymer rapidprototyping system and used as templates to cut and form standard titanium mesh,creating implants with a 3 dimensional ‘true-to-original’ shape. Postoperatively, MDCTwas used to assess implant placement and orbital dimensions.Results: Study group: 3 retreatments, 3 inveterate fractures, 6 acute fractures.Significant improvement in four cases and total recovery in eight cases wereobserved after surgery, on the basis of ortoptic examination. Pre-formed customimplants accurately reflect the shape and dimensions of the orbital floor andresulted in reduced operating times -15 to 20 min, less soft tissue manipulation,fewer trial fittings, decreased likelihood of damaging intraorbital structures, moreprecise fit and repair.Conclusion: Rapid prototyping can be used to create accurate anatomical modelson the basis of CT imaging. The mirroring method is a valuable technique for creatingtemplates used to fabricate custom implants.C-293Semi-automated volumetric analysis of lymph nodes during follow-upM. Fabel 1 , H. Bolte 1 , H. von Tengg-Kobligk 2 , L. Bornemann 3 , V. Dicken 3 ,B. Geisler 3 , J. Biederer 1 , M. Heller 1 ; 1 Kiel/DE, 2 Heidelberg/DE, 3 Bremen/DE(m.fabel@rad.uni-kiel.de)Purpose: Therapy monitoring in oncological patients requires accurate and reliableimaging and post-processing. RECIST criteria are the current standard fortherapy monitoring with inherent disadvantages. The aim of this study was tocompare semi-automated volumetric analysis of lymph node metastases duringfollow-up to RECIST.Methods and Materials: Multislice-CT data were acquired in 50 patients withmalignant melanoma stage III/IV during follow-up covering chest, abdomen andpelvis with thin-slice collimation in clinical routine. Volumetric analysis was performedusing semi-automated software (OncoTreat, MeVis Research, Germany). 174 lymphnode metastases were evaluated by two independent readers regarding manualRECIST measurements and effective diameters (DM) (computed from volume (ml)into mm to allow direct comparison to RECIST max. DM). Further segmentationtime, need for corrections and obtained quality were recorded.Results: The software demonstrated feasibility of robust volumetric analysis for lymphnode metastases. Quality of segmentation was rated acceptable to excellent in ~85%per reader. Time spent per lymph node (for search, segmentation, optional correctionand manual RECIST measurements) averaged ~40-60 sec. In 20%, manual correctionswere needed. In about 1 out of 5 cases, differences regarding therapy response classifications(partial response, progressive disease or stable disease) were found betweenRECIST and volumetry. Tumor growth rate showed a significantly higher variation withRECIST (27.5% standard deviation) than for volumetry (10.6%). Variability of the sizemeasurements was 0.94 mm for eff. DM and about 3 mm for max. DM.Conclusion: Semi-automated 3D-volumetric analysis software allows a reliable,fast and convenient segmentation of lymph node metastases during follow-up.C-294From DICOM to print: A guide to importing, converting, editing, annotating,and exporting DICOM images to make them suitable for publicationG. Rajeswaran, N. Chew, D.R. Tsukagoshi, J.C. Healy, J.C. Lee; London/UK(grajeswaran@hotmail.com)Learning Objectives: To explain how to import and convert DICOM (Digital Imagingand Communications in Medicine) images using the freely available OsiriX softwareand how to edit and annotate these images to make them suitable for print usingAdobe Photoshop CS3 software.Background: DICOM is the accepted standard file format for medical images. However,the majority of scientific journals require submitted images to be anonymised,annotated and converted into a more widely accepted format such as TIFF or JPEG.We explain how to do this using widely available software.Procedure Details: Using OsiriX to: import and view DICOM files, convert (export)DICOM files into a variety of image formats suitable for print (e.g. TIFF, JPEG, etc).Using Adobe Photoshop CS3 to: crop the image to an appropriate size, Optimisethe colour balance, brightness and contrast for print, Annotate the image with text,arrows, etc. Reconvert the image file into a format suitable for print.Conclusion: We have shown the reader how to use widely available and commonlyused software to import, convert, edit, annotate and export a DICOM image intoan image format suitable for publication.C-295Integrating PACS, pathology findings, multidisciplinary team meetings anddigital patient management records as effective tools for problem basedlearning in radiologyS. Krishan, R. Briggs, A. Chalmers, D. Tolan; Leeds/UK(sonalkrishan11@yahoo.co.uk)Learning Objectives: 1. To learn how electronic patients records and multidisciplinaryteam (MDT) meetings can be integrated with radiopathologic correrelationdatabase. 2. To know the software and hardware components involved. 3. To beaware of steps in implementation and potential hurdles in creating such a database.4. To appreciate how effective PBL sessions can be created for radiology teachingfrom such a database.Background: Current trends in medical education focus on outcome and PBL asa means to facilitate student learning. MDT meetings provide a wealth of trainingto the radiology residents in clinico-pathological correrelation and clinically orientedinterpretation of imaging findings. We envisage integration of PACS, MDT meetingsand digital patient management records as a means for providing a teaching minefor structured PBL modules in radiology.Procedure Details: Simple data warehouse can be constructed using digital MDT reports,PACS images and relevant digital patient management records using a combination opensource software, XML version of reports and MIRC software. Structured PBL sessions canbe created by retrieving cases using flexible queries. This can further be incorporated increating competency based assessment systems in radiology. We describe the design,steps in implementation and potential hurdles in creating such a database.Conclusion: Such systems have immense potential in providing a vast range ofclinicopathologically oriented radiological case material. PBL in radiology howeverneeds to be validated further before it can be universally adopted. Whether sucha database can replace or complement traditional time tested didactic teachingremains to be seen.Computer ApplicationsACB D E F G HS397

Scientific and Educational ExhibitsC-296Indexing of radiological reports: Moving the human-computer languagebarrierT. Voet, P. Devolder, P. Duyck; Gent/BE (Tony.Voet@uzgent.be)Purpose: When using a computerised index of words originating from a large collectionof radiological reports, users tend to encounter a human-computer languagebarrier. This obstacle arises whenever a complex query cannot be adequatelyformulated in the language required by the computer interface. This study seeksto alleviate this interface problem.Methods and Materials: Since its conception in 2004, the indexing systemdeveloped at the Ghent University Hospital covers 130 million words originatingfrom 2 million reports. The index contains 350,000 unique words and resultsare typically returned within 31 ms. To counter the problems related to complexqueries, we educated the users regarding basic search engine features: wordgrouping, wildcards, and binary logic. We also implemented word stemming infour European languages, automatic rewriting of queries for common synonyms,and contextual searching.Results: Following education, users started to pick up search engine features:phrases (3.0%), wildcards (2.9%), binary operator “and” (4.6%), “not” (1.7%), “or”(1.2%), and parentheses (0.6%). Both the word stemming and the automatic inclusionof synonyms received positive feedback. However, only administrators usedcontextual searching because of the composite syntax.Conclusion: The search engine features we implemented helped to move the interfacelanguage barrier away from our users. These 45 radiologists and researchersuse the integrated indexing system on a daily basis as a convenient way of quicklyfinding radiological studies.C-297Computer-aided diagnostic tools in cancer detection and therapy usingstatistical modeling of normal torso FDG-PET scansT. Hara 1 , T. Katafuchi 2 , S. Ito 3 , D. Fukuoka 1 , G.N. Lee 1 , T. Kobayashi 1 , X. Zhou 1 ,H. Fujita 1 , K. Doi 4 ; 1 Gifu/JP, 2 Seki/JP, 3 Ichinomiya/JP, 4 Chicago, IL/USPurpose: To develop an automated software to visualize the temporal changes ofSUV, and to provide the SUV score of abnormality based on 95% confidence interval(CI) calculated by using normal FDG-PET scan cases for male and female.Methods and Materials: FDG-PET scans (male: 143, female: 54) interpreted asnormal were collected to calculate the CI of SUV. For each male and female, thetorso regions were registered into one standard physique shape by using bodyregion recognition, liver and bladder detection. Surface deformation using thin-platesplinewas also applied to register the scans to the standard physique. The meanand standard deviations of SUV in each voxel in the assembled normal scans werestored as a three dimensional statistical model (3D-model). Current and previouspatient scans were registered to the 3D-model to calculate the score of SUV. Thescore shows the distance from normal cases. Both of the difference of SUV andthe score were visualized in a color scale to show the changes.Results: In a colon cancer case, for example, the current SUV was 1.57, but thescore using the 3D-model was 3.58. The abnormal accumulation was also verifiedon the subtraction image. The means of SUVs from abnormal spots in lung andliver are statistically different from the means of the corresponding regions in 3Dnormal model by using the T-test (p 0.001).Conclusion: Temporal subtraction and scoring approach has the potential togreatly assist radiologists. We will begin a prospective clinical study for evaluatingthe utility of the system developed.Contrast MediaC-298Are radiologists ready to care for acutely ill patients? The standard of adultCPR amongst UK radiologistsA.D. Culverwell 1 , C.R. Tapping 2 ; 1 Leeds/UK, 2 Hull/UK(adamculverwell@hotmail.com)Purpose: To assess the attitudes and ability of radiologists to manage adult lifesupport in cardio-pulmonary arrest and acute anaphylaxis reactions.Methods and Materials: A questionnaire survey assessing the knowledge andconfidence managing an adult cardio-respiratory arrest scenario was sent to 165radiology consultants and registrars in 6 NHS trusts in Yorkshire, 106 participated.The questionnaire included basic demographic details and 9 questions to assessrecent training, knowledge and confidence in adult resuscitation as per the ResuscitationCouncil (UK) 2005 guidelines and management of acute anaphylaxis.Results: Despite the fact that 90% of participants stated they would feel confidentto initiate life support, the average score from the questions assessing life supportprocedure was 2.3 out of 5, with only 13% of participants answering all questionscorrectly. There was no correlation between the grade of radiologist and likelihood ofa correct answer, nor was there a correlation between feeling confident and knowingthe correct life support procedure. Flaws in training were highlighted with only 61%of radiologists having attended a life support course in the last 4 years. Those whohad attended a course more recently were more likely to perform CPR correctly(p=0.02). Individuals who were confident in initialising CPR were more likely to beconfident that other members of staff could assist them (p=0.028).Conclusion: This study emphasises the need for regular life support training andthe need to alter the attitude of radiologists who must consider it their role to initiateeffective life support in the radiology environment.C-299Apoptotic and antiproliferative effects of the iso-osmolar contrast mediumiodixanol on renal proximal tubular cells in vitroM.C. Heinrich, M. Scheer, M. Heckmann, M. Küfner, W. Bautz, M. Uder;Erlangen/DEPurpose: The mechanisms of contrast-medium-induced tubulotoxicity are incompletelyunderstood. In particular, the tubulotoxic effects of iso-osmolar contrastmedia, which were often used in patients at the highest risk of contrast-mediuminducednephropathy, have barely been investigated. Thus, the aim of our studywas to evaluate the cytotoxic effects of iso-osmolar iodixanol on renal tubular cellcultures.Methods and Materials: LLC-PK 1-cells (a well-established, proximal tubularepithelial cell line) were incubated with iodixanol or isotonic NaCl (18.75-75 mg I/ml, 1-24 hours). Necrotic cell death was assessed by trypan blue exclusion test.The number of trypan-blue positive, non-viable cells was determined using ahemocytometer. To assess apoptosis mono- and oligonucleosomes of cell lysateswere determined based on a quantitative sandwich-enzyme-immunoassay-principleusing monoclonal antibodies directed against DNA and histones. Measurement ofBrdU (5-bromo-2’-deoxyuridine) incorporation into the DNA by means of an ELISAwas used for quantification of cell proliferation.Results: Iodixanol induced no significant increase in the number of necrotic cells(8 and 9% at 37.5 and 75 mg I/ml vs. 8% for control, p 0.05). In contrast, iodixanolincreased significantly the number of oligonucleosomes indicating induction ofapoptosis (1254% of control, p 0.05). Iodixanol induced a significant, dose- andtime-dependant inhibition of BrdU-incorporation indicating inhibition of cell proliferation(922 and 792% of control at 18.75 and 37.5 mg I/ml, p 0.001).Conclusion: Apoptosis without significant necrosis contributes to the renal tubulartoxicity of iodixanol. Additionally, we demonstrated for the first time an antiproliferativeeffect of iodixanol on renal tubular cells.C-300Contrast induced nephropathy (CIN): Differences between isosmolar(IOCM) and low osmolar contrast media (LOCM) in patients evaluated forperipheral arterial occlusive disease (PAOD): A prospective multicenterstudyR.P. Karlsberg, S.Y. Dohad, V. Multicenter Group; Beverly Hills, CA/US(karlsberg@cvmg.com)Purpose: To compare the incidence of CIN following administration of IOCM(iodixanol-GE Healthcare, Princeton, NJ), versus LOCM (iopamidol-Bracco Diagnostics,Princeton, NJ; ioversol-Mallinckrodt, St. Louis, MO; iohexol-GE Healthcare,Princeton, NJ; iopromide-Berlex, Montville, NJ).CS398 A B D E F FG H

Scientific and Educational ExhibitsMethods and Materials: 253 patients (mean age: 64.4 10.8, 63.2% male)underwent invasive digital subtraction angiography (DSA) for PAOD followingwashout of 72 hours to 14 days after intravenous iodixanol (320 mg I/mL) computedtomography (CTA) of the abdominal aorta with runoff. Contrast agent forDSA was each center's normal practice. Serum creatinine (SCr) levels at baselineand 24 hours following DSA were measured. CIN was defined as a SCr increaseof 25% from baseline.Results: 148 (58.5%) received IOCM and 105 (41.5%) LOCM (iopamidol 92subjects, ioversol 8, iohexol 3, and iopromide 2). Baseline risk factors and averagecontrast dose and hydration protocols were comparable between the IOCMand LOCM groups except for renal function: Prior to DSA, 8.1% IOCM patients(12/148) versus 2.9% LOCM patients (3/105) had renal dysfunction ( 1.5 ml/dl).Overall, 22 of 253 patients (8.7%) experienced CIN: 8 (8/148, 5.4%) from IOCMand 14 (14/105, 13.3%) from LOCM. Of the 14 patients with CIN receiving LOCM,13 had iopamidol and 1 had ioversol. CIN difference was statistically significantbetween IOCM (iodixanol) and LOCM (p=0.027) and between IOCM (iodixanol)and iopamidol (p=0.020).Conclusion: In patients suspected of PAOD undergoing DSA after CTA, theincidence of CIN was significantly less for patients who received IOCM for DSArather than LOCM.C-301Nephrogenic systemic fibrosis: A prospective follow-up methodologyfor patients with suspected brain tumors and chronic kidney diseaseundergoing MRI with gadolinium contrast agentN.S. Mamilla palli 1 , M.J. Kuhn 1 , M. Minn 1 , K. Vallurupalli 1 , A.R. Kuhn 2 ;1Springfield, IL/US, 2 Chicago, IL/US (matthew.kuhn@st-johns.org)Purpose: To evaluate the incidence of nephrogenic systemic fibrosis (NSF) inpatients with stages 3 to 5 chronic kidney disease (CKD) undergoing MRI withgadobenate dimeglumine.Methods and Materials: As part of a prospective multi-center study, patientsreferred for MR neuroimaging with contrast were screened with a calculatedeGFR (MDRD method) from a serum creatinine value obtained within 24 hoursprior to MRI. Patients with eGFR 30-59 mL/min/1.73 m (2) were categorized ascohort 1 and eGFR 30 mL/min/1.73 m (2) as cohort 2. Patients who receivedany gadolinium agent within the previous year were excluded. Eligible patientssigned the informed consent and received 0.1 mmol/kg gadobenate dimeglumine(MultiHance). Patients are followed up to two years with scheduled telephone callsand office visits to evaluate for any signs of nephrogenic systemic fibrosis. A skinbiopsy by a dermatologist is part of the protocol for any suspected cases. To date,we have enrolled 14 patients over 6 months at our site and enrolment is ongoingat our center and other sites participating in this multi-center study.Results: No confirmed cases of NSF have been seen so far in the group of 14patients enrolled at our site. One patient was lost to follow-up and another patientdied of unrelated causes.Conclusion: A prospective study to evaluate the incidence of NSF in patientsundergoing gadolinium enhanced MRI has not been previously accomplished. Themethodology of our study may serve as a model for other institutions.C-302Contrast enhanced harmonic sonography (CEUS) of focal liver lesions:Discordant enhancement pattern with contrast enhanced MDCT and MRP. Cabassa, E. Brunelli, S. Mombelloni, M. Narbone, E. Gatti, R. Maroldi; Brescia/IT(paolocab@libero.it)Purpose: To evaluate frequency, type and possible causes of discordant enhancementpatterns between CEUS and CT/MR during vascular phases.Methods and Materials: From our database of focal liver lesions studied withCEUS, we reviewed retrospectively 338 patients who underwent CEUS and at leastone cross sectional contrast enhanced imaging (CT or MR). CEUS was performedwith Sonovue at the standard dose of 2.4 ml with continuous real time scanning atlow mechanical index (0.1-0.2). Arterial, portal and late phases for each imagingmodality were assessed comparing the ecogenity/attenuation/intensity of the lesionrelatively to the adjacent liver. Final diagnosis was obtained histologically (surgical/biopsy) or with clinical and imaging follow-up of at least 6 months.Results: Final diagnosis was: 125 HCCs, 58 metastases, 20 colangiocarcinomas,46 hemangiomas, 40 FNH and 49 others. 125/338 (36.9%) lesions showed discordancewith CT or MR imaging. Discordant enhancement was found in: 73/125 HCC,17/58 metastases, 19/20 colangiocarcinomas, 16/46 hemangiomas and 23/40 FNH.Discordant pattern in portal phase was found especially in HCCs (63/73) resultingisoechoic at CEUS and hypodense on CT/RM. Discordant pattern in arterialphase was more frequent for metastases (13/17). Possible explanations of thesefindings are: 1. Microbubbles are purely intravascular agents; 2. Timing to peak ofenhancement can be missed with CT/MR, not with CEUS; 3. CEUS is extremelysensible to depict micro and macrovasculature of focal lesions.Conclusion: Discordances are relatively frequent; their recognition is useful for acorrect characterization of focal liver lesions.C-303Comparison of intravenous (IV) isosmolar contrast (IOCM) vs. intraarterial(IA) IOCM or low osmolar contrast media (LOCM): A prospectivemulticenter trialR.P. Karlsberg, S.V. Dohad, V. Multicenter Group; Beverly Hills, CA/US(karlsberg@cvmg.com)Purpose: IV contrast administration differs from IA and may be further confoundedby the use of isosmolar (IOCM) or low osmolar contrast media (LOCM). We studiedthe incidence of CIN following IV IOCM (iodixanol, 320 mg-I/m), for computed tomography(CTA) versus IA IOCM or IA LOCM for IA digital subtraction angiography(DSA) in the same patient population.Methods and Materials: First patients with suspected peripheral arterial occlusivedisease underwent CTA with IV IOCM. After 72 hours to 14 days, DSA was performedwith contrast chosen by clinical practice. CIN was defined as SCr increase25% from baseline after 24 hours.Results: 265 CTA patients (mean age: 64.7 10.9, 63.8% male) with IV IOCM and253 DSA patients (mean age: 64.4 10.8, 63.2% male) with IA IOCM or IA LOCMhad complete SCr levels. Of the DSA patients, 148 (58.5%) received IA IOCM and105 (41.5%) received IA LOCM (iopamidol, 92; ioversol, 8; iohexol, 3; iopromide2). Contrast volume for CTA and DSA was comparable. CIN developed in 20 of265 patients (7.5%) post-CTA and 22 of 253 patients (8.7%) post-DSA (p = NS).Of those with CIN following DSA, 14 (14/105, 13.3%) received IA LOCM comparedto fewer patients (8/148, 5.4%) receiving IA IOCM (p=.027).Conclusion: The incidence of CIN following CTA with IV IOCM was not statisticallydifferent from that following DSA with IA administration of various contrast media.However, when CIN occurred with DSA and IA administration of contrast it wasless frequent with IOCM.C-304Contrast-enhanced ultrasound (CE-US) of kidney transplantation andcorrelation with clinical-laboratory data: Diagnosis of early renal allograftdysfunctionN. Caproni, A. Grossi, I. Mancarella, P. D’Alimonte, G. Cappelli, P. Torricelli;Modena/IT (ncaproni@sirm.org)Purpose: Compare CE-US with spectral-Doppler-US (sD-US), s-creatinine clearancelevel and GFR in the assessment renal graft function.Methods and Materials: 56 renal transplanted patients (62 kidneys) underwents-creatinine (mg/dL) and GFR (ml/min) evaluation, CE-US and sD-US at day 15post-transplant. At CE-US, it was quantitatively analyzed the CE peak intensity(PI%) and the regional blood flow (RBF ml/sec). At sD-US, it was evaluated themedian resistance index (RI).Results: 47 patients (52 kidneys) had an uneventful clinical course, 9 patients (10kidneys) had acute renal rejection, confirmed by biopsy. In the control group, themean s-creatinine, GFR, PI, RBF and RI were 1.93, 58.9, 61.87, 80.45 and 0.78,respectively. In the other 9 patients, the mean s-creatinine, GFR, PI, RBF and RIwere 5.34, 19.2, 40.16, 53.7 and 0.95. A high correlation was found between thes-creatinine and PI and RBF both in the control group and in the reject group (r=-0.478, p 0.001; r =-0.42, p 0.01; r =0.844, p 0.001; r =0.828, p 0.01).There was high correlation between GFR and PI and RBF in the reject group (r=-0.77, p 0.01; r =-0.78, p 0.01) and between GFR and PI in the control group(r =0.32, p 0.5), but not between GFR and RBF. No correlation was found betweenIR e CE-US parameters. Significant correlation exists between s-creatinineand RI (r =-0.67, p 0.05) and between GFR and IR (r =0.65, p 0.5) only in thereject group, but not in the control group. The sensibility, specificity, accuracy andpredictive value negative (PVN) of PI and RBF was calculated (respectively, 90,86, 86, 97% and 80, 86, 85, 95%).Conclusion: CE-US allows the evaluation of renal transplanted perfusion, withhigh accuracy and PVN. Clinical laboratory parameters correlate better with CE-USparameters, especially in cases of acute rejection than with sD-US parameters.Contrast MediaACB D E F G HS399

Scientific and Educational ExhibitsC-305Dynamic T1 Functional MRI examinations with use of blood pool contrastagent: An approach to optimization of the techniqueA. Majos 1 , T. Wolak 2 , P. Bogorodzki 2 , E. Piatkowska-Janko 2 , L. Stefanczyk 1 ;1Lodz/PL, 2 Warsaw/PL (egnys@poczta.onet.pl)Purpose: In order to detect the BOLD effect, T2*-sequences are used. Their limitationscould be overcome by using a T1-sequence with the coincident intravenousadministration of a blood-pool contrast medium (cm). It has been shown in vesseltrials that gadofosveset significantly shortens relaxation values for a period of 4hours (h). The aim of this study was to determine the optimal time point for thedynamic T1 functional imaging.Methods and Materials: For each of the 10 healthy subjects, T1 sensitive 3DGR sequences were carried out (TR=8.5 ms/TE=3.14 ms/FA=10 deg) with forty3 mm thick slices and 1.8 mm in plane resolution, immediately after administration(0.03 mmol/kg) of VASOVIST (Schering) and after 2, 4 and 6 h. Subjectsperformed block type challenging paradigm with 30 finger tappings in 30 s length‘on’ periods followed with this same length ‘off’ resting periods. Ten repetitions ofabove conditions took 600 s giving as a result 100 volumes. SPM5 software wasused for statistical analysis.Results: Exactly the same localization of activation areas was found in all subjectsin all examinations. The increase of the signal intensity in primary motor cortex(hand knob) was determined using RFX group analysis: T-value (p 0.001) for theright hand- 0 h-12.62, 2 h-8.82, 4 h-9.18, 6 h-7.8, for the left- 0 h-7.34, 2 h-7.14,4 h- 8.34, 6 h- 7.23.Conclusion: Dynamic T1 fMRI is a reliable and sensitive technique to detectcortical activations in 6 h after the blood-pool agent administration. This techniqueshould be carried out directly after cm administration; however, it is possible to getsatisfactory results up to 4 h afterwards.C-307Extravasation of iodinated contrast media in CT studies: Frequency andeffectsP. Carrascosa, J. Vallejos, C.M. Capuñay, E. Martin Lopez, J. Carrascosa;San Isidro/ARPurpose: Subcutaneous extravasation is a well-recognized complication of intravenousadministration of iodinated contrast media. Local toxicity effects can rangefrom minor erythema and swelling to extensive tissue necrosis. The objective of thispresentation is to establish the frequency and clinical effects of extravasation ofiodinated contrast media related to mechanical power injection during CT exams.Methods and Materials: During a 2-year period, 11,520 patients underwentcontrast media-enhanced CT studies at our institution. In all exams a mechanicalpower injector was used for infusion of ionic and non-ionic iodinated contrast mediathrough a plastic cannula in an upper extremity.Results: Extravasation was detected in 26 (0.2%) patients. Nineteen patients hadextravasation of less than 10 mL and only referred minor symptoms. Six patientshad extravasation of at least 30 mL, and referred mild to moderate pain, swelling,erythema and skin changes at the injection site without severe or permanent effects.One patient had a severely damaged with tissue necrosis that required surgicalintervention. The mean contrast media volume used per exam was of 105 mL.The mean infusion rate was 2.6 mL/seg. The principal causes of extravasationwere noncommunicative patients (elderly, infants) and chronically ill patients withdebilitated veins. No correlation was found between amount of contrast media orinfusion rate and frequency of extravasation.Conclusion: The frequency of extravasation of contrast media after mechanicalbolus injection is higher that reported for hand-injection, but similar to that of otherstudies using power injectors. Adequate treatment should be applied to preventsevere effects.C-306Temporal aspects of contrast-induced nephropathy (CIN): Considerationsfor future trialsC. Davidson 1 , W. Laskey 2 , M. Rudnick 3 , P. Sherwin 4 , J. Stafford 5 , G. Stevens 6 ;1Chicago, IL/US, 2 Albuquerque, NM/US, 3 Philadelphia, PA/US,4Princeton, NJ/US, 5 Baltimore, MD/US, 6 Bastrop, TX/US (paulsherwin@ge.com)Purpose: Examine temporal aspects (time to onset; by-day incidence and prevalence;duration) of contrast-induced nephropathy (CIN; 0.5 mg/dL serum creatinine(SCr) increase) in chronic kidney disease patients undergoing coronary angiographyrandomized to low-osmolar (LOCM) or iso-osmolar (IOCM) contrast medium.Methods and Materials: Post-hoc, hypothesis-generating analyses of data from the68 CIN patients (23%, 68/299; 34/CM group) in a prospective double-blind CIN trial(VALOR) comparing LOCM ioversol 320 mg-I/mL versus IOCM iodixanol 320 mg-I/mL were conducted for: CIN incidence on days 1, 2, and 3 after administration; CINprevalence over 28 days (7 visits); and CIN duration.Results: By-day CIN incidences overall and by CM (ioversol, iodixanol) were: day1, 20 (29%) (13 [38%], 7 [21%]); day 2, 35 (51%) (15 [44%], 20 [59%]); day 3, 13(19%) (6 [18%], 7 [21%]). CIN prevalence rose rapidly days 1 and 2 and peakedon day 2 (iodixanol and overall) or 3 (ioversol). Numbers of subjects with CIN of1, 2, and 3 days duration overall and by CM (ioversol, iodixanol) were: 1 day, 31(46%) (13 [38%], 18 [53%]); 2 days, 26 (38%) (12 [35%], 14 [41%]); 3 days, 11(16%) (9 [26%], 2 [6%]).Conclusion: In this study CIN rates varied by day. This suggests that multiplepost-dose SCr assessments in clinical trials that investigate CIN will providegreater accuracy in overall CIN reporting than trials that employ a single post-dosemeasurement over a wide time period.CS400 A B D E F FG H

Scientific and Educational ExhibitsGenitourinaryFemaleC-308Magnetic resonance imaging of deep and visceral pelvic endometriosis:Examination technique and imaging findingsG. Restaino, M. Missere, M. Ciuffreda, E. Cucci, M. Occhionero, G. Sallustio;Campobasso/IT (gennares@hotmail.com)Learning Objectives: MRI provides the best preoperative assessment of pelvicendometriosis. MRI technique must be adapted to the typical appearance of thedisease, with emphasis on T1-W fat suppressed and on T2-W high resolution images.Typical MRI features are T1-hyperintensity with shading in T2-W images forendometriomas and low-intermediate SI with regions of signal hyperintensity inT1-W images and uniform low signal intensity on T2-W images for deep lesions.Background: Endometriosis represents a common and important clinical problemof childbearing age women. Accurate preoperative assessment of extension ofpelvic endometriosis is required for planning surgical excision, but is difficult withphysical examination. US lacks panoramic evaluation. Exploratory laparoscopycannot accurately demonstrate endometriotic lesions hidden by adhesions orlocated in the subperitoneum.Imaging Findings: The MRI findings in deep and visceral pelvic endometriosisvary with the type of lesions: infiltrating small implants, solid deep lesions in theanterior or posterior cul-de-sac and involving the uterosacral ligaments and torusuterinus, ovarian or extraovarian endometrioma, visceral endometriosis involvingthe bladder or sigmoid and rectal wall, laminar lesions, cystic lesions, complexlesions and adhesions. Endometriomas show high SI at T1- and T2-W sequencespersisting at fat-suppressed T1-W images, often with gradual variation of SI atT2-W images. Solid deep lesions show low to intermediate SI with punctateregions of signal hyperintensity on T1-w images, uniform low signal intensity onT2-W images, and enhancement, corresponding to the abundant fibrous tissueseen in these lesions.Conclusion: MRI provides best preoperative assessment of pelvic endometriosis.C-309Imaging appearances of the post-operative and post-radiotherapy pelvisH.C. Addley, A.H. Vargas, E. Sala; Cambridge/UK(helenclareaddley@hotmail.co.uk)Learning Objectives: To illustrate the normal imaging appearance of the femalepelvis following surgery and radiotherapy. To demonstrate the appearance of importantpost-operative and post-radiotherapy complications. To demonstrate theimaging findings in disease recurrence.Background: Hysterectomy bilateral salpingoophorectomy (BSO) is used inthe treatment of malignant and benign gynaecological disease. Trachelectomy isa fertility sparing treatment option for small cervical cancers. Radiotherapy is alsoa treatment for malignant gynaecological disease. The CT and MR appearancesfollowing these treatments are used to determine disease recurrence and futuremanagement.Imaging Findings: The CT and MR appearances following surgery depend on thetreatment (trachelectomy, hysterectomy or pelvic exenteration) as do the complicationsseen, which include lymphocoeles and pelvic haematoma. Radiation changesin the pelvis include bone changes (from signal alteration to sacral insufficiencyfractures), bowel changes (radiation colitis and proctitis), bladder changes (cystitis)as well as fistulae either to the bowel or bladder. Local disease recurrence canbe demonstrated as a mass, as signal change on MR and can involve the uretercausing hydronephrosis.Conclusion: Imaging of the female pelvis following treatment for malignancy(whether surgical or radiotherapy) will guide the future management of the patient.Disease recurrence can be subtle and in the post-operative and post-radiotherapypelvis difficult to detect due to loss of anatomical tissue planes and changes insignal intensity. There are benign and malignant complications of surgery andradiation to the pelvis, which are important to recognise both on early and furtherfollow-up imaging in these patients.C-310MRI and CT findings after uterine fibroid embolizationS.K. Verma, D. Bergin, O.H. Baltarowich, C. Gonsalves, A.S. Lev-Toaff,D.G. Mitchell; Philadelphia, PA/US (medskv@yahoo.com)Learning Objectives: 1. To identify the spectrum of findings on magnetic resonanceimaging (MRI) and computed tomography (CT) of 74 women performed after uterinefibroid embolization (UFE) 2. To illustrate UFE associated common and uncommonMRI and CT appearances 3. To discuss post UFE complications that require urgentmedical or surgical intervention.Background: UFE is an effective treatment for symptomatic uterine fibroids as agood alternative to surgical management. Major complications following UFE arerare. MRI and CT are typically employed to evaluate the uterus following UFE forfibroid infarction, size, location change, persistent enhancement and changes inadenomyosis or to assess complications that may require intervention in acutephase. Variable pattern of calcification on CT can differentiate embolic particles andfibroid involution. Visualization of gas in uterus and uterine vessels following UFE isan expected finding that should not be misinterpreted as a sign of infection.Imaging Findings: MRI and CT findings includes post procedural appearances,patterns of calcification, gas after UFE: sterile and infectious, fibroid locationchanges, fibroid vascularity, adenomyosis following UFE, fibroid recurrence, uterinenecrosis and ovarian dysfunction.Conclusion: MRI and CT appearances vary depending upon time interval afterUFE and success of the procedure. CT following UFE may be requested becauseof acute pelvic pain or pyrexia or for an unrelated indication. Awareness of expectedand abnormal imaging findings is essential for correct diagnosis and treatment.Radiologists should be familiar with the range of post UFE appearances on MRIand CT to better aid clinicians in correct diagnosis and treatment.No Material Submitted to EPOSC-311Pitfalls in staging uterine neoplasm with MRI: Recognize and avoid themM.A. Portilha, B. Graca, A. Canelas, C. Marques, F. Caseiro-Alves; Coimbra/PT(maportilha@hotmail.com)Learning Objectives: To review pitfalls in pretreatment staging of endometrial andcervical cancers with MRI.Background: Accurate assessment of the extent of uterine neoplasm on preoperativeMRI is expected to greatly optimize surgical procedure and therapeutic strategy.However, possible misdiagnoses in defining the extent of uterine neoplasms byMRI have been reported.Procedure Details: We present a series of cases from our MRI department thatdemonstrate the following aspects: 1) Summary of MRI technique and FIGO stagingsystem; 2) Endometrial cancer: 2.1 Pitfalls in the diagnosis of myometrial invasion;2.2 Pitfalls in the diagnosis of cervical invasion; 3) Cervical cancer: 3.1 Pitfalls in thediagnosis of stromal invasion; 3.2 Pitfalls in the diagnosis of parametrial invasion;and 4) Common aspects: 4.1 Pitfalls in the diagnosis of bladder and rectal wallinvasions; 4.2 Pitfalls in lymph node assessment.Conclusion: Although pitfalls in staging endometrial and cervical cancers havebeen reported, MRI remains the optimal imaging technique compared with CT orultrasound. This presentation provides a review of these pitfalls in analyzing patient,technique and tumor-related reasons to allow improvement of routine clinical stagingof uterine neoplasms with MRI.C-312Acute female pelvic disease: Role of MDCT in emergency radiology withemphasis on gynecologic and obstetric disordersR. Cano Alonso, P. Díez Martínez, M. Navallas Irujo, L. Ibañez Sanz,J. Gómez Herrera, S. Borruel Nacenta; Madrid/ES (rakitori@hotmail.com)Learning Objectives: To highlight the role of multidetector CT (MDCT) in emergencyradiology as a useful tool in the diagnosis and management of acute femalepelvic disease. To describe key radiologic signs to narrow differential diagnosis.Background: We retrospectively reviewed imaging findings of acute pelvic diseasein women reporting to the emergency room at our institution from December 2006to August 2008. MDCT was essential in the management of patients in whichgynecologic exploration was not confluent or undone since it was not the initialsuspicion.Imaging Findings: We focus on gynecologic and obstetric disorders such ashemorrhagic ovarian cysts, ovarian torsion, pelvic inflammatory disease, rupturedectopic pregnancy, complicated uterine myomas, intravascular leiomyomatosis,traumatic hematocolpos, blunt maternal trauma, postpartum complications (rectussheath hematoma, pelvic abscess and hematoma, endometritis) and post-cesareansection complications (uterine perforation, uterine dehiscence at the incision siteGenitourinaryACB D E F G HS401

Scientific and Educational Exhibitsof caesarean section, ovarian vein thrombosis, colovaginal fistula). We also brieflyreview gastrointestinal entities that may mimic these conditions such as appendicitis,diverticulitis, intestinal inflammatory disease, neoplasms and pelvic abscesses asa complication of any of the previous entities.Conclusion: Although ultrasound (US) is the imaging modality of choice for theevaluation of female pelvic pain, the role of MDCT remains important if US findingsare equivocal or the abnormality extends beyond the field of view achievable withthe endovaginal probe and further characterization is required. Many gynecologicand gastrointestinal disorders present with typical MDTC findings that radiologistsmust recognize to improve the diagnosis and management of these patients.C-313Threatened abortion: Early diagnostic toolsI. Tsikhanenka; Minsk/BY (tihonenko2005@rambler.ru)Purpose: To evaluate uterine blood flow and circulation in corpus luteum in earlypregnancy complicated with threatened abortion.Methods and Materials: Ultrasound and color Doppler data of blood flow in uterine,spiral arteries and corpus luteum at 5-11 weeks of pregnancy were obtained in 80women with threatened abortion (1 group), in 30 women of 2 (control) group. Datawere combined with biochemical markers (progesterone, b-hCG and trophoblasticglycoproteid).Results: Intervilluos blood circulation was registered in 86.25% in 1 group and in100% in 2 group. Chorion and corpus luteum were ipsilateral in 71.25% in 1 groupand in 53.3% in control group. Corpus lutei blood flow was presented as single colorlocus in 43.75% in group 1 and just in 20% (p 0.05) in control group. Resistantindices of spiral arteries were higher in 1 group comparing with 2 group (p 0.05).Serum concentration of progesterone, hCG, and rophoblastic glycoproteid weredecreased in group 1 if compared to control group (p 0.005), and changes weremore significant in patients having genital infections. There was inverse correlationbetween IR in spiral arteries and hCG concentration (R 0.24, p 0.04).Conclusion: Intervilluos blood flow probably present in normal and complicatedearly pregnancy. Absence of peripheral vascular ring in corpus luteum can beconsidered as a sign of complications. Changes in resistant indices of spiral arteriesin combination with biochemical markers can define patients with a high riskof early pregnancy loss.No Material Submitted to EPOSC-314MR imaging diagnosis of dilated fallopian tubesP. Papadopoulou, N. Michailidis, I. Kalaitzoglou, A. Haritanti,P. Psychidis-Papakyritsis, D. Goulis, D. Rousso, A.S. Dimitriadis; Thessaloniki/GR(peggy_pap@yahoo.co.uk)Learning Objectives: To illustrate and discuss the MR imaging features and differentialdiagnosis of dilated fallopian tubes.Background: Dilated fallopian tubes are a common finding in female pelvisimaging, often associated with pelvic inflammatory disease or endometriosis.Although endovaginal ultrasound is the primary diagnostic tool, MR imaging isan invaluable complementary method, especially in complex lesions that maysimulate malignancy.Procedure Details: We retrospectively reviewed sixty-two cases of dilated fallopiantubes from our database. Diagnosis was confirmed clinically or surgically. Lesionsize, shape, multiplicity, presence of complete or incomplete septa, haemorrhage,shading and presence or absence of solid portion or mural nodules was recorded.The commonest configuration was that of a folded tubular structure, often C or Sshaped. The finding of incomplete mural folds or plicae was highly specific. Twentyfourcases were attributed to endometriosis, thirty-one to pelvic inflammatorydisease including six tuboovarian abscesses, two to extrauterine pregnancy, two tobenign ovarian neoplasm, one to malignancy, and two to previous surgery.Conclusion: Dilated fallopian tubes can be correctly identified in MR imagingon the basis of morphology. The signal intensity of the contents may be used tofurther characterize the lesion and the underling pathology, most commonly pelvicinflammatory disease or endometriosis.C-315MR imaging of vulval cancerM.Y. Kataoka 1 , E. Sala 1 , P. Baldwin 1 , A. Farhadi 2 , C. Reinhold 2 ; 1 Cambridge/UK,2Montreal, QC/CA (mk435@cam.ac.uk)Purpose: Little is studied about the optimal sequence and contrast-enhanced(CE) MRI for vulval cancer so far. The purpose of our study is to retrospectivelyevaluate the diagnostic ability of MRI in vulval cancers and to examine the addedvalue of CE imaging.Methods and Materials: MRIs of 39 patients who had been diagnosed with vulvalcancer (mean age 70 years) from two institutions were evaluated by three radiologistsusing five-point scoring for recognition of the main vulva lesion and degreeof enhancement on CE-MRI. Lymph nodes of more than 5 mm in short axis weremeasured and scored for margin, necrosis, loss of fatty hilum, signal intensitycompared to the main vulval lesion, and diagnostic confidence for presence ofmetastasis. The scorings were repeated for CE-MRI (n=26). The above evaluationswere compared to pathological findings.Results: MRI accurately categorized size of vulva lesions in 81% of patients.Evaluation changed after CE-MRI in 19 patients and recognition of the main vulvallesion improved in 7 cancer lesions. Ratio of short to long (S/L) axis of lymphnodes was the best quantitative criteria to predict tumour involvement (area undercurve: 0.84). Diagnostic confidence by radiologist accurately predicts groin nodalmetastasis in 87% of groins. Using the combined criteria of “S/L of 0.8 or above”or “with spiculated margin”, 82% of groins can be diagnosed correctly.Conclusion: MRI can be useful in predicting size of the vulval cancer and groinlymph node metastasis. CE-MRI can improve recognition of vulval lesion.C-316Long echo time diffusion-weighted imaging (long TE-DWI) in diagnosingfemale pelvic tumorsA. Tamura, H. Tanaka, C. Ishii, R. Asai, S. Katano, M. Nakano, M. Sakamoto;Tokyo/JP (ayatake@ttp-r.dlenet.com)Learning Objectives: To learn the role of DWI in offering additional information forthe diagnosis of female pelvic tumors. To investigate the usefulness of long TE-DWI(TE 200 msec) in tumor characterization.Background: Although most malignant tumors in the female pelvis tend to showhigh intensity on DWI with short echo time (about 70 msec), which is consideredto reflect high cellular density in the tumors, borderline tumors and benign tumorsalso can show high intensity. Accurate preoperative diagnosis is desired to take anappropriate management. We hypothesized that not cellular density but relaxationtime of water protons in the cells is different among malignant tumor, benign tumorand normal tissues. The difference could be emphasized by long TE-DWI becauseof prolonged T2 of water molecules in malignant tumors.Imaging Findings: Many malignant tumors (leiomyosarcoma, endometrial cancers,cervical cancers, tubal cancer, ovarian surface epithelial-stromal malignant tumors,dysgerminoma, metastasis and dissemination) remained high intensity on long TE-DWI. Smooth muscle tumor with unknown malignant potential kept high intensity onlong TE-DWI. Cellular leiomyomas that showed high intensity on short TE-DWI lostintensity on long TE-DWI. Degenerated leiomyoma and thecofibroma diminishedintensity on long TE-DWI. Granulosa cell tumor, ovarian surface epithelial-stromalborderline tumor reduced intensity on long TE-DWI. Two major pitfalls are alsodemonstrated. Mature cystic teratoma with less fat component maintains very highintensity on long TE-DWI. Hemorrhagic component affects the intensity on DWI.Conclusion: Female pelvic tumors can be qualitatively diagnosed by a longTE-DWI.C-317Ovarian borderline tumors of MRI: Imaging findings and radiologicpathologiccorrelationR.N. Matsubayashi 1 , Y. Matsuo 2 , T. Nakazono 3 , Y. Okajima 2 , T. Muranaka 1 ;1Fukuoka/JP, 2 Tokyo/JP, 3 Saga/JP (radmad311@yahoo.co.jp)Learning Objectives: To illustrate the MR imaging features of ovarian borderlinetumors. To learn the essential diagnostic clues based on the histologic featuresof borderline tumors.Background: Ovarian tumors are classified as benign, borderline, and malignant.Borderline tumors have a relatively good prognosis and originate in younger patientscompared with malignant tumors, and it is important to diagnose them correctly foradequate treatment. In this exhibit we show MR images of surface epithelial-stromalborderline tumors and correlate the findings with histologic features. Additionally,granulosa cell and carcinoid tumors are also shown.Imaging Findings: Serous borderline cystic tumor showed polypoid excrescensesin the cyst. On T2-weighted images (T2WI), these excrescenses showed a ‘broccoli’-like appearance, and had low signal-intensity (SI) stalk with delicate branching.This reflected the histologic ‘hierarchical branching’. Mucinous borderline tumor ofintestinal type had many loculi with partly thickened walls. Mullerian mucinous/mixedepithelial borderline tumors (MMBT/MEBT) often originate in endometriotic cysts inyoung women, and they showed a very high SI of the outer part on T2WI (cottonball-like). The very high SI reflected severe edematous stroma. Rare borderlineendometrioid adenofibroma was shown as a slowly enhanced mass in endometrioticcyst. Borderline Brenner tumor is very rare. Benign Brenner tumor shows a verylow SI, but the borderline tumor showed relatively high SI on T2WI.CS402 A B D E F FG H

Scientific and Educational ExhibitsConclusion: It is important to know the characteristics of ovarian borderline tumorsto distinguish them from highly malignant tumors. In particular, in cases of tumorsassociated with endometriosis careful interpretation is recommended.C-318MR imagings of sex cord-stromal tumors of the ovary: Usual and unusualappearances and their mimickersY. Okajima 1 , T. Nakazono 1 , H. Irie 1 , Y. Matsuo 1 , M. Nishihara 1 , A. Tamura 2 ,Y. Saida 2 , F. Yamasaki 1 , S. Kudo 1 ; 1 Saga/JP, 2 Tokyo/JP (yk_okaji@yahoo.co.jp)Learning Objectives: To demonstrate MR imaging findings of sex-cord stromaltumors of the ovary and their mimickers with pathological correlation.Background: Sex cord-stromal tumors are uncommon ovarian tumors, representingless than 8% of all ovarian neoplasms. Some of these rare tumors show characteristicimaging findings representing abundant stroma; however, they may alsoshow unusual imaging findings due to degeneration. Sex cord-stromal tumors havegood prognosis compared to malignant epithelial tumors. Therefore, recognitionof various imaging findings is essential for the accurate preoperative diagnosis, toavoid excessive surgical intervention and to preserve infertility.Imaging Findings: Thecoma-fibroma group typically show hypointense solidmasses on T2WI with gradual enhancement. Cystic degeneration and edema canbe seen in larger tumors. Chemical shift MRI can be useful to identify intracellularlipid of the cells. Fibromas can be associated with torsion and Meigs syndrome.Adult granulosa cell tumors usually show solid masses with a various amountof cystic components and hemorrhage. They may be associated with rupture.Sclerosing stromal tumors demonstrate hyperintense cystic components andheterogenous solid components with thick peripheral hypointense rim on T2WI. Ondynamic contrast study, the solid components show peripheral early enhancementwith centripetal progression. Sertoli-stromal tumors and steroid cell tumors arealso demonstrated. Brenner tumors, adenofibromas, malignant epithelial tumors,metastatic tumors, subserosal and broad-ligament leiomyomas, and rare sertoliformendometrioid carcinomas will be demonstrated as mimickers.Conclusion: To differentiate sex cord-stromal tumors of the ovary from other tumors,detailed evaluation of T2WI and dynamic contrast study can be useful.C-319MR inter-observer agreement in the analysis of endometriosisL. Saba 1 , S. Guerriero 1 , B. Virgilio 1 , R. Sulcis 2 , M. Gerada 1 , G. Melis 1 , G. Melis 1 ,G. Mallarini 1 ; 1 Cagliari/IT, 2 Muravera/IT (lucasaba@tiscali.it)Purpose: The purpose of this work was to evaluate inter-observer agreement in theevaluation of the deep pelvic endometriosis by using magnetic resonance (MR).Methods and Materials: From June 2006 to August 2007, two radiologists evaluated47 women (mean age 38; range 23-49) who underwent MR study for suspectedendometriosis. MR was at 1.5 Tesla. Exams were completed with Gadolinium. Eachdataset was independently evaluated by the radiologists for the presence or absenceof deep pelvic endometriosis and localization (utero-sacral ligaments (USLs), pouchof Douglas, the vagina, the rectosigmoid, rectovaginal septum and the bladder) ofsuspected lesions was recorded. Cohen kappa statistic was performed in order tocalculate agreement between measurements.Results: We observed an inter-observer agreement of 89.36% and the kappavalue was 0.635. In the USLs, the inter-observer agreement was 85.11% and thekappa value 0.571. In the pouch of Douglas, the inter-observer agreement was82.98% and the kappa value 0.552. In the vagina, the inter-observer agreementwas 91.49% and the kappa value was 0.552. In the rectosigmoid, the inter-observeragreement was 91.49 % and the kappa value 0.725. In the rectovaginal septum, theinter-observer agreement was 91.49% and the kappa value 0.746. In the bladder,the inter-observer agreement was 93.62% and the kappa value 0.538.Conclusion: Results of our study indicate that MR has a high inter and intraobserveragreement in the identification of endometriosis located in the rectosigmoidand in the rectovaginal septum, whereas the agreement is sub-optimal in theendometriosis located in the USLs.C-320Cystic pelvic masses of non-ovarian originP.L. Moyle 1 , M.Y. Kataoka 1 , A. Nakai 2 , A. Takahata 2 , C. Reinhold 3 , E. Sala 1 ;1Cambridge/UK, 2 Kyoto/JP, 3 Montreal, QC/CA (pennymoyle@doctors.org.uk)Learning Objectives: To recognise the main causes and differential diagnosesfor non ovarian cystic lesions in the female pelvis.Background: Cystic masses in the female pelvis are common. The majority ofcystic lesions originate from the ovary but there are other causes of cystic masseswithin the pelvis, which may be mistaken for ovarian pathology. This may lead toinappropriate management. The anatomical location of lesions, identification ofnormal ovaries, and clinical history are important clues to the diagnosis. We illustrateimaging findings of non-ovarian cystic lesions using US, CT and MRI.Imaging Findings: Tubal lesions such as hydrosalpinx, haematosalpinx, andpyosalpinx can mimic ovarian cystic mass. Sausage-, C-shaped mass separatefrom ovary is a key finding. Another common cystic lesion is peritoneal inclusioncyst, which occurs among pre-menopausal women with peritoneal adhesions andis characterized by a cystic lesion conforming to pelvis with entrapped normal ovary.Cystic masses of gastrointestinal origin include appendiceal mucocele, which canbe traced back to the caecal pole. Sacral meningocele can present as a cysticpelvic mass. Cross-sectional imaging demonstrates continuation to sacral area.Lymphocele is a thin-walled cyst commonly encountered after pelvic surgery. It canhave thickened wall when infected and may be confused with ovarian malignancy.Haematoma, abscess, pelvic lymphangioleiomyomatosis, and cystic degenerationof leiomyoma are also discussed.Conclusion: Not all cystic disease in the female pelvis is of ovarian origin. Understandingthe anatomical location of a lesion, combined with clinical history, isthe key to avoid this pitfall.C-322Comparative efficacy of uterine artery embolization (UAE) and MR-guidedfocused ultrasound surgery (MRgFUS)T. Sycheva, V.E. Sinitsyn, A.E. Bugerenko, E.A. Mershina, K.V. Lyadov,Y.B. Kurashvili, A.V. Stepanov; Moscow/RU (elena_mershina@mail.ru)Purpose: To compare results of organ-saving methods for treatment of femaleswith uterine fibroids (UAE and MRgFUS).Methods and Materials: UAE was used for treatment of 85 women (mean age -365.8 years). Average uterine size (long axis) was 89.319.4 mm, average sizeof myomas was 56.428.9 mm. The focused ultrasound system was used to ablatetissue in combination with on-going magnetic resonance imaging, 1.5 T. MRgFUSwas performed in 40 women (mean age 37.65.6 years). Average uterine size was85.228.1 mm, size of myomas - 40.720.9 mm. Both groups were comparable bymain clinical symptoms (lower abdominal pain, pelvic organs dysfunction, menorrhagia,menometrorrhagia, anemia) and concomitant gynecological diseases(endometrial polyps, infection, cervical erosion).Results: Good results were obtained in both groups. 1. Severity of clinical symptomswas reduced in 89% of women after UAE and in 76.2% after MRgFUS. 2. Averageuterine size has been reduced in 1.4 and 1.22 times after UAE and MRgFUS,respectively. Uterine size became normal in 33% and 25% cases, respectively.Average size of myomas reduced in 2 and 1.5 times after UAE and MRgFUS,respectively. 3. Technical success was achieved in 99.2% (UAE) and 95% (MRg-FUS) cases. Complications after UAE were noted in 4.7% cases, after MRgFUSno complications were registered.Conclusion: Both methods of uterine fibroid treatment were effective and organsaving.MRgFUS is a noninvasive alternative to surgical treatment (hysterectomy,myomectomy) and minimally invasive operation (embolisation of uterine arteries).MRgFUS allows reducing morbidity attributable to other methods.C-323Many faces of adenomyosis: Usual, unusual MR manifestations, pitfallsand problem-solving techniquesM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Learning Objectives: To demonstrate various MR manifestations of adenomyosis.To describe problem-solving MR techniques for the diagnosis of adenomyosis:diffusion-weighted imaging (DWI), susceptibility-weighted imaging (SWI), 1H-MRspectroscopy (MRS), cine-MRI, and high resolution MRI at 3 T.Background: Typical adenomyosis shows characteristic MR imaging: diffuse orfocal thickening of junctional zone, or ill-demarcated low intense myometrial lesionon T2-weighted images. However, adenomyosis may exhibit various MR manifestationsand mimic benign or malignant gynecologic pathologies.Imaging Findings: Various physiologic or pathologic states may influence MRappearances of adenomyosis; amount of functional endometrial tissue, phase ofthe menstrual cycle, endogenous hormonal abnormality, and exogenous hormonalstimulation. Abundant endometrial tissue, hemorrhage, edema, and decidualizationmay cause complex MR appearances mimicking malignancy. Atypical morphologicappearances of adenomyosis should be recognized; solid mass-like “adenomyoma”,hemorrhagic cyst-forming “adenomyotic cyst”, polypoid “adenomyomatous polyp”,and endometrial lesion-like “pseudowidening”. Benign and malignant adenomyosismimickes; physiological myometrial contraction, myometrial involvement of pelvicendometriosis, low-grade endometrial stromal sarcoma, and myometrial metas-GenitourinaryACB D E F G HS403

Scientific and Educational Exhibitstases should be differentiated. DWI with ADC measurement, detection of smallhemorrhagic foci by SWI, evaluation of the choline peak by MRS, demonstratingmorphologic changes on cine MRI, and revealing detailed internal structures on highresolution MRI are helpful for differential diagnosis. DWI is also useful in evaluatingmyometrial invasion of endometrial cancer with co-existing adenomyosis, andmalignant transformation of adenomyosis.Conclusion: Recognizing various MR manifestations of adenomyosis and makingaccurate diagnosis by using problem-solving MR techniques are important forappropriate management of the patients.C-324Clinical application of susceptibility-weighted MR imaging in gynecologicdiseasesM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Learning Objectives: To demonstrate the role of susceptibility-weighted MR imaging(SWI) in diagnosing various gynecologic diseases.Background: SWI combines magnitude and phase information from fully velocitycompensated gradient-echo sequence, and visualizes the susceptibility effectscaused by local inhomogeneity of the magnetic field as signal voids. SWI has exquisitesensitivity to the blood products such as hemosiderin and deoxyhemoglobin,and may contribute to the diagnosis of various gynecologic pathologies with freshor obsolete hemorrhage.Imaging Findings: Punctate or curved linear signal voids along the cyst wall due tohemosiderin deposition as a result of repeated hemorrhages are characteristic forendometrioma, and useful sign for differentiating from non-endometrial hemorrhagiccyst. The presence of signal voids due to hemosiderin deposition in extra-ovarianendometriosis (i.e. urinary bladder, abdominal wall and peritoneal implants), andin adenomyosis is also diagnostic. SWI is sensitive to a small amount of hemorrhagiccontents, and can differentiate mucinous cysts from hemorrhagic cysts bothexhibiting high signal intensity on T1-weighted images. SWI can also demonstratefresh hemorrhage, and is helpful for detecting ectopic pregnancy, small hemorrhagicnecrosis in uterine sarcomas, hemorrhagic infarction in red degeneratedleiomyomas, and placental polyp with hemorrhagic foci. The signal voids on SWIare demonstrated more prominent at 3 T than at 1.5 T reflecting the higher sensitivityof 3 T to the magnetic susceptibility effect. Calcification and intestinal gas maycause susceptibility artifacts on SWI as pitfalls.Conclusion: SWI is sensitive for the presence of hemorrhage within various gynecologicpathologies, and provides helpful information for the differential diagnosis.C-325Staging of endometrial cancer: Role of diffusion-weighted MR imaging incomparison with T2-weighted and dynamic gadolinium-enhanced imagesG. Rechichi, D. Ippolito, S. Galimberti, P. Perego, M. Signorelli, S. Sironi;Monza/IT (gilda_82@hotmail.com)Purpose: To compare the reliability of MR diffusion weighted with background bodysignal suppression images (DWIBS) with T2-weighted and dynamic Gadoliniumenhancedimaging in the pre-operative local staging of endometrial cancer.Methods and Materials: The study group consisted of 40 patients with proved endometrialadenocarcinoma, who underwent pre-operative MR staging. In addition tothe standard MR protocol imaging, including T2-weighted and Gadolinium-enhancedsequences, we performed DWIBS obtained with b-value of 0 and 1000 s/mm 2 . Allthe patients underwent radical hysterectomy; the imaging findings were comparedwith histopathological results to evaluate the sensitivity of the three different MRsequences used. We considered as superficial invading tumors those cases stagedas FIGO IA/IB (confined to endometrium/invading 50% of myometrium) and asdeep invading tumors all FIGO IC cases (invading 50% of myometrium).Results: A significant difference (p 0.005) for sensitivity was found for each ofthe sequences employed, having the histopathological findings as standard (39cases of superficial invading cancer vs 9 of deep invading cancer). The sensitivitywe obtained for DWIBS, T2-weighted and Gadolinium-enhanced images was of 92,100 and 75%, respectively. Statistical analysis showed that T2-weighted imagesare the most accurate in local staging of endometrial cancer, followed by DWI andthen Gadolinium-enhanced sequences.Conclusion: Due to their sensitivity, the association between T2-weighted imagesand DWIBS could represent the most reliable MR imaging protocol in pre-operativelocal staging of endometrial cancer.C-326Mid-trimester anomaly screening: A resident’s guideS.S. Hedgire, K. Narsinghpura, P. Gupta, T. Kalyanpur, S. N, R. Krishnan,S. Pene, R. Renganathan, P. Mehta; Coimbatore/IN (hedgire@gmail.com)Learning Objectives: To formulate an approach for fetal anomaly screening insecond trimester.Background: Use of a systematic approach to fetal anomaly screening and whya mid-trimester scan is preferred.Imaging Findings: 1. Technique. 2. Normal and abnormal findings in the head andneck, thorax, heart, abdomen, pelvis, limbs and spine. 3. Pitfalls.Conclusion: Antenatal anomaly screening assumes importance as it enablesthe radiologist to detect lethal anomalies and aids in counselling the patients.We attempt to formulate a systematic approach to the mid-trimester detection ofvarious anomalies.C-327Magnetic resonance imaging appearances of borderline ovarian tumoursH. Sbano, R. Williamson, M. El-Bahrawy, S. Babar; London/UK(Hala.Sbano@imperial.nhs.uk)Purpose: To describe the MRI appearances of borderline ovarian tumours, andthe frequency of MR features indicative of malignancy.Methods and Materials: MRIs from 27 patients with 31 histologically confirmedborderline ovarian tumours were reviewed. Mass size, signal intensity on T1, T2,T1 WATTS, septal thickness, nodules, papillary projections, solid elements, haemorrhage,ascites, peritoneal and mesenteric nodules, omental thickening andlymphadenopathy were recorded.Results: 31 tumours (19 serous and 12 mucinous) were diagnosed in 27 patients.Each mass ranged from 3 - 31 cm (mean 13 cm). 27/31 (87%) of the tumourswere cystic. 4/31 (13%) were cystic with solid components. Multiple septa weredemonstrated in 25/31 (81%). 8/31 (26%) had thickened septa ( 3 mm). The rangeof septal thickness was 1 - 6.3 mm (mean 2.9 mm). Solid components includingnodules and papillary projections were noted in 26/31 (84%). The range of diametersof the largest solid components was 2.4 - 33 mm, with multiple solid elementsdemonstrated in 19/31 (61%). 4/31 (13%) had ascites. Omental thickening wasdemonstrated in 2/31 (6.5%). Mesenteric deposits were observed in 1/31 (3.2%).6/31 (19%) had completely benign appearance (4, serous and 2 mucinous). Onemalignant feature was observed in 14/31 (45%); 9 serous, 5 mucinous. 10/31 (32%)had 2 malignant features (5 serous and 5 mucinous). 3 malignant features wereobserved in 1/31 (3.2%) (Serous).Conclusion: Borderline ovarian tumours remain a diagnostic challenge with 81%displaying features on MRI indicative of malignancy. Such features were observedin 79% of the serous and 83% of the mucinous subtypes.C-328Uncommon ovarian teratomas: Imaging findings and pathologiccorrelationS. Motoshima, H. Irie, T. Nakazono, Y. Okajima, T. Otsuka, S. Kudo; Saga/JP(s4649@m2.gyao.ne.jp)Learning Objectives: 1. To review imaging findings of uncommon ovarian teratomasand correlate them to pathologic findings. 2. To illustrate various imagingfindings of uncommon ovarian teratomas and to discuss the cause of atypicalpresentations. 3. To learn the crucial imaging findings in differentiating from otherovarian masses.Background: 1. Presenting cases: various types of mature cystic teratomas (typical,torsion, ruptured, without intracystic lipid material, malignant transformation, withmassive hemangiomatous element), immature teratoma, struma ovarii, carcinoidtumor, etc. 2. Review of CT and MRI findings. 3. Imaging-pathologic correlation.Imaging Findings: Imaging findings of torsion of teratoma include deviation ofuterus and absence of enhancement of the mass. Rupture of teratoma causesleakage of sebaceous content into the peritoneum. Mature cystic teratoma withmalignant transformation and immature teratoma appear to be fat-containing masswith a solid component. The former occur in the 6 th or 7 th decade of life, the latteroccur in the 1 st or 2 nd decade of life. Struma ovarii and carcinoid tumor are classifiedmonodermal teratoma, which have strong contrast enhancement.Conclusion: It is important to be familiar with the variety of imaging appearanceof uncommon ovarian teratomas to distinguish them from other significantdiseases.CS404 A B D E F FG H

Scientific and Educational ExhibitsC-329Patients with ovarian lesions: spectrum of diseases evaluated withcontrast enhanced ultrasound (CEUS)F. Lacelli 1 , L.M. Sconfienza 2 , M. Bertolotto 3 , N. Gandolfo 4 , C. Murolo 2 , G. Serafini 1 ;1Pietra Ligure/IT, 2 Genua/IT, 3 Trieste/IT, 4 Sanremo/IT (io@lucasconfienza.it)Learning Objectives: To illustrate the spectrum of ovarian pathologies that canbe effectively evaluated with CEUS.Background: Transvaginal US is the first imaging modality of choice in evaluatingovarian diseases. Color Doppler analysis allows detecting intralesional flow in arelevant number of situations. However, it is often inadequate in the detection ofsmall perfusion abnormalities, being almost useless to differentiate poorly vascularfrom avascular lesions. The detection of microvascularization is particularly importantin complex lesions, giving a relevant aid in the differential diagnosis betweenbenign or malignant features.Imaging Findings: CEUS was used to assess a wide range of adnexal affections.Cases of ovarian torsion, ovarian fibroids, hemorrhagic lesions, complex masseswith papillary projections, solid tumors, paraovarian lesions and pseudotumorsperitonei are presented, both in standard conditions and during CEUS evaluation.Differences between findings on conventional ultrasound examination and CEUSassessment will be highlighted.Conclusion: CEUS allows detection of microcircle perfusion abnormalities inpatients affected by a wide range of pathology. This information is mandatory inobtaining a correct differential diagnosis and in many cases is significant to modifythe therapeutic approach.C-330Signs in imaging of the female pelvis: A pictorial reviewM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Learning Objectives: To demonstrate various diagnostic signs in imaging of thefemale pelvis with pathologic correlation.Background: Various diseases may occur in the female pelvis from not only reproductiveorgans but also intestinal, mesenteric, urinary, or extra-peritoneal organs.Imaging Findings: Signs associated with signal intensity pattern on MRI: “Shadingsign” for endometrioma (T2-shortening by repeated hemorrhagic contents),“Stained-glass appearance” for mucinous tumors (various contents in loculi), “Hyperintenserim sign” for red degenerated leiomyoma (T1-shortening by Methemoglobin),“Black sponge-like appearance” for ovarian cystadenofibroma (fibrous mass withmultiple tiny glands), “Black garland” for ovarian fibromatosis (fibrous cortical thickening),“Black rim sign” for polypoid endometriosis (surrounded by adhesive fibroustissue), “Mural Othello pieces” for malignant Brenner tumor (combination of benignfibrous hypointense nodule and malignant hyperintense nodule on T2WI). Signsassociated with morphologic appearances: “Bridging vascular sign” (feeding arteries)and “Beak sign” for subserosal leiomyoma, “Preserved follicle sign” for benignenlarged ovaries (polycystic ovaries; massive edema; torsion; oophoritis), “Floatingfat balls” for mature cystic teratoma, “Uterine scalloping” for pseudomyxoma peritonei,“Marginal crescent sign” for ancient schwannoma (residual solid component),“Target sign” for urethral clear cell carcinoma (preserved urethra as central dot),“Centripetal replacement sign” for extra-peritoneal tumors (anterior replacement ofrectum; inward replacement of iliac vessels and ureter), “Black worms” for low-gladeendometrial stromal sarcoma (preserved muscular bandles).Conclusion: Diagnostic signs in imaging are helpful for the differential diagnosis inthe routine clinical practice, and recognition of characteristic signs in imaging mayform an important part of the training process for diagnostic radiologist.C-331Benign physiologic conditions and tumor-like lesions simulatingneoplasms in the female pelvis: Clues to the differential diagnosisM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Learning Objectives: To demonstrate various benign physiologic conditions andtumor-like lesions simulating neoplasms in the female pelvis, and to describe cluesto the differential diagnosis.Background: Physiologic conditions may affect the morphologic appearances offemale reproductive organs. Benign physiologic conditions and tumor-like lesionsmay mimic neoplasms in the female pelvis.Imaging Findings: Non-neoplastic ovarian enlargement mimicking solid or multilocularcystic tumors may occur under various conditions: Massive ovarian edemafollowing chronic incomplete torsion, polycystic ovaries/ovarian fibromatosis withstromal proliferation, Hyperreactio luteinalis/ovarian hyperstimulation syndromecaused by the endogenous or exogenous hormonal stimulation, and Oophoritis/tubo-ovarian abscess due to infection. Recognition of preserved follicles on imagingand understanding of clinical information are important for the diagnosis.Endometriosis may occasionally mimic neoplasms: decidualization associatedwith pregnancy/polypoid endometriosis may mimic malignancies in ovaries, vaginaor peritoneal cavity. High ADC due to their vascularized edematous nature ondiffusion-weighted imaging is diagnostic. Endometriosis may involve intestine, bladder,and abdominal wall, and simulate cancers. Revealing hemosiderin-depositionby susceptibility-weighted imaging is helpful for the diagnosis. In the uterus, deepnabothian cyst and adenoma malignum, edematous/decidualized adenomyosis andsarcomas, adenomyotic cyst and uterine/ovarian malignancy, myometrial contractionand leiomyomas should be differentiated by characteristic MR manifestations,sequential morphologic changes and clinical information of physiologic conditions.Urethral diverticulum mimics clear cell carcinoma, and contrast-enhanced MRIcan differentiate them.Conclusion: Recognition of imaging manifestations of normal organs and benigntumor-like lesions under various physiologic conditions is important for makingaccurate diagnosis and appropriate management of the patients.C-332Differential diagnosis of uterine myometrial masses: Clinical challenge bydiffusion-weighted MR imaging and in-vivo 1H-MR spectroscopyM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Learning Objectives: To demonstrate the feasibility of diffusion-weighted MRimaging (DWI) and in-vivo 1H-MR spectroscopy (MRS) in differentiating benignmyometrial lesions from malignancy.Background: Hyperintense leiomyomas on T2-weighted MR images have adiagnostic dilemma in the differentiation from uterine sarcomas. Adenomyosismay show various signal intensity and mimic malignancy. It is occasionally difficultto differentiate these benign myometrial lesions from sarcomas on the basis ofmorphologic appearances.Imaging Findings: Uterine sarcomas show high signal intensity on DWI withsignificantly lower ADC (0.790.26, n=7) compared with benign myometrial lesions(1.340.29, n=60) due to high cellularity of malignant tumor cells. In benignhyperintense leiomyomas on T2-weighted images, cellular leiomyomas show highersignal intensity with relatively low ADC (1.180.16, n=6) compared with degeneratedleiomyomas (1.600.30, n=21). Hydropic/myxomatous degeneration in leiomyomas,and edema/decidualization in adenomyosis may increase the signal intensity onT2-weighted images; however, high ADC in such benign lesions is helpful for thedifferential diagnosis. High choline peaks are observed in sarcomas by MRS reflectingtheir prominent cellular proliferating activity, whereas moderate to low cholinepeaks are observed in benign myometrial lesions. High-grade sarcomas tend toshow higher choline peaks by MRS.Conclusion: DWI and MRS can provide useful information for the differentialdiagnosis of hyperintense myometrial masses on T2-weighted images.C-333Ovarian lesions: MRI findings with histopathological correlationP.V. Foti, R. Farina, D. D’Aniello, M. Coronella, E. Fisichella, G. Politi, G.C. Ettorre;Catania/IT (pietrofoti@hotmail.com)Learning Objectives: To show the diagnostic performance of magnetic resonanceimaging (MRI) in the characterization of ovarian lesions: we illustrate typical andatypical MRI findings of adnexal lesions and correlate them with histopathologicfindings.Background: 20 women (age range, 26-65 years) with 24 ovarian lesions underwentMR imaging before surgical excision. MR protocol included FSE T2-weightedand plain and gadolinium-enhanced T1-weighted sequence. MR images werecorrelated with histologic findings.Imaging Findings: The lesions observed were as follows: 4 functional cysts, 4endometrial cysts, 4 fibromas, 4 mature cystic teratomas, 7 serous cystadenocarcinoma,and 1 tubo-ovarian abscess. Functional cysts show low signal in T1-weightedsequence and high signal in T2-weighted sequence. Endometrial cysts show highsignal in both sequence T1-weighted and T2-weighted. Fibromas have extremelylow signal intensity on T1- and T2-weighted MRI, as does muscle, with moderatecontrast enhancement. Mature cystic teratomas can contain variable cystic and solidcomponents (adipose and ectodermal structures). Solid component do not enhancewhen the lesion is benign, and in cases of malignant degeneration enhancementof these solid component will be observed. Malignant tumors typically appear ascomplex solid/cystic adnexal masses; any solid components will enhance followingadministration of contrast. Inflammatory lesions can mimic an ovarian cancer,clinical correlation is essential for diagnosis.GenitourinaryACB D E F G HS405

Scientific and Educational ExhibitsConclusion: MR showed high diagnostic accuracy and sensibility in the diagnosisof endometrial cysts and mature cystic teratomas; it moreover can help distinguishamong benign and malignant tumors, though a degree of overlap remains.C-334Evaluation of histological type in uterine endometrial cancer by threedimensionalMRI in which CO 2gas was infused into the uterine cavityD. Kakizaki, S. Xu, K. Saito, S. Akata, M. Yoshimura, J. Park, K. Tokuue; Tokyo/JP(dkdk@tokyo-med.ac.jp)Purpose: We conducted MRI by 3D-VIBE (3 dimensional image with volumetricinterpolated breath-hold examination) method in which CO 2gas was infused intothe uterine cavity, and created an endoscopic image (MR hysteroscopy) and multiplannarreconstruction (MPR) of the uterine cavity. And we performed evaluationof histological type and clinical stage in uterine endometrial cancer.Methods and Materials: The pulse sequence of MR imaging was 3D-VIBE method.CO 2gas was pumped into a catheter inserted in the uterine cavity and images weretaken by 3D-VIBE. MPR and endoscope image processing were then performed.There were 36 cases of cancer of uterine body.Results: Based on the FIGO classification, the cancer of uterine body types were15 cases of Ia, 15 cases of Ib, 7 cases of Ic, 6 cases of IIa and 7 cases of IIb.The histological type were 50 cases: 29 adenocarcinoma, 5 adenoacanthoma, 6adenosquamous, 3 serous (papillary serous), 1 mutinous, 1 clear cell, 2 squamouscell, 1 mixed and 2 undifferentiated.Conclusion: CO 2gas infusion into the uterine cavity made it possible for MRIintrauterine endoscopy and MPR. And the most important conclusion that emergedfrom the research is that this study will surely contribute to determine the histologicaltype of uterine endometrial cancer.C-335Hysterosalpingography (HSG) anatomy, imaging and pathology revisitedA.M. Browne, E. DeLappe, H. Khosa, G. Colleran, K. Cronin, C. Roche;Galway/IE (shellybrowne79@gmail.com)Learning Objectives: We provide an interesting, informative and concise radiologicalguide of HSG technique, anatomy and pathology.Background: HSG is the radiographic evaluation of the uterus and fallopian tubeswith the use of radiographic contrast medium. The most common indications forperforming HSG are infertility, recurrent abortion and evaluation of the uterus andfallopian tubes post tubal surgery. We provide an educational exhibit of the presentationand imaging findings of uterine and tubal pathology identified on HSGin our institution and correlate imaging findings with clinical features. We illustratecharacteristic appearances and differentiate these from other pathologies whereappropriate.Imaging Findings: We illustrate, using imaging findings, normal uterine and fallopiantube anatomy. We demonstrate the characteristic appearances of a widespectrum of uterine and tubal pathologies including acquired and congenital anomalies.We also briefly discuss HSG technique and potential complications. Uterineabnormalities demonstrated include congenital abnormalities, polyps, leiomyomas,surgical changes, synechiae and adenomyosis. Tubal abnormalities demonstratedinclude tubal occusion, polyps, hydrosalpinx and peritubal adhesions.Conclusion: HSG is a valuable imaging modality in the evaluation of the uterus andfallopian tubes. A wide variety of uterine and tubal abnormalities can be demonstratedwith hysterosalpingography. Accurate diagnosis allows for early managementof treatable conditions including those affecting patient fertility.Results: Endometrial cancer show high signal intensity on DWI with significantly(p 0.01) lower ADC (0.840.19) compared with benign endometrial lesions(1.580.36) due to high cellularity of cancer cells. The staging accuracy on DWI andcontrast-enhanced T1-weighted images were 94 and 88%, respectively. The depthof invasion was overestimated in three patients with co-existing adenomyosis andunderestimated in one patient with infiltrative tumor growth on contrast-enhancedT1-weighted images. DWI could accurately evaluate the tumor extent in three ofthese four patients.Conclusion: DWI can provide useful information for the differential diagnosis ofendometrial masses and for the evaluation of the depth of invasion by endometrialcancer. Especially, when adenomyosis co-exists with endometrial cancer at thesame site, DWI improves the accuracy of staging.C-337Virtual hysteroscopy: A promise less invasive methodP. Carrascosa 1 , M. Baronio 2 , C.M. Capuñay 1 , J. Vallejos 1 , E. Martín López 1 ,M. Borghi 2 , C. Sueldo 2 , S. Papier 2 ; 1 San Isidro/AR, 2 Caba/ARPurpose: To evaluate the accuracy of virtual hysteroscopy (VH) for the evaluationof cervical and uterine pathology in comparison with hysteroscopy (H).Methods and Material: Twenty-five patients with diagnosis of infertility werestudied. All patients underwent VH with a 64 row multidetector CT. A volume of10-15 ml of a dilution of low-osmolality iodine contrast agent was instilled into theuterine cavity. All patients were derived to H after VH. The studies were performedand evaluated independently and in a blinded way. The diagnostic accuracy forVH and H were calculated.Results: Three of 25 patients presented cervix pathology in VH (2 with polyps and1 with folds thickening). Two lesions (1 polyp and 1 synechiae) were detected by Hand not by VH (false negatives for VH). However, in a second evaluation they wereidentified. Twenty patients presented elevated lesions in uterine cavity. Both VHand H detected 19 polyps, 3 submucosal myomas, 1 cesarean scar and 1 patientwith septate uterus. Two polyps were detected by VH and not by H in a first lecturebut confirmed by the second look (false negative findings for H). Both VH and Hhad the same sensitivity, specificity, positive and negative predictive values of 92,100, 100 and 92%, respectively.Conclusion: VH result exceeds those of H for the evaluation of uterine pathology,identifying two polyps overlooked in the first H exam. The false negative findingsof the cervical region were retrospectively seen in VH studies.C-336Diffusion-weighted MR imaging of endometrial cancer: Differentiation frombenign endometrial lesions and evaluation of myometrial invasionM. Takeuchi, K. Matsuzaki, H. Nishitani; Tokushima/JP(mayumi@clin.med.tokushima-u.ac.jp)Purpose: To demonstrate the feasibility of diffusion-weighted MR imaging (DWI) indifferentiating benign endometrial lesions from malignancy, and in evaluating thedepth of myometrial invasion by endometrial cancer.Methods and Materials: Pathologically proven 67 uterine endometrial lesionsincluding 22 benign lesions (polyps/hyperplasia) and 45 endometrial cancerswere evaluated on DWI (b=800 seconds/mm 2 ). The ADCs (x 10 -3 mm 2 /seconds)in all lesions were measured. In 33 endometrial cancers the histologic findingswere compared with DWI and contrast-enhanced T1-weighted images. The depthof myometrial invasion was classified as stage S (superficial invasion/ limited toendometrium) and stage D (deep invasion: tumor invades more than 50% of themyometrium). The staging accuracies of each sequence were assessed.CS406 A B D E F FG H

Scientific and Educational ExhibitsGenitourinaryKidneyC-338Effect of acquisition duration on parameters measurement of CT perfusionin rabbit kidneyL. E 1 , D. Ma 1 , Z. Wu 2 , J. Li 2 ; 1 Beijing/CN, 2 Taiyuan/CN (elinning@163.com)Purpose: To evaluate if there is a significant change in the parameter of CT perfusionof kidney when differing scan acquisition times are used with the objectiveof reducing radiation dose and examination duration, while not compromising onparameter estimation accuracy.Methods and Materials: CT perfusion of kidneys was studied by a 64-row multidetectorCT in eight male New Zealand white rabbits. Acquiring time is 60 seconds,and these raw data could subsequently be subdivided into 3 different acquisitiontimes (30, 45 and 60) by selecting a specified number of images to be loaded upinto the workstation. The mean values of renal cortex (BV, BF and MTT) werecompared using the two-way analysis of variance.Results: There was no significant difference between values obtained at the 3different acquisition times for BV (p=0.056), BF (p=0.184) and MTT (p=0.675). Theabsolute values of BF and BV have a large variability.Conclusion: There was no significant difference in rabbit kidney BV, BF and MTT forany of the scan times studied. Data acquired in the period of first pass is sufficientto calculate BV, BF and MTT. The advantages of a reduction in total acquisitiontime include reduced likelihood of patient movement and may enable perfusionstudies in a single breath hold, and the more important thing is that radiation dosecan be reduced greatly. Our study also revealed that the measured BF and BV inthe renal cortex have a larger variability in absolute values.C-339Imaging aspects of urachal remnant pathologyS. Palma, J. Inácio, J. Leitão, L. Lobo, M. Abecasis, I. Távora; Lisbon/PT(soniapalma@iol.pt)Learning Objectives: The authors propose an embryologic and anatomic featuresreview of the urachus, regarding the two major group anomalies (congenital/acquired).This review will be illustrated by CT and MRI images of our department.Background: The urachus is a remnant of the intraembryonic portion of the allantois.This is an extraperitoneal structure that typically closes at birth. Congenitalanomalies include patent urachus, urachal sinus/cyst, vesicourachal diverticulumand umbilical-urachal sinus. Acquired anomalies concern infectious complicationsof congenital anomalies and a broad spectrum of very rare benign and malignanttumors.Imaging Findings: TC and MRI imaging techniques give an important contributionto differentiate urachal from bladder apex pathologies. According to several authors,the extension of urachal carcinoma through the space of Retzius, the midline positionand calcifications in a midline supravesical mass are considered nearly diagnosticfor urachal carcinoma. Usually this is a silent pathology, and so the radiologist mustbe aware if a midline supravesical mass is diagnosed.Conclusion: Understanding the anatomy and the imaging features of urachal remnantdiseases, along with the typical locations and distributions of these diseases,is essential for correct diagnosis and proper management.C-340Study of renal MR perfusion weighted imagingH. Shi, H.-Y. Ding; Jinan/CN (hansenschie@msn.com)Purpose: To study the method and findings of MR perfusion weighted imaging(PWI) in normal kidney and renal diseases.Methods and Materials: Thirty-three cases, including 9 volunteers, 14 cases withrenal carcinoma, 6 cases with renal cyst, 2 cases with renal angiomyolipoma and2 cases with renal tuberculosis were examined with T 1WI, T 2WI and PWI. The datafrom the cases were processed with workstation to obtain time-signal intensitycurves, color perfusion maps and relative perfusion value. The relative renal bloodvolume (rRBV), the relative renal blood flow (rRBF), the mean Transition Time(MTT) and the time to peak (TTP) in the normal renal cortex and medulla and therenal lesions were calculated.Results: After the treatment of statistics, the results showed that rRBV and rRBFof the cortex was greater than that of the medulla in the normal kidneys (p 0.01and p 0.01); MTT and TTP of the cortex was shorter than that of the medulla inthe normal kidneys (p 0.01 and p 0.05). The values of rRBF and TTP of the renalcarcinoma were evidently higher than the normal tissues (p 0.01). The valuesof rRBV and rRBF of the renal cysts distinctly decreased (p 0.01) and MTT andTTP lengthened (p 0.01). The value of rRBV of the renal angiomyolipoma andthe renal tuberculosis was distinctly decreased (p 0.01).Conclusion: PWI can demonstrate the hemodynamic and the functional states ofthe normal renal tissues and the renal lesions and will become an ideal method forshowing the morphological and functional changes of the kidney.C-341Beyond renal cell carcinoma - expanding the differential for solid renalmasses: A series of unusual, pathologically proven renal massesN.P. Hanson, A. Hawari, W.D. Boswell, V.A. Duddalwar; Los Angeles, CA/US(nikthered@gmail.com)Learning Objectives: To review differentiating imaging characteristics of unusualrenal masses. To correlate clinical and radiological findings for unusual and rarerenal masses as well as unusual imaging appearances of common renal masses. Toprovide multi-modality correlation of imaging findings for renal masses. To discussimaging protocols and follow-up in the management of these renal masses.Background: There is significant overlap in the appearance of both benign andmalignant masses in the kidney. This presentation provides pathologically provenexamples of unusual renal masses such as metastatic lesions, granulomas, leiomyoma,focal infiltrations, inflammatory pseudotumor and others. The goal is toprovide visual examples to the radiologist in order to allow consideration of bothclinical factors and differentiating imaging characteristics to provide a narrow butaccurate differential diagnosis for an unusual renal mass. We also discuss unusualimaging appearances of common renal masses.Imaging Findings: Multi-modality imaging findings will be provided for each of thedifferent cases including CT, MRI and US. These findings will be compared andtheir value in differentiating various pathologies discussed.Conclusion: Differentiating between solid renal masses can be difficult. Usingclinical factors and imaging characteristics to narrow the differential diagnosisprior to invasive procedures may improve patient care by avoiding unnecessaryprocedures, or allowing nephron sparing procedures to be performed.C-342Contribution of diffusion-weighted MR imaging for predicting benignity ofcomplex adnexal massesI. Thomassin-Naggara, I. Toussaint, C.A. Cuenod, E. Darai, C. Marsault,M. Bazot; Paris/FR (isabellethomassin@gmail.com)Purpose: To prospectively assess the contribution of diffusion-weighted MR imaging(DWI) for characterizing complex adnexal masses.Methods and Materials: Seventy-seven women (22 to 87 years old) with complexadnexal masses underwent MR imaging including DWI before surgery. Incases of bilateral tumors, the most complex tumor was analyzed (30 benign and47 malignant). Conventional morphological criteria of malignancy (size, papillaryprojections, thickened irregular septa, solid portion and T2-signal intensity withinsolid component) were recorded in addition to b1000 signal intensity and apparentdiffusion coefficient (ADC) measurements of cystic and solid components. Statisticaldescriptive analysis was performed using Mann-Whitney test and Fisher’s exacttest. Positive likelihood ratios (PLR) were calculated for predicting benignity andmalignancy.Results: The most significant criteria for predicting benignity were low b1000 signalintensity within solid component (PLR=10.9), low T2 signal intensity within solidcomponent (PLR=5.7), absence of solid portion (PLR=3.1), absence of ascites orperitoneal implants (PLR=2.3) and absence of papillary projections (PLR=2.3). Allmasses that displayed simultaneously low signal intensity within solid componenton T2 weighted and on b1000 diffusion weighted images were benign. Alternatively,the presence of a solid component with intermediate T2 signal and high b1000signal intensity was associated with a PLR of 4.5 for a malignant adnexal tumor.Calculated ADC values, however, did not contribute to differentiating benign frommalignant adnexal masses.Conclusion: DWI is an accurate tool for predicting benignity of complex adnexalmasses. DWI should have a role for selecting treatment strategy in women withcomplex adnexal masses.GenitourinaryACB D E F G HS407

Scientific and Educational ExhibitsC-343Incidental adrenal adenomas: Are we doing the right thing?N. Schembri, G. Lamb; Liverpool/UK (nschembri@nhs.net)Purpose: To evaluate the local practice of reporting incidental adrenal masses.Methods and Materials: The initial report of adrenal adenomas picked up incidentallyon CT or MR between January and December 2006 at the Royal LiverpoolUniversity Hospital was looked at retrospectively. The contents of the initial reportwere analysed for documentation for the need of biochemistry assessment, size,morphology, HU or signal drop of the lesion, and follow-up imaging.Results: 56 CT and 31 MR adrenal scans were analysed. Female to male ratio was38:49, mean age of 55 years. 40 scans were carried out as follow-up investigationsof a previous incidental finding. Adrenal masses picked up as part of abnormalbiochemistry work-up or if malignancy was suspected were excluded. The NationalInstitutes of Health (NIH) Consensus Development Panel on Management of theClinically Inapparent Adrenal Mass (2002) was referred to as a standard. Differencesemerged when compared with standard: biochemistry investigations weresuggested in only 37.5% of cases, morphological description was documented in42.5%, size of the lesion was measured in 87.5% and HU/signal drop was documentedin 40%. Follow-up imaging was advised in 67.5%, although the majoritydid not specify a time interval. Follow-up imaging suggested varied among CT(42.5%), MR (27.5%) and US (5%). 17.5% of scans were requested by cliniciansdespite contrary advice given by the reporting radiologist.Conclusion: In the absence of official UK national guidelines, we propose recommendationsfor reporting incidental adrenal adenomas to advise appropriatemanagement aimed at eliminating unnecessary over-investigation.C-344Infrarenal retroperitoneum: Detailed anatomy and various pathologicconditionsJ. Sung, S. Lee, Y. Ku, Y. Won, I. Hwang, K. Chun; Uijongbu/KR(bebop0301@hanmail.net)Learning Objectives: To review embryogenesis and layered anatomy of infrarenalextraperitoneal space. To demonstrate various kinds of pathologic conditionsinvolving infrarenal retroperitoneum.Background: The retroperitoneum is divided into the retroperitoneal spaceand retroperitoneal plane. The retroperitoneal space at the level of the kidney issubdivided into great vessels space, posterior renal space, perirenal space, andanterior pararenal space (pancreaticoduodenal compartment and colonomesocoliccompartment). The retroperitoneal plane at the level of kidney is subdivided intoretromesenteric, retrorenal, lateral conal plane, and sufascial plane. But, belowthe level of renal fascial cone, perirenal space and pancreaticoduodenal compartmentof the retroperitoneal space disappear. The retromesenteric and retrorenalplanes are combined and make a combined interfascial plane. Then, infrarenalretroperitoneum is composed of three spaces (colonomesocolic compartment ofthe retroperitoneum, posterior pararenal space, and great vessel space) and twointerfascial planes.Procedure Details: We divide infrarenal retroperitoneal space into 4 layers, fromventral to dorsal aspect. Layer 1 colonomesocolic compartment: colon cancer,lymphoma, diverticulitis. Layer 2 interfascial plane compartment: pancreatitis,mesenteric hematoma, round ligament hematoma, ovarian vein thrombosis. Abovethe level of iliac crest: retromesenteric plane, perirenal space, retrorenal plane.Below the level of iliac crest: combined interfascial plane. Layer 3 great vesselcompartment: rupture of abdominal aortic aneurysm, May Thurner syndrome,paraganglioma of organ, Zukerkandle. Layer 4 posterior pararenal space andmuscular compartment: schwannoma, psoas abscess.Conclusion: The knowledge of layered anatomy of infrarenal retroperitoneumis helpful in diagnosing and understanding the spread of the diseas involvingretroperitoneal space.C-345MDCT is very useful to indicate the appropriate management of adrenalhemorrhage in patients with severe blunt traumaA. Pinto, S. Merola, A. Sparano, C. Stavolo, S. Daniele, T. Cinque, L. Romano;Naples/IT (antopin1968@libero.it)Purpose: To describe the management and the outcome of 35 cases of MDCTdetectedadrenal hemorrhage in patients with severe blunt trauma.Methods and Materials: We reviewed 35 patients who suffered from severetraumatic adrenal hemorrhage after motor vehicle collisions (n = 20), falls (n = 9)and sports-related (n = 6). MDCT images were analyzed for multi-organ traumaticinjury and at the level of the adrenal gland the following CT findings were searched:indistinct or enlarged adrenal gland, focal hematoma expanding and distorting theadrenal gland, gross or focal adrenal hemorrhage in an otherwise normal-sizedgland and active adrenal bleeding.Results: All 35 patients manifested multi-organ traumatic injuries. On MDCT images,adrenal gland hemorrhage appears as focal hematoma ranging from 20 to60 mm in length and from 12 to 55 mm in width expanding and distorting the adrenalgland (n=16), enlarged adrenal gland (n= 9), gross or focal adrenal hemorrhagein an otherwise normal-sized gland (n=7) and active adrenal bleeding (n=3) withpseudoaneurysm formation in one patient. Thirty-two patients were followed withoutany intervention; two patients with active adrenal bleeding were submitted to surgeryand the last patient with active adrenal bleeding and pseudoaneurysm receivedtransarterial embolization. Follow-up CT scans obtained in all patients 3-90 daysafter the trauma showed various degrees of resolution of the adrenal injury.Conclusion: MDCT can accurately indicate the size of the hematoma and thepresence of extravasation helping in determining the appropriate management ofpatients with traumatic adrenal hemorrhage.C-346The volume of adrenal glands and its impact factors of average humanadults on 64-slice MSCTX. Wang, H. Xue, W. Liu, Z. Jin; Beijing/CN (wx8203@yahoo.com.cn)Purpose: To measure volume and other parameters of normal adrenal glands inhuman adults and to correlate these measurements to age, sex and descriptorsof body size.Methods and Materials: Measurements of adrenal glands were obtained fromcomputed tomographic images in 81 patients (M:F=1.5:1, age: 20-76, mean=48y) who underwent enhanced 64-slice abdominal CT scan for routine clinicalindications. Patients with conditions known to affect the size of adrenal glands orcases with focal adrenal enlargement suggesting a mass were excluded. Imagesof portal phase were studied. Both the reconstruction interval and thickness were1.5 mm. Adrenal gland was outlined by hand on each slice with computer-assistanttechnology to calculate its volume. The maximal sectional area, length, width andthickness of each adrenal gland were also measured.Results: The average measurements for left/right adrenal gland were: meanvolume 4.23 cm³ (2.85-5.83, SD: 0.74)/4.26 cm³ (2.59-6.56, SD: 0.86); maximalsectional area 1.86/2.22 cm², length 3.93/3.76 cm, width 2.52/3.33 cm and thickness0.97/0.76 cm. The volumes slightly correlates with weight (L:r=0.2777, P=0.0174;R:r=0.3417, P=0.0033) and BSA (L:r=0.3019, P=0.0094; R:r=0.3453, P=0.0030).There was no significant difference in adrenal volume with regard to sex afterapplying GLM procedure to reduce the impact of weight, nor did volume changesignificantly with age. Length has a stronger correlation with volume than otherparameters in both left (r=0.4176, P=0.0001) and right (r=0.5157, P 0.0001)adrenal glands.Conclusion: Body size, rather than age and sex, affects the volume of adrenalgland in human adults. Length has a stronger correlation with volume than otherparameters in both adrenal glands.C-347Bosniak categorisation of renal cysts using gadolinium-enhanced 3-Dflash MRIA. Snow, E. Ward, D. Halpenny, G. McNeill, N. Swan, W.C. Torreggiani; Dublin/IE(aislingsnow@gmail.com)Learning Objectives: To illustrate the use of gadolinium-enhanced 3D fast lowangle single shot (FLASH) MRI in the categorisation of renal cysts according to theBosniak classification system. To correlate these findings with histology.Background: Renal cysts seen on imaging commonly present a prognostic dilemmafor the reporting radiologist. The Bosniak system of cyst classification is awell-recognised, usually CT-based, method that provides a guide as to the need forfurther imaging or intervention. MRI has previously been shown to be a valuable toolin the assessment of renal masses, including cystic lesions. In this exhibit, we willdescribe the imaging protocol used and demonstrate the ability of 3D FLASH MRIto easily and accurately categorise renal cysts according to the Bosniak system.In addition, we will provide histological correlation.Imaging Findings: 3D FLASH MRI provides excellent detail of cystic renal massesthrough the whole spectrum of Bosniak categories, including small lesions that maybe poorly seen using other imaging modalities. We give examples of all categories(I, II, IIF, III and IV). Gadolinium administration further assists in the differentiation ofbenign from malignant lesions by enhancing soft tissue structures within the massand is routinely used in appropriate patients in our department.Conclusion: We demonstrate that gadolinium-enhanced 3D FLASH MRI allowsclear differentiation of all categories of Bosniak cysts and is a useful tool in theworkup of such masses.CS408 A B D E F FG H

Scientific and Educational ExhibitsC-348Ormond’s disease or secondary retroperitoneal fibrosis: An overview ofretroperitoneal fibrosisM. Heckmann, M. Uder, W. Bautz, M.C. Heinrich; Erlangen/DELearning Objectives: This poster illustrates the spectrum of retroperitoneal fibrosis(RF) and describes how to assess its activity. It should help to differentiate betweenmalignant and benign RF.Background: RF represents a rare inflammatory disease. About two-thirds seemto be idiopathic (=Ormond’s disease). One-third is secondary to infections, traumata,radiation-therapy, malignant diseases or the use of certain drugs. The clinicalsymptoms are non-specific.Imaging Findings: On sonography, RF appears as a hypoechoic mass that caninvolve the ureters and cause hydronephrosis. IVU and MRU can demonstrate thetriad of medial deviation, extrinsic compression of the ureters and hydronephrosis.The lesion typically begins at the level of the forth or fifth lumbar vertebra, encasingthe aorta and often displacing the ureters medially. On unenhanced CT, RF isisodense with muscle. On MRI, the mass is hypointense on T1-weighted images. OnT2-weighted images, it may be hyperintense at early stages, and at late stages itssignal may be low. After administration of contrast-media, enhancement is greatestin the early inflammatory phase and minimal in the late fibrotic phase. To differentiateretroperitoneal masses diffusion-weighted MRI may provide useful information.Conclusion: RF is a rare, but complex condition in which the role of the radiologistis essential, both in suggesting the diagnosis and in aiding management. Therefore,CT and MRI play an important role. T2-weighted images and dynamic enhancementcan help in assessing activity, monitoring response to therapy and detectingrelapse. ADC-values may provide useful information in differentiating benign andmalignant retroperitoneal masses.C-349The enhancement parameters of renal tumours with reference toopacification of aorta in multiphase CT examinationL. Grzycka-Kowalczyk, E. Czekajska-Chehab, G. Staskiewicz, S. Wojtaszko,K. Bar, A. Drop, D. Skomra, E. Korobowicz; Lublin/PL (grzycka@poczta.onet.pl)Purpose: Precise prediction of tumor type may be helpful for treatment planning.The aim of the study was to evaluate MSCT imaging of renal tumors, estimate apattern of tumor enhancement with the reference to abdominal aorta and measurethe differences in attenuation values according to grade of differentiation (G) amongclear cell subtype.Methods and Materials: 61 CT examinations with pre-contrast and contrastenhancedacquisition on arterial (AP), corticomedullary (CMP) and excretoryphase (EP), with subsequently confirmed 45 clear cell renal carcinomas (including5 cystic type); 6 papillary renal cell tumors, 4 oncocytomas, 4 cystic nephromas,2 uroepithelial carcinomas. The attenuation in three regions of interest (ROI) wasmeasured on pre-contrast scanning and after IV administration of contrast agenton all phases.Results: Pairwise comparison showed different attenuation values on AP betweenclear cell and papillary subtypes - with predominance of clear cell tumor; strongerenhancement of oncocytoma than relevant part of clear cell tumor and higher attenuationvalues of all RCC subtypes than cystic nephroma. The attenuation valuesamong G-1, G-2 and G-3 clear cell subtypes differ on CMP, in central parts of G-2and G-3 tumors and during EP, in central parts of G-2 and G-3. Tumor densitywith reference to aorta showed higher enhancement value (on CM phase) amongoncocytomas than clear cell and RCC tumors.Conclusion: The degree of enhancement during post-contrast scanning can bea valuable parameter for differentiating among renal tumors and evaluating gradeof differentiation among clear cell subtype.C-350Urolithiasis: Toward more comprehensive radiological reportingW. Shabana, R.P. Galwa; Ottawa, ON/CA (shabana.wael@gmail.com)Learning Objectives: To illustrate the role of different imaging modalities and recentupdates in urolithiasis with emphasis on the reported findings that are crucial inclinical decision making.Background: Flank pain is a common presentation in the emergency department.Diagnostic imaging plays a crucial role in detection of urolithiasis and exclusion ofother etiologies as well as choosing the best treatment plan. Factors such as stonesize, stone location and urinary tract anatomy significantly influence the decisionbetween invasive and noninvasive treatments.Imaging Findings: Plain radiography (KUB): The maximum renal stone diameteron KUB is the standard used by the urology guidelines for stone management.Sensitivity and specificity of KUB for detecting renal stones will be discussed.Ultrasonography: The sensitivity, specificity, various factors that contribute to urolithiasisdetection and new techniques (e.g. twinkling) will be discussed. Intravenousurogram: It is considered by urologists as the gold standard in treatment planning.However, currently it is a suboptimal modality for urolithiasis. Unenhanced CT: Itreplaced urogram with sensitivity and specificity of 95-100%. The clinical relevanceof ureterolithiasis depiction with respect to the anatomical landmarks used by urologistsis still lacking in radiology reports. The use of multiformatted CT images is alsounderutilized despite its high potential in stone size assessment.Conclusion: Unenhanced CT is currently the gold standard for urolithiasis. Theradiology report should include the stone size, location and detailed urinary tractanatomy, which are significant factors in treatment planning and approach.C-351Spectrum of CT and MR findings in disease of the adrenal glandA. Perez Martinez, Y. Herrero Gomez, M.J. Adan Martin, R. Juarez Tosina,C.N. Cereceda Perez, J.M. Pinto Varela, C.R. Caracela Zeballos,P.M. Aguilar Angulo; Toledo/ES (perezmartinezalejandro@hotmail.com)Learning Objectives: The aim of this teaching exhibit is to illustrate the imagingfindings obtained with computed tomography (CT) and magnetic resonance imaging(MRI) in a wide spectrum of usual and unusual adrenal diseases.Background: The adrenal gland is a common site of disease. Adrenal diseaseis often discovered incidentally during the evaluation of a variety of abdominalcomplaints. CT and MRI play a significant role not only in the detection of adrenalabnormalities but also in characterizing them as benign or malignant. The imagingfindings of patients with disorders involving the adrenal were reviewed from ourdatabase of abdominal pathology. CT was performed in all cases, while MRI wasperformed in all masses and whenever TC images were not conclusive. The keyfindings at each imaging modality are shown and compared with the underlyingpathologic features when available.Imaging Findings: Abnormalities of the adrenal gland include adrenal hyperplasia,traumatic haemorrhage, benign masses (functional and non-functional adenomas,cysts, myelolipoma, angioma pheochromocytoma, ganglioneuroma), malignantmasses (carcinoma, metastases), infections and Addison disease. In addition, wedescribe the normal adrenal anatomy with CT and MR imaging, and some usualpitfall of adrenal masses.Conclusion: Evaluation of patients with adrenal disorders frequently requiresmultiple imaging modalities for diagnosis and surgical management planning.Because many of these disorders have characteristic imaging appearances, thisexhibit will help the practicing radiologist to better understand and recognize thepathologic processes affecting the adrenal gland.C-352Retroperitoneal liposarcoma: Imaging findingsM.M.M.D. Djosev 1 , M.M.M.S. Stojanovic 1 , J.J.S.I. Ilic 1 , B.B.O.R. Begenisic 1 ,N.N.M.D. Djuric 1 , D.D.J.L. Lalosevic 1 , S.S.M.A. Arsenovic 1 , M.M.N.D. Djuric 2 ,M.M.Z.G. Glumac 2 ; 1 Belgrade/RS, 2 Sombor/RS (kbcdedinje@verat.net)Learning Objectives: In this exhibit, we will illustrate and discuss the imagingfindings in MSCT of retroperitoneal liposarcoma.Background: Liposarcoma is the second commonest malignant retroperitonealsoft-tissue tumor in adults and classically presents as a large mass with minimalsymptoms and a high local recurrence rate. It is a slow growing tumor that displacesrather than infiltrates surrounding tissue and may attain enormous size before itis detected.Imaging Findings: Computed tomography scanning plays an important role inthe diagnosis of lipomatous and myxoid tumors of soft tissue. We reviewed the CTfindings of patients with retroperitoneal liposarcoma. Because the tumorous massmay consist predominantly of fat or soft-tissue components, depending on its gradeand histology, CT findings demonstrate 3 distinct patterns, as follows: solid pattern(inhomogenous, poorly marginated infiltrating mass with contrast enhancement( 20 HU)); mixed pattern (focal fatty areas (-40 to -20 HU) with areas of higherdensity ( 20 HU)); pseudocystic pattern (water density mass -20 to +20 HU).Conclusion: Preoperative diagnosis of retroperitoneal liposarcoma is a commonproblem due to lack of characteristic clinical presentations. CT is used to diagnosisand assess the size and extent of retroperitoneal tumors, as well as assess theinvolvement of organs and vasculature. Different subtypes of retroperitoneal liposarcomashow different CT features relating to their major histologic component.GenitourinaryACB D E F G HS409

Scientific and Educational ExhibitsC-354Imaging of renal infections: A pictorial reviewM. Franca, B. Ramos, J. Pires, R. Maia, M. Certo, P. Varzim; Porto/PT(mariamanuela.franca@gmail.com)Learning Objectives: To review the role of imaging in the evaluation of renal infectionsand related complications. To show its imaging findings, focusing on ultrassonography (US) and computed tomography (CT). To present manifestations ofunusual infections, as emphysematous pyelonephritis and xantogranulomatouspyelonephritis.Background: Although not routinely indicated in noncomplicated pyelonephritis,imaging plays a significant role to assess clinically equivocal cases, to evaluatehigh risk patients, to determine the extent of inflammatory process and to depictits complications.Imaging Findings: US is frequently used in evaluation of suspected pyelonephritisand has a major role in pregnant women. It can identify areas of renal infection,abscesses, pyonephrosis and extension to perinephric space. Doppler-US improvesits sensitivity in detecting parenchymal infection. CT is the modality of choice toimage pyelonephritis. The presence of gas, calculi, haemorrhage or masses canbe revealed with unenhanced CT. Administration of contrast demonstrates areas ofabnormal nephrogram, obstruction to renal excretion, and identifies complications.The authors review the imaging findings of renal infections and its complications,exemplifying with representative cases. They pay attention both to typical andmore unusual forms of pyelonephritis, such as emphysematous pyelonephritis andxantogranumolatous pyelonephritis.Conclusion: The role of imaging is fundamental in patients with pyelonephritis andrecurrent, equivocal or persistent symptoms despite adequate treatment, and inevaluation of patients with high-risk factors to renal infection. Familiarity with imagingfindings of typical and unusual forms of renal infections, as well of its complications,is crucial to make the correct diagnosis.C-355Diagnostic features and follow-up of complicated pyelonephritis onsecond generation contrast ultrasoundT. Fontanilla, J.M. Arriaga, C. García Roch, J. Hernanz, R. Pérez Arangüena,I. Rivera, E. Van denBrule; Madrid/ES (tfontanilla@telefonica.net)Purpose: Our objectives are to describe the diagnostic features of complicatedpyelonephritis on contrast enhanced ultrasound (CEUS), to distinguish focalpyelonephritis from abscess, and to describe the findings during the follow-up ofthese patients.Methods and Materials: Baseline grey scale, power Doppler and contrast enhancedultrasound (CEUS) were performed in 23 patients (mean age 27 years),suspects of complicated pyelonephritis. Contrast specific programs were usedafter an intravenous bolus 2.4 ml dose of a sulphur hexafluoride contrast agent(SonoVue). Follow-up was done in 10 patients.Results: CEUS showed: No findings (n=5 patients), focal pyelonephritis (n=14)and abscess (n=8). In 4 cases, there were both abscess and focal pyelonephritis.Pyelonephritis and abscess showed distinctive enhancement patterns. Focalpyelonephritis appeared as a focal hipoenhanced lesion in cortical and late corticomedularphase; iso or hipoenhanced on early corticomedular phase. Abscessesappeared as focal areas of absence of enhancement in all phases. Follow-upshowed rapid healing of focal pyelonephritis, and a much slower resolution of thesonographic findings in abscesses. 3 patients developed hipovascular corticalscars; one of them developed arterial hypertension.Conclusion: CEUS improves the diagnostic performance of baseline sonographyin the detection of complications of pyelonephritis. It provides enhancement featuresthat make possible to distinguish abscess from focal pyelonephitis. Due to theabsence of radiation, CEUS may be considered as a first line tool in the follow-upof these usually young patients.C-356Imaging of complex cystic lesions of the kidney with contrast-enhancedultrasonographyH. Moschouris 1 , M.G. Papadaki 1 , A. Foteinos 1 , P. Goutzios 2 , D. Matsaidonis 1 ;1Piraeus/GR, 2 Athens/GR (hipmosch@in.gr)complex renal mass in order to evaluate the vascularity of the lesion and increasethe yield of information provided by baseline US.Imaging Findings: Several cases of complex cystic renal masses studied byultrasound before and after the i.v. administration of a last generation ultrasoundcontrast agent (SonoVue, Bracco) are demonstrated: Cystic renal cell carcinomas(unilocular with mural nodule, multilocular with thickened irregular septa, heterogeneouswith microcystic and solid components), benign cystic renal tumor (cysticmultilocular nephroma), complicated non neoplastic renal cysts, renal abscesses,liquefied renal hematoma with cystic morphology and renal hydatid cyst. The highsensitivity of CEUS in detecting blood flow in the neoplastic or inflammatory tissueis demonstrated and several patterns of enhancement are described. The abilityof CEUS to differentiate hemorrhagic (non-enhancing) cysts from semi-solid renaltumors is underlined. The findings of CEUS are correlated with those of grey-scaleand color Doppler ultrasonography and with CT and MRI.Conclusion: CEUS can increase the diagnostic efficiency of US in the assessmentof complex cystic renal masses and may, in a few cases, obviate the needfor further imaging investigation.C-357Chronic renal infections in the third world: Spectrum of imaging findingsZ.A. Khan, S. Ahmad; Karachi/PK (zahidanwarkhan@yahoo.com)Learning Objectives: 1. To understand the imaging characteristics of renal infections.2. To outline salient differentiating features of various renal infections.Background: Diagnosis of renal infection particularly in its chronic stage is oftenchallenging. Clinical presentation is usually non-specific and often confusing resultingin delay in the diagnosis and initiation of proper therapy. Often the diagnosis isfirst suggested on imaging done for workup of non-specific abdominal complaints.On imaging these infections could have varied features. In developing countrieswhere a large segment of population has limited access to medical care, diagnosisof these infections is even more difficult because of the late presentation andadvanced nature of the disease.Imaging Findings: In this exhibit, we will present typical and atypical characteristicsof different kinds of renal infections presenting in a tertiary care center of athird world country. These include acute and chronic pyelonephritis, pyonephrosis,renal tuberculosis, hydatid, fungal infection (candidiasis, aspergillosis etc)., andxanthogranulomatous pyelonephritis etc.Conclusion: Diagnosis of chronic renal infections is a challenging task due tonon-specific clinical presentation and more varied imaging characteristics. Awarenessof the complete spectrum of imaging finding of different kinds of infection isimportant to arrive at a correct diagnosis.C-358Renal oncocytomas: computed tomography (CT) and magnetic resonance(MR) patternsG. Cardone, C. Iabichino, P. Mangili, G. Guazzoni, G. Balconi; Milan/IT(cardoneg@tin.it)Learning Objectives: To illustrate the most frequent CT and MR patterns of renaloncocytomas. To evaluate the most effective CT and MR imaging examinationtechniques in the diagnosis of renal oncocytomas.Background: Renal oncocytoma, a subgroup of renal adenoma, is a benign neoplasmthat arises from tubular epithelial cells of the kidney. 22 patients with renaloncocytomas were evaluated by means of both CT and MR examinations.Procedure Details: MDCT were performed using unenhanced and post-contrastscans, followed by urographic acquisition. MR was performed using pyelographic,urographic and conventional GRE-T1w, TSE-T2w and ce-GRE FS-T1w sequences.Ce-T1w MR images were also obtained before and after digital subtraction.Conclusion: The most frequent CT patterns were isodensity on pre-contrast images,hyperdensity on early ce images and relative hypodensity on late ce images.The most frequent MR patterns were hypointensity with a hyperintense centralscar on T2w images, hyperintensity with a hypointense central scar on early ceimages and hyperintensity on late ce-images. The most effective CT techniquewas multiphasic acquisition. The most effective MR techniques were TSE T2w anddynamic ce-FS-GRE T1w sequences.Learning Objectives: To illustrate the findings of contrast-enhanced ultrasonography(CEUS) in the main types of complex cystic renal masses. To demonstratethe advantages and limitations of this method and assess its role in the diagnosticwork up of these lesions.Background: Complex cystic renal masses often pose diagnostic and therapeuticproblems. CEUS can be utilised immediately after the sonographic detection of aCS410 A B D E F FG H

Scientific and Educational ExhibitsC-359Laparoscopic cryoablation (LC) of small renal tumors imaging follow-up:Comparison between magnetic resonance (MR) and multi-detector rowcomputed tomography (MDCT) imaging patternsG. Cardone, A. Cestari, P. Mangili, G. Guazzoni, G. Balconi; Milan/IT(cardoneg@tin.it)Learning Objectives: To illustrate the differences between MR and MDCT patternsin patients treated with LC for small renal tumors. To show the advantages of MRimaging in the follow-up of patients treated with LC.Background: LC is considered a minimally invasive approach for the treatmentof small renal masses. Since it is not possible to document histopatologically thecomplete tissue necrosis after cryoablation, an adequate radiological follow-upis mandatory. We reviewed 2 year MR and CT imaging follow-up of 5 pts, whoperformed abdominal MR follow-up for LC of small renal tumors and whole bodyMDCT follow-up due to concomitant neoplastic pathologies.Imaging Findings: On MR and CT imaging 24h after treatment all cryolesionswere more than 1 cm larger than the original masses. Cryolesions decreased insize by an average of 38% at 1 month, 80% at 12 months and 88% at 24 monthsfollowing cryoablation. Postprocedural MR ce-T1w and ce-MDCT images showedcomplete ischemia of the cryolesions. Retroperitoneal and pleural effusion wasfound in all cases 24 h after surgery. On CT images, cryolesion was isodense withrespect to perilesional effusion.Conclusion: LC is a safe and minimally invasive therapy for small renal tumors. MRis an effective tool in the imaging follow-up of renal lesions treated with LC. MDCTcan be used as alternative choice to MR, but lower contrast resolution comparedto MR imaging makes it difficult to differentiate cryolesion from the surroundingperilesional collections.C-360Laparoscopic cryoablation (LC) of renal carcinomas: Medium termoutcome after 7 years MR imaging follow-upG. Cardone, A. Cestari, L. Nava, P. Mangili, G. Guazzoni, G. Balconi; Milan/IT(cardoneg@tin.it)Purpose: This study aims to determine the safety and efficacy of LC in the managementof small renal carcinomas and assess its medium term outcome.Methods and Materials: 67 pts underwent LC of 82 renal carcinomas betweenJuly 2000 and December 2007. All treatment was administered under laparoscopicUS guidance. Pts were followed up clinically, biochemically and by MR imaging24 hours after surgery, and subsequently at 1, 3, 6, 12, 18, 24, 36, 48, 60 and 84months. All MR examinations were performed with a 1.5 T MR system using GRET1w, TSE T2w and ce-dynamic GRE FS-T1w sequences.Results: 24 hours after treatment all cryolesions were more than 1 cm largerthan the original masses; cryolesions decreased in size by an average of 38% at1 month, 64% at 6 months, 80% at 12 months and 93% at 84 months followingcryoablation. Postprocedural MR ce-T1w images showed complete ischemia ofcryolesions. Follow-up revealed no evidence of local recurrence in 65/67 pts (97%).2 pts showed local recurrence at 12 and 24 months. 8/67 (12%) pts demonstratedmetachronous nodules in the same or in the contralateral kidney at 12-24 months.7/67 pts died for metastasis of a previous malignancy. After surgery, 21% of thecases showed a small intralesional haematoma and 11% of the cases a smallperilesional haematoma.Conclusion: Our medium term experience suggests that LC is a safe, well toleratedand minimally invasive therapy for small renal carcinomas, and MR is an effectiveimaging technique in the follow-up of renal lesions treated with LC.C-361Imaging spectrum of genitourinary tuberculosis: Our experience at atertiary care centre of a third world countryZ.A. Khan, S. Ahmad; Karachi/PK (zahidanwarkhan@yahoo.com)Learning Objectives: To illustrate the spectrum of genitourinary tuberculosis in atertiary care centre of a third world country where the disease is endemic.Background: Tuberculosis (TB) is a global emergency particularly with the growinginfection rate of AIDS worldwide. Genitourinary tuberculosis (GUTB) is an exampleof secondary tuberculosis and is the third commonest extra pulmonary lesion. Theincidence of GUTB is also increasing especially in the developing countries wherethe incidence can be five times higher than in the western countries. This could bea reflection of the social deprivation, poor diet and over crowded living conditionsthat have a direct effect on the disease by increasing the susceptibility.Imaging Findings: In this exhibit, we present imaging features in 122 patients whohave tuberculous involvement of various parts of genitourinary tract including kidney,ureter, urinary bladder, prostate and urethra. These patients were diagnosed andtreated at Sindh Institute of Urology and Transplantation, Karachi over a period of 10years. The diagnosis was based on microbiological and histopathological grounds. Ina few cases, the diagnosis was presumptive where clinical and radiological featureswere suggestive and anti tuberculous treatment resulted in improvement.Conclusion: Genitourinary tuberculosis remains a significant diagnostic problemespecially in developing countries. Imaging studies are only suggestive orcompatible for the disease and should not be used for confirmation or exclusionof the disease.C-362Ultrasound and contrast-enhanced ultrasound in the management andfollow-up of percutaneous radiofrequency ablation of renal tumorsC. Hoeffel 1 , O. Helenon 2 , F. Tranquart 3 , A. Méjean 2 , A. Khairoune 1 , J.-M. Correas 2 ;1Reims/FR, 2 Necker/FR, 3 Tours/FR (jean-michel.correas@nck.aphp.fr)Learning Objectives: To illustrate the role of ultrasound (US) and contrastenhancedultrasound (CEUS) during percutaneous radiofrequency ablation of renaltumors (RFA). To illustrate the spectrum of CEUS findings in renal tumors successfullytreated and to show typical patterns of residual tumor after RFA. To highlightpitfalls that may be encountered in assessing residual tumor with CEUS.Background: Between January 2006 and June 2008, 65 tumors in 43 patients(mean age 61, range 24-90) were treated and prospectively followed-up with CTand/or MR examinations the day after the RFA procedure, at six weeks, four months,one year and each year subsequently. 17 patients had Von Hippel Lindau (VHL)disease. Seven tumors were retreated at least once.Imaging Findings: This exhibit illustrates the major value of US and CEUS forguiding biopsy and electrode placement, as well as for immediate assessmentof renal RFA and electrode repositioning on residual tumor. CEUS role in thefollow-up is crucial as CEUS allows real time identification of a residual or recurrenttumor in the RF ablation zone when an enhancing nodule or crescent, most oftenperipheral, is seen. Comparison of follow-up CEUS with CEUS of the renal tumorbefore treatment is mandatory.Conclusion: CEUS has an important role to play in the immediate and mid termfollow-up of RFA procedures, particularly for detection of a residual tumor. It isan interesting complement to CT or MRI as it can be easily performed (no renaltoxicity).C-363Pearls and pitfalls in the MR imaging and CT evaluation of renal tumorstreated with percutaneous radiofrequency ablation (RFA)C. Hoeffel 1 , A. Khairoune 2 , S. Merran 2 , O. Helenon 2 , A. Méjean 2 , J.-M. Correas 2 ;1Reims/FR, 2 Paris/FR (jean-michel.correas@nck.aphp.fr)Learning Objectives: To illustrate the spectrum of CT and MRI findings in renaltumors successfully treated using percutaneous RFA and to show typical patternsof residual tumor. To illustrate the spectrum of complications. To highlight pitfalls thatmay be encountered in assessing residual tumor after RFA. To suggest guidelinesfor an accurate imaging diagnosis of residual tumor.Background: Between January 2006 and June 2008, 65 tumors in 43 patients(mean age 61, range 24-90) were treated and prospectively followed-up with CT and/or MR examinations the day after the RFA procedure, at six weeks, four months,one year and each year subsequently. 17 patients had a Von Hippel Lindau (VHL)disease. Seven tumors were retreated at least once.Imaging Findings: Differential diagnosis of residual disease is illustrated, includingpresence of devascularized renal parenchyma, arteriovenous fistula, vessels,detached renal parenchyma. The following issues are highlighted: Comparison offollow-up imaging with initial imaging pattern is mandatory. Analysis of unenhanced,arterial, tubular and delayed phases after contrast administration is essential forevaluation of residual tumor and complications (urinomas, hematomas and hemorrhages,bowel perforation, and vascular disorders). MDCT multiplanar reformatsmay prove useful, as well as subtraction between enhanced and unenhanced fatsuppressed T1- weighted sequences.Conclusion: MDCT is the reference imaging modality in the evaluation of renaltumors after RFA. MRI is an alternative modality in case of renal insufficiency ormay be performed in addition to MDCT when assessment of residual disease isdifficult.GenitourinaryACB D E F G HS411

Scientific and Educational ExhibitsC-364Functional VCT XT 80 mm perfusion imaging simultaneously with dynamicCTA for diagnosis of the stenosis of renal arteryX. Ye, C. Zhou, H. Cao; Beijing/CN (huizhi.cao@ge.com)Purpose: To evaluate the value of functional VCT XT 80 mm perfusion imagingsimultaneously with dynamic CTA for diagnosis of the stenosis of renal artery.Methods and Materials: Functional 80 mm perfusion imaging with dynamic CTAwas performed in 30 patients with stenosis of renal artery using VCT XT. One 49.4s (include 18 pass) axial scanning was performed in each case. Dynamic scanningstarted at the 8 th second after injection of a bolus of contrast material. Total 288images with 5 mm slice thickness were obtained through the kidneys. All imageswere reconstructed at 0.625 mm slice thickness. The perfusion images and thedynamic renal artery CTA (include 3D MIP and MPVR) of different phase at aninterval of 2.8 s were obtained on workstation.Results: Satisfying dynamic CTA images of renal artery were obtained in 30 patients,which clearly showed the location and degree of the stenosis of renal artery.Degree of stenosis 50% in 13 cases (group A), 51~75% in 10 cases (group B),75% in 7 cases (group C). Comparing with the intact kidney, the value of BF andBV of the affected kidney were decreased, but the value of MTT was increased.There was significant difference of these values between bilateral kidneys in groupB and group C.Conclusion: The functional 80 mm perfusion images simultaneously with dynamicCTA clearly show the hemodynamic information of the kidney and the morphologicalchange of the renal artery. It is useful for diagnosis and follow-up of the stenosis ofrenal artery and function of the kidneys.No Material Submitted to EPOSC-365Transdiaphragmatic decompression pathways of pneumomediastinum andpneumoretroperitoneumJ. Isogai, J. Kaneko, S. Maejima; Hasuda/JPLearning Objectives: 1. To describe transdiaphragmatic pathways of compressedair in the pneumomediastinum and pneumoretroperitoneum based on 9 and12 patients, respectively. 2. To illustrate each compartment of retroperitonealinterfascial spaces into which air is dissected. 3. Not to mistake extraperitonealinfradiaphragmatic air for intraperitoneal air in order to avoid unnecessary exploratorysurgeries.Background: It has been mentioned the retroperitoneal fascia has potential spaceand its continuity among compartments by the direct injection of contrast materials.Since compressed air dissects into interfascial spaces more physiologically, we caneasily understand the continuity between mediastinum and retroperitoneum.Imaging Findings: 1. CT features of air distribution in the extraperitoneal andextrapleural spaces via diaphragm. 2. To illustrate anterior and posterior transdiaphragmaticpathways of compressed air.Conclusion: Radiologists must be aware of extraperitoneal infradiaphragmaticair to avoid unnecessary exploratory surgeries and recognize decompressionpathways to select an appropriate drainage route if abscess formation occurs inthe periphrenic space.C-366When the kidney is bleeding: A review of traumatic and not traumatic acuterenal bleedingM.I. Rossi Prieto, E. Monedero Martínez- Pardo, P. Díez Martínez,J.J. Gómez Herrera, A. Marín Toribio, S. Borruel Nacenta; Madrid/ES(mariaisabelrossi@yahoo.es)Learning Objectives: To explain the different causes of acute renal bleeding(ARB). To correlate and illustrate the findings in ultrasound, CT and arteriography.To assess the role of the radiologists in the management of these patients and thedifferent possibilities of treatment.Background: The ARB is an emergency situation and can lead to a hemodynamicfailure. A proper and fast management of these cases allows a good prognosisoverall in politrauma patients. While ultrasound only gives us indirect signs, CTcan provide anatomic and pathologic information required to determine the managementof ARB. Patients in stable condition should be referred for angiographicembolization, while life-threatening bleeding is the only absolute indication forsurgical exploration.Imaging Findings: We show numerous cases of active kidney bleeding. The causeswere traumatic and nontraumatic. In most cases, we have correlated US and CTimages as well as those obtained by angiography. We have made a follow-up ofthe treatment given to the different cases evaluating the possible complications(urinome, rebleeding, renal ischemia, parenchymatous hematoma and venousthrombosis). CT is the best initial method to diagnose ARB and in most cases toidentify the underlying complications.Conclusion: CT is the technique of choice in the initial management of patientswith active bleeding, showing great efficacy and good correlation with angiography.If the renal bleeding is important, nephrectomy is the best treatment with the lessnumber of complications.C-367Clinical practice results of new CT urography protocolsV. Taboada, B. Suárez, C. Rodríguez Paz, A. Fabbricatore, M. Otero; Vigo/ES(vanevigo@hotmail.com)Learning Objectives: 1. Practical CTU protocols technique adapted from the ESURconsensus. 2. Selection of the CTU protocol depending on the clinical suspicion. 3.Optimization of radiation dose and results on every CTU protocol.Background: CTU Working Group of the European Society of Urogenital Radiology(ESUR) proposal on indications and technique for CTU was the first consensusreached on the application of this technique. We have adapted our CT protocolsaccording to this consensus and present our results.Procedure Details: We assessed renal function with creatinine clearance value. Allprotocols include furosemide use (10 mg/1 min previous contrast injection). Singlephase: Congenital anomalies, traumatic lesions, complicated urinary infections,haematuria (low risk of TCC), percutaneous nephrolithotomy planning, urinarydiversions. Split-bolus single CTU: Nephrographic-Excretory phase. Triple-bolussingle CTU: Corticomedullary-nephrographic-excretory phase. Dual Phase: Haematuria(high risk of TCC), invasive extraurinary tumor, papillary and medullarnecrosis. Single-bolus CTU: Portal or nephographic phase and excretory phase.CT exploration systems: 16 and 64 detectors CT with appropriated reconstructionparameters for each model and multiplanar and 3D post-processing imaging. Wehave evaluated the radiation dose with the CTDI, DLP and effective dose parametersin each one of the news protocols.Conclusion: 1. We have achieved a relievable and reproducible CTU technique. 2.The adaptation of the CTU protocol depending on the clinical suspicion improvesdiagnostic efficiency and the decreases the global radiation dose. 3. We review theradiation dose parameters values in every CTU protocol.C-368Metastatic renal cell carcinoma: Assessment of tumour response totargeted therapyN. Bharwani, N. Griffin, M. Gore, S.A. Sohaib; London/UKLearning Objectives: 1. To review the CT appearances of advanced metastaticrenal cell carcinoma (mRCC) at presentation and following treatment. 2. To highlightthe potential pitfalls in image interpretation that can occur following treatment withtargeted therapy.Background: Metastatic disease occurs in a significant proportion of patients withRCC. Recent advances in systemic treatments for mRCC using targeted therapyhave shown a significant increase in progression-free survival. These new drugs arecytostatic and inhibit growth rather than induce tumour regression. Therefore, theuse of accepted tumour response criteria (WHO and RECIST) has limitations andpotential pitfalls. This pictorial review will discuss and illustrate the post-treatmentappearances and highlight possible misinterpretations.Imaging Findings: RCC metastases are typically vascular, enhancing lesions.Following treatment with targeted therapy, responders show a decrease in lesionattenuation. This may be accompanied by a decrease in size, although most lesionsshow disease stabilisation by CT size criteria. A common pitfall is the apparentdetection of “new” visceral lesions on post-treatment imaging, e.g., within the liver.We will also demonstrate the evolution in appearances of disease response withindifferent organs.Conclusion: Tumour size response criteria have limitations in mRCC in patientson targeted therapies. With increasing use of these new systemic treatments, radiologistsshould be aware of typical post-treatment appearances and the potentialpitfalls in interpretation.CS412 A B D E F FG H

Scientific and Educational ExhibitsC-369Renal cell carcinoma: Hunt the metastasisN. Bharwani, N. Griffin, M. Gore, S.A. Sohaib; London/UKLearning Objectives: a) To illustrate the typical CT appearances of RCC metastases.b) To determine common sites of metastatic disease and identify importantreview areas.Background: Metastatic disease is seen in approximately 25-30% of patientspresenting with RCC. In patients presenting with early stage disease, approximately50% will develop recurrent or metastatic disease, usually within 3 years of initialnephrectomy. With increasing treatment options available for patients with metastaticRCC, knowledge of the imaging patterns is essential. We have reviewed the imagingof 70 patients with metastatic RCC presenting for treatment targeted therapies toidentify the common sites of disease and highlight the frequently missed lesions.Imaging Findings: RCC metastases have typical appearances within the thorax,abdomen and pelvis. This pictorial review will discuss and illustrate the pattern andcharacteristic features of recurrent and metastatic disease in our patient population.Common sites of disease are the lung (83%), lymph nodes (73%), liver (34%) andbone (31%) where lesions are typically lytic and expansile. Frequently overlookedsites of disease include the pancreas, thyroid and subcutaneous tissues.Conclusion: Imaging has a pivotal role in assessment of disease extent andevaluation of treatment response in patients with metastatic RCC. With the adventof new systemic therapies for metastatic RCC, the reporting radiologist needs tobe aware of the patterns of disease spread as imaging has an ever increasing rolein informing management decisions.C-370To illustrate pathophysiology and CT imaging features of various uretericcolic mimicsM. Sreenivas, A. Razack; Hull/UKLearning Objectives: To illustrate the pathophysiology and CT imaging featuresof various ureteric colic mimics. To emphasise the importance of reviewing everyCT KUB study systematically.Background: Ureteric colic secondary to a stone disease is one of the most commonurological emergencies. In many centres, plain CT KUB has become a wellestablishedtechnique in the investigation of ureteric colic. Our institutional review of780 consecutive CT KUB studies revealed about 4% of acute non-urological surgicalemergency conditions. In addition, another 4% of cases were non emergency butsignificant pathological conditions. In this exhibit, we describe the pathophysiologyand plain CT features of various ureteric colic mimics.Imaging Findings: Images were reviewed on a dedicated CT workstation with mutliplanarreformatting and using various window settings. Presence of free gas andfluid, and inflammatory fat stranding were noted. Inflammatory or tumour featuresinvolving particular organ system were analysed. Examples include diverticulits,appendicitis, pancreatitis, panniculitis/epiploic appendagitis, bowel perforation,intussussception, gall stone ileus, dermoid cyst, renal cell carcinoma, carcinoidtumour and complex ovarian cyst.Conclusion: A number of non-urological conditions mimic ureteric colic and canbe detected on CT KUB. It is important to beware of these conditions so that thepatients can be appropriately managed.C-371An illustration of the MR appearances of renal lesions treated withradiofrequency ablation in patients suffering from Von Hippel LindausyndromeD.J. Alcorn; Glasgow/UKPurpose: To illustrate the spectrum of MR appearances of renal lesions treated withradiofrequency ablation in patients suffering from Von Hippel Lindau Syndrome.Methods and Materials: Von Hippel Lindau syndrome is an autosomal dominantinherited neurocutaneous dysplasia complex. Multiple bilateral renal cell carcinomasarise in 50% of the patients usually developing in cyst wall. Previously treatmentwas largely surgical. From 2005 to 2008, 5 patients with VHL with enlarging renalcysts were referred for radiofrequency ablation & lesion were ablated using BostonScientific bipolar leveen probe. All patients had pretreatment MR and post treatmentMR scans at 3 monthly intervals (mean 18 months).Results: The appearances of the 7 lesions before and after treatment are comparedincluding the enhancement during dynamic contrast enhanced acquisitions.No evidence of progressive disease is seen in any lesion. 2 treatment relatedcomplications are illustrated.Conclusion: The treatment of enlarging cystic lesions in patients with VHL usingradiofrequency ablation appears successful at least in the short term with no radiologicalevidence of continued cyst enlargement in any patient. The MR appearancesare illustrated along with the 2 treatment related complications.C-372Complex renal stones: The benefit of a pre-operative planning with 3D CTA. Magnusson 1 , M. Brehmer 2 , M. Beckman 2 ; 1 Uppsala/SE, 2 Stockholm/SE(anders.magnusson@radiol.uu.se)Purpose: To evaluate the impact of an extended preoperative radiological planningwith 3D CT in patients with complex renal stones.Methods and Materials: 31 consecutive patients with complex renal stones wereincluded. Initially, the patients were examined with excretory urography or abdominalCT. In consensus, an endourologist and a radiologist decided an optimal track fromthese images. All patients were then examined with CT with thin slices ( 1 mm)and 3D reconstructions of the collecting system and the stone/stones. In order tosimulate positioning during surgery, the patients were scanned in a prone positionand with a wedge cushion under the lower part of the abdomen. In consensus andblinded for the result from the initial decision, a track was estimated from the 3DCT. All patients underwent percutaneous nephrolithotripsy (PCNL).Results: From the initial examination, a track was planned in 24 patients. The decisionwas changed in 14 patients after the 3D CT. With 3D CT, it was possible toestimate a track for all patients. In 9/10 patients, a track for PCNL was establishedin agreement with the decision from the initial examination and in 20/21 patientsin agreement with the 3D CT examination. 24 patients (78%) were stone free withone PCNL session, and in 21 of these patients only one track was established. 7patients required further treatment with ESWL (4), PCNL (1) or ureteroscopy (2).Conclusion: An extended preoperative planning with 3D CT resulted in successfultreatment of most complex renal stones through one track.C-373Malignancy after kidney transplantation: A radiological approachJ. Quintero, P. Puyalto, J. Jiménez, S. Mourelo, E. Barluenga, B. Bayès;Badalona/ES (jcquintero.germanstrias@gencat.net)Learning Objectives: To review the spectrum of malignancies occurred afterkidney transplantation. To shows their typical and atypical radiological features,not commonly seen in not transplanted patients.Background: After cardiovascular disease, cancer is the second cause of deathfollowing renal transplantation. The aetiology of post transplant malignancy isunknown, it might probably be multifactorial. Advancements in immunosuppressivetherapy have significantly improved patient and graft survival following renaltransplantation. This is paralleled by an increasing occurrence of post transplantationmalignancy.Imaging Findings: We reviewed retrospectively 29 patients (19 men and 10women) with cancer diagnosed after renal transplantation. In our institution theincidence of cancer after renal transplantation is 5.7%. 54% developed cancerwithin the first 5 years after transplantation, and 46% did after 10 years or more.In our series linfoproliferative disease was the most frequent cancer (7), followedby renal cell carcinomas (6), lung cancer (5), and liver metastasis (2). Isolatedcases of skin carcinoma, bladder carcinoma, breast carcinoma, prostatic cancer,meningioma, peritoneal carcinomatosis, cholangiocarcinoma, iliopsoas liposarcomaand melanomas were also seen.Conclusion: Radiologists should be aware of the higher incidence of malignanciesin inmunocompromised patients after renal transplantation and their specialradiologic appearances due to their more aggressive behaviour. Follow-up of renaltransplant patients must include screening tests directed at tumor detection. Imagingstudies and other tests in this patient group should be interpreted by physicianswho are familiar with transplant related peculiarities.GenitourinaryACB D E F G HS413

Scientific and Educational ExhibitsC-374New concepts of renal tumors: Histopathology-radiologic correlationsJ. Hayoun, D. Eiss, S. Merran, V. Vasiliu, O. Helenon; Paris/FRPurpose: To describe the radiological features of the new entities of renal tumorsof the 2004 World Health Organisation (WHO) classification of the adult renalneoplasms and new concepts of renal tumors that appeared recently.Methods and Materials: A multicentric retrospective study during 5 years (January2002- September 2007) in the departments of uroragiology.Results: We describe the imaging features with macroscopic and histologic featuresof new entities of the 2004 World Health Organisation (WHO) classification of theadult renal neoplasms such as: mixed epithelial and stromal tumor of the kidney(n=1), mucinous tubulocystic renal carcinoma with fusiform cells (n=1), cysticmultilocular renal cell carcinoma (n=21), renal cell carcinomas associated withXp11.2 translocations (n=5), épithelioid angiomyolipoma (n=2), and two interestingnew concepts not yet described in the WHO classification: hybrid oncocytoma andchromophobe renal cell (n=7) and tubulocystic carcinoma (n=1).Conclusion: The radiologists should know these new and rare renal tumors forimplications in patients’ clinical management.C-375The use of dynamic contrast enhanced MRI (DCE MRI) with quantitativedata analysis in the differentiation between RCC and AMLM.M.H. Abd Ellah, L. Pallwein, C. Kremser, R. Peschl, M. Elsharkawy, G. Mikuz,W. Jaschke, F. Frauscher; Innsbruck/AT (dr_m_hamdy2006@hotmail.com)Purpose: We aimed to evaluate DCE MRI with quantitative data analysis usingtracer kinetic modeling for studying the microvasculature differences betweenRCC and AML.Methods and Materials: We examined 20 patients with small renal masses. AT1-map dynamic contrast perfusion MR imaging was done for all patients using1.5T Magnetom VISION (Siemens, Erlangen, Germany). All the obtained data wereanalyzed using the software program Matlab (MathWorks, Inc, USA). Differentstandard tracer kinetic parameters, as blood perfusion, blood volume, extractionfraction and permeability surface area product were calculated. The different obtainedparameters were compared with the different tumor types. Final diagnosiswas confirmed by histopathology in 18 patients and by follow up in 2 patients.Results: Of the totally examined patients 16 showed clear cell RCC, 4 AML (2 ofthem were low fat containing). Among the variously calculated tracer kinetics, theextraction fraction showed significant differences between both types (p

Scientific and Educational ExhibitsResults: Prostate cancer was pathologically detected in 12 of the 22 patients, andin 46 of 132 sextants. The receiver operating characteristic curve analysis revealedan optimal cut-off ADC value of 1.25 x 10 - ³ mm²/s to predict prostate cancer. Thesensitivity, specificity, positive predictive value, negative predictive value, and accuracyfor the detection and localization of prostate cancer within peripheral zonewere 72, 74, 60, 83, and 73% for T2WI; 85, 77, 66, 90, and 80% for DWI; 83, 83,72, 90, and 83% for the combined T2WI+DWI, respectively.Conclusion: Compared with T2WI, use of DWI improved accuracy in prostatecancer localization. The combination of T2WI and DWI may be a valuable toolfor detecting and localizing prostate cancer within the peripheral zone and maypotentially reduce false-negative biopsy rates and unnecessary biopsies.C-3792D and 3D T2-weighted MR sequences for the assessment ofneurovascular bundles changes: After nerve-sparing radical retropubicprostatectomy with erectile function correlationM. Osimani, V. Panebianco, D. Lisi, L. Di Mare, S. Bernardo, R. Passariello;Rome/IT (marc_osi@hotmail.com)Purpose: Aim of this study is to assess, in patients submitted to a bilateral nervesparingradical retropubic prostatectomy (RRP), the capability of a dedicated 3Disotropic MRI T2 weighted sequence (3D T2 ISO) in the depiction of post surgerychanges of neurovascular bundles (NVBs) formation. Furthermore, our aim is alsoto introduce a new morphologic MRI classification score of the NVBs alterationpatterns, using the International Index Erectile Function 5-item (IIEF-5) questionnaireas standard of reference for correlation analysis.Methods and Materials: Fifty-three consecutive patients were post-operativelysubmitted to two MR examinations, including both a 2D TSE T2-weighted (2D T2)and 3D T2 ISO sequences. Images findings were scored using a relative five-pointclassification and correlated with post-operative IIEF-5 score.Results: Both radiologists enclosed 13.2 % patients in class 0, 11.3% in classI, 34% in class II, 24.5% in class III and 16.9% in class IV. With 3D T2 ISO images,the same radiologists enclosed 43.3 % in class 0, 32% in class I, 11.4%in class II, 7.5% in class III and 5.7% in class IV. In all cases, the correlation andregression analysis between the 3D T2 ISO and IIEF-5 score resulted in highercoefficients values.Conclusion: Our study confirmed the major correlation level with IIEF-5 score of3D T2 ISO sequence in the morphologic MR depiction of NVBs alterations after abilateral nerve sparing RRP.C-380Inflammation, high grade prostatic intraepithelial neoplasia (HGPIN) andprostate cancer: Evidence for a link at spectroscopic magnetic resonanceand dynamic contrast enhanced MRD. Lisi, V. Panebianco, M. Osimani, E. Santucci, A. Sciarra, R. Passariello; Rome/IT(da.lisi@libero.it)Purpose: Recent evidences suggest a link between inflammation and prostatecancer. Aim of this study was to determine and to compare magnetic resonancespectroscopic imaging (MRSI) and dynamic contrast-enhanced magnetic resonance(DCEMR) features in histologically confirmed prostatic inflammation, high gradeprostatic intraepithelial neoplasia (HGPIN), low grade (LGPC) and high grade(HGPC) prostate cancers.Methods and Materials: The present prospective study comprised a group of32 men who showed at histology a diagnosis of inflammation (Group B), HGPIN(Group C) or prostate adenocarcinoma (LGPC = Group D and HGPC = Group E).The protocol included all patients who merited a prostate biopsy because of anincreased serum PSA level (greater than 4 ng/ml). All 32 cases were submitted toMRSI and DCEMR 2 weeks before biopsy.Results: ANOVA analysis shows that a constant and significant (P 0.05) differencein almost all metabolic assessments (MRSI) exists between controls (groupA) and the other groups (Group B, C, D, E). Moreover, inflammation (Group B)showed no significantly (p 0.05) different choline and citrate levels when comparedto HGPIN and LGPC. The results of the ratio analysis were consistent with nosignificant (p 0.05) differences between inflammation and HGPIN and betweenLGPC and HGPC.Conclusion: This is the first study in the literature in which a quantitative analysis ofindividual metabolites concentration at MRSI has been specifically used to sustainthe hypothesis for a link among inflammation, HGPIN and PC.C-381Role of multimodality imaging in penile carcinomaR. Kochhar, B. Taylor, V. Sangar; Manchester/UK (kochhar_rohit@hotmail.com)Learning Objectives: To illustrate the role of magnetic resonance imaging (MRI)in local staging of penile carcinoma. To outline the use of non invasive imagingtechniques for assessment of regional lymph nodes. To highlight the potential ofnovel techniques.Background: Penile cancer is a rare neoplasm in the developed world affecting1 per 100,000 males per annum in the UK. Assessment on the basis of clinicalfindings alone can often result in inaccurate staging. Our hospital is the referralcentre for penile cancer for a population of about 7 million, with 55 new casesbeing imaged each year. The various radiological techniques, their advantagesand limitations, and imaging appearances of penile cancer are described andillustrated in this exhibit.Imaging Findings: MRI depicts penile anatomy in detail. It is the most accuratetechnique to define the local extent, to determine depth of tumour invasion andfor postoperative follow-up. Ultrasound with Doppler is useful for FNAC of suspiciousnodes but unreliable for nodal staging. It helps to select patients suitable forlymphoscintigraphy and is used for follow-up. Preoperative lymphoscintigraphy withsentinel node biopsy is used to predict lymphogenous metastases in occult inguinaldisease. Novel imaging techniques like PET-CT and nano-particle enhanced MRIhave a high sensitivity and specificity for lymphogenous metastases but their clinicalutility has not been established.Conclusion: Imaging has an important role in the management of penile cancer.MRI accurately assesses local invasion and novel imaging techniques have shownpotential in accurate prediction of metastatic lymph nodal disease.C-382Prostatic carcinoma (PC) treated with cryosurgical ablation: Medium termoutcome after 3-year magnetic resonance (MR) imaging follow-upG. Cardone, A. Losa, L. Nava, P. Mangili, G. Guazzoni, G. Balconi; Milan/IT(cardoneg@tin.it)Purpose: To determine the safety and efficacy of cryosurgical ablation in themanagement of PC and to assess its medium term outcome after 3-year MRimaging follow-up.Methods and Materials: 12 patients with PC underwent cryosurgical ablation.Patients were followed-up clinically, biochemically and by MR imaging 24 hoursafter surgery, and subsequently at 3, 6, 12, 24 and 36 months. MR examinationswere performed with a 1.5 T MR system using TSE T1w, TSE T2w and ce-FSTSE T1w sequences; ce-T1w images were also evaluated before and after digitalsubtraction.Results: No significant rise in PSA was noted post-procedurally in all the cases.On MR images, 24 hrs after treatment the prostate was 59% larger than the originalvolume of the gland; the treated gland decreased in size of an average of 41, 52and 65% at 3, 6 and 12 months, respectively. Ce-FS TSE T1w and subtracted MRimages showed complete ischemia of the gland in all the cases, with periurethralzone sparing to preserve the urethra. Follow-up revealed no evidence of local ordistant recurrence in all the patients. After surgery, 2 patients showed little areasof perilesional enhancement due to perilesional haematomas, disappearing 3months after surgery.Conclusion: Our medium term experience suggests that cryosurgical ablationis a safe, well tolerated and minimally invasive therapy for localized PC, and MRis an effective imaging technique in the follow-up of PC treated with cryosurgicalablation, in the early evaluation of the efficacy of the treatment and in the evaluationof complications.C-383Local recurrence of prostate cancer (PC): Usefulness of keyholesubtracted dynamic contrast-enhanced (KSDce) MR sequenceG. Cardone, C. Iabichino, L. Nava, M. Freschi, P. Mangili, G. Guazzoni,G. Balconi; Milan/IT (cardoneg@tin.it)Purpose: The aim of this study is the evaluation of the usefulness of digitalsubtracted-keyhole-GRE sequence in the study of local recurrence of prostatecancer using ce-dynamic MR imaging.Methods and Materials: We retrospectively reviewed 34 patients treated withradical prostatectomy for prostatic cancer with a rise in PSA level (0.2 to 7 ng/ml) and subsequently biopsy proven local recurrence. All the patients underwentMR examinations, performed with a 1.5 T MR system and an endorectal coil, usingmultiplanar TSE T2w, dynamic ce-keyhole-GRE T1w and digitally subtracteddynamic ce-keyhole-GRE T1w sequences. All data sets were qualitatively andquantitatively evaluated.GenitourinaryACB D E F G HS415

Scientific and Educational ExhibitsResults: On T2w MR images neoplastic lesions were evident in 61% of the cases.On dynamic ce-GRE T1w MR images neoplastic lesions were evident in 79% of thecases. On subtracted dynamic ce-keyhole-GRE T1w MR images neoplastic lesionswere evident in 91% of the cases. The keyhole technique allowed acquisition timereduction, with improvement in time resolution. Subtracted images showed highercontrast resolution in the focal early enhancement areas evaluation compared tothe conventional dynamic images. Local recurrences were evident on subtractedce T1w images only in 4 cases. Digital subtraction technique minimized the highsignal intensity of perirectal and perianastomotic fat and improved the evaluationof the focal areas of contrast enhancement.Conclusion: In our study, subtracted dynamic ce-keyhole-GRE T1w MR sequenceallowed better results compared to the T2w and conventional dynamic MR sequences,and can be successfully employed in the evaluation of local recurrenceof prostate cancer.C-384Can diffusion-weighted MR imaging reduce unnecessary prostate biopsy?New strategy employed high b value diffusion-weighted imaging (DWI) forpatients with elevated PSAY. Yamabe 1 , Y. Kuroki 1 , K. Nasu 2 , Y. Yoshida 1 , R. Sekiguchi 1 , T. Yamamoto 1 ;1Utsunomiya/JP, 2 Tsukuba/JP (ykuroki@tcc.pref.tochigi.jp)Purpose: We analyzed whether patients with elevated PSA could be stratifieddepending on therapeutic necessity by non-contrast MR imaging including highb value DWI.Methods and Materials: The subjects were 130 patients with elevated PSA whoseserum PSA levels were 4 ng/ml or more. They were obtained by MR images priorto prostate biopsy. We used an MR scanner (Gyroscan Achieva 1.5 T, Philips) andSENSE-body coil. Images used for this study were trans axial section of DWI (bvalue: 1500 and 2000), ADC map (b value: 1500), and T2WI. We classified thesubjects into 2 groups. Group A showed high signal intensity area on DWI withunclear or disappear normal prostate gland pattern on T2WI. Group B showedany signal intensity on DWI with normal prostate gland pattern. It was speculatedthat Group A needed prostate biopsy and group B was recommended watchfulwaiting. We compared MRI diagnosis with pathological diagnosis by biopsy asreference standard.Results: Of 130 cases, 78 cases were diagnosed as Group A and 52 cases asGroup B. Group A consisted of 53 cases of significant cancer, 8 cases of insignificantcancer, and 17 cases without cancer. Group B consisted of 1 case of significantcancer, 2 cases of insignificant cancer, and 49 cases without cancer.Conclusion: It was speculated that using of non-contrast MR imaging with highb value DWI enabled stratification depending on therapeutic necessity of the PSAgroup.C-385High-b-value diffusion-weighted imaging at 3T for detection of prostatecancerY. Ohgiya, T. Hashizume, J. Suyama, N. Seino, M. Hirose, T. Gokan; Tokyo/JPPurpose: The purpose of this study was to investigate usefulness of high-b-valuediffusion-weighted imaging (DWI) in combination with T2-weighted imaging (T2WI)for detection of prostate cancer.Methods and Materials: Seventy-three patients underwent T2WI and DWI (b =50, 500, 1000, and 2000) at 3T. Three independent observers reviewed imagesobtained from combination of T2WI and DWI (b = 500) (protocol A), combinationof T2WI and DWI (b = 1000) (protocol B), combination of T2WI and DWI (b = 2000)(protocol C), and combination of T2WI, DWI (b = 50, 500, 1000, and 2000), andADC maps (protocol D). Area under the receiver operating characteristic (ROC)curve (Az) was calculated under results of systemic biopsy as the standard ofreference. Significant difference was defined as a P value less than 0.05 for theAz tested with a two-tailed paired Student t test.Results: Prostate cancer was pathologically detected in 55 of the 73 patients. Thesensitivity, specificity, accuracy, and Az for the detection of prostate cancer wereas follows: 19, 86, 69%, and 0.591, respectively, in protocol A; 43, 83, 73%, and0.667, respectively, in protocol B; 39, 87, 75%, and 0.742, respectively, in protocolC; 54, 77, 71%, and 0.804, respectively, in protocol D. Mean Az in protocol A wassignificantly lower than in the other protocols.Conclusion: Combined reading of DWI with b value more than 1000 or 1000 andT2WI showed higher accuracy in the detection of prostate cancer than combinedreading of DWI (b = 500) and T2WI.C-386Prostatic endorectal magnetic resonance: Recent changes in clinicalindicationsS. Cirillo, M. Petracchini, T. Gallo, D. Campanella, A. Macera, F. Russo,D. Molinar, S. Debernardi, D. Regge; Candiolo/ITPurpose: The aim of the present study was to summarize recent changes in theindication for endorectal magnetic resonance (eMR) starting by our database ofthe last 46 months.Methods and Materials: From August 2004 to May 2008 in our institute, 880 eMRexaminations were performed in 856 consecutive male patients. Patients werescheduled for eMR by urologists from collaborating institutions with different clinicalindications. We considered the indications in two different periods of 23 monthseach one (August 2004 - June 2006 and July 2006 - May 2008); chi square testwere performed to assess differences in frequency for each indication betweenthe two different periods.Results: Four hundred and twenty eMR examinations were executed in the firstperiod and 460 in the second period. In the first and in the second periods, respectively,46.90 and 30.21% of eMR were executed for local staging of prostatecancer, 27.85 and 20.65% for localizing local recurrence after primary treatment;25.23 and 49.13% for the evaluation of prostatic glands in patients with previousnegative biopsies and increased PSA values. A statistical difference was foundfor the first ( 2 =53.34, p-value 0.001) and for the third indication ( 2 =25.90,p-value 0.001). No statistical difference was found for the second indication ( 2=6.23, p-value: 0.012).Conclusion: The use of new functional studies (such as magnetic resonancespectroscopy, dynamic contrast enhancement and diffusion weighted imaging)increased eMR accuracy in detecting cancer tissue and consequently led to achange in the clinical indications.C-387Tumors and tumor-like conditions of the testis: Gray-scale and colorDoppler US findings with radiologic-pathologic correlationE. Xinou, K. Lytras, S. Iosifidou, M. Gialamoudi, F. Patakiouta, D. Doula,E. Karoglou, D. Anestakis, L. Grassos; Thessaloniki/GR (dimsterg@otenet.gr)Learning Objectives: 1. To illustrate the spectrum of gray-scale and color DopplerUS findings of usual and unusual testicular tumors. 2. To correlate these imagingfeatures with pathologic findings. 3. To describe conditions that can mimic suchtumors. 4. To delineate which imaging findings can be used to help differentiatetumors from tumor-like conditions.Background: Ultrasonography (US) is the initial imaging modality for investigatingtesticular tumors. The ability of color Doppler US to demonstrate testicular perfusionaids in reaching a specific diagnosis. With rare exception, solid intratesticularmasses should be considered malignant. The sonographic appearance of testiculartumors reflects their gross morphology and underlying histologic characteristics.Imaging Findings: Approximately 95% of malignant testicular tumors are germ celltumors, of which seminoma is the most common histologic subtype. Rare malignantconditions that can also manifest as testicular masses include leukemia, lymphoma,plasmacytoma and metastases. A variety of benign intratesticular processes, suchas hematoma, orchitis, abscess, infarction, and granuloma, can mimic testicularmalignancy and must therefore be considered in the differential diagnosis. Grayscaleand color Doppler US imaging features of a wide variety of testicular tumorsare presented and correlated with their pathologic findings, emphasizing thosefeatures that can help establish a specific diagnosis.Conclusion: The use of color Doppler US can help to establish the correct diagnosisof a variety of testicular tumors, appropriately guiding treatment. A short-termfollow-up US examination can help exclude acute conditions, which can occasionallyappear as a mass.C-388Prostate ultrasound elastography in cancer detectionE. Panfilova, A. Emelyanenko, S. Alferov, A. Zubarev; Moscow/RU(kozicheva@bk.ru)Purpose: To evaluate the diagnostic possibilities of ultrasound (US) elastographyimaging in diagnosis of prostate cancer in patients with elevated PSA level or withpalpable prostate nodules.Methods and Materials: 400 consecutive patients underwent TRUS (gray scale,color Doppler, elastography) with the EUB 900 (Hitachi Medical, Japan) usingEUP-V53 W of 6.5 MHz transduser (PSA level 4-14 ng/ml, prostate volume 40-95 cm³, mean age 639). Sonoelasticity score of the suspicious for prostate cancerlesions were evaluated (from 1 to 4). Prostate sexstant biopsies were performed inCS416 A B D E F FG H

Scientific and Educational Exhibitsall cases. Sensitivity, specificity, accuracy, positive predictive value (PPV), negativepredictive value (NPV) were calculated in all cases.Results: 301 patients using sonoelastography were suspected to have prostatecancer. The sonoelastography was in agreement with histopathology results in278 cases. Prostate cancer were characterized of 3.80.8 sonoelasticity score,compared to prostatitis - 1.70.9 (p 0.001), and BPH - 2.51.1 (p 0.05). Ourstudy shows sensitivity - 97.4%, specificity - 75.4%, accuracy - 90.75%, PPV -97.0%, NPV - 75.4%.Conclusion: US elastography shows high potential in prostate cancer diagnostics.It offers additional information that increased the sensitivity of conventionalultrasound methods.C-389Imaging of bulbo-urethral glands pathologyM. Valentino, M. De Matteis, C. Poggi, M. Casadio Baleni, P. Pavlica, L. Barozzi;Bologna/IT (valentino@aosp.bo.it)Learning Objectives: To illustrate the imaging findings of the pathology of bulbourethralglands.Background: Bulbo-urethral glands or Cowper’s glands are accessory sexualglands and are made of a main gland situated on either side of the bulbar urethraat the level of the urogenital diaphragm. Their long ducts are drained into thebulbar urethra by small paramedian orifices. The glands can be the site of cysticdilatation or inflammation and their ducts can show a dilatation that can producevoiding obstruction.Imaging Findings: 23 adult patients with bulbo-urethral glands pathology wereobserved. Sonography was used in 16 cases, radiography in 23 and cystoscopy in7. The most common symptoms (15 pts) were stranguria and post-urinary dribbling,two with perineal pain during straining and six were asymptomatic and investigatedfor different pathology. In two cases, small calcifications were detected at the levelof the urogenital diaphragm on the plain film and transrectal sonography. Abscessof the gland was observed in 1 patient and cystic dilatation in 2 cases. The dilatedbulbo-urethral duct or syringocele was the most frequent pathology.Conclusion: Bulbo-urethral glands pathology is considered rare but the diagnosisshould be entertained in any male presenting with long standing irritative or obstructivesymptoms when no other explanation is found. The diagnosis is obtained onlywith voiding or retrograde urethrography. Transperineal sonourethrography is veryhelpful in all cases prior to any therapeutic procedure.C-391Is real-time elastography targeted biopsy able to enhance prostate cancerdetection? An analysis of detection rate using an elasticity-scoring systemL. Pallwein, F. Aigner, V. Spiss, M. Mitterberger, W. Jaschke, F. Frauscher;Innsbruck/AT (leo.pallwein@i-med.ac.at)Purpose: Real-time elastography (RTE) has already shown its ability to detectPCa. This prospective study was performed to evaluate RTE for targeted prostatebiopsy in a PSA screening population in comparison to cancer detection rate ofsystematic biopsy.Methods and Materials: Included were 383 patients with elevated PSA (mean:7.0 13.8) and scheduled for systematic biopsy. Before systematic approach, atargeted biopsy with a limited number of cores (maximum 5) was performed. Targetedbiopsy was based on findings in RTE. Stiff lesions were considered malignant.Appearance of elasticity of outer gland areas was divided into: score 1- normal(regular stiffness), score 2- indeterminate (inhomogeneously increased stiffness),and score 3- suspicious (homogeneously increased stiffness). PCa detection ratesof each stiffness grades were compared with findings of systematic biopsy.Results: Sensitivity for PCa detection (134 of 383 patients; 35%) was 91.0%(122/134) for RTE targeted biopsy and 76.9% (103/134) for systematic biopsy. Score1 elasticity pattern was found in 129 patients, 3 of them (2.3%) showed cancer,score 2 elasticity pattern in 146 patients, 42 of them (28.8%) showed cancer, andscore 3 elasticity pattern in 108 patients, 89 of them (82.4%) showed cancer. Thecorrelation between stiffness grade and Gleason Score was significant. The prostatevolume and the PSA also were correlated with the stiffness grades.Conclusion: RTE has already shown its value for PCa detection. The use of astiffness grading system seems to be able to further enhance the PCa detectionrate and can increase the diagnostic accuracy of RTE.C-390Prostate cancer (PCa) detection in patients with a total PSA (tPSA) 10 ng/ml: Targeted biopsy with a sonographic triple approach and a reducednumber of cores vs systematic 10 core biopsyF. Aigner, L. Pallwein, V. Spiss, M. Mitterberger, W. Jaschke, F. Frauscher;Innsbruck/AT (friedrich.aigner@uki.at)Purpose: Results of a targeted biopsy approach based on findings in grey scale(GS), color Doppler (CD) and real-time elastographical (RTE) imaging were comparedwith systematic biopsy findings for detection of prostate cancer.Methods and Materials: 94 patients (mean age: 61.8; range: 42-86) with a tPSAserum value lower than 10 ng/ml (mean: 5.1; range: 1.3-10) underwent a 5 coretargeted biopsy by an uroradiologist. Targeted cores only were taken from areaswith pathologic patterns in GS, CD, or RTE imaging (Hitachi EUB-8500). In thesame session, a 10 core systematic biopsy was performed by a blinded urologist.PCa detection rates were compared.Results: 28/94 patients showed PCa (mean gleason score: 6.3; range: 5-9).Systematic approach detected 18/28 (64.2%), targeted biopsy approach detected23/28 (82.1%). In the group of patients with a tPSA of 4 ng/ml, 12 patients showedcancer and targeted biopsy was able to detect 10 and systematic biopsy 7 of these12. The detection rate in the group with tPSA of 4-10 ng/ml was 15/16, for targetedbiopsy and 11/16 for systematic biopsy.Conclusion: The targeted biopsy based on a sonographical triple approach witha reduced number of cores seems to increase PCa detection rate even in patientswith a tPSA of 10 ng/ml. Therefore, the targeted technique may be able to reducecosts and complications of prostate biopsy.GenitourinaryACB D E F G HS417

Scientific and Educational ExhibitsGI TractAcute AbdomenC-392Radiological review of acute and chronic mesenteric ischaemia: How toimage, diagnose and treatP.L. Skippage, M. Ingram, G. Bydawell, G. Munneke; London/UKLearning Objectives: 1) To review the pathophysiology and aetiology of both acuteand chronic mesenteric ischaemia. 2) To discuss the imaging modalities available:what should be used and when. 3) To discuss treatment options that are available,with a particular emphasis on percutaneous interventional procedures.Background: Acute and chronic mesenteric ischaemia can present with differingclinical scenarios. As radiologists we should be aware that imaging findings, althoughclassical, can be subtle and therefore we should also know how to tailor imagingtechniques for individual cases to ensure that an accurate and timely diagnosis ismade. Treatment options should always include discussion around interventionalradiological techniques.Imaging Findings: We will present cases collected from our institution of imagingfindings in both acute and chronic mesenteric ischaemia. This will focus on CTappearances, in particular the role of MDCT, but will also include other imagingmodalities such as angiography. We will also discuss and show examples of treatmentof mesenteric ischaemia, emphasising radiological interventional techniquesthat can be used.Conclusion: Radiologists must be aware of how to image the different clinical entitiesof acute and chronic mesenteric ischaemia. Specific imaging findings shouldbe sought and investigations tailored to provide optimal results. The treatment ofboth types should always include discussions with interventional radiologists aspercutaneous techniques provide a good alternative to standard open surgicalprocedures.C-393Abdominal plain film versus multi-detector CT in the evaluation ofnonspecific abdominal pain in the emergency department: A model forevaluating process, cost and effectivenessM. O’Brien 1 , L. Milne 2 , T. Ptak 2 ; 1 Amherst, MA/US, 2 Boston, MA/US(tptak@partners.org)Purpose: To construct a simple model to assess the role and impact of diagnosticimaging in abdominal pain. Scenarios employing a combination of modalities areanalyzed with respect to length of stay, cost, and radiation dose.Methods and Materials: A Markov model was constructed for abdominal painin the emergency department (ED). Diagnostic decisions are directed through anobservation pathway or MDCT, abd plain film (ABX) or ultrasound. Models wereconstructed for two paradigms, one with ABX and one without. Model data werefrom 2724 adult patients presenting to our ED with abdominal pain between 1/1and 31/12/2007. Expected values were calculated for time (hrs), cost (dollars)and radiation exposure (mGy) in each paradigm. Cost-effectiveness and sensitivityanalyses were performed for change in the preferred scenario. Monte Carlosimulation estimated scenario specific cost.Results: Values favored no-ABX pathway for cost and time analysis, but favoredABX pathway in the radiation exposure analysis. Sensitivity analyses revealed anABX preferred pathway in time and cost only when diagnostic efficiency of ABX waselevated and MDCT severely reduced. Radiation dose model consistently favoredABX scenario in all analyses. Values in cost-effectiveness models favored ABXscenario, but were essentially collinear using dollar cost and time.Conclusion: MDCT is favored over ABX in the initial ED evaluation of abdominalpain in simple models using dollar cost and ED time metrics. ABX scenario is favoredonly when the sole consideration was radiation exposure. All cost-effectivenessmodels favor ABX scenario, but are nearly collinear in dollar cost and length-ofstay(time) models.C-394Gastrointestinal (GI) tract perforation: Accuracy of CT in prediction ofpresence, site and causeJ. Mendiola Arza, I. Arrieta Artieda, M. Carreras Aja, A. Dolado Llorente,I. Terreros Bejo, M. Berástegui Imaz; Baracaldo/ES (josumendi2002@yahoo.es)Purpose: The purpose of this study was to review the accuracy of CT for determinationof the GI tract perforation and to emphasize the most characteristic findingsthat indicate the site and cause of perforation.Methods and Materials: We prospectively studied 65 patients with abdominalpain, pneumoperitoneum and surgically proven GI tract perforation. Two emergencyradiologists evaluated the images and both completed a questionnaire onthe presence or absence of seven CT findings indicative of acute bowel diseaseand gastrointestinal perforation. The seven CT findings evaluated were: focal defectin the bowel wall, segmental bowel wall thickening, perivisceral fat stranding,abscess, extraluminal fluid, few bubbles of extraluminal air concentrated in closeproximity of the bowel wall and extraluminal air in both abdomen and pelvis. Afterreviewing these findings the two radiologists predicted site and cause of perforation.Fisher´s exact test and contingency tables were performed to assess thesignificance of CT findings.Results: The presence of concentrated extraluminal air bubbles (p 0.001) and theperivisceral fat stranding (p=0.002) are the best predictors of the site of perforation.The cause of GI tract perforation was predicted in 49 of 65 patients (75%).Conclusion: CT has high performance in diagnosing the presence, site and causeof GI tract perforation. The presence of concentrated extraluminal air bubbles andthe perivisceral fat stranding are the best predictors of the site of perforation. Correctdiagnosis of the presence, level and cause of perforation are essential for appropriatemanagement and surgical planning in patients with GI tract perforation.C-395Abdominal gossypiboma: A pictorial reviewA. Canelas, M. Seco, B. Graça, F. Cavalheiro, L. Curvo-Semedo, L. Teixeira,F. Caseiro-Alves; Coimbra/PT (andreacanelas@gmail.com)Learning Objectives: To describe the clinical and radiologic spectrums of abdominaland pelvic gossypibomas.Background: A retained surgical sponge or swab is also known as a gossypiboma,derived from gossypium (Latin, cotton) and boma (Swahili, place of concealment).Gossypiboma occurs with a frequency of one in 100-5000 operations and accountsfor 50% of malpractice claims for retained foreign bodies. Clinically, retained spongesmay be asymptomatic or result in a granulomatous response with abscess development,intestinal obstruction or fistula formation. The aim of this pictorial essay isto provide an update review of the radiologic findings of retained surgical spongesin the abdomen and pelvis.Imaging Findings: Several cases of abdominal and pelvic gossypibomas will beillustrated using a multimodality approach - X-ray, ultrasound, CT and MRI.Conclusion: Awareness of the typical radiologic appearances is critical to thediagnosis of retained surgical sponges or swabs. Inadvertently retained spongesare often clinically unsuspected and may be first recognized by imaging. A highindex of suspicion is required because a history of an incorrect sponge count isfrequently lacking and because a radiopaque marker is not always visible. CT orMR imaging may be helpful in problematic cases.C-396Use of abdominal X-ray in accident and emergency departmentsI. Din, J. Rathore, H. Aniq; Liverpool/UK (islahu@yahoo.com)Purpose: Abdominal X-ray involves exposure to significant amount of radiation. TheRoyal College of Radiologists (RCR) UK has published guidelines on the appropriateuse of abdominal X-rays. We aimed to find out the extent to which unnecessaryabdominal X-rays are requested based on RCR guidelines.Methods and Materials: We retrospectively audited 200 patients in whomabdominal X-ray was performed in accident and emergency of Royal LiverpoolUniversity Hospital (between August and November 2007). Only first 50 cases fromeach month were selected. Clinical notes and X-ray request forms were reviewedseparately against the guidelines.Results: There were 106 females and 94 males. The mean age of patients was52.51 (range 16-94). Clinical impression/diagnosis was not made in 29% of thecases. Based on clinical notes, only 45% of the abdominal X-rays were requestedappropriately. Based on the information given on request forms, 75.5% of the X-rays appeared to be appropriately requested. 70% of the abdominal X-rays werereported normal by radiologist.CS418 A B D E F FG H

Scientific and Educational ExhibitsConclusion: The results suggest that significant number of abdominal X-rayswere requested inappropriately. In a few cases, there was marked discrepancybetween clinical notes and the information provided on radiology request forms.Increased awareness of local/national guidelines is essential to prevent unnecessaryexposure of patients to radiation. Accurate and honest information shouldbe provided on request forms to help our radiology colleagues and to avoid anymedico-legal problems.C-397Believe it or not: Unusual abdominal diseases diagnosed with CT inemergency roomL. Figueroa Nasra, A. Verón Sánchez, E. Valbuena Durán, E. Alonso Gamarra,A. Diez Tazcón, G. Gallardo-Madueño; Madrid/ES (lourdesfi@hotmail.com)Learning Objectives: To discuss the use of CT in the evaluation of patients withnonspecific abdominal complaints. To recognize the CT findings of various uncommonabdominal diseases that can cause acute abdominal pain in the emergencyroom.Background: Acute abdominal pain in adults is a nonspecific but common clinicalcomplaint in emergency room. In these cases, the clinical presentation is oftenconfusing and ultrasound has been used with a poor degree of success in thediagnosis, but the CT findings are characteristic and allow early recognition andoften decide on operative versus nonoperative therapy.Imaging Findings: Appendicitis is the most common cause of the acute abdomen.Numerous other entities (epiploic appendagitis, omental infarction, intussusception,gallstone ileus, inferior mesenteric venous thrombosis, small bowel torsion,perforated small bowel diverticulitis, typhlitis, hepatic hydatid cyst rupture) arerelatively uncommon, but taken as a whole they make up a substantial number ofpatients who present with acute abdominal pain. In this exhibit all these entities willbe discussed, stressing their key CT findings and the differential diagnoses.Conclusion: CT plays a pivotal role in establishing the diagnosis and in deciding onoperative versus nonoperative therapy in a patient with abdominal pain of uncertainetiology in the emergency room.C-398Imaging of perforation as a result of GI tract endoscopyP. Steyerova, J. Horejs; Prague/CZ (petra.steyerova@centrum.cz)Learning Objectives: To learn about usual and less common appearance of perforationon different levels of GI tract resulting from GI tract endoscopy procedures.To highlight important features of clinical importance.Background: Perforation is a quite uncommon complication of endoscopy, encounteredin 0.03 to 0.11% of patients undergoing endoscopy. The significance ofradiologist is to provide early and accurate information whether the perforation ispresent, to reveal its location and evaluate its extent and other possible complications.In our presentation, we would like to show series of images of perforationresulting from upper GI tract endoscopy, ERCP, trans-esophageal echocardiographyand colonoscopy encountered in our clinic during last 4 years of cooperation withendoscopic centre.Imaging Findings: Patients were indicated for imaging because of previousendoscopic procedure and either suspected perforation or clinical/laboratorydisturbances following the endoscopy. Though some of the patients underwentconventional X-ray first, the main technique for imaging of these patients was CT.CT usually revealed different amount of free air outside the GI tract with maximumin the vicinity of the perforation site; sometimes we observed the perforation directlywith leak of contrast media which was administered orally prior to scanning. In acase of ERCP stent migration with perforation of duodenal wall, we observed acovered perforation with creation of a small fistula.Conclusion: Imaging techniques are crucial for evaluation of GI tract perforationas a result of endoscopic procedure. Early and precise recognition and descriptionis necessary for subsequent management of the patient.C-399A practical approach in diagnosing mesenteric ischemia usingmultidetector computed tomographyA. James, J.H. Chauh, B. Thomas, V. Rudralingam, S.A. Sukumar;Manchester/UK (anithajames@aol.com)Learning Objectives: 1. To illustrate the various imaging features of mesentericischemia (MI) on multidetctor computed tomography (MDCT). 2. To depict theanatomy of mesenteric vasculature. 3. To relate the etiology and pathogenesis ofmesenteric ischaemia to the different imaging patterns seen on MDCT.Background: Mesenteric ischemia is one of the most common causes of anacute abdomen in patients over 50 years of age and is potentially life threatening.MI can affect the large or small bowel, may be segmental or diffuse and variesin extent from partial mural to transmural ischemia. Surgical resection is still themainstay of treatment for bowel ischemia and may be combined with mesentericendarterectomy in select cases. Correct diagnosis and timely intervention determinethe clinical outcome.Imaging Findings: The MDCT findings vary with the degree, distribution, causeand severity of MI and include: Bowel wall thickening - hypoattenuaton (oedema)or hyperattenuation (intramural haemorrhage); “Paper-thin” dilated bowel; Specificsites such as splenic flexure. Hyperenhancement or hypo/non enhancement of thebowel wall depending on the extent and cause of MI and the presence of superaddedinfection. Fat stranding and ascites; Pneumatosis intestinalis, portomesenteric airand perforation; Primary cause of MI such as arterial or venous thrombosis.Conclusion: In practice, diagnosing MI is challenging due to the variable clinicaland radiological features, especially in the absence of classical features. A combinedsystematic clinical and radiological approach is vital for accurate diagnosisand prompt intervention.C-400Diagnosis in active abdominal bleeding: Importance of MDCT andcorrelation with arteriographyE.I. Monedero Martínez-Pardo, M.I. Rossi Prieto, P. Diez Martínez,A. Alcalá-Galiano Rubio, E. Salvador Álvarez, S. Borruel Nacenta; Madrid/ES(ele.monedero@gmail.com)Purpose: To compare the diagnostic capacity of MDCT and arteriography to demonstrateactive abdominal bleeding. To make a correlation between both techniquesshowing the findings obtained in each one. To show the important role of MDCT inthe management of this emergency.Methods and Materials: We have revised patients with active abdominal bleedingstudied at our hospital during one year, collecting those that required both urgentMDCT and arteriography. There were a variety of different etiologies found in thegroup of patients included in our study: traumatisms, focal lesions, iatrogenesis andspontaneous bleeding. We could classify the origin in hepatic, pancreatic, renal,splenic, from lumbar vessels or pelvic structures. We only considered a positiveactive bleeding in MDCT in those cases where we could see leak of contrast(although there were indirect signs in all of them).Results: We have observed an important correlation between MDCT and arteriography(72%). We found more discrepancy in splenic location, where nearly60% of the results were false negative for MDCT (the general rate was 17%).Renal origin was the location with the highest agreement (83% of correlation, nofalse negatives).Conclusion: There is an important correlation between the direct signs of activeabdominal bleeding in MDCT and arteriography (apart from splenic bleeding, whereindirect signs become of greater importance). According to this, we recommendMDCT as the technique of choice in these patients’ management.C-401Acute abdominal and pelvic pain in pregnancyG. Murphy, P. Beddy, R. Dunne, M. Keogan; Dublin/IELearning Objectives: 1. Outline aetiology and incidence of common pathologythat presents as an acute abdomen in pregnancy. 2. Retrospectively assess theimaging findings of pregnant patients presenting with acute abdominal or pelvicpain. 3. Review the imaging modality of choice for pregnant patients.Background: The incidence of the acute abdomen during pregnancy is 2%. Nonobstetric surgical intervention will be required in 0.5%. The role of imaging is todistinguish between cases requiring urgent intervention and those that can bemanaged conservatively. The anatomical and physiological changes of pregnancyrender the diagnosis and management of abdominal pain challenging. Non-ionisingmodalities including ultrasound and MRI are preferred due to concerns regardingradiation dose to the foetus. This article reviews and illustrates both common andrare conditions presenting as acute abdominal pain during pregnancy.Imaging Findings: The following cases are presented: Hepatobiliary, Acute cholecystitis,Biliary obstruction, Biliary colic. Ascending cholangitis Pancreatic, Acutepancreatitis, Pancreatic carcinoma. Intestinal: Small bowel obstruction due to aspigelian hernia, acute appendicitis, acute Crohn’s colitis. Renal: Renal obstruction.Pelvic: Dermoid cyst torsion, Ovarian torsion, Degenerating fibroid, Benignand malignant ovarian masses. Trauma: Domestic violence with splenic laceration.Musculoskeletal: Sacral stress fracture.Conclusion: This comprehensive case series illustrates the spectrum of conditionspresenting as an acute abdomen in the pregnant patient.GI TractACB D E F G HS419

Scientific and Educational ExhibitsC-402MDCT differential diagnosis of acute colonic conditionsS. Romano, G. Tortora, F. Maisto, A. Russo, L. Romano; Naples/IT(stefromano@libero.it)Learning Objectives: To illustrate the spectrum of MDCT findings of common andrare acute colonic conditions giving some “key points” to consider for an effectivedifferential diagnosis.Background: Acute disease of the colon could be due to various and differentpathologic entities, ranging from occlusion to the endoluminal transit to parietalvascular affections from arterial origin or impaired venous drainage, to “flogosis”,which could represent manifestations of different etiologies causing similar (butnot equal) bowel damage and imaging findings. MDCT scanning with i.v. contrastmedium administration, without any endoluminal opacification or distension representsa common diagnostic method to perform in Emergency in patients withsuspected acute colonic condition.Imaging Findings: MDCT findings related to the following acute disease of thecolon will be considered, illustrated and evaluated for criteria of differential diagnosiswith correlation to the bowel wall appearance (thickening, stratification with focusedattention to mucosal and submucosal feature, density, enhancement, air or fluiddistension, presence of pneumatosis): Ischemia from arterial occlusion or low-flowstate, disease from impaired venous drainage, alterations from chemiotherapics,hemorrhage, appendicitis, diverticulitis, alterations from haematological disorders,occlusions and obstructions.Conclusion: MDCT examinations could represent a good tool for an effective differentialdiagnosis of acute disease of the colon from various origins.GI TractColonC-403Evaluation of preoperative staging and resectability of colon cancer usingCTC: Correlation with surgical resultsA. Stagnitti, A. Marini, L. Testaverde, F. Iafrate, M. Marini, A. Pichi, A. Laghi;Rome/IT (a.stagnitti@libero.it)Purpose: To evaluate the diagnostic performance of CTC in the evaluation ofpreoperative staging and resectability of colon cancer.Methods and Materials: Fifty-eight patients with colon cancer who underwentsurgical treatment and had available preoperative CTC with i.v. contrast wereincluded in the study. All the images of preoperative CTC were independentlyanalyzed by two radiologists with different experience and the differences in theirassessment were analyzed by consensus using MPR reconstructions and VRimages. The radiologists were asked to determinate the depth of invasion of thecolon wall (T stage) classifying into T2, T3 and T4; involvement of loco-regionalnodes (N stage) and distant metastasis (M stage). TNM staging with CTC werecorrelated with surgical results.Results: The overall accuracy values for T staging of reviewer 1, reviewer 2 andconsensus reading were 91.6, 86.2 and 92.8%, respectively; 92.2, 79.8 and92.5% for T2; 88.1, 85.5, and 89.7% for T3; and 94.5, 93.5 and 96.2% for T4.Three out of 14 T4 lesions were understaged due to inadequate distension (n=1)and misinterpretation of adjacent organ involvement as partial volume averaging(n=2).The accuracy values for N staging and M staging were 81.8 and 94.0% forreviewer 1; 78.2 and 88.1% for reviewer 2; and 81.8 and 94.0% for consensusreading, respectively.Conclusion: Contrast enhanced CTC shows good performance in the preoperativeevaluation of staging and resectability of cancer colon.C-404Diagnosis of uncomplicated stercoral colitis: CT findingsA. Linda 1 , J. Heiken 2 ; 1 Udine/IT, 2 St. Louis, MO/US (annalinda33@gmail.com)Learning Objectives: 1. To review the pathophysiology of stercoral colitis. 2. Todiscuss the importance of early recognition of uncomplicated stercoral colitis. 3. Toreview the risk factors and clinical presentation. 4. To illustrate the CT findings.Background: Stercoral colitis is an inflammatory disease of the colon due to thepersistent pressure over the bowel wall by hard stools, in patients with chronicconstipation. The fecal mass may cause pressure necrosis of the wall leading toperforation of the colon, which is a life-threatening condition. It is crucial to recognizeclinical and CT findings suggestive of stercoral colitis and treat it before it resultsin perforation. Risk factors are immobilization, diseases predisposing to constipation,and drugs reducing bowel mobility. Patients can present with abdominal pain,vomiting, abdominal distention, or be asymptomatic.Imaging Findings: CT findings of uncomplicated SC are: 1. fecal impaction withoverdistention of the involved colonic segments, 2. thickened and strongly enhancingcolonic wall, and 3. pericolonic fat stranding.Conclusion: Knowledge of risk factors, clinical presentation and imaging featuresof uncomplicated stercoral colitis allows prompt diagnosis and treatment, beforethe development of life-threatening complications.C-405Cytomegalovirus enterocolitis in non-AIDS patients: Evaluation of CTfindings and clinical featuresE. Chae, S. Lee, H. Kim, S. Park, A. Kim, H. Ha; Seoul/KR (chaeey@hanmail.net)Purpose: To evaluate CT findings and clinical features of cytomegalovirus (CMV)enterocolitis in non-AIDS patients.Methods and Materials: Twenty-two non-AIDS patients (eleven women, elevenmen; mean age, 55 years) with pathologically proven CMV enterocolitis were included.Medical records were reviewed for immune status, presenting symptoms,clinical courses. CT scans were retrospectively reviewed for the location of involvedbowel (i.e. small bowel, colon, and both), maximal bowel thickness, pattern of bowelwall enhancement (i.e. single ring, double ring, and homogeneous), the presenceof ascites and pericolic/perienteric infiltration.Results: Five patients were apparently immunocompetent, whereas 17 hadmedical conditions that may alter immune status including chemotherapy (n=5),immunosuppression (n=4), blood dyscrasia (n=2), diabetes mellitus (n=3), recentmajor surgery (n=2), and renal failure (n=1). The presenting symptoms were abdominalpain (n=14), hematochezia (n=12), diarrhea (n=11), and fever (n=3). OnCS420 A B D E F FG H

Scientific and Educational ExhibitsCT, all patients, except one, showed bowel wall thickening (mean maximal thickness,8.8 mm for the colon and 6.3 mm for the small bowel) involving both smallbowel and colon (n=5) or limited to the colon (n=11) or small bowel (n=5). Bowelwall enhancement pattern was single ring (i.e. strong enhancement of inner layer)in 13 patients, double ring in five, and homogenous in three. Bowel involvementwas continuous in 14 patients. Ascites was present in 10 patients and pericolic/perienteric infiltration in fourteen. Four patients with delayed diagnosis underwentsurgery due to bowel perforation or refractory GI bleeding.Conclusion: CMV enterocolitis can develop in immunocompetent as well asimmunocompromised hosts, and is characterized by mild continuous bowel wallthickening with single or double ring enhancement. Delayed diagnosis may leadto serious complication.C-406Accuracy of CT in colonic obstruction: Analysis and reviewI. Terreros, A. Dolado, J. Mendiola, I. Arrieta Artieda, M. Carreras, G. Iglesias;Barakaldo/ES (ignacioterreros@seram.org)Purpose: 1. To determine the accuracy of computed tomography (CT) in diagnosingcolonic obstruction and recognizing the location and severity of this entity. 2. Weevaluate and show the different causes of colonic obstruction dividing these intointraluminal, intrinsic and extrinsic.Methods and Materials: We analyzed prospectively 58 patients with clinical orradiologic colon obstruction suspicion, to whom a Helicoidal CT was performed inour Emergency Radiology Section. CT results were compared with surgery, endoscopyor clinical evolution. We studied the ability of CT for diagnosing mechaniccolonic obstruction, and also the location, cause and complications (ischemia orperforation) of each obstruction.Results: CT diagnosed correctly 46 of the 47 mechanic obstructions (sensibility of97.9%) and 10 of the 11 non obstructive diffuse dilatations (specificity of 90.9%). Thepoint of obstruction was satisfactorily located in 45 of the 47 obstructions (95.8%)and the specific cause in 43 of them (91.5%). The complications were correctlydetermined in 7 of the 10 cases in which surgery was finally performed. We analyzeseveral of these data by mean of kappa index. Causes of colonic obstruction includethe following: intraluminal (25.5%), intrinsic (57.4%) and extrinsic (17%).Conclusion: CT is the diagnostic technique of election for patients with clinical orradiologic suspicion of colonic obstruction, with great effectiveness for diagnosis(differentiating among intraluminal, intrinsic and extrinsic causes), location andpossible complications in order to contribute information enough for an optimumtherapeutic management.C-407Perfusion CT using 64-channel slice MDCT in colorectal cancer:Comparison of perfusion parameters with tumor grade and angiogenesisusing microvessel count (MVC)J. Kim 1 , Y. Jeong 1 , S. Heo 1 , S. Shin 2 , J. Lee 1 , H. Kang 2 ; 1 Jeollanam-do/KR,2Kwangju/KR (jw4249@hanmail.net)Purpose: To correlate CT perfusion parameters with tumor grade, and to assessCT perfusion for evaluation of angiogenesis of rectal adenocarcinoma.Methods and Materials: Preoperative perfusion CT was performed with 64-channelvolume CT (Lightspeed VCT, GE Healthcare Technologies, WI, USA) in 20 patients(12 women, eight men; age range, 32-82 years). Dynamic CT perfusion was performedin rectal carcinoma for 65 seconds after injection of contrast medium. Oneradiologist analyzed tumor blood flow (BF), blood volume (BV), mean transit time(MTT), and permeability surfaces (PS) on GE workstation (GE Healthcare Technologies,Milwaukee, WI, USA). CT perfusion parameters were compared amongtumors of different grades and correlated with microvessel count (MVC).Results: In 20 patients with colorectal cancer, histologic grade was well-differentiated(n=9), moderately-differentiated (n=11), and poorly-differentiated adenocarcinoma(n=2). BF was higher in moderately-differentiated adenocarcinomathan in well-differentiated tumors (p .05). MTT was shorter in moderately- thanwell-differentiated adenocarcinoma (p .05). However, there were no significantdifferences in other CT perfusion parameters between well- and moderatelydifferentiatedcolorectal adenocarcinomas. There was no significant correlationbetween CT perfusion parameters and MVC.Conclusion: BF and MTT on perfusion CT provide useful information for histologicalgrade of rectal adenocarcinoma. However, CT perfusion parameter was notcorrelated to MVC.C-408DWI of the post-operative colonT. Gerukis, D. Voultsinou, A. Papachristodoulou, A. Pantazopoulou, E. Vafiadis,A. Petridis, V. Kalpakidis, P. Palladas; Thessaloniki/GR (gerukis@yahoo.gr)Purpose: To investigate the value of diffuse-weighted imaging (DWI) with the use ofapparent diffusion coefficient (ADC) measurements in the post-operative follow-upof patients with primary colon malignancy.Methods and Materials: We examined 17 patients (7 males, 10 females) withsingle-shot echo-planar diffusion-weighted MR imaging (DWI) in addition to theroutine MR protocol for the abdomen in a 1.5 T MR unit. All patients were subjectedin the past (3 months to 3 years) to colectomy for large bowel adenocarcinoma.Images were obtained in 3 b-values (0, 400, 800 s/mm 2 ) with generation of ADCmaps. Quantitative analysis was performed in regions of interest, placed on normaland pathologic tissue at the corresponding ADC maps.Results: 7 patients presented with relapse (5 local relapse and 2 presentedpathologic periregional lymph node), 5 with post-radiation fibrosis and 5 with normalfindings. The ADC values of carcinoma relapse were from 0.95 to 1.17, witha mean value of 1.08 (x 10 -3 mm 2 sec -1 ). Post-radiation changes (edema, fibrosis)showed significant higher ADC values (1.85 0.13).Conclusion: DWI with ADC measurements can give valuable additional informationduring the post-operative follow-up of patients with colon malignancies andmay be used (in adjunction to the other available sequences and techniques) fordiscrimination of post-radiation changes from relapse. Thus, we believe that it musttake a permanent place in the routine abdominal MR examination protocols.C-409Colon CAD: What the radiologists need to knowR. Ferrari, P. Paolantonio, M. Rengo, F. Vecchietti, P. Lucchesi, M. Maceroni,A. Laghi; Latina/IT (ferraririccardo@gmail.com)Learning Objectives: To provide basic and advanced description of colon CADsoftware, concerning technical basis and principal pitfalls; to understand what arethe benefits and the disadvantages of using it in the clinical workflow; to reviewresults of the most recent literature.Background: Colon CAD softwares are promising diagnostic tools in helpingradiologists reporting virtual colonoscopy and they are now being integrated inthe main 3d reconstruction workstations. It is widely demonstrated in literature thatexperience is one of most factors that affects results in reporting virtual colonoscopy.And in the recent literature, CAD software seems to be useful in reducing the gapbetween expert and inexpert readers.Procedure Details: This exhibit describes the technical basis of colon CAD softwareand the advantages or disadvantages of using them as primary, secondaryor concurrent reader. It provides knowledge on the main false positives and howto discriminate.Conclusion: Colon CAD softwares are now integrated in the major 3D reconstructionworkstations; knowing what are the main benefits of using CAD software inyour clinical workflow is a primary goal for the radiologist who approaches thistechnique and seems to reduce gap between inexpert and expert radiologists. Itis still debated in literature if the best use is as secondary reader or concurrentreader. The number of false positives in the recent softwares’ versions is not sohigh and most of them are easily discriminated.GI TractACB D E F G HS421

Scientific and Educational ExhibitsC-410ESGAR CT colonography databaseE. Neri 1 , S. Halligan 2 , J. Stoker 3 , D. Burling 4 , P. Lefere 5 , S.A. Taylor 6 , P. Rogalla 7 ,A. Laghi 8 ; 1 Pisa/IT, 2 London/UK, 3 Amsterdam/NL, 4 Harrow/UK, 5 Roeselare/BE,6Northwick Park/UK, 7 Berlin/DE, 8 Latina/IT (neri@med.unipi.it)Purpose: The European Society of Gastrointestinal and Abdominal Radiology(ESGAR) organizes CT colonography (CTC) workshops that consist in hands-ontraining on dedicated workstations. The purpose of this study (carried out by theESGAR CTC working group) was provide to the course participants a teachingresource available after the course for training in CTC.Methods and Materials: To reach this objective, 73 endoscopically verified CTCcases have been collected by multiple European centers of reference and a databasehas been developed to allow the remote access. The CTC cases, used alsofor the training during the workshops, have been stored in a DICOM web server,accessible through the Internet. Once entered in the database, a DICOM browserallows to search the cases and visualize the full dataset; dedicated remote clientscan also browse and retrieve the DICOM study.Results: The CTC cases are classified according to the C-RADS (CTC Reportingand Data System) and consist in 26 C-RADS-4 (35%), 23 CRADS-3 (31%),11 CRADS-2 (15%), 10 CRADS-1, 1 CRADS-0 (1%) and 4 flat lesions (5%). Theinternal search tool, based on the C-RADS, allows stratifying the cases in the differentclinical situations that the radiologists need to know. The first access to thedatabase has been provided to 90 radiologists who attended the 9 th ESGAR CTCworkshop in Berlin (Sept. 2008).Conclusion: The database represents a valuable teaching tool for training in CTCand a source of high quality CTC datasets compliant with the C-RADS.GI TractEsophagusC-411Eosinophilic oesophagitisS. Morgan, J. Ash-Miles, H. Roach, M. Callaway, J. Virjee; Bristol/UK(stevenmorgan21@hotmail.com)Learning Objectives: To describe the clinical manifestations and epidemiologyof eosinophilic oesophagitis (EO), and to illustrate its typical radiological findingson upper gastro-intestinal barium studies.Background: EO is a chronic and benign condition increasingly being recognisedas a distinct form of oesophagitis. It usually presents as food bolus obstruction in ayoung adult and is therefore important for the general radiologist to be aware of thediagnosis and recognise the typical radiological features. Barium swallow examinationis often the first diagnostic test, and can demonstrate features diagnostic of EO.This may obviate the need for more invasive and expensive investigations.Imaging Findings: We present a collection of subtle yet typical radiological signsof EO. We will illustrate these and provide endoscopic and pathological correlations.Conclusion: EO is often an unrecognised diagnosis in young adults. There aresubtle yet typical radiological findings of this increasingly prevalent disease that areimportant for the general radiologist to be aware of and recognise.C-412Imaging findings in esophageal carcinoma: Diagnosis, follow-up andcomplicationsA.F.L. Carneiro, P.F.G. Sousa, D.M. Rocha, A.S. Preto; Porto/PT(alexandrelimacarneiro@gmail.com)Learning Objectives: To describe the imaging findings in MDCT and MRI ofesophageal carcinoma.Background: Esophageal carcinoma is a common and deadly cancer, usuallydiagnosed with endoscopic or fluoroscopic studies. Advances in MDCT and MRItechniques, combined with use of oral or multiphasic IV contrast media improvethe detection, staging and monitoring of esophageal carcinoma and its complications.Imaging Findings: Esophageal carcinoma most commonly presents in CT studiesas a wall thickening or mass, most conspicuous in the arterial or venous phase.The latter phase is also optimal for detection of local nodal involvement or distant(thoracic or abdominal) metastasis. Similar findings can be expected, and, as such,characterized, following local cancer recurrence after surgery. CT is also useful fordetection of complications such as mediastinitis, fistulous tracts and monitoring ofendoluminal stents. Suspected fistulas, not apparent in fluoroscopy, may be betterdelineated with CT after oral contrast. MRI studies best depict the esophageallayers in T2w sequences. In selected cases, mucosal thickening not visible in CTwill be apparent in MRI and more accurately staged accordingly.Conclusion: Current CT and MRI techniques for examination of the esophagusallow diagnosis of most cases of esophageal carcinoma, as well as confidentstaging and follow-up.C-413The accuracy evaluation of FDG-PET for the diagnosis of lymph nodemetastasis of esophageal cancer and relationship between cancer amountin lymph node and the FDG uptakeS. Okazumi 1 , K. Shuto 2 , K. Narushima 2 , R. Kato 1 , H. Matsubara 2 ; 1 Sakura/JP,2Chiba/JP (sokazumi@hotmail.com)Purpose: Currently, diagnosis of lymph node metastasis by FDG-PET is consideredto show high specificity and low sensitivity. In this study, the relationship betweenFDG uptake of metastatic lymph nodes and the amount of metastatic cells in eachnode was investigated by dissected lymph nodes specimen and its significancewas estimated.Methods and Materials: 83 cases with esophageal cancer (which included 40cases with preoperative chemoradiation and 43 cases with no adjuvant therapy) whounderwent esophagectomy with 3 field lymph node dissection. The total number ofdissected nodes was 3434 including 124 metastatic nodes. 370 MBq of FDG wasadministered intravenously and whole body PET (GE Advance NXi) was done beforeesophagectomy. Lymph nodes uptakes of FDG were evaluated by standardizeduptake value (SUV) and SUV 3.0 was used as the index of preoperative diagnosisof metastatic node. After operation, the accuracy of preoperative FDG-PETwas estimated in each node, and then the diameter and occupying ratio of cancerCS422 A B D E F FG H

Scientific and Educational Exhibitscells in each metastatic node on the pathological specimen was examined andcompared with its FDG uptake.Results: The sensitivity, specificity and accuracy of the preoperative PET diagnosiswere 96.3, 16.8 and 99.3%, respectively. The uptakes (SUV) and thediameter:cancer occupying ratios were significantly correlated (r=0.47, p 0.001),and the uptake of the SUV 3.0 needed the diameter (mm):cancer occupyingratio 3.0.Conclusion: FDG-PET diagnosis for lymph node metastasis of esophagealcancer depends on the diameter:cancer occupying ratio of the lymph node and itsdiagnostic index is over 3.0.C-414Ultrasonographic evaluation of coronary veins as an esophageal varicespredictorO. Persiva 1 , X. Serres 1 , M. Sarrias 2 , S. Roche 1 , C. Vilà 1 , J. Genescà 1 ;1Barcelona/ES, 2 Sant Pere de Ribes/ES (opersiva@yahoo.es)Purpose: To assess ultrasound as an esophageal varices presence predictor inchronic hepatopathy patients on the basis of coronary/left gastric veins evaluationby using endoscopy as the reference standard.Methods and Materials: Ultrasound data in 274 patients are included and correlatedto endoscopy findings. Sonographic parameters include: spleen size, portalvein velocity and diameter, liver parenchyma characteristics and coronary veinspresence, size and flux direction. Endoscopy evaluation assessed presence andseverity of esophageal varices. Multivariate statistical analysis is calculated and receiveroperating characteristic (ROC) curves are constructed for these variables.Results: Results are shown as area under ROC curves (AUC) with 95% confidenceinterval (CI). Portal vein diameter (AUC 0.68 [95% CI: 0.621, 0.750]), spleen size(AUC 0.66 [95% CI: 0.606, 0.72]), liver characteristics (AUC 0.70 [95% CI: 0.646,0.755]) and coronary veins size and flux direction (AUC 0.69 [95% CI: 0.631, 0.748])are statistically significant non-invasive predictors of esophageal varices.Conclusion: Sonographic assessment of size and flux direction in coronary/leftgastric veins is a useful non-invasive test to predict the presence of esophagealvarices in chronic hepatopathy patients.GI TractPeritoneumC-416Abdominal tuberculosis: A reemerging diseaseC. Pérez, M. Sola, M. Menso, X. Salvador, J. Pernas, D. Hernandez,E. Montserrat, P. de la Torre; Barcelona/ES (msola@santpau.cat)Learning Objectives: To review the abdominal tuberculosis physiopathology. Toreview by means of CT, MR, US and barium studies several cases of abdominaltuberculosis involving liver, pancreas, kidney, bladder, mesentery, peritoneum,esophagus, colon and ileocecal area. To emphasize, especially for new radiologistgenerations, that tuberculosis is still an important diagnostic.Background: Due to several factors, tuberculosis has experienced a new increasein our population. Tuberculosis is well known for its mimicking abilities and is oftenconfused with neoplastic processes. Its diagnosis can be very difficult and oftenrequires invasive procedures.Procedure Details: Several cases of, histologically or culture positive proven,abdominal tuberculosis involving liver, pancreas, genitourinary, mesenteric, peritoneum,esophagus and ileocecal area by means of CT, MR, US and barium studiesare used to illustrate the many faces of this infectious entity.Conclusion: The increase in abdominal tuberculosis in general population, dueto several demographic changes, obliges to include this entity in the differentialdiagnosis of several abdominal pathologies, especially in atypical cases. Knowingthe different presentations helps, especially for younger radiologists, to reach thediagnosis.C-417Peritoneum: Anatomy, physiology and pathologyC.L. Fernandez Rey, I. Gutierrez Lopez, E. Montes Perez, S.M. Costilla Garcia,D.J. Gonzalez Suarez, A. Alvarez Cofiño; Oviedo/ES(cristinarey80@hotmail.com)C-41564-MDCT perfusion of esophageal carcinoma with 40-mm tumor coverageA. Djuric-Stefanovic, D. Saranovic, D. Masulovic, A. Ivanovic; Belgrade/RS(avstefan@eunet.yu)Purpose: 64-MDCT enables quantitative assessment of the perfusion parameters(BF, BV, MTT and PS) within 40-mm length of the tumor volume. In the majority ofthe available studies, perfusion parameters were calculated for the 5- or 10-mmthick part of the tumor. Therefore, we analyzed the differences in the values of theperfusion parameters between 5- and 40-mm esophageal tumor coverage.Methods and Materials: CT perfusion studies were performed in 24 patients usingthe following protocol: 50 ml contrast, flow 4 ml/s, delay 5 s, cine mode acquisitionof 8 contiguous 5-mm axial images/1 s, scan duration 50 s. Perfusion CT studywas loaded into the software (Perfusion 3, GE) and perfusion parameters (BF, BVand MTT) were calculated for each of 8 tumor levels scanned. The average valuesof BF, BV and MTT for 40-mm long tumor volume were statistically compared withvalues of single 5-mm axial image at the level of maximal tumor diameter, for eachpatient (paired-sampled T test).Results: The average values of BF and BV in 40-mm long part of tumor weresignificantly different in comparation with single 5-mm thick slice at the level ofmaximal tumor diameter (BF- 89 ml/min/100 g: 96 ml/min/100 g, p 0.01; BV -4.97 ml/100 g: 5.51 ml/100 g, p 0.05). No significant difference was find for MTT(6.31 s: 6.39 s, p 0.05).Conclusion: 64-MDCT with 40-mm tumor coverage could improve quantitativeassessment of esophageal carcinoma perfusion parameters, if each of eight 5-mmthick tumor levels is analysed by perfusion software.Learning Objectives: To describe the normal anatomy and the pathology of theperitoneum. To discuss the usefulness of multidetector CT with multiplanar reformationin the evaluation of peritoneal pathologies.Background: Peritoneum is a large and thin serous membrane that lines peritonealcavity and involves most abdominal viscera. Therefore, peritoneum and peritonealspaces are commonly affected in many primary and second pathologies. Radiologistsmust be familiar with the anatomy and physiology of the peritoneum, as wellas the spectrum of peritoneal pathologies.Imaging Findings: 1. Anatomy: We review the anatomy of the peritoneum: peritonealspaces, omentum, ligaments and mesenteries. 2. Physiology: We discuss thephysiological factors that determine the location and the dissemination of peritonealdiseases: anatomic boundaries and physiologic flow of peritoneal fluid. 3. Pathology:We present a diverse spectrum of both primary and second peritoneal pathologiesincluding inflammatory conditions, tumor and tumor-like lesions, systemic diseases,traumatic and vascular processes, and internal hernias. We also discuss the keyconcepts in the diagnosis of the peritoneal diseases: characteristics of peritonealfluid and collections (density, location, mass effect), malignant ascitis versus beningascitis, and disproportionate fat stranding.Conclusion: Knowledge of anatomy and physiology is important to determine theorigin, cause and extent of the peritoneal pathologies. Multidetector CT with multiplanarreformation improves the resolution of peritoneal spaces and the detectionof pathologic conditions.C-418[18 F]FDG-PET/CT diagnosis of radiologically occult peritonealcarcinomatosis in asymptomatic patients with suspected recurrent pelvicmalignancies based on elevated tumor marker serum levelsM.G. Skilakaki, D.N. Exarhos, E.V. Skoura, S. Tsolaki, P. Rondogianni,I.E. Datseris; Athens/GR (skmaria@otenet.gr)Purpose: Although peritoneal metastases are commonly encountered in patientswith pelvic malignancies, their diagnosis with conventional imaging modalities (US,CT, MRI), especially during early peritoneal spread, is challenging. The aim of thisretrospective study is to assess the value of [18 F]FDG-PET/CT in the identificationof radiologically occult peritoneal carcinomatosis.Methods and Materials: From July 2007 to June 2008, 17 patients with knownpelvic malignancy (7 with colorectal cancer, 8 with ovarian cancer and 2 with cervicalcancer), status post-treatment, 39-78 years old (mean age: 60 years) underwent[18 F]FDG-PET/CT at our institution for suspected recurrence because of asymp-GI TractACB D E F G HS423

Scientific and Educational Exhibitstomatically elevated tumor marker serum levels (CEA, CA-125, CA 19-9). All patientshad previously performed - within less than a month - negative conventional imagingtests: CT of the chest and CT and/or MRI of the abdomen and pelvis.Results: Peritoneal infiltration was revealed in 12 of 17 patients (70%). Peritonealmetastatic disease was present in 5 men with colorectal cancer, 6 women withovarian malignancy and 1 woman with cervical cancer. In 8 of 17 patients (47%), thepresence of peritoneal metastases was the only finding indicative of recurrence.Conclusion: In this study, [18 F]FDG-PET/CT had increased sensitivity for diagnosisof peritoneal metastases compared to conventional imaging modalities. We thinkthat at the appropriate clinical setting, 18 F]FDG-PET/CT could be incorporated inthe diagnostic work-up of suspected peritoneal carcinomatosis. Further investigationwith prospective studies is needed to address this hypothesis.C-419The different types of internal hernia after laparoscopic Roux-En-Y gastricby-pass for morbid obesity: MDCT featuresA. Kawkabani Marchini, A. Paroz, S. Romy, M. Sutter, A. Denys, P. Schnyder,S. Schmidt; Lausanne/CHLearning Objectives: 1. To provide an overview of the different types of internalhernia (IH) occurring after laparoscopic Roux-en-Y gastric bypass (LRYGBP) formorbid obesity. 2. To describe correspondent MDCT features in relation with theunderlying anatomical landmarks in order to differentiate their localisation and todirect the surgeon during following laparoscopic closure of mesenteric defects.Background: LRYGBP for morbid obesity is associated with less perioperativecomplications, shorter hospital stay and a more rapid recovery compared with theopen surgical procedure. However, a relatively high incidence of IH is seen thatmay be due to the laparoscopic approach, but also caused by rapid weight losswith consecutive loosening of the mesenteric sutures.Procedure Details: After briefly reviewing the surgical procedure of LRYGBP(ante- versus retrocolic), we describe the exact anatomical landmarks of the differenttypes of IH occurring at any time after operation: They are caused by surgicaldefects at the level of the transverse colon mesentery, at the Petersen’s space,which represents an opening between the mesocolon and jejunal mesentery, orat the entero-enterostomy site. Typical MDCT features of each IH type in axial andcoronal planes as well as targeted vascular reconstructions are demonstrated.Conclusion: Exact knowledge about underlying pathophysiology and anatomicallandmarks is essential for distinguishing the different types of IH occurring afterLRYGBP on MDCT, since radiological features are difficult to recognize and mayeven overlap. The radiologist should be aware of the potential anatomic sites toensure subsequent straightforward laparoscopic exploration.C-420A myriad of mesenteric massesS.P. Ramachandra, M. Bydder, S. Vessal; Stoke-on-Trent/UK(spr31@hotmail.com)Learning Objectives: The aim of this article is to describe the CT features of variousmesenteric tumours, tumour like conditions and also to discuss the approachto differential diagnosis.Background: The primary mesenteric neoplasms are rare. However, small bowelmesentery is a major route for the tumour dissemination. CT is the imaging modalityof choice for identifying these lesions. CT features along with clinical historymay guide towards the diagnosis, although image guided/surgical open biopsyis often required to confirm the diagnosis. Due to the clinical symptoms beingnon-specific, CT plays an important role towards the diagnosis and managementof the patient.Imaging Findings: In this article, we discuss the characteristic CT features ofprimary mesenteric tumours, metastases as well as conditions mimicking thetumours.Conclusion: CT remains the dominant imaging modality for the diagnosis ofmesenteric masses. As there is an overlap of radiology and pathologic features,knowledge of these neoplastic and inflammatory conditions is important for thediagnosis and appropriate management of the patient.C-421Peritoneal carcinomatosis: Pathways of disease spread and spectrum ofimaging findings in MDCTD. Miranda 1 , R. Duarte 2 , A. Salgado 3 , A. Salgueiro 1 , M. Ribeiro 1 ; 1 Matosinhos/PT,2Vila Nova de Gaia/PT, 3 Porto/PTLearning Objectives: To review the anatomy of the peritoneal spaces. To describethe mechanisms and pathways of disease spread through the peritoneal cavity. Toillustrate the imaging findings of malignant peritoneal seeding on MDCT, basedon 50 pathologic proved cases.Background: The peritoneal recesses are important anatomic boundaries thatdefine the dynamic routes of peritoneal fluid circulation. The normal ascendant flowof the peritoneal fluid, which depends on the negative pressure gradient betweenthe abdomen and pelvis, is arrested by these peritoneal reflections. Malignantperitoneal seeding tends to accumulate in four major dependent sites due to theseanatomic landmarks: pouch of Douglas, left lower quadrant, right lower quadrantand right paracolic gutter.Imaging Findings: The presence of peritoneal carcinomatosis significantly influencestumor staging, prognosis and patient management. Thus, an early andaccurate recognition of this entity is essential. Peritoneal carcinomatosis canhave a variety of appearances, including ascites, pseudomyxoma peritonei andperitoneal implants.Conclusion: The recognition of peritoneal carcinomatosis is essential in tumorstaging and patient management. A comprehensive knowledge of the peritonealanatomic landmarks and pathways of seeding provides a systematic review approach,improving the accuracy in peritoneal metastases detection.C-422Update in mesenteric and omental disease: CT and MR findingsM. Fernández López-Peláez, M. García Isidro, F. Bergaz Hoyos,E. Ayerbe Unzurrunzaga, M. Parras Jurado, E. De Luis Pastor, A. Duque Taurá,J. Cobo Soler; Madrid/ES (fernandezlpm07@yahoo.es)Learning Objectives: To update a review of pathologies, which may involvemesentery and omentum. To approach differential diagnosis based on CT andMR images. To illustrate common and unusual radiological findings. To discuss orillustrate radiopathological correlation.Background: Mesentery and omentum may be involved in many systemic processes,but less commonly, they present as isolated disease. Differential diagnosis,initially based on imaging techniques, is crucial for management and prognosis.Procedure Details: We show an interesting review of diffuse and focal involvementfrom primary or secondary etiology, diagnosed in our department with multislice-CTor MR. Confirmation was made by cytology or biopsy.Conclusion: Mesentery and omentum may be involved in many systemic processes.However, differential diagnosis with primary diseases is important for theirmanagement and prognosis. This exhibit illustrates a current review of severaldiseases, which may involve primarily or secondly mesentery and omentum, withspecial emphasis on multislice-CT and MR radiological findings.C-423Tumour seeding: Spectrum of imaging findings and clues to diagnosisS.V. Setola, O. Catalano, A. Nunziata, A. Siani; Naples/IT (sesetol@tin.it)Learning Objectives: The aim of this exhibit is to illustrate the imaging findings inpatients with tumour seedings and to review their causes.Background: Tumour seeding is the consequence of an iatrogenic transport oftumour cells during open surgery, laparoscopic procedures (port tracks), or percutaneousprocedures (biopsy, drainage, and ablation therapy). In most cases, tumourseeding appears few months after the procedure as a single, vascularised nodulewithin the abdominal wall, placed along a surgical scar or along the presumptivepath of a percutaneous procedure. The underlying tumour mass is typically locatedin proximity to the seeding site with a superficial location. Risk factors includemetastatic mass nature, poor differentiation grade, large instrumentation calibre,repeated percutaneous procedures, and scarce operator skill.Imaging Findings: We show a variety of tumour seeding locations (chest wall,abdominal wall, liver parenchyma, etc). as imaged by several modalities (sonography,colour-Doppler, CT, and MRI). The presumptive path of the needle or anyother percutaneous instrument is considered. Differential diagnosis mostly includesnon-iatrogenic tumour spread, infection, granulomas, and fluid collections.Conclusion: Knowledge of patient history is important to detect a tumour seedingdeveloped at level of surgical scars, laparoscopic accesses, or percutaneousaccesses. Early diagnosis is important because frequently patients with tumourseeding can still be treated radically (surgery or ablation therapy).CS424 A B D E F FG H

Scientific and Educational ExhibitsC-424Appliance of the new Choi CT response patterns to the MR evaluation ofpatients affected by advanced GIST during molecular targeted therapy(imatinib mesylate)A. Messina, C. Morosi, P. Casali, A. Gronchi, E. Fumagalli, M. Raciti,D. Vergnaghi; Milan/IT (messanto@tin.it)Purpose: To evaluate the applicability of the new Choi CT patterns of tumorresponse to molecular targeted therapy in advanced GIST to MR imaging, withcorrelation to Recist criteria.Methods and Materials: 25 pts with abdominal advanced GIST (225 liver lesionsand 75 peritoneal lesions) underwent therapy with imatinib mesylate. All ptsperformed MR examinations at baseline and then at 2, 4, 6, 8, 10 and 12 monthsduring treatment with a 1.5 T system using TSE T2w and dynamic ce 3D-GRET1w sequences. MR pattern in responsive patients according to Recist criteriawas tumor decrease in size. MR pattern in responsive patients according to thenew Choi criteria was the decrease of vascularization 15% on semiquantitativeperfusional evaluation.Results: On morphologic MR evaluation, using dimensional criterion, 14/25 ptshad a RECIST “Partial Response”, 5/25 pts had a RECIST “Stable Disease” and6/25 pts had a RECIST “Progression Disease”. On MR vascularization, evaluation20/25 pts had an MR “Partial Response” pattern, 3/25 had an MR “Stable Disease”pattern and 2/25 had an MR “Progression Disease” pattern.Conclusion: Through the morphologic RECIST criteria, we were able to appreciateonly a portion of pathologically responsive patients. The assessment of vascularizationon MR imaging may usefully integrate the dimensional data, in order to clinicallypredict the pathologic tumor response.C-425Abdominal wall mass: Evaluation with CT and USGY. Lee, Y. Kang, E. Heo, Y. Sohn; Iksan/KR (yjyh@wonkwang.ac.kr)Learning Objectives: 1. To understand the anatomy of abdominal wall for differentialdiagnosis of abdominal wall masses. 2. To review the spectrum of imagingfindings of high resolution ultrasonography and multi-detector CT of various palpableor non-palpable abdominal masses.Background: In many clinical practices, abdominal wall masses can be detectedby patient’s symptoms or physical examination. However, without the typical clinicalmanifestation, it is difficult to detect or characterize various abdominal masses.Ultrasonography is an easy and convenient method to determine the presence orabsence of abdominal wall lesions and it is useful for differential diagnosis with itscharacteristic imaging findings. Recent development of multi-detector CT technologyallowed high resolution body imaging; it can detect more small masses ofabdominal wall and it can also evaluate peritoneal pathology.Imaging Findings: In this exhibit, we will illustrate the CT and US imaging findingsof various pathologic conditions of abdominal wall such as hernia, variable solidand cystic tumors, hematoma, infectious diseases, endometriosis, and vasculardiseases. The clinical history, location of the lesion and characteristic imaging featuresare key points to reach the correct diagnosis. We also perform the radiologicpathologiccorrelations, if they are surgically confirmed cases.Conclusion: 1. Abdominal wall masses are not uncommon diseases that manifestwith solitary or multiple, palpable or non-palpable lesions, can be associatedintraperitoneal disease processes. 2. Imaging diagnosis including CT and ultrasonographycan play an important role to detect and characterize the variousabdominal wall masses.Learning Objectives: Early diagnosis of peritoneal spread in malignant diseaseis essential to prevent unnecessary laparotomies and to select the patients inwhom complete cytoreduction and perioperative intraperitoneal chemotherapyis feasible.Background: Although anatomic imaging is the mainstay for evaluating peritonealseeding, small neoplastic implants can be difficult to detect with CT and MRimaging.Results: 64 rows MDCT with I.V. contrast has the potential by using thin slice(625 mm) and MPR reconstructions to improve detection of peritoneal metastases.In this poster, we review different appearances, diagnostic patterns of peritonealspread after dividing abdomen into 9 anatomical regions. It is important for radiologiststo know what is important to evaluate in those patients affected by peritonealcarcinomatosis. Distinct patterns appear to predict the presence of either nodularor diffuse peritoneal pathology. MDCT is one of most suitable imaging modality inpatients with high tumor markers in selecting patients for complete cytoreductionand perioperative intraperitoneal chemotherapy.Conclusion: 64 rows MDCT imaging in the detection and staging of peritonealcarcinomatosis and is a useful diagnostic tool in evaluating peritoneal carcinomatosis,monitoring response to therapy and in long follow-up.C-427Exploring peritoneal cavity: Practical approach to peritoneum visualized inmulti slice computed tomographyE. Czekajska-Chehab, G. Staskiewicz, S. Uhlig, E. Siek, A. Drop; Lublin/PL(uhlig.s@eranet.pl)Learning Objectives: To review normal anatomy of peritoneum, particularly foridentification of ligaments, recesses and vessels. To remind main pathologies andtheir potential routes of spread in relation to communication of parts of peritonealcavity.Background: The peritoneum serves not only as a support for abdominal organs,but also forms a complex communication system of blood and lymph vessels,ligaments and recesses that determines specific pathologies of peritoneum andpotential routes of spread of diseases such as inflammations or neoplasms. Thefamiliarity with normal anatomy of peritoneum is essential for correct comprehensionof pathophysiology of these processes. The authors realized that this knowledge islimited among young residents, who consider it exceptionally difficult. Therefore, anattempt of clear and short explanation anatomy and the review of most commonpathologies of peritoneum was made.Procedure Details: Axial scans as well as VR, multiplanar and MIP reformationswere used for visualization of peritoneum. Colored segmentation technique wasapplied for clear presentation of separate structures of peritoneum paying specialattention for its possible involvement in selected pathologies. The most commondiseases affecting peritoneum are presented.Conclusion: Multi slice computed tomography allows detailed visualization ofperitoneum and its substructures and appropriate knowledge of anatomy is usefulin evaluation of pathologies of abdominal cavity, especially diffused ones. Postprocessingtechniques are extremely useful in explaining the complex anatomy of bloodvessels, spaces and ligaments especially for inexperienced readers.C-426Imaging of peritoneal carcinomatosis with 64-MDCT: What radiologistsneed to know now - diagnostic patterns, case examples and pitfallsF. Iafrate 1 , A. Stagnitti 1 , A. Pichi 1 , D. Caruso 2 , F. Vecchietti 1 , D. Geiger 1 , A. Laghi 2 ;1Rome/IT, 2 Latina/IT (francoiafrate@gmail.com)GI TractACB D E F G HS425

Scientific and Educational ExhibitsGI TractRectumC-428Dynamic MRI assessment of rectocele in obstructed defecation: Evaluationof symptoms related to the evacuation dynamics, expulsion times andassociated pelvic floor disordersA. Salzano 1 , V. Nocera 2 , V. Cavallo 2 , A. Nunziata 2 , E. Montemarano 2 , P. De Feo 2 ;1Frattamaggiore/IT, 2 Naples/ITLearning Objectives: A series of 68 female patients (mean age of 61 years)suffering from obstructed defecation were studied by dynamic MRI. Our objectiveis to evaluate the main shape changes of rectum as rectocele in order the wholepelvic floor dynamics, the size of rectocele during evacuation phases and expulsiontimes, the association with rectal prolapses, and their relationship with pelvicfloor disorders.Background: MRI was carried out in breathe hold with T2-weighted scans at supinepatient, previously investigated by defecography. To better understand the functionalmechanism of rectocele in order to obstructed defecation, dynamic MRI scans wereacquired during different manoveurs of pelvic floor. This is to depict well the sizeand MRI appearance of rectocele during pelvic floor excursion.Imaging Findings: We recognized 56 perineal descent syndromes, 52 rectoceles,48 rectal mucosal and wall prolapses, 29 cystoceles, 17 rectal intussusceptions,15 puborectalis muscle syndromes and 14 urethroceles. In 39 patients with largerectoceles (mean diameter of 5.6 cm), we observed blockage sensation of evacuation,subjective sensation of incomplete defecation, long evacuation times (up to5 minutes), prevailing more than of 67% of perineal descent syndromes and rectalprolapse pathologies.Conclusion: Thanks to dynamic MRI of pelvic floor, we focused a correlation betweenMR features and obstructed defecation, suggesting that in patients with largerectoceles the symptomatology is worsened by rectal wall prolapse and rectal intussusception.In fact, in the other cases of rectoceles with low percentage and entityof rectal prolapse, the treatment of symptoms improved defecation difficulties.C-429A pain in the butt: An MRI pictorial review of benign anorectal conditionswith clinical correlationN. Chew, K. Shahabuddin, N. Khan; London/UK (drchew01@googlemail.com)Learning Objectives: To review the anatomy, pathophysiology and MRI appearancesof benign conditions affecting the ano-rectal region. To understand thecentral role of imaging in these benign anorectal conditions in terms of patientmanagement.Background: Benign anorectal conditions can be painful and debilitating. Broadly,it divides into 2 categories: 1. Infective conditions: Condyloma acuminata, perianalabscess and fistulae. 2. Non-infective/ Iatrogenic conditions: Anal fissures,haemorrhoids including thrombosed haemorrhoids, solitary rectal ulcer syndrome,rectal prolapse, proctitis.Imaging Findings: Imaging findings on MRI in benign anorectal pathology arediverse. We illustrate these conditions with real life examples and line drawingcorrelation.Conclusion: We describe clinically and illustrate on MRI a spectrum of benignanorectal diseases.C-430High-field (3 T) magnetic resonance defecography with functionalassessment of the evacuation phase: A pictorial essayA. Anaye, V. Goncalves-Matoso, J.-Y. Meuwly, P. Schnyder, S. Schmidt;Lausanne/CHLearning Objectives: 1. To describe the adequate technique of dynamic highfieldMRI (3 T) in assessing pelvic floor disorders. 2. To provide an overview of themost common pathologies occurring during the evacuation phase, especially incomparison with results of conventional defecography.Background: Dynamic high-field magnetic resonance (MR) defecography includingthe evacuation phase is a promising tool for the assessment of functional pelvic disorders,nowadays seen with increasing frequency in elderly women in particular.Procedure Details: After description of the ideal technical parameters of MRdefecography performed in supine position after gel rectal filling with a 3 Tesla unitand including the evacuation phase, we stress the importance of using a standardizedevaluation system for the exact assessment of pelvic floor pathophysiology.The typical pelvic floor disorders occurring before and/or during the evacuationphase, such as sphincter insufficiency, vaginal vault and/or uterine prolapse,cystourethrocele, peritoneo-/entero-/ sigmoïdocele or rectal prolapse are demonstrated.The difference between the terms “pelvic floor descent” and “pelvicfloor relaxation” are pictorially outlined. MR results are compared with these ofconventional defecography.Conclusion: Exact knowledge about the correct technique including the evacuationphase and the use of a standardized evaluation system in assessing pelvic floordisorders by dynamic high-field MRI is mandatory for accurate and reproduciblediagnosis.C-431Perianal fistulae: MRI appearance and classificationK. Au Yong, N.J. Coupe, G. Tony, S. Vessal; Stoke-on-Trent/UK(kong.auyong@gmail.com)Learning Objectives: 1. A pictorial review of the complex anatomy of the perianalregion and how the organization of anatomy dictates the course of fistulous tracts.2. Illustration of the MRI appearance of perianal fistulae and associated complications.3. Description and demonstration of imaging classification and the relevanceto surgical planning.Background: Perianal fistula is a relatively uncommon GI condition but associatedwith high morbidity. A previous anorectal abscess usually causes the condition butfistulae can develop secondary to trauma, Crohn’s disease, fissures, carcinoma,radiation therapy and infections. MRI is excellent in demonstrating the anatomy ofthe perianal region including the extent of fistulous tracts and their relationship tothe sphincter complex and ischiorectal fossae. This is important for correct surgicalmanagement and MRI has been shown to provide 80-90% concordance withoperative findings.Imaging Findings: Our exhibits use a variety of MRI sequences and post-processedimages to demonstrate the spectrum of imaging findings in perianal fistulaewith specific emphasis on the relationship of fistula extent to the normal anatomyand the appearance of complications. We will also relate the imaging findings tothe Parks surgical classification system.Conclusion: MRI is excellent in the diagnostic work-up of patients with perianalfistula. It is able to demonstrate secondary extension of the primary fistulae andany complicating pathology. The recognition of fistulae and accurate imaging classificationwill allow appropriate surgical planning and management.C-432MR imaging classification of perinal fistulas: All that the radiologist needto knowJ. de Miguel Criado, M. Diez de Vacas, F. Aguilera del Hoyo,L. Gutierrez Velazquez, L. Garcia del Salto, A. Marco Sanz, C. Cristos Alvaro,E. Cuevas, P. Fraga Rivas; Coslada/ES (jaimedemiguel@telefonica.net)Learning Objectives: To illustrate the MRI spectrum of perianal fistulas. To explainthe essential teaching points and its important implications for surgical managementand outcome. To describe the MRI anatomy of the perianal region.Background: Perianal fistulization is an uncommon but important condition of thegastrointestinal tract that causes a substantial morbidity. To understand the surgicaloptions for treating fistulous disease, it is necessary to demonstrate accurately theanatomic relationship between the perianal fistula and the anal sphincters. In thisexhibit, we will review the anatomy of the perianal region, the surgical managementand the useful MR imaging protocols.Imaging Findings: MR imaging examinations was performed with a body-array coil,without patient preparation. We used T1 and T2-weighted sequences in sagital andaxial planes and T1-weighted contrast-enhanced sequences in axial and coronalplanes. We used an MR imaging-based grading system for perianal fistulas (StJames’s University Hospital classification) to characterise the perianal fistulas.Conclusion: We show the essential key points in the assessment of perianal fistulaand their surgical implications as well as examples of the imaging findings of StJames’s University Hospital MR imaging classification of perianal fistula.C-433Rectal cancer: The role of MR imagingS.C.P. Costa Dias, L. Gonçalves, S. Kurochka, H. Torrão, V. Mendes; Braga/PT(silviacostadias@hotmail.com)Learning Objectives: To review the MR anatomy of the rectal region and theimaging features of rectal cancer. To discuss the advantages and limitations of MRimaging in this pathology. To systematize the information that the radiologist shouldprovide in the report, presenting practical cases.CS426 A B D E F FG H

Scientific and Educational ExhibitsBackground: Rectal cancer is a common disease with a high mortality rate. Imagingplays a fundamental role in the preoperative evaluation, providing local anddistant staging. In the local staging, MR has clearly gained advantage to endorectalultrasound due to its large field of view, being more suitable for staging advancerectal cancer. In the distinction among T1 or T2 stage tumors, endorectal ultrasoundremains the more accurate technique, offering better spatial resolution.Imaging Findings: The evaluation of the involvement of the mesorectal fat andmesorectal fascia is now considered the cornerstone for treatment planning,even more important that T staging. The assessment of the distance between thetumor and the mesorectal fascia is a valid criterion to predict the infiltration of thecircumferential recession margin, defining which patients benefit from preoperativetreatment or direct surgery. Another parameter that has to be analyzed is thesphincteral involvement in order to consider a sphincter-sparing surgery. Thisreview will be documented with cases of our institution, providing an overview ofthe different tumor stages and illustrating the mentioned crucial points in the MRevaluation of the rectal cancer.Conclusion: MR imaging in rectal cancer is a very powerful instrument, improvingthe management of these patients.C-434MRI evaluation of extra mural vascular invasion in rectal cancerP.L. Perera, S. Patel, J. Sington, S.M. Williams; Norwich/UK (pras@doctors.org.uk)Learning Objectives: To present a pictorial representation of the appearances ofextramural vascular invasion (EMVI) in rectal cancer as seen on MRI and histology.To demonstrate the signs of EMVI on MRI. To evaluate the accuracy of detectionof EMVI on MRI in a non-specialist centre.Background: Treatment of rectal cancer includes surgery pre and/or post operativechemo-radiotherapy. The advent of improved neo-adjuvant therapies hascalled for accurate preoperative staging to enable optimal timing and combinationof treatment. For example, presence of EMVI is one of the factors that would favourpre operative therapy. Compared to previously used imaging techniques, such asendorectal US and CT, MRI demonstrates greater accuracy in identifying EMVI,depth of invasion, nodal status and circumferential resection margin (MERCURYproject).Imaging Findings: 12 patients who had histologically proven EMVI were selectedand their MRI reports reviewed. The scans were reviewed to look for radiologicalsigns of invasion. None of the 12 patients was reported as having definite EMVIon MRI. In retrospect, four of these patients could be identified on MRI. SelectedMRI images with corresponding histology slides are presented.Conclusion: The detection rate of EMVI on MRI is poor. This could be due toseveral reasons including inadequate imaging protocols and reporter dependantfactors. Reiteration of MERCURY guidelines on the radiological signs of EMVI andreviewing imaging protocols will be of value.C-435Perfusion CT of rectal cancer: How to perform it and information we can getL. Curvo-Semedo, M. Seco, F. Cavalheiro, F. Caseiro-Alves; Coimbra/PT(rdd61333@mail.telepac.pt)Learning Objectives: To explain how to perform a perfusion CT examinationfor the study of rectal cancer. To discuss the functional information that could bederived from such a study.Background: In the Western world, colorectal cancer is one of the most frequentlydiagnosed tumours and is among the highest mortality rates due to neoplasticcauses. The 5-year survival depends on tumor stage at the diagnosis: tumours withadvanced stage at presentation are associated with poor outcome. Accordingly, thetumor stage guides treatment options. Some therapies created a need for functionalassessment of tumour response and this purpose has driven the development ofperfusion CT examinations.Imaging Findings: Perfusion CT is obtained through acquisition of a series of imagesat the same location over a period of time from which it is possible to generatea time-attenuation curve displaying the temporal changes in iodine concentrationresulting from the contrast injection. With appropriate mathematical modelling ofdata from tissue and the vascular systems, quantitative functional information canbe derived. It allows measurement of tumour vascular physiology and providesquantitative information on perfusion parameters including blood flow, blood volume,mean transit time, and vascular permeability-surface area product.Conclusion: Functional perfusion CT measurements are increasingly used tomonitor changes in tumour perfusion in response to chemotherapy and radiationtherapies. These measurements provide an in vivo biomarker of tumor angiogenesisand may obviate invasive histological analysis. Assessment of tumour vascularityby perfusion CT suggests that perfusion parameters could be important inprognostic terms.C-436Preoperative T and N staging of colorectal cancer with fusion imagingbetween diffusion-weighted imaging and 3D fat suppressed contrastenhancedT1-weighted imaging (FDWI)H. Horikoshi, T. Akiyoshi, N. Oya, A. Okayama; Ota/JP (koutan2@gunma-cc.jp)Purpose: To prospectively determine diagnostic performance of predictive criteriafor T and N staging with FDWI in primary colorectal cancer patients, with histopathologicfindings as reference standard.Methods and Materials: Seventy-two colorectal cancer patients (39 men and 33women, mean age; 62 years) underwent preoperative whole abdominal MRI using1.5 T MRI (Magnetom Avanto, Siemens, Erlangen, Germany) with total imagingmatrix (Tim) and surgical resection. DWI and 3D fat-suppressed contrast-enhancedT1WI were obtained in the axial plane. DWI was performed with respiratory gatingEPI-CHESS sequence and high b-value of 1000 s/mm 2 . FDWI was obtained byworkstation. T staging of FDWI was evaluated by one radiologist and surgeon byconsensus preoperatively. T and N staging were determined and correlated withhistopathologic results.Results: Histologically, tumors were classified as T1 in 1 patient, T2 in 8, T3 in 61,and T4 in 2, and T staging was correctly determined with FDWI in 52 patients (82%).The sensitivity, specificity, positive predictive value, negative predictive value, andaccuracy of N staging on FDWI were 71, 58, 60, 69, and 64%, respectively.Conclusion: FDWI may have an acceptable diagnostic ability for T and N stagingof colorectal cancer.C-437High resolution MRI for rectal cancer: Primer for radiology residentsS. Krishan, R. Briggs, A. Chalmers, D. Tolan; Leeds/UK(sonalkrishan11@yahoo.co.uk)Learning Objectives: 1. To understand the relevant local anatomy with emphasis onfascial planes. 2. To correlate appearances on MRI with surgical planes of excision.3. To be able to appreciate how the imaging findings relate to pathology specimens.4. To understand the pearls and pitfalls in the various imaging techniques. 5. Toknow what the surgeons and oncologists expect from radiologists.Background: En bloc surgical excision of rectal cancer with lymph nodes hasbeen proven to reduce recurrence. High resolution Imaging plays a key role in localstaging and providing the surgeons with a roadmap for their operation.Imaging Findings: We provide a pictorial review of the common imaging findingsin high resolution MR of rectum. We further describe radiolopathologic correrelationwith demonstration of various facial planes. Finally, common pearls and pitfalls arepresented that can be used as a ready reckoner by radiology residents.Conclusion: High resolution rectal MRI can provide vital anatomic informationimportant to a good surgical outcome. It is very important in planning surgery,deciding resectability and assessing benefit from pre-operative neo adjuvantchemotherapy.C-438Making sense of MR imaging of perianal fistulae, fissures, and abscesses:A gentle algorithm for beginnersP. Khatri, N. Chew, C. Davies, N. Khan; London/UKLearning Objectives: 1. To illustrate the normal MR anatomy of the anal canal andischioanal fossa, correlated with line drawings. 2. Describe a simple algorithmicapproach in the MR interpretation of perianal fistulae, fissures and abscesses withemphasis on what the surgeon needs to know. 3. Understanding the managementof these diseases and their follow-up imaging.Background: The interpretation of perianal fistulae, fissures and abscesses on MRcan be complex and confusing. Clear understanding of the anatomy is essentialin delineating the pathology on MRI and hence for planning further medical andsurgical management.Imaging Findings: Pictorial review with illustration of the normal pelvic anatomywith emphasis of the anal canal and ischioanal fossa on MRI is demonstrated.Further examples of perianal fistulae (simple and complex), fissures and abscessesare included with a systematic approach illustrated.Conclusion: Understanding the anatomy and pathophysiology of periananl fistulae,fissures and abscesses aids the accurate diagnosis of these conditions. Theseprovide the surgeons with essential information to plan further management.GI TractACB D E F G HS427

Scientific and Educational ExhibitsC-439Pearls and pitfalls of magnetic resonance staging of rectal carcinoma,post-downsizing chemoradiotherapyM. Anderson; Oxford/UK (eanderson@doctors.org.uk)Learning Objectives: To review the role of MR in the staging of rectal cancer andplanning of total mesorectal excision. To understand and illustrate the changesin the appearance of rectal tumours caused by neoadjuvant chemoradiotherapy(CRT), with pathologically staged examples. To highlight the common features thatprevents accurate image interpretation.Background: Downsizing chemoradiotherapy has transformed the treatmentof locally advanced rectal cancers. Sphincter sparing surgery is increasinglypractised.Imaging Findings: The main teaching points are: 1. The appearance of tumoursand lymph nodes after CRT and how to assess disease response both for preoperativeand palliative treatment. 2. Features that indicate a threatened resectionmargin post CRT and the role of MRI in surgical planning. 3. Features that indicatecomplete clinical response to CRT. 4. The difficulties of imaging and planning treatmentof low rectal tumours.Conclusion: The imaging of rectal tumours post downsizing chemoradiotherapyis important in surgical planning but is limited by the variability of the tumourresponse.GI TractSmall BowelC-440Feasibility of MRI in experimentally induced inflammatory small boweldisease: A pilot study in a porcine modelA. Negaard, E.-M. Loeberg, P. Naess, N.-E. Klow; Oslo/NO(anne.negard@medisin.uio.no)Purpose: To compare macroscopic and microscopic findings of experimentallyinduced inflammatory lesions in jejunum and ileum with magnetic resonance imaging(MRI) findings.Methods and Materials: In six pigs, inflammatory small bowel lesions wereexperimentally induced. Segments in jejunum and ileum were isolated and trinitrobenzenesulfonicacid and ethanol (TNBS-EtOH) solution was installed. MRI ofthe small bowel was performed 7 days after the surgery. Before the MRI, a 6%mannitol solution was installed through a nasogastric tube. The MRI protocol consistedof T2, BFFE and T1 weighted sequences with intravenous contrast. Bowelwall thickness (BWT), bowel wall enhancement (BWE) and bowel stenosis (BWS)were evaluated. After the MRI, the animals were sacrificed. The small bowel wasremoved and inspected macroscopically and microscopically.Results: Inflammatory lesions developed in jejunum and ileum. The lesions werevisible macroscopically and microscopically. The microscopic findings consistedof variable degrees of inflammation, ulcer formation and fibrosis. In jejunum theinflammatory lesions had normal bowel wall thickness and were not diagnosed withMRI, except in one pig with a bowel necrosis probably caused by an intramuralinjection or leakage of the TNBS-EtOH solution. In ileum, the bowel wall thicknesswas increased and the inflammatory lesions were diagnosed with MRI.Conclusion: The inflammatory lesions were visible macroscopically and microscopically.Lesions in ileum had increased BWT and were possible to image withMRI. Lesions in jejunum had normal BWT and were not diagnosed with MRI, exceptin one pig with increased BWT probably caused by complications.C-441A comprehensive pictorial review of inflammatory bowel disease withpathological correlationP. Balan 1 , G. Griffiths 1 , E. Morris 2 , R. Winter 2 , R. Owen 1 , G. Davies 2 ; 1 Cardiff/UK,2Llantrisant/UK (drbalan@hotmail.com)Learning Objectives: 1. Review the pathophysiology of inflammatory boweldisease. 2. Review the imaging findings. 3. Review the differentiating features andcomplications. 4. Highlight the potential pitfalls in diagnosis.Background: Inflammatory bowel disease is a common condition encounteredin routine radiological practice. It could be due to infective, ischaemic, vasculiticand other rare causes.Procedure Details: We describe the pathophysiology of inflammatory bowel diseaseand present a comprehensive pictorial review of findings on different imagingmodalities, including ultrasonography, 64 MDCT, MRI, nuclear medicine and bariumstudies to demonstrate the differentiating features and various complications. Theimaging findings are correlated with pathological findings. This review is also usedto highlight potential pitfalls.Conclusion: Accurate diagnosis of inflammatory bowel disease and identificationof complications is essential for appropriate management of patients. Knowledgeof the pathophysiology, imaging findings, differential diagnosis and awareness ofpotential complications is important for useful interpretation of images.C-442Complications of Meckel’s diverticulum: Imaging diagnosisR. Iwasa, K. Itoh, M. Hino, H. Ueda, T. Shibata, M. Hashimoto, Y. Imai; Hyogo/JP(renaiwasa0629@hotmail.co.jp)Learning Objectives: To illustrate multimodality imaging for diagnosis of Meckel’sdiverticulum and its complications, and to provide surgical correlation and pathologicfindings.Background: Meckel’s diverticulum is the most common malformation of thegastrointestinal tract, and clinical symptoms arise from complication of the diverticulum.Preoperative diagnosis of the diverticulum is sometime difficult despite theavailability and wide use of various imaging techniques. Recently as multidetectorcomputed tomography (MDCT) has become widespread, it allowed rapid, highresolutionimaging of the entire abdomen and pelvis, and multiplanar reformation(MPR) images give the best visualization of Meckel’s diverticulum often concealedby overlying small-bowel loops.CS428 A B D E F FG H

Scientific and Educational ExhibitsImaging Findings: We will illustrate the following: 1. incidentally detected Meckel’sdiverticulum without complications, 2. hemorrhagic ulcer in the diverticulum, 3.ileal strangulation associated with the diverticulum, 4. intussusception caused byinverted diverticulum, and 5. diverticulitis and perforation. Some cases mimic suchdisorders as appendicitis, peptic ulcer disease, and small intestinal lipoma. Theimaging features of these diseases will be presented on different types of imagingmodalities, including ultrasonography, MDCT, barium examination, endoscopy andscintigraphy with surgical and pathologic correlation. Usefulness of MPR imagesobtained by MDCT and specificity of scintigraphy will be discussed, and the relativeadvantage and indication for the various imaging procedures will be assessed.Conclusion: Knowledge of the clinical and radiologic characteristics of Meckel’sdiverticulum will aid in the early and accurate diagnosis of cases with complications.The imaging evaluation of patients should be tailored to their age and clinicalpresentation.C-443Diagnosing small bowel carcinoid tumor with MDCT enteroclysisG. Tóth 1 , L. Tóth 2 , E. Turupoli 1 ; 1 Budapest/HU, 2 Miskolc/HU (totgez@freemail.hu)Learning Objectives: To show the usefulness of MDCT enteroclysis in the diagnosisof carcinoid tumor. To show the different types of carcinoid tumor in thesmall bowel.Background: MDCT enteroclysis has proved to be useful for evaluating minimal bowelwall thickening, stenosis and dilatations of the small bowel, and also we can study thepathological changes of mesentery. Our goal was to localise exactly the site of carcinoidtumor, if other examinations were negative. We present the typical imaging findings ofour experience of MDCT enteroclysis. We demonstrate some of our cases.Imaging Findings: From December 2005 to September 2008, 38 CT enteroclysiswere performed to find carcinoid tumor in the small bowel. Positive findings weredemonstrated in 7 of 38 patients. CT enteroclysis were performed using the followingparameters: slice 2 mm, with overlap scans, reconstruction interval 2 mm,after administration of methylcellulose by nasojejunal tube, before and after infusionof 120 ml iv. contrast agent, at a rate of 4 ml/s with a scan delay of 35 seconds.In all cases, multiplanar reformatted images were performed. Collimation was16x0.75 mm. We found soliter, and multiplex lesions with polipoid, annular stenosing,and infiltrating appearances with typical mesenterial reactions. In 3 casespatients already had a liver mets.Conclusion: MDCT enteroclysis is a good tool in detecting carcinoid tumor inthe small bowel.C-444Is there a good correlation between perfusion of enlarged lymph nodesand CDAI in active Crohn’s disease?G. Tóth 1 , E. Turupoli 1 , L. Tóth 2 ; 1 Budapest/HU, 2 Miskolc/HU (totgez@freemail.hu)Purpose: The purpose of this study was to measure the perfusion of enlargedlymph nodes in Crohn’s disease, and to compare results with CDAI.Methods and Materials: We examined 35 patients with known Crohn’s disease.These patients had thickened wall small or large bowel with lymph nodes 1 cm.26 patients had clinically suspected exacerbation of Crohn's disease. Region ofinterest were placed over the biggest lymph node near the inflamed bowel segment.We measured the perfusion of lymph nodes. We administered 1.5 ml/kg i.v. contrastmaterial. The flow was 3.5 ml/s. Acquisition started after 20 sec of administrationof the contrast material and lasted for 45 sec at a rate of one image per 1.5 sec.Collimation was 8x3 mm. The slope of enhancement, perfusion (P) ml/100 ml/min,peak enhancement intensity (PEI), time to peak enhancement (TTP), and bloodvolume (BV) ml/100 g were determined. These results were compared with CDAI.Statistical analysis was performed using the Wilcoxon rank sum test.Results: The signal intensities of the perfusion scans were measured and displayedin a graph. The graphs showed a typical enhancement pattern in patients with CDAIhigher than 350. A good correlation was found between CDAI and P, TTE and BV(0.913, 0.942, 0.961), p 0.009.Conclusion: Measuring the perfusion in enlarged lymph nodes can be a valuabletool in assessing Crohn’s disease activity.C-445Multidetector-CT (MDCT) with polyethylene glycol (PEG) solution versusmultidetector-CT enteroclysis in small bowel diseaseL.M. Minordi, A. Vecchioli, L. Verrastro, G. Poloni, L. Bonomo; Rome/IT(lauraminordi@virgilio.it)Purpose: The aim of the study is to evaluate multidetector-CT with polyethyleneglycol solution (PEG) (PEG-CT) as an alternative technique to multidetector-CTenteroclysis (E-CT) in patients with suspected small bowel disease.Methods and Materials: 145 patients underwent abdominal contrast-enhanced16-row multidetector-CT after administration of 2000 mL of PEG by mouth (n=75)or after administration of 2000 mL of methylcellulose by naso-jejunal tube (n=70).Small bowel distention, luminal and extraluminal findings were evaluated and comparedwith small bowel follow-through examination in 60 patients, barium enemain 50, surgery in 25 and endoscopy in 35. Statistical evaluations were carried outby 2 test with Yates correction.Results: Crohn’s disease was diagnosed in 64 patients, neoplasms in 16 (6 withlymphoma non Hodgkin, 3 with carcinoid, 2 with Peutz-Jeghers syndrome, 2 withadenocarcinoma, 2 with lypoma, 1 with metastasis from melanoma), adhesionsin 6. Distension of the proximal and distal jejunum was found to be significantlybetter in patients studied with E-CT than those studied with PEG-CT, as confirmedby the 2 test with Yates correction (p 0.05: statistically significant difference). Nosignificant difference was present for others sites (p 0.05). Evaluation of pathologicalileal loops was good with both techniques. The values of sensitivity, specificityand diagnostic accuracy were, respectively, 94, 100 and 96% with E-CT and 93,94 and 96% with PEG-CT.Conclusion: PEG-CT is a good alternative technique to E-CT in patients withsuspected small bowel disease.C-446Carcinoid tumours: A pictorial reviewK. Slaven, P. Healey; Liverpool/UK (kirstyslaven@hotmail.com)Learning Objectives: To recognize common radiological presentations of carcinoidtumours and metastases.Background: Neuro-endocrine tumours (NETs) develop from enterochromaffincells and can be divided into gastroenteropancreatic and carcinoid tumours. Carcinoidtumours arise from the embryonic gut and are found incidentally in 1:300 ofautopsies. They are classified either by organ of origin (embryonic foregut, midgut orhindgut) or by a histological-based system. Although typically slow growing, all havea malignant potential and the ability to metastasize. 10% of metastatic carcinoids(predominantly those of a mid-gut origin) secrete the hormone serotonin (5-HT),which causes the symptoms of carcinoid syndrome.Imaging Findings: When imaging a suspected carcinoid tumour, contrast enhanced CT,radionuclide imaging (octreotide) and fused imaging (SPECT/CT) are used. While it maybe difficult to identify the primary tumour, appearances of metastatic disease can assistwith diagnosis. Typical findings in metastatic disease include enhancement, calcificationwithin the tissue mass (70%) and adjacent desmoplastic reactions. Routine follow-upincludes interval CT or MRI, although further radionuclide imaging may be required.Conclusion: Although relatively rare, tumours imaging is crucial in the initial assessmentand follow-up of carcinoid tumours. Knowledge of the diversity of imagingpresentations and use of different modalities is essential in diagnosing, stagingand following up these patients.C-447Semi-quantitative assessment of enhancement in contrast-enhancedultrasound in patients with Crohn’s disease: Comparison with Crohn’sdisease activity indexM. Jedrzejczyk, K.T. Szopinski, A. Cybulska; Warsaw/PL (kazszo@poczta.onet.pl)Purpose: To evaluate the usefulness of semi-quantitative parameters of sonographiccontrast enhancement in the assessment of activity of Crohn’s disease (CD).Methods and Materials: Enhancement curves of the bowel and iliac artery werecalculated in 52 contrast-enhanced ultrasound examinations performed in 36 patientswith confirmed CD (22 males, 14 females, mean age 32 years). The Crohn’sdisease activity index (CDAI) was calculated in all patients. The bowels were imagedon a Voluson 730 Expert (General Electric) machine using a 2-5 MHz convex probe.Contrast-enhanced images were obtained after intravenous administration of 1.2 mlof SonoVue (Bracco). Maximal signal intensity (I max), area under curve (AUC), meantransit time (mTT), time-to-peak (TTP), and rise time (RT) were calculated, and theresults obtained in patients with active and inactive disease were compared andassessed using Student t test.GI TractACB D E F G HS429

Scientific and Educational ExhibitsResults: In patients with CDAI 150 (n=27), the mean ratio of I maxin the bowel andin the iliac artery was -5.1 dB, and in patients with CDAI150 (n=25) the mean ratioof Imax was -7.3 dB (p 0.01). In patients with CDAI 150, the mean ratio of AUCin the bowel and in the iliac artery was -7.4 dB, and in patients with CDAI150 themean ratio of AUC was -11.6 dB (p 0.05). mTT, TTP and RT were not statisticallydifferent in patients with active and inactive Crohn's disease.Conclusion: Ratio of the maximal signal intensity and ratio of the AUC, measuredin the bowel wall and in the iliac artery, are suitable parameters in the assessmentof the activity of Crohn’s disease.C-448Contrast-enhanced ultrasound (CEUS) in Crohn’s disease: Technique,image interpretation, and clinical applicationsT. Ripollés, M.J. Martinez-Perez, F. Delgado, E. López-Pérez, G. Figueres,J.M. Paredes; Valencia/ESLearning Objectives: To describe the technique of the CEUS in the evaluation ofpatients with Crohn´s disease. To illustrate the sonographic findings and clinicalapplications, including complications and assessment of disease activity. To provideexamples of CT or MR correlation.Background: Recent meta-analysis has demonstrated no significant differencesin diagnostic accuracy among different imaging techniques in the evaluation ofCD. Ultrasound is now established as a valuable technique in the diagnosis andfollow-up of patients with CD. The use of echo-contrast agents provides accuratedepiction of bowel wall perfusion due to the high sensitivity in the detection ofmicrovascularization. This method permits real-time examination of the bowel wallperfusion with similar contrast resolution than CT and MR.Imaging Findings: Contrast-specific US techniques allow continuous imagingevaluation of the bowel wall and the perienteric tissues after IV administration ofsecond generation contrast agent (Sonovue ® ). The introduction of imaging quantificationtechniques enables objective quantitative measurement of enhancement.Current CEUS applications: to characterise inflammatory masses distinguishingphlegmons from abscesses; to differentiate fibrotic from inflammatory stricture; CDactivity assessment (evaluation of pattern of enhancement or quantitative measureof increase in wall brightness); prognostic value to detect relapses; to monitor efficacyof drug treatments.Conclusion: Ultrasound now has clearly defined roles in the diagnosis and follow-upof CD. CEUS is part of the entire sonographic evaluation and its results are comparablewith other modalities, such as CT or MR. Familiarity with the technique willextend its use in clinical practice.GI TractStomachC-449The role of gastric distention with additional water in differentiating locallyadvanced gastric carcinomas from physiological uptake in the stomach onFDG PETK. Kamimura 1 , S. Nagamachi 1 , H. Wakamatsu 1 , S. Fujita 1 , S. Ueno 1 ,Y. Umemura 1 , M. Ogita 1 , T. Fujimoto 1 , M. Nakajo 2 ; 1 Miyazaki/JP, 2 Kagoshima/JPPurpose: In the current study, we investigated the role of gastric distention withadditional water to determine whether it is beneficial for the differentiation of locallyadvanced gastric carcinomas from physiological FDG uptake in the stomachand to characterise the FDG uptake of gastric carcinomas by relating it to thehistopathological properties of the tumours.Methods and Materials: Sixteen patients with locally advanced gastric carcinomasand 20 control subjects were studied by FDG PET. After whole-body PET imaging,the patients drank 400 ml of water, and then spot imaging, with additional water, ofthe stomach was performed. The final diagnosis was determined from the results ofsurgery. The gastric areas were divided into the upper, middle, and lower parts. Thedegree of FDG uptake in the stomach was qualitatively evaluated by visual gradinginto 3 degrees. For quantitative analysis, the regional tumour uptake was measuredby mean standardised uptake values using a region of interest technique.Results: In visual analysis, the sensitivity, specificity, positive predictive value,negative predictive value, and accuracy of PET without additional water ingestionwere 100, 50, 62, 100, and 72%, respectively, and those of PET with additionalwater ingestion were 88, 100, 100, 91, and 94%, respectively. Using spot imagingunder the condition with additional water ingestion, four gastric carcinomas weredepicted more clearly.Conclusion: Gastric distention as a result of patients drinking a glass of water isa simple and noninvasive method for improving the diagnostic accuracy of FDGPET in patients with locally advanced gastric carcinoma.C-450CT evaluation of gastric lymphoma with drug induced hypotonia and waterfilling of the stomachA. Gligorievski; Skopje/MK (atglmed@gmail.com)Purpose: The purpose of our study was to determine the value of computedtomography (CT) with a drug-induced hypotonia and water filling in diagnosis andpreoperative staging of 27 patients with gastric lymphoma (GLy) confirmed byendoscopic biopsy.Methods and Materials: CT scans were performed in supine and prone positionswith drug induced hypotonia and water filling of stomach with 500-700 ml., andintravenous administration of non-ionic contrast agent. Prone position and druginducedhypotonia allowed visualization of the whole gastric wall and preventedgas artifacts, commonly present during supine imaging.Results: CT scans were analyzed with respect to the thickness of the stomachwall, rugal thickening, presence of wall infiltration, mucosal nodularity, ulcerationsand tumor masses, regional tumor spread, lymph node deposits and presenceof distant metastases. The most common findings in GLy was ulcers of variablesize, depth and number in 43% of cases, a mass with or without an ulcer in 36%of cases, and rugal thickening in 21% of cases. According to CT results, GLy wasstaged in four groups: IE, IIE1, IIE2, IIIE and IVE. Precise preoperative staging wasachieved in 73%, overstaging in 18% and understaging in 9% of patients. Sensitivityand specificity of the technique was 93 and 85%, respectively. Low grade MALTlymphoma was in 69% and high grade MALT lymphoma in 31% of cases.Conclusion: We believe that CT performed with this method is a useful noninvasivemethod for preoperative evaluation and staging of gastric lymphoma and shouldbe used before surgery is planned.CS430 A B D E F FG H

Scientific and Educational ExhibitsC-451Staging of gastric cancer: A comparative study with 64-MDCT and 1.5 T MRIB. Cavallo Marincola, A. Napoli, M. Anzidei, F. Zaccagna, C. Catalano,R. Passariello; Rome/IT (beacm@libero.it)Purpose: compare the usefulness of MRI with T2-weighted turbo spin-echo andfast T1-weighted 3D gradient-echo sequences with 64-DCT in the staging ofgastric carcinoma.Methods and Materials: Thirty patients with gastric carcinoma underwent MRIand MDCT. MR (1.5 T) and 64-MDCT (200 mA, 120 kv, thickness 1.25 mm, rec.int. 0.6 mm) were performed after i.m. injection of scopolamine and water distensionof the stomach. In the MRI protocol True-FISP T2-weighted sequences, turbospin-echo T2-weighted sequences (TR 4000 ms, TE 100 ms, thickness 3 mm,matrix 384x384, TA 30) and gadolinium-enhanced fat-suppressed 3D gradientechosequences (TR 5.8 ms, TE 2.75 ms, thickness 3 mm, matrix 384x384, TA18) were included. 64-MDCT was performed 60 sec after contrast agent injection(3.5-4 ml/sec). Two groups each of two radiologists independently analyzed MRIand 64-MDCT images; results were compared with pathologic findings.Results: MR accuracy was higher than 64-MDCT (85 and 79%, respectively) inthe differentiation of T1-T2 stages; the accuracy of MR and CT was not significantlydifferent in the differentiation of T2-T3 and T3-T4 stages (p 0.05). Overstaging wasnoted in 6% of cases with MRI and 10% with 64-MDCT. Understaging was notedin 15% of cases with MR and 18% with 64-MDCT.Conclusion: MRI and 64-MDCT accuracies were not different in advanced stages,while MRI was superior in the differentiation of early stages of gastric cancer.GI TractMiscellaneousC-452Gastrointestinal imaging findings in collagen vascular diseasesT. Ichikawa, J. Koizumi, Y. Nagata, H. Yamamuro, Y. Imai; Isehara/JP(tamaki-i@mars.sannet.ne.jp)Learning Objectives: To illustrate abdominal imaging features in collagen vasculardiseases on CT and barium study.Background: Collagen vascular diseases are known to present with variousgastrointestinal manifestations classified as: 1) gastrointestinal damage due to thecollagen vascular disease itself; 2) adverse events by pharmacotherapies; or 3)gastrointestinal infections secondary to corticosteroid administration. The first groupincludes lupus enteritis in systemic lupus erythematosus (SLE), pneumatosis cystoidesintestinalis (PCI) in scleroderma, and ileocecal ulcer in Bechet disease.Imaging Findings: This exhibit illustrates specific imaging findings on CT andbarium study in collagen vascular diseases. The target sign on contrast enhancedCT is observed in vasculitis such as SLE and Henoch-Schonlein purpura. PCIcharacterized by intramural air in the intestine is associated with scleroderma, mixedconnective tissue disease and SLE. The demonstration of cystic gas collection inthe intestinal wall and pneumoperitoneum are detected with highest sensitivity usingCT. Lupus cystitis is a rare manifestation associated with hydronephrosis andlupus enteritis. Small aneurysms and stenosis of vessels in polyarteritis nodosa aredemonstrated on MDCT as well as angiography. Barium study is useful to detectesophageal dysmotility and small intestinal dilatation in scleroderma, thumb-printingsign consistent with intestinal edema or hemorrhage in SLE and Henoch-Schonleinpurpura and multiple ulcers in SLE and Bechet disease.Conclusion: To recognize image findings on CT and barium study is important incorrect diagnosis and treatment in patients with collagen vascular diseases.C-453Abdominal endoscopic procedures complications: Spectrum of imagingfindingsP.A.A.F. Santos, J. Pires, M. Gomes, M. França, F. Reis; Porto/PT(paafds@gmail.com)Learning Objectives: To highlight the role of different imaging techniques in theassessment of complications arising from endoscopic procedures (diagnostic and/or therapeutic). Several cases will be illustrated, representative of complicationsresulting from upper endoscopy, colonoscopy and ERCP, and demonstrated byconventional radiography, ultrasound and CT.Background: The complications arising from endoscopic procedures are indecline at present thanks to improvements in technology and greater experienceof endoscopists. However, the increasing number in the therapeutic endoscopicprocedures, which leads to many complications such as perforation and bleeding,continue to occur with a frequency not negligible.Imaging Findings: From the list of complications associated with these techniques,special emphasis will be given to parietal perforation (leading to pneumomediastinum,pneumoperitoneum and pneumoretroperitoneum), bleeding (includinghemoperitoneum as a result of direct trauma or stretching of splenic vessels),parietal hematomas from more invasive procedures and acute pancreatitis in thesetting of ERCP. CT scan was shown to be the most valuable technique in thiscontext, because of its greater sensitivity and specificity in the evaluation of theclinical entities mentioned above.Conclusion: It is important to be aware of potential risks of endoscopic proceduresas these can represent a life-threatening event. The role of imaging techniques isvery important in this setting, since early diagnosis may provide a favorable clinicaloutcome to the patient.C-455How can evidence-based medicine change abdominal imaging practice?A.N. Chalazonitis 1 , G. Tsimitselis 2 , J. Tzovara 1 , G. Neofytou 1 , F. Laspas 1 ,N. Ptohis 1 ; 1 Athens/GR, 2 Larissa/GR (red-rad@ath.forthnet.gr)Learning Objectives: 1. To present the definitions of evidence-based medicine.2. To show how abdominal imaging and intervention decisions in patient groupsor individual patients must be based on the best available current evidence. 3. Todescribe how evidence-based medicine can change the current and the futureabdominal imaging practice.GI TractACB D E F G HS431

Scientific and Educational ExhibitsBackground: Abdominal radiology is a rapidly evolving field, with new diagnosticmethods and interventional techniques continuously replacing the previously accepted.Traditionally radiologists were taught how to practice their specialty throughtextbook memorization and copying the behavior from acknowledged experts. Theremodeling of the today’s radiological practice requires new skills that are not usuallypart of medical training.Procedure Details: We will demonstrate how EBM can change the way abdominalradiologists look after their patients by accessing and applying valid and relevantsummaries of guidelines and systematic reviews. We will also provide guidelineshow and where to use appropriate, ‘technology assessment’ principles to find answersthat are based on the best current evidence for problems arising in currentimaging or interventional practice.Conclusion: Today there is a powerful demand for ways of getting evidence intoradiological practice in the most efficient way. EBM can change the way abdominalradiologists look after their patients by accessing and applying valid and relevantsummaries of guidelines and systematic reviews.C-456The Iliopsoas compartment: A pictorial review of anatomy and commonpathologiesM.J. Kaduthodil, H. Ganesh S. Rajaram, R. Vijay; Sheffield/UK(jismathew@yahoo.com)Learning Objectives: To review the anatomy and the spectrum of pathologiesaffecting the iliopsoas compartment with emphasis on cross sectional imaging.Background: The iliopsoas compartment is an important anatomical landmark inthe abdomen and can be the site of a variety of pathological processes. A detailedknowledge of the anatomy and imaging appearances can help increase diagnosticaccuracy, and CT in particular is useful not only in delineating pathology but alsocan help in image guided intervention.Procedure Details: We review the detailed cross sectional anatomy and the commondisease processes affecting the iliopsoas compartment using cross-sectionalas well as diagrammatic images.Conclusion: A combination of detailed knowledge of anatomy and pathologiesand the advanced imaging techniques that are available now will enable clearlydefining disease processes affecting the iliopsoas compartment.C-457Usefulness of [18 F]FDG-PET/CT for assessment of recurrent pelvic cancerin patients with rising tumor serum markers and negative conventionalimaging testsM.G. Skilakaki, E.V. Skoura, P. Rondogianni, C. Giannopoulou, D.N. Exarhos,I.E. Datseris; Athens/GR (skmaria@otenet.gr)Purpose: To determine the ability of [18 F]FDG-PET/CT in detection of recurrencein patients with previously treated pelvic malignancies who have elevated tumormarker serum levels and negative results on conventional imaging.Methods and Materials: 17 patients (6 men, 11 women) aged from 39 to 78 years(mean age: 60 years) who underwent [18 F]FDG-PET/CT at our institution betweenJuly 2007 and June 2008 were included in the study. Inclusion criteria were: known,post-treatment pelvic cancer, increased serum tumor markers (CEA, CA-125, CA19-9) and recent negative conventional imaging evaluation: CT of thorax, CT and/or MRI of abdomen and pelvis. Of the 17 patients, 7 had colorectal cancer, 8 hadovarian and 2 cervical cancer.Results: Recurrent disease was revealed in all 17 patients: of 7 patients withcolorectal cancer, 4 had peritoneal metastases, 2 had lymphadenopathy (1paraaortic and common iliac and 1 mediastinal lymph nodes) and 1 patient hadboth peritoneal infiltration and iliac lymph nodes. Of 8 women with ovarian cancer,3 had peritoneal carcinomatosis, 2 had intraabdominal lymphadenopathy and therest 3 had peritoneal disease in association with: intraabdominal lymphadenopathy(2), supraclavicular lymph nodes (1), inguinal lymph nodes (1), axillary lymphadenopathy(1), and hepatic lesions (1). Finally, the 2 women with cervical cancer hadmediastinal lymph nodes and peritoneal carcinomatosis, respectively.Conclusion: Although further confirmatory work is needed, [18 F]FDG-PET/CTseems to be a very important tool in the assessment of recurrent disease suggestedby rising tumor serum markers in patients with pelvic cancer and negativeconventional imaging tests.C-458CT appearance of abdominal liposarcomaP. Sadaba, I. Aloa, I. Aguirre, S. López, A. Cancho, K. Armendariz, Z. Fernandez,N. Serrano, I. Iraola; Galdakao/ESLearning Objectives: To illustrate CT features of different types of abdominalliposarcomas.Background: Abdominal liposarcomas are uncommon; nevertheless, they are thesecond commonest malignant retroperitoneal soft-tissue tumor in adults. CT is anexcellent tool for diagnose this entity, with high sensitivity and specificity, allowinga precise anatomical localization. There are four histological types recognized, themyxoid being the most common.Imaging Findings: We reviewed clinical and radiological data of 12 patients, 7women and 5 men (age range: 42-80 years; mean: 61 years) with histologicallyproven abdominal liposarcoma diagnosed at our institution from 1995 to august2008. Abdominal liposarcomas were found in retoperitoneum (10) and mesentery(2). The size of the tumours ranged from 8 to 35 cm. CT appearance of the liposarcomasvary on different histologic subtypes.Conclusion: CT provides accurate information regarding abdominal liposarcomas.Knowledge of their radiological characteristics is essential in the diagnosis andpatient´s management.C-459A free and customized online tool to facilitate quick and accurate stagingof common gastrointestinal malignanciesR. Talanow; Cleveland, OH/US (roland@talanow.info)Learning Objectives: To create a free, web-based and customized cancer stagingtool for common gastrointestinal malignancies, which easily integrates into theradiologist’s daily work from any monitor or PACS station.Background: Complex cancer staging systems describe the anatomic spreadof a particular malignancy. Staging provides prognostic information and is vitalin guiding appropriate therapy. However staging can be difficult to perform for theinexperienced physician and inaccurate staging can lead to unnecessarily adversepatient’s outcome. The author provides a free, comprehensive, web-based,on-the-fly solution that is easy to use and aids in accurate staging of commongastrointestinal malignancies.Procedure Details: The tumor classification information is based on the CollaborativeStaging Network. On-the-fly staging is done by calculating and comparing theinformation provided by the user with the tumor classification database saved on theserver. The staging tool can be used in several modes for the user’s convenience.Output of information is also offered in several modes to increase flexibility andbetter integration into the reader’s workflow.Conclusion: This free, web-based and customized program easily integratesinto the radiologist’s daily work from any monitor or PACS station. The interface isflexible and easily adapts to the individual physician’s preferences by seamlesslyincorporating into the workflow. It is an intuitive, user friendly educational programthat makes staging of common gastrointestinal malignancies easy and accurate.C-460Diffusion Wi in abdominal MRI: PET CT is threatened!P.A. Ganne, O. Bruot, J. Mathias, V. Laurent, D. Régent;Vandoeuvre Les Nancy/FR (pa.ganne@free.fr)Purpose: We performed diffusion Wi in MRI abdominal imaging in different clinicalbackgrounds, and we fusioned DW images with T1 or T2W images to obtain “virtualPET-MRI” images. We tried to know if such images can be helpful in tumoral andinflammatory GI tract disease.Methods and Materials: We retrospectively studied DWi in different GI tract tumoralor inflammatory pathologies (Crohn’s disease, pancreatic cancer, peritoneal carcinomatosis,lymphoma, rectal cancer). Thanks to Osirix software, DW and anatomicalimages were fusioned. Results were compared with clinical and surgical data.Results: Virtual PET-MRI allows a better detection and a better small tumorallesions localisation before treatment. This technique is indeed quite efficient todetect small carcinomatosis nodules. Furthermore, this functional and anatomicalimaging allows a physiological approach of digestive inflammatory disorders. Thisnon-irradiant exam may be an interesting choice to assess GI tract inflammatoryactivity in young patients suffering from Crohn’s disease.Conclusion: Virtual PET MRI imaging is a non irradiant, non invasive and nonexpansive efficient technique that is sensible in tumoral and inflammatory GI tractdisease, but has to be evaluated with larger studies and compared with PET-CTin terms of specificity.No Material Submitted to EPOSCS432 A B D E F FG H

Scientific and Educational ExhibitsC-461Advanced gastrointestinal stromal tumors in treatment with imatinibmesylate:Response evaluation with CT and MRIE.R. Amador, G. Alonso, E. Usamentiaga, L. Picó, P. Lopez, J. Martin;Palma de Mallorca/ES (evareginaamador@hotmail.com)Learning Objectives: To illustrate response with CT or MRI to imatinib-mesylatetreatment in advanced GIST. To correlate tumour response assessment with theprognosis of the disease. To review the CT technique and method to quantify theresponse.Background: Gastrointestinal stromal tumours (GIST) are primary mesenquimaltumours of the gastrointestinal tract, mesentery or retroperitoneum, CD117 positive.Malignant GIST account for the majority of gastrointestinal sarcomas. 61% ofthem being advanced at diagnosis. Imatinib-mesylate is highly effective in advanceddisease with response of nearly 50%. CT is adequate to assess tumour response.In addition to RECIST criteria, density and enhancement variations correspondbetter to clinical outcome. Between 2002 and 2008, CT/MR images of 44 lesions(liver, lung, mesentery, peritoneum and gastrointestinal tract) in 13 patients withadvanced GIST on glivec therapy were reviewed. These were classified accordingto responders (stable and remission disease) and non-responders (progressivedisease); we illustrated treatment response and analysed technique influence.Imaging Findings: Multiphase MDCT were carried out in all patients. One patientwith pelvic recurrence was studied with MRI. Tumour control was achieved in 72.7%of the cases; a quarter of them attained complete remission. The average follow-upperiod was 33.5 months. All patients were alive at the moment of the study. A possiblefalse positive due to a deficient bolus technique was reviewed. Arterial phasedid not contribute to decide treatment.Conclusion: Optimal tumour evaluation response with CT requires a standardizedand comparative method of lesion analysis, based on an adequate IV bolusportal phase.C-462CT-colonography (CTC): Which are the right scanner parameters to use?P. Paolantonio, R. Ferrari, M. Rengo, F. Vecchietti, P. Lucchesi, M. Maceroni,A. Laghi; Latina/IT (paolantoniopasquale@hotmail.com)Learning Objectives: To describe acquisition parameters of CT-colonographyprotocols using different scanners generations moving to single slice spiral CTto the 64-MDCT.Background: Nowadays, the “panorama” of technical approaches for CTC is expandingoffering a wide spectrum of different possibilities. As technology continuesto advance, there will be a continuing need to reassess the relative tradeoffs betweenscan width, image noise, patient dose, image artefacts, breath-hold times, and thenumber of reconstructed images to be viewed and archived.Procedure Details: We will discuss the relationship among collimation, tube currentsettings, patient dose exposure and accuracy in polyp detection of variousCTC protocols valid for different scanner generation. We will offer some practicalguidelines for CTC technique based on evidences of literature and on our personalexperience of more than 800 CTC examinations performed on different scannersgeneration including a 64-MDCT (VCT; GE).Conclusion: A single scanning protocol with identical parameters for all scannersand patients cannot be recommended due to technological differences as wellas different clinical indications to CTC. What is possible to do is to offer generalguidelines according to the consensus statement on CTC. Collimation should notbe larger than 5 mm for SSCT and no larger than 3 mm for MDCT. With the adventof 64-slice MDCT, sub-millimeter collimation will be mandatory, although clinicalbenefits are still unclear.C-463Mesenteric venous thrombosis: MDCT features according to theunderlying etiologyR. Duran, A. Denys, P. Schnyder, S. Schmidt; Lausanne/CH (rafael.duran@chuv.ch)Purpose: To work out certain, well-defined aetiologies frequently associated withmesenteric venous thrombosis (MVT) in order to predict a typical population atrisk, since MVT is nowadays often incidentally detected on cross-sectional imaging.To demonstrate the MDCT features, frequency and extent of associated bowelischemia according to the underlying pathology.Methods and Materials: Our electronic database revealed 71 patients (25 women,mean age 55) with thrombosis of the superior and/or inferior mesenteric veindetected by MDCT between 2000 and 2008. Two radiologists jointly reviewed thecorresponding MDCT features including intraluminal extension, underlying aetiologyand associated bowel ischemia, if present.Results: MVT was associated with carcinoma in 31 (43.7%) patients (pancreas21.1%, liver 9.9%, others 12.7%). Concomitant inflammation was seen in 15(21.1%) patients (pancreatitis 11.3%, diverticulitis 4.2%, others 5.6%), whereascoagulation/hematologic disorders were found in 7 (9.9%) patients, liver cirrhosisin 6 (8.5%), mixed/miscellaneous causes in 5 (7%) and still unknown aetiologies in5 patients (7%). MVT resulted from recent operations in 2 (2.8%) patients. MDCTfeatures of venous bowel ischemia were present in 15 patients (21.1%). 46.5% ofMVT were (sub)acute, while 53.5% chronic. The luminal extension was complete in52.1%, subtotal ( 50% of lumen) in 22.5% and partial ( 50% of lumen) in 25.4%of patients, consisting either of blood clots (76.1%) or tumoral tissue (23.9%), thelatter mainly due to pancreas adenocarcinoma (76.4%).Conclusion: MDCT features of MVT are seen with a wide range of underlyingdiseases. Signs of intestinal ischemia are infrequently associated, mostly occurringwith coagulation/hematologic disorders (40%).C-464Principles of computed tomographic enterography and recent trends ininterpreting imaging findingsK.M. Elsayes, J.D. Nadig, M. Al-Hawary, J. Platt; Ann Arbor, MI/US(jnadig@med.umich.edu)Learning Objectives: To discuss the imaging techniques, clinical indications,and utility of computed tomographic enterography (CTE) in diagnosing variousgastrointestinal diseases. Characteristics of these diseases will be illustrated withrepresentative examples. Special emphasis will be placed on the recent trends ininterpreting the imaging findings.Background: The introduction and continuing technical improvements in CTEtechnique have increased its utility as an effective, efficient, and non-invasive toolin the diagnosis and management of a variety of gastrointestinal disorders. Subsequently,an increasing number of CTE examinations are performed. Therefore,the radiologist must be familiar with the technique and imaging findings relevantto various gastrointestinal diseases.Imaging Findings: The exhibit begins with a short introduction of CTE followed bydiscussion of the imaging parameters, patient preparation, and types of negativeoral contrast. We then discuss the utility of CTE in diagnosing various gastrointestinaldiseases and review the imaging findings according to the recent trends ininterpretation. The exhibit concludes with sample cases illustrating the diagnosticrole of CTE and imaging findings of a spectrum of diseases including inflammatorybowel disease, mesenteric ischemia, gastrointestinal bleeding, small bowelobstruction, and gastrointestinal tumors.Conclusion: CTE is frequently performed with modern equipment. When performedappropriately, it is a powerful tool capable of characterizing small bowel pathology,identifying lesions within the stomach, duodenum and colon, and providing anopportunity to evaluate both extraluminal and extraintestinal tissues. Radiologistsneed to be able to recognize and interpret the relevant findings in CTE and applythem to the various gastrointestinal diseases.C-465The post-operative abdomen: A diagnostic challenge for the radiologistA. James, J.H. Chauh, F. Grieve, B. Thomas, V. Rudralingam, S.A. Sukumar;Manchester/UK (anithajames@aol.com)Learning Objectives: 1. To review the normal post operative appearances onmulti detector abdominal computed tomography (CT). 2. To depict the numerousimmediate and late complications of abdominal surgery ranging from trivial tocatastrophic.Background: Suspected post operative complications are a common indication forCT imaging. Interpreting the post operative abdomen is challenging to the radiologistas knowledge of the surgical technique is vital in understanding the new anatomy.Also the postoperative changes in the mesentery, omentum and bowel may leadto diagnostic pitfalls and hence clinical correlation is of utmost importance. CT is apowerful tool for identifying the early and late post operative complications.Imaging Findings: The spectrum of imaging features of the post operative abdomenincludes the following: Expected features - omental and mesenteric fat stranding,oedema, ascites, free gas and ileus. Wound sepsis - dehiscence and abdominalwall collections. Intra abdominal sepsis- collections, abscesses, retained surgicalforeign bodies and dropped gallstones. Anastomotic leak and peritonitis. Vascular-massive intra abdominal haemorrhage, vessel injury and ischemia. Bowelobstruction and due to acute and late onset adhesions. Organ injury- ureters andbowel. Hernias- incisional, parastomal and internal.Conclusion: Radiologists are frequently asked to assess the post operative abdomen.Radiological findings should be interpreted in conjunction with knowledge ofthe surgical technique and the clinical picture. Timely and accurate diagnosis isthe key to optimal management.GI TractACB D E F G HS433

Scientific and Educational ExhibitsC-466Postsurgical changes in abdominal CT: Where to lookB. López-Botet Zulueta, I. Pena Fernández, M. Manzano Paradela,T. Presa Abós, C. Andreu Arasa, L. Del Campo Del Val; Madrid/ES(begolbz@hotmail.com)Learning Objectives: To review the most common abdominal surgical procedures.To describe the anatomical changes occurring after the surgical procedures andradiological findings in abdominal CT.Background: In different procedures of abdominal surgery, the normal anatomyis substantially altered. In many occasions, these variations can make the imageinterpretation difficult for the radiologist. The knowledge of the spectrum of postsurgicalchanges is indispensable for a correct discrimination between normaland pathological findings, to find out surgical complications or for the follow-up ofoncological patients.Procedure Details: We have retrospectively reviewed abdominal CT performedin our hospital in patients who previously underwent abdominal surgery becauseof diverse reasons (oncological, inflammatory, bariatric). We show different CTprotocols employed according to what pathology the patient presented and we usedmultiplanar reconstructions that may be extremely useful to recognise postsurgicalchanges. We have classified the surgical procedures in three groups: gastrointestinaltract, genitourinary tract, and other surgery.Conclusion: Because of its high frequency and its clinical importance, radiologistsmust be familiar with the different abdominal surgical procedures, the anatomicalchanges and its manifestations in CT.Head and NeckAnatomyC-467Micro-CT of the hyoid-larynx complex: A new tool in forensic pathologyB. Ilsen, D. Van Varenbergh, I. Willekens, J. de Mey; Brussels/BE(bart.ilsen@uzbrussel.be)Learning Objectives: The aim of this study is to determine the feasibility of detectinghyoid-larynx fractures with micro-CT in post mortem specimens and to betterunderstand the complex anatomy of the laryngeal skeleton.Background: Examination of the hyoid-larynx complex is part of the routine procedureof the medico-legal autopsy. Hyoid-larynx complex injuries occur in differentcauses of death. Strangulation is the most common cause of a fractured laryngealskeleton. Post-mortem detection of fractures is relevant in interpreting homicideby strangulation, because of the difficult interpretation of skeletal abnormalitiesdue to the misleading polymorphism of the hyoid-larynx complex. Because of thisneed of accurate documentation in medico-legal examination, we evaluated a newtechnique for the detection of traumatic lesions using post-mortem radiologicalmicro-CT-studies (spatial resolution of 83 µm) on excised specimens. 10 datasetswere analysed with a 3D volume rendering program in order to examine shape,ossification, fusion of synchondroses and fracture site.Imaging Findings: In all cases, the shape, ossification and eventual synchrondroseswere nicely depicted. Analysis of our 3D-data resulted in 32 synchondrosesand 25 ossifications (fusions). Two fractures of the superior corn of the thyroidcartilage were easily depicted in one patient. Medico-legal anatomopathologicalexamination of the laryngeal skeleton confirmed these last findings.Conclusion: Our study presents the first radiological images of fractured hyoidlarynxcomplex. Micro-CT of the hyoid-larynx complex is a promising new methodfor the detection of post-traumatic lesions in post-mortem specimens. It could be anew helpful tool in forensic pathology. Further investigation is warranted.C-468Head and neck spaces: Where and what?K. Au Yong, N.J. Coupe, V. Chidambaram, C.K. Jadun; Stoke-on-Trent/UK(kong.auyong@gmail.com)Learning Objectives: 1. To revisit the anatomy of spaces in the neck as demonstratedby cross-sectional imaging. 2. How the different spaces give rise todifferent pathologies and why knowledge of the anatomy is important for accuratedifferential diagnosis.Background: Head and neck lesions are a very challenging subject for radiologistsdue to the complex anatomy and wide ranging pathology. Cross sectional imagingis now commonly used to assist the clinical evaluation of head and neck lesions.The anatomical location and borders of head and neck lesions are vital in narrowingradiological differential diagnosis and allowing formation of an appropriateclinical management plan.Imaging Findings: We present normal cross sectional images using CT and MRIto demonstrate the boundaries, contents and relationships of the many spaces inthe neck. Pathological imaging is also presented to demonstrate how this knowledgeaids formation of an appropriate differential diagnosis.Conclusion: A working understanding of the location, borders and contents ofthe spaces in the head and neck is vital to the role of the radiologist in accuratedetermination of the location of head and neck mass lesions. This in turn enablesappropriate subsequent management and intervention.C-469Interactive anatomy of the skull baseF.A. Gomes de Almeida, V.M. Fernandes, G.G. Cerri, E.M.M.S. Gebrim;São Paulo/BR (fabio.abilio@ig.com.br)Learning Objectives: To present in a didactic and interactive way the complexanatomy of the skull base with images acquired in the new generation of multidetectorcomputed tomography scanners (MDCT) with post-processing techniquesof volume rendering, three-dimensional reconstructions and maximum intensityprojections (MIP).Background: As a transitional zone, the skull base has a complex anatomy and,besides its inherent pathologies, is affected by extension both by neurological processescoming from the skull as well as by head and neck diseases. Understandingits anatomy is the key to identify the pathologic process that may involve it.CS434 A B D E F FG H

Scientific and Educational ExhibitsProcedure Details: Our presentation begins with an introductory overview ofthe skull base anatomy, focusing on its divisions, anatomic structures and bonelandmarks. Then, we proceed to a stepwise interactive quiz of enhancing complexitypresenting multiple choice questions based on the relations between differentstructures and the pathways of pathologic entities of different sites. All this richlyillustrated with volume rendering reformats acquired in a 64-channel MDCT.Conclusion: The skull base houses innumerous pathways of disease spreading.With the advent of MDCT, it became much easier to find its lesions and to trackdown the original sites of these disorders. But first it is necessary to understandits complex anatomy, its different connections and how they present at MDCTexamination.C-470Static and dynamic evaluation with MRI of larinx and oro-pharingeal cavityin professional opera singersM. Di Girolamo, F. Assael, G. Scavone, K. Piccotti, V. David; Rome/IT(kety82@yahoo.it)Purpose: To assess the anatomy of phonetic organs by MRI in professional operasingers with different vocal ranges.Methods and Materials: 26 opera singers 7 tenors, 5 basses, 8 sopranos and6 mezzosopranos were evaluated with MRI. We performed static study to evaluatethe area of superior surface of vocal cord, and the dynamic study during theprolonged vocalization of the vowel a, measuring the mouth area and pharyngeallumen. These data considered: 1) vocal tessitura; 2) vocal cord size; 3) mouth areaand pharyngeal lumen.Results: The average size of the vocal cord was: 0.71 cm 2 for sopranos; 1.20 cm 2for mezzosopranos; 1.58 cm 2 for tenors; 2.88 cm 2 for basses. The average area ofmouth and pharyngeal lumen during the vocalization was: 15.8 cm 2 for sopranos;14.6 cm 2 for mezzosopranos; 23.6 cm 2 for tenors; 32.2 cm 2 for basses. The differencesin vocal cord size between sopranos and mezzosopranos (P: 0.0641) andbetween tenors and basses (P: 0.0833) are tendentially and statistically significant.The size variation during the vocalization between tenors and basses is tendentiallyand statistically significant (P: 0.0833) while is it not between sopranos andmezzosopranos (P: 0.6434).Conclusion: Our results demonstrate a correlation between the surface of thevocal cord, the vocal tract and the tessitura of a singer. Long vocal cord and widevocal tract characterize low-pitched voice types (bass, baritone, contralto, mezzosoprano)while short vocal cord and narrow vocal tract characterize high-pitchedvoice types (tenor, soprano).C-472Web-based tutorial of oral cavity MRI anatomyA. Lo Casto, P. Purpura, F. Ganguzza, V. Giacalone, G. La Tona, S. Vitabile;Palermo/IT (antoniolocasto@hotmail.com)Learning Objectives: To review the MR imaging anatomy of oral cavity, supplyingan easy access web-based tutorial. After viewing this exhibit, the reader will beable to recognize the main anatomic structures and spaces of the oral cavity asdisplayed on MRI multiplanar sections.Background: Oral cavity diseases can involve different anatomic structures andspread through the deep facial spaces. Therapeutic choices for oral cavity diseasesare managed also on the basis of MR imaging findings that allow to precisely depictthe local extension of the diseases. This is possible thanks to the superior softtissue contrast resolution of MRI. A good knowledge of the anatomic structuresand spaces of the oral cavity is thus fundamental to report an MRI study of thisanatomic region.Imaging Findings: A pictorial review of T1, T2 weighted, and contrast enhancedmultiplanar MR imaging was used as learning material for the tutorial. Web-basedinfrastructure allows for a fast and intuitive investigation. Web interface is organizedin frames and each section has been developed following the WBC guidelines forweb content accessibility. By using a mouse to select specific parts on MR images,the user can recognize single normal anatomic structures or identify the boundariesof deep spaces within the oral cavity.Conclusion: This custom-developed interactive MRI tutorial software should beuseful in assisting even those new to MR imaging of oral cavity with a friendlyinterface tool.C-471Important vascular anomalies of head and neck vesselsG. Sarti, S. Cappabianca, L. Casale, R. Fenza, M. Montemarano, A. Rotondo;Naples/IT (sartigiuseppe@gmail.com)Learning Objectives: The aim of the study is to illustrate normal vascular anatomyand most common anomalies of the head and neck vasculature in normal subjectsand in patients with head and neck neoplasm in order to define clinical concern ofthem in presurgical assessment.Background: 97 studies of head and neck performed with 32 slices MDCT wereretrospectively reviewed. In all cases, CT study was performed using a standardized3 phase protocol and both the arterial and venous phases were successivelyemployed in order to obtain 3D and MIP post-processing reconstructions. Anatomicdistribution of principal arteries and veins of the face were evaluated in order todefine normal and not-significant clinical variants.Imaging Findings: The major variations observed were the following: low bifurcationof common carotid artery and anomalous branching of external carotid artery,lateral position of external carotid artery facial vein continuing as external jugularvein after receiving retromandibular and submental veins, low bifurcation of commoncarotid artery and anomalous branching of external carotid artery, lateral positionof external carotid artery, common facial vein draining into external jugular vein,anomalous formation of external jugular vein.Conclusion: Knowledge superficial venous system variations and of the arteriesand their branch anomalies seems to be extremely important in the assessment ofpatients with surgical treatable head and neck neoplasms; their recognition duringdiagnostic imaging are moreover important before vascular surgical procedures bothin patients with anomalous development of facial vasculature and in pre-treatmentassessment of patients with important facial trauma.Head and NeckACB D E F G HS435

Scientific and Educational ExhibitsHead and NeckHead and Neck CancerC-473Extranodal primary non-Hodgkin lymphomas of the head and neck: CT andMRI findingsS. Capurro, L. Oleaga, M. Squarcia, F. Calaf, M. Olondo, J. Berenguer, T. Pujol;Barcelona/ESLearning Objectives: 1. To describe the most common imaging findings. 2. Toshow the most frequent sites of involvement. 3. To depict the differences on imagingbetween carcinomas and lymphomas in this location.Background: NHL of the head and neck arises in lymph nodes in 65% of casesand in extranodal sites in 25 to 30% of cases. Extranodal primary NHL are classifiedbased on cell of origin in B-cell lymphomas, T-cell and natural killer- (NK-)cell lymphomas. They occur predominantly in patients between the ages of 50 and60 years. The primary site of involvement is the Waldeyer’s ring, representing 5 to10% of all lymphoma patients; they can also occur in the nasopharynx, oral cavity,nasal cavity, orbit and larynx.Imaging Findings: CT is the primary modality for the assessment of tumoralmasses in the head and neck. Extranodal lymphomas manifest as submucosalmasses covered by intact mucosa, frequently associated with enlarged lymph nodesin the neck, with moderate enhancement after the introduction of contrast. Unlikecarcinomas ulceration is rare. Occasionally, high grade aggressive lymphomas canpresent with bone destruction mimicking infiltrating carcinomas. On MR imagingthey display low in signal intensity on T1-weighted images and intermediate onT2-weighted images with low enhancement after gadolinium injection.Conclusion: CT and MRI represent useful tools in the staging of extranodal primaryNHL; staging is important to select the appropriate therapy. Imaging characteristicscan help differentiate extranodal primary NHL of the head and neck form carcinomasin this location.C-474Perineural spread in extracranial head and neck malignancies - MDCT orMR imaging: Which is better?H.V. Vadodaria, M.K.N. Neelagiri, P.B. Vasani, K.G. Goswami; Ahmedabad/IN(him_vadodaria@yahoo.co.in)Purpose: 1. To study the incidence and pattern of perineural spread (PNS) invarious extracranial head and neck malignancies with CT and MR imaging. 2. Tocompare the efficacies of MDCT and MRI in the assessment of PNS.Methods and Materials: 189 cases of extracranial head and neck malignancieswere studied with 6 slice MDCT and 0.4 T MRI. Both plain and contrast enhancedscans were performed with FOV of 16-18 cm and 3 mm thick slices along with highresolution reconstruction algorithm and fat suppressed post contrast sequences.The primary features of PNS like extent, enhancement, skip lesions and changesin neural foramina, and secondary features like muscle atrophy were studied. Theresults of both imaging techniques were compared.Results: A total of 24 cases of PNS were detected of which 23 were detected onMRI and 17 on MDCT. MRI was especially useful in detecting the obliteration of fatplanes and early denervation changes, whereas MDCT was helpful in detectingsubtle bone erosions.Conclusion: MRI was found to be clearly superior to MDCT in detecting anddelineating the extent of PNS and thus should be the primary imaging modality.However, MDCT is a useful adjunct to rule out doubtful bony involvement.C-475Metastatic salivary gland tumors: A pictorial review of an infrequent findingR. Cano Alonso, M. Navallas Irujo, P. Díez Martínez, L. Ibáñez Sanz,I. Arribas García, A. Alcalá-Galiano Rubio; Madrid/ES (rakitori@hotmail.com)Learning Objectives: To review our series of patients with malignant salivary glandtumors (MSGT). To describe epidemiologic characteristics, treatment results andprognosis, with emphasis on local recurrence and distant metastases and theirimaging findings.Background: We designed a retrospective analysis of 86 patients diagnosed of MSGTbetween 1991 and 2001, with a mean follow-up time of 75 months. Thirteen patientsdiagnosed of metastatic-SGT were included in our study. The aim of this work is to describeepidemiologic characteristics, surgical management and imaging findings of these tumorsand their distant metastases by means of multidetector TC (MDTC) and/or MR.Procedure Details: An exhaustive analysis of clinical onset, diagnostic and surgicalmanagement was performed, with emphasis on local recurrence and distantmetastases rates. Thirteen patients (15, 11%, mean age 52.3 years) developedone or more distant metastases, with a mean survival rate of 73 months. The mostfrequent histologic type was adenoid cystic carcinoma (50%, 7 cases), followedby terminal duct carcinoma (18%, 2 cases), ex-pleomorphic carcinoma (1), poorlydifferentiated epidermoid carcinoma (1), ex-pleomorphic carcinosarcoma (1) andundifferentiated tumor (1). The most frequent locations for distant metastases inour study population were lung (50%, 7 cases), bone (21%, 3), liver (14%, 2),intraocular (7%, 1) and cavernous sinus (7%, 1).Conclusion: SGT account for less than 3% of all neck and head tumors. Metastatic-SGT is an infrequent finding, with a small number or reported cases. Knowledge oftheir main characteristics may help in the management of these patients.C-476Head and neck cancers: Comperative evaluation by CT, MRI and FDG-PETM. El-Kholy 1 , A.A. Zytoon 1 , O. Ebied 1 , K. Murakami 2 ; 1 Shebin El-Koom/EG,2Tochigi/JPPurpose: To investigate the diagnostic accuracy of head and neck cancers, lymphnode metastasis, and local tumor recurrence by FDG-PET compared with CT andMRI, and to validate the results with the histopathological data.Methods and Materials: Forty-one patients with head and neck cancers wereenrolled. Our patients presented for primary staging of head and neck cancers(n=23) or monitoring after therapy (n=18). The three imaging modalities (FDG-PET,MRI and CT) were compared.Results: Overall, 82 head and neck regions were analyzed for detection of malignancy(for primary tumors, n = 23; for lymph node metastasis, n = 41; for local tumorrecurrence after therapy, n = 18). The overall sensitivity and specificity were: CT 88.9and 89.2% (95% CI; 80.2-94.9%, r = 0.7791, P 0.0001), MRI 88.9 and 91.9% (95%CI; 81.9-95.8%, r = 0.8049, P 0.0001), and FDG-PET 97.78 and 86.49% (95%CI; 84-96.9%, r = 0.8551, P 0.0001). Only FDG-PET by its unique advantage asa whole-body examination could detect distant metastases in 4/41 (9.8%) patients,all outside the head and neck regions (liver, lung, paraortic lymph nodes, and bonemetastases), and synchronous breast cancer in 1/41 (2.4%) patients.Conclusion: Compared with CT and MRI, FDG-PET was found to have the highestsensitivity with lower specificity than CT and MRI. Moreover, the whole-bodyFDG-PET imaging proved a useful tool for detection of distant metastasis andsynchronous tumors.C-477The diagnostic value of computed tomography in invasion of carotid andjugular vessels by head and neck malignant tumorsL. Aghaghazvini, H. Sharifian, H. Mazaher; Tehran/IR (la_ghazvini@yahoo.com)Purpose: In head and neck malignancies, awareness of invasion to cervical vesselwalls is greatly important before surgery because it could severely affect patients’management. This study was designed to assess the diagnostic value of computedtomography (CT) in determining the presence and extent of carotid artery (CA) andjugular vein (JV) invasions by head and neck malignant tumors.Methods and Materials: Contrast enhanced CT was performed on 46 patients withhead and neck malignant tumors before surgery. Five abnormal CT findings wereconsidered for CA invasion: I) tumor encasement greater than 180°; II) compression; III)displacement; IV) ill-defined wall of CA and V) deletion of fat planes between tumor andCA. Five abnormal CT findings were considered for JV invasion: I) tumor encasementgreater than 180°; II) compression; III) segmental thrombosis; IV) deletion of fat planesbetween tumor and JV and V) segmental obliteration of JV. The CT appearances ofall tumors were prospectively compared with surgical and pathology findings as goldstandard. The diagnostic indices (sensitivity, specificity, positive predictive value andnegative predictive value) were calculated for all variables separately.Results: Surgical findings revealed invasion to CA in 13 of 40 tumors and to JVin 22 of 46 tumors. The specificity of finding IV was 0.9 for CA (95% confidenceinterval [CI]=0.73-0.99) and sensitivity of finding V was 1 for CA (% CI=.9-1). Thesensitivity of finding IV was 0.95 for JV (CI=0.87-1).Conclusion: CT should be considered as a good diagnostic staging method andcould be helpful in determining cervical vessel invasions but it is not as a definitemethod in all patients.CS436 A B D E F FG H

Scientific and Educational ExhibitsC-478Malignant laryngeal neoplasms: CT and MR pictorial reviewsR.M. Maia, A. Salgado, M. França, J. Pires, J. Reis, M. Ribeiro; Oporto/PTLearning Objectives: To illustrate the imagiologic spectrum of malignant laryngealneoplasms and describe the classic findings in CT and MR imaging.Background: Squamous cell carcinoma is the most common malignant tumor inthe larynx. The risk factors for cancer of the larynx are considered to be smokingand alcohol. They are more common in men, especially after 50 years of age.Mucosal abnormalities can be evaluated by the clinician, but these tumors spreadsubmucosally. Non-squamous cell carcinomas typically grow beneath an intactmucosal layer and biopsy results inconclusive or negative. The tumor extension ofmalignant laryngeal neoplasms must be evaluated by CT or MR, which demonstratelocal tumor and lymphatic extension.Imaging Findings: Criteria used for tumor involvement are soft tissue thickening,presence of a bulky mass, abnormal contrast enhancement, infiltration of fattytissue or a combination of these. The authors reviewed CT and MR exams ofmalignant laryngeal tumors performed in their institution and illustrate the generalimaging findings.Conclusion: CT and MR are useful cross-sectional imaging of the head andneck to delineate the extent of primary disease, the presence of bone or cartilageinvasion and the presence of nodal disease. The head and neck radiologist playsa very important role in assessing the extent of disease and therefore influencesthe appropriate selection from the available treatment options.C-479Cystic masses of the head and neck: A pictorial essayV.M. Joshi; Hyderabad/IN (dr_varshamj@rediffmail.com)Learning Objectives: To describe and illustrate the spectrum of cystic lesions ofthe extracranial head and neck on CT and MRI scans. To help formulate a comprehensivelist of differential diagnosis for such lesions based on their characteristiclocations and imaging features.Background: The gamut of cystic lesions of the extracranial head and neck is notextensive. Many of these lesions are rare, but their radiologic features often permitdefinitive diagnosis to be rendered by the radiologist. We present CT and/or MRIfindings of 17 patients with such lesions.Imaging Findings: The following masses are described - first, second and thirdbranchial cleft cysts, lymphangiomas, Tornwaldt’s cyst, thyroglossal duct cyst, abscesses,ranula, epidermoid, laryngocele, cystic schwanoma, thyroid cyst, jugularvein thrombosis and necrotic adenopathy. Two cases of “clinically cystic” lipoma andcarotid artery pseudoaneurysm are illustrated. Characteristic locations, imagingfeatures and brief description of the pathology is provided.Conclusion: 1. CT and MRI scans optimally depict the entire spectrum of cysticlesions of the extracranial head and neck. 2. The true nature of “clinically cystic”lesions can be optimally delineated on imaging. 3. A thorough knowledge of thecharacteristic locations and imaging appearances of these masses gives the radiologistthe advantage of describing both the deep tissue extent and the probablehistopathology to the clinician.C-480The added value of 18 F-FDG-PET CT for diagnosing occult primarytumours in head and neck cancerR. Hanlon, H. Lewis-Jones, D. White, N.H. Wieshmann; Liverpool/UK(Rebecca.Hanlon@aintree.nhs.uk)Purpose: To establish the added value of 18 F FDG-PET CT imaging for diagnosingoccult primary tumours in head and neck cancer patients.Methods and Materials: Data was collected from all patients who presented tothe Regional Head and Neck Cancer Multidisciplinary meeting with metastasesto cervical lymph nodes from an unknown primary origin (September 2003 andNovember 2007). Patients with negative conventional imaging and clinical examinationwere referred for 18 F FDG-PETCT scan. The results of the PETCT scanwere compared with biopsy results and with cross sectional imaging. The clinicaloutcome of the patients was recorded.Results: 2022 patients with head and neck cancer were reviewed between September2003 and November 2007. 42/2022 patients had metastatic squamouscell carcinoma to cervical nodes of unknown primary origin. 20 of 42 patients withan unknown primary were referred for an FDG-PETCT. In 4/20 patients, the FDG-PET CT indicated an occult primary tumour at the base of the tongue. This wasconfirmed by biopsy in 3 patients but in 1 there was no histological confirmation.In 6/20 patients, the FDG-PETCT demonstrated asymmetrical FDG activity in thetonsils but subsequent histology was negative. In 10/20 patients, the FDG-PETCTwas negative and blind biopsies were negative. Follow-up to date has not identifieda primary. All patients have survived to date.Conclusion: 18 F-FDG-PETCT scanning can be useful in the detection of occultprimary tumors presenting with metastases to cervical lymph nodes. In our practice,it is used when clinical examination and conventional imaging are negative.C-481The frequency and characteristics of posterior fossa lesions that aremissed on CTJ. Ni Mhuircheartaigh, O. Carney, M. Browne, E. DeLappe, T. Walshe,D. O’Keeffe; Galway/IEPurpose: The reduced sensitivity of CT compared with MRI in evaluating posteriorfossa lesions is an oft quoted axiom of radiology. When asked to support this statementwith evidence from the literature, it is extremely difficult to justify. The aim ofthis study was to identify how many lesions are missed on CT and to characterisethe nature of these lesions.Methods and Materials: We reviewed all the MRI brain or MR skull base studiesperformed and identified any studies where posterior fossa lesions were identified.These were reviewed to identify which patients had also a CT brain performedwithin 8 weeks. The number and nature of lesions were recorded. Patients withdemyelination were excluded as this would not be identifiable outside of the posteriorfossa either.Results: 2,678 patients underwent 2,860 MRI scans. Of these, 158 studies on 120patients had demonstrated posterior fossa lesions. Within this group, 55 patientshad a CT brain within 8 weeks. The only cases where neoplastic lesions were notidentifiable on CT were those in which it was not possible to administer intravenouscontrast. The non-neoplastic lesions not identified on CT were small infarcts in thecerebellum and brainstem and 2 cases of central pontine myelinolysis.Conclusion: While much emphasis has been placed on the limited usefulness ofCT in the evaluation of posterior fossa lesions, these findings indicate that CT issensitive in detection of significant lesions. Furthermore, the importance of intravenouscontrast to improve the sensitivity should not be underestimated.C-482Nasopharyngeal carcinomas: Clinical and radiologic assessmentA. Salgado, R. Maia, F. Pires, P. Oliveira, M. Bacelar, M. Gouvêa; Porto/PTLearning Objectives: To describe the CT and MRI features of nasopharyngealcarcinomas (NPCs). To present the role of MRI in the staging and follow-up. Todescribe the different ways that this tumor can spread.Background: NPC is a relatively rare cancer and represents 0.2% of malignantdisease in the white population. Undifferentiated carcinoma is the most commonhistopathologic type and is associated with EBV. The principal presenting symptom isa nodal neck mass. Imaging manifestations of NPCs are variable and optimally evaluatedby CT and MR imaging. The most reliable imaging finding is that of an aggressive,often enhancing mass, centered in the lateral pharyngeal recess, that infiltrates thedeep fascial planes about the nasopharynx. Nodal metastases are present in 90%of cases at presentation and distant metastases in less than 10%.Procedure Details: We retrospectively reviewed the clinical and imaging findingsof NPCs and present the most representative cases. We show the essential roleof the CT and MRI in staging and treatment of patients with NPC.Conclusion: Imaging is vital for tumor mapping and recurrence assessment. MRimaging provides excellent visualization of nasopharynx soft-tissue planes andenhanced MR imaging is the best tool for evaluation of intracranial extent via direct,perivascular and/or perineural routes. Both CT and MRI may be used for identifyingskull base involvement. CT is superior to MRI for identifying early cortical invasion,while MRI is superior to CT for detecting marrow involvement.Head and NeckACB D E F G HS437

Scientific and Educational ExhibitsC-483Role of dynamic susceptibility contrast perfusion MR imaging indifferentiation of recurrent head and neck tumors from post radiationchangesA.A.A. Abdel Razek, W. Rudwan, M. Amer; Mansoura/EG (arazek@mans.eun.eg)Purpose: To assess the role of dynamic susceptibility contrast perfusion MR imagingecho-planar MR imaging for differentiation recurrent head and neck tumorsfrom post radiation changes.Methods and Materials: Prospective study was conducted on 33 consecutivepatients (21 M, 12 F aged 39-73 ys: mean 51 ys) with head and neck cancer aftercomplete course of radiotherapy. Multislice dynamic contrast enhanced single shotechoplanar T2*-weighted MR imaging was done after bolus infusion of Gadolinium-DTPA at a dose of 0.2 ml mol/kg BW after 8 seconds. Image acquisition was repeatedevery 2 seconds for 120 seconds. The images were processed and lesionsignal intensity versus time curve was created.Results: The mean percentage of maximum signal intensity loss of recurrent tumorwas 38.6% and of post radiation changes was 15.55%. There was statistical differencein the maximum percentage of signal intensity loss between recurrent tumorand post radiation changes (p 0.03). Selection of maximum signal intensity lossof 25.6% as the thresholds to predict recurrence has sensitivity of 91%, specificityof 93%, accuracy of 92%, positive predictive value of 63.6, negative predictivevalue of 100% and area under the curve was 0.956.Conclusion: We concluded that dynamic susceptibility contrast enhancedechoplanar MR imaging increased diagnostic performance of MR imaging indifferentiation recurrent tumor from post radiation changes in patients with headand neck cancer.C-484Enhancing lesions of the tongue and floor of mouth on fat-suppressedcontrast-enhanced MR images: Normal and abnormal findingsI.M. Brennan, G. Murphy, J.F. Meaney; Dublin/IELearning Objectives: To illustrate the spectrum of normal and abnormal enhancinglesions within the floor of mouth on contrast-enhanced MR imaging. To highlightthe pitfalls in interpretation of areas of increased enhancement and to correlate thefindings with T2W images. To demonstrate correct tumour staging with MRI.Background: Detection of primary tumours within the tongue and floor of mouthis frequently difficult for many reasons, including image degradation due todental amalgam and mucosal opposition. This leads to poor lesion conspicuity.Fat-suppressed contrast enhanced T1W imaging is the optimal method for lesiondetection and is superior to T2W imaging. However, accurate tumour staging iscomplicated by the presence of multiple sites of focal enhancement within thenormal oral lymphoid and salivary gland tissues.Imaging Findings: We illustrate non-contrast (T2W) pre and post-contrast MRimaging in normal subjects, benign and malignant tumours, and inflammatorylesions of the tongue and floor of mouth in a cohort of patients presenting to atertiary referral centre. We present the normal spectrum of enhancement withinthe tongue and floor of mouth. We illustrate the differing patterns of enhancementamongst these processes that aid in confident identification and accurate stagingof malignant disease.Conclusion: MR is a valuable modality for the local staging of primary tongueand floor of mouth tumours. Knowledge of the spectrum of normal enhancementis essential to allow accurate staging and planning.Head and NeckMaxillofacial ImagingC-485Pearly whites and pearly cysts: A review of maxillary, mandibular anddental lesionsE.K. Dillon, R. Chinn, R.P. Barker; London/UK (elizabethk.dillon@mac.com)Learning Objectives: To review important and common radiological pathologyseen in the mandible and maxilla.Background: Maxillary and mandibular radiological abnormalities may have odontogenicand nonodontogenic origins and are not uncommonly encountered inboth the paediatric and adult populations. Comprising both benign and aggressivelesions, they may present acutely, more indolently, or be imaged incidentally.Imaging Findings: 1) Benign cystic lesions of the mandible and maxilla (periapical,dentigerous, and odontogenic keratocysts and fibrous dysplasia). 2) Benign solidlesions (ameloblastomas, odontomas, ossifying fibromas, periapical cemental dysplasiaand neurofibromas). 3) Malignant solid lesions (squamous cell carcinomas,osteosarcomas and metastatic tumours). 4) Lesions associated with teeth and theirsupport structures. 5) Craniofacial syndromes affecting this region.Conclusion: Mandibular and maxillary lesions may present in a variety of ways.Whilst biopsy is often required ultimately to make the diagnosis, it is important thatradiologists recognise the abnormality and suggest a likely cause.C-486Ultrasound diagnostics of children’s maxillofacial area vascularmalformationsA. Vasylev, M. Vykluk; Moscow/RU (auv62@mail.ru)Purpose: Optimization of ultrasound diagnostics of children’s maxillofacial areavascular malformations.Methods and Materials: High resolution ultrasound examinations were performedin 243 children (with the age from 2 months to 14 years) with vascular malformationsof maxillofacial area.Results: Capillary cavernous hemangiomas were detected in 85 children asinhomogeneous structure formations with areas of liquid genesis (caverns) andvascular component and primarily arterial flow. Arterial-venous communicationswere found in 12 cases as additional vascular structures with non-linear course injaws projections; were characterized by high linear velocities (up to 100 - 150 cm/s)and fistulas. In 39 children, venous angiodysplasia was found as heterogeneousformations with dilated veins. Angiofibromas were found in 35 children as formationswith capsules and consisting of several nodules separated by fibrous septas. In 26cases, hypervascularisation of formations were found in other observations andsingle vessels were detected in projections. Lymphangiomas were diagnosed in 72patients as avascular formations with average echogenicity with hypoechoic areas ofa small size (cavernous component) and anechoic cavities with incomplete septas(cystous component). At the period of inflammation (22 observations), increase offormations size, increase of cystous cavities, appearance of suspension septasthickening and foliation was noted.Conclusion: Ultrasonic examinations allow determining the character of vascularmalformations of children’s maxillofacial area. This adequately influences thechoice of treatment tactics.CS438 A B D E F FG H

Scientific and Educational ExhibitsC-487Is it so important to differentiate the cysts and cystic lesions of the jaw?The role of MDCT in the diagnosisR. Prada, E. Santos, J. Aguilar, G. Tardáguila, F. Tardáguila; Vigo/ES(rachelpg@terra.es)Learning Objectives: 1. To review the different types of cysts and cystic lesions ofthe jaw. 2. To describe the characteristic imaging patterns useful for narrowing thedifferential diagnosis. 3. To outline the value of MDCT in their diagnosis.Background: Cysts and cystic lesions of the jaw are common in our daily practice.The understanding of the main pathological processes and of whatever the clinicianneeds to know about them ought to make easier the study of these lesionsfor radiologists.Imaging Findings: Although cysts in the jaws are commonly diagnosed and treatedby general dental specialists, MDCT is being increasingly used to evaluate thispathology. Jaw cystic lesions can be odontogenic or nonodontogenic. We present arange of richly illustrated cases with the help of 64-MDCT images so as to provideradiologists with an excellent opportunity to become familiar with odontogenic andnonodontogenic lesions alike. Odontogenic cysts include follicular and radicularcysts, residual and paradental cysts, odontogenic keratocysts and ameloblastomas.Nonodontogenic cysts are mainly traumatic bone cysts, incisive canal cysts andbenign fibro-osseous lesions. The location of the lesion within the jaw, its borders,its internal architecture, as well as its effects on adjacent structures makes generallypossible the narrowing of their differential diagnosis.Conclusion: The definitive diagnosis of cysts and cystic lesions of the jaw relieson a constellation of clinical and radiological findings. Although the imaging appearancecan be non-specific, certain MDCT patterns should allow us to makean accurate diagnosis.Head and NeckTemporal BoneC-488Increased signal intensity of the cochlea on pre- and post-contrastenhanced 3D-FLAIR in patients with vestibular schwannomaM. Yamazaki, S. Naganawa, H. Kawai, T. Nihashi, H. Fukatsu; Nagoya/JP(yamazaki@med.nagoya-u.ac.jp)Purpose: To evaluate the signal intensity of the cochlear fluid on pre- and postcontrastenhanced thin section three dimensional fluid attenuated inversion recovery(3D-FLAIR) in patients with vestibular schwannoma.Methods and Materials: Twenty-seven patients with vestibular schwannoma whounderwent MR imaging of inner ear between January 2006 and June 2008 wereretrospectively analyzed. 3D-heavily T2 weighted images (T2WI), 3D-T1 weightedimages (T1WI) and 3D-FLAIR images were obtained in all patients. In 18 patients,post-gadolinium enhanced 3D-T1WI and 3D-FLAIR were also obtained. Slicethickness of all images was 0.8 mm. Region of interest (ROI) of both cochlea (C)and medulla oblongata (M) were determined on 3D-FLAIR images by referring to3D-heavily T2WI at workstation. Signal intentisy ratio between C and M on 3D-FLAIR(CM ratio) was defined as follows: signal intensity (SI) of C divided by SI of M. In 20patients, correlation between CM ratios and hearing level was also evaluated.Results: CM ratios of affected side were significantly higher than those of unaffectedside (p 0.001). In affected sides, post contrast signal elevation was observed(p 0.005). CM ratios were correlated with hearing level (p 0.05).Conclusion: The results of the present study suggest the alteration of cochlearfluid composition and the disruption of blood-labyrinth-barrier in the affected sides.Furthermore, the positive correlation between cochlear signal intensity and hearinglevel was shown. These warrant further study to clarify the relationship of 3D-FLAIRfindings and prognosis of hearing preservation surgery.C-489Temporal bone fractures: CT findingsS. Rosa, E. Domènech, M. Larios, C. Delgado, D. Villa, T. Sempere; Tarragona/ESLearning Objectives: To review the anatomic relationships of temporal bone andadjacent structures (blood vessels and nerves), since petrous bone is the mostcommon place for fractures of the skull base. To identify and describe CT findingsof 3 types of fractures of petrous bone (longitudinal, transverse and oblique) andto know complications associated to them.Background: There are three types of petrous bone fracture depending on the wayof the fracture line: 1 - horizontal or longitudinal (70-80%) 2 - vertical or transverseand 3 - oblique or mixed. Transverse processes are less frequent but more seriousones, because they often affect the inner ear structures and cause total sensorineuraldeafness, as well as 50% of the cases that are accompanied by permanentfacial paralysis. Intracranial complications that can arise from these fractures are:meningitis, injury to adjacent venous sinuses with accumulation of blood or extraaxialthrombosis, traumatic meningoencefalocele and leak of LCR.Imaging Findings: CT imaging findings.Conclusion: Petrous bone fractures are relatively frequent and important to betaken into account in patients with cranial trauma because they can have seriousconsequences. It is important to recognize anatomic structures in order to make acorrect diagnosis of petrous bone fractures.Head and NeckACB D E F G HS439

Scientific and Educational ExhibitsC-490Magnetic resonance imaging of temporomandibular joints in patientstreated for internal derangementL. Gentile, F. Molinari, E. Faloni, P. Manicone, L. Raffaelli, R. Ursini, A. D’Addona,T. Pirronti, L. Bonomo; Rome/IT (luigia.gentile@gmail.com)Learning Objectives: To illustrate the spectrum of magnetic resonance imaging(MRI) findings of the temporomandibular joint (TMJ) in patients treated for internalderangements.Background: Internal derangements of the TMJ may be treated conservativelywith long-term use of splints. The potential changes in condilar-disc relationshipand position induced by such devices are rarely understood by radiologists. In thisexhibit, we show the normal, pathological and post-treatment MRI findings of theTMJ in patients with internal derangement.Imaging Findings: Normal MR images of TMJ with anatomic schemes. Static anddynamic MR images showing all the grades of internal derangement of the TMJdisc. MRI studies obtained in patients treated with the use of splits.Conclusion: Treatment-related remodeling of the TMJ may be understood anddescribed when patient’s clinical condition and history are known. Dynamic imagingoffers the opportunity to visualize the spontaneous range of TMJ motion, which mightbe normal even when extensive alterations are detected by static images.Head and NeckMiscellaneousC-491Magnetic resonance ophthalmoscopy: The usefulness of half-Fouriersingle-shot rapid acquisition with relaxation enhancement sequence with amicroscopy coil in the morphologic evaluation of eyeballsK. Tanitame, K. Sasaki, T. Sone, M. Sumida, T. Ichiki, K. Ito; Hiroshima/JP(tntrad@ms1.megaegg.ne.jp)Purpose: The first purpose of this study was to compare half-Fourier single-shotrapid acquisition with relaxation enhancement (RARE) sequence with balancedsteady-state free precession (b-SSFP) sequence in the evaluation of eyeballs usinga microscopy coil. The second purpose was to clarify the usefulness of RAREmagnetic resonance (MR) imaging in the evaluation of glaucoma eye, retinaldetachment and postoperative eye.Methods and Materials: 1-mm and 2-mm section thickness images of half-Fouriersingle-shot RARE sequence and b-SSFP sequence with a 1.5-T MR unit anda 23 mm microscopy coil were obtained in 8 healthy volunteers. In addition tospatial and temporal resolutions, the visualization of the eyeball’s morphologicalfeatures was assessed among those images. Furthermore, RARE MR imagingwas performed in 21 glaucoma patients including 6 patients after surgical treatment,1 patient with retinal detachment and 2 patients who underwent cataractsurgery. These results were compared with those of established ophathalmologicalexaminations.Results: The best image quality was achieved by half-Fourier single-shot RAREsequence with 2-mm section thickness in the morphologic evaluation of theeyeballs (P .01). There was excellent agreement between RARE MR imagingand slit-lamp biomicroscopy in the classification of the anterior chamber anglesas narrow or open in glaucoma patients (=0.90 [95% CI: 0.70, 1.09]) and RAREMR imaging corresponded to optical coherence tomography in the patient withretinal detachment. Moreover, RARE MR imaging was useful in the evaluation ofpostoperative eyes.Conclusion: Half-Fourier single-shot RARE MR ophthalmoscopy using a microscopycoil delineates the details of the eyeball’s anatomy.C-492MR imaging of the neck at 3 Tesla using T2-weighted BLADE comparedwith T2-weighted fast spin-echo sequenceY. Ohgiya, T. Hashizume, J. Suyama, N. Seino, M. Hirose, T. Gokan; Tokyo/JPPurpose: BLADE and PROPELLER (periodically rotated overlapping parallel lineswith enhanced reconstruction) techniques have been proposed to reduce the effectof head motion. The purpose of this study was to evaluate T2-weighted BLADE(T2W-BLADE) compared with T2-weighted fast spin-echo (T2W-FSE) regardingmotion artifacts, tissue contrasts, and lesion detectability.Methods and Materials: Forty-six patients (31 men, 15 women; mean age, 57.2years) referred for MR imaging of the neck were included in a comparison ofT2W-BLADE and T2W-FSE. All examinations were performed at 3 T in the axialimage orientation using the same parameters and spatial resolution. Two observersevaluated unlabelled images for motion artifacts (ghosting and pulsationartifacts), the preferred image quality, and lesion detectability. ROI-based quantitativemeasurements were performed to assess tissue contrasts. The frequency ofoccurrence of the different assessed motion artifacts was tested using McNemar’stest. Reader agreement was assessed using Cohen’s kappa test. Tissue contrastswere compared using paired Student’s t-tests. Lesion detectability was comparedby using Chi-Squared test.Results: T2W-BLADE showed less ghosting and pulsation artifacts than T2W-FSE(P 0.01). T2W-BLADE images were rated as better than or equal to T2W-FSEimages in the majority of cases (93.5%; kappa = 0.60). There was no significantdifference in tissue contrasts between T2W-BLADE and T2W-FSE. Thirty twolesions were present in 32 patients and equally well seen on T2W-BLADE andT2W-FSE.Conclusion: T2W-BLADE imaging for the neck is applicable at 3 T. T2W-BLADEsequence can reduce motion artifacts and provide tissue contrasts and lesiondetectability equivalent to T2W-FSE sequence.CS440 A B D E F FG H

Scientific and Educational ExhibitsC-493Rapid prototyping in manufacturing of external auditory canal model for ahearing aid deviceR. Chrzan 1 , A. Urbanik 1 , S. Miechowicz 2 , O. Markowska 2 , T. Kudasik 2 ;1Krakow/PL, 2 Rzeszow/PL (rchrzan@mp.pl)Learning Objectives: To illustrate the possibilities of modern biomedical engineeringin ENT patients. To describe the steps of hearing aid manufacturing, using rapidprototyping based on CT data.Background: Rapid prototyping is the automatic construction of physical objectsfrom virtual CAD (computer aided design) models. For medical objects, the modelsmay be created using data from CT or MR examinations. In ENT patients withimpaired hearing, an intracanal hearing aid is commonly adjusted by taking directexternal auditory canal impression. In many cases it results in an inaccurately fitteddevice and patient’s discomfort. However, currently it is possible to quickly manufactureperfectly fitted hearing aids using rapid prototyping based on CT data.Procedure Details: CT of external auditory canal was performed using dedicatedhigh resolution protocol. Virtual CAD model was generated based on CT data.Location of hearing aid electronic elements was planned based on CAD model.Material model of external auditory canal with hearing aid was produced usingstereolitography. Finally, hearing aid was manufactured using vacuum castingbased on stereolitography model.Conclusion: Rapid prototyping may utilize data obtained from commonly used spiralCT scanners. This technology may help in manufacturing biomedical prostheses,reducing time of device production and improving its fitting.C-494Brain and head and neck protocols on multi-detector row CT (MDCT): Eyelens dosimetry and clinical implicationsJ.S.P. Tan, K.-L. Tan, J.C.L. Lee, C.-M. Wan, J.-L. Leong, L.-L. Chan;Singapore/SG (wan.ching.ming@sgh.com.sg)Learning Objectives: To understand dosimetric differences between identicalneuroimaging studies on multi-detector row CT (MDCT) of different numbers ofdetectors and their clinical implications.Background: CT examination is a high radiation dose imaging modality. The rapidadvancement in MDCT technology has paralleled the exponential increase in thenumber of CT examinations performed. The eye lens is especially susceptible toradiation-induced cataracts. However, the dosimetric differences between identicalneuroimaging studies on MDCT using different numbers of detectors are notwell known.Procedure Details: Six cadaveric CT scans were performed on a 64-slice MDCTfor each of the following clinical studies, viz, brain, paranasal sinus and temporalbone/orbits, and the eye lens dose measured using thermoluminescent dosimeters(TLDs). The studies were repeated on a 16-slice MDCT using identical protocols.The dose length product, volume CT dose index and TLD readings for each CTprotocol were tabulated and compared between scanners and protocols.Conclusion: CT brain in tilted axial mode on the 16-slice MDCT imparts thelowest radiation dose to the eye lens due to deliberate angulation of the radiationbeam out of the eyes. Conversely, when CT gantry tilt is impossible, hyperflexionof the neck is an alternative. For paranasal sinuses and temporal bone/orbits CTprotocols, eye lens radiation doses delivered by 64-slice MDCT are significantlylower than 16-slice MDCT, partly due to improvements in automatic tube currentmodulation technology.C-495Application of educational theory regarding teaching for skill transferenceusing the compartment model for orbital imaging in postgraduateeducation and training: Assessment and evaluation of a group ofophthalmology and radiology residents and fellowsP.-S. Goh; Singapore/SG (dnrgohps@nus.edu.sg)Learning Objectives: To illustrate how educational theory on teaching for transference(i.e. teaching strategies to promote the ability of students to apply case basedlearning to new clinical problems) can be applied in the use of the compartmentmodel for orbital imaging in postgraduate education and training of ophthalmologyand radiology residents and fellows.Background: Many radiologists are unaware of best practices in teaching andparticularly evidence based educational theory, which can be immediately andeffectively applied to postgraduate training. As a consequence, current practicesin radiology education follow a see one do one approach.Procedure Details: This exhibit will present key research regarding transference,show its relevance to postgraduate training applying the compartment model fororbital imaging with a group of ophthalmology and radiology residents and fellows,as well as present data to show its effectiveness in postgraduate education. Inparticular, a combination of: a) presenting paired examples, asking students towork out underlying principle, then presenting principle, b) mixed practice - i.e.presenting two contrasting cases, asking students to work out differences, thenpresenting principle, and c) distributed practice will be shown to be the best methodfor encouraging transference of skills.Conclusion: Application of educational theory regarding teaching for skill transferencecan significantly improve radiology training and educational efforts asillustrated in this presentation using the compartment model for orbital imaging.C-496The capability of microfocal radiography during intraoperational stage ofstomatological implantationI.N. Gipp, N.S. Serova, A.Y. Vasiliev, A.I. Ushakov; Moscow/RU (ilgipp@yandex.ru)Purpose: Evaluation of microfocal radiography possibilities at the intraoperationalstage of stomatological implantation.Methods and Materials: 60 patients were examined (27 female and 33 male) withage from 19 to 62. Mandibular implantation was performed to 37 patients, maxillary- 23 patients. All examinations were performed in the operation room with portabledigital microfocal radiography unit. The following exposition parameters were used:60 kV, 0.1 mA, exposure time - 0.2 s.Results: Obtained data had allowed evaluation of the correct relationship of implantationspace and surrounding anatomical structures in the course of operationprocedures. 26 mandibular patients had indicated impermissible distance betweenthe lower wall of implantation space and the mandibular canal (less than 1.8 mm)and in 3 patients distance to foramen mental was less than 1.4 mm. Maxillary bonetissue volume among the examined group was sufficient enough for implant installation.Intraoperational microradiography had allowed surgeons to make decisionson implantation technique that differed from preplanned ones based on preoperativeradiology examinations (orthopantomography and spiral CT): in 9 cases, decisionwas made to decrease the depth of implant installation and in 6 cases to install animplant of a smaller size, compared to the one preplanned.Conclusion: Use of portable digital microfocal radiography equipment in the intraoperativestage of stomatological implantation allows making final decision duringthe operation about the tactic and its performance. This significantly increases thequality of treatment procedures.C-497Multidetector computerized tomographic (MDCT) findings during andfollowing osteo-odonto-keratoprosthesis (OOKP) surgeryL.L. Chan, C.M. Wan, J. Tan, Y.M. Por, W. Lim, D. Tan; Singapore/SGPurpose: Osteoodontokeratoprosthesis surgery (OOKP) is a two-stage sightrestoringprocedure for patients with refractory corneal blindness. The purpose ofthis exhibit is to report: 1) the complex CT findings at each stage of the surgeryand 2) the serial post stage 2 CT findings of the prosthesis on multi-detector computerizedtomography (MDCT).Methods and Materials: The 2 stages of the OOKP surgery are spaced about4 months apart. Tooth harvest for prosthesis formation and ocular resurfacingpreparations are performed during the first stage. The keratoprosthesis is thenimplanted onto the neo-ocular surface during the second stage. Measurements ofthe keraotprosthesis on baseline and follow-up CT scans in our patient cohort arerecorded and compared for resorption and tilting.Results: The CT findings at each stage of surgery are explained with intraoperativephotographic correlation. To date, three of 21 patients (11 women, 18 - 58 years)have shown resorption of at least 25% of the baseline prosthetic dimensions, andat as early as five months follow-up. One patient demonstrated significant tilting ofthe prosthesis with respect to the optic nerve.Conclusion: MDCT scans graphically demonstrate the stages of the complexOOKP surgery. Prosthetic resorption and tilting are detectable on early serialMDCT imaging.Head and NeckACB D E F G HS441

Scientific and Educational ExhibitsC-498I cannot swallow, doctor: What is wrong with me? Head and neckinfections in the emergency roomE. Alonso Gamarra, F. Guerra Gutiérrez, P. García Raya, M. Parrón,V. Pérez Dueñas; Madrid/ES (edualonsogamarra@gmail.com)Learning Objectives: To review the head and neck infections at the emergencyroom. To suggest the most likely source of infection. To describe possible complicationsand typical pathways of extension, following head and neck spaces on CT.Background: Head and neck anatomy is usually a long and wearisome chapterof any radiologist resident’s book. Nevertheless, studying lesions following cervicalspaces can help us make a better approach to their possible source. CT is widelyused to diagnose head and neck infections, and usually the medical managementor surgical intervention is based on imaging findings.Procedure Details: 81 patients with neck infections were studied with CT in thelast two years in our emergency department. Our image protocol depends on thetype of infection, physical examination being the first diagnosis step. If mediastinalor vascular involvement is suspected, thoracic structures must be included in thestudy. We will discuss, with imaging examples, the most common infections arisingin each facial compartment, and their typical spread pathways. The radiologistshould communicate if the infection is presented as cellulitis or as an abscess,its size and space location. A delay in diagnosis can lead to fatal complications,such as descending mediastinitis, jugular vein thrombosis, or even systemic dissemination.Conclusion: After reviewing this exhibit, a radiologist in training will be able to: A.Realize the importance of the head and neck infections. B. Suggest the possiblesource of infection following cervical spaces description. C. Optimize the patient’soutcome by a correct team-work with head and neck surgeons.C-499MR imaging of common and uncommon extraocular orbital lesionsC.L. Fernandez Rey, A. Saiz Ayala, E. Santamarta Liebana, E. Montes Perez;Oviedo/ES (cristinarey80@hotmail.com)Learning Objectives: To illustrate the compartmental anatomy of the orbit. Todiscuss radiological findings of both common and uncommon extraocular orbitallesions.Background: MR imaging is often used in the detection and differential diagnosisof orbital pathology. We show some key facts to help us to detect usual orbitaldiseases and to familiarise with some unusual lesions.Imaging Findings: 1. Anatomy: We describe the anatomy of the orbit and illustratethe principal lesions that can involve the major anatomic orbital spaces. 2. Pathology:We have made a pictorial review showing the wide spectrum of lesions that caninvolve the extraocular orbit including primary and secondary neoplasms, vascularmalformations, pediatric tumors and inflammatory conditions.Conclusion: Multiple pathological conditions can involve the extraocular orbit.The location, MR imaging characteristics and clinical history can help narrow thedifferential diagnosis.C-500Pulsatile vascular masses of the extracranial head and neck: CT and MRIfeaturesV.M. Joshi, U.K. Nayak; Hyderabad/IN (dr_varshamj@rediffmail.com)Learning Objectives: To illustrate the imaging features of pulsatile vascular massesof the extracranial head and neck.Background: Paragangliomas are the commonest causes of pulsatile vascularmasses in the extracranial head and neck. Paragangliomas of the head and neckhave characteristic distribution, originating from the paraganglia or glomus cellswithin the carotid body, vagal nerve, middle ear and jugular foramen. Carotid orvertebral artery aneurysms and pseudoaneurysms are the other rarer causes ofsuch masses. Contrast CT and/or MRI findings in 15 patients who presented toour imaging department with pulsatile swellings of the extracranial head and neckare presented.Imaging Findings: Characteristic locations and the striking imaging features ofthe paragangliomas are illustrated and described in detail. All paragnagliomaswere seen as intensely enhancing soft-tissue masses in the carotid space, jugularforamen, or tympanic cavity at CT and a salt-and-pepper appearance at standardspin-echo magnetic resonance imaging. A classic permeative pattern of bonedestruction was seen in jugular foramen paraganglioma. Contrast CT with sagitaland coronal reformations in two patients with aneurysms and pseudoaneurysm ofthe carotid artery are illustrated with brief description about the pathology.Conclusion: 1. Paragangliomas, aneurysms and pseudoaneurysms have classiclocations and imaging features that are exquisitely depicted on CT and MRIstudies permitting a definitive diagnosis. 2. Imaging studies accurately depict thelocation and extent of involvement and help determine the surgical approach intreating these lesions.C-501MR cisternography with fast imaging employing steady-state acquisition(FIESTA)P.V. Foti, R. Farina, S. Palmucci, M. Coronella, D. D’Aniello, D. Bellomia, G. Politi,G.C. Ettorre; Catania/IT (pietrofoti@hotmail.com)Learning Objectives: To illustrate the main features of FIESTA sequence, andits advantages over other MR imaging sequences in imaging cisternal parts ofcranial nerves V-VII-VIII.Background: FIESTA sequence generates T2/T1 contrast because of its shortrepetition time (TR) and the symmetrical and balanced gradient around the echotime (TE). It provides very high signals from tissues with large T2/T1 ratios, such asfluid, blood and fat. Scanning time is shorter than in conventional CISS and FISP,and movement and flow artifacts occur less often than with other sequences. Thecontrast to noise ratio (CNR) is higher. Blurring artifacts occur less often becausethe MR signal is always achieved in a coherent state. Magnetic susceptibility artifactsoccur with lower frequency due to very short TE and wide band thickness.Imaging Findings: We assessed FIESTA sequence’s performance in patients withV-VII-VIII cranial nerve’s related symptoms. In cases of posterior fossa tumors,FIESTA sequence depicted clearly tumor’s extension and facilitated a superiorassessment of tumor’s effect on cranial nerve anatomy. When a neuro-vascularconflict was suspected, FIESTA identified in all patients the anatomical relationshipbetween vascular structures and trigeminal, facial and cochleovestibular nerves.Moreover, volumetric 3D acquisition allowed very high quality from multiplanarreformations using minimum intensity projection algorithm.Conclusion: 3D FIESTA sequences are superior to other heavily T2-weightedsequences in visualizing cisternal parts of the posterior fossa cranial nerves for thefollowing reasons: high-resolution, short acquisition time, less artifacts from CSFpulsation and magnetic susceptibility. Thus, high quality images can be obtained.C-502Denervation cervical muscular atrophy: CT and MR evaluationsA. Piscopo, R.L.E. Gomes, E.M.M.S. Gebrim, L.N. Silva, F.K.I. Cevasco,M.M. Daniel, G.G. Cerri; Sao Paulo/BR (adriana@piscopo.com.br)Learning Objectives: To illustrate the spectrum of cervical muscular atrophy afternerve injury. Computed tomography (CT) and magnetic resonance (MR) studieswere selected to exemplify the denervation muscular atrophy by lesions of V, VI,VII, X, XI and XII nerves.Background: Patients with denervation cervical muscular atrophy usually have aprior history of tumoral resection and radical neck dissection, tumor invasion andradiation neuropathy.Imaging Findings: The sequence of events has been divided into the acute, thesubacute and the chronic phases. During the acute phase, the MR appearance ofmuscle is frequently normal. More recent works have shown that signal changesand contrast enhancement can be detected as early as 24 h. The subacute phaseis characterized by a relative increase in the extracellular water compared with theintracellular water. There is a high signal intensity within the denervated muscle onT2 weighted and STIR images and may occur enhancement with contrast. Chronicdenervation is best seen on T1-weighted images, and show as a loss of muscle bulkwith diffuse areas of increased signal intensity within the muscle corresponding tofatty replacement, fibrosis and atrophy.Conclusion: It is important to become familiar with acute, subacute and chronicchanges of muscle denervation because neoplastic and inflammatory processesmay have a similar imaging appearance. Head and neck clinically silent tumorscan signal its presence only as a cranial nerve dysfunction through the denervatedmuscle. Therefore, in denervated muscle, we must evaluate the entire course ofthe cranial nerve searching for a lesion.CS442 A B D E F FG H

Scientific and Educational ExhibitsC-503Vascular lesions of the orbit: A pictorial reviewC.L. Fernandez Rey, A. Saiz Ayala, E. Santamarta Liebana, E. Montes Perez,P. Sanchez Lopez, I. Noval Tuñón; Oviedo/ES (cristinarey80@hotmail.com)Learning Objectives: To illustrate the spectrum of vascular lesions that can involvethe orbit. To discuss and emphasize the role of MR angiography.Background: Multiple vascular lesions can affect the orbit including neoplasms,malformations and shunts. These lesions can manifest with proptosis or diplopia.Imaging differentiation is essential because the management and prognosis varygreatly. MR angiography provides useful information in the preoperative evaluationof these lesions.Imaging Findings: The spectrum of vascular lesions that can involve the orbitinclude hemangiomas, cavernous malformations, orbital varices, venous lymphaticmalformations, hemangiopericytomas, hemangioblastomas, vascular metastases,etc. We have made a pictorial review showing the more significant cases and describethe specific imaging features that can help us in their diagnosis.Conclusion: Imaging studies are essential for the evaluation of the vascular processesaffecting the orbit. Location, age patient and characteristics on MR imagingare key facts that can help narrow the differential diagnosis, thereby helping toguide patient treatment.C-504Dental CT: Substantial findings the radiologist needs to communicate tothe clinicianA. Gahleitner, U. Kuchler, F. Kainberger; Vienna/AT(andre.gahleitner@meduniwien.ac.at)Learning Objectives: Unfortunately, most radiologists have had little experiencewith dental-CT and many of the findings remain undescribed. Our objective, therefore,was to determine the CT appearance of dental related diseases of the jawsand to demonstrate typical and frequent findings.Background: Dental-CT has become an established method for anatomic imagingof the jaws prior to dental implant placement. More recently, this high-resolutionimaging technique has gained importance in diagnosing dental associated diseasesof the mandible and maxilla.Imaging Findings: Dental-CT investigations using the usual high resolution protocol(1 mm slice thickness, 1.0 mm table feed) were performed and reconstructed on aworkstation). Patients prior to implant placement as well as patients with cysts, oroantralfistulas, odontogenous maxillary sinusitis, impacted teeth and dental fractureshave been investigated. Anatomic and pathologic conditions of the jaws are clearlyvisualized and serve as an aid to the clinician for therapeutic management.Conclusion: This exhibit reviews our experiences from over 24000 CT investigationsand will summarize the imaging possibilities and indications, which dental-CTis able to cover.No Material Submitted to EPOSInterventional RadiologyVascularC-505Central venous occlusion: Back to the heart of the matterD.A. Covarrubias, D.M. Flamini, R.F. Leonardo, J.M. Martino; Brooklyn, NY/US(dacovarrubias@yahoo.com)Learning Objectives: To review the anatomy and physiology of the central veinsof the upper extremity and the major clinical etiologies of occlusion. To demonstratea variety of cases that depicts the typical imaging appearance of central venousocclusion across multiple modalities and address pertinent aspects of imagingguidedmanagement options.Background: As the number of patients requiring extended central venous accesscontinues to rise, central venous thrombosis of the upper body has becomean increasingly common clinical dilemma. Diagnosis and often management ofthese conditions depends heavily on multi-modality imaging. The purpose of thisexhibit is to review the relevant anatomy of the venous system of the upper torsoand extremities and to portray the imaging findings of both primary and secondarycauses of central venous occlusion as well as present a brief examination ofsignificant collateral pathways and their imaging manifestations. Finally, treatmentoptions will also be discussed.Imaging Findings: Examples of imaging findings of central venous occlusion usingmultiple imaging modalities will be presented, including venography, computedtomography, and magnetic resonance angiography/imaging. Brief examples ofimaging-guided therapeutic interventions will also be presented.Conclusion: The goal is to develop a confident approach to the diagnosis of centralvenous occlusion and an understanding of relevant clinical aspects of the conditionas well as available treatment options.C-506The role and method for performing fistuloplasty on a poorly functioninghaemodialysis fistulaS. Stuart, A. Hameeduddin, P. Boavida, B. Roberton; London/UK(sstuart@doctors.org.uk)Learning Objectives: To explain when fistuloplasty is an appropriate techniquefor managing poorly functioning haemodialysis fistulae. To describe the techniqueof fistuloplasty for managing poorly functioning haemodialysis fistulae. To outlinethe possible complications of fistuloplasty.Background: The number of patients with end stage renal failure is increasingworldwide. Haemodialysis is one of the main methods of renal replacement therapyand the use of haemodialysis is increasing. Formation and maintenance of a functioningarterio-venous fistula is vital for long term haemodialysis. Unfortunately,complications with the fistula such as thrombosis and stenosis can render the fistulaunsuitable for use. Fistuloplasty is a technique that can help improve the functionof a fistula and allow it to be used for haemodialysis once again.Procedure Details: The multimodality methods of imaging a non functioning fistulaand their relative advantages and disadvantages are illustrated. The role of fistuloplastyin the management of a non functioning haemodialysis fistula is explained.The method of performing fistuloplasty and the equipment needed is carefully explainedand illustrated. The possible complications of fistuloplasty including contrastextravasation, fistula rupture and pseudoanuerysm formation is covered along withthe role of interventional radiology in managing these complications.Conclusion: Fistuloplasty is a safe and effective method for treating a non functioninghaemodialysis fistula. Fistuloplasty can be associated with complications thatmay be treated using interventional radiology.C-507Evaluation of vascular supply with angio-CT during intra-arterialchemotherapy for advanced maxillary cancerN. Kashiwagi, K. Nakanishi, M. Koyama, Y. Satou, K. Yoshino, H. Uemura; Osaka/JP(kasiwagi-no@mc.pref.osaka.jp)Learning Objectives: To identify the feeding arteries of advanced maxillary cancerand illustrate these supplying territories using angio-CT.Background: Combined therapy with radiotherapy and superselective intra-arterialchemotherapy for advanced maxillary sinus carcinoma has been recently attemptedin many institutions to preserve the organ and improve poor prognosis. Understandingthe tendency of the feeding arteries of advanced maxillary cancer could aid inappropriately performing this interventional procedure and in shortening its time.Interventional RadiologyACB D E F G HS443

Scientific and Educational ExhibitsImaging Findings: We studied 13 patients with maxillary cancer by angio-CT. Theclinical T factors for these patients were T3 (N=6) and T4 (N=7). Feeding arterieswere as follows: 13 via the maxillary artery, 6 via the orbital artery, 6 via the facialartery, 4 via the transverse facial artery, 4 via the ascending palatine artery, 1via the ascending pharyngeal artery, and 1 via the middle meningeal artery. Thesupplying territories of feeding arteries were as follows: The maxillary arteriessupplied the tumors in the maxillary sinus, its wall, and the pterygopalatine fossa.Other arteries supplied the tumor, which extended to the extra maxillary sinus asfollows: the tumors with an upward extension were supplied by the orbital arteries,medial frontal tumors were by the facial arteries, lateral frontal tumors were by thetransverse facial arteries, those extending downward were supplied by the ascendingpalatine arteries, and those towards posterior were supplied by the ascendingpharyngeal artery or middle meningeal artery.Conclusion: The parasitic supplying arteries of the maxillary cancer exhibiteduniform tendencies depending on the tumor site.C-508The role and contributable factors for preservation of long term patency instent assisted subintimal angioplasty in a patient with a critical lower limbischemiaS. Lee, Y. Cho, Y. Choi, H. Kim, J. Woo, J. An, Y. Jeong, C. Han; Seoul/KR(penginman@hanmail.net)Learning Objectives: To illustrate variable features of stent-assisted subintimalangioplasty for severe stenosis of multifocal infrapopliteal arteries in a critical limbischemia. To analyse contributable factors of preservation of long term patency ofstent-assisted subintimal angioplasty between angioplasty alone and combinedstent placement in infrapopliteal arteries.Background: Percutaneous intentional subintimal angioplasty has become anaccepted and successful method of treatment for chronic atherosclerotic occlusivedisease in femoropopliteal and infrapopliteal arteries. But, there are few studiesand reported literature for analysis of factor for preservation of long term patencyof treated infrapopliteal arteries and role of additional stent after subintimalangioplasty.Procedure Details: A total 36 patients were treated with subintimal angioplastyfor segmental occlusion of superficial femoral artery only (15/36), superficialfemoral artery combined infrapopliteal artery (12/36) and infrapopliteal artery only(9/36) during the last three years. The percutaneous subintimal angioplasty onlywas performed in 10 patients in 21 patients of treated infrapopliteal arteries andcombined stent assisted angioplasty was performed in 14 patents in severe occlusiveinfrapopliteal arteries.Conclusion: The stent assisted subintimal angioplasty may be helpful in preservinglong term patency and successful recanalization after angioplasty than subintimalangioplasty alone, but adequate anticoagulation medication, serial follow-up Dopplerultrasonograpy and additional angioplasty are needed in continuing initialpatency.C-509Management of intractable bladder and prostate hemorrhage with selectivearterial embolization: Short- and long-term outcomesR. Loffroy, A. Delgal, B. Guiu, F. Michel, I. Kermarrec, J.P. Cercueil, D. Krausé;Dijon/FRPurpose: To evaluate the efficacy and outcomes of transcatheter arterial embolizationas an alternative therapeutic option in the control of intractable hematuria ofvesical or prostatic origin after failed conservative treatment.Methods and Materials: Retrospective study of 22 consecutive embolization proceduresin 19 patients (17 men, 2 women, mean age 7317.2 years) with refractorybladder or prostate hemorrhage referred from 1999 to 2008 for selective pelvicangiography after failed conventional therapy. Vascular embolization was performeduni- (n=5) or bilaterally (n=12) as follows: superselective distal particulate or glueembolization of the vesical or prostatic arteries in 10 patients, selective proximalcoil occlusion of the anterior division of internal iliac artery in 2 patients, both in 3patients, and coil blockade technique in 2 patients. Success was monitored withpostembolization angiography and cessation of hematuria clinically.Results: The technical success rate was 89.5% (17 of 19 patients). The primaryclinical success rate was 82.3% (14 of 17 patients). Secondary clinical successoccurred in one additional patient (88.2%). The periprocedural mortality rate was21% (4 of 19), mostly related to underlying conditions. No major complicationsrelated to catheterization occurred. Late bleeding recurrence was reported in 4(23.5%) of 17 patients. Median follow-up postembolization was 7 months (range,7 days-56 months). Six additional patients died during follow-up, but none of thedeaths were due to re-bleeding.Conclusion: Selective angiographic embolization is safe and effective for controllingchronic life-threatening bladder or prostate hemorrhage regardless of the cause,and should be considered as the treatment of choice, usually obviating the needfor emergency surgery in critically ill patients.C-510Transarterial management of renal angiomyolipomas in elective andemergency settingsE.T.H. Liu, S.K. Venkatesh, K.Y. Seto, L.K.A. Tan; Singapore/SG(eugliu2002@yahoo.com.sg)Learning Objectives: To describe the indications, methods, efficacy and complicationsof transarterial management of renal angiomyolipomas (AMLs) in bothelective and emergency settings.Background: Renal AMLs are uncommon benign hamartomas composed of fat,smooth muscles and aggregates of thick-walled blood vessels with incompleteelastic layers. The incomplete elastic layers make the tumor blood vessels prone toaneurysmal formation and bleeding. Indications for embolization include symptomatictumours, high risk of morbidity or mortality due to surgery and patients’ desire toobviate surgery. Large tumours ( 4 cm) are more likely to present with spontaneoushemorrhage and therefore candidates for elective management to prevent bleedingand associated complications. The treatment options include surgery and transarterialembolization where the latter is preferred as it is minimally invasive. Surgery isperformed when transarterial management fails to control the bleeding.Imaging Findings: We describe the imaging appearances of renal AMLs on ultrasound,CT, MRI and catheter angiography. The angiographic appearances andtranscatheter management of the AMLs with different embolic materials will beillustrated with examples. The present accepted strategy of renal AML embolizationis preservation of the normal renal parenchyma by super selective embolizationof tumor vessels only. The various embolic agents used include gelfoam, polyvinyl alcohol (PVA) particles, metallic coils, absolute alcohol, and iodized oil. Thereported complication rate with transarterial embolization is about 10% and mostcommonly is an abscess formation.Conclusion: Transarterial management of renal AMLs is an effective and safeprocedure in both elective and emergency settings.C-511Drug eluting stents for the treatment of small caliber obstructivefemoropopliteal artery disease: A clinical trial, early and mid term resultsF.Z.H.M. Moukhtar, A.M.A. El Marakbi; Jiddah/SA(fatmazeinhomhassan@yahoo.com)Purpose: The study is designed to review our experience with endovascular therapyusing coronary drug eluting stents in obstructive femoropopliteal segments.Methods and Materials: Angioplasty and selective stenting of femoropoplitealocclusive disease was performed in 33 limbs in 28 patients using coronary drugelutingstents from April 2005 to Jan 2007. All patients who had endovasculartherapy for intractable lower limb ischemia due to TASC 2000 A, B and C lesionspass through our routine surveillance protocol that includes a clinical evaluation,an ABI, and a color-flow duplex scan at 24 hours, 1 month, 6 months, and 1 yearafter the procedure.Results: Selective stenting were done in 33 limbs, either due to residual stenosismore than 30% or flow limiting dissection of the artery. Single stent was used in 14limbs (42%), while using more than one stent in 19 limbs (58%). Mean lesion length52 mm .053 mm. mean diameter of the obstructive lesion 3.22 mm. Endovasculartherapies was technically successful in all patients. During follow-up, stenosis freepatency was 100, 86, and 77% by 1, 6, and 12 months intervals, respectively.Conclusion: Drug eluting coronary stenting can be used exceptionally at proximalSFA with small caliber artery 3.5 mm with good short and mid term patencyrates and with better results in TASC A&B. In our series, endovascular therapyproved technically feasible and safe modality for small caliber femoropoplitealarterial segment.C-512Management of peripheral venous malformationsC.B. Hernandez, B. Zudaire, M.J. Herraiz, J. Arias, M. Arraiza,A. Martinez-Cuesta; Pamplona/ES (cbhernan@unav.es)Learning Objectives: 1. To describe the classification system of vascular anomaliesin order to differentiate between benign tumors (hemangiomas) and vascularmalformations. 2. To show our experience in the treatment of peripheral venousmalformations with ultrasound-guided microfoam sclerotherapy.CS444 A B D E F FG H

Scientific and Educational ExhibitsBackground: We present our experience as a major referral center for vascularanomalies. We have reviewed the most representative cases treated in our centerwith ultrasound-guided microfoam sclerotherapy. Marked improvement is shownusing advanced imaging techniques (Doppler ultrasound, angio-computerisedtomography, angio-magnetic resonance, and angiographic techniques). Treatmentwith ultrasound-guided microfoam sclerotherapy may be considered the first choicetreatment for venous malformations.Procedure Details: Particular emphasis is made on the application of new diagnostictechniques (CT and MR venography) used to depict with greater precisionthe extension of the lesions and involvement of anatomical structures. We alsodescribe the combination of sclerotherapy with other interventional techniques inorder to obtain better results.Conclusion: Venous malformations are congenital lesions that usually manifestin childhood or early adulthood and can experiment growth causing serious complicationssuch as functional limitation, ulceration, and haemorrhage. Their clinicalpresentation is variable depending on the size and location. Surgical resection isoften contraindicated as complete excision is difficult or impossible, particularlywhen the malformation is diffuse.C-513Intracranial aneurysms volume and coil packing density: The impact of themeasurement methodD. Knap 1 , M. Zbroszczyk 1 , K. Gruszczynska 1 , W. Wawrzynek 2 , M. Korzekwa 1 ,P. Bazowski 1 , J. Baron 1 ; 1 Katowice/PL, 2 Piekary Slaskie/PL (dknap@wp.pl)Purpose: To check if different techniques of intracranial aneurysms volume measurementin 3D rotational DSA can impact the calculated coil packing density duringintravascular aneurysm embolisation.Methods and Materials: 35 patients with intracranial aneurysms underwentintravascular embolisation. Aneurysm volume was measured three times: firstwith dedicated software on workstation with 3D DSA data. Then with the formulafor ellipsoid volume, with two diameters measured on DSA, and third with threediameters measured on DSA. Calculated data were used to generate coil packingdensity of embolised aneurysms. Anova statistics was used to compare valuesobtained with the three techniques.Results: Mean aneurysm volume, obtained with dedicated software, was 0.517 ml,SD 1.02 ml, with three diameters: 0.548 ml, SD 1.18 ml. Largest volumes wereobtained with two diameters method: mean 0.624 ml, SD 1.33 ml. Coil packingdensity calculated with dedicated software was: mean 19.9%, SD 13.3%; with twodiameters: mean 23.8%, SD 16.6%; and for 3 diameters: mean 28.4%, SD 20.1%.Differences among aneurysm volumes obtained with three methods were not statisticallysignificant (p= 0.928); however, differences among coil packing densitiesbased on aneurysm diameters were statistically significant (p=0.002).Conclusion: Different measurement techniques used for calculation of intracranialaneurysm volume resulted in statistically significant differences in calculatedcoil packing densities. Technique of aneurysm measurement on 3D DSA imagesshould be taken into consideration in the evaluation of intravascular embolisationresults.C-514Superior vena cava syndrome: What the radiologist needs to knowP.-Y. Marcy, L. Gastaud, V. Mari, C. Hebert, N. Amoretti, M. Poudenx; Nice/FR(pymarcy@hotmail.com)Learning Objectives: To understand the physiopathogenesis of superior venacava syndrome (SVCS). To recognize the early clinical and radiological signs ofSVCS. To report the critical usefulness of radiological pre/post procedure means.To describe the technical key points of SVC stenting. To recognize and treat postoperative complications.Background: SVCS is associated to a malignancy in more than 90% of cases.SVC obstruction causes elevated venous pressure upstream and creation of athird compartment (Interstitial Space). Percutaneous endovascular stenting canbe performed as a first or second option procedure. Clinical complications includeSVCS recurrence and cardio respiratory impairment. Early clinical symptoms includeheadache when leaning, hoarseness and supra clavicular fossa swelling.Imaging Findings: The impact in the diagnosis and follow-up of Chest X-ray (bodyhabitus, body mass index, central line, cardiomegaly, pleural effusion), Dopplerultrasound (subclavian, jugular and internal thoracic veins), MDCT venography(location, length, severity of the stenosis/thrombosis; pericardial/pleural effusion,radiation therapy sequellae, subclavian/inominate/SVC involvement)) and MRvenography will be presented and discussed.Conclusion: Patients presenting with tumors that respond well to chemotherapyneed a central I.V. line to be inserted to start treatment. Otherwise, percutaneousstenting can be performed and reaches a high rate of efficacy. The Lanciego scale(clinical status), chest X-ray, Doppler ultrasound and Stanford classification are usefultools to assess the patient’s condition. The physiopathogenesis and treatmentof cardiac shock with jugular vein distension (pulmonary embolism, pericardialtamponnade, overload syndrome) will be highlighted.C-515Endovascular management of intracranial aneurysms: Resident’s guide toABC of hardwareS.S. Hedgire, K. Narsinghpura, D. Raja, R. Krishnan, P. Mehta, M. Cherian;Coimbatore/IN (hedgire@gmail.com)Learning Objectives: To highlight the importance of correct hardware selectionin the treatment of varieties of intracranial aneuryms.Background: Endovascluar coiling is high acuity level treatment modality forruptured and unruptured intracranial aneurysms. Complete filling, promotionalthrombosis or redirection of flow into the parent artery are goals of endovasculartreatment. To achieve this one should be aware of available hardware.Procedure Details: Location and morphology of aneurysm as well as tortuosity ofvasculature decide the basic hardware required. Neck of the aneurysm, i.e. wide ornarrow, decides whether auxillary therapy (stent, balloon etc) is to be used or not.An easy step-by-step selection of hardware starting from the sheath to the coilsensures completeness of the procedure in short time.Conclusion: Apt selection of hardware is key to successful embolization of intracranialaneurysms.C-516Higher incidence of complication in valved than in non-valved chemoport:By referral rates to interventional radiologyA. Choi 1 , E.-Y. Jeon 1 , H. Kim 2 ; 1 Anyang/KR, 2 Goyang/KR (alam0211@hanmail.net)Purpose: To compare the complication rates of traditional non-valved chemoportand valved chemoport, according to the referral rates to interventional radiologydepartment because of problem using the chemoports.Methods and Materials: During 5 years, 438 cases of chemoport insertion throughinternal jugular vein under US guidance were done in angiographic suite in 410patients. The position of chemoports was right (289 cases) and left (149 cases)side chest wall. The purpose of chemoport insertion was for chemotherapy andintravenous fluid infusion. We used valved chemoport in 109 cases and non-valvedchemoport in 329 cases. A total of 30 cases of problematic chemoports referred tointerventional radiology were included in this study. The problems were classifiedas sepsis, pocket infection, catheter migration, occlusion with thrombus, leakage,rotation, skin necrosis, cannulation difficulty, and fibrin sheath formation by retrospectivereview of medical records according to the types of chemoports.Results: The complication rates related to chemoport is higher in valved (11.93%)than non-valved (5.17%) chemoports. Also the complication rates related to positionof chemoport is higher in left (13.42%) than right (3.46%) side chest wall.Conclusion: The higher referral rates to interventional radiology were present invalved than non-valved chemoports. When there is a need to insert valved chemoport,a different method of insertion and management seems to be necessarycompared with those of non-valved chemoports.C-517Embolization of wide neck intracranial aneurysmsN. Limbucci, A.V. Giordano, M. Gallucci; L’Aquila/IT (niclimb@libero.it)Learning Objectives: To review the available techniques for embolization of wideneck aneurysms. To underline the growing number of indications for endovasculartreatment of brain aneurysms.Background: Coiling is becoming the favourite treatment for brain aneurysms inmany institutions. However, treatment of wide neck aneurysms often requires theuse of more complex techniques.Procedure Details: Here, we review the procedural steps, advantages, complicationsand controversies of the main techniques used for wide neck aneurysmsembolization, including balloon assisted coiling, stent assisted coiling, intrastentremodelling and liquid polymer embolization.Conclusion: Confidence with complex embolization techniques allows treatmentof most cases of wide neck intracranial aneurysms.Interventional RadiologyACB D E F G HS445

Scientific and Educational ExhibitsC-518Management of life-threatening pelvic hemorrhage by emergency uterineartery embolizationL. Flors, E. Lonjedo, C. Leiva-Salinas, G. Figueres, E. López-Pérez, A. Ruiz,J. Martínez-Rodrigo; Valencia/ES (luciaflorsblasco@hotmail.com)Purpose: To evaluate the efficacy and safety of emergency selective uterine arteryembolization and its role as an alternative to surgery (hysterectomy or arterial ligation)in the management of intractable pelvic hemorrhage.Methods and Materials: Sixteen patients with life-threatening hemorrhage underwentuterine hemostatic uterine embolization in our institution during a 2 yearperiod. The pelvic hemorrhage was related to uterine atony (10 patients), bleedingtumour (3 patients), false aneurysm (2 patients) and pelvic hematoma (1 patient).The approaches employed were: 13 right-side unifemoral, 2 bilateral femoral and1 radial. After selective uterine arteries catheterization (cobra shaped or vertebralcatheter, 4 F or 5 F), the embolization was performed with absorbable gelatinesponge and/or particles of polyvinyl alcohol (PVA) depending on the case.Results: The procedure consisted of embolization under angiographic guidanceof both uterine arteries (n =32), and vaginal (n =2) or anterior division of internaliliac artery (n = 1). In all patients, pelvic hemorrhage was successfully controlled.One patient needed repeated embolization the next day. Angiographic embolizationallowed preservation of the uterus. Embolization controlled the vaginal hemorrhagein a previously hysterectomized patient. No major complication related to embolizationtherapy was observed.Conclusion: Emergency arterial embolization is a safe and effective means ofcontrolling pelvic hemorrhage. The procedure avoids high risk surgery in an unstablepatient and allows maintenance of reproductive ability.C-519Pulmonary artery pseudoaneurysms related to Swan-Ganz catheterplacement: CT findings and embolization with vascular plugsM. Burrel, M. Real, M. Sanchez, P. Arguis, A. Sierra, M. Barrufet, X. Montañá;Barcelona/ES (marta_burrel@yahoo.com)Learning Objectives: 1. To describe radiological findings on CT images and vascularreconstructions of pulmonary artery pseudoaneurysms related to Swan-Ganzcatheter placement. 2. To introduce the use of the amplatzer vascular plug anddescribe the technique for embolization of pulmonary artery pseudoaneurysms.Background: Perforation of a pulmonary artery after placement of a Swan-Ganzcatheter is a serious complication that requires immediate management. Exactdescription of size and anatomic localization of a pulmonary pseudoaneurysmis crucial for planning further therapy. Multidetector CT has proved not only tocorrectly demonstrate the anatomic location of the pseudoaneurysm but also tobe able to directly visualize the feeder vessel and its connection to the aneurysm.The amplatzer vascular plug is an embolization device that has been increasinglyapplied for various vascular embolization procedures.Procedure Details: 64-row Multidetector CT angiography was performed to evaluatethree patients who presented massive hemoptysis after placement of a Swan-Ganz catheter for monitoring during cardiac surgery. MDCT detected the presence ofa pseudoaneurysm in all cases, as well as depicted the feeding vessel on MIP andMPR reconstructions. The information obtained was essential for the endovascularmanagement. The embolization was performed successfully using an amplatzervascular plug; the technical aspects of the procedure are described.Conclusion: MDCT is essential for subsequent superselective angiographic visualizationof the feeder vessel and for successful embolization. The vascular plugsallow a rapid, safe and effective occlusion of the bleeding artery.C-520Multimodality evaluation of consecutive patients with abdominal aneurysmtreated with endovascular graft: Color-Doppler-US vs low-MI CEUScompared with 64-slice-CTA and MRAV. Cantisani, E. Marotta, G. Menichini, L. Coletta, P. Ricci, R. Passariello; Rome/IT(paolo.ricci@uniroma1.it)Purpose: To evaluate the efficacy of color-Doppler-US and low-MI CEUS in theassessment of endovascular graft treatment for abdominal aneurysm as comparedwith 64-slice-angio-CT and angio-MRI.Methods and Materials: From February 2006 to June 2008, 120 consecutivepatients (90 M; 30 F - mean age: 63aa) treated with endovascular aortic graftunderwent color-Doppler-US, low-MI CEUS, 64-slice-angio-CT, angio-MRI andangiography if re-treatment was indicated. Sensitivity and specificity of ultrasoundexaminations were compared with CT and MRI as the reference standards or whenavailable with the angiography. McNemar test was then calculated.Results: Twelve true endoleaks (type II: 10, Type III: 2) were identified (10%) bythe FU or by angiography. Sensitivity and specificity of color-doppler-US, CEUS,angio-CT, and angio-MRI were: 50, 100, 83, 92% and 60, 100, 100, 100%, respectively.CEUS was significantly more accurate than US (p 0.001) and highlycomparable to angio-CT and angio-MRI. Consequences to treatment occurred in6 patients (50%).Conclusion: CEUS is a feasible tool in follow-up of endovascular aortic aneurysmtreatment since it may identify endoleaks missed at other imaging techniques.C-521Endovascular repair for thoracic aortic disease involving aortic arch usingcurved nitinol stent-graft: An early experience with midterm follow-upN. Hongo, R. Shuto, T. Kono, S. Matsumoto, S. Miyamoto, H. Mori; Oita/JP(hongou@med.oita-u.ac.jp)Purpose: The purpose of this study was to report the mid-term feasibility, efficacy,and durability of endovascular repair of aortic disease involving aortic arch such asthoracic aortic aneurysm (TAA) and DeBakey type III aortic dissection (AD).Methods and Materials: Between February 2007 and August 2008, 50 patientswith aortic disease including TA and AD involving aortic arch were enrolled andevaluated for a curved nitinol stent-graft (Matsui-Kitamura stent-graft). As controlsubjects, an open surgical group of 58 patients enrolled. Just before stentgrafting,32 patient received debranching bypass to create a proximal landing zone: 20 weresubclavian debranching, 9 were carotid and subclavian debranching and 3 werethree vessel debranching.Results: 50 patients had successfully implanted of the stentgraft. The medianfollow-up was 8.3 months (range 1-19.5 months). Perioperative mortality rate inthe endovascular versus open surgical group was 6 (n=3) versus 6.8% (n=4).Neurological complication rate were 8 (n=4) versus 8.6% (n=5), while the rate ofpulmonary or cardiac complications in endovascular group is significantly lowerthan that in open surgical group. Median hospital stay was 16.5 versus 27.95 days.A type I or II endoleak was detected in 3 cases on the 1 month follow-up CT scan,but there were no cases with secondary endoleak and with significant enlargementof the aneurysms.Conclusion: The treatment of aortic disease involving aortic arch using curvednitinol stent-graft is technically feasible. Considering the lower complication andmidterm results, this series can be valid therapy for TAA or AD.C-522Clinical presentation and management of spinal dural arteriovenous fistulain 20 consecutive casesA.K. Gupta, A.L. Periakaruppan, N.K. Bodhey, S.N. Patro, J. Saini; Trivandrum/IN(gupta209@gmail.com)Purpose: To evaluate the efficacy of the endovascular embolisation of spinaldural AV fistulas.Methods and Materials: In this retrospective study between 1998 and 2008, 20patients were included. The presenting symptoms in these patients were consistentwith progressive myelopathy, and included lower extremity weakness (52%),paraesthesias (30%), back pain (24%), and urinary symptoms (6%). All the patientswere diagnosed to have spinal dural AVF based on imaging and angiographic findings.All the patients underwent endovascular embolisation of the fistula. Varyingconcentrations of the glue (NBCA) was used for embolisation.Results: Endovascular treatment resulted in a significant symptomatic improvementin all the treated patients. No technical/procedural failures were documented in anyof the patients. Total obliteration of the fistulae was achieved in all the patients. Noprocedural morbidity/mortality was documented. On follow-up 6-132 months, allpatients have shown clinical improvement.Conclusion: Endovascular embolisation is an alternative treatment of choice forspinal dural AV fistulae. It is safe and efficacious and complete occlusion can beobtained in all the patients.C-523How to manage pelvic arterio-venous malformationH. Rikimaru 1 , A. Sato 2 ; 1 Ichinoseki/JP, 2 Sendi/JP (rikimaru@rad.med.tohoku.ac.jp)Learning Objectives: To learn clinical feature of pelvic arterio-venous malformation(AVM). To learn imaging feature of pelvic AVM. To learn treating strategies. Tolearn complication and outcome of each treatment.Background: Pelvic AVM is a rare, but known as a difficult-to-treat disease. It hasbeen treated with surgery, by IVR, or by combination of both techniques, althoughhigh-incidence of recurrence still remain even in these days. On IVR technique,transarterial embolotherapy has been used for long years using absolute ethanol,CS446 A B D E F FG H

Scientific and Educational Exhibitsmicrocoil, NBCA, etc. Recently, however, transvenous treatment was introduced inmanner of balloon occluded-retrograde trasvenous obliteration (BRTO).Procedure Details: On transvenous embolotherapy, drainage vein should beobstructed by balloon catheter initially. Next, microcatheter should be insertedand left in place near the nidus. Then, ethanolamin oleate (EO) should be injectedintermittently to expose EO to the nidus effectively. Balloon should be deflatedafter few hours. We completely cured a patient of recurrent huge pelvic AVM usingaforementioned transvenous technique. Furthermore, we treated four morepatients of pelvic AVM in these 10 years by transarterial approach: One of themwas completely cured in one session by using NBCA; other three patients havegone through years of cure and recurrence.Conclusion: The choice of therapy for pelvic AVM should be based on their types:Localized pelvic AVM can be treated with surgery or by embolotherapy irrespectiveof transareterial or transvenous approach. Large and widely-spreading AVM shouldbe treated by transarterial embolotherapy in a repetitive manner. Finally, recurrentpelvic AVM can be treated by transevenous embolotherapy.C-524Retrograde transpopliteal approach for subintimal recanalization of SFA inpatients with complex vessels anatomyR. Gandini, E. Pampana, M. Stefanini, C.A. Reale, L. Di Vito, S. Spano,G. Simonetti; Rome/ITPurpose: The aim of the study was to evaluate efficacy of subintimal angioplastyby retrograde transpopliteal approach in patients, unsuitable for antegrade orcontrolateral approach, with CLI and candidates to amputation.Methods and Materials: From January 2006 to January 2007, 13 patients (10male, 3 female) 8 with SFA occlusion at the origin and undetectable ostium ofSFA, 5 with femoro-femoral by-pass create a misunderstanding for the origin ofSFA, underwent to intentional subintimal angioplasty through ultrasound-guidedretrograde popliteal approach. All the patients were preliminarily evaluated with USDoppler and angio-MRI. Ultrasound evaluation of the popliteal fossa was carriedout after the procedure to exclude local complications.Results: Technical success was obtained in 92.3% with resolution of pain andlimb salvage. In one case, the subintimal dissection was carried out at the originof profunda artery causing occlusion and thrombosis of this; so the complicationwas solved with surgery intervention. There were no puncture site hematomas orpopliteal arteriovenous fistulae.Conclusion: Subintimal angioplasty with trans-popliteal approach is a safe andeffective technique, especially in patients with multivessel disease poor candidateto surgery. It should be considered for SFA occlusions or CFA disease where thecontralateral femoral or antegrade ipsilateral femoral approach is often technicallyor anatomically difficult.C-525Evaluation of cost and fluoroscopy’s time in subintimal recanalization ofSFA using true lumen re-entry device or “double approach” techniqueR. Gandini, E. Pampana, C.A. Reale, L. Di Vito, S. Spano, L. Boi,G. Anghelopulos, G. Simonetti; Rome/ITPurpose: Assessment of difference of cost and fluoroscopy’s time in the treatmentof long obstruction of superficial femoral artery in unsuccessful true lumenre-entry after subintimal revascularization using two different technique: “doubleapproach”(femoral and popliteal puncture)and re-entry device outback catheter.Methods and Materials: From June 2006 to June 2007, 128 patients with CLIand long obstruction of SFA were treated with intentional subintimal angioplasty.In 40 patients after 15 minutes it was not possible to re-entry the true lumen withstandard technique and so we randomized the patients in two different groups: 20 ofthem were treated with "double approach" technique, others with outback catheterre-entry device. The “Outback” group had mean time fluoroscopy of 148 min, the"double approach" technique group of 2612 min.The mean cost of procedure was4025 for the "Outback" group and 2025 for the other group.Results: Technical success was 100% in the "double approach" group, and in theother group is 95% due to high calcification. In the "Outback" group it was necessaryto place stent in the site of re-entry in the 60%, whereas in “double approach”group stent was necessary in the 20%. Three complications were detected in the“double approach” group: one arteriovenous fistulae and two haematoma in siteof puncture.Conclusion: Both techniques are safe and effective, despite the shortest time offluoroscopy in the Outback group, the "double approach" technique group presentedlower cost and much discomfort for the patients.Interventional RadiologyNon-VascularC-526Minimally invasive management of biliary complications after partial livertransplantation in adult and pediatric patients with two separate biliaryanastomosesR. Miraglia, L. Maruzzelli, S. Caruso, M. Milazzo, G. Marrone, G. Mamone,V. Carollo, A. Luca; Palermo/ITLearning Objectives: To describe the anatomical variants of the donors’ bile ductswith significant impact on partial liver transplantation. To describe the minimallyinvasive management of biliary complications after adult and pediatric partial livertransplantation in patients with two separate biliary anastomoses.Background: Liver transplantation is the standard of care for adult and pediatricpatients with end-stage liver diseases and unresectable primary hepatic tumors. Dueto the insufficient number of livers from deceased donors, partial liver transplantationfrom deceased donors or living related has become an important therapeuticoption. For possible anatomical variants of the donors’ bile ducts, in partial livertransplantation, two separate biliary anastomoses are performed in up to 45% ofcases. Biliary complications are seen in 20 to 40% of recipients and are responsiveof graft dysfunction and significant morbidity and mortality. Interventional radiologyis often the first choice of treatment.Procedure Details: Diagnosis and treatment of the most frequent biliary complicationsas anastomotic bile ducts strictures and anastomotic large bile leak arediscussed. Indications, possible complications and results achievable of interventionalradiology procedures and combined radiological-endoscopic procedures(rendezvous technique) utilized in the minimally invasive management of patientswith two separate biliary anastomoses are described.Conclusion: Radiologists play a key role in early diagnosis and non-surgical treatmentof biliary complications after partial liver transplantation.C-527The synergic effect of radiofrequency and embolization in the treatment ofHCC: More responses and fewer recurrencesJ. Urbano, J. Cabrera, A. Glez-Guirado, B. Polo Lordiu, S. Albertos, S. Vazquez;Madrid/ES (jurbano@fjd.es)Purpose: To show our experience in percutaneous treatment of HCC with a synchoriccombination of radio frequency and hepatic embolization.Methods and Materials: Since 2001, 115 nodular, low or intermedial stage HCCwere treated in 80 child A and B cirrhotic patients. All patients were non surgicalcandidates for hepatic resection. 26 women and 54 men had a mean age of 65.6years (43 - 84). Average tumors size was of 33.2 mm (10 - 150). If tumor was 3 cm we performed TAE. For the recurrences or tumors 3 cm we did TAQE. Acombination of fluoroscopy and ultrasound guidance was used for tumoral puncture.Treatment response evaluation follows EASL and RECIST criteria.Results: Mean follow-up is of 29.1 months (1 - 85). Complete response was 100%in tumors 3 cm, 94% in tumors 3 5 cm and 23% in tumors 5 cm. Thereis 0% of local recurrence during the FU in tumors 3 cm. Distant metachronicnodule recurrence occurred in 47% during FU. One patient died of colon perforation.There were a 6.9% of readmissions because of severe pain or fever. SpecificHCC survival was 91, 70 and 46% at 12, 24 and 36 months, respectively. Logranktest shows non significative differences in survival between tumors of 3 cm andtumors of 3 5 cm.Conclusion: There is a synergy effect between RF and embolization. A very goodlocal control of HCC is achieved by this combined treatment.C-528Balloon kyphoplasty for treatment of vertebral compression fractures:Outcomes at 2 yearsM. Runge, D. Wendling, J.-F. Bonneville; Besançon/FR (mrunge@chu-besancon.fr)Purpose: To evaluate the clinical and radiographic efficacy of balloon kyphoplastyin the treatment of VCF caused by osteoporosis, myeloma, osteolytic metastasisand hemangioma. To describe the clinical and radiographic outcomes with 2 yearsfollow-up.Methods and Materials: 80 consecutive patients with 86 vertebral fractures(T4-L5) were treated with balloon kyphoplasty. All patients were included after anidentification of symptomatic levels by clinical and imaging evaluation (X-ray, CTscan, magnetic resonance imaging) regardless of the underlying pathologic cause.Clinical and imaging follow-up were performed for each patients at 3, 6, 12 and 24Interventional RadiologyACB D E F G HS447

Scientific and Educational Exhibitsmonths after the procedure. Evaluation at each follow-up time point included painreponse (VAS), change in pain usage, pre and post operative imaging outcome (CTor MRI). Vertebral body height and kyphotic deformity were measured by comparingpre and postoperative measurements.Results: Pain score decreased significantly and immediately in all patients afterthe procedure with reduction (21.1%) or stopping (82.9%) of analgesic drugs andpersisted through the follow-up. Imaging studies demonstrated a stabilization of vertebralbody height and no complications were related. 3 patients (3.75%) sustainedfracture in the first 2 months after the procedure at the adjacent above level. Withmedical treatment, pain disappeared without loss of vertebral body height.Conclusion: According to our results, kyphoplasty has a high success rate (painreduction and vertebral body height restoration) and low complication rate. Theprevalence of a new vertebral fracture in the adjacent level is low. These resultsremain stable for 2 years following treatment.C-529The post radiofrequency ablation scar or tumor tissue of hepatocellularcarcinoma: Comparison of 3.0 T MR diffusion-weighted imaging and PET-CTL. Yu Bao; Guangzhou/CN (ybliu28@yahoo.com.cn)Purpose: To evaluate the post radiofrequency ablation scar or tumor tissue ofhepatocellular carcinoma (HCC) by 3.0 T MR diffusion-weighted imaging (DWI)and PET/CT, to analyze whether the value of ADC correlated with the post radiofrequencyablation (RFA) scar or tumor tissue.Methods and Materials: Thirty-eight patients with HCC were enrolled in ourstudy. All the patients underwent RFA. 3.0 T MR diffusion weighted imaging wasperformed with b value of 600 s/mm 2 . An echo-planar sequence was performed.The ADC values of the lesion after RFA were measured in diffusion weighted images.All the patients underwent fluorodeoxyglucose (FDG) PET/CT (FDG-PET/CT) examinations after the MR examinations. It was analyzed whether the valueof ADC correlated with the scar or tumor tissue of HCC after RFA. The scar ortumor tissue of HCC after RFA was confirmed by PET/CT and clinical follow-up.The values of ADC of the scar or tumor tissue and normal liver tissue were compared.The data were analyzed by SPSS13.0 statistical software, and p 0.05 wasconsidered to be significant.Results: Thirty-six patients with post RFA scar or tumor tissue of HCC were confirmedby PET/CT. Compared with the results of PET/CT, the mean ADC of tumortissue was 1.81×10 -3 mm 2 /sec, The mean ADC of scar tissue was 5.96×10 -3 mm 2 /sec. The mean ADC between scar and tumor tissue were statistically significant(p=0.015).Conclusion: Compared with PET/CT, the ADC value of DWI is a promising functionalMRI tool for prediction of therapeutic response to radiofrequency ablation,DWI is useful in the differential diagnosis of scar tissue and tumor tissue in patientswith HCC after RFA.No Material Submitted to EPOSC-530Paravertebral nerve block for transhepatic percutaneous interventionalproceduresJ.J. Echevarria, J.L. Miguélez, P. Makua, J. Aguirre, I. Aloa, A. Cancho; Galdakao/ES(fizer@telefonica.net)Purpose: Intravenous sedation often leads to the appearance of deep breaths thathinder the realization of percutaneous interventional procedures of hepatobiliaryterritory. We present our experience in implementing paravertebral nerve block(PNB) as a technique of selective analgesia in carrying out upper abdominal percutaneousprocedures that allow the collaboration of the patient during the practiceof the therapeutic interventional procedure.Methods and Materials: We have practiced using PNB 12 percutaneous interventionalprocedures: five ablations of malignant liver masses (three thermal ablationsand two ethanolizations), six transhepatic biliary drainages motivated by commonbile duct stenosis (five malignant and one postsurgical) and one extraction of choledocholithiasis.PNB was carried out by local infiltration of 0.75% ropivacaine atthe level of T6-T9. Both in the percutaneous approach as during the implementationof the procedures, response to pain was evaluated using visual analog pain score.The hemodynamic response was controlled too.Results: The quality of analgesia was satisfactory in all patients, not requiringgeneral anesthesia in any case. All patients were able to collaborate properly oncontrolling ventilatory movements, when it was indicated by the radiologist. Adverseeffect was found with the onset of episodes of hypotension in two patients, andsymptoms of epidural extension of the anesthetic drug, manifested by paresis ofboth lower limbs, in one patient.Conclusion: PNB provides adequate analgesia allowing the comfortable practiceof percutaneous interventional procedures of the hepatobiliary territory, and enablesthe active collaboration of the patient to facilitate the work of the radiologist.C-531Depiction of the feeding artery of hepatocellular carcinoma in the caudatelobe using flat panel detector C-arm cone-beam CT imagesM. Honda 1 , T. Gokan 1 , T. Kitanosono 2 ; 1 Tokyo/JP, 2 Rochester, NY/USPurpose: The feeding artery of hepatocellular carcinoma (HCC) in the caudatelobe (S1) is often difficult to recognize on digital subtraction angiography (DSA). Weconducted this study to evaluate the ability of flat panel detector C-arm cone-beamCT (CBCT) in detection of feeding arteries of HCCs arising in S1.Methods and Materials: In fourteen patients with HCC in S1, the combination ofCBCT during arterial portography (CBCTAP) and CBCT during hepatic arteriography(CBCTHA) was performed using a single plane C-arm angiography system witha flat panel detector. We evaluated visualization of feeding arteries of the HCCson CBCT and compared with the DSA images. The location and size of the HCC,intrahepatic metastasis, portal vein invasion, and the success rate of superselectivecatheterization into the feeders were also evaluated.Results: Identification of origin of the feeding artery was possible in four patientswith DSA (28.6%) and 14 patients (100%) in CBCT. The feeding arteries originatingfrom the right, left or middle hepatic artery were detected in 11, 1, 1 patients,respectively. In one patient, right inferior phrenic artery fed the HCC. The meanlong axis length of an HCC nodule was 27.5 mm (range, 10-80 mm). Intrahepaticmetastasis was seen in 13 patients (92.9%). Three patients (18.8%) had portalvein invasion. The success rate of superselective microcatheter feeder selectionwas 92.9% (13/14).Conclusion: CBCT images are able to depict the feeding artery of HCC in S1. CBCTimages are helpful in selecting the feeding artery of HCC for chemoembolization.C-532Stents implantation as complementary treatment in thrombosedhaemodialysis vascular accessesJ. García-Medina, N. Lacasa, S. Muray, I. Pérez-Garrido, V. Garcia; Murcia/ES(josegmedina@seram.org)Purpose: To communicate our experience with the implantation of stents in haemodialysisvascular accesses in cases in which they were thrombosed.Methods and Materials: We treated 40 dialysis accesses in which we inserted 45covered stents (3 Passager, 14 Wallgraft, 5 Viabahn and 19 Fluency) and 4 noncoveredstents (Wallstent) in 38 patients. The accesses were 10 radial fistulas, 18brachial fistulas, and 12 grafts.Results: All cases except one (thrombosis during another stent implantation) camein with total or partial thrombosis. So, we use manual catheter-directed thromboaspirationin all cases. Stent indications were: non-controlled venous rupture postangioplasty (n=3; 7.5 %), pseudoaneurysms with attached thrombotic material inthe lumen (n=30; 75%), and grafts boucles and irregularities (n=7; 17.5%). Theclinical success rate was 95%. Median follow-up was 11.43 9.3 months (r=0-35months). Primary patency rate was 65 7% at 6 months, 37 7% at 12 monthsand 7 4% at 24 months. Secondary patency rate was 70 7% at 6 months,45 8% at 12 months and 10 4% at 24 months. Better patencies found in radiocephalicfistulas (40 15% and 50 15% at one year in primary and secondarypatencies, respectively).Conclusion: Metallic stents are useful to treat lesions in thrombosed haemodialysisaccesses in selected cases.C-533Radiofrequency ablation of hepatic tumors: Effect of post-ablation marginon local tumor progressionC.-H. Liu 1 , R.S. Arellano 2 , R.N. Uppot 2 , A.E. Samir 2 , D.A. Gervais 2 , P.R. Mueller 2 ;1Taipei/TW, 2 Boston, MA/US (cute610627@gmail.com)Purpose: To retrospectively evaluate the relationship between post-ablation marginsand local tumor progression following radiofrequency ablation (RFA) of hepatocellularcarcinomas and colorectal liver metastases.Methods and Materials: Institutional review board approval with waived informedconsent was obtained for this HIPAA-compliant study. Eighty-three patients (66men and 17 women) with 107 hepatic tumors who underwent RFA during a 7-yearperiod were divided into two groups: hepatocellular carcinoma group (HCC) (55patients with 69 lesions) and the colorectal liver metastases group (28 patientswith 38 lesions). Post-ablation margins were calculated on one-month follow-upcontrast-enhanced computed tomography (CT) or magnetic resonance imaging(MRI) studies. Efficacy was evaluated at one-month post ablation, then at 3-monthintervals for the first year and biannually thereafter. The Kaplan-Meier method anda Cox model were used for the analyses.CS448 A B D E F FG H

Scientific and Educational ExhibitsResults: The results of the log-rank test showed that the minimum threshold postablationmargin of 0.4 cm (P =.020) and the tumor size smaller than 2.5 cm (P=.001) significantly correlated with local control for the HCC group. Cox regressionanalysis showed that the minimum threshold post-ablation margin of 0.4 cm andtumor size smaller than 2.5 cm were independent factors (P =.036 and.017). Inthe colorectal liver metastases group, the result of the log-rank test showed thatthe minimum threshold post-ablation margin of 0.4 cm (P =.345) did not correlatewith local control.Conclusion: Percutaneous RFA is more effective in achieving local control inpatients with HCC than with colorectal liver metastases.enhanced CT was performed after the electrode removal to evaluate the immediatelesion’s response to the ablation and to detect any local complication. Follow-up wasperformed at 1, 3, and 6 month’s post-RFA and every 6 months afterwards.Results: 14/21 (66.6%) patients showed complete response. 7/21 (33.4%) patientsshowed partial necrosis and in those a second RFA following the same protocolwas performed. 4/21 patients showed a local recurrence and they also underwenta second RFA. Major complications did not occur. 5/21 patients suffered from postablation syndrome.Conclusion: RFA of adrenal metastasis seems to be a promising alternative treatmentin cases of adrenal metastases.C-534Selective and super selective chemoembolization (TACE) for advancedstage hepatocellular carcinoma (HCC): 5 years follow-upG. Moggio, C. Castagnolo, A. Sorbo, F. Maisto, G. Belfiore; Caserta/IT(giovannimoggio@virgilio.it)Purpose: To report the experience of 5-years follow-up in selective and superselectivechemioembolization (TACE and precision TACE) of HCC.Methods and Materials: From 2001 to 2006, 30 patients with 50 HCC nodules 3 cm and non resectable (range 3-7 cm) underwent TACE and pTACE. Patientswere all affected by cirrhosis (18 HCV, 12 HBV-related) with class A child-pugh in23 cases and B in 7. All treatments were executed with selective or superselectivecatheterism of segmental branch of liver artery using a coaxial technique and 2.7 Fmicrocatheter. Imaging checks with triphasic CT were made at 1, 3, 6 months, every6 months for the first 2 years and every year for the next 5 years. The responsewas considered complete when no area of nodular enhancement was evident, andincomplete when a nodular portion was still appreciable.Results: Initial success was 100% of cases and there were no major peroproceduralcomplications observed. Of 9 cases treated with non superselective TACE(conventional TACE), only 4 cases reported post embolization syndrome, whilethe remaining 21 treated with pTACE experienced this syndrome. CT control after1 month showed complete necrosis in 16 (54%) and partial necrosis of 14 (46%).The remaining cases were reprocessed with a new pTACE obtaining completenecrosis in 1/3 and persistence of nodular residual in 2/3; all the complete necrosispersisted even in a 5-year follow-up.Conclusion: Treatment with TACE of HCC, according to our experience, if properlyexecuted is still today a safe and effective method for tumor necrosis.C-535CT guided placement of fiducials in malignant lesions: Presentation of thetechniqueE. Sotiropoulou, O. Konstantinopoulos, A. Manataki, K. Verigos, N. Salvaras,L. Thanos; Athens/GR (loutharad@yahoo.com)Learning Objectives: To describe the technique of positioning gold fiducials astumor landmarks under CT guidance to facilitate treatment with Cyberknife systemof malignant lesions.Background: Cyberknife is a new robotic radiosurgery system, allowing maximumconcentration of the beam on the target lesion with minimum damage on the surroundingtissues. To achieve this, fiducials are used as tumor landmarks and theyare advanced inside/around the lesion percutaneously.Procedure Details: To discuss the indications for fiducial positioning, namely thelesions at which site are indicated for Cyberknife treatment. To describe the implantationtechnique: kind of needle used, how to deliver fiducials and where should theybe placed relative to the tumor in order to achieve optimal result with Cyberknifestereotactic radiosurgery. To present the complications that may be encounteredas well as their management, depending on the tumor site.Conclusion: Fiducial positioning inside malignant tumors under CT guidanceseems to be a safe and efficient procedure.C-536Treatment of adrenal metastases originating from primary lung cancer withradiofrequency ablationE. Seferos, E. Sotiropoulou, A. Manataki, O. Konstantinopoulos, I. Tsangaridou,L. Thanos; Athens/GR (loutharad@yahoo.com)Purpose: The purpose of this presentation is to evaluate the feasibility, efficacyand safety of CT guided RFA of adrenal metastatic lesions in patients with primarylung cancer.Methods and Materials: Over a 2 year period, a total of 32 RFA sessions wasperformed at our institution in 21 patients with adrenal metastatic neoplasms usingexpandale needle electrodes. After CT-guided insertion of the electrode, a pulsed RFenergy was applied for 12 to 15 min in every case. A dual-phase dynamic contrastC-537Utility of ultrasound-guided interventional procedures as a treatment forhaematomas in the musculoskeletal system and predictor factors duringtheir evolutionI. Corta, S. Cisneros Carpio, I. Lauzirika, L. Alvarez de Eulate Santacara,J. Del Cura Rodriguez, D. Grande Icaran; Bilbao/ES (igone@seram.org)Purpose: To evaluate the technical usefulness of ultrasound (US) guided percutaneousdrainage treatment for haematomas in the musculoskeletal system. To definewhich factors predict the evolution of haematomas.Methods and Materials: We reviewed all the US-guided interventional procedurescarried on musculoskeletal system from April 2004 to September 2007 in BasurtoHospital. We selected those who received a fibrilolityc treatment (urokinase). Inthe study were included 91 procedures carried on 79 patients (aged 12-98, mean64). We have recorded the localization and cause of the haematomas, durationof drains, the necessity of hospitalization of the patients and how long it was, andif the patients had been treated with anticoagulant drugs or not. We have registeredthe failure and complication rates and which factors can influence them.We evaluate which factors can modify the admission time and the duration of thecatheter drainage.Results: The drainage was effective in 89% of the haematomas, and complicationspresented in 9.9%. Patients treated as outpatients were 39.6%, whilst 40.7% requiredhospitalization because of the haematoma. Another 19.8% were hospitalizedfor other pathologies not related with the haematoma. Failure and complication rateswere higher in younger patients and in patients without anticoagulant treatment.Time of drain was significantly higher for haematomas located in articulationscompared to those located in soft tissues.Conclusion: US-guided percutaneous drainage with intracavitary fibrinolytictreatment is simple, fast, safe and an efficacious alternative for the treatment ofthe musculoskeletal system haematomas. Failure and complication rates are notlinked to age.C-538Ventilation causes heat-sink effect in laser ablation of lung tumorsA. Vietze 1 , F. Koch 1 , U. Laskowski 2 , S. Fillmer 1 , A. Linder 2 , N. Hosten 1 ;1Greifswald/DE, 2 Hemer/DE (anvie@gmx.de)Purpose: To evaluate in an ex-vivo lung model whether ventilation has a similarheat sink effect as perfusion on the temperature development during laser ablationof tumors.Methods and Materials: Sixty-one resected specimens were ventilated and perfusedin an isolated human lung perfusion model (IHLP) immediately after surgery.This model offers the opportunity of keeping the lobes under almost physiologicalconditions for 6 hours. Laser ablation in the model was performed using a Nd:YAGlaser. The effects of perfusion and ventilation on temperature development wereevaluated by selectively turning these off for 6 minutes each in 5 specimens (n=5).The standard procedure started with a steady state at 60 °C 10 mm away from thelaser fiber before ventilation was turned off. Invasive temperature measurementallowed recording slope, peak and the following decrease at a distance of 10 mmfrom the laser fiber.Results: As expected, discontinuation of perfusion caused a significant increasein temperature (2.86 °C over 6 minutes, p 0.05). This phenomenon is known asthe heat sink effect. The effect was even greater after discontinuation of ventilation(increase of 9.01 °C over 6 minutes, p 0.05).Conclusion: Ventilation has an even greater impact on temperature developmentduring thermal ablation than perfusion. This may influence the extent of necrosisand has to be considered while planning ablation of lung tumors.Interventional RadiologyACB D E F G HS449

Scientific and Educational ExhibitsC-539Interventional procedures in obstetrics and gynecology: An overviewS.T. Laroia, H. Abada, M. Sharafuddin, A.T. Laroia, S. Sun; Iowa City, IA/USLearning Objectives: The purpose is to review the various interventional radiologyprocedures in current obstetrics and gynecological practice.Background: The interventional radiologist can now offer many services tothe obstetrician-gynecologist. This exhibit will highlight various applications andtechniques.Imaging Findings: The exhibit will be organized under following headings: Embolizationfor post partum and post surgical bleeding, uterine artery embolization,percutaneous drainage of uterine abscesses, cervical stenting, fallopian tuberecanalization, radiofrequency ablation of pelvic and vaginal tumors, drainage ofpelvic fluid collections, transvaginal biopsy. All the topics will be well illustrated withimages and relevant line diagrams.Conclusion: The attendee will be able to review the state of art radiological interventiontechniques in current obstetric-gynecological practice.C-540Percutaneous ethanol lipiodol injection therapy of recurred hepatocellularcarcinoma after trans-arterial chemoembolization in high-risk locationsH.-K. Ko, L. Jong Tae, J. Won, S. Choi; Seoul/KR (mdko@yuhs.ac)Purpose: To evaluate the safety and effectiveness of percutaneous ethanol lipiodolinjection therapy (PELIT) of hepatocellular carcinoma (HCC) after trans-arterialchemoembolization (TACE) in high-risk locations.Methods and Materials: Between April 2006 and March 2008, 22 patients with 22recurred HCC nodules after repeated TACE underwent PELIT. Repeated TACE wasimpossible to treat recurred nodules due to hypovascularity (n=12) and rudimentaryfeeding artery after repeated embolization (n=10). All lesions were impossible tobe treated with radiofrequency ablation (RFA) due to high-risk location. PELIT wasperformed under real time fluoroscopy guidance and cone-beam CT (Dyna-CT;Siemens Medical Solution, Forchheim, Germany). Complications, effectiveness ofPELIT, and prognosis of the patients were evaluated.Results: 31 PELIT sessions were performed for 22 nodules. Apparent tumornecrosis after first PELIT was noted at follow-up CT in 15 nodules (68.2%). Duringfollow-up (mean, 14 months 6 [SD]), local recurrence was seen in 7 nodules(31.8%). Four of seven recurred lesions were performed repeated PELIT (meansession; 2.4) and two of them showed complete necrosis during follow-up. Fivepatients with progressive disease after first and repeated PELIT received conservativetreatment. All of the patients survived during follow-up period. There wasno major complication.Conclusion: PELIT under fluoroscopy and cone-beam CT guidance is safe andeffective for the treatment of recurred HCC after TACE especially in high-risklocations.C-541Fluoroscopic placement of self-expanding metallic stent for the treatmentof obstructing left-sided colorectal cancerH.-P. Hong 1 , P. Kang 1 , S. Kim 2 ; 1 Seoul/KR, 2 Saint Louis, MO/US(pyeongguk.kang@samsung.com)Purpose: To evaluate the feasibility and effectiveness of fluoroscopic placementof self-expanding metallic stent for the preoperative colonic decompression orpalliative treatment of obstructing left-sided colorectal cancer.Methods and Materials: From January 2004 to December 2007, 92 fluoroscopicplacement of self-expanding metallic stents were attempted in 87 patients (M:F=40:47, mean age: 65 years) with malignant colonic obstruction. Sites, purpose ofthe stent insertion, type, technical clinical success rates and complication rates ofthe stent were evaluated.Results: Site of the stent placement were rectum (n=33), rectosigmoid junction(n=16), sigmoid colon (n=34) and descending colon (n=4). 60 cases (65.2%) ofstent insertion were done for preoperative colonic decompression and 32 cases(43.8%) were done for palliative purpose. 87 uncovered and 5 covered metallicself-expanding stents were used. Technical success rate of stent placement was95.6% (88/92). In 81 out of 92 cases, symptoms of the colonic obstruction wererelieved, giving clinical success rate of 88.04%. Among 60 cases of preoperativedecompression, 55 cases underwent elective operation with primary anastomosis(91.7%). In the palliative group, the patency rates were 87.9% at 3 months, 75.2%at 6 months and 75.2% at 12 months. Complications associated with stent insertionwere minor bleeding (67.4%), severe pain (18.5%), migration (4.34%), and tumoringrowth (3.26%). No procedure related mortality was noted.Conclusion: Fluoroscopic placement of self-expanding metallic stent for the treatmentof obstructing left-sided colorectal cancer is feasible and effective. Also, thisprocedure gives good clinical results for both preoperative colonic decompressionand palliative purposes.C-542Ultrasound guided fine-needle aspiration biopsies: Comparison of sampleadequacy with different needle sizes and with/without onsite cytologicanalysisR. Erman Yalcin, C. Yucel, P. Uyar Göcün, A. Poyraz, F. Taneri, H. Özdemir;Ankara/TR (cyucel68@hotmail.com)Purpose: The aim of this study was to compare the adequacy of samples obtainedwith different sized needles and with/without onsite cytologic analysis.Methods and Materials: Two hundred patients (169 women and 31 men; agerange, 17-80 years; mean, 49 years) with solitary (n=65) or multiple (n=135) thyroidnodules underwent ultrasound (US) guided fine-needle aspiration biopsies (FNAB).Nodule diameters were between 6-45 mm (mean: 15.2 mm). Patients were randomlydivided into four groups according to needle size (NS) and whether onsitecytologic analysis (OCA) was performed or not. Group I: NS=21 gauge, OCA (-),Group II: NS=27 gauge, OCA (-), Group III: NS=21 gauge, OCA (+) and Group IV:NS=27 gauge, OCA (+). Each group consisted of 50 patients. Sample adequacyrates and number of needle passes were calculated for each group and comparedwith chi-square test.Results: The number of needle passes were 1-4 (mean: 2.20) in Group I, 1-4 (mean:2.48) in Group II, 1-4 (mean 2.38) in Group III and 1-4 (mean 2.44) in Group IV.In Group I, significantly less passes were performed. Sample adequacy rates fordifferent groups were 96, 90, 100 and 98%, respectively. There was no significantstatistical difference between groups. In Groups I and III, hematoms were developedin three cases after the procedures.Conclusion: Best results were obtained with thicker needles and onsite cytologicevaluation. However, the use of 21 gauge needles carries higher risk for complications.Our experience shows that, for high adequacy rates and patient comfortat the same time, thinner needles and onsite cytologic analysis should be thepreferred approach.C-543Is doxorubicin the most effective drug for chemoembolization?B. Guiu, B. Chauffert, S. Guiu, R. Loffroy, J.-P. Cercueil, D. Krausé,M.-H. Guignard, L. Bedenne, M. Boulin; Dijon/FR (bguiu@hotmail.fr)Purpose: Lipiodol emulsions of anticancer drugs with faster and higher activity couldbe more efficient than the classical doxorubicin-Lipiodol for chemoembolization. Theaim of our study was to evaluate the in vitro cytotoxicity of different anticancer drugsin the presence or not of amiodarone on three digestive human cell lines.Methods and Materials: The three cell lines we used were HepG2 (hepatomacells), HCT8 and HT29 (colic cells). Tested drugs were cisplatin, daunorubicin,doxorubicin, epirubicin, idarubicin, mitomycin C and mitoxantrone. Confluent cellswere washed, resuspended in 100µl of HAM culture medium and exposed to thechosen concentrations of drugs. Cells were then placed 1 hour in a CO 2-incubatorat 37 °C, washed twice and incubated for 4 additional days at 37 °C in 200 µl MNCculture medium. Cytotoxicity was measured by a classical colorimetric assay. Cellsurvival was expressed as a percent of control untreated cells. Each point was themean SD of the three wells.Results: Idarubicin was the most effective drug in inducing cytotoxicity in thethree cell lines. The efficacy of idarubicin was already observed at the lowestconcentration (31 µg/ml) whereas the activity of doxorubicin, for example, seemedto be dependent on its concentration. On the HepG2 hepatocarcinoma cell line,the three less effective drugs were doxorubicin, cisplatin and mitomycin C. Theconcentration of three drugs causing a 50% decrease in viability of these cellswas around 500 µg/ml.Conclusion: Our results show that idarubicin could be a better choice than doxorubicinfor chemoembolization.No Material Submitted to EPOSC-544CT evaluation after radiofrequency ablation of hepatic tumorsM. Fatehi, S. Akhlaghpoor, A. Arjmand Shabestari, F. Fattahi,M. Shojae Moghadam; Tehran/IR (mansoor.fatehi@gmail.com)Learning Objectives: To illustrate CT findings after radiofrequency ablation ofhepatic mass lesions, to review signs of treatment success or failure and to overviewfollow-up protocols for liver RF ablation based on the experience of 108 cases.CS450 A B D E F FG H

Scientific and Educational ExhibitsBackground: Three phase contrast enhanced CT scan is the most widely usedmethod for follow-up of RF ablated hepatic tumors that are usually performed within1 month after intervention and repeated after 3 months. Those radiologists whoare not familiar with typical changes after RF of liver may misinterpret the CT scanresulting in disappointment of clinician and patient. The radiologist should be awareof change in size, enhancement pattern and evolution of ablated areas and alsoresidual/recurrent tumor or added metastatic deposits. The paper reflects findingsof 211 RF ablated hepatic tumors in 108 cases.Imaging Findings: The first CT scan performed after RF ablation may showring like enhancement around ablated area, which actually reflects hyperemiaand should not be mistaken for residual or recurrent tumor. The scan may showchanges attributable to complications of intervention. Another important issue inpost-RF scans is apparent increase in size of the lesion since a larger area is ablatedto secure safe margins. The size of ablated area will show gradual decreaseover time. Any enhancing structure in previously sharp ablation area should beconsidered as recurrence.Conclusion: Clear understanding of typical and atypical findings after RF ablationof liver tumors will help radiologists and referring clinicians correctly assessresponse to treatment.C-545Ultrasound guided fine-needle aspiration biopsy of the thyroid: Experiencefrom an oncologic hospitalI. Georgiou, H. Tsokou, N. Paximadakis, S. Karvelas; Athens/GR (irinig@tin.it)Purpose: We reviewed the “St. Savvas” Anticancer Hospital of Athens’ experiencewith ultrasound fine-needle aspiration biopsy (FNAb) of the thyroid and correlatethe results with sonographic and color Doppler characteristics of thyroid nodulesto predicting risk of malignancy.Methods and Materials: 932 ultrasound guided FNAbs of thyroid nodules performedat our institution during the last three years were reviewed. We retrospectivelyanalyzed the following sonographic parameters: size, number, echogenicity,echo structure, shape, margin regularity, presence of calcifications, presence ofa hypoechoic rim and internal vascularity. Individual features and combination offeatures were analyzed for their correlation with benign and malignant diseases.Results: FNA diagnosis included 93% benign and 7% malignant nodules. Theprobability of malignancy was higher in solitary nodules. The size did not showany significant difference between benign and malignant nodules in this study. Thesonographic features significantly associated with malignancy were: hypoechogenicity,irregular margins, absence of hypoechoic rim and intranodular vascularnodes. Presence of “snowstorm” pattern of calcification was 100% specific formalignancy.Conclusion: Fine-needle aspiration biopsy of the thyroid has proved to be anexcellent diagnostic tool in the initial management of thyroid nodules, with highsensitivity and specificity in diagnosing malignant tumors and well accepted bypatients because of minimal discomfort and complication. However, its effectivenessis highly dependent on the expertise of the operator performing the procedureand the adequacy of the cytological specimen. Ultrasound guided FNAb should beperformed on thyroid nodules with diameter greater than 8 mm and sonographiccharacteristics suspicious for malignancy.C-546MR-guided interventions on only MR-detectable lesions in breast MRI:A pathologic-radiologic comparisonA. Malich, A. Kott, J. Feger, R. Gorna; Nordhausen/DE (ansgar.malich@shk-ndh.de)Purpose: MR-guided interventions on mammographically/sonographically occultlesions are still time consuming, and depend critically on the experience of theradiologist. The study is aimed to analzye imaging characteristics of those lesionsvisible in MRI only and the feasibility of MR-guided interventions.Methods and Materials: 130 MR-guided interventions on enhancing lesionswere performed at our hospital between 12/06 and 9/08. All cases were analyzedretrospectively regarding dynamic/morphological data, histopathology, and size. Allimages were done using the same standardized protocol (1.5 T Achiva, Philips;0.1 mmol Gd-DTPA/kgbw; same slice thickness, dynamic analyses by CAD (Confirma),intervention planning by SureLoc (Confirma), intervention positioning byNoras positioning aid, Suros-biopsy kid).Results: 35/130 interventions were histologically malignant/premalignant. Meansize was 4 mm. Contrast uptake of benign vs. malignant lesions 4 mm did not differ.Morphology did differ in lesions sized 4 mm (irregular edge, subtle spiculations,hypointense T2 in malignancies). Most common benign lesions were papillomata(21%), fibroadenoma (24%), sclerosing adenosis (19%). Most common malignantentity was DIN3. Planning of the intervention was highly accurate. 14 further plannedinterventions were not realizable due to non enhancing (during interventional procedure)of those enhancing pattern in dynamic diagnostic breast-MRI, due to inoptimallocalization of lesions. No technical problems occurred during intervention.Conclusion: The ratio of up to 30% (pre)malignant findings of MR-guided interventionof enhancing small lesions support clinical relevance of this procedure even onsubtle lesions. Due to time consuming procedure, MR-guided interventions shouldbe done only on those lesions being not otherwise visualizable.C-547Clinical and radiological characteristics of hepatocellular carcinoma thatenable performing radiofrequency ablation as a single-treatment: A 2-yearfollow-up resultW. Jeong, P. Kim, K. Kim, Y. Shin, H. Won; Seoul/KR (jeongwk@medimail.co.kr)Purpose: To predict whether radiofrequency ablation as a single-treatment ofhepatocellular carcinomas will be possible by pre-procedural examinations.Methods and Materials: A total of 343 consecutive patients diagnosed withhepatocellular carcinomas (HCC) following percutaneous radiofrequency ablationand followed up for more than 6 months were enrolled. Considered pre-proceduralfactors were as follows: 1) larger than 3 cm of a HCC size, 2) more than three ofnumber of HCC, 3) encapsulation, 4) extranodular extension, 5) duct invasion, 6)adjacent vessel larger than 4 mm, 7) subcapsular location, 8) previous history oftransarterial chemoembolization (TACE), 9) marginal recurrence of treated HCC ifundergoing TACE previously, 10) viral induced HCC, and 11) more than 300 ng/mlof serum alpha-fetoprotein level. For the comparison of each cumulative ablationmaintenancerate and multivariate analysis, Log-rank test and stepwise Cox hazardsmodel were performed.Results: In 134 patients, treatment methods changed to TACE (n=130) or surgery(n=4), and radiofrequency ablation was maintained as a single-treatment in 209patients. Mean follow-up period was 17.7 months (range, 6-36 months) and meaninterval in which the treatment method changed was 8.6 months (range, 0-31months). Log-rank test revealed that significantly contributing factors were tumorsize, non-encapsulation, extranodular extension, duct invasion, adjacent vessel,subcapsular location, history of TACE and level of alpha-fetoprotein (p .05). Coxhazard model showed that history of TACE was the most significant factors (oddsratio =3.02; p .05).Conclusion: Several meaningful radiologic and laboratory findings of pre-proceduralexamination help to decide radiofrequency ablation as a single-treatmentof the HCC.C-548Challenging bone tumors managementA. Gangi, G. Bierry, X. Buy; Strasbourg/FR (gangi@rad6.u-strasbg.fr)Learning Objectives: To know the different techniques to manage bone tumorspercutaneously in challenging cases (location, proximity to nerve roots, cord, loop).To understand when and how to use each ablation technique (alcool, laser, RF,or cryoablation). To know all protective techniques (insulation, thermal monitoring,fluid injection) to reduce complications of percutaneous procedures.Background: Percutaneous bone tumor management is now recognized and sometumors as osteoid osteoma are treated in the majority of cases percutaneously.Other primary or metastatic tumors can be also treated percutaneously. The purposeof this exhibit is to report the challenging situations with difficult location, largeextension of the tumor, proximity to root, cord, loop and to describe how to avoidcomplications using combination of different techniques. Emphasis is put on theinsulation techniques, thermal monitoring and protection of surrounding organs.Procedure Details: Description of different technique in challenging tumors andwhen and how to use them: Tumor ablation, tumor consolidation, tumor cavitation,combination of different techniques, and thermal insulation.Conclusion: Interventional radiology allows percutaneous management of themajority of metastatic bone tumors, and of some primary ones, even in difficultlocation.C-549Percutaneous removal of biliary foreign bodies: A pictorial reviewH. Baek 1 , Y. Lee 1 , A. Park 1 , J. Juhn 1 , J.-I. Bae 2 ; 1 Busan/KR, 2 Suwon/KRLearning Objectives: To illustrate techniques for percutaneous removal of biliaryforeign bodies.Background: Presence of a foreign body in biliary tree is known to act as a nidusfor sludge and microlithiasis formation. With increasing number of hepatobiliarysurgery and non-surgical endoscopic or percutaneous interventions, many unexpectedforeign bodies in the biliary tract are encountered. In this exhibit, we willInterventional RadiologyACB D E F G HS451

Scientific and Educational Exhibitsdescribe the spectrum of biliary foreign bodies and techniques for their retrieval.Foreign bodies were fractured external internal drainage catheter, malfunctioningplastic stent, detached olive tip of stent delivery sheath, migrated bare metallicstent, migrated covered metallic stent, and broken stone basket, broken tooth ofbiopsy forcep, etc.Procedure Details: Percutaneous transhepatic biliary drainage was performedthrough a bile duct suitable for the easiest access to the foreign bodies. Initially,an adequate size sheath was introduced. Coaxially various kinds of devices wereused to capture and retrieve the foreign body to avoid bile duct injury.Conclusion: Percutaneous approach is a safe and effective method for removalof biliary foreign bodies alternative to endoscopic management.C-550Blunt tip coaxial introducer: Spectrum of indications in variousinterventional procedures in the chest and abdomenC. de Bazelaire, C. Farges, J. Frija, E. de Kerviler; Paris/FR(eric.de-kerviler@sls.aphp.fr)Learning Objectives: To outline the advantages of the blunt tip coaxial introducer.To exhibit the wide spectrum of indications of the blunt tip coaxial introducer indifferent interventional radiology procedures.Background: Coaxial introducers are widely used in interventional radiology forbiopsy or drainage accesses. However, they are often provided with a sharp stylet,requiring careful manipulation. The use of a blunt tip stylet allows easy access todifficult targets, and safe manipulation in the chest or in the abdomen.Procedure Details: We routinely use blunt tip coaxial introducers for CT-guidedprocedures. The kit is composed of a 17G external canula fitted with a sharp stylet,replaceable by a second one having a blunt tip. The coaxial introducer may giveaccess to 18G biopsy guns, or 0.35 guide wires for the purpose of percutaneousdrainages or nephrostomies. We have started using the technique when no clearpath to work through was seen on the images, taking advantage of the capabilityof the blunt tip to bounce off the great vessels, ureters, bowel loops, the capsule ofthe liver and kidneys. In difficult nephrostomies, the sharp tip enters the cavities andthe blunt tip helps navigating within renal cavities, i.e., among calculus, reachingthe ureter when necessary.Conclusion: The alternating use of the 2 stylets facilitates difficult biopsies, drainagesor nephrostomies. This technique has become the method of choice for mostof our procedures in the chest and abdomen. Examples of various procedures willbe shown in the exhibit.C-551Evaluation of therapeutic response and major complications after imageguidedradiofrequency ablation of liver tumors: A pictorial reviewP.A.A.F. Santos, M. Gomes, M. França, R. Themudo, R. Maia, F. Reis; Porto/PT(paafds@gmail.com)Learning Objectives: Description of both typical and atypical imaging findingsafter liver tumor radiofrequency (RF) ablation, concerning with therapeutic responseand complications.Background: Image-guided RF ablation has been used increasingly during the pastdecade to treat hepatic tumors. After the procedure, a close radiologic follow-upis mandatory, in order to exclude both immediate and delayed complications andtumor response to the treatment. Contrast-enhanced ultrasonography, computedtomography (CT) and magnetic resonance imaging all can be useful for this assessment.At most institutions, a dynamic CT-scan is preformed within the first 24hours to evaluate immediate complications and after 1 month to assess technicalsuccess. If this is achieved, CT may be repeated every 3 months for evaluationof tumor recurrence.Imaging Findings: The overall complication rate for RF is low and ranges fromminor complications (pleural effusion, self-limited hemobilia, thermal skin injuryand minimal perihepatic fluid), to major complications (intraperitoneal hemorrhage,hepatic infarction, hepatic abscess formation, intestinal perforation, bile peritonitisand delayed tumor seeding). Post-treatment CT should show a completely nonenhancinghypodense area with diameter larger or equal to the pretreatmentdiameter and with no enhancing focus, although early in the course, a peripherallyenhancing rim may be seen due to inflammatory response of the normal tissue.Conclusion: RF of liver tumours has many advantages over surgery, includinglow complication rate, reduced cost and increased patient compliance. However,radiologists should be aware of both the typical and the atypical CT findings in theRF ablation zone and their clinical significance.C-552Absolute and relative contraindications of radiofrequency ablation of focalliver tumorsF. Vandenbroucke, J. de Mey; Brussels/BE (spovef@uzbrussel.be)Learning Objectives: To outline the relative and absolute contraindications ofimage-guided percutaneous radiofrequency ablation (RFA) in the liver. To describethe major and fatal complications after a series of 146 RFA procedures and to lookfor possible risk factors.Background: RFA is increasingly used for the treatment of focal tumors in theliver. The indications of these procedures on the basis of tumor size, number andlocation are well established. In this exhibit, we will describe the contraindicationsthat can lead to major complications or even death. Between March 1999 andSeptember 2008, a total of 156 RFA procedures of the liver were performed in ourdepartment. We counted 2 patients who died within one month after RFA. Anothertwo patients had a major complication, one liver abscess and one peritoneal bleeding.We analyzed the patients’ records and looked for risk factors that could haveattributed to those events.Procedure Details: The RFA procedures were performed under general anesthesia,or conscious sedation combined with local anesthesia. A cool-tip electrodewas introduced under CT-guidance for lesion ablation. We ablated up to 5 lesionsin a single patient during one procedure. Clinical and radiological feedback wasused to determine unsuitable candidates after registration of direct and long termcomplications.Conclusion: A profound preliminary examination of the history and previous imagesof candidates for RFA leads to better patient selection, and will minimize therisk in future procedures.C-553Percutaneous cryoablation of renal tumors: Initial experience in 20 patientsX. Buy, G. Bierry, D. Szwarc, H. Lang, C. Roy, A. Gangi; Strasbourg/FR(xavier.buy@chru-strasbourg.fr)Purpose: To evaluate the feasibility, safety and efficacy of percutaneous cryoablationfor the management of renal tumors.Methods and Materials: From May 2007 to June 2008, 21 renal tumors in 20non surgical patients (mean age 65) were treated with cryoablation. Mean tumorsize was 26 mm (13-52). 13 tumors were endophytic and 7 were abutting therenal pelvis. 6 lesions were in close contact with the bowel. All procedures wereperformed percutaneously under CT guidance, with biopsy performed during thesame session. Up to four cryoprobes were used simultaneously for the biggesttumor. For bowel insulation, thermal protection technique with CO 2insufflation andtemperature monitoring with thermocouple was used. Minimum follow-up with MRIand creatinin was 4 months.Results: No complication occurred. The first patient in the series required an additionalsession due to insufficient freezing time protocol. All others were treated ina single session with no evidence of residual tumor on follow-up. CT control allowedprecise monitoring of the ice ball and CO 2insulation. Pain was minimal with majorityof the procedures performed under low sedation. All patients could be dischargedwithin two days. Creatinin remained unchanged after 4 months.Conclusion: Percutaneous cryoablation is a promising low-pain alternativetechnique for the management of renal tumors in non surgical patients. The intentis curative in a single session for tumors less than 4 cm. For central tumors, therisk of thermal damage to the pyelic structures seems to be reduced compared toradiofrequency ablation.C-554Percutaneous cryoablation of painful musculoskeletal tumors: Initialexperience in 32 patientsX. Buy, S. Daniel, G. Bierry, A. Gangi; Strasbourg/FR(xavier.buy@chru-strasbourg.fr)Purpose: To evaluate the feasibility, safety and efficacy of percutaneous cryoablationfor the management of painful musculoskeletal tumors.Methods and Materials: From June 2007 to August 2008, 32 patients suffering frompainful non surgical musculoskeletal tumors underwent CT-guided percutaneouscryoablation. All patients were refractory to morphine medication and radiotherapy.Cementoplasty was combined during the same session if weight bearing bone wasinvolved with risk of pathological fracture. In case of close contact with sensitivestructures, particularly nerves, thermal protection techniques (CO 2insulation,continuous monitoring with thermocouple) were used. Pre- and post-proceduralpain was evaluated with VAS pain score and medication.CS452 A B D E F FG H

Scientific and Educational ExhibitsResults: All procedures were technically successful. CT guidance allowed aprecise visual control of the ice ball. Peri- and post-procedural pain was hardlyreduced compared to similar procedures performed with radiofrequency ablation.88% (28/32) patients reported a major reduction of pain. One transient crural paresisoccurred after cryoablation of a painful L3 osteoblastic metastasis. No othercomplication occurred. 8 patients died within 8 weeks due to advanced diseasebut without significant recurrence of pain at the treated area.Conclusion: Percutaneous cryoablation of painful musculoskeletal tumors is apromising technique when conventional therapies have failed. Peri- and postproceduralpain is low and majority of procedures are performed under conscioussedation. The visual control of the ice ball with sharp margins gives a high safetywhen performing cryoablation close to sensitive structures. However, a good knowledgeof thermal protection techniques is mandatory to avoid complications.C-555Reducing risk and stabilizing the vertebral body in advanced metastaticspine lesions: A combined approach using plasma-mediated tumorablation and cement augmentationB. Georgy; Escondido, CA/US (bgeorgy@earthlink.net)Purpose: Combining percutaneous plasma-mediated radiofrequency ablationwith cement augmentation offers a less invasive treatment option for advancedmetastatic lesions of the spine while providing immediate pain relief. The treatmentis particularly useful for cases with cortical destruction and/or epidural extension.This study evaluated bone cement deposition patterns and leakage rate in relationto the metastatic lesion after using this combined approach.Methods and Materials: A void is created in the anterior portion of the tumorinfiltratedvertebral body using a bipolar plasma radiofrequency-based device(ArthroCare Corp., Austin, TX), followed by cement augmentation. Retrospectiveassessments of CT images performed before/after the procedures were evaluatedin 37 patients (44 levels) with advanced metastatic lesions. All patients reportedpain status (VAS) pre-procedure and 2-4 weeks afterwards.Results: Assessment found that 90-100% cement was deposited in the anterior 2/3of the vertebral body in 19 levels (43%), while 75-90% of the cement was depositedin this region in 16 levels (36%). In 13 of 15 levels with posterior lesions (86%),cement deposited anterior to the lesion. 13 levels showed no leakage (29.5%).Two clinically insignificant incidences of epidural cement leakage recorded. 25 of28 patients (89.5%) reported pain relief post-procedure.Conclusion: Plasma-mediated radiofrequency ablation allows greater control ofcement deposition, increases likelihood of stabilizing the anterior 2/3 of the vertebralbody, and may replace extensive anterior surgical stabilization techniques. Thiscombined technique appears particularly useful in cases with posteriorly-locatedlesions. Cement leakage using this approach is clinically insignificant, while postprocedurepain relief is excellent.C-556Complications of percutaneous lung radiofrequency ablationA. Afaq, S. Khan, U. Patel, E. Leen; London/UKLearning Objectives: A review of the complications of radiofrequency ablation(RFA) use in lung tumour management.Background: Radiofrequency ablation (RFA) is gaining increasing popularity inthe management of unresectable lung tumours. Feasibility and safety continuesto be supported with continuing trials. However, further study is also necessary inorder to minimise the recognised complications.Procedure Details: Recognised commoner minor adverse effects and complicationsinclude pain, subcutaneous emphysema, hemoptysis, pyrexia, pleural effusions,small pneumothorax and skin burn. Less common major complications includelarge pnemothorax requiring drainage, abscess, intrapulmonary hemorrhage andair embolism. Death has been reported from intractable pneumothoraces/massivehemoptysis and from interstitial pneumonitis - the latter being related to previousexternal beam radiotherapy and larger tumor size.Conclusion: As the technique develops and knowledge of higher risk profilesimproves, complications are likely to reduce in the future. However, of the limitedrelatively small studies on complications, adverse symptoms have occurred in approximatelya third whereas minor complications in up to a half and major complicationsin less than a quarter. The procedure continues to gain recognition as a safeand effective minimally invasive treatment option for unresectable lung tumors.C-557Laser, radiofrequency and microwave ablation therapy of lung tumors:Qualitative and quantitative analysisN.-E.A. Nour-Eldin, N.N.N. Naguib, M.G. Mack, T.J. Vogl; Frankfurt a. Main/DE(nour410@hotmail.com)Learning Objectives: To provide a qualitative description of principle and basicphysics of most applicable tools of ablation (LASER, radiofrequency and microwave)and quantitative analysis of the advantages and limitations of each modality tomake maximal benefit on clinical practice.Background: Ever since its introduction in the management of lung tumors,thermal ablation became a promising minimal invasive therapy of lung tumors,opening new horizons in pulmonary neoplastic therapy. The potential advantagesof local tumor ablation therapy over surgical resection might include: 1) selectivedamage, 2) minimal treatment morbidity and mortality, 3) less breathing impairmentin patients with borderline lung function through sparing healthy lung tissue,4) repeatability, 5) fairly low costs, 6) excellent imaging during the procedure andfor follow-up and last but not least 7) the gain in quality of life with less pain, muchshorter hospitalization times with the interventions performed on an outpatient baseor with overnight stays and thus a quicker re-access to social life. For oncologyinterventionists, physical background advantages and limitations of the therapeuticablative tools represent the backbone of successful treatment representing a nonavoidable learn demand.Procedure Details: Description of the terminology of the thermal ablation of lungtumors, principle of function, indications and contraindications, advantages anddisadvantages of LASER, radiofrequency and microwave regarding ablation capabilitiesand potential complications associated with reference of each qualitativeand quantitative item to literature and institutional experience.Conclusion: The pulmonary thermal ablation therapy is an operator dependantprocedure that requires comprehensive understanding of how, what and whento apply.C-558Imaging and intervention in unstable pelvic traumaN. Fotiadis, C. Bent, I. Ahmed, I. Renfrew, K. Brohi, M. Matson; London/UK(fotiadis.nicholas@gmail.com)Learning Objectives: This presentation aims: To review the normal CT and angiographicallyvascular anatomy of the pelvic vessels. To reveal the spectrum ofimaging findings in arterial and venous injuries encountered in severe pelvic trauma.To present ways of successful endovascular treatment of pelvic bleeding.Background: Arterial hemorrhage is one of the most serious problems associatedwith pelvic fractures, and it remains the leading cause of death attributableto pelvic fracture. Early detection of arterial bleed at CT angiography can leadto prompt performance of angiographic embolization, which can be lifesaving. Apictorial review, based on the authors’ extensive experience, is used to present arepresentative series of vascular injuries seen in severe pelvic trauma.Imaging Findings: Arterial injuries and extravasation of the iliolumbar artery, lateralsacral arteries, the superior and inferior gluteal artery, the internal pudendal arteryand the obturator artery are illustrated with CT and angiographic images. Differentembolization approaches are discussed.Conclusion: Pelvic multidetector CT and classic angiography have a cardinal rolein the management of patients with severe pelvic trauma and vascular injuries.Interventional RadiologyACB D E F G HS453

Scientific and Educational ExhibitsMolecular ImagingC-559First-pass CT perfusion of FN13762 murine breast cancer: Region-byregioncorrelation with histological vascular parametersC. Park 1 , J. Goo 1 , H. Lee 1 , M. Kim 1 , K. Kim 2 , C. Lee 1 ; 1 Seoul/KR, 2 Gyeonggi-Do/KR(cmpark@radiol.snu.ac.kr)Purpose: To investigate the correlation between first-pass CT perfusion indices andhistological vascular parameters using region-by-region correlation methods.Methods and Materials: The institutional animal care and use committee of ourinstitute approved this study. FN13762 murine breast cancer cells were implantedin 14 female Fischer rats and first-pass perfusion CT was performed. Tumor perfusionmaps including blood flow (BF), blood volume (BV), mean transit time (MTT)and permeability-surface-area product (PSA) were generated using commercialperfusion software. The entire tumor area was divided into 6 separate regions onperfusion maps, and the regional perfusion indices were quantified. Histologicalvascular parameters including microvessel density (MVD), luminal vessel number(LVN), luminal vessel area (LVA), and luminal vessels perimeter (LVP) weremeasured in the corresponding histological region to perfusion maps. Correlationanalysis was performed between regional tumor perfusion indices and histologicalvascular parameters of the corresponding tumor region. Additionally, mean perfusionvalues of entire tumor were correlated with histological vascular parametersof the hottest spot within the entire tumor.Results: In region-by-region correlation manner, regional BF (r=0.476), BV(r=0.348), and MTT (r=-0.506) was significantly correlated with MVD in the correspondingtumor region (P 0.01). Also in each Fischer rat, MVD showed significantlygood correlations with BF, BV, and MTT (P 0.01). Correlation analysis between CTperfusion indices of entire tumor and histological vascular parameters of the hottestspot within entire tumor did not show significant correlations (P 0.05).Conclusion: Regional BF, BV, and MTT are significantly correlated with MVD inthe corresponding tumor region.C-560Phosphorus: 31 magnetic resonance spectroscopy of skeletal musclein maternally inherited diabetes and deafness A3243G mitochondrialmutation carriersS.G.C. van Elderen, J. Doornbos, E.H.R. van Essen, H.H.P.J. Lemkes,J.A. Maassen, J.W.A. Smit, A. de Roos; Leiden/NL (s.g.c.van_elderen@lumc.nl)Purpose: To investigate high-energy phosphate metabolism in striated skeletalmuscle of patients with the maternally inherited diabetes and deafness (MIDD)syndrome.Methods and Materials: Patients were recruited from the local MIDD databaseof the diabetes mellitus (DM) outpatient clinic of our institution. In 11 patients withthe MIDD mutation (6 with DM and 5 non-DM) and 8 healthy subjects, phosphocreatine(PCr) and inorganic phosphate (Pi) in the vastus medialis muscle wasmeasured immediately after three minutes of repeated knee extension by using³¹P-magnetic resonance spectroscopy (MRS). The half time of recovery (t½) ofmono-exponentially fitted (PCr+Pi)/PCr was calculated from spectra obtained everyfour seconds after cessation of exercise. A multiple linear regression model wasused for statistical analysis.Results: Patients with the MIDD mutation showed a significantly prolonged t½(PCr+Pi)/PCr) after exercise as compared to controls (13.63.0 vs. 8.71.3 s,p=0.01). No association between the presence of DM and t½ (PCr + Pi)/PCr wasfound (p=0.382).Conclusion: MIDD patients showed impaired mitochondrial oxidative phosphorylationin skeletal muscle shortly after exercise, irrespective of the presence ofdiabetes mellitus.C-561Quiz yourself in lymph node characterization with lymphotropicnanoparticle-enhanced MRI using superparamagnetic iron oxides!T. Islam, M. Braschi, G.R. Oliveira, M.G. Harisinghani; Boston, MA/US(Islam.Tina@mgh.harvard.edu)Learning Objectives: The purpose of this educational exhibit is to familiarize viewerswith various patterns of enhancement in lymphotropic nanoparticle-enhancedMRI (LNMRI) with ferumoxtran-10 using test cases.Background: Evolving technologies such as LNMRI with ferumoxtran-10 improvethe accuracy in distinguishing benign from malignant lymph nodes. However, accuratenodal characterization requires reader training and experience. This exhibitwill showcase the variations in signal intensity changes with ferumoxtran-10 inbenign and malignant nodes. Multiple histologically proven lymph nodes fromvarious primary tumors will be shown pre and post contrast enhancement in a quizmanner followed by the correct answers.Procedure Details: This technique employs superparamagnetic iron oxidenanoparticles targeted at the reticuloendothelial system.They are phagocytozedby macrophages that accumulate within lymph nodes. Disturbances in lymphflow or in nodal architecture caused by metastases lead to abnormal patternsof accumulation of the particles, which are detectable by MRI. On post contrastT2- and T2*-weighted MRI benign lymph nodes show a drop in signal intensityand homogenous darkening whereas areas of malignant infiltration show lack ofnanoparticle uptake and remain signal-intense.Conclusion: Taking this quiz, the viewer will acquire confident knowledge of thefeatures of benign versus malignant lymph nodes in lymphotropic nanoparticleenhancedMRI.C-562Limitations of 18 FDG-PET/TC in oncology: False positive and false negativefindingsA. Díez Tascón, I. Pinilla Fernandez, M. Hernández Maraver, J. Coya Viña,B. Rodríguez-Vigil Junco, N. Gómez León; Madrid/ES (aureadiez@yahoo.es)Learning Objectives: To review the spectrum of potential pitfalls and limitationsof whole-body 18 FDG-PET/CT scans in oncologic patients with emphasis on falsepositive and false negative interpretations, and how some of them can be avoidedor appropriately interpreted.Background: Accurate diagnosis and staging are essential for an adequatemanagement of oncologic patients. 18 FDG-PET/CT has emerged as a powerfulimaging tool in oncology. The combined acquisition of morphologic and functionalimages has synergistic advantages and minimizes their limitations, resulting in amore accurate test than either of its constituents. However, there remain potentialpitfalls the interpreters must be aware of.Imaging Findings: 18 FDG is not a cancer specific tracer and is physiologically takenup by various organs making difficult identification of lesions in these localizations.There are also benign pathologic causes of 18 FDG uptake that can mimic malignantneoplasm (infectious, inflammatory processe, benign tumors). Other limitations arerelated to the variable 18 FDG avidity of several types of cancers. Tumors exhibitingvery low 18 FDG uptake may lead to false negative interpretations. In addition, thereare potential pitfalls related to technical factors or the timing of the study that cancompromise the sensitivity of 18 FDG-PET/CT for detecting tumors.Conclusion: 18 FDG-PET/CT plays an important role in the management of cancerpatients. Despite its benefits, 18 FDG-PET/ CT has recognized limitations. Thisexhibit will help to identify physiologic variants and benign pathologic conditionswith increased 18 FDG uptake that can be confused with malignant neoplasm,to increase awareness of potential false negative findings, and to reduce falseinterpretations.C-563Macrophage imaging by USPIO-enhanced MR for the differentiation ofinfectious osteomyelitis and aseptic vertebral inflammationG. Bierry 1 , F. Jehl 1 , N. Boehm 1 , P. Robert 2 , J.-L. Dietemann 1 , S. Kremer 1 ;1Strasbourg/FR, 2 Roissy/FR (guillaume.bierry@chru-strasbourg.fr)Purpose: To prospectively evaluate macrophage imaging using USPIO enhancedMRI for the differentiation of vertebral infectious osteomyelitis and sterile inflammation.Methods and Materials: Vertebral osteomyelitis and sterile vertebral inflammationwere induced in two groups of 6 rabbits. MRI examinations were performedin the 12 rabbits twice a week including unenhanced and gadolinium-enhancedSE T1w sequences. Once endplates enhancement was observed on gadoliniumenhancedMR sequence, a second MRI examination (FS SE T1w sequence) wasperformed in the 12 rabbits 24 hours after USPIO administration (Sinerem, 45 µmolFe/kg). MR imaging were correlated with histopathologic findings (macrophageimmunostaining and Perls blue staining). Endplates signal-to-noise ratio (SNR)changes after gadolinium and after USPIO administration were calculated andcompared in two groups.Results: On gadolinium-enhanced T1 sequences, a significant SNR enhancementof vertebral endplates was present in both groups without significant differencebetween the two groups (p=0.26). On USPIO-enhanced T1 sequences, a significantSNR enhancement was only observed in the infection group (p=0.03) with asignificant difference of SNR between the infection and the sterile inflammationgroups (p=0.002). Infected areas presented a replacement of bone marrow by anintense macrophage infiltration. On Perls blue stain, some of those macrophagesCS454 A B D E F FG H

Scientific and Educational Exhibitswere iron-loaded. At the opposite, sterile inflammation showed a replacement ofbone marrow by an inflammatory tissue with only rare macrophages; no stainingwas observed on Perls stain.Conclusion: USPIO-enhanced MR imaging can distinguish infectious osteomyelitisfrom sterile vertebral inflammation because of a different macrophages distributionbetween the two types of lesions.C-564FDG PET/CT in the primary staging evaluation of adenocarcinoma of lungR. Talanow, S. Shrikanthan, T.-L. Mohammed; Cleveland, OH/US(roland@talanow.info)Purpose: Purpose of this study was to analyze prevalence, patterns and factorsassociated with FDG uptake in lung adenocarcinoma and to investigate associationof FDG uptake with metastatic disease.Methods and Materials: FDG-PET/CT findings of 132 patients (42-86 years, 50males, 82 females) with lung adenocarcinoma at initial staging were analyzed.Maximum standard uptake value (SUV) of primary lesion was correlated withlesion size, presence of nodal or distant metastasis and histology. Histology wasfurther investigated for differentiation and presence of coexisting bronchoalveolarcell (BAC) component. Patients were divided into 3 groups based on SUV of theprimary: low (SUV 2), intermediate, (SUV 2-4) and high (SUV 4).Results: There were 18 cases with SUV 2 (14%), 21 with SUV 2-4 (16%) and93 had SUV 4 (70%). Among the 18 with SUV 2, there was coexistent BACcomponent in 12 (67%) and 14 were well differentiated with metastasis in only 3(17%). Primary lesion was 1.5 cm in 7 (39%) of these cases. Among the 21 withSUV 2-4, BAC component was present in 9 (43%), 18 (86%) were well differentiatedand metastasis was present in 10 (48%). 7 (33%) were less than 1.5 cm.Among the 93 with SUV 4, BAC component was present in only 10 (11%), 57(61%) were differentiated and metastasis was present in 38 (41%). Only 6 (6%)were less than 1.5 cm.Conclusion: Majority of lung adenocarcinomas were FDG avid, with low FDGavidity likely to have a BAC component and less likely to have metastasis. FDGavid lesions were larger, tended to have metastasis and less likely to have a BACcomponent.C-565Comparison of Tc-99m sestamibi and Tc-99m tetrofosmin for preoperativelocalization in primary hyperparathyroidismR. Talanow, D. Neumann; Cleveland, OH/US (roland@talanow.info)Purpose: Both Tc-99m sestamibi and Tc-99m tetrofosmin have been used for thepreoperative detection of parathyroid lesions in patients with hyperparathyroidism.The purpose of this study was to compare the diagnostic utility of these radiopharmaceuticalsin the evaluation of patients with primary hyperparathyroidism.Methods and Materials: 130 consecutive patients with primary hyperparathyroidismunderwent SPECT imaging preoperatively. Each patient received I-123 NaIorally, followed by Tc-99m sestamibi IV in 64 patients and and Tc-99m tetrofosmin IVin 66. Simultaneous, dual-isotope SPECT of the neck and chest was then obtained.Normalization/subtraction of I-123 SPECT from the Tc-99m SPECT was performed,and the resultant SPECT images were interpreted for focal residual Tc-99m activity.SPECT results were compared to surgical and histopathological findings.Results: In the Tc-99m sestamibi group, 55 single parathyroid adenomas, 4 doubleparathyroid adenomas, and 7 hyperplastic parathyroids were found; surgery wasunsuccessful in 2 patients. Sestamibi SPECT had 60 true positive findings, 12false positives, 14 false negatives and 6 true negatives (81% sensitivity). In theTc-99m tetrofosmin group, 57 single parathyroid adenomas, 6 double parathyroidadenomas, and 3 hyperplastic parathyroids were found; surgery was unsuccessfulin 2 patients. Tetrofosmin SPECT had 50 true positive findings, 9 false positives,22 false negatives, and no true negatives (69% sensitivity).Conclusion: Sensitivity of dual-isotope subtraction Tc-99m sestamibi SPECTwas greater than that for Tc-99m tetrofosmin. Tc-99m sestamibi might be superiorto Tc-99m tetrofosmin for detection of parathyroid lesions in patients with primaryhyperparathyroidism and the preferred radiopharmaceutical for preoperative localization.C-566Ga-68 labelled peptides for PET/CT imaging of neuroendocrine tumorsC. von Falck, T. Rodt, S. Waldeck, W.H. Knapp, H.-o. Shin, M. Galanski;Hannover/DE (c.v.falck@gmx.de)Learning Objectives: To outline the advantages and limitations of 68 Ga-labelledsomatostatin analogues for PET/CT imaging. To illustrate the spectrum of PET/CT imaging findings of various neuroendocrine tumors. To demonstrate potentialpitfalls and artefacts.Background: The detection of neuroendocrine tumors using morphologic imagingmodalities can be challenging. PET/CT with 68 Ga-labelled somatostatinanalogues is a valuable imaging modality for this tumor entity that combines thehigh sensitivity and specificity of PET with the superior morphologic informationprovided by CT. It is valuable for staging, restaging, surgical planning and theevaluation of patients scheduled for internal radiotherapy. Profound knowledge ofthe physiological tracer distribution and potential pitfalls and artefacts is essentialto minimize false findings.Imaging Findings: PET/CT using 68 Ga-labelled somatostatin analogues showsphysiological tracer uptake in the pituitary gland, the liver, the spleen, the adrenalglands and the urinary tract. Notably, only a minor anatomic background is providedby somatostatin-receptor PET alone and correlation of focal uptake with morphologicinformation is essential. In this exhibit, typical examples of different benignand malignant neuroendocrine tumors in somatostatin-receptor PET are presentedand correlated with the corresponding CT and MR imaging findings. Typical pitfallsand artefacts are presented and commented.Conclusion: Combined PET/CT using 68 Ga-labelled somatostatin analoguesallows for highly sensitive and specific detection and precise anatomic localizationof neuroendocrine tumors and should be considered as the primary imagingmodality in these patients.C-567Fever of unknown origin, a value of hybrid 18 F-FDG PET/CT imagingE. Ferdová, J. Ferda; Plzen/CZ (ferda@fnplzen.cz)Purpose: The aim of presented work is to evaluate the clinical value of 18 F-FDG-PET/CT in patients with fever of unknown origin (FUO) and to compare PET/CTfinding with the results of the following investigation.Methods and Materials: 48 patients (24 men, 24 women, mean age 57.6 years withrange 15 - 89 years) underwent 18 F-FDG-PET/CT due to the fever of unknown origin.All examinations were performed using complex PET|/CT protocol combined PETand whole diagnostic contrast enhanced CT with sub-millimeter spatial resolution(except patient with history of iodine hypersensitivity or sever renal impairment). CTdata contained diagnostic images reconstructed with soft tissue and high-resolutionalgorithm. PET/CT finding were compared with results of biopsies, immunology,microbiology or autopsy.Results: The cause of FUO was explained according to the PET/CT findings andfollowed investigations in 44 of 48 cases - 18 cases of microbial infections, ninecases of autoimmune inflammations, four cases of non-infectious granulomatousdiseases, eight cases of malignancies and five cases of proved immunity disorderswere found. In 46 cases, the PET/CT interpretation was correct. Only in one case,the cause was overlooked and the uptake in atherosclerotic changes of arterieswas misinterpreted as vasculitis in the other. The reached sensitivity was 97%(43/44), and specificity 75% (3/4), respectively.Conclusion: In patients with fever of unknown origin, 18 F-FDG-PET/CT might enablethe detection of its cause.C-568Imaging of neuroendocrine tumorsN.H. Wieshmann 1 , R. Hanlon 1 , D. Cuthbertson 1 , S. Hughes 2 , A. Groves 3 ;1Liverpool/UK, 2 Belfast/UK, 3 London/UK (Hulya.Wieshmann@aintree.nhs.uk)Purpose: This pictorial review aims to familiarize the general radiologist with theincreasing choice of the hybrid imaging techniques and the imaging patterns seen incommon and uncommon neuroendocrine tumours (NETs). We also aim to emphasizethe complementary role of hybrid molecular imaging to conventional radiologicalworkup and the important role of nuclear medicine in the management of NETs.Methods and Materials: NETs derive from diffuse endocrine cells dispersedthroughout the respiratory and gastrointestinal tract although they can arise anywherein the body. Common sites include the adrenal medulla, pancreas, pituitary,thyroid and parathyroid glands. NETs are generally small, tend to progress slowly(but inexorably) and can be difficult to localize with routine imaging. Identificationand staging of NETs with conventional morphological imaging methods such assonography, computerized tomography and magnetic resonance imaging can beMolecular ImagingACB D E F G HS455

Scientific and Educational Exhibitsdifficult and sometimes unreliable. Many NETs express specific receptors for peptidesand increased molecular uptake mechanisms. This is the foundation of theexpanding use of molecular imaging techniques which utilise the specific propertiesof NETs by using specific radiolabelled molecules/tracers.Results: Depending on the molecular properties of the tumor, radiopharmaceuticalssuch as meta-iodobenzylguanidine (MIBG), somatostatin receptor scintigraphy(SRS) and positron emission tomography combined with CT (PETCT) using [ 18 F]Fluoro-deoxy-glucose, [ 18 F] dihydroxyphenylalanine and 68 Ga-DOTATATE/DOTATOCplay an increasingly important part in the management of NETs.Conclusion: Molecular imaging aims to overcome some of the weaknesses ofroutine radiological imaging with the use of radiolabelled tracers and hybrid imagingwith increased accuracy of localization, staging and characterization of NETs.C-569PET/CT: Artifacts and pitfalls in oncologic diagnosisE. Fdez. Delgado, R. Sáiz Martínez, A. Olavarría Delgado, L. Gorospe Sarasúa,V. García Blázquez, V. Segur Nieto; Madrid/ES (stefania.fdez@hotmail.com)Learning Objectives: The aim of this poster is to review and illustrate some of themost frequently encountered artifacts and pitfalls in PET/CT imaging since theirdetection and accurate interpretation is essential for the optimal management ofpatients with cancer.Background: Accurate diagnosis and precise staging (or restaging) of cancerpatients is essential in the management of oncologic patients. The use of combinedequipments allows for an accurate fusion and correlation of anatomic and metabolicactivity images. In order to make the most of the PET/CT study, a thoroughunderstanding of the physiopathology of cancer, physiological distribution of F-18fluorodeoxyglucose (FDG), recognition of frequently encountered physiologic variationsin FDG distribution and possible causes of non-malignant non-physiologicFDG uptake is required. In addition, there may be specific artifacts that could lead toimportant therapeutic consequences. These artifacts occur because the combinedPET/CT units use the CT information to correct the attenuation of the PET emissiondata, and for reconstruction of the PET images.Imaging Findings: We present images that illustrate the most frequent pitfalls inPET/CT and that are explained by variable physiologic uptake, benign pathologicFDG uptake, malignant tumoral lesions with low FDG uptake, and technical artifacts(breathing artifacts, attenuation correction artefacts).Conclusion: A thorough understanding of the cancer physiopathology and of PET/CT technique is necessary for the correct reading and reporting of the PET/CTscans in order to avoid interpretation errors.C-571Patterns of FDG uptake seen in the brain PET/CT scan for differentdementiasA. Nasoodi, S.J. Hughes; Belfast/UK (simon.hughes@belfasttrust.hscni.net)Learning Objectives: To understand the difference in performing a combinedpositron emission tomography and computed tomography (PETCT) scan for dementiaand oncology. To understand the patterns seen in the normal aging brain.To understand the patterns seen in the common and uncommon dementias.Background: PETCT with [F18] 2-fluoro-2-deoxy-D-glucose (FDG) is well establishedfor routine oncological investigations but not for the assessment of earlydementia. FDG PET is better than perfusion scintigraphy for the assessment ofearly dementia. The patterns of disease seen in early dementia assessment in FDGPETCT are sometimes different from those seen in perfusion studies.Imaging Findings: We will show the indicators of a high quality FDG PETCTbrain scan. We will show normal brain patterns and patterns seen in the normalaging brain. We will show the patterns of disease seen in Alzheimer’s disease,frontotemporal dementia, Lewy body dementia, vascular dementia, mixed dementiaand Creutzfelt-Jacob disease. We will discuss the possible benefit of the combinedfindings of the FDG distribution and the unenhanced CT which can be obtainedfrom the PETCT scan. We will discuss the accuracy and reliability of this scanningtechnique in these different diseases. We will discuss the problems with using thistechnique in mild cognitive impairment (MCI) as opposed to early dementia.Conclusion: The delegate should feel more confident in recognising the patternsof disease seen in dementia scanned with FDG PETCT and realise the advantagesand shortcomings of this exciting technique.C-570Impact of differently functionalized gold nanoparticles on endothelial cellsin cultureI. Müller 1 , C. Rosman 2 , C. Sönnichsen 2 , W.A. Kaiser 1 , I. Hilger 1 ; 1 Jena/DE, 2 Mainz/DEPurpose: The interest in applications of nanoparticles for diagnostic and therapeuticpurposes is increasingly growing. For example, functionalized gold nanoparticles(GNP) have been proposed as optical/thermal probes for cancer detection or ascontrast agents for magnetic resonance imaging. Considering that nanoparticlesare mostly applied intravasally, we investigated the impact of differently functionalizedGNP on endothelial cells by determining the IC50 (inhibitory concentration)values.Methods and Materials: Murine endothelial cells (SVEC4-10) were incubatedwith spherical gold nanoparticles (Ø 40 nm, 0.06 mg/mL gold) functionalizedwith polyethylenglycol (SH-PEG-NH2; SH-PEG-COOH; SH-PEG-OCH3) or cetyltrimetylammonium bromide (CTAB, a cationic surfactant) at concentrations of0.003 to 30 µg/mL or to 240 µg/mL, respectively. Cell viability was measured after24, 48 and 72 h of GNP incubation using a colorimetric cytotoxicity assay formitochondrial activity.Results: CTAB-modified GNP showed an IC50 value in a concentration range of0.03 to 0.3 µg/mL gold (24-72 h of incubation). In contrast to this, PEG-functionalizedGNP was comparatively less cytotoxic. The IC50 value of SH-PEG-NH2 (cationic)and SH-PEG-COOH (anionic) nanoparticles were higher than 0.003 to 30 µg/mLgold, the SH-PEG-OCH3 (neutral) derivatization was non-toxic up to 240 µg/mLgold (24-72 h of incubation).Conclusion: Cytotoxicity assays revealed the impact of surface functionalization ofGNP on endothelial cells. The nanoparticle modification with the surfactant CTABseems to be cytotoxic. This effect can be prevented by the use of PEG independentlyfrom the respective functional groups. Our results basically demonstrate the potentialof intravasal applications of functionalized GNPs in the long term.CS456 A B D E F FG H

Scientific and Educational ExhibitsMusculoskeletalBoneC-574Interventional radiology in the treatment of the osteoid osteoma (OO)J. Alvarez-Tutor 1 , E. Alvarez-Tutor 1 , J. Sauret, M.D. 2 ; 1 Pamplona/ES, 2 Buffalo, NY/USC-572How not to miss a fracture: Assessing the impact of focused radiologicalteachingD.Y.F. Chung, R.R. Misra; High Wycombe/UK (daniel.chung@doctors.org.uk)Purpose: To evaluate whether formal teaching of radiographic ‘rules’ improvesthe diagnostic accuracy of trauma radiographs reported by emergency departmentofficers.Methods and Materials: Nine emergency department officers, of varied experience,reported thirty radiographs of the upper limb, in three separate reportingtests. It was clarified that the assessment included both normal and abnormalcases. They were asked to comment on the presence of an abnormality and itsnature. Sensitivity, specificity and overall accuracy were assessed. Once phase 1was completed, formal teaching of radiographic ‘rules’ was given under consultantradiologist guidance. A new reporting test was conducted as previously, immediatelypost teaching. After 2 weeks, a final reporting test was conducted. All radiographsused were independently reported by two consultant radiologists. Paired samplet-test was used to compare data to assess for statistical significance.Results: Statistically significant improvement (p=0.0055) in the mean value sensitivitieswas seen between phase 2 (81.0012.91) and phase 1 (64.3317.37).Likewise, a significant improvement (p=0.0022) was also seen in mean valuesensitivities between phase 3 (75.7814.06) and phase 1. No significant differencein sensitivity was identified (p=0.3043) between phases 2 and 3, indicating thatthe 'rules' were being appropriately maintained. Overall accuracy also improvedthroughout the study.Conclusion: Formal radiological guidance has demonstrated significant improvementin the identification of abnormal radiographs despite limited radiologicaltraining. This study supports education in radiograph interpretation for emergencyofficers prior to clinical practice, which will have a positive impact on patient managementin a busy accident and emergency department.C-573Semi-automating bone segmentation from MRI wrist images: Applicationin clinical trials in rheumatoid arthritis (RA)A. Rastogi, K. Leung, C. Foley, L.V. Krasnosselskaia, E.J. Hughes, N. Saeed,J.S. Angwin, M.H. Binks, K. McLeish, D. Hill, J.V. Hajnal, P.C. Taylor; London/UK(a.rastogi@ic.ac.uk)Purpose: We present a semi-automated method of measuring bone volume andcompare it with manual delineation on a cohort of normal and RA subjects in alongitudinal trial.Methods and Materials: 2 patients and 2 healthy volunteers (n=4) enrolled in alongitudinal RA MRI study were scanned on a Philips Achieva 3 T MR scanner witha dedicated wrist coil. T1w FFE water select images (TE/TR/FA: 2.3 ms/11 ms/20º,0.5 mm 3 isotropic resolution) were used for the analysis. The hamate bone wassegmented by two methods: manual and semi-automatic. The former method wasperformed using a tablet laptop and interactive viewing tool. The latter used regiongrowing based on voxel intensity thresholding technique (s/w from: http://www.doc.ic.ac.uk/~dr/software/index.html). The performance of two independent observers(O1 and O2) was compared using difference in bone volumes (VD) (%) (meanSD)and similarity index (SI) (meanSD) (2x intersection/union of regions).Results: The total time taken for manually segmenting hamate bones (n=4) weresimilar between observers (263 vs 288 minutes for approx. 384 total slices); correspondingtimes for semi-automated method were 8 and 10 minutes. SI and VDfor manual inter-rater technique were 0.950.01 and 8.071.71, and for manualintra-rater O1 was 0.970.01 and 2.081.97, respectively. SI and VD comparisonsbetween O1 manual vs semi-automatic were 0.930.02 and 8.17.9; for O20.930.02 and 10.65.7, respectively.Conclusion: The semi-automated method is less labor intensive and performs wellin extracting bone volumes when evaluated against the manual technique, the latterhaving good intra and inter-observer reproducibility but being time consuming.Purpose: To validate the development of CT-guided percutaneous procedures,such as percutaneous resection with trephine (PR), and the radiofrequency ablation(RF). To remove the core of the lesion and therefore relieve the symptoms ina considerably less invasive way.Methods and Materials: We treated 65 lesions in 60 patients with a presumptivediagnosis of osteoid osteoma. We performed 49 PRs and 16 RFs. Of the 49 PRs, 5required curettage. One required an ethanol injection. The procedures were guidedby CT imaging under general or spinal anesthesia with 24 hour hospitalization.Tumor samples were taken for anatomical pathology analysis (AP).Results: All lesions were accessed successfully. In 5 of them it was necessaryto broaden the resection due to a possible insufficient margin. In 38 of the 65 lesions(58.5%), AP confirmed the OO diagnosis; in 6/65 (9.2%) of them, AP foundother specific lesions, such as enostoma (n=2), bone cyst (n=1), inclusion cyst(n=1), chondroma (n=1), and chronic osteitis (n=1); and in the rest of the casesthe findings were unspecified. All patients (60/60) showed no pain within 24-48hours of the procedure, and 5/60 (8.3%) received further treatment due to recurringsymptoms.Conclusion: The percutaneous procedure has shown to be an effective techniquefor the treatment of OO. Compared to surgical excision, the percutaneoustechnique is less invasive, requires less anesthesia and hospitalization time, andallows an earlier return to active life. PR is less expensive than RF, but it requiresa wider bone incision.No Material Submitted to EPOSC-575Magnetic resonance imaging in bone abnormalities of the forefoot:A pictorial reviewM. Vilagran, P. Melloni, A. Sanchez-Montañez, L. Riera, A. Marín, M. Veintemillas,R. Valls; Sabadell/ES (mvilagran@tauli.cat)Learning Objectives: To provide a comprehensive overview of normal andpathologic findings in the bones of the forefoot and discuss the differential diagnosisof forefoot abnormalities. To describe and illustrate the bone abnormalitiesof the forefoot: osteochondral lesions, necrosis, bruises, occult or stress fractures,necrosis, diabetic osteitis, tumours, etc.Background: Over a five-year period, 848 feet in 796 patients were examined using1.0T MRI at our centre. All patients had previously undergone X-ray and some USand/or CT as well. We used T1-weighted density and T2-weighted spin-echo or fastspin-echo sequences in the sagittal and coronal planes, together with gradient-echoand occasionally spin-echo T1-weighted sequences in the axial plane. STIR or fatsuppressedT1-weighted sequences were also used in some cases. Intravenousgadolinium contrast was administered when necessary.Imaging Findings: We present illustrative cases of bone abnormalities, such asosteochondral lesions, bruises, fractures (occult or not), stress fractures, necrosis,sesamoiditis, osteomyelitis, diabetic osteitis, erosive arthritis, intraosseous tumour(cyst, enchondroma) and others. When useful, we also show with plain-film and/orCT images to help to better appreciate the MR findings.Conclusion: Plain films are essential for the evaluation of osseous abnormalities.They should be the initial imaging study performed and may be helpful in excludingother etiologies of forefoot pain. MRI is a powerful noninvasive method for detectingand diagnosing many causes of abnormalities in the forefoot.C-576Don’t put your foot in it: Pitfalls and pearls in the diagnosis of mid-footfractures and dislocationsP.A. Tyler, C. Thorning, W.M.W. Gedroyc, E.A. Dick, C. Burnett; London/UKLearning Objectives: To allow viewers to identify and categorise this unusual andfrequently missed group of injuries of the foot using anatomical illustrations andmultimodality imaging of a range of examples.Background: Foot and ankle injuries account for many accident and emergencyradiographs performed in the UK. With several common patterns of injury accountingfor the majority of radiographic abnormalities, it is important to maintainvigilance for the more subtle and unusual injuries. Failure to recognise and treatthese injuries can result in the development of serious complications, includingcompartment syndrome, ischaemia, neurological compromise and later Charcot’sjoints and osteoarthritis.MusculoskeletalACB D E F G HS457

Scientific and Educational ExhibitsImaging Findings: We illustrate the relevant anatomy and review a range offractures and dislocations of the mid-foot, using plain radiographs, computedtomography and magnetic resonance imaging. Guidelines for reporting to reduceerrors are described and illustrated, with recommendations about how to minimisecommon errors and classify these injuries into their various categories.Conclusion: This exhibit will allow the viewer to recognise and classify an importantbut frequently missed group of traumatic injuries to the foot.C-577Dual X-ray absorptiometry (DXA): A comprehensive reviewR.M. Lorente-Ramos, Y. del Valle-Sanz, F. Azpeitia-Armán, J. Acosta-Batlle;Madrid/ESLearning Objectives: To review DXA procedure in terms of proper positioning andanalysis in order to achieve correct interpretation. To describe potential artifacts anddisorders that can affect bone mineral density (BMD) measurements.Background: DXA is the technique of choice in the assessment of bone mineraldensity (BMD). Multiple conditions may affect BMD measurements, being the mostimportant inappropriate patient positioning. Artifacts that should be excluded fromthe analysis, and disorders previously diagnosed or that require further exams,may also be identified. Excluding artifacts from the ROI in densitometry analysisis essential for adequate assessment.Imaging Findings: We review appropriate positioning for DXA scans and emphasizepotential mistakes due to incorrect positioning. We also present artifactssuch as dense objects (catheters, piercing), surgical material (spine fixations,meshes), contrast media, calcification (hydatid cyst, lymph nodes, dermatomyositis).Multiple disorders may also appear: osteoarthosis, osteopetrosis, fractures, lyticor sclerotic bone lesions (metastasis, lymphoma, bone island, Paget´s disease,hemangioma).Conclusion: The major teaching point of the exhibit is to be familiar with DXAanalysis ad interpretation. The radiologist should be able to recognize and avoidpitfalls due to inappropriate positioning, artifacts or disorders and to be aware ofpossible lesions sometimes previously undiagnosed.C-578Fluid-fluid levels in bone tumors: A pictorial reviewL. Figueroa Nasra, C. Martín Hervás, M. Tapia-Viñé, D. Bernabeu Taboada,F. López Barea, V. Pérez Dueñas; Madrid/ES (lourdesfi@hotmail.com)Learning Objectives: To describe the features fluid-fluid levels (FFL) on bonetumors with various imaging modalities, highlighting the value of this sign. To reviewthe bone tumors that may present FFL, emphasizing their most important imagingfindings, differential diagnoses, and pathologic correlation.Background: FFL are not a frequent finding in bone tumors and are an importantsign that can be useful in the differential diagnosis. They have been usuallyreported as being strongly suggestive of aneurysmal bone cysts, but have beenalso seen in other entities. These can be studied with CT, but MR is the mostuseful technique.Imaging Findings: We reviewed our experience with bone tumors that showedFFL on CT or MR. They can be present in several tumors: aneurysmal bone cysts,telangiectatic osteosarcoma, chondroblastoma, osteoblastoma, brown tumor, giantcell tumor, condromixoid fibroma, fibrous dysplasia, simple bone cyst, metastases,and intraosseous lipoma. Typical signs and morphological features of thesetumours will be reviewed. MR plays the main role detecting FFL and their features,but CT can also contribute with valuable information. FFL indicates extracellularmethemoglobin (relatively recent hemorrhage) and not indicate aggressiveness.Pathologic correlation, including results of the dissection of gross specimens andexamination of the fluid within cavities, was available in all patients.Conclusion: FFL is a non-specific finding but its presence can significantly aid informulating a limited differential diagnoses, in combination with clinical and otherimaging findings. They are related to prior hemorrhage, and cannot be consideredindicative of malignancy.C-579Diabetic foot - comparison of MR and SPECT/CT with 99mTc-HMPAOlabeled leucocytes in osteomyelitis: Preliminary studyE. Vano-Galvan, E. Capilla, J. Cardona, M. Moreno Casado, M. Vega Gonzalez;Madrid/ESPurpose: To check the efficacy of MR and SPECT/CT to diagnose and stageosteomyelitis in diabetic foot. To graphically show semiologic criteria in MR andSPECT/CT that proved to be more specific for osteomyelitis in diabetic foot.Methods and Materials: In 14 patients with diabetic foot and suspicion of osteomyelitisan MR at least with Fat Sat CE T1WI sequence was performed. In the following10 days a SPECT/CT with 99mTc-HMPAO labeled leucocytes. A comparison andqualitative analysis of both tests were made in each patient. Gold standard wasclinical follow-up of 1-10 months.Results: In all cases uptake regions in SPECT/CT correlated with soft tissue abscesses,edema, cortical destruction and enhancement in MR. On the other hand,the patients who showed in MR edema and enhancement not always correlatedwith positive SPECT/CT, probably caused by edema of the neuropathic arthropathy.The most specific criteria that we found in MR for osteomyelitis were fistulae andabscesses plus bone abnormalities at pressure points. Clinical follow-up demonstratedgreater efficacy of SPECT/CT in the staging of osteomyelitis.Conclusion: Both techniques are supposed to show similar efficacy evaluatingosteomyelitis in diabetic foot, but, in our preliminary study, gadolinium enhancementwas not always specific for osteomyelitis, and so other semiologic criteriamust be considered. SPECT/CT with 99mTc-HMPAO labeled leucocytes may beuseful in evaluating the extension of osteomyelitis in diabetic foot, thus improvingtheir therapeutic management.C-580Magnetic resonance imaging of abnormalities of the nonosseousstructures of the forefoot: A pictorial reviewL. Riera, P. Melloni, M. Veintemillas, A. Marin, A. Sanchez-Montañez, M. Vilagran;Sabadell/ES (luisrierasoler@gmail.com)Learning Objectives: To catalogue the wide spectrum of forefoot injuries depictedby MRI by means of a pictorial review of the findings in abnormalities of the tendons,ligaments, nerves, and soft tissues and to discuss the differential diagnoses.Background: Over a five-year period, we examined 848 feet in 796 patients using1.0 T MRI. All patients had previously undergone X-ray and some US and/or CT aswell. We used T1-weighted density and T2-weighted spin-echo or fast spin-echosequences in the sagittal and coronal planes, together with gradient-echo andoccasionally spin-echo T1-weighted sequences in the axial plane. STIR or fatsuppressedT1-weighted sequences were also used in some cases. Intravenousgadolinium contrast was administered when necessary.Imaging Findings: Abnormalities were classified into: musculotendinous abnormalities,such as tenosynovitis; nerve abnormalities, such as Morton’s neuroma,schwannoma; synovial abnormalities, such as arthritis; soft-tissue abnormalities,such as abscesses, bursitis, vascular tumours (haemangioma, arteriovenousmalformation), fibroblastic tumours (Ledderhose), fibrohistiocytic tumours (giantcelltumour, proliferative fascitis), soft-tissue mass (sarcoma), adipocytic tumours(lipoma), pericytic tumours (glomus tumour), chondro-osseous tumours (chondroidmetaplasia), tumours of uncertain differentiation (angiomyxolipoma), etc.Conclusion: MRI can provide high-quality multiplanar images useful in the evaluationof forefoot pathology. MRI has proven especially useful in detecting the numeroussoft-tissue and joint processes occurring in the forefoot that are not depictedor not as well characterized on other modalities. MRI often enables a specificdiagnosis based on the location, signal intensity characteristics, and morphologicfeatures of the abnormality. Consequently, MR imaging is increasingly being usedto evaluate patients with forefoot complaints.C-581Steroid-induced musculoskeletal changesC. Paulino, L. Rodrigues, F. Cavalheiro, A. Canelas, M. Goncalo, M. Ferreira,F. Caseiro-Alves; Coimbra/PT (claudia_paulino@hotmail.com)Learning Objectives: To provide a pictorial review of the musculoskeletal changesinduced by corticosteroids, identifying their characteristic features at multimodalityimaging. To discuss their pathophysiology and the factors that increase their riskand review therapeutic options for their prevention and treatment, with special attentionto osteoporosis since it is the most common change and has an importantmorbidity.Background: Corticosteroids use is widespread in medicine. They are used totreat a wide variety of autoimmune and inflammatory diseases. While they are oftenlife-saving, side-effects are well known. The most common side-effect of corticosteroidsis osteoporosis, which can be avoided or minimized by being aware of itspathophysiology and predisposing factors. Other side-effects are unavoidable buttheir resolution may be aided by early diagnosis and appropriate treatment.Imaging Findings: Patients on long-term steroid treatment show varied musculoskeletalchanges with osteoporosis and its insufficiency fractures being the mostcommon. Other changes include avascular necrosis, acute and chronic myopathy,excessive callus formation and musculoskeletal infections (such as septic arthritis,osteomyelitis and pyomyositis).CS458 A B D E F FG H

Scientific and Educational ExhibitsConclusion: Radiologists should be familiar with the various musculoskeletalchanges induced by corticosteroids. Awareness and early identification of thoseside-effects allow appropriate management. Regarding steroid-induced osteoporosis,its recognition and identification of patients with additional risk factors for boneloss are extremely important, given the availability of effective therapeutic optionsfor its treatment and prevention.C-582Imaging findings in musculoskeletal paracoccidioidomycosisL.M. Monsignore, S.R. Teixeira, M.N. Simao, R. Martinez, J. Elias Jr.,M.H. Nogueira-Barbosa; Ribeirao Preto/BR (lucasmonsignore@gmail.com)Purpose: To retrospectively review imaging findings of musculoskeletal (MSK)paracoccidioidomycosis (PCM).Methods and Materials: After institutional board approval, medical records ofpatients with MSK PCM were reviewed (1980 to 2008). Cases were included whenpositive culture or typical fungal cells were obtained from MSK tissues or whenimaging evidence of MSK infection was present and the pathogen isolated fromother tissues. Radiographs were available in 17/18 patients, ultrasound in 3/18,computed tomography in 5/18, and magnetic resonance (MRI) in 4/18.Results: The mean age was 15 8.7 years (ranging from 4 to 33) and 55.6% weremale. In 6/18 patients (33.3%), MSK was the exclusive system involved. Osseouslesions were the most common in 17/18 (94.4%). Fifty-four osseous lesions wereidentified. The usual manifestation was a well-defined lytic lesion (64.8%), withoutmarginal sclerosis (81.5%) and without periosteal reaction (88.9%). Articular involvementwas present in 3/18 (16.7%), with one case of primary arthritis. Soft tissueinvolvement was identified in 5/18 (27.8%), and exclusive muscular involvementin 1/18. Ultrasound showed fluid collections with debris in 3/3 cases, one in softtissue and two adjacent to cortical bone destruction. All cases evaluated by MRIshowed soft tissue involvement with high signal intensity in T1-weighted imagesand peripheral contrast enhancement.Conclusion: MSK PCM is rare, but could be the first and/or the only presentationof the disease. MSK lesions described here should raise the possibility of PCMin the differential diagnosis, mainly if the patient had visited or lived previously inan endemic region.C-583Diagnostic dilemma in sicklers with acute bone crisis: Role ofsubperiostael fluid collection on MRI in resolving this issueS. Ahmad, Z.A. Khan; Al-Ahsa/SA (sarfraz1212@yahoo.com)Purpose: To establish MRI criteria to diagnose early osteomyelitis in sickle celldisease patients with acute bone crisis. To differentiate it from normally occurringischemic changes in these patientsMethods and Materials: MRI study with and without Gadolinium contrast wascarried out in 56 sickle cell disease patients with acute bone crisis and clinicalsuspicion of osteomyelitis. The diagnostic criteria included: 1) Marrow edema, 2)Periosteal thickening, 3) Subperiosteal or soft tissue fluid collection and 4) Softtissue edema. Our emphasis was mainly on subperiosteal fluid collection as this isthe solely finding which is not seen in ischemic crisis. Diagnosis was confirmed onpathological grounds in most of the patients and on clinical basis in few cases wherefluid could not be aspirated and antibiotic treatment resolved the condition.Results: Depending on these criteria, we diagnosed early osteomyelitis in 32cases out of 56 patients who were clinically confirmed and treated accordinglyand improved. Sixteen cases were diagnosed as ischemic changes/avascularnecrosis. Two cases showed soft tissue changes. Six cases were equivocal forinfection/ischemia.Conclusion: Early osteomyelitis is a challenging diagnosis clinically and radiologicallyin patients with sickle cell disease, which can be diagnosed on MRI if specialemphasis is put on subperiosteal fluid collection.C-584Evaluation of proton MR diffusion with selection of different areas forcharacterization of musculoskeletal tumoursB. Osemont, D. Roch, R. Detreille, M. Louis, S. Lecocq, J. Wassel, T. Batch,A. Blum; Nancy/FR (ben_osemont@yahoo.fr)Purpose: Evaluate the interest of MR diffusion by using ADC values in selectedareas for differentiating benign and malignant musculoskeletal tumours.Methods and Materials: Magnetic resonance imaging (MRI) at 1.5 and 3 T includingecho-planar DWI sequences was performed prospectively in 50 patients withmusculoskeletal tumours; 24 were malignant and 26 were benign. The b valueswere 0 and 600 s/mm 2 . For each tumour, the apparent diffusion constant (ADC)was calculated in the different area of the lesions, highlighted by the colour mappingof the lesion reflecting the different ADC values as well as the T2 and T1 afterGadolinium injection pattern.Results: The different area of the tumours exhibit significantly different ADC values.Although, there is an overlap of some values, mostly due to giant cell tumours, theminimal ADC value is the most important one to differentiate benign from malignanttumours. The mean ADC values of benign lesion (2.12 x 10 -3 mm 2 /s) and ofmalignant lesions (1.35 x 10 -3 mm 2 /s) are significantly different. The maximal ADCvalue is dependant on the myxoid nature of the tumour or of necrosis or haemorrhagicchanges within the lesion.Conclusion: The ADC value could be used to differentiate benign from malignanttumours but a thorough selection of the different tumour areas is necessary.C-585An MR study of osteoporotic compression fractures: Correlation betweenproton MR spectroscopy, in-phase/opposed-phase imaging and perfusionindices at 3 TeslaA. Regis Arnaud, D. Ben Salem, N. Trodi, F. Ricolfi, D. Krausé, P.M. Walker;Dijon/FRPurpose: To improve MR performance in compression fractures, various techniqueshave been proposed. In our study, proton magnetic resonance spectroscopicimaging ( 1 H MRSI), quantified in-phase/opposed-phase imaging (In-Out MRI)and dynamic contrast-enhanced (DCE) MRI were performed to evaluate vertebralmarrow fat in acute and chronic lesions.Methods and Materials: Fourteen patients were evaluated for vertebral collapsedue to osteoporosis. MR imaging and spectroscopy were performed at 3Tesla. Marrow fat content (% fat fraction: FF) estimated through spectroscopy wascompared with fat quantification using In-Out imaging. Supplementary analyseson DCE-MR images yielded maximum percentage of enhancement and enhancementslope. Data were acquired in lumbar marrow; a multivoxel spectroscopy wasacquired on and around the fracture. We compared acute compression (15), chroniccompression (9) and non-compressed vertebrae (47). Pearson’s correlation andnon-parametric statistics were used.Results: In order to validate the In-Out imaging, we used a dual flip angle algorithm(20°, 70°) for the identification of the dominant constituent (water or fat). Weillustrated an age-dependent correlation for estimated FF. We found statisticallysignificant differences between the FF of normal vertebrae and chronic compressedfractures with respect to acute lesions (p 0.002). For DCE-MRI, we found significantdifferences between non-compressed, acute and chronic compression fractures.Conclusion: Fat quantification and perfusion analysis of vertebral bone marrowcan represent a new approach compression fracture studies and may help us tostudy potential risks for compression fracture.C-586Stature estimation on the basis of sacrum beam distance in AnatolianCaucasians: The use of volumetric MDCT scanning in forensicanthropometryH.M. Karakas 1 , O. Celbis 1 , A. Harma 1 , B. Alicioglu 2 ; 1 Malatya/TR, 2 Edirne/TR(banualicioglu@trakya.edu.tr)Purpose: The accurate estimation of stature is a cardinal milestone to establishan individual’s identity in medicolegal investigations involving skeletal remains.Intact long bones have been used in the derivation of regression equations forthe estimation of stature in different population groups. The present work wasperformed to investigate the possibility of estimation of stature from sacrum beamdistance (SBD).Methods and Materials: SBD was visualized and measured on 2D maximum intensityprojection computed tomographic images of pelvic bone. Data was obtainedusing 64-channel multi-detector computed tomography (MDCT) with an isotrophicresolution of 500 micron. Sixty-six males (41.56 14.86 years of age) and 43females (41.14 14.15 years of age) were investigated. Sacrum was visualizedon sagittal plane, and was measured electronically.Results: SBD is measured 89-138 mm (108.811.2) in Anatolian Caucasians.The parameter is not significantly related to age (p=.175). A significant correlationis found between the stature and SBD (r=0.481, p 0.0001). Regression formula[SBD x 0.374] + 126.741 was developed to estimate stature.Conclusion: Sacrum is usually a well protected compact bone. SBD is a stableparameter, unrelated to age. Incomplete skeletons even if sex is unknown, SBD ishelpful to estimate sex. This study is the unique use of SBD parameter to determinestature also demonstrates the use of MDCT in forensic medicine to collect data ondifferent populations to determine geographical, racial and diachronic variances aswell as revealing contemporary anthropometric data of the population.MusculoskeletalACB D E F G HS459

Scientific and Educational ExhibitsC-587Who is who in bone tumoursE. Pluot, S.L.J. James, A.M. Davies; Birmingham/UK (e.pluot@voila.fr)Learning Objectives: To provide the reader with a specific insight into medicalhistory through potted biographies of some of the physicians whose names havebecome eponymous or synonymous with bone tumours and tumour-like conditionsof bone.Background: Over the past 300 years, the medical fraternity has enthusiasticallynamed diseases, symptoms and tests after their supposed discoverers. A numberof physicians from many different areas of expertise have contributed to our understandingof tumours and tumour-like lesions of bone.Imaging Findings: Listed in alphabetical order are illustrated biographies of thosewhose names are used to define or characterise numerous signs, syndromes ordiseases associated with tumours and tumour-like conditions of bone.Conclusion: It is still much debated whether these eponyms provide a less thantruthful account of how diseases were discovered and should therefore be abandonedin the daily practice, or are a rather practical form of medical shorthand aswell as a tribute to our glorious forefathers. However, the spectrum of all thesecolourful characters, from different medical and cultural backgrounds, may mirrorthe complexity of bone tumours and tumour-like conditions in today’s medicine.C-588Renal osteodystrophy: Radiological manifestations in adultsO. Abeyakoon, R. Senasi, M. Kaduthodil, S. Morcos; Sheffield/UKLearning Objectives: To illustrate the spectrum of common radiological manifestationsof what is collectively often known as renal osteodystrophy (ROD), whichdevelops in patients with end stage renal disease (ESRD).Background: Bony changes in patients with ESRD result from a combinationof different pathological processes that include secondary hyperparathyroidism,osteomalacia, osteosclerosis, arthropathy, amyloidosis and avascular osteonecrosis.Imaging Findings: Secondary hyperparathyroidism (subperiosteal/subchondral/subligamentous bone resorption, generalised loss of bone density, brown tumours,periosteal reaction, vascular and soft tissue calcification). Osteoslerosis (e.g. ruggerjersey spine). Osteomalacia (Looser’s zones, bone deformity e.g., kyphosis,triradiate pelvis, bell shaped thorax, bowing of the legs, osteopenia). Amyloidosis(loss of bone density, lytic lesions, soft tissue masses and extensive joint destruction).Crystal deposition (chondrocalcinosis). Aseptic spondylitis (irregular discnarrowing, destruction of adjacent bone). Avascular osteonecrosis, which could besecondary to corticosteroid therapy, micro emboli and vascultitis (patchy sclerosisand radiolucent areas, collapse of the articular surface, dense irregular calcificareas in the shafts of long bones).Conclusion: Knowledge of the radiological appearances of ROD is important forthe long term management of patients with ESRD.C-589Conventional osteosarcoma: The most common primary malignant bonetumor in adolescents - imaging features on radiography, CT and MRIJ. Campos, A. Preto, D. Rocha, M. Pimenta, P. Sousa, A. Vieira; V. Castelo/PT(jtraila@hotmail.com)Learning Objectives: Discuss the imaging findings of conventional osteosarcomain radiography, CT and with a special focus in MRI. Comment on the differentialdiagnostics.Background: Conventional osteosarcoma comprises 75% of all osteosarcomas,being more common in the adolescent age group (10-25 years). It is commonly ofmetaphyseal origin, frequently crossing the physeal plate. It is usually located aboutthe knee, but can occur in other long bones as proximal humerus. It is a highly aggressivelesion with permeative change, cortical breakthrough and soft-tissue mass.Periosteal reaction is usually present (sunburst or Codman´s triangle pattern).Imaging Findings: Osteoid matrix is produced in 90% of the osteosarcomas,which is visible on radiography or CT images. The amount of matrix changesthe radiographic appearance from densely blastic to nearly completely lytic. Thefindings of conventional osteossarcoma also vary according to the mineralizationof the matrix. In a highly dense matrix, the signal will be low in every sequence.If less dense, there will be low heterogeneous signal on T1 and heterogeneoushigh signal on T2. Skip lesions will be present in 1-10% of cases. Metastases arecommon, with hematogenous spread to lungs or bone and lymphatic spread locally.The differential diagnosis includes Ewing´s sarcoma, cortical desmoid andmyositis ossificans.Conclusion: Radiology plays an important role in diagnosing and staging thedisease. MRI is essential to evaluate the local extent, plan the biopsy and thedefinitive therapy.C-590Cierny-Mader classification of chronic osteomyelitis: Preoperativeevaluation with cross-sectional imagingM. Wisniewska, I. Babiak, P.D. Palczewski, J. Swiatkowski, M. Golebiowski;Warsaw/PL (sounded@wp.pl)Learning Objectives: To know the anatomical part of Cierny-Mader classificationof chronic osteomyelitis. To understand the role of cross-sectional imaging in pretreatmentstaging of osteomyelitis.Background: Cierny-Mader classification is an anatomico-physiological stagingsystem of chronic osteomyelitis that defines the extent of bone infection and immunologicalstatus of the host. Widely used by orthopedic surgeons, it is seldommentioned in radiologic literature. The anatomical staging distinguishes four stagesof disease with different treatment options. Stage 1 is a contained intramedullaryprocess. Stage 2 represents superficial infection caused by penetrating soft-tissueinjury. Stage 3 corresponds to full-thickness cortical sequestration that can beremoved without comprising bone stability, while stage 4 lesions are diffuse andrequire intercalary bone resection.Imaging Findings: Plain film features of stage 1 osteomyelitis may be subtle andresemble acute osteomyelitis with soft-tissue swelling, periosteal elevation, and latersclerosis. Stage 2 manifests with thickening of outer cortex and sclerosis. Stages 3and 4 osteomyelitis are difficult to assess with plain film radiography due to abundantsclerosis. CT allows precise visualization of bone destruction and sequestra, whichhelps in differentiating stages 3 and 4 disease. MRI is indispensable in definingthe extent of bone marrow involvement and soft tissue extension. PET/CT, whichis increasing in availability, allows the precise gradation of inflammatory changesintensity, both in axial and longitudinal planes.Conclusion: Staging of osteomyelitis according to Cierny-Mader classificationcan be performed with a combined use of CT and MRI, improving communicationbetween the radiologist and clinician and facilitating treatment planning.C-591Interpretation of radiographs in emergency department: Impact of misseddiagnosisV.B. Pakala, A. Kirwadi, D. Kumar, P. Evans; Swansea/UK(vijayabhaskarp@yahoo.com)Purpose: To assess the impact of errors by emergency doctors in interpretingemergency radiographs on patient management.Methods and Materials: A retrospective study conducted over 13 month period ina teaching hospital emergency unit. Clinical notes of the patients recalled to casualtybased only on radiology reports were reviewed. Non radiological and plannedelective recalls were excluded. All the X-rays were independently reassessed bya musculoskeletal radiologist.Results: 100 patients were included in the study. After radiologist review, a totalof 88 cases were considered as true or strongly suspicious abnormalities in whichone is an incidental finding and 12 were considered false positive. Out of twelve,eight were reported by consultant, three by radiographers and one by a trainee.Among the true positive abnormalities, 58 patients were seen by junior doctors,25 by middle grade doctors, 3 by nurse practitioners and 2 by consultants. In 68patients, there was change in management (further imaging-26, specialist referral-37and follow-up only-5). All patients were managed conservatively, except twopatients who needed surgical intervention. One of them was a fracture fixation andthe other was a foreign body removal.Conclusion: Considering the huge number of patients (approximately 75,000 peryear) reviewed by emergency doctors, the errors were few. Significant change inmanagement happened only in fewer cases. Lack of adequate clinical information tothe reporting radiologist might have contributed to the false positive reports. Furthertraining for junior doctors is needed in interpreting emergency radiographs.CS460 A B D E F FG H

Scientific and Educational ExhibitsC-592Differentiation of normal and neoplastic bone tissue in dynamicgadolinium-enhanced magnetic resonance: Validation of a semi-automatedtechniqueF. D’Agostino, C. Quattrocchi, F. Occhicone, P. Dell’Aia, R. Del Vescovo,R. Grasso, B. Beomonte Zobel; Rome/IT (f.dagostino@unicampus.it)Purpose: To clinically validate accuracy of a semi-automated software tool in theanalysis of the enhancement curve in focal malignant bone lesions.Methods and Materials: 23 patients affected by cancer with malignant focal bonelesions underwent dynamic gadolinium enhanced MRI performed using the followingprotocol: T1 weighted TSE sequences (TR 600 msec, TE 8.6 msec, FOV 40 x40), before and after intravenous injection of contrast agent containing gadolinium.Images post-processing was performed using the software DyCoH. Each region ofinterest (ROI), drawn to include the area of the lesion with the highest values of theAUC (area under curve) map, was analyzed to obtain time-intensity curves and relativeperfusional parameters: time to peak (TTP), Peak Intensity (PI), slope (60’’slope)and intensity (60’’I) after contrast agent injection, and final intensity (FI).Results: Data were obtained by analysis of 86 malignant lesions and 86 apparentlynormal bone regions. PI, 60’’slope, 60’’I and FI were significantly different betweenneoplastic and apparently normal (p 0.001) samples. Sensitivity, specificity andaccuracy were, respectively, 94, 93 and 94% at a PI threshold of 100 (SNR), withpositive and negative predictive values of 93 and 94%. At a threshold value of0.85 for 60''slope, sensitivity, specificity, accuracy, positive and negative predictivevalues were both 91%.Conclusion: The semi-automated technique we present appears to be accuratefor identification of neoplastic tissue and for mapping perfusion parameters, withthe added value of a consistent measurement of perfusion parameters on colorcoded maps.C-593Radiographic findings in imaging of ochronosisG. Argento, G. Fabbri, F. Caporilli Razza, C. Porcari, F. Capparella, W. Calandro,G. Scavone, I. Pochesci; Rome/IT (gargento@sirm.org)Learning Objectives: We describe the radiographic findings in ochronotic patientswith acute arthritis.Background: Alkaptonuria is a rare disorder of phenylalanine and tyrosine metabolicpathway, inherited as an autosomic recessive trait and characterized by adefect of the homogentisic acid oxidase enzyme. As a consequence, the pool ofhomogentisic acid is increased which this results in alkaptonuria (i.e. increasedexcretion of the acid in urine) and ochronosis (i.e. the deposit of grossly bluishblackand microscopically ochre pigmented polymer of the sclera, skin connectivetissues and cartilage).Imaging Findings: Ochronosis leads to a disabling degenerative arthropathy inthe advanced stages of the disease. Knees, hips, shoulders and spine, mainly atdorsal and lumbar levels are involved. A progressive calcification of intervertebraldiscs occurs, sometimes with narrowing, resorption and fusion of adjacent vertebralbodies, vertebral osteophyte formation and intervertebral ligament calcification.Conclusion: Conventional X-ray images are still considered to be the gold standardin this rare arthropathy. Nevertheless, non-contrast CT scanning and in some caseseven contrast-enhanced MRI may introduce new evaluation elements.C-594Skeletal manifestations of sarcoidosisC.M. Arriagada 1 , S. Kattapuram 2 , G. Stasinos 3 ; 1 Vina del Mar/CL,2Boston, MA/US, 3 Athens/GR (dr.arriagada@terra.cl)Learning Objectives: The objective of this project is review and propose differentialdiagnosis of radiological lesions of sarcoidosis, affecting parts of the skeleton,excluding hands.Background: Manifestations of bone sarcoidosis were first described, affectinghands, with a classic cyst like form in the distal phalanges, this granulomatousdisease of unknown cause, usually, can spread to other skeletal zones.Imaging Findings: We review 94 reports of patients (1 st decade to 7 th decade)ruling for bone sarcoidosis. There are 11 cases of sarcoidosis affecting hands andwe found 13 cases of sarcoidosis in long bones, pelvis, skull, spine and soft tissue.The manifestations were most lytic, but there are also sclerotic lesions, found inMR, CT and radiographs.Conclusion: Sarcoidosis extra hand lesions is as common like hand lesions. Thebone lesions must be suggested in patients with clinical sarcoidosis, even withouta biopsy, clinical correlation and image follow-up is strongly recommended.MusculoskeletalJointsC-595Tears of rotator cuff: What has happened? Revisiting with pathologiccorrelationM.L.A.D. Pimenta, A. Vieira, M.A. Pereira Gutierres, J.M.C. Ferrera Torres;Porto/PT (madalenapimenta@yahoo.com)Learning Objectives: The aims of this study are to discuss the clinical and radiologicfeatures of rotator cuff tears, and to compare the imaging findings witharthroscopy findings as well as to improve the relevance of radiology reporting ofshoulder MRI in surgical decision-making.Background: Shoulder injuries are common among all ages, but tend to be morewidespread with growing age. MRI is an important tool in the diagnosis of rotatorcuff tears. Arthroscopic techniques can evaluate the entire shoulder joint and canusually fix the tear.Imaging Findings: The MR characteristics of rotator cuff tears, based on ourhospital data base, are compared with the arthroscopic features to allow a morecomprehensive approach to this entity. All patients underwent an MR investigationperformed using 3 T MR device, and had arthroscopy confirmation.Conclusion: Correlation between pathology and imaging helps in understanding theimaging presentation of rotator cuff tears. The imaging studies allow the diagnosisof the rotator cuff tear and are essential in follow-up.C-596A new dynamic technique for assessing acromio-clavicular joint instabilitywith ultrasoundP. Peetrons; Brussels/BE (ppeetrons@bigfoot.com)Learning Objectives: The objective is to show how the dynamic ultrasoundimaging of the A-C joint may reveal subtle instability in low grade (Tossy I) jointdislocation.Background: Crossarm position (i.e. the hand on the opposite shoulder) is one ofthe best tools to see A-C joint instability. In fact, this position is used by cliniciansto reveal a painful A-C joint. In the crossarm position, both acromion and clavicletend to move towards each other. This movement is normally impossible due tonormal interposition of the articular discus and the normal surrounding ligaments.In low grade dislocations (i.e. with normal coraco-clavicular ligaments but alteredacromio-clavicular ligaments), however, ultrasound reveal abnormal movementswith clavicle going onwards and outwards to the acromion, even if there is noelevation of the clavicle distal end.Imaging Findings: In the images provided (movies), the absence of movementis shown in normal findings, while in documented A-C joint Tossy I lesions, themovements between the clavicle and the acromion are easily seen.Conclusion: Dynamic examination of the A-C joint in suspected instability is a goodtool to see minor instability with ultrasound. This maneuver is often more sensiblethan the habitual stress X-rays (with weight bearing).C-597Primary synovial chondromatosis: Main imaging findings and differentialdiagnosisM.C.T. Gomes, C. Ribeiro, J. Venâncio, P. Santos, A. Ramos, M. França, P. Costa,J. Vasconcelos, M. Ribeiro; Oporto/PT (mantgomes@mail.telepac.pt)Learning Objectives: To review the main imaging findings of primary synovialchondromatosis. To describe the differences between primary and secondarysynovial chondromatosis. To illustrate the spectrum of diseases related with secondarychondromatosis.Background: Primary synovial chondromatosis is an uncommon benign neoplasticprocess with hyaline cartilage nodules forming on the subsynovial tissue of a joint,tendon sheath or bursa. These nodules may enlarge and become detached fromthe synovium producing loose bodies; when these bodies undergo secondarycalcification, the condition is called synovial osteochondromatosis.Imaging Findings: The knee is the most frequent involved joint, followed by thehip, elbow and shoulder. Imaging findings are usually pathognomonic, with conventionalradiographs and CT revealing multiple intraarticular calcifications of similarsize and shape, with “ring and arc” mineralization. MR findings are more variable,depending on the degree of mineralization of the intraarticular bodies. This imagingmodality is especially useful in the initial stages of the disease when there isno calcification of the loose bodies. Secondary synovial chondromatosis resultsfrom mechanical or inflammatory injury to the intraarticular hyaline cartilage. It isMusculoskeletalACB D E F G HS461

Scientific and Educational Exhibitsmuch more common than the primary form and is typically related to osteoarthritis,neuropathic osteoarthropathy, trauma, osteochondritis dissecans and inflammatoryarthritis or infection. Differential diagnosis with the primary form is usually possiblebased on radiological findings.Conclusion: The authors review and illustrate the main imaging findings of primarysynovial chondromatosis on different modalities. Differential diagnosis with thesecondary form of this entity will be discussed, with particular emphasis on casesrelated to osteoarthritis and neuropathic osteoarthropathy.C-598Comparative findings with MR-arthrography and multidetector CTarthrographyin cam and pincer femoroacetabluar impingement in oneshot examinationM. Dobado Bellon, X. Alomar Serrallach, S. Bordegaray, O. Ares Rodriguez,J. Clavero Torrent, A. Salvador Aznar; Barcelona/ES (dobado@gmail.com)Learning Objectives: To show the criteria and measurements that indicate the twotypes of FAI. To explain and compare the utility of MRI arthrography and particularlyCT arthrography in the diagnosis of the secundary labral abnormalities, cartilagelesions and osseus abnormalities and its location. To describe the associateddisorders, the secondary changes and other incidental lesions.Background: Femoroacetabular impingement is a more recently noticed cause ofhip pain in young patients, and early diagnosis is critical to prevent osteoarthritis.Imaging Findings: We have retrospectively characterized the FAI and its type in30 MR and CT arthrographic studies by the lateral center angle, the acetabularindex, the femoroacetabular relacion with the ilioischial line, the femoral head extrusionindex, the lateral center edge angle, the anterior and posterior acetabularwalls relation in the coronal plane and the alpha angle. We have also analyzedand correlated the secondary acetabular, osseous and cartilage changes withboth imaging methods.Conclusion: Arthrography with multidetector CT and MRI performed in a doublecontrasttechnique after single puncture and simultaneous injection of the contrastagents for both imaging methods in patients suffering from FAI seems to give moreinformation than CTA or MRA separately.C-599Bucket-handle meniscal tears revisited: Value of specific MRI signs andassociated findingsI. Tritou, S. Mavrakakis, E. Katechaki, K. Pagonidis, A. Kozana, E. Androulidakis;Iraklion/GRLearning Objectives: To systematically review the specific MR signs of buckethandlemeniscal tears, assess the correlation of these signs to the anatomicalclassification and illustrate the associated findings.Background: Bucket-handle tears are extensive vertical or oblique tears withdisplacement of the free fragment. As a result, in addition to causing pain, mechanicallocking, catching and giving away of the knee joint occur. They are clinicallysignificant, as surgery is almost always the appropriate treatment. When recognizedearly, the displaced fragments can be reduced. If ignored, however, degenerativechanges of the residual segments necessitate, often extensive, meniscectomy.We reviewed the MRI examinations of 1877 consecutive patients presented withclinical symptoms of meniscal tear performed over the last two years. Thirty-six(36) of them were found to have a displaced meniscal fragment. The MR imagingfindings were recorded and related with anatomical classification.Imaging Findings: Medial (n=25) and lateral (n=11) menisci tears were found.Five specific signs were depicted: a) the absent bow tie sign (n=36), b) fragmentin the intercondylar notch (n=18), c) the double posterior cruciate ligament sign(n=18), d) the flipped meniscus sign (n=8), and e) the double anterior horn sign(n=15). Anterior and posterior cruciate ligament tears and synovial fluid were additionalfindings.Conclusion: MRI can provide excellent anatomic demonstration of the buckethandlemeniscal tears. The use of the specific signs increases the sensitivity ofMR imaging and the effectiveness of the method in the diagnosis of displacedmeniscal tears.C-600Ultrasound of the shoulder: Normal anatomy, pathology, and pitfalls withMR and CT arthrographic and arthroscopic correlationJ.-A. Choi, J. Oh, H. Kang; Seongnam/KR (isabelle_img@yahoo.com)Learning Objectives: To demonstrate ultrasonographic findings of normal anatomy,pathologic conditions, and pitfalls of the shoulder with MR and CT arthrographicand arthroscopic correlations.Background: With the development of high resolution ultrasound, ultrasound hasbecome a very useful tool in the evaluation of rotator cuff pathologies, includingpartial and full thickness rotator cuff tears, calcific tendinitis, biceps tendon pathology,and bursitis. In this exhibit, we will demonstrate ultrasonographic images, whichwere obtained from ultrasound examinations performed between January 2004 andDecember 2007, of normal shoulder anatomy and the above-mentioned pathologicconditions of the shoulder. Correlations will be made with MR or CT arthrographicimages and arthroscopic images chosen among 446 surgically confirmed cases.Imaging Findings: Partial rotator cuff tears were diagnosed when mixed hyper- andhypoechoic focus in critical zone or when a hypoechoic lesion was seen with eitherarticular or bursal extension. Full thickness tears were diagnosed when there wasabsence, focal nonvisualization, hypoechoic or anechoic cleft, direct joint communicationthrough a tendon gap with a distended subacromial-subdeltoid bursa, or nakedtuberosity. Calcific tendinitis is most commonly seen as hyperechoic focus witha well-defined shadow (80%). Biceps tendon tear and dislocation at extraarticularportion are readily identified at ultrasound and often associated with subscapularistendon tear. These pathologies correlated well with MR or CT arthrographic imagesand arthroscopic findings in 446 surgically confirmed cases.Conclusion: Ultrasonography is a useful technique for the evaluation of rotatorcuff and the diagnosis of rotator cuff pathology.C-601Subacromial spur in patients with rotator cuff tears: Morphologicalclassification and clinical significanceJ.-A. Choi, J. Oh, H. Lee, H. Kang; Seongnam/KR (isabelle_img@yahoo.com)Purpose: To classify the morphology of subacromial spurs and to evaluate therelationship between subacromial spur morphology and rotator cuff tears.Methods and Materials: MR or CT arthrographic images of 254 patients were analyzedprospectively regarding acromial shape, thickness, and presence and morphologyof subacromial spurs among other lesions by two musculoskeletal radiologistsunder consensus. Out of these, 175 patients with surgically confirmed rotator cuff tearswere included. Acromial shape was classified into 3 types (flat, curved, or hooked)based on sagittal images. Acromial thickness was measured on sagittal images atthe thickest portion. Subacromial spurs were classified into 4 types (heel, birdbeak,traction, medial) on coronal images and 2 types (birdbeak, traction) on sagittal images.Statistical analysis was performed using student t-test, chi-square test, logisticregression analysis, and kappa reliability coefficient (SPSS v.12).Results: There were 115 flat, 41 curved, and 19 hooked types of acromion. Acromialthickness ranged from 5-15 mm with mean of 7.9 mm. There was no significantcorrelation between the acromion shape and cuff tears, whereas acromial thicknessof greater than 8.7 mm had a significant correlation with rotator cuff tears. Presenceof spur was significantly correlated with full thickness and bursal surface partialthickness tears. Heel type of spur on coronal images was significantly correlatedwith both partial and full thickness tears.Conclusion: Thick acromion (thickness greater than 8.7 mm) and heel type ofsubcromial spur had a significant correlation with bursal surface partial thicknessand full thickness rotator cuff tears regardless of the acromial shape.C-602Tear of hiatus in capsule for popliteus tendon: Relationship between lateralmeniscal tear and fluid collection along popliteus muscleY. Kobashi 1 , T. Yamaguchi 1 , T. Fukushima 1 , Y. Tazawa 1 , A. Fujikawa 1 , Y. Kitanaka 2 ,J. Fukuda 2 , S. Suzuki 2 ; 1 Kawasaki/JP, 2 Fujisawa/JP (ykobashi@marianna-u.ac.jp)Purpose: We may see fluid collection along the popliteus tendon and muscle onMR examination; however, relatively few patients have popliteus tendon tear evidenton arthroscopy. We observed fluid collection along the popliteus tendon on MRI andinvestigated if there was a tear of the hiatus in capsule of the popliteus tendon, andwe simultaneously correlated our observations with arthroscopy.Methods and Materials: Retrospectively, we reviewed MR examinations of 50 patientswho complained of knee pain from sports trauma. All patients underwent kneearthroscopy and to check for tearing of the hiatus in capsule for popiteus tendon.Results: Twenty-eight patients had lateral meniscal tear; 13 of the 28 had fluidcollection along the popliteus muscle and had tearing of the hiatus in capsule ofpopliteus tendons on arthroscopy; 1 of the 13 patients also had popliteus tendontear. Fifteen of the 28 patients had lateral meniscal tearing, which was locatedon anterior horn or body of lateral meniscus with no tear of hiatus in capsule ofpopliteus tendon on arthroscopy.Twenty-two of the 50 patients had no lateral meniscal tearing; however, they hadanother traumatic change. None of the 22 patients had fluid collection.Conclusion: Tearing of the posterior horn of the lateral meniscus sometimesincludes tearing of the hiatus in capsule of popliteus tendon; therefore, it might beproven as fluid collection in the popliteus muscle on MR examination.CS462 A B D E F FG H

Scientific and Educational ExhibitsC-603Popliteal fossa: Spectrum of diseasesM.E. Hjelt, D. Garzon, R. Lopez Quintero, E. Salomon; Buenos Aires/AR(marcoshjelt@yahoo.com.ar)Learning Objectives: To illustrate the spectrum of diseases that can affect thedifferent contents found in the popliteal fossa. We will also mention different entitiesthat can affect the anatomical boundaries of the popliteal fossa.Background: The popliteal fossa is a space with a diamond shape and is situatedat the back of the knee joint. Its boundaries are formed by muscle structures laterally(semitendinosus, semimembranosus, biceps femoris and gastrocnemius), theknee capsule and distal femur inferiorly. Its contents are adipose tissue, poplitealartery, popliteal vein, tibial and common peroneal nerves. We can also find lymphnodes and superficially the posterior cutaneous nerve of the thigh.Imaging Findings: We will divide our presentation by anatomical location, describinglesions that can affect the arteries, veins, nerves and lymph nodes. We willalso include lesions that can affect the boundaries, such as muscle, distal femuror capsule. These lesions can present as a palpable mass or pain. Some entitiesare incidental findings on routine knee examinations.Conclusion: Imaging plays an important role in the diagnosis of the lesions thatcan affect this anatomical region. MRI is the most sensitive technique providingexcellent evaluation of soft tissues and bone, providing the radiologist with sufficienttools to establish a confident diagnosis.C-604Imaging of intra-articular masses: A pictorial essayM. Franca 1 , J. Pires 1 , M. Certo 1 , G. Fernandez 2 , P. Varzim 1 , J.C. Vasconcelos 1 ;1Porto/PT, 2 Vigo/ES (mariamanuela.franca@gmail.com)Learning Objectives: To review the many findings of intra-articular masses, focusingon radiographs, computed tomography (CT) and, especially, on magneticresonance imaging (MRI), identifying those findings that may help to reach a specificdiagnosis for the underlying disease causing intra-articular masses.Background: Intra-articular masses can be associated with several diseases, suchas non-infectious synovial proliferative processes (lipoma arborescens, synovialosteochondromatosis, pigmented villonodular synovitis, rheumatoid arthritis), infectiousgranulomatous diseases (tuberculous arthritis, coccidioidomycosis arthritis),deposition diseases (gout, amyloid arthropathy), vascular malformations (synovialhemangioma, arteriovenous malformations), malignant neoplasms (synovialchondrosarcoma, synovial sarcoma, synovial metastases), or other miscellaneousprocesses (cyclops lesion).Imaging Findings: The authors review the diverse imaging findings of intra-articularmasses, especially on MRI, exemplifying with representative cases. They also pointto several imaging aspects of intra-articular masses that allow to diagnose the diseasescausing them, such as the signal intensity on specific MRI pulse sequences;the presence of fat, calcifications, hemosiderin deposits, flow voids or cystic areason the intra-articular masses; the specific localization within the joint; and the presenceof other lesions in joint spaces and articular bone surfaces.Conclusion: The differential diagnosis for intra-articular masses includes diversedisorders. Familiarity with their typical imaging findings helps in the making ofconfident and specific diagnoses of many of the diseases causing intra-articularmasses.C-605MRI findings of elbow joint injuries in young athleteT. Inaoka 1 , Y. Takada 1 , K. Kobayashi 1 , N. Watanabe 1 , R. Murata 1 , K. Takahashi 1 ,K. Ohashi 2 , T. Aburano 1 , T. Matsuno 1 ; Asahikawa/JP, 2 Iowa City, IA/US(tinaoka@asahikawa-med.ac.jp)Learning Objectives: To learn diagnostic pitfalls of MRI of the elbow joint and MRIfindings of abnormalities of the elbow joint in young athletes.Background: The elbow joint may be evaluated with various imaging modalities,including radiography, US, CT, and MRI, each of which has advantages and disadvantages.MRI has been an indispensable method for the evaluation of the elbowjoint in young athlete that is mainly concerned with the abnormalities of muscles,ligaments, tendons, nerves, bone marrow, and hyaline cartilage and MR featurescan help establish the cause of elbow pain by depicting accurately the presenceand extent of bone and soft tissue abnormalities. Particularly in children and adolescentsin whom bony growth is still immature, MRI provides practical informationin evaluation of the soft tissue structures of the elbow joint.Imaging Findings: We will describe diagnostic pitfalls of MRI of the elbow joint(pseudodefect of the capitellum, transverse trochlear ridge and pseudodefect ofthe trochlear groove, synovial plica/fold, ossification centers, and growth plate) andabnormalities (osteochondritis dissecans, apophyseal injury, lateral epicondylitisand lateral collateral ligament injury, medial epicondylitis and medial collateralligament injury, loose body and os supratrochlear, nerve injury (neuritis), andsecondary osteoarthritis).Conclusion: MRI is the most accurate, noninvasive method for identifying elbowinjuries in young athletes. It is very important for radiologists to make an early andaccurate diagnosis of an elbow injury with MRI, particularly in children and adolescents,as these injuries can significantly reduce a player’s career.C-606The value of MRI in assessment of groin pain in young athletesM. Mustapic 1 , I. Boric 1 , A. Tripalo Bartos 1 , V. Kosovic 2 , I. Pedisic 1 , T. Vrdoljak 1 ,I. Krolo 1 ; 1 Zagreb/HR, 2 Dubrovnik/HR (igor.boric1@zg.t-com.hr)Purpose: The aim of study was to assess the role of MRI in the evaluation of acuteand chronic pain in young athletes.Methods and Materials: MRI was performed in 50 young male athletes aged from13 to 18 years (average age 16) with acute onset or chronic groin pain. Of thosepatients, 27 were soccer players and 33 were ice-hockey players. In all patients,US examination was performed before MRI.Results: In 6 patients, abnormal sign in T2 weighted image and STIR image wasdemonstrated within anterior pubic bone and the attachment of adductor longusand brevis muscles as sign of entesitis. MRI showed focal areas of muscle fibres’disruption within the adductor muscles in 14 patients. Pubic symphysitis wasfound in 8 athletes. In our youngest patient inguinal hernia was found. Six patientsdemonstrated irregularity of the rectus abdominis muscle and increased signal onthe T2 weighted image within the rectus abdominis musculotendineous complex.Ilopsoas bursitis was the cause of the groin pain in 4 of our patients. In 4 patientslesion of the acetabular labrum was found, and in one patient our finding wasbilateral sacroileitis as a part of the spondyloarthropaty. The cause of groin pain inother 6 patients was apophyseal avulsion of anterior inferior iliac spine.Conclusion: MRI findings significantly correlate with the athletes’ symptoms evenwhen the findings with other diagnostic methods are negative. Therefore, MRI is avaluable method for evaluating groin pain in young athletes and planning appropriatetreatment especially when ultrasonography is not useful.C-607Labral tear or normal vessel? Blood vessels mimicking pathology inmusculoskeletal MRIR.N. Poley 1 , L.S. Steinbach 1 , G.M. Riley 2 ; 1 San Francisco, CA/US, 2 San Ramon, CA/US(rainer.poley@radiology.ucsf.edu)Learning Objectives: To demonstrate the wide spectrum of pathology simulated byblood vessel “artifacts” in musculoskeletal MRI. To increase the radiologist’s awareness,understanding, and diagnostic accuracy when encountering such cases.Background: Normal blood vessels frequently mimic pathology in MR imaging ofthe musculoskeletal system, often resulting in reduced diagnostic accuracy.Imaging Findings: A series of challenging cases will be presented in a quiz format.Cases will feature frequently encountered pathology simulated by blood vessels.In addition, each case will include a discussion highlighting normal anatomy, keypitfalls, diagnostic pearls, and important differential diagnoses. Cases presented willinclude: Intraosseous and intramuscular cysts, tendon, ligament and fibrocartilagetears, ligament sprains, neural lesions, fractures, and masses.Conclusion: Blood vessels frequently masquerade as pathology in musculoskeletalMR. A familiarity with the wide spectrum of appearances of these mimicsis essential for differentiating normal tissue from pathology. As MRI volumes,sensitivity, and resolution increase, the ability to make this distinction becomesparticularly important.C-608Patella nail syndrome: Imaging findings in conventional radiography andMRID. Floery, J. Roeper-Kelmayr, F.A. Fellner; Linz/AT (daniel.floery@gmx.at)Learning Objectives: 1. To illustrate the spectrum of imaging findings in patellanail syndrome in conventional radiography and MRI. 2. To link imaging findings tocommon clinical presentation of patients with patella nail syndrome. 3. To proposeimaging strategies for patients with suspected patella nail syndrome as well as forcartilage assessment and follow-up.Background: Patella nail syndrome (synonym: iliac horn disease) is a rare hereditaryskeletal disorder that is characterized by typical dysplastic alteration ofparticularly the patella, the radius head and the fingernails. It leads to progressivearhralgia caused by secondary cartilage degeneration of the affected joints. InMusculoskeletalACB D E F G HS463

Scientific and Educational Exhibitsmost cases, conventional radiography is sufficient for the diagnosis of patella nailsyndrome. Cartilage sensitive MRI sequences (such as double echo steady stateand proton density weighted sequences) are used to assess the degree of cartilagedegeneration and for surveillance of patients with known disease.Imaging Findings: The hallmarks of patella nail syndrome are the tetrade of 1,dysplastic fingernails, 2, dysplastic and lateralized patella, which usually articulateswith a dysplastic lateral femur condyle, 3, dysplastic radius head and 4, typical exostoseson the os ilium (“iliac horns”), which are well demonstrated by conventionalradiography. MRI additionally depicts secondary cartilage degeneration. Particularlywith cartilage sensitive sequences, cartilage softening as well as caritlage lesionsand subchondral lesions are demonstrated.Conclusion: Patella nail syndrome demonstrates typical imaging findings andshould be regarded as a possible differential diagnosis in the clinical managementof patients with an unclear presentation of arthralgia.C-609Multidetector computed tomographic imaging of wrist and hand disorders:Pictorial review of scanning techniques and common pathologiesJ.V. Raj, K. Jeyapalan; Leicester/UK (drvimalraj@googlemail.com)Learning Objectives: To establish the role of multidetector computed tomography(MDCT) in the imaging of wrist and hand disorders. To illustrate examples of commonpathologies, discuss scanning techniques, limitations and propose specificindications to perform these.Background: Imaging of wrist has been a challenge to radiologists and orthopaedicsurgeons for decades. Primarily, this is due to the complex anatomy and functionalityof the wrist. This is further complicated by frequent injuries sustained to the handand wrist. Recent developments in MDCT with its ‘state-of-the-art’ post processingcapabilities have revolutionised this field.Imaging Findings: Specific examples would include: 1. Scaphoid imaging: fracturedetection and importance in surgical planning and follow-up. 2. Other carpal injuries:suspected or occult carpal fractures. 3. Distal radial fracture analysis. 4. Assessmentof lumps. 5. Arterio venous malformations. 6. Tendon assessments. 7. Arthrogramsto assess scapho lunate, triangular fibro cartilage and luno triquetral ligaments. 8.Post operative assessment of alignment and union.Conclusion: MDCT plays a vital role in the assessment of hand and wrist injuries.In an acute setting, it improves diagnostic confidence and allows assessment ofother occult carpal injuries. CT arthrogram images intrinsic ligaments reducing theneed of invasive diagnostic arthroscopy. Post operative wrist no longer remains adiagnostic challenge largely due to excellent post processing abilities of MDCT.In all, the role of CT in imaging wrist is crucial and will keep expanding as newertechnology is made available.C-610Imaging of resurfacing arthroplasty of the hipZ. Chen, H. Pandit, Y.-M. Kwon, P. Monk, D. Murray, S. Ostlere; Oxford/UK(zhongbo.chen@hmc.ox.ac.uk)Learning Objectives: To be aware of the various complications related to metalon-metalresurfacing arthroplasty of the hip (RSA) and the spectrum of findingsthat may be encountered on imaging.Background: The bone conserving metal-on-metal hip resurfacing has becomeincreasingly popular over the last ten years, especially in young and active patients.Initial reports have been encouraging, but long-term outcome is still unknown. Earlypost operative complications include femoral neck fractures and have been welldocumented in the literature. Medium and long term complications are less wellunderstood. A rare but important problem seen at this stage is the appearance ofa cystic or solid periarticular reactive mass (pseudotumour), which requires revisionsurgery in a high proportion of patients. These lesions occur predominatelyin females and usually affect both hips when seen in patients with bilateral RSAs.Possible causes of these masses are metal allergy or a toxic reaction to excessivewear debris due to suboptimal alignment of the components.Imaging Findings: The following imaging findings are illustrated and their significancediscussed: periarticular lucency, prosthetic loosening, femoral neck notching,femoral neck thinning, fracture femoral neck, fracture of the femoral stem, poorprosthetic position, bone lysis, solid pseudotumour in psoas, cystic pseudotumour,psoas bursitis, trochanteric bursitis, heterotopic bone formation.Conclusion: The radiologist should be aware of the normal radiographic appearancesand the variety of complications that may occur following RSA and shouldrecommend ultrasound or MRI in patients who present with unexplained hip painin the presence of normal radiographs.C-611Diagnostic pitfalls mimicking meniscal tears: MR imaging evaluation witharthroscopic correlationI. Tsifountoudis, I. Kalaitzoglou, A. Haritandi, I. Economou, A.S. Dimitriadis;Thessaloniki/GR (jtsif@mycosmos.gr)Learning Objectives: MRI has been established as a very sensitive method forthe diagnosis of meniscal tears. To maintain high accuracy, radiologists should beaware of potential pitfalls in interpretation. Our purpose is to review these potentialcauses of confusion, to describe the mechanisms by which they may create foci ofpathologic signal intensity similar to meniscal tears and to recommend methods toavoid false-positive and false-negative interpretations.Background: The findings from MRI examinations of 310 knees were retrospectivelyinterpreted and correlated with prospectively recorded results fromarthroscopic examinations performed between 2006 and 2008. Of the kneesexamined, 255 meniscal tears were identified. Furthermore, 27 false-positive and14 false-negative findings were detected.Imaging Findings: False-positive and false-negative findings were attributed topitfalls in interpretation which may be caused by: (a) normal structures of the kneethat project in close relationship to the menisci, such as anterior transverse ligament,meniscofemoral ligaments, popliteal tendon and bursa and oblique meniscomeniscalligament, (b) artifacts created by the pulse sequences used, such asmagic angle phenomenon, volume averaging, motion and truncation artifacts, (c)causes that are related to healed or healing tears and operative manipulations ofthe menisci and (d) some rare meniscal pathologies of different etiology, such aschondrocalcinosis, meniscal ossicles and gas within the joint.Conclusion: MRI is a valuable tool for the evaluation of meniscal pathology. Athorough knowledge of pitfalls that commonly mimic meniscal tears is essential ifone is to maximize diagnostic accuracy.C-612Glenohumeral joint: Normal anataomy, normal variants, and pathologicconditions that lead to glenohumeral joint instabilityK. Amin, R. Kakarla, J. Weiss, S. Herwick; Chicago, IL/US (ketanaminmd@gmail.com)Learning Objectives: To outline the normal anatomy of the glenohumeral (GH)joint, describe normal variants of the GH joint, elucidate the causes of GH jointinstability, and differentiate the various pathologic processes that lead to GH jointinstability.Background: The glenohumeral joint is a commonly injured joint in young, activeindividuals. Due to the large size of the humeral head in relation to the smallglenoid fossa, there is significant mobility within this joint that makes it prone todislocation. The glenohumeral ligaments, glenoid labrum, and joint capsule makeup the labrocapsular ligamentous complex (LLC), which plays an important role instabilization of the joint. Knowledge of the different types of pathology associatedwith GH joint instability as well as normal anatomic variants of the joint will greatlyimprove diagnostic accuracy.Imaging Findings: We will use MRI arthrography to present normal anatomy of theGH joint and LLC. We will also present various pathology of the GH joint includingSLAP tear (Superior Labrum Anterior to Posterior), GLAD (Glenoid labral articulardisruption), ALPSA (Anterior labroligamentous periosteal sleeve avulsion), Bankartlesions, Perthes, and HAGL (Humeral avulsion of glenohumeral ligament).Conclusion: MRI arthrography is the most accurate modality to outline the GH jointand LLC anatomy and the pathologic processes that affect this area. Being ableto accurately diagnose the various pathologies will greatly benefit the orthopedicsurgeon in patient management.No Material Submitted to EPOSC-613MR imaging of painful hip in adult patients younger than 50 years oldE.A.S. Eracleous 1 , C.F. Economides 1 , Y.T. Seimenis 1 , S.P. Kokkis 1 ,C. Natsiopoulos 1 , T.C. Posporis 1 , A.H. Karantanas 2 ; 1 Nicosia/CY, 2 Iraklion/GR(elenerac@logosnet.cy.net)Learning Objectives: To illustrate the important role of MR imaging in the earlydiagnosis of a wide spectrum of hip pathologies that may cause hip pain in adultsyounger than 50 years old.Background: The differential diagnosis of a painful hip in young adults is quitedifficult as the clinical tests often are not typical. Therefore the imaging findingsplay an important role in patient’s management. Young adults may suffer a widespectrum of disorders with the exception of entities found exclusively in children andosteoarthritis and tumours found in the elderly. The early diagnosis of the recentlydescribed femoroacetabular impingement-cam type syndrome is very important asthe timely treatment will prevent an early osteoarthritis in this age group. Subclinicalhip dysplasia may also predispose to early osteoarthritis.CS464 A B D E F FG H

Scientific and Educational ExhibitsImaging Findings: The MR imaging findings of labrum including normal variants,types of tear and associated abnormalities will be described. MR imaging of hipdysplasia, femoroacetabular impingement, bone marrow edema (including transientand migratory osteoporosis), avascular necrosis, hip osteomyelitis, PVNS,osteochodromatosis, inflammatory and septic arthritis, post traumatic degenerativearthritis, malignancy, muscular denervation, sport injuries, bursitis and insufficiencyfractures will be discussed. The postoperative evaluation of avascular necrosis willalso be presented. MR imaging techniques including MR arthrography as well asdifferences between MR imaging of 1.5 T and 3.0 T will be highlighted.Conclusion: MR imaging plays an important role in the correct diagnosis of hippathology in young adults and directs clinicians to an effective treatment.C-614Diagnostic accuracy of high resolution ultrasound in the diagnosis ofrotator cuff tearsM. Chelli Bouaziz, F. Jaboun, H. Jlassi, S. Chaabane, M. Ladeb; Tunis/TN(fethi.ladeb@rns.tn)Purpose: High resolution ultrasound is known to be performant in the investigationof rotator cuff pathology. However, reports in the literature as to the diagnosticaccuracy of ultrasound vary widely. The purpose of our study was to compare thediagnostic accuracy of ultrasound with reference to multislice arthro-CT.Methods and Materials: We prospectively studied sixty-four consecutive patients(35 men and 29 women aged from 35 to 75 with a mean of 56 years) with rotatorcuff pathology diagnosed on ultrasound and who underwent pre-operative multislicearthro-CT of the shoulder from February 2006 to January 2008. Full thickness andcommunicating partial thickness tears of the supraspinatus, infraspinatus, subscapularistendons as well as long biceps abnormalities have been assessed.Results: The right shoulder was involved in 44 patients. The supraspinatus tendonwas the most frequently involved either by full thickness (n=50) or partial thickness(n=29) tears. Ultrasound correctly identified full thickness rotator cuff tears in 84%of cases with a good positive predictive value (83%). The sensitivity and specificityof ultrasound in the detection of partial thickness tears were, respectively, of 76 vs44%. These data significantly increased with presence of joint effusion (77 vs 70%)and double joint and subacromial subdeltoid bursa effusion (80 vs 67%).Conclusion: Ultrasound allows an accurate diagnosis of full thickness tears. Thediagnostic performance of ultrasound in the assessment of partial thickness tearsincreases when a joint effusion or double effusion is present.C-615The spectrum of synovial diseases: A multimodality approachL. Berrocal, S. Carbó, C. Blancas, S. Medrano, D. García, N. Arcalís, A. Conejero,N. Rosón, X. Pruna; Granollers/ES (lara_berrocal@hotmail.com)Learning Objectives: To review and depict the wide spectrum of musculoskeletaldisorders where synovial cell takes part by using the different radiological modalities.To emphasize the imaging key features that can help in the main differentialdiagnosis (rheumatic arthritis vs infectious synovitis, primary vs secondary osteochondromatosis,benign vs malignant lesions).Background: Synovial disorders are frequent but difficult to diagnose clinicallybecause of non-specific symptoms and physical examination that may delay diagnostic.Synovium is the site for a large number of pathologic processes that arecaracteristic, and in some cases, specific to this distinctive tissue. The knowledgeof the typical imaging features and the main differentials is essential for their correctdiagnosis.Imaging Findings: This pictorial essay shows the normal synovial microscopicstructure and function, and normal anatomy imaging with drawing schemes. Wedivide synovial cell diseases in the following cathegories: the spectrum of proliferativedisorders; cartilaginous lesions; non specific synovitis; and distinction betweenrheumatic and infectious processes. In each category synovial diseases are depictedusing different imaging modalities (radiographs, ultrasound, CT and MRI). A tablewith differential diagnosis key features is displayed in each section.Conclusion: Familiarity with the typical imaging characteristics as described in thiswork allows to make confident diagnoses of many of synovium diseases. Emphasisis given to imaging key features, which can help in the diagnosis of the proliferative,cartilaginous, and non-specific synovial disorders.C-616Predictive factors for new onset or progression of osteoarthritis in theknee joint one year after trauma: MRI follow-up in general practiceI.M. Koster, E.H.G. Oei, J.-H.J. Hensen, D. Vroegindeweij,S.M.A. Bierma-Zeinstra, M.G.M. Hunink; Rotterdam/NLPurpose: To prospectively evaluate prognostic factors for new onset or progressionof degenerative change on follow-up MRI one year after traumatic knee injury andthe association with clinical outcome.Methods and Materials: We studied 117 patients (67 male; mean age 41, range18-63 years) in general practice who underwent initial knee MRI 3-6 weeks afteracute trauma and follow-up MRI after one year. Degenerative femorotibial changeon both MRI examinations was graded using the Kellgren and Lawrence scales.We used univariable and multivariable logistic regression analysis to analyzethe prognostic value of demographics, trauma mechanism, pain score and initialMRI findings on development of new or progression of pre-existing osteoarthritis.We studied the association between degenerative change and clinical outcome,reflected by perceived recovery.Results: On initial MRI, 33 knees showed degenerative abnormalities. On follow-upMRI, 22 of 84 knees demonstrated new degenerative change, 5 knees with preexistingosteoarthritis showed progression. In univariable analysis, age 50 yearsand body mass index 25 kg/m2 were significant predictors for new or progressivedegenerative change (p 0.10). Bone marrow edema on initial MRI was thestrongest and only significant prognostic variable in multivariable analysis (OR 6.01(95% CI 1.92-18.8), p=0.002). No significant association between new or progressivedegenerative change and clinical outcome was found (p=0.13).Conclusion: Bone marrow edema on MRI for acute knee injury is strongly predictivefor new onset or progression of degeneration of the femorotibial joint on follow-upMRI one year after trauma, which is clinically not manifest.C-618Joint puncture techniques: A step-by-step approach for residentsP. Vincke, B. Maldague, J. Malghem, S. Koutaïssoff, P. Simoni, F. Lecouvet,P. Omoumi, B. Vande Berg; Brussels/BELearning Objectives: To provide the residents a systematic guide on how to successfullyperform joint puncture.Background: Fluoroscopy-guided joint puncture is routinely performed either toaspirate joint fluid (for lab studies) or to inject contrast material or drugs into thejoint. Residents often ask for practical information about joint puncture techniquesthat are no longer available in general textbooks. We decided to provide them witha practical guide as the basis of their training on the ground under the supervisionof a senior radiologist.Procedure Details: General concepts common to all procedures will be illustrated:precautions, contraindications, asepsis, and local anaesthesia techniques. Technicalaspects specific to each joint will then be detailed with a focus on patient position,target areas, and expected pattern of intraarticular and extraarticular contrast distributions.Most common sites of joint puncture will be reviewed: knee (and kneeprosthesis), shoulder, elbow, hip (and hip prosthesis), wrist, ankle, lumbar facetjoints and subtalar joint. These procedures, tricks and pitfalls will be illustrated byphotographs, drawings and plain radiographs of cases from our experience.Conclusion: This original step-by-step guide gives the residents a systematicapproach on joint puncture techniques and makes their practical training on theground more efficient.C-619Reverse shoulder prosthesis’ complications: RadiologyB. Weryha, J. Wassel, G. Navez, F. Sirveaux, D. Molé, A. Blum; Nancy/FR(bweryha@sincal-cto.fr)Purpose: Illustrate the most common complications associated with reverseshoulder prosthesis (RSP).Methods and Materials: Using our electronic data base, we reviewed all thecomplications associated with RSP observed since 1994. 115 prostheses wereimplanted in 106 patients. 13.6% of the patients had complications associated withRSP. 10.3% of all patients had revision surgery. All cases with complication wereexplored by radiography (SOFCOT protocol) and CT scan except hematomas,which need US.Results: A RSP is a modular prosthesis composed of 5 to 7 pieces explaining itsown share of biomechanical features and complications. In our series, the differentcomplications were: hematoma, infection, luxation, glenoid implant dissociation,acromial fracture, stiffening, etc. We illustrate the normal aspect of the RSP andthe most typical pattern of the different types of complications.Conclusion: Complications associated with RSP are quite specific and most ofthem are depicted with standard X-rays.ACB D E F G HS465Musculoskeletal

Scientific and Educational ExhibitsC-620Compartmental anatomy of the lower extremities: Achievement of aninteractive radio-anatomical atlasM. Louis, N. Labonne, D. Roch, A. Blum; Nancy/FR (m.louis@chu-nancy.fr)Learning Objectives: To assist the doctor in the assessment of tumours as well asother musculo-skeletal pathologies. To guide the radiologist performing percutaneousneedle biopsies. To provide educational tools in the study of anatomy.Background: Compartmental anatomy of the extremities is not well-known bymost radiologists. Presently, few references including compartmental anatomyare available. It is however essential for the study of musculoskeletal and softtissuetumours, in order to correctly describe and grade them, according to theclassification of Enneking.Procedure Details: The images were performed with a 1.5-T MR unit (GE SignaHDx 1.5 T). This atlas contains 1152 pages, including 384 MR 3D-slices, with a detailedanalysis of muscular compartments and their relationship with osteo-articular,vascular and nervous structures. It is presented as an interactive CD-ROM.Conclusion: An interactive radio-anatomical atlas was performed, allowing aneasy and fluid manipulation by radiologists, surgeons, rheumatologists, generalpractitioners (GP) and students.C-621Imaging sportsmen: Practical points in the imaging diagnosis of posteriorankle impingement syndromes (PAIS)N. Chew, M. Sriharan, J. Lee, J. Healy; London/UKLearning Objectives: To describe the imaging appearances (on plain radiographs,US, MR and CT) of the three posterior ankle impingement syndromes, correlatedwith arthroscopy. To describe the role of each imaging modality in reaching thediagnosis.Background: Ankle impingement is a chronic progressive painful condition ofthe ankle resulting from friction of joint tissues secondary to altered ankle jointbiomechanics. We describe the imaging clues and spectrum of abnormalities,which may lead to its diagnosis.Imaging Findings: Posterior ankle impingement syndromes can be divided into: 1.True posterior ankle impingement syndrome. 2. Posteromedial ankle impingement(PoMI). 3. Haglund’s phenomenon. Imaging findings are discussed.Conclusion: Posterior ankle impingement is a diagnosis of exclusion. However,making the diagnosis is important to guide treatment of this debilitating condition.C-622Bone marrow of the non-traumatic knee: Expected findings at MR imagingM. Castro, N. Silva, A.T.B. Almeida, B. Viamonte, A. Vieira; Porto/PT(miguelhcastro@gmail.com)Learning Objectives: To understand the normal “maturation” of the knee marrowsignal concerning to age. To identify normal variations of the knee medullarysignal. To recognize the different pathologic non-traumatic changes of the kneemedullary signal.Background: The knee is the most frequent musculoskeletal MR study. In MRevaluation of the knee, we are frequently faced with focal or diffuse signal changesof the bone marrow that does not correspond to the common adult pattern (uniformhigh T1 signal, intermediate T2 signal and low STIR signal). These changesmay be related to the expected red bone marrow in a child, reflect some kind ofbenign marrow heterogeneity or be associated with multiple different pathologicprocesses such as medullary reconversion (chronic anaemia, increased oxygendemands, kidney or liver failure, myeloid depletion (chemotherapy, aplastic anaemia,radiation therapy, marrow edema (trauma, infection, transient osteoporosis,marrow infiltration (leukemia, lymphoma, metastases, primary bone tumors) orbone marrow ischemia.Procedure Details: A didactic format will be used and organized to discuss andillustrate the normal and abnormal findings of the knee bone marrow at MR imaging.The different causes of knee non-traumatic marrow signal change are reviewedand illustrated with different cases from our iconography.Conclusion: Bone marrow should be evaluated on every MR examination performed.The normal and the expected abnormal bone marrow signal (in a specificclinical context) should be recognized.C-623Intravendor interscanner variability of T2 relaxation times in human tibialcartilage at 1.5 T and 3 TY. Fukuda 1 , A. Horng 1 , J. Raya 1 , J. Weber 1 , S. Hirota 2 , M.F. Reiser 1 , C. Glaser 1 ;1Munich/DE, 2 Nishinomiya/JP (fukudayuko519@yahoo.co.jp)Purpose: To evaluate the influence of scanner type and magnetic field strength(1.5 T and 3 T) on global and regional T2 relaxation time of tibial cartilage.Methods and Materials: Eight healthy volunteers were examined in 3 different1.5 T scanners and one 3 T scanner (same manufacturer) using a coronal 3D-T1-w-FLASH-WE sequence (TR/TE/FA=20 ms/8 ms/25°, resolution=0.6x0.6x3 mm 3 )and a fat-saturated multislice-multiecho-sequence (MSME) (TR/TE=3000/13.2 ms,8 echoes, resolution=0.6x0.6x3 mm 3 ). Semiautomatic segmentation of tibial cartilagewas performed in the FLASH-sequence. Averaged cartilage T2 (global T2)and regional T2 (8 ROIs/slice) were calculated. Variability of global and regionalT2 was calculated as root mean square average of the individual coefficients ofvariation (COV) and as standard deviation (SD). The difference among 1.5 T andbetween 1.5 T and 3 T were evaluated.Results: Considering all scanners, relative variability was 17.4/21.6% for globalT2 and 21/28.4% for regional T2, absolute variability was 5.1/6 ms (global T2) and6.2/7.7 ms (regional T2). Comparing the 1.5 T scanners only, variability was 7.6/8.2%globally and 13.4/15.5% regionally, 2.3/2.5 ms globally and 4.0/4.7 ms regionally.T2 values at 3 T were significantly (P 0.005) lower than at 1.5 T.Conclusion: Inter-scanner variability of cartilage T2 at 1.5 T is in the order ofmagnitude of reported test-retest T2 precision errors and thus a significant contributorto overall data scattering in potential studies of cartilage T2 in OA. Therefore,ideally, only one scanner type should be used in studies of cartilage T2 in OA. Theknown differences of calculated T2 between 1.5 T and 3 T are more than doublepotential errors.C-624Total elbow arthroplasty: A pictorial review of its associated complicationsD.Y.F. Chung, J.L. Teh; Oxford/UK (daniel.chung@doctors.org.uk)Learning Objectives: To provide learning tools and quick reference to juniorradiologists and inexperienced clinicians the radiological findings of complicationsseen after total elbow arthroplasty.Background: The relative lack of familiarity to many radiologists of elbow arthroplastymay result in poor or delayed recognition of complications. Osteolysis, asepticloosening and instability are recognized complications of total elbow arthroplasty.Follow-up radiographic analysis is vital to assess the surgical result and detectionof complications or risk factors of prosthetic loosening.Imaging Findings: Pictorial review of various imaging modality demonstratingpost operative complications encountered at our institution will be presented.These will include instability, loosening, fracture, infection, tricep insufficiency andulnar neuropathy.Conclusion: We believe this review will help viewers to acquaint themselves withthe radiological feature of complications associated with total elbow arthroplasty,and thus be able to formulate optimal imaging strategies to ensure early accuratedetection.CS466 A B D E F FG H

Scientific and Educational ExhibitsC-625Relationship between the degeneration of the cruciate ligaments andcalcium pyrophospate dihydrate (CPPD) crystal deposition of the knee:Anatomic, radiographic and MR imaging study with histologic correlationin cadaversB. Dirim 1 , M. Abreu 2 , M. Wangwinyuvirat 2 , D. Trudell 2 , P. Haghighi 2 , D. Resnick 2 ;1Izmir/TR, 2 San Diego, CA/US (bernadirim@gmail.com)Purpose: Investigate the association of CPPD crystal deposition and cruciate ligaments(CLs) degeneration and to describe the distribution of such deposits, usingmagnetic resonance (MR) imaging, high-resolution radiography and anatomicalinspection of cadaveric knees.Methods and Materials: Ten fresh cadaveric knees were studied with 1.5 TeslaMR imaging and sectioned in three planes. The anatomic slices were evaluatedwith high-resolution faxitron radiography. The images and anatomical specimenswere evaluated by two radiologists. Histologic sections were obtained from 8 thatcontained calcifications and from 2 as controls without such calcifications. Theywere investigated under light and polarising light microscope.Results: Radiographic imaging and histologic analysis demonstrated CPPD crystaldeposition in 8 of the 10 specimens (80%). CPPD crystal deposition was determinedin 12 of the 16 CLs (75%) in these 8 specimens. Degenerative changes in the CLsassociated with this deposition were observed in 9 of 12 (75%) cyrstal depositionedCLs. Degeneration pattern of the CLs were determined as follows: loose fibroustissue in seven of 9 (78%); chondroid metaplasia in one of 9 (11%); and osseousmetaplasia in one of 9 (11%). No evidence of CPPD crystals and degeneration wereobserved in the control specimens. In 8 specimens with deposition, radiographyand histologic analysis were more sensitive than MR imaging.Conclusion: More degenerative changes were demonstrated in those CLs thatcontain CPPD deposits on histologic analysis. High-resolution radiography andhistologic analysis are more sensitive than MR imaging for the detection of calcificationsin cadavers with CPPD crystal deposition.MusculoskeletalSoft TissueC-626Dynamic MRI to define the best time for surgery after isolated limbperfusion in advanced soft tissue sarcomasD. Vanel, H. Debbabi, C. Le Pechoux, J. Domont, F. Rimareix, A. Le Cesne,S. Bonvalot; Villejuif/FR (daniel.vanel@igr.fr)Purpose: Isolated limb perfusion with TNF-alpha and melphalan allows an overallresponse rate of 78% on locally advanced soft tissue sarcomas of the extremities.Surgery is usually performed 2 months after the perfusion. We have studiedprospectively all patients with dynamic MR examinations at 1 and 2 months afterthe perfusion in order to evaluate the best surgical timing between perfusion andplanned excision.Methods and Materials: Eighty-four patients had MR examinations 1 and 2 monthsafter the perfusion. MR examinations included a dynamic sequence after injectionof contrast medium, allowing a precise mapping of the early uptake. A new lesion,increase in size or larger surface of early uptake were considered indicators oftumour progression, whereas decrease of either the early vascularised part of thetumour or size were indicators of an improvement.Results: In 62 (73%) cases no changes were observed between the two MRexaminations. Eight patients (9.5%) progressed: both in size and vascularisation(two patients), on vascularisation only (four patients), on size only (one patient)and finally a new lesion appeared (one patient). Fourteen (17.5%) patients had aradiological improvement between 1 and 2 months.Conclusion: The best timing of surgery seems 2 months after perfusion. It isadequate in the majority of cases (90.5%). In rare cases where surgery is possibleand easy to perform 1 month after perfusion, it should be considered as 9.5% ofthe patients may progress between 1 and 2 months.C-627Analysis of magnetic resonance imaging features for the differentiation ofmusculoskeletal myxoid soft tissue tumorsM. Seo, S. Lee; Seoul/KR (radseo@hanmail.net)Purpose: To assess the diagnostic value of MR imaging features for the differentiationof musculoskeletal myxoid soft tissue tumors.Methods and Materials: Among the pathologically proven musculoskeletal myxoidsoft tissue tumors, we enrolled 73 cases who had undergone enhanced musculoskeletalMR imaging. Two radiologists retrospectively reviewed the features of eachtumor by consensus approach: margin, pattern of lobulation, signal intensity andhomogeneity on T2WI -T1WI, pattern of enhancement, extent of enhancement,intra-lesional necrosis, intra-tumoral fatty component, and regional bony metastasis.Kruskall-Wallis test and Bonferroni correction were done for statistical analysis.Results: There were intramuscular myxomas (n=13), low-grade fibromyxoidsarcoma (n=9), extraskeletal myxoid chondrosarcoma (n=8), myxofibrosarcoma(n=16), and myxoid liposarcoma (n=27). For differentiation of musculoskeletalmyxoid tumors, margin, pattern of lobulation, signal intensity on T1WI, homogeneityof signal intensity on T1WI and T2WI, pattern of enhancement, extent ofenhancement, intra-tumoral fatty component, and regional bone metastasis werevaluable (p 0.05). There was considerable overlap of remained MR features.Intramuscular myxomas were homogeneously low SI on T1WI, homogeneouslyhigh SI on T2WI, and enhanced less than half of the lesional volume. Low-gradefibromyxoid sarcoma showed less extensive enhancement than other sarcomas.Extraskeletal myxoid chondrosarcoma showed partially infiltrative margin, high SIon T1 weighted image, extensive enhancement, and regional bone metastasis.Myxofibrosarcoma characterized by infiltrative margin, multilobular or intra-lesionallobular appearance, and diffuse spread along the fascia. Myxoid liposarcoma wascharacterized by intra-tumoral fat or linear septa showing high SI on T1WI.Conclusion: MR features are valuable for the differentiation of musculoskeletalmyxoid soft tissue tumors.No Material Submitted to EPOSMusculoskeletalACB D E F G HS467

Scientific and Educational ExhibitsC-628Plantar fascia evaluation with a low-field MRI scanner in weight-bearingposition: Our initial experience in patients with plantar fasciitis and inhealthy volunteersR. Sutera, A. Iovane, F. Sorrentino, F. Candela, P.G. Cimino, M. Midiri; Palermo/IT(raffaello.sutera@alice.it)Purpose: To assess the usefulness of weight-bearing examination of the ankleperformed with a low-field MRI scanner in the evaluation of plantar fascia in normalhealthy volunteers and in patients with a clinical evidence of plantar fasciitis.Methods and Materials: We retrospectively evaluated ankle MR examinationsin two groups of 40 patients each, performed between January and July 2008.Spin echo T1W, Gradient echo T2W, and Short Tau Inversion Recovery (STIR)images were acquired with a 0.2 T scanner (G-Scan, Esaote Biomedica, Genoa,Italy) in both weight-bearing position and normal conventional supine position.A dedicated extremities transmitter/receiver coil was used. The lesion site andsignal intensity changes were evaluated in consensus by three musculoskeletalexperienced radiologists.Results: In all healthy volunteers, a normal appearance of plantar fascia wasobserved in both conventional supine and in weight-bearing positions. In the latter,an increased stretching of plantar fascia fibers was revealed. In patients withclinical evidence of plantar fasciitis, MRI performed in both positions confirmedthe diagnosis in 35/40 cases. Only in the weight-bearing position a subtle plantarfascia rupture was also detected in 4/40 cases. In 5/40 cases the plantar fasciawas normal in both positions, and there were other causes of heel pain such asAchilles tendinopathy, calcaneal spur, and calcaneal edema without plantar fasciainvolvement.Conclusion: Imaging the heel in weight-bearing position with a new developedMRI scanner is useful in demonstrating subtle ruptures of plantar fascia, which canbe overlooked when imaging the ankle only in supine position.C-629Imaging of soft-tissue fibrous tumorsB. Sanchez Cordon, V. Vaquerizo Garcia, P. Quintana Valcarcel, E. Diez Uriel,M. Martinez Montalban; Alcala de Henares/ES (linfocitoTpeludo@yahoo.com)Learning Objectives: To illustrate imaging characteristics and typical anatomiclocations of benign/malignant fibrous soft-tissue tumors in adults.Background: Fibrous soft-tissue tumors are a heterogeneous group of lesionswith varied anatomic locations, pathologic features and biologic behavior. Theyare among the most common soft-tissue lesions encountered in clinical practicein adults. They can be classified in three major groups: benign fibrous proliferations(include nonaggressive fibroblastic lesions such nodular fasciitis), fibromatoses (includingdesmoid tumors) and fibrosarcoma. In this exhibit, we will describe the mosttypical radiologic features and anatomic locations of fibrous soft-tissue tumors.Imaging Findings: The diagnosis of fibrous soft-tissue tumors can be suggestedfrom their imaging appearances and typical anatomical locations. Benign fibroblasticproliferations are highly cellular, tend to grow rapidly and clinically simulatemalignant neoplasms. However, they have a self-limited course, rarely recur afterexcision, and never metastasize. Fibromatoses show more aggressive biologicbehavior than do benign fibrous proliferations. MR imaging, CT and sonographyare useful for defining the intrinsic imaging characteristics, size and extension ofthe lesions. It is particularly important to obtain T2-wighted images in MR imagingstudies; lesions with lesser degree of cellularity and increased collagen contentshow hypointense signal. However, fibromatoses with less collagen and more cellularitymay have high signal intensity.Conclusion: It is important for radiologists to recognize the imaging features,common sites of occurrence and pathologic characteristics of soft-tissue fibroustumors. This knowledge will determine an appropriate differential diagnosis andhelp guide the correct management of these lesions.C-630MRI of peripheral nerves and selected peripheral neuropathiesA.S. Robertson; Sydney/AULearning Objectives: To present the MRI appearances of selected peripheralneuropathies (both acquired and inherited), particularly radial, ulnar and commonperoneal neuropathies and associated muscle changes as well as imaging appearancesof some causes.Background: Traditionally, peripheral neuropathies are diagnosed by a combinationof history, clinical examination and neurophysiological/electrophysiologicalstudies, the latter of which are usually performed by a subset of neurologists andhave up to now been considered the gold standard for diagnosing and localizingperipheral neuropathies.However, there is often no clue provided as to the exact cause and, in manysituations, the neurophysiological studies do not localize the level of the lesion.MRI can be used as an adjunct in the diagnosis of, identifying the causes of, andlocalization of peripheral neuropathies and may provide a time advantage in diagnosis,as neurophysiological studies may have a time lag of up to 3 weeks prior toproviding meaningful results.Imaging Findings: The MRI imaging findings of case studies with diagnosticneurophysiologic examinations, demonstrating signal changes of acute and chronicpatterns of muscle denervation, as well as the causes of the peripheral neuropathies(some of which have been confirmed operatively), with particular emphasis onradial, ulnar and common peroneal neuropathies and their subtypes.Conclusion: MRI of the peripheral nerves has been demonstrated in this set ofcase studies to be a useful adjunct in the diagnosis and localization of causes ofperipheral neuropathies with significant potential to influence management.C-631Could it be a desmoid tumor?M.F. Armas Goncalves 1 , G. Castanha 1 , C. Ruivo 2 , B. Gonçalves 2 , C. Marques 2 ;1Funchal/PT, 2 Coimbra/PTLearning Objectives: Describe the most representative imaging findings of desmoidtumors in order to make a differential diagnosis from other soft-tissue andintra-abdominal masses. Illustrate radiologic-pathologic correlation.Background: Desmoid tumors are included in the group of deep fibromatoses,characterized by fibroblastic proliferation of muscle-aponevrotic tissues. They arecomposed of uniform-appearing fibroblasts surrounded by variable amounts of collagenfibers. Desmoids can be divided into intra-abdominal, abdominal (soft tissuesof the abdominal wall) and extraabdominal (affecting other regions). Although theydo not metastize, the recurrence rate is high and they can be locally aggressive.Most cases manifest as solitary lesions; however, synchronous multicentric lesionscan occur. There is a higher incidence in patients with Gardner syndrome and aftertrauma (also in surgical scars). A retrospective analysis (1998-2007) of CT and MRIexaminations of 30 patients with proven desmoid tumors was performed. Pathologicfindings and clinical background were also recorded.Imaging Findings: The imaging appearance of desmoids depends on the relativeamount of fibroblasts, fibrosis and collagen and of tumor vascularity. At both CTand MRI, their margins may appear irregular or smooth and show mild contrastenhancement. MRI may show low to moderate signal intensity in T1-w SE imagesand variable heterogeneous signal intensity in T2-w TurboSE.Conclusion: CT and MRI of desmoids have no specific features to achieve a confidentdiagnosis with statistical significance. But some characteristics may resemblethem. Desmoids should always be included in differential diagnosis in patients withan abdominal or soft tissue mass in the appropriate clinical setting.C-632Imaging of tumours and tumour-like conditions associated with Paget’sdisease of boneE. Pluot, S.L.J. James, A.M. Davies; Birmingham/UK (e.pluot@voila.fr)Learning Objectives: To review the imaging features and differential diagnosis ofneoplastic transformation and tumour-like lesions in Paget’s disease of bone. Todiscuss the role of different imaging modalities in assessing tumours or tumor-likeconditions associated with Paget’s disease.Background: Paget’s disease of bone is a localized or multifocal disorder characterizedby abnormal bone turnover with increased osteoclastic resorption andcompensatory increased osteoblastic activity. Bone sarcoma is by far the mostserious of the numerous complications that can occur in Paget’s disease. Referringto tumour as a mass, not all tumours arising in Paget’s disease are malignantor even neoplastic.Imaging Findings: The identification of an ill defined or permeative lytic lesion,with cortical destruction and a soft tissue mass, developing within Paget’s diseaseshould raise the question of a sarcoma. Metastases, myeloma and lymphomacannot be distinguished from a sarcoma on imaging features alone. Benign bonetumours such as giant cell tumour and several tumour-like conditions may alsomimic a sarcoma.Conclusion: The imaging investigations of choice are radiography and MRI. Scintigraphyis of limited value. Preservation of the fatty marrow signal on MRI tendsto exclude malignant infiltration or other complications of Paget’s disease. Whereany doubt remains as to the presence or absence of malignancy and whether thetumour is a sarcoma or not, biopsy is mandatory.CS468 A B D E F FG H

Scientific and Educational ExhibitsC-633Soft tissue sarcomas: A diagnostic challengeA.S.R. Preto, A.L. Carneiro, M. Pimenta, L. Melão, S. Brandão, A. Vieira;Porto/PT (sofiapreto@hotmail.com)Learning Objectives: To present several illustrative cases of the most commonsoft tissue sarcomas found at our institution in a 5 year period. To review the imagingfeatures on cross-sectional studies with pathological correlation. Differentialswill also be discussed.Background: The authors will present, in a quiz format, multiple examples of thismesenchymal tissue malignancy. Almost half of all soft tissue sarcomas occurin the limbs - especially the legs. Other common sites are the chest, abdomenand pelvis. Less commonly they may occur in the head and neck. Some of theexamples will include neoplasms of fibrous tissue, fat, muscle, blood vessels andperipheral nerves.Imaging Findings: CT and MR are the main diagnostic tools to study thesemalignancies. MR is superior in the local evaluation of disease, allowing a betteranatomical definition, reliable tumoral extension and malignant involvement offasciae compartments or vascular-nervous bundles. MR is also the main tool inpost-surgical follow-up. CT has its main role evaluating distant spread of disease,mainly on parenchymal organs (liver and lung) and bone.Conclusion: A practical guide to diagnosis will be reviewed, knowing that definitivecharacterization is done by biopsy and pathology.C-634MR imaging of muscle oedema: A pictorial review of its many guisesS. Gadde, N. Napier, D. Taylor, M. Crone, A. Grey, R. Sathyanarayana; Belfast/UK(saratgadde@gmail.com)Learning Objectives: We aim to visually summarise the MR imaging appearancesand distribution of muscle oedema in different clinical conditions and to review theimportant clinical and radiological findings relevant for diagnosis.Background: Muscle oedema is common and frequently a non-specific indicatorof injury; however, it can also be secondary to diverse causes including infective,autoimmune, inflammatory, neoplastic, neurologic and iatrogenic conditions. Whenits distribution, symmetry and localised pattern are properly interpreted on MRimaging, important diagnostic clues to the underlying pathology are found.Imaging Findings: Muscle oedema is high signal on and is best seen on T2 Fatsaturated and STIR sequences. The distribution pattern and the associated featuresprovide crucial information and aid diagnosis in inflammatory myopathies, infectiousmyositis, compartment syndrome, early myositis ossificans, rhabdomyolysis, sicklecell crisis, neoplasia, neuritis and diabetic muscle infarction and are well appreciatedon wide field of view imaging or whole body studies, enabling side to side andproximal to distal comparison between muscle groups.Conclusion: Muscle oedema on MRI can be a manifestation of many conditions.The imaging distribution and associated features provide vital clues for diagnosisand can suggest the most suitable site for biopsy.C-635Peritrochanteric high T2 signal: Report or not reportN. Haliloglu, D. Inceoglu, G. Sahin; Ankara/TR (nurayunsal2@hotmail.com)Purpose: To evaluate the incidence of peritrochanteric high T2 signal (peritendinitis)on MR imaging studies and to determine whether reporting peritendinitis is alwaysclinically relevant depending on the age and gender of the patients.Methods and Materials: We evaluated 79 consecutive hip MR images performedin our department between January 2006 and December 2006 (57 female, 22 malepatients, mean age 49 years). Each study was evaluated for areas of T2 hyperintensityrepresenting edema around the greater trochanter. Patients with a knownfracture, tumor, history of radiation therapy, history of hip surgery and prosthesiswere excluded from the study. Patients with signal intensity alterations within thethickened gluteus medius/minimus tendons (tendinitis) or peritrochanteric bursalfluid accumulation (bursitis) were also excluded. All patients were scanned withour routine MR imaging protocol for hip imaging.Results: In 55 of the 79 patients (70%) peritendinitis was detected on MR imagesand 52 of these 55 patients (95%) had these changes on both hips. The medianage was 56 years for the patients with peritendinitis and 35.5 years for the patientswithout peritendinitis. There was significant difference between the median ages ofthe patients (p 0.05) and a significant increased risk of peritendinitis was foundover 40 years of age (odds ratio 15.2 (4.34-53.22)). There was no significant differencebetween male and female patients (p 0.05).Conclusion: Bilateral peritendinitis may be a part of the degeneration processand we suggest that it may not be necessarily reported if the clinical findings donot support greater trochanter pain syndrome.C-636Cutaneous and regional spread of melanoma: Sonographic featuresA. Nunziata, O. Catalano, S.V. Setola, A. Siani; Naples/ITLearning Objectives: To show the typical high-resolution sonography (US) andcolour-Doppler feature recognizable during the superficial spread of melanomastoward their drainage basin.Background: Cutaneous melanoma spreads along the lymphatic channels toreach the regional lymph nodes. Additionally, satellite lesions can be found aroundthe primary tumour and also haematogenous metastasis can develop. US playsa relevant role in the staging and follow-up of cutaneous melanoma, helping toselect patients for the sentinel lymph node biopsy procedure and detecting locoregionalrecurrences.Imaging Findings: We illustrate the appearance of satellite lesions, “in transit”lesions, and distant cutaneous metastases. Hypo-anechoic appearance is thelandmark of poorly-reflecting melanin content. These lesions may show a proximaland/or distal hypoechoic bands due to the lymphatic ducts. Partial metastatic lymphnodes are frequent, with one or more nodules within an otherwise normal lymphnode. Clues to differential diagnosis (scarring, lymphocele, sebaceous cyst, reactivelymph node) are given.Conclusion: US and colour-Doppler can accurately identify the routes throughwhich melanoma spreads. Knowledge of typical and atypical features is mandatoryto avoid an unnecessary sentinel biopsy procedure (when lymph nodes are clearlypositive at US scanning), to avoid incomplete resection of multifocal lesions, or todetect early tumour recurrence during follow-up. Surgeon guidance with US-placeddermographic markers or guide wires is important to minimize the extent of surgicalexploration and excision.C-637Nerve root enhancement on contrast-enhanced MR: DifferentialconsiderationsH. Choo, S. Lee, M. Kim; Busan/KRLearning Objectives: 1. To illustrate normal anatomy to mimic the enhancementof the nerve root. 2. To describe the various disorders manifested as the nerveroot enhancement.Background: Single or multiple extramedullary enhancing lesions along caudaequina of the lumbosacral intradural space on contrast-enhanced MRI are oftenencountered. It can be the normal anatomy of spine or the true abnormality. Thisexhibit describes the normal anatomy to mimic the enhancement of true nerve rootsand the various diseases manifested as nerve roots enhancement.Imaging Findings: The normal anatomy of great radicular vein or filum terminalecan mimic the nerve root enhancement. However, the tendency of typical location ofnormal anatomy is helpful for the differential diagnosis from true nerve root enhancement.There are various disorders manifested as nerve root enhancement. Thesecan be degenerative, inflammatory, infectious, and malignant conditions. The radiologicfeatures and its differential diagnosis of each disease will be illustrated.Conclusion: Normal structures of spine can mimic the nerve roots enhancement.There are various disorders manifested as nerve roots enhancement. Recognitionof these diseases entities would help direct patient management.C-638Evaluation of skeletal muscles after strenuous exercise by using magneticresonance diffusion-weighted and tensor imagesO. Yanagisawa, T. Kurihara, K. Okumura, T. Fukubayashi; Tokorozawa/JP(o.yanagisawa@aoni.waseda.jp)Purpose: Time-course changes in exercise-induced muscle damage have notbeen sufficiently evaluated. This study aimed at investigating the physiological andstructural changes in exercised skeletal muscles by using T2-weighted, diffusionweighted,and tensor images.Methods and Materials: The medial and lateral gastrocnemius and soleus musclesof 7 males were studied. Transverse axial diffusion-weighted (ADC calculation), diffusiontensor (FA calculation), and T2-weighted (T2 calculation) images of the rightleg were obtained using a 1.5-Tesla MR device with a Quadknee coil before andat 1-8 days after ankle plantar flexion exercise with eccentric muscle contraction.Plasma creatine kinase (CK) level and visual analog scale (10 cm) were assessedas a parameter of muscle damage and muscle soreness, respectively. Time-coursechanges in these parameters were analyzed using repeated measure analysis ofvariance followed by the Dunnett test.Results: Only the medial gastrocnemius showed significant changes in the ADC(1.57 to 1.76 × 10 -3 mm 2 /s), FA (0.25 to 0.21), and T2 values (32.6 to 43.0 ms) at3 days postexercise, when compared with each pre-exercise value. The CK valueMusculoskeletalACB D E F G HS469

Scientific and Educational Exhibitsand muscle soreness level peaked at 3 days (142.7 to 6150.0 U/L) and 2 days (0to 8.1 cm) postexercise, respectively (P 0.05).Conclusion: Eccentric muscle contraction causes micro injury (structural damage)to skeletal muscles; this injury induces an increase in the CK value and musclesoreness level. Moreover, muscle damage frequently causes temporal edema,which probably contributes to significant changes in the ADC, FA, and T2 valuesof the medial gastrocnemius.C-639Investigations of muscles with different fibre distribution by using31P-MRSR. Rzanny, N. Stutzig, A. Gussew, H.P. Burmeister, W.A. Kaiser, H.A. Thorhauer,J.R. Reichenbach; Jena/DEPurpose: Different shifts of the muscle’s pH-value in different fibre types can inducetransient splitting of the Pi signal into low- and high-pH-components in 31 P-MRspectra during exercise. The intensity ratios of these components may then beused to estimate non-invasively muscle fibre distributions in vivo.Methods and Materials: Six male volunteers (23-31 years) with different sportivespecializations were examined by 31 P-MRS during rest and exhaustive dynamic load.Dynamic spectroscopic series were acquired in the M. gastrocnemius with a 3 Twhole-body scanner (Magnetom TIM Trio, Siemens, Erlangen, Germany). Volumelocalization was based on the sensitivity of a small-loop, double-tuned 1 H/ 31 P-surfacecoil (Rapid Biomedical GmbH, Rimpar, Germany; diameter: 80 mm).Results: PCr/ATP peak-area-ratios during rest were found to be highest for sprinters(3.78, 3.63) and one sportive active student (3.77), medium for basketball-players(3.45, 3.36) and lowest for one biathlete (3.10). Different components of the Pi signalwere clearly resolved in all volunteers during exercise. Analysis of the distributionof high- and low-pH-components of the split Pi-peak revealed the smallest acidicpH-component for the biathlete (31%), and the largest for one basketball-player(67%), a sprinter (61%) and the student (58%). Nearly half of the Pi-intensity wasrelated to the acidic pH-component for the second sprinter (50%) and basketballplayer(46%).Conclusion: Both PCr/ATP ratios during rest and the distribution of high- andlow-pH Pi-components during exercise differ among athletes with different specialisation,indicating different fibre distributions in the M. gastrocnemius. Exceptfor one basketball-player, the results correspond to the expected fibre distributionknown from literature.C-640Watch your step: Painful conditions of the plantar region of the footF.C . Miranda, R.D. Carneiro, L.A. Rosemberg, C.H. Longo, H.P. Guidorizzi,R.Y. Fernandes, D.C.B. Santos, N.J.T. Kim, M.B.G. Funari; São Paulo/BR(fredericocmiranda@gmail.com)Learning Objectives: To review the anatomy of the plantar compartment of the footand describe the imaging findings of painful conditions arising from or extendinginto plantar region of the foot.Background: Pain in the plantar region of the foot is a symptom with high prevalence,especially in athletes and runners. It can be caused by numerous entities(inflammatory, vascular, cancer, trauma, among others) that can be evaluated by differentimaging methods, from radiography to magnetic resonance imaging (MRI).Imaging Findings: 1) Plantar fasciitis, 2) Morton’s neuroma, 3) Sesamoiditis,4) Plantar vein thrombosis, 5) Fat pad necrosis, 6) Fat pad atrophy, 7) Ulcers indiabetic foot, 8) Plantar infection, 9) Plantar fibromatosis, 10) Trauma, 11) Fascialrupture, 12) Calcaneal entesophyte, 13) Osteonecrosis, 14) Tenosynovitis, and15) Tumors.Conclusion: Many disorders produce discomfort in the plantar region of the footand the cause may be difficult to establish based solely on clinical findings. MRimaging, with its excellent contrast resolution and multiplanar imaging capacity, isuseful in the detection of numerous soft-tissue, as well as bone and joint processesthat occur in this portion of the foot. Radiologists should be familiar with the differentialdiagnosis and MR imaging features of these disorders.C-641Soft tissue solitary fibrous tumour: A pictorial reviewC. Simon-Olivé, J.R. García-Bennett, A. Rivas, R. Dominguez, P. Huguet,M. Perez; Barcelona/ES (cristinasimon@yahoo.es)Learning Objectives: To illustrate the imaging features of soft tissue solitary fibroustumour (SFT) and to correlate these findings with pathological results.Background: This tumour has been recently described as a soft tissue neoplasmwith a wide spectrum of histological features that share common morphology andimmunochemistry. Different tumours have recently fallen into this new category.Although most frequently affecting the pleura, SFT has been reported in almostevery anatomic location. The major preferred extrapleural sites are abdominal cavity,orbit, upper respiratory tract and soft tissue. In this exhibit, we will describe US, CTand MRI findings of soft tissue SFT retrieved from clinical histories in our institutionsince 1993. Two cases were reported as malignant variants of SFT.Imaging Findings: Sonographic images showed well defined, homogeneous, ovalshaped, hypoechoic masses. Posterior reinforcement was not observed and sometumours showed hypervascularity. On CT, these tumours appeared homogeneouswith soft tissue attenuation and heterogeneous enhancement after contrast administration.On MRI sequences, tumours appeared unspecific (hypo/isointense on T1and hyperintense on T2 and STIR). Dynamic contrast-enhanced studies showedhighly vascularized tumours with early uptake and washout SI/T curves, translatingsevere local aggressiveness.Conclusion: Radiological findings of soft tissue SFT are consistent in all casesbut are not sufficient for diagnosis. The differential diagnosis is broad. Althoughthe majority of cases prove to be histologically benign, radiological findings suggestaggressiveness. On the other side, imaging techniques provide an adequatevisualization of the tumour and its relation to adjacent structures.C-642Prevalence of bifid median nerve in patients with clinical signs of carpaltunnel syndromeK.T. Szopinski, T. Mazurczak-Pluta; Warsaw/PL (kazszo@poczta.onet.pl)Purpose: To evaluate the prevalence of bifid median nerve in patients with clinicalsigns of carpal tunnel syndrome.Methods and Materials: 180 sonographic examinations of the median nerve wereperformed with a ATL HDI 5000 scanner, using a linear 7.5 MHz probe in 90 patientswith clinical signs of carpal tunnel syndrome (78 females and 12 males, mean age53). The presence of bifid median nerve was noted, and the cross-section area ofthe branches was measured.Results: Twenty-three (23/180=12.7%) bifid median nerves were found in 20(20/90=22.2%) patients. Bifid median nerves were almost twice more common inmales (5/24=20.8%), than in females (16/156=10.3%). Bifid median nerves werefound on the right side in 7 patients, on the left side in 10 patients, and bilaterallyin 3 female patients. The mean area of the radial branch of the median nerve in thecarpal tunnel was 10.9 mm 2 (range 6-18) on the right side, and 10.1 mm 2 (range3-22) on the left side. The mean area of the ulnar branch of the median nerve inthe carpal tunnel was 3.5 mm 2 (range 1-8) on the right side, and 4.4 mm 2 (range1-10) on the left side.Conclusion: Bifid median nerve is a common finding in patients with clinicalsigns of carpal tunnel syndrome. The presence of this anatomic variant should beconsidered, especially if surgical treatment is contemplated.C-643Magnetic resonance imaging (MR) with sensitization maneuvers forthoracic outlet syndrome (TOS)J.H. Yang 1 , M.C. Francisco2, J.J.H. Yang 2 , A.R.C. Fernandes 2 , M.R. Denardi 1 ,E.H. Figueiredo 2 , S.M.C. Freitas 1 , A.A. Suzan 1 ; 1 Jundiaí/BR, 2 São Paulo/BR(jehoon@uol.com.br)Purpose: To determine diagnostic value of MR with sensitization maneuversamong the patients with TOS.Methods and Materials: 12 unilateral thoracic outlets in 6 healthy volunteers and33 in 21 TOS patients were imaged in a 1.5 T MR scanner. Among the patients, 25in 17 individuals presented clinical and sonographic arterial compression, and 8 in4 patients presented nervous compression. Images in sagittal plane were acquiredfrom anterior scalene to pectoral minor muscles. First, with the arms placed alongthe body, then with sensitization maneuvers: arm was abducted to 135°, head wasextended and rotated toward the abducted arm, and sustained maximal inspirationapnea. The criteria for nervous compression were tight contact of bone or musclesto brachial plexus, or disappearance of the fat surrounding the brachial plexus.Arterial compression was determined when subclavian artery presented at least50% reduction in its diameter, compared to adjacent segments.Results: Healthy volunteers did not demonstrate arterial or nervous compression byMR, with and without sensitization maneuvers. None of the patients demonstratedarterial or nervous compression by MR without sensitization maneuvers. MR withsensitization maneuvers presented 100% sensitivity for neural compression (33/33).Sensitivity for subclavian artery compression was 48% (12/25) among the patientswith arterial compression, and 0% with nervous compression.Conclusion: Sensitization maneuver is required in MR for evaluation of TOS, andit is able to demonstrate nervous compression.CS470 A B D E F FG H

Scientific and Educational ExhibitsC-644Foreign bodies: Their appearance on X-ray, ultrasound, CT and MRIA. Kraus 1 , A. Farooq 1 , E. Buschmann 2 ; 1 Bangor/UK, 2 Newcastle, NSW/AU(alexandra.kraus@nww-tr.wales.nhs.uk)Learning Objectives: To demonstrate the appearance of different types of foreignbodies in different imaging modalities and choose the right modality for detectionof foreign bodies of various size, shape and material.Background: After penetrating injuries, there is often a suspicion of a foreign bodyremaining in situ. Not all imaging modalities are suited to detect various types offoreign bodies.Imaging Findings: We examined the appearance of different types of foreignbodies, e.g. glass, metal and wood, on plain X-ray, ultrasound CT and MRI byintroducing foreign bodies of different sizes, shapes and materials into a pieceof skin-covered meat. This was then examined by different image modalities. Wedemonstrate detectability and appearance of these foreign bodies. Correlation isalso made to appearance of foreign bodies in clinical cases.Conclusion: It is important to know which modality is best suited for the detectionof various types, shapes and sizes of foreign bodies and the limitations foreach modality.C-645Preoperative chemo-radiation therapy in mixoid liposarcoma of theextremities: Correlation between morphologic and perfusional MR patternsand pathological patterns to predict pathologic tumor responseA. Messina, C. Morosi, P. Casali, A. Gronchi, P. Collini, F. Grosso, S. Stacchiotti,D. Vergnaghi; Milan/IT (messanto@tin.it)Purpose: To correlate the morphologic and perfusional MRI patterns and pathologicalpatterns of tumor response to preoperative chemotherapy and radiotherapy inpatients with myxoid liposarcomas of the extremities.Methods and Materials: 13 pts with myxoid liposarcomas of the extremities underwentchemotherapy and radiotherapy, followed by surgery. All pts performed MRexaminations before and after the treatment with a 1.5 T MR system using TSE T2wand dynamic ce 3D-GRE T1w sequences, with perfusional evaluation. All data setswere qualitatively and quantitatively (time/intensity curves) evaluated. RadiologicalMR patterns in responsive pts were considered tumor decrease in size (accordingto Recist criteria) and vascularitation decrease 15% on perfusional evaluation(according to the new Choi response criteria). All pts were evaluated.Results: On morphologic MR evaluation, using dimensional criterion, 7/13 ptshad a RECIST “Partial Response”, 4/13 pts had a RECIST “Stable Disease” and2/13 pts had a RECIST “Progression Disease”. On MR perfusional evaluation,10/13 pts had an MR “Partial Response” pattern, 3/13 had an MR “Stable Disease”pattern and no pts had a “Progression Disease” pattern. Histologically, 10/13 ptshad post-treatment changes (reduction in antitumor activity of the neoplastic tissue)and 3/13 pts had no “tissutal changes”.Conclusion: Morphologic RECIST criteria were able to appreciate only a portionof pathologically responsive patients. The assessment of vascularization on MRperfusional imaging may usefully integrate the dimensional data, in order to clinicallypredict the pathologic tumor response in patients with myxoid liposarcomasof the extremities treated with chemotherapy and radiotherapy.C-646Schwannomas from head to toeE.Y.C. Hsu, S.K. Venkatesh, A.J. Stanley, S. Quek; Singapore/SG(hsueugene@hotmail.com)Learning Objectives: To illustrate the spectrum of imaging appearances of schwannomasin various locations.Background: Schwannomas, also known as neurilemmomas, neuromas, orneurinomas, are uncommon benign tumours arising from the schwann cells of peripheralnerve sheaths and may originate from any peripheral, cranial or autonomicnerve of the body. A vast majority of these are found within the cranial vault, mostcommonly in the cerebello-pontine angles, arising from the vestibular branch ofthe eighth cranial nerve. Uncommonly, they may be found extracranially, typicallyarising from the major nerve trunks. In these uncommon locations, they can pose adiagnostic dilemma, particularly when clinical findings vary with location, and imagingfeatures are also varied. The recognized potential for malignant transformationmeans that schwannomas should be suspected when appropriate.Imaging Findings: Schwannomas usually appear as well-circumscribed fusiformmasses, typically hypoechoic on ultrasound; hypodense on CT, and T1-isointenseand T2- heterogeneously hyperintense on MRI with variable post contrast enhancement.As schwannomas arise from the nerve sheath, it is encapsulated and usuallyhas an eccentric attachment to the nerve. A small exiting or entering nerve rootmay be difficult to identify on imaging, but should alert the reader to this possiblediagnosis if found. However, imaging appearances can be variable and overlap withother soft tissue tumours. Differential diagnoses will vary according to the locationof the tumour and appearance.Conclusion: Schwannomas are important benign soft tissue tumours, and althoughuncommon, can be found in various locations with varied imaging appearances.C-647Hoffa’s fat pad pathology: MR findingsR.M. Maia, P. Santos, M. Gomes, B. Ramos, J. Reis, M. Ribeiro; Oporto/PTLearning Objectives: To illustrate the imagiologic spectrum of Hoffa’s fat padpathology in magnetic resonance imaging.Background: The infrapatellar fat pad of Hoffa is a structure located in the spacebetween the back side of the patellar ligament and the real capsule. It is routinelyvisualized on magnetic resonance (MR) images of the knee. Intrinsic abnormalitiesinclude Hoffa’s disease, localized nodular synovitis, intracapsular chondroma,postsurgery and postarthroscopy fibrosis and shear injury. Extrinsic processes thatmay involve the infrapatellar fat pad include synovial abnormalities (pigmentedvillonodular synovitis; primary synovial chondromatosis; lipoma arborescens; chondrosarcoma;synovial hemangioma; hemophilia; arthritis and synovitis), articulardisorders (meniscal cyst, ganglion cyst, cyclops lesion, intraarticular bodies andjoint effusion) and anterior extracapsular abnormalities.Imaging Findings: Magnetic resonance imaging has become the modality ofchoice in the evaluation of knee disorders, including Hoffa’s fat pad pathology. Theapproach to pathologic processes involving the infrapatellar fat pad of Hoffa issimplified when one is familiar with local anatomy and differential diagnosis. Theauthors reviewed MR exams of the knee performed in their institution and illustratethe imagiologic findings of the many differential diagnosis.Conclusion: It is important to be familiar with the various pathologic entities thatmay occur in the Hoffa’s fat pad. MR is a very useful tool in the study of Hoffa’sfat pad, whose local and systematic involvement is an often ignored cause ofanterior knee pain.C-648Ultrasound guided tendon interventions: Top ten tipsG. Ansede, J. Lee, J. Healy; London/UK (gonzaloansede@gmail.com)Learning Objectives: To describe and illustrate the spectrum of techniques andindications of sonographically-guided tendon intervention. To outline how to set upand deliver an ultrasound guided tendon intervention service.Background: A wide spectrum of sonographically-guided tendon interventions cannow be performed for a number of indications. These diagnostic and therapeuticprocedures play a major role in the management of tendon pathology. The provisionof an efficient sonographically-guided musculoskeletal intervention service ispivotal in the multidisciplinary management of tendon conditions.Procedure Details: 1. Service development & multidisciplinary teams. 2. Technicalconsiderations: imaging & equipment. 3. Consent, complications and audit. 4.Needle position technique. 5. Bursitis. 6. Tenosynovitis. 7. Tendinopathy techniques:A. Analgesia & steroid administration. B. Sclerotherapy. C. Needle tenotomy andAutologous blood injection. 8. Patella tendinopathy. 9. Achilles tendinopathy. 10.Acute & chronic calcific tendinopathy.Conclusion: This exhibit demonstrates the wide spectrum of established and noveltendon ultrasound guided techniques that can be performed quickly, simply andsafely. We provide top tips on which procedures to perform and how to performthem. We also provide tips on setting up an efficient one-stop combined diagnosticand therapeutic service.No Material Submitted to EPOSC-649Leprosy (Hansen’s disease): Why it is important to remember “forgottendiseases” in EuropeA. Sanchez-Montanez 1 , M. Veintemillas 1 , P. Melloni 1 , R. Valls 1 , A. Marin 1 ,T. Sauri 2 ; 1 Sabadell/ES, 2 Girona/ES (asanchez-montanez@tauli.cat)Learning Objectives: To draw attention to the need to modify our focus due tothe high rate of immigration in Europe. To acknowledge the importance of leprosyin the differential diagnosis of osteoarticular disorders, like acral ulcer, where wefirst think about diabetes or rheumatoid arthritis.Background: Leprosy is a chronic granulomatous infection caused by mycobacteriumleprae, an obligate intracellular bacillus that is resistant to alcohol and acids,and stains with Ziehl-Neelsen. It is cryophilic and has an evident neurotropism. Itis mainly transmitted by air and is very prevalent in developing countries. Physicalexamination shows chronic scarred lesions in the digital pulp with distal sharpen-MusculoskeletalACB D E F G HS471

Scientific and Educational Exhibitsing, hypochromic lesions with circinate rim in the limbs, anhidrosis, hypoesthesia/anesthesia, claw hand, fever, and even acral ulcers.Imaging Findings: A wide variety of imaging findings are possible, but the mosttypical are bone resorption and distal phalanx head sharpening (licked candystick appearance), soft-tissue increase, radiolucent areas (abscess), osteitis, andperiostitis. MRI findings include tenosynovitis, neuritis, and ulcers, which maybe associated with arthritis and osteitis. These patients tend to present surgicalamputations.Conclusion: Due to immigration, diseases eradicated in some developed countriesare surfacing again. Thus, it is important to know ‘exotic’ diseases like leprosy toinclude them in the differential diagnosis of ‘domestic’ problems of our patients.C-650Pilomatricoma: Diagnostic value of ultrasoundH. Choo 1 , Y. Lee 2 , J. Lee 2 , S. Lee 1 , M. Kim 1 , M. Oh 1 ; 1 Busan/KR, 2 Taegu/KRPurpose: The purpose of this study was to analyze the accuracy of various diagnosticcriteria for pilomatricoma on the basis of ultrasonic features.Methods and Materials: Sonographic exams were retrospectively reviewed for44 patients with surgically-proven pilomatricomas, and in 43 control subjectswith other subcutaneous tumors except typical lipomas. Two radiologists underconsensus researched for the tumoral shape, margin, echotexture, echogenicity,presence and pattern of posterior shadowing or enhancement, hypoechoic rim andcalcification and vascularization on color Doppler. Chi-square test and Fisher exacttest were used to evaluate the valuable US criteria for pilomatricoma. Significancewas defined at P 0.05.Results: The reliable diagnostic criteria for pilomatricoma were heterogenitiy (sensitivity,37/38; specificity, 20/43; P 0.00001), internal scattered (sensitivity, 35/42;specificity, 10/19; P 0.005) or arc (sensitivity, 8/42; specificity, 19/19; P 0.05)calcification, hypoechoic rim (sensitivity, 29/38; specificity, 33/43; P 0.00001);and posterior shadowing (sensitivity, 12/43; specificity, 42/43; P 0.005). Ellipticalshape, posterior enhancement, linear calcification were significantly more commonin other subcutaneous tumors (P 0.05). Tumoral margin, echogenicity andvascularization on color Doppler were not useful criteria.Conclusion: This study indicates that US is helpful in the diagnosis of pilomatricomawith detection of heterogenitiy, internal scattered calcification, hypoechoicrim and posterior shadowing.C-653Long head of biceps brachii tendon, biceps-labral complex and the bicepspulley: Evaluation with MRI and MR arthrogram of the glenohumeral jointJ. Singh, S. Tapasvi, A. Babhulkar; Pune/IN (joshitasingh@hotmail.com)Learning Objectives: To illustrate the anatomy of the intra-articular long head ofbiceps tendon, the biceps-labral complex and the biceps pulley. To illustrate variouspathologies affecting the long head of biceps brachii.Background: MRI and MR arthrogram of the glenohumeral joint is a frequentlyperformed imaging procedure. The long head of biceps originates from the posterosuperiorlabrum and superaglenoid tubercle, traverses the rotator interval and isstabilized as it enters the bicipital groove by a pulley formed by the coracohumeralligament and superior glenohumeral ligament. Understanding the anatomy of bicepstendon and biceps-labral complex is crucial to an accurate interpretation ofpathologies and their differentiation from normal anatomical variants.Procedure Details: Patients underwent MRI and MR arthrogram of the glenohumeraljoint with multiplanar fat saturated proton density, T2 TSE, T1 SE, GREsequences and post arthrogram fat saturated T1 SE sequences. In this exhibit, wedepict the normal anatomy along with variants of the long head of biceps, the bicepslabral complex and the biceps pulley. We discuss various pathologies involving thelong head of biceps including tendinosis, tenosynovitis, tendon rupture, dislocationsubluxation,biceps pulley lesions and SLAP tears.Conclusion: The long head of biceps is an important stabilizer of the glenohumeraljoint that can be involved with various degenerative, traumatic and sports relatedinjuries. Understanding the anatomy helps accurately define pathologies.C-651Sonography of the median, ulnar and radial nerves: How we do itN. Chew, J. Healy, J. Lee; London/UK (drchew01@googlemail.com)Learning Objectives: To describe and illustrate the normal anatomical courseof the median, ulnar and radial nerves from their origin from below the brachialplexus to the wrist, with sonographic correlation. To illustrate the morphology andsize of the peripheral nerves in normality. To describe common normal variantsand pathology involving the peripheral nerves.Background: High resolution ultrasound has revolutionised the imaging of peripheralnerves. Compared to MRI, this modality is cheaper and allows dynamicevaluation of the nerves.Procedure Details: The method of identification of the individual nerves is illustrated.A spectrum of common pathology is also demonstrated.Conclusion: Ultrasonography accurately depicts the medial, ulnar and radial nervesand can be used as an excellent modality in evaluation of these nerves.C-652Sonographic guided intervention of Achilles tendinopathy: How we do itand a review of its current evidenceN. Chew, N. Wijesekera, J. Lee, J. Healy; London/UKLearning Objectives: To review the role of ultrasound in the diagnosis of Achillestendinopathy (AT). An overview of techniques available in treatment of AT. Describeour experience in these utilising these techniques.Background: Achilles tendinopathy is a common overuse syndrome in sportsmen.Non-surgical intervention is the first line treatment. Surgery is reserved when conservativemanagement has failed. In this exhibit, we describe the sonographic guidedtechniques we utilise to treat this condition and review their evidence basis.Procedure Details: Available procedures include: a) intratendinous lidocaine injectionand peritendonous corticosteroid injection, b) dry needling and autologous bloodinjection, c) sclerosis of neovessels with polidocanol and hyperosmolar dextrose, d)electrocoagulation, and e) percutanous tenotomy. We describe the techniques wecommonly use and explain their reasoning based on the best available evidence.Conclusion: A variety of techniques can be used in treatment of Achilles tendinopathy.We describe our experience in this field.CS472 A B D E F FG H

Scientific and Educational ExhibitsMusculoskeletalSpineC-654Imaging assessment of postsurgical cervical spineP. Bartumeus-Martinez, M. Graells-Ferrer, M. Vega-Martinez, S. Muñoz-Donat;Valencia/ES (bartumeus_pau@gva.es)Learning Objectives: To familiarize the radiologist with indications and techniquesfor cervical spine surgery, illustrating the spectrum of instrumentation and the expectedpostoperative radiological findings, as well as the most frequent potentialcomplications. To describe the utility of each imaging modality depending on thetype of surgery and clinical situation.Background: Imaging assessment of lumbosacral spine following surgery has beenthoroughly reported. However, postoperative imaging of cervical spine has not beenwidely described despite the recent increase in number and tremendous technicaladvances of procedures. We retrospectively reviewed all patients that underwentcervical spine surgical procedure at our hospital during the last 4 years, with a totalof 150 patients. Surgery was performed for a wide spectrum of indications, includingcorrection of degenerative deformities, trauma, infection and tumour. Follow-up wascarried out in all patients with plain radiography and complementary techniques(CT, MR and NM) with recurrent or persistent symptoms.Imaging Findings: All images were evaluated for implant’s optimal appearancesand location and integrity of all anatomic structures of the cervical region, describingthe most important potential complications: hardware failure, suboptimal positioningof instrumentation, fractures, incomplete fusion, degenerative changes, instability,infections, collections and haematomas.Conclusion: The increasing number and variety of cervical spine surgical proceduresmakes necessary that radiologists become familiar with postsurgical findings,types of graft material more frequently employed in every clinical ground and mainsuspected complications. Radiologists can play an important role improving communicationwith surgeons by accurately evaluating the imaging modality requiredfor each clinical situation.C-655Complex craniocervical injury: Patterns of injury and the role ofmultidetector CTN.J. Coupe; Stone/UK (optimus2050@hotmail.com)Learning Objectives: 1. To review normal anatomy and traumatic injury patternsof the cervical spine. 2. To recognise the role of multidetector CT (MDCT) withmultiplanar reformats (MPR) in the evaluation of trauma of the cervical spine. 3. Touse MDCT to infer stability and identify the need for further evaluation with MRI.Background: In patients who have suffered traumatic injury, the cervical spine isroutinely imaged in the standard radiological survey according to ATLS guidelines.Increasingly, MDCT is used in the acute setting due to increased accuracy comparedto plain radiographic imaging in the delineation of fractures and dislocations.Spiral MDCT allows images to be viewed in any plane with little or no degradationof image quality. The ability of plain films and MDCT to diagnose ligamentous andcord injuries is limited primarily to secondary signs and this is further illustratedwhere patients have had subsequent MRI.Imaging Findings: Our exhibit revises anatomy, and reviews the patterns of injurywith particular emphasis on the diagnostic power and limitations of MDCT comparedto plain film and MRI. Cases reviewed include typical, atypical and complex cervicalspine injuries with associated plain X-ray, CT and MRI findings.Conclusion: Radiologists need to recognise stable and unstable injuries of thecervical spine and to know the diagnostic advantages of MDCT, the limitationsof plain films, and the value of MRI in evaluating for spinal cord and ligamentousinjury where appropriate. This will help to reduce patient morbidity and ultimatelyimprove outcomes.C-656Ten things not to miss on a MRI scan of the lumbar spineP. Balan 1 , R. Kishore 1 , R. Rhys 2 ; 1 Cardiff/UK, 2 Llantrisant/UK(drbalan@hotmail.com)Learning Objectives: 1. To illustrate the important diagnoses and significant pathologyon routine MRI scans of the lumbar spine. 2. To provide a systematic approachfor reporting lumbar spine MRI. 3. To highlight the potential pitfalls.Background: MRI scan of the lumbar spine is one of the more commonly performedinvestigations in most radiology departments. A systematic approach will ensureaccurate diagnosis and prevent errors.Procedure Details: We use a comprehensive pictorial review to describe andillustrate ten significant abnormalities relating to marrow, disc and soft tissuescovering a wide range of pathologies such as infection, inflammation and infiltration.We include significant pathology in the periphery of the field of view, which canpotentially be missed unless attention is paid to these review areas.Conclusion: The major learning points are: 1. significant pathology not to be missedon lumbar spine MRI, in particular, infection and neoplastic infiltration and 2. to checkspecific review areas looking for pathology in the periphery of the field of view.C-657Normal zygoapophyseal joint sign on MR: The useful finding fordistinguishing between degenerative and isthmic spondylolisthesisW. Liu, G. Choi, S.-H. Lee, H. Park, D. Yoon, T. Ahn, S. Park; Seoul/KR(weichiang@mac.com)Purpose: The purpose of this study was to evaluate the significance of normalzygoapophyseal joint sign to differentiate isthmic from degenerative spondylolisthesis.Methods and Materials: Three hundred patients who were treated with anteriorand posterior interbody fusion due to spondylolisthesis were enrolled in this study.These were composed of 78 men and 222 women. The average age of the patientsat the time of admission was 56.9 years, ranging from 21 to 77 years. Weretrospectively reviewed using normal zygoapophyseal joint sign on axial MR todifferentiate isthmic from degenerative spondylolisthesis.Results: Isthmic spondylolisthesis (n=143) and degenerative spondylolisthesis(n=157) were confirmed with conventional radiography, CT, and MRI. Normal zygoapophysealjoint sign showed 141 of 143 (98.6%) in isthmic spondylolisthesisand 2 of 157 (1.3%) in degenerative spondlolisthesis (p 0.000).Conclusion: Normal zygoapophyseal sign on axial MR is a reliable predictor ofpresence of defects of the pars interarticularis of a spondylolisthesis. This sign couldbe a useful finding for distinguishing isthmic from degenerative spondylolisthesis.C-658Thoracolumbar fractures - radiological diagnostic and surgical treatmentconcepts: A pictorial essayM. Reiss-Zimmermann 1 , S. Katscher 1 , J. Fuchs 1 , T. Kahn 1 , T. Schulz 2 ;1Leipzig/DE, 2 Jena/DELearning Objectives: To illustrate the spectrum of fractures of the thoracolumbarspine. To outline dis-/advantages of different radiological modalities. Short up-todateexcursion on spine classifications and surgical treatment concepts. To displaypostoperative results and possible complications.Background: Böhler initially attempted to classify thoracolumbar spine fracturesin 1930. Since then, this injury has received much attention in the literature asregards its radiological diagnosis and also its clinical management. Thoracolumbarvertebral fractures are not only characterized by frequent osteoligamentousinstability, but also often by irreversible damage to the intervertebral disc andneurological complications.Imaging Findings: Surgical management depends on classification of thoracolumbarfractures for which the Magerl-classification is mainly used in Europe.This classification separates injuries due to compression, flexion/distraction orrotational components. Although plain radiography (CR) can diagnose vertebralfractures in most cases, CT is often used additionally to categorize the fractureas a navigation dataset and postoperative control. In cases of suspected ruptureof the posterior ligamentous complex or osteoporotic fractures, MRI is mandatory.Postoperative imaging provides an estimation on transpedicular fixation andreposition of spinal deformation.Conclusion: Due to its high incidence, image findings of vertebral fractures,postoperative changes and complications need to be well-known. Diagnosis mainlydepends on CR and CT; MRI is needed in cases of osteoligamentous trauma andosteoporosis. A comprehensive diagnostic algorithm will be presented.MusculoskeletalACB D E F G HS473

Scientific and Educational ExhibitsC-659A comparison of limited MRI of the axial skeleton (lumbar spine and pelvicbones) with whole body bone scintigraphy in detecting bone metastasisfrom prostate carcinomaR. Kenningham, R. Beable, A. Rajesh, K. Mulcahy; Leicester/UKLearning Objectives: The addition of the limited retroperitoneal sequences to theprostate scan may increase the detection of bone metastatic disease to a level thatcan be achieved with bone scintigraphy.Background: Patients undergoing staging for prostate carcinoma traditionally haveMRI of the prostate for local staging and, if warranted, isotope bone scan to stagedistant metastatic disease. Regional MRI has been proved to be more sensitivethan isotope bone scan at detecting metastasis and more recent work on wholebody MRI has reproduced these results. We have compared limited MRI of the axialskeleton against whole body isotope bone scan in staging bone metastasis.Imaging Findings: Of 241 eligible patients, there was agreement between thebone scan and MRI in 226 of cases, of which 208 had both scans negative. Therewere 4 cases where the bone was deemed positive, but MR negative. Similarly,there were 4 cases where the bone scan was deemed negative, but MR positivefor metastatic disease. In 7 cases the bone scan was equivocal. In three of theequivocal cases, the limited MRI protocol confirmed metastasis.Conclusion: A modified MR protocol, including the lumbar spine, performs veryfavourably when compared to `standard` imaging protocol for the assessment ofbone metastases in prostate cancer.C-660Cervical spine involvement in rheumatoid arthritis: Role of imagingS. Kriaa, S. Ben Elghali, M. Younes, C. Hafsa, R. Salem, M. Jellali, N. Bergaoui,M. Golli; Monastir/TN (soulef.kriaa@gmail.com)Purpose: To determine the role of conventional radiographs, computed tomographyand MRI of the spine in the diagnosis of cervical rheumatoid involvement.Methods and Materials: 40 consecutive patients suffering from rheumatoid arthritiswere included in the study. All patients were examined with cervical spine radiography,frontal and lateral projection with dynamic study, open-mouth incidence,computed tomography and MRI of the cervical spine.Results: Conventional radiographs detected anterior atlantoaxial dislocation in 9cases (22.5%), C1-C2 arthritis in 9 cases, lateral dislocation in 5 cases (12.5%),vertical atlantoaxial dislocation in 4 cases (10%), rotatory dislocation in 4 cases(10%) and posterior dislocation in 1 case. Sub-axial dislocation in 4 cases, inflammatoryspondylodiscitis in 3 cases. Computed tomography lateral and rotatorydislocation in 4 cases (10.3%), posterior dislocation in 1 case (2.56%) and odontoiderosion in 16 cases (41%). MRI showed odontoid destruction in 27 cases (67.5%),synovial pannus in 25 cases (62.5%), anterior atlantoaxial dislocation in 7 cases(17.5%), inflammatory spondylodiscitis in 5 cases (12.5%), Sub-axial dislocationin 4 cases (10%), Basilar impression in 4 cases, posterior dislocation in 1 caseand cord compression in one case.Conclusion: Functional plain radiography was superior to functional MRI in identifyinganterior atlantoaxial dislocation. Computed tomography is the investigationof choice to detect rotatory dislocation. MRI provides more information to detectC1-C2 arthritis, and inflammatory spondylodisicitis. It demonstrates to be theimaging method of choice to detect the pannus and spinal cord compression bythe synovial pannus.Imaging Findings: Different examples of calcification and ossification in the spineare shown, including ligament involvement (calcification of the anterior or posteriorlongitudinal ligament or of the ligamentum flavum), arthritis and enthesopathy(ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis and bursal synovialosteochondromatosis), systemic depositional diseases (calcium pyrophosphatedihydrate and hydroxyapatite deposition disease), disk calcifications and normalvariants (such as spur projections), We also describe primary spinal tumors andtumorlike lesions (bone-forming tumors, cartilage-forming tumors, soft-tissuetumors).Conclusion: The spine can be affected by a variety of processes that may producecalcifications or ossifications. MDCT helps the radiologist to establish the properdifferential diagnosis and to evaluate their clinical importance.C-662Primary vertebral body Ewing’s: A diagnostic dilemmaV. Sindhwani, D.P. Mueller, D. Vaslow; Columbia, MO/US(sindhwaniv@health.missouri.edu)Learning Objectives: 1) Lesions mimicking primary vertebral body Ewing’s. 2) Asequential imaging based approach to differentiate one from the other. 3) Specificfeatures of primary vertebral body Ewing’s. 4) Imaging based prognostic indicatorsand their impact on patient management.Background: Varied lesions can mimic vertebral body Ewing’s posing a diagnosticchallenge. Clinically and radiographically: primitive neuroectodermal tumor (PNET)and Langerhans cell histiocytosis, Other small round cell tumors (lymphoma, leukemia,myeloma and metastatic neuroblastoma), osteomyelitis, osteosarcoma andother primary sarcomas and metastatic disease can have similar characteristics.Delay in diagnosis poses serious threat to prognosis and eventual outcome, therebymaking it utmost important to differentiate one from the other.Imaging Findings: MRI best shows involvement of adjacent bones & soft tissues,which can be underestimated on CT scan. Sagittal T1WI, axial and sagittal STIR,post-contrast T1WI are most important sequences. Plain radiographs, CT scan,bone scan & PET all have a sequential role in differentiating these varied lesionsfrom one another.Conclusion: 1) It is of prime importance to differentiate varied lesions from primaryvertebral body Ewing’s and in a didactic format this exhibit outlines the same. 2)Hallmark imaging features of different lesions mimicking Ewing’s. 3) By the end,the readers will be able to organize their thoughts as to how different imaging modalitiesare to be used in a particular sequential order to reach diagnosis affectingpatient management. 4) And above all readers will have an appreciation of differentimaging prognostic indicators.C-661Looking for calcium the spine: Clinical importance of spinal calcificationsseen in MDCTJ.A. Aguilar Arjona, E. Santos Armentia, R. Prada Gonzalez, D. Castellon Plaza,G. Tardaguila de la Fuente, J. Calatayud Moscoso del Prado; Vigo/ES(jantonioaguilar@hotmail.com)Learning Objectives: To review the different kinds of calcifications and ossificationsthat can be found in the spine. To describe the typical imaging findings of thesecalcifications in the study with 16 and 64-MDCT.Background: When a MDCT of the spine is performed, a great variety of calcificationsand ossifications can be found involving the vertebral bodies, intervertebralspaces and adjacent soft tissues. Although some of them are normal variants orcasual findings, other may reflect different kinds of pathology (metabolic or rheumaticdeseases deposition disease, degenerative changes, tumors etc). The knowledgeof the different spinal calcifications is an essential tool to narrow the differentialdiagnosis of spinal pathology.CS474 A B D E F FG H

Scientific and Educational ExhibitsMusculoskeletalMiscellaneousC-663Computer-assisted diagnosis in radiology: State-of-the-art methods inresearch of musculoskeletal diseasesA. Valentinitsch, F. Kampl; Vienna/AT (m0299vaal@edu.fh-kaernten.ac.at)Learning Objectives: To become familiar with the current state of CAD applicationsof the musculoskeletal system.Background: Computer-assisted diagnosis (CAD) is an emerging medical researcharea. It aims at improving medical diagnosis by providing the physician with toolsto support decision-making by automatically extracting useful measurements fromdata. Due to the difficulty in interpreting the large amount of medical image datanow available, computer based methods for extracting important features fromimages are becoming increasingly significant. The best validation of CAD applicationshas been performed in medicine because of the high demand for precisediagnostics in this field.Procedure Details: There are approaches of CAD methods for musculoskeletaldiseases, predominantly based on active appearance models, which are well suitedfor the task of automated investigation of medical images to collect quantitativebiomarkers. A prototypical method of CAD of inflammatory joint destruction wasdeveloped, which allows a fully automatic measurement of the joint space widthof selected finger joints and to detect irregularities of bony surface such as erosionson digital radiographs. Another CAD application was designed for precisequantification and comparative evaluation of knee cartilage MRI parameters tomeasure local thickness and volume. However, the mentioned CAD-applicationsare at this point only used in research and still need to be tested and evaluatedreliable before they gain the acceptance of clinical physician.Conclusion: CAD tools can increase detection rates, though problems have to besolved when structures interfere with each other on medical images.NeuroBrainC-664Normal variants of the cerebral circulation on CT angiographyS.J. Dimmick, K.C. Faulder; Sydney/AU (sdimmick@gmp.usyd.edu.au)Learning Objectives: To illustrate the common normal variants of the cerebralcirculation and correlate their prevalence and clinical relevance and the prevalenceof associated anomalies and aneurysms with the literature.Background: Multi-detector Computed Tomography (MDCT) angiography is themodality of choice for the initial evaluation of the cerebral circulation in the settingof acute stroke or subarachnoid haemorrhage. Knowledge of the normal variantsand persistent foetal arteries, their prevalence and clinical relevance including associationswith other anomalies and intra-cranial aneurysms is extremely importantand may play a crucial role in the diagnosis and management of acute stroke andsubarachnoid haemorrhage.Procedure Details: Retrospective analysis has been undertaken of 300 MDCTangiograms of the Circle of Willis conducted from the 1 st of January 2007 to the 1 stof February 2008 at the Royal North Shore Hospital (Sydney). Three dimensionalreconstructions using Advantage Workstation 4.3 (General Electric, Milwaukee)have been produced to illustrate the relevant normal variants. This study classifiescerebral circulation normal variants into four categories: fenestrations/duplications,variants of the Circle of Willis, persistent carotid-basilar anastamoses and variantswithin the skull base. An extensive literature review has been undertaken to correlateclinical relevance and prevalence of these variants, associated anomaliesand possible sites of associated aneurysm formation.Conclusion: This study demonstrates the value of 64 slice MDCT angiography inelegantly depicting the commonly known, rare, and in this study, newly describednormal variants of the cerebral circulation.C-6654D imaging in cerebrovascular insufficiency by using 320-detector row CTG. Bohner, E. Siebert, M. Dewey, H.-C. Bauknecht, S. Diekmann, F. Masuhr,R. Klingebiel; Berlin/DE (georg.bohner@charite.de)Purpose: To report initial experience with a 320-detector row CT scanner in assessingcerebrovascular (CV) disorders.Methods and Materials: 26 patients with acute and/or chronic CV insufficiencyunderwent 320-detector row CT. Single-rotation CT of the head, incremental CTangiography (3D CTA) as well as 4D whole-brain CTA (4D CTA) and whole-brainCT perfusion (CTP) were performed and assessed for image quality in comparisonwith 64-detector row CT scanner protocols.Results: 320-detector row CT neuroimaging could be performed in all cases. Inferiorimage quality was noted for the 320-detector row protocols of the head CT and the3D CTA compared to 64-detector row protocols. Image quality of the 4D CTA wasrated inferior compared to both the 320-detector row and the 64-detector row 3DCTA. 4D CTA and CTP imaging provided dynamic angiographic and whole-brainperfusion information with pivotal clinical implications.Conclusion: 320-detector row CT neuroimaging is a feasible method that permitswhole-brain 4D imaging with promising potential regarding pathologies with alteredhemodynamics. However, image quality limitations are a drawback at present.C-666Proton magnetic resonance spectroscopy (MRS) in the evaluation ofdiffuse axonal injuryW.B. Zheng, H.D. Zhang, G.R. Liu; Shantou/CN (hwenb@126.com)Purpose: To determine whether proton magnetic resonance spectroscopy (MRS)would be accurate in predicting long-term outcomes of patients with diffuse axonalinjury.Methods and Materials: Sixty-one victims (14 - 51 years, mean age, 24.3 years)of traumatic brain injury who were in the coma state immediate and prolongedunconsciousness between 1 day and 30 days after injury underwent MRI andMRS studies. The N-acetyl aspartate to creatine (NAA:Cr) and Choline to creatine(Cho:Cr) ratios were obtained for the occipital lobe and the corpus callosum of 61patients and ten healthy volunteers. Sixty-one patients were divided into group A( 1 w), group B (1~2 w) and group C (2 w~30 d) according the time point theyunderwent MRS after injury.Results: On conventional MR images, thirty-seven patients were with normalappearingand 24 patients were with visibly-injured in the corpus callosums,respectively, all patients were with normal-appearing in occipital lobes. A significantNeuroACB D E F G HS475

Scientific and Educational Exhibitsdecrease in NAA/Cr and increase in Cho/Cr was observed in the occipital lobes ofpatients (P .001) compared with controls. For the location of MRS acquisition, thecorrelation between NAA/Cr and Glagow Outcome Scale score (GOS) (r =0.777,P=.000) was stronger in occipital than that in corpus callosums. For the early timepoint following injury, the strongest correlation was between NAA/Cr in the occipitaland GOS of group A (r =0.910, P=.000).Conclusion: Early MRS in brain that appeared normal on imaging is more accuratefor predicting long-term outcomes for patients with DAI.C-667Early proton magnetic resonance spectroscopy (MRS) in patients afteraxonal injury: Correlation with clinical outcomeW.B. Zheng, H.D. Zhang, C.L. Ma; Shantou/CN (hwenb@126.com)Purpose: We studied the relationship of normal-appearing occipital regions NAA,choline (Cho), and creatine (Cr) to test the hypothesis that reduction in NAA ispredictive of Glagow Outcome Scale score (GOS).Methods and Materials: Thirty-one victims (17 - 49 years, mean age, 27.3 years)of traumatic brain injury who were in the coma state immediate and prolongedunconsciousness between 1 day and 20 days after injury underwent MRI andMRS studies. The N-acetyl aspartate to creatine (NAA:Cr) and Choline to creatine(Cho:Cr) ratios were obtained for the occipital lobe of 31 patients and ten healthyvolunteers. Spectra in the normal appearance of the occipital lobe of the graymatter (midline) were averaged for analysis by using LC Model, with a phantomestablishedbasis function, for quantification of NAA, Cho, and Cr concentrations.GOS was determined at least 3 months after injury.Results: NAA concentration was lower in TBI patients than in control subjects,but no group differences were present for Cho or Cr. The correlation was foundbetween NAA of the normal-appearing occipital regions and GOS. Two patientswith low NAA after injury remained in a persistent vegetative state, whereas sixpatients with normal NAA recovered with a good outcome.Conclusion: NAA levels remain low after TBI and are related to GOS. MR spectroscopycan quantify damage after TBI, and NAA levels may be a sensitive indicatorof the neuronal damage that results in a worse clinical outcome.C-668Diffusion tensor analysis in treatment-resistant depression:A preliminary studyY. Zhou, J.-R. Xu, L.-J. Qian, H.-L. Zhao; Shanghai/CNPurpose: Treatment-resistant depression (TRD) is a therapeutic challenge for theclinician. The aim of this study is to investigate potential white matter abnormalitiesin patients with TRD, and try to further understand the pathologic mechanisms ofTRD.Methods and Materials: Subjects with TRD (n=15), first-episode depression (n=10)and healthy controls (n=15) were recruited. Groups were matched for age, genderand education. All subjects underwent DTI and structural magnetic resonance imaging(MRI) scans. Voxel-based analysis was performed to investigate brain regionswhere fractional anisotropy (FA) values differed significantly between groups.Results: In TRD patients, FA values significantly lower than those in healthy controlswere located in the white matter of right inferior frontal gyrus, right superiortemporal gyrus, left superior frontal gyrus, left anterior cingulated gyrus and rightextra-nuclear. While comparing with the first-episode depression patients, FAvalues were significantly lower in the white matter in left frontal lobe, left extranuclear, left inferior parietal lobule, right extra nuclear, right amygdale and leftcingulated gyrus.Conclusion: Widespread structural disconnectivity including the subcorticalregions is already presenting in patients of depression in their first episode ofillness. And the severity of and the location of the disconnectivity may be relatedto the treatment outcome.C-669Multimodality imaging of intractable epilepsy: A comprehensive reviewand pictorial essayT. Nishiguchi, S. Sakamoto, N. Tsuyuguchi, Y. Inoue; Osaka/JP(tomokazu-n@med.osaka-cu.ac.jp)Learning Objectives: To review protean epileptogenic pathologies and to discussthe role of radiology for successful image interpretation.Background: Although radiological approach is of little benefit in idiopathic generalizedseizure, the main purpose of neuroimaging in epilepsy patients is identifyingunderlying structural abnormalities that are epileptogenic in most partial seizures.Focal epileptogenesis is categorized into: (1) hippocampal sclerosis, (2) malformationsof cortical development, (3) neoplasms, (4) vascular lesions, (5) gliosis and(6) miscellaneous. Dedicated imaging sequences, a systematic approach andcareful image interpretation are mandatory in recognizing these focal lesions anddifferentiating pathologic conditions from normal variation or minor asymmetrybecause they can be subtle and easily missed on imaging studies.Procedure Details: Optimal MR imaging parameters rely on pulse sequences andslice thickness. FLAIR sequences appear to have the best sensitivity for depictingabnormal signals. Short-tau inversion recovery sequences (STIR) and T1-weighted3-D gradient imaging acquisition contribute to assessing the morphology of thesubtle structural abnormality especially in hippocampus. Diffusion tensor andfunctional MR imaging is useful in preoperative localization of the motor strip andeloquent region adjacent to the epileptogenic foci. In addition to neurologic assessment,fluorodeoxyglucose positron emission tomography (FDG-PET) or magneticsource (MS) imaging superimposed on conventional MR images preoperativelyprovide adequate functional information for epileptogenic foci.Conclusion: Neuroimaging plays a pivotal role in the evaluation of patients withintractable epilepsy. Advances enabling higher spatial resolution, excellent tissuecontrast, multiplanar imaging capability and functional assessment by MR, CT, PETand MS imaging are increasingly expected.C-670Reproducibility of CT brain perfusion assessment in patients with carotidartery stenosisZ. Serafin, A. Nowak-Nowacka, M. Kotarski, R. Mindykowski, M. Karolkiewicz,W. Lasek, S. Molski; Bydgoszcz/PL (serafin@cm.umk.pl)Purpose: To determine intraobserver, interobserver, and interexamination variabilityof brain perfusion CT (PCT) absolute measurements in patients with significantcarotid artery stenosis, and to evaluate the effect of the use of relative perfusionvalues on the reproducibility.Methods and Materials: Imaging was completed in 61 patients before endarterectomy,and in 38 after the treatment. Cerebral blood flow (CBF), cerebralblood volume (CBV), time to peak (TTP), and peak enhancement intensity (PEI)were calculated. Interexamination variability was evaluated based on perfusion ofhemisphere contralateral to the treated CAS, from repeated examinations. Interobserverand intraobserver variability were established for untreated side, basedon pre-treatment examination.Results: Interobserver and intraobserver variability were the highest for CBF(28.8 and 32.5%, respectively), and interexamination variability was the highest forCBV (24.1%). Intraobserver and interobserver variability were higher for absoluteperfusion values compared with their ratios for CBF and TTP. The only statisticallysignificant difference between perfusion values measured by two observers wasfor CBF (mean 78 vs. 67.5 ml/100 g/min). The interexamination variability of TTP(12.1%) was significantly lower than the variability of other absolute perfusionmeasures, and the interexamination variability of ratios were significantly lowerthan absolute values for all the parameters.Conclusion: In longitudinal studies in patients with chronic cerebral ischemia,PCT ratios and either TTP or CBV are more suitable measures than absoluteCBF values, because of their considerably lower inter and intraobserver variability.Differences in CBF between two examinations as high as 30% may be consideredas significant in such patients.C-671Susceptibility-weighted MR imaging (SWI): Review of clinical applicationsM. Arraiza, M. García de Eulate, P. Dominguez, C. Hernandez, B. Zudaire,J. Broncano, M. Herraiz, J.L. Zubieta; Pamplona/ESLearning Objectives: To evaluate and review the clinical applications of susceptibility-weightedimagine (SWI) as a new imaging method that maximizes sensitivityto magnetic susceptibility effects and to demonstrate its usefulness helping thediagnosis of many clinical conditions.Background: SWI is a 3D gradient-echo (GE) sequence that combines both magnitudeinformation (conventional T2* GE) with phase information, to accentuate thevisibility and diagnosis of susceptibility foci like smaller veins (deoxihemoglobin) andother sources of susceptibility effects (hemosiderin, ferritin and calcium).Imaging Findings: We present a review of a variety of cases with different pathologiesusing this unique MR sequence: vascular malformations, specially thoseof low flow (venous angiomas, cavernomas and telangiectasias), brain tumors(neovascularity, hemorrhages and calcifications), diffuse axonal injury (DAI), traumaticbrain injury, acute infarct with hemorrhage, cerebral microbleeds (cerebralamyloid angiopathy), subarachnoid hemorrhage, siderosis and other situations ofdeposition of iron and calcium.CS476 A B D E F FG H

Scientific and Educational ExhibitsConclusion: Susceptibility weighted imaging (SWI) is a technique that providesadditional information, characterizing diverse brain diseases according to themagnetic susceptibility effect. This new technique (SWI) improves the diagnosisbecause it offers much more sensitivity than conventional T2* imaging.C-672Meningioangiomatosis: CT and MRI features correlation with pathologicalfindingsZ.W. Yao , X.Y. Feng; Shanghai/CN (aocnhnr@126.com)Purpose: Meningioangiomatosis (MA) is a rare, benign, localized lesion of leptomeningesand underlying cerebral cortex. Preoperative diagnosis is difficultand challenging due to its diverse clinical, pathological and imaging features. Weretrospectively analyzed 7 cases of MA to explore any correlation of their imagingand pathological features.Methods and Materials: Imaging studies including computed tomography (CT)and magnetic resonance (MR) images obtained in 7 patients with surgically andpathologically verified intracranial meningioangiomatosis (not associated with neurofibromatosis)were reviewed. CT studies were performed in axial plane withoutiodinated contrast material administration; MR studies consisted of axial T1-, T2-,FLAIR and post-contrast T1-weighted sequences and coronal or sagittal, pre- andpost- contrasted T1-weighted sequences.Results: CT images showed focal extensively calcified lesions in 3 cases, lesionswith patchy calcification in 2 cases, and no apparent calcification in 2 cases. MRimages demonstrated predominantly hypointensity on T1-weighted images andhyperintensity on T2-weighted images. 5 of 7 cases exhibited gyriform hyperintensityon FLAIR sequences, which correlated with proliferating microvessels with perivascularcuffs of spindle-cell proliferation within the cortex on histopathology. Aftercontrast material administration, all but one showed heterogeneous enhancement.The non-enhancing lesion on MR imaging was completely calcified on CT.Conclusion: Gyriform hyperintensity on FLAIR sequence is the main MR featureof meningioangiomatosis, which correlates with proliferating microvessels withperivascular cuffs of spindle-cell proliferation within the cortex on pathology. PlainCT scan is necessary to demonstrate the extent of calcification of these lesions.C-673Accuracy of reporting of cerebral atrophy by consultant neuroradiologistsand traineesC. Farrell, J. Wardlaw; Edinburgh/UK (catfarrell2@yahoo.co.uk)Purpose: The finding of cerebral atrophy on an MR or CT brain may influencediagnosis and management in elderly patients with borderline cognitive function.This study aims to evaluate whether radiologists under or over reported cerebralatrophy in elderly patients.Methods and Materials: 3 consultant neuroradiologists and 5 senior radiologytrainees evaluated a total of 99 MR brain examinations in elderly patients, commentingon the presence or absence of atrophy and its degree if present. Theradiologists then re-evaluated the scans following a time interval of at least 2 weeksusing a template showing a range of normal brain sizes, created from patients withnormal cognitive function.Results: Of 99 MR examinations assessed by eight radiologists, 39/58 scans(67%) reported as moderate or severe atrophy without the template were reportedas normal when reference was made to the ‘normal range’ template (p=0.00011).There was no difference in the over-reporting of cerebral atrophy by consultantneuroradiologists (38.9%, p=0.03) and trainees (40.0%, p=0.00069).Conclusion: Both consultant neuroradiologists and trainees significantly overreportedthe presence of cerebral atrophy when asked to review MR brain scansin an elderly population.C-674Cerebral metabolic changes in neurologically presymptomatic patientsundergoing hemodialysis: In vivo proton MR spectroscopic findingsM.-L. Chiu, T.-S. Jaw, T.-J. Hsieh, Y.-T. Kuo, J.-M. Chang; Kaohsiung/TW(alan6021@gmail.com)Purpose: To investigate silent metabolic changes in the brains of end-stage renaldisease (ESRD) patients undergoing hemodialysis by in vivo proton magneticresonance spectroscopy (MRS).Methods and Materials: Totally 32 patients with ESRD and 32 healthy controlswere enrolled in this prospective study, aging from 26 to 50 years. Short echotime single-voxel proton MRS was acquired from the volumes of interest (VOIs)at the frontal gray and white matter, temporal white matter, and basal ganglion.The trimethyl ammonium (TMA), myo-inositol (mI), N-acetylaspartate (NAA), andtotal creatine (tCr) were measured and the metabolic ratios to tCr were calculated.Cognitive function testing was also obtained.Results: The hemodialysis duration of ESRD patients is 6.253.96 (meanSD)years. There were no significant differences of gender, age, and cognitive functiontesting between the patients and the controls. Significant elevation of the TMA/tCrand mI/tCr ratios were observed in the frontal gray matter (p=0.005, 0.001), frontalwhite matter (p=0.0148, 0.0003), temporal white matter (p=0.0032, 0.0182), andbasal ganglion (p= 0.001, 0.005). There was no significant difference of the NAA/tCr ratio in all VOIs between the patients and the healthy controls.Conclusion: Metabolic changes, elevation of TMA/tCr and mI/tCr ratios are detectablein neurologically presymptomatic ESRD patients. These data suggest that glialeffects or osmolyte changes may be more sensitive than neuronal effects as anindicator of ESRD patients undergoing hemodialysis.C-675A web-based interactive functional brain atlasB. Bernal, J. Perdomo, H. Shanbhag; Miami, FL/US (byron.bernal@mch.com)Learning Objectives: To provide an interactive online tool to find the brain functionsrelated with each of the Brodmann’s areas, accordingly with published fMRIand PET abstracts.Background: Functional neuroimaging studies usually report areas of corticalactivations in terms of Brodmann’s areas, since tridimensional coordinates systemsare not utilized in regular clinical practice. However, an organized repository site thatlists all the function-related-brain activations has not been developed yet.Procedure Details: We reviewed all the abstracts on fMRI and PET (brain) availablein PubMed, limited to normal volunteers, in which “FMRI” or “brain” AND “PET”appear in the title or in the abstract. Only abstracts mentioning specific Brodmanns’areas or anatomical equivalent regions were included. 2,275 abstract fulfilled therequirements for further review. From this pool, 869 citations were utilized to create52 web pages, referring all the functions reported involving specific areas. A frontpage was created with lateral and medial views of the brain with all the Brodmann’sareas outlined on it. Clicking a specific area or a number opens its respective pagewith the list of functions and their respective abstract links. In some functions, theoverwhelming evidence accounted for numerous abstracts, in which case, the words“many abstracts” follow the first few citations. (The entire site has been uploadedtemporarily to the URL: http://www.fmriconsulting.com/brodmann).Conclusion: We present an interactive web-based tool to find Brodmann’s areasfunctions and their respective citations aimed to help clinicians involved in functionalneuroimaging.C-676Ultrasonic estimation of a cerebrovascular reactivity in patients withocclusive disorders of carotid arteriesI.E. Timina, A.V. Pokrovsky, G.G. Karmazanovsky; Moscow/RU (timina68@mail.ru)Purpose: To estimate the changes of the cerebral circulation during the hypercapnicprobes in patients with the occlusive atherosclerotic disorders of carotid artery.Methods and Materials: 107 patients with occlusive disorders of carotid arterieswere investigated and operated. The hypercapnic probes were carried out beforeoperation and 8 - 10 days after operation. Cerebrovascular reactivity was calculatedas ratio (in %) of changes of the systolic blood flow velocity in the middle cerebralartery to the initial velocity during hypercapnic probe (when CO 2in expirationreached 7%).Results: The mean values of the cerebrovascular reactivity ranged from 27%in 20 healthy volunteers to -9% in patients with occlusion of one internal carotidartery and 75% stenosis of contralateral artery. The cerebrovascular reactivitywas compared with backup flow pressure (measured during carotid endarterectomy).A linear relationship (correlation coefficient r = 0.74, p 0.05) was revealedbetween the cerebrovascular reactivity and the backup flow pressure. Progressivedevelopment of atherosclerotic disorders was accompanied by a decrease of thecerebrovascular reactivity. Thus, the reactivity was decreased in 50% of patientswith hemodynamically significant stenosis of one internal carotid artery and in90% of patients with occlusion of one internal carotid artery and 75% stenosisof contralateral artery. So the reserve of the collateral circulation was decreasedin 65% of patients with symptoms of cerebrovascular insufficiency.Conclusion: The correlation between the backup flow pressure and cerebrovascularreactivity demonstrates the diagnostic value of the ultrasonic investigation ofthe collateral circulation reserve.NeuroACB D E F G HS477

Scientific and Educational ExhibitsC-677Reverse engineering technology in cranioplasty prosthesis manufacturingR. Chrzan, A. Urbanik, K. Karbowski, M. Moskała, J. Polak, M. Pyrich; Krakow/PL(rchrzan@mp.pl)Purpose: Most patients with large skull focal bone loss after craniectomy arereferred to cranioplasty using synthetic universal bone prosthesis, individuallyadjusted during surgery. Reverse engineering is a technology of creating CADmodel of real structure. The aim of study is to present the application of reverseengineering technology in cranioplasty prosthesis manufacturing.Methods and Materials: In 15 patients with skull focal bone loss after craniectomy,CT was performed in the Radiology Department of Cracow University Hospitalusing dedicated high resolution protocol. The virtual model of the skull was generatedusing CAD software CATIA in Cracow University of Technology. In the firstway the material model of bone loss was produced, and then used for manualadjustment of a universal prosthesis before surgery. In the second way, the virtualmodel was the base for direct designing individually adjusted prosthesis. Finally,the prosthesis was implanted in the patient in the Neurosurgery Department ofCracow University Hospital.Results: Till now, the universal prosthesis for cranioplasty was manually adjustedto bone loss by a surgeon, which took about 1 hour. In many cases the fitting wasnot good enough. After the application of reverse engineering technique, the timeneeded for adjustment was reduced to a few minutes. Additionally, the prosthesiswas much better fitted.Conclusion: Reverse engineering technology may utilize data obtained fromcommonly used spiral CT scanners. This technology may reduce time of neurosurgeryand improve the prosthesis fitting. Manufacturing of individually adjustedprostheses using reverse engineering technology should be commonly used inpatients planned for cranioplasty.C-678Dural arteriovenous fistula (DAVF) associated with unusual anatomicalvariation of dural sinusesY. Sagara 1 , H. Kiyosue 1 , H. Mori 1 , S. Tanoue 1 , R. Shimada 1 , Y. Hori 2 , M. Okahara 1 ,J. Kashiwagi 1 ; 1 Yufu/JP, 2 Oita/JPLearning Objectives: To review imaging anatomy of dural sinuses of patients withDAVF on MDCT, MR venography, and DSA. To demonstrate various anatomicalvariations of dural sinuses with and without DAVF. To demonstrate the importanceof the knowledge of these venous anatomy for diagnosis and treatment of DAVF.Background: DAVF can involve various intracranial venous sinuses. Occasionally,DAVF associates with unusual anatomical variations of dural venous sinuses whichoften requires special attention in transvenous embolization and/or can causeunexpected complications. The knowledge of these variations as well as normalvenous anatomy is essential for the diagnosis and treatment of DAVF.Imaging Findings: We have reviewed image studies performed in our hospital duringthe last five years. We describe the imaging findings of normal basal anatomy ofdural sinuses on contrast-enhanced multidetector CT, MR imaging (3D field echoMR venography), and cerebral angiography. And we demonstrate case presentationof DAVF with unusual anatomical variations of venous sinuses and drainageroute associated with inferior petrosal sinus, torcular herophili, tentorial sinus,superficial middle cerebral vein, and occipital sinus. We discuss about treatmentstrategy with literature review.Conclusion: Based on our treatment experiences of DAVF, this exhibit gives anoutline of the basic venous anatomy and unusual variations of venous sinusesassociated with DAVF.C-679fMRI retinotopic mapping in patients with anterior visual pathway disease:Correlated with visual field lossW. Tang, X. Shen, X. Feng; Shanghai/CN (tangwj83@gmail.com)Purpose: Anterior visual pathway disease may cause visual field defects. Thepurpose of this study is to demonstrate that the relationship between visual fieldloss and the retinotopic organization of V1 can be measured using novel fMRImethods.Methods and Materials: Six patients (2 cases of pituitary adenoma, 1 case ofcraniopharyngioma and 3 cases of optic neuritis) participated in our study. Thedistribution of visual field defects were obtained by Goldmann perimetry withOCTOPUS 101. Retinotopic mapping was performed using a standard approachconsisting of eccentricity and polar mapping. A GE 3 T scanner and a custom opticalsystem were used to acquire sets of coronal echo-planar images within a TRof 2000 ms and a 2.97*2.97*3 mm 3 voxel resolution. The inflated surface modelsNo Material Submitted to EPOSof each subject’s brain were constructed using the FreeSurfer software from asagittal T1-weighted image with a 1 mm 3 voxel resolution. Statistical analyses ofthe functional data were made by AFNI. The resultant retinotopic mapping wascompared with the Goldmann perimetric maps.Results: fMRI responses to visual stimulation were related to tumor location andinflammation range of the optic nerve. The retinotopic organization of the visualcortex was altered in these patients. The Goldmann perimetry correlated well withthe color phase encoded map obtained from the functional data.Conclusion: Retinotopic orgnization in human V1 was altered in patients withanterior visual pathway disease, and phase encoded map obtained from fMRI wascorrelated well with the visual field loss.No Material Submitted to EPOSC-680Magnetic resonance susceptibility-weighted imaging complementsconventional contrast-enhanced T1-weighted MRI in characterizing brainabnormalities in Sturge-Weber syndromeG. Wang; Jinan/CN (wgb7932596@hotmail.com)Purpose: To study the value of SWI in detecting and diagnosing Sturge-Webersyndrome comparing with conventional T1-weighted contrast enhanced imaging.Methods and Materials: Thirteen children with the diagnosis of SWS wererecruited prospectively. MR was carried out on a 1.5 T Siemens Sonata system.The MR protocol includes 3D high resolution SWI and gadolinium-enhancedT1W. The gadolinium-enhanced T1W was performed after injection of 0.1 mmol/kg Gd-DTPA, Magnevist. The SWI acquisition was performed with a turbo 3Dgradient echo sequence with FA= 20°, TR/TE=89/40 ms, EPI factor=5, acquisitionmatrix=512x256x48, FOV=256x256x96 mm 3 . Flow compensation was applied inall 3 directions. Both magnitude and phase images were saved for further postprocessingand analysis. Two investigators evaluated both SWI and T1-Gd imagesand made a consensus agreement on six types of imaging findings by using afour-grade scoring system. The performance of SWI vs. T1-Gd images was thencompared for each type of abnormality.Results: SWI was superior to T1-Gd in identifying the enlarged transmedullaryveins (p=0.0020), abnormal periventricular veins (p=0.0078), cortical gyriformabnormalities (p=0.0020), and grey matter/white matter junction abnormalities(p=0.0078). Conversely, T1-Gd was better than SWI in identifying enlarged choroidplexus (p=0.0050) and leptomeningeal abnormalities (p=0.0050).Conclusion: SWI offers the potential to visualize the presence of subtle venousabnormalities and the typical cortical gyriform calcification. It provides usefuldiagnostic information that could complement the standard contrast enhancedT1W in the clinical setting for SWS patients. It is particularly suitable to monitorthe progression of the SWS disease longitudinally.C-681Readers depended influence on correlation between analyses of perfusionCT (perf-CT) results in patients with cerebral ischemic stroke and theirclinical statusT.J. Popiela, J. Pera, R. Chrzan, A. Urbanik, A. Słowik; Krakow/PL(msjpopie@cyf-kr.edu.pl)Purpose: We investigated the results of analysis of noncontrast CT (NCCT) andperf-CT in patients with acute cerebral ischemic stroke performed independentlyby radiologists and neurologists. We also assessed the correlations between CTfindings and clinical status of these patients.Methods and Materials: We analyzed data of 34 patients, in whom NCCT andperf-CT were performed within 12 hours after stroke onset. Two pairs of reviewersindependently assessed NCCT and perf-CT using the Alberta Stroke Program EarlyCT Score (ASPECTS). It was decided, based on the literature data, to dichotomizethe score. The chosen cut-off points were: = 6 versus 6, = 7 versus 7 and= 8 versus 8. The agreement between readers was evaluated using the kappacorrelation coefficient. The patient's clinical status was assessed by National Instituteof Health Stroke Scale (NIHSS).Results: The best agreement between the results of the scans analyses wasachieved for perf-CT comparing with NCCT, where the cut-off point was = 7 versus 7. The detailed results were as follows: TTP - substantial agreement (=0.77), CBFand CBV - moderate agreement (=0.46 and =0.57) and slight agreement NCCT(=0.27). We also found a significant correlation between the patient's clinical statusand perf-CT parameters. The calculated Spearman's R correlation coefficient wasas follows: for CBF r=-0.38, for CBV r=-0.50, for TTP r=-0.34.Conclusion: In contrast to NCCT, there is no noticeable readers depended differencein the analyses of perf-CT. The results of perf-CT show a good correlationwith baseline neurological deficit of acute ischemic stroke patients.CS478 A B D E F FG H

Scientific and Educational ExhibitsC-682Hippocampus dysfunction may explain symptoms of fibromyalgiasyndrome: A study with single-voxel magnetic resonance spectroscopyY. Ragab 1 , Y. Emad 1 , J. Rasker 2 , F. Zienhom 1 ; 1 Cairo/EG, 2 Enschede/NL(yragab61@hotmail.com)Purpose: (1) To investigate dysfunction of hippocampus in patients with fibromyalgiasyndrome (FM) using proton magnetic resonance spectroscopy (1H-MRS),and to compare these findings with healthy controls. (2) To correlate levels ofmetabolites obtained with aspects of cognition, depression, and sleep symptomsin the patient group.Methods and Materials: 15 female patients, who met American College ofRheumatology criteria for classification of FM, and 10 healthy age-matched femalecontrols. In all patients and controls, 1H-MRS was used to assess N-acetylaspartate(NAA), choline (Cho), creatine (Cr), and their ratios from both hippocampi. Levelsof metabolites and their ratios were determined and the findings compared betweenthe groups.Results: NAA levels of right and left hippocampi differed significantly betweenpatients and controls (p 0.05). Cho levels in the right hippocampus were higherin the patient group than in controls (p = 0.005), while no differences were foundwith respect to Cr levels in both hippocampi. NAA/Cho and NAA/Cr ratios differedsignificantly between patients and controls (p 0.05), while the Cho/Cr ratio showedno differences. Significant correlations were found between language score andright Cho and right Cr levels (p = 0.041, p = 0.006, respectively), while no significantcorrelations were found between metabolites and their ratios with FIQ, VAS forpain, or number of tender points.Conclusion: The hippocampus was dysfunctional in patients with FM, as shownby lower NAA levels compared to controls, representing neuronal or axonal metabolicdysfunction.C-683The role of 3D MR cisternography as a clinical routineA. Kunimatsu 1 , M. Hiratsuka 1 , I. Anno 2 , N. Kunimatsu 1 , M. Minami 2 , K. Ohtomo 1 ;1Tokyo/JP, 2 Ibaraki/JP (akrk-tky@umin.ac.jp)Learning Objectives: To outline basic concepts, advantages and limitations ofcurrently used techniques for 3D MR cisternography (MRC). To illustrate how toemploy MRC efficiently through case-based reviews: how and when to use it, andhow to interpret its findings.Background: T2-weighted 3D MR cisternography (MRC) or ventriculography is atechnique that can visualize fine structures in the CSF space with high contrast tothe liquor signal. Since MRC was initially introduced as heavily T2-weighted turbospin echo (TSE) imaging, clinical applications have been expanding as newertechniques evolve. We will review updated techniques for MRC and discuss itseffective application as a clinical routine.Procedure Details: 3D balanced turbo field echo and 3D TSE with reset pulsesare modern and adequate sequences for MRC with high contrast and less flowartifacts. MRC usually less than five minutes can be easily incorporated into mostclinical MR protocols. Common indications for MRC include visualization of cranialnerves and intracranial vessels, differentiation between extra- and intra-duralaneurysms, and evaluation of obstruction of CSF outflow tracts. MRC can alsohighlight intratumoral architectures (e.g. cysts) and peritumoral environments (e.g.adjacent nerves and vessels, tumor attachment sites). Gadolinium agents mightimprove delineation of a tumor contour with the use of a balanced steady-statefree precession sequence.Conclusion: MRC might be valuable as a clinical routine. It is important for radiologiststo understand the main indications for MRC and to get familiar with findingsto evaluate with MRC.C-684Comparison of superparamagnetic iron oxide particles and Gd-DTPA assusceptibility contrast agents for perfusion imaging of hyperacute cerebralinfarction in ratsS.-X. Zhang, C.-H. Liang; Guangzhou/CN (shui7515@126.com)Purpose: To compare the evaluation of perfusion weighted imaging (PWI) usingGd-DTPA and Resovist in the experimental model of hyperacute cerebral infarctionin rats.Methods and Materials: All 30 Wistar rats were divided into 2 groups (n=15 foreach); groups A, B were divided according to the different contrast agents forPWI. After occluding left middle cerebral artery with thread for 1 hour in all rats,two dynamic MR perfusion imaging series were acquired after intravenous bolusinjections of 8 umolFe/kg SPIO and 0.2 mmol/kg Gd-DTPA, respectively. The doseswere chosen to obtain similar maximum signal change in normally perfused brain.The perfusion imaging was compared in a region of interest (ROI) in the core areawith severe ischemia and in a ROI in the penumbra area of moderate ischemia.The parameters were compared in two groups and correlated with pathologicfindings and TTC stain.Results: The first-passage profiles were found to be similar for Gd-DTPA and SPIO,both in the core area with severe ischemia and in the penumbra area of moderateischemia in this rat stroke model. The parameters (CBV, MTT, TTP) values of PWIfor ischemic penumbra in group A and B had no statistical disparity.Conclusion: The efficacy of the SPIO (Resovist) used in the MR PWI was similarto Gd-DTPA for diagnosis of the perfusion reduction in the rat stroke model. Thestrong susceptibility effects may be achieved with small injection volumes, and ifit is safe for human investigations, the SPIO (Resovist) may play a important rolein MR PWI.C-685Not so mild head injury: diffusion tensor imaging implicates prefrontalaxonal injury in executive function impairment following very mildtraumatic brain injuryE. Gulko 1 , M.E. Zimmerman 1 , B.W. Friedman 1 , M. Kim 1 , K. Shiften 1 , C.A. Branch 2 ,M.L. Lipton 1 ; 1 Bronx, NY/US, 2 Orangeburg, NY/US (mlipton@aecom.yu.edu)Purpose: Diffusion tensor imaging (DTI) can detect brain abnormalities aftertraumatic brain injury (TBI), but it is not clear whether these abnormalities are trulyresponsible for impairment. We sought to identify frontal lobe substrates of acuteexecutive dysfunction within two weeks after mild TBI (mTBI).Methods and Materials: The study had IRB approval and informed consent. DTIand standardized neuropsychological assessments were performed on 20 mTBIpatients within two weeks of injury and 20 matched controls. Fractional anisotropy(FA) and mean diffusivity (MD) images (3.0 T; 25 directions; b=1000) were comparedusing whole brain voxelwise analysis at a false discovery rate 0.01. The continuousperformance task (CPT) and the executive maze task (EMT) were used to quantifyexecutive function. Spearman's rank correlation analyses evaluated associationsbetween diffusion measures and executive function, while accounting for potentialconfounders in multivariable analyses.Results: Five frontal white matter clusters of lower FA, including the dorsolateralprefrontal cortex (DLPFC), were present in patients (p 0.005), with several clustersalso demonstrating higher MD (p 0.005). Patients performed worse on the (CPT)(p=0.03) and the EMT (p=0.008), indicating impaired executive function. In correlationanalyses, lower DLPFC FA predicted worse executive function in patients (p 0.05),independent of age, gender, education, stress, anxiety and depression.Conclusion: FA indexes DLPFC axonal injury after mild TBI and predicts deficientexecutive function. Correlation of DTI with an important mTBI outcome (executivefunction impairment), at a location essential for that outcome, suggests that DTI isa meaningful indicator of brain injury and merits further investigation.C-686Cerebral glucose metabolism in perihematomal edema tissue afterintracerebral hemorrhage in catsX. Lin, Z. Hou, L. Wu; Jinan/CN (linxt@sdu.edu.cn)Purpose: To investigate the changes of cerebral glucose metabolism in perihematomaledema tissue in cat ICH models using magnetic resonance imaging(MRI), 18 F-fluoro-deoxy glucose positron emission computer (18 F-FGDPET)and lactate (LA) testing.Methods and Materials: Forty-eight 3 years old male cats were assigned into onesham operation group and seven ICH model groups, cats in ICH model groupswere injected 1 ml autologus nonheparinized blood into the thalamus. After operation,the cats underwent MRI and PET scanning at 2, 6, 12, 24, 48, 72, and 120 hafter ICH formation. Perihematomal edemous tissue appeared high signal on T2images of MRI, the standardized uptake value (SUV) of 18 F-FDG in the edemaregion was measured by PET. Cats in each model group were sacrificed after PETexamination and to be taken 1 gram edemous tissue surrounding the hamotomafor LA testing by LA testing kit.Results: The SUV of 18 F-FDG in perihematomal edema tissues markedly reducedat 2 h after ICH on PET images, and it reached the lowest level at 12 - 24 h, thenstarted to increase from 72 h, and at 120 h it was comparable to control group.The cerebral lactate in perihematomal region began to increase at 2 h (P 0.05),to i peaked at 24 h and still keep high level at 72 h (P 0.05), then it decreased,which is markedly different from those of control group.Conclusion: Perihemorragic glucose metabolism was markedly reduced from 2 to72 h, then started to increase, it may relate to vasogenic edema formation.NeuroACB D E F G HS479

Scientific and Educational ExhibitsC-687Schistosomiasis mansoni as a cause of hyperintense basal gangliaA. Manzella, P. Borba Filho, C. Brandt, K. Fonte; Recife/BR(adonismanzella@yahoo.com.br)Purpose: The purpose of this study is to describe basal ganglia (BG) bilateralsymmetric hyperintensity on T1-weighted images (T1WI) at magnetic resonanceimaging (MRI) in young patients with hepatosplenic schistosomiasis mansoni(HSM), without neurological symptoms.Methods and Materials: This study included eight young individuals, ranging inage from 9 to 19 years. All patients came from endemic regions for schistosomiasismansoni (SM) and had been previously treated with oxamniquine as well as hadundergone splenectomy, ligature of the left gastric vein and auto-implantation ofspleen tissue. All of them underwent neurological evaluation and were scannedon a 1.5-T system. Multiplanar T2WI, T1WI and FLAIR images were obtained andthe reports were done by two radiologists after a consensus review. Liver functiontests were also performed at the time of the brain MRI exams.Results: The MRI exams showed symmetric hyperintense globus pallidus in 7patients associated with symmetric hyperintense cerebral peduncles in 6. In onepatient only the cerebral peduncles were affected. Associated periacqueductal T1hyperintensity was observed in two patients. The pituitary gland appeared hyperintenseon T1WI in one patient. All liver function tests were normal.Conclusion: To the best of the authors’ knowledge, this abnormality has only beenreported once in a patient with HSM who developed PSE. These findings suggestthat SM should be included in the differential diagnosis of hyperintense BG and thatthis abnormality can be found even in patients without overt neurological symptomsand with normal liver function tests.C-688View and review of the posteromedial brain: Anatomy, structure,connectivity and pathologyJ.M. Garcia Santos, M.C. Alcaraz Soto, C. Lungan, S. Torres del Río; Murcia/ES(mcarmenas@yahoo.es)Learning Objectives: To illustrate the anatomy, ultrastructure, connections andpathology of the posteromedial brain (PMB).Background: The PMB, involving the restrosplenial cortex, posterior cingulateand precuneus, has a medial and deep location avoiding an easy approach withclassical analytic tools. Moreover, only rarely is individually affected by prevalentdiseases like infarction or neoplasm. Accordingly, it has traditionally received littlestudy. However, PMB strategic location and wide-spread connections support that itis an important association area. And it has been pointed out as a pivotal region forconsciousness and cognition. Furthermore, some common degenerative diseases,like Alzheimer’s disease, have shown early PMB impairment. As imaging technologyrelentlessly develops, it is important to increase the radiologist knowledge onanatomy, structure, function and dysfunction of specific brain areas like PMB.Imaging Findings: PMB is located between the cuneus, paracentral lobe and corpuscallosum splenium. It can be affected by ischemia, neoplasm, or demyelinizatingdiseases, but normally within a more extensive disease. Diffusion weighted anddiffusion tensor imaging demonstrate shifts in diffusion and anisotropy between thedifferent PMB constituents. In Alzheimer’s disease and other cognition impairments,metabolite and blood flow changes can be demonstrated with magnetic resonancespectroscopy and perfusion imaging.Conclusion: PBM is a heterogeneous region, normally affected as part of morewidespread lesions. It shows functional and metabolic changes only demonstratedwith non-conventional MRI techniques. Apart from the increase of cutting edgeresearch on the field, imaging performed in standard clinical facilities also allowsthe radiologist to go into PMB in depth.C-689Differentation between high grades gliomas and solitary brain metastasisusing peritumoral MR spectroscopy, diffusion and perfusionL. Serrano Velasco, V. Vázquez Sáez, I. Bañón García, F. Velázquez Marín,L. Martínez Encarnación, D. Carbonell Ruiz, E. Domenech Abellán; Murcia/ES(laurasevel@hotmail.com)Purpose: To evaluate the effectiveness of MR diffusion, perfusion and spectroscopyin the differentiation between high grade gliomas (HGG) and solitary brainmetastasis (M), by means of tumoral and peritumoral evaluation.Methods and Materials: Prospective study since November 2004 in 115 patients(70 HHG and 45 M) with solitary brain tumors. All diagnoses were confirmed histologically.Conventional MR imaging, multivoxel proton MR spectroscopy, diffusionweighted imaging and perfusion was performed. With conventional MR cerebral theknown signs of high grade tumor were evaluated. In axial 3DT1 contrast enhancedimages there were calculated the values of spectroscopy and metabolic profilesof those areas of maximum tumoral enhancement, peritumoral tissue ( 1 cm and 1 cm) and contralateral healthy parenchyma. The values of perfusion and diffusionin the maps of ADC and rCVB were studied.Results: Our most relevant statistically significant findings were the lesional CBVand the perilesional CBV 1 cm, both higher in gliomas. In 1 cm peritumoralregion, Cho/NAA ratio and % Cho were greater in high grade gliomas. In 1 cmperitumoral region, Cho/NAA ratio was higher in gliomas than in metastasis. Thevalues of rADC in the tumoral region were greater in gliomas. There were no significantdifferences in diffusion of the peritumoral region.Conclusion: This study demonstrates that MR perfusion and MR spectroscopycan be used to differentiate high grade gliomas from solitary metastasis based onthe analysis of peritumoral regions.C-690Normal findings in cranial CT that need no further investigationsP. Sadaba 1 , S. Lopez 1 , I. Aloa 1 , I. Aguirre 1 , E. Marco2, A. Cancho 1 , M. Gorriño 1 ,N. Serrano 1 , A. Garcia Bolado 2 ; 1 Galdakao/ES, 2 Santander/ESLearning Objectives: To illustrate normal findings in cranial CT that can be misinterpretedas pathologic conditions, leading to performing unnecessary diagnostictests and hospital admissions.Background: Nowadays, there is a large increase in the number of cranial CTscans performed out of hours, these studies being normally interpreted by on-callradiologist, who may be a resident, or sometimes a staff radiologist not specializedin neuroradiology. In this setting, we may pay attention to normal variants that couldbe misunderstood as pathological findings.Imaging Findings: We review most commonly seen cranial variants in CT, includingnormal intracranial calcifications, the different variants of the ventricular system,normal findings in the subarachnoid space and possible pseudomasses. Finally,we go over the different imaging artefacts usually seen on cranial CT.Conclusion: The knowledge of the different normal variants and physiologicalfindings in cranial CT is essential for radiologist in order to avoid potential errorsthat could increase the health costs and in some cases could influence the clinicaldecisions.C-692The added value of the perfusion, diffusion and spectroscopy MRI in thedifferentiation and grading of gliomasL. Serrano Velasco, V. Vázquez Sáez, V. Miñano, I. Bañón García,F. Velázquez Marín, L. Martínez Encarnación, D. Carbonell Ruiz; Murica/ES(laurasevel@hotmail.com)Purpose: To evaluate the sensitivity, specificity and the predictive values of theperfusion MRI, proton MR spectroscopy imaging and diffusion MRI, in the presurgicalgrading of gliomas, compared with the conventional MRI.Methods and Materials: From November 2004 to March 2008, 80 patients withgliomas histologically confirmed were prospectively evaluated by conventional,perfusion, spectroscopy and diffusion MRI. In conventional MRI, the known signsof high grade tumor were evaluated. In spectroscopy MRI, we considered thesemetabolites ratios (Cho/Cr, Cho/NAA, NAA/Cho, Lip/Cr y mI/Cr) in the enhancinglesion, peritumoral region ( 1 cm and 1 cm), in relation to the contralateralparenchyma as a control (%Cho, %NAA, %Cr, %Lip y %mI). We analyzed thetumoral and peritumoral regions of maximal perfusion and the apparent diffusioncoefficient (ADC).Results: In the conventional MRI, the intratumoral gliomas signal void was themost specificity value ( 80%). The absolute ADC and ADC ratios were higher inhigh-grade gliomas. The ADC ratios with b 1500 s/mm 2 (rADC1500) showed thehigher sensitivity and specificity. The tumoral absolute CBV and rCBV showed valuessignificantly increased in high-grade gliomas, with a sensitivity and specificity 85%.In spectroscopy, Lip T, Lip/Cr, %Lip, Lip/Cr 1 cm, %Lip 1 cm were higher in highgradegliomas with a sensitivity and specificity 80%. The %mI and mI 1 cm wasdecreased in high-grade gliomas, with a sensitivity and specificity 90%.Conclusion: The increase of rADC1500 and rCBV, and the decrease of %mIin high-grade gliomas, were the values that showed the highest sensitivity andspecificity to distinguish between high and low-grade gliomas.CS480 A B D E F FG H

Scientific and Educational ExhibitsC-693The middle cerebellar peduncle in diagnostics of MSA and PSP revisited:An MRI studyA. Christensen, K. Winge, T. Ullberg, J.K. Nielsen; Copenhagen/DK(anderschristensenemail@hotmail.com)Purpose: Aim of study was to characterise the middle cerebellar peduncle C (MCP)in MSA and PSP using MRI-measurements of ADC and diameter, and investigateasymmetry of degeneration in the MCP.Methods and Materials: 35 Patients. 9: MSA-C, 11: MSA-P and 15: PSP underwentdiffusion-weigthed MRI. One observer evaluated examinations. Diameter and ADCvalueof the left and right MCP was compared to clinical data. Difference in averageADC and diameter asymmetry between the left and right MCP was calculated. Twoformulas expressed differences in the asymmetries between patient groups.Results: The difference in ADC asymmetry of left and right MCP between patientswith MSA-C and PSP as also between MSA-P and PSP was significant. The differencein diameter asymmetry of the left and right MCP between patients withMSA-C and MSA-P as also between MSA-C and PSP was significant. Patientswith MSA-C and 3 symptoms had significantly lower diameter of MCP than patientswith MSA-C and 2 or less symptoms (P 0.05). Significant differences were foundbetween patients with MSA-C and both patients with MSA-P and patients with PSPusing formula 1. Significant differences were found between patients with PSP andboth patients with MSA-C and patients with MSA-P using formula 2. The use ofboth formulas in combination thus significantly discriminates between all 3 patientgroups on the basis of the MRI-measurements.Conclusion: The present study demonstrates a significant difference in degreeof asymmetry in ADC and diameter between AP-syndromes and presents a novelMRI-based method to help subdiagnosing these syndromes.C-694Fetal cerebral ventriculomegaly: Prenatal diagnosis, associatedmalformations and postpartal outcomeV. Tauscher, M. Mailath-Pokorny, D. Prayer, E. Krampl-Bettelheim,A. Messerschmidt, P.C. Brugger; Vienna/AT (Verena.Tauscher@gmx.at)Purpose: To identify fetuses affected by ventriculomegaly (width of lateral ventricles 10 mm), to examine the prevalence of associated malformations and to documentthe postpartal outcome.Methods and Materials: This retrospective study includes 124 cases of fetalventriculomegaly, which were diagnosed sonografically over a 9 year period (1997to 2006) in the Vienna General Hospital. In 103 (83.1%) cases a fetal MRI wasperformed to confirm the diagnosis. The population was divided into three groupsaccording to the ventricular width: borderline (10 to 12.0 mm), mild (12.1 to 15.0 mm)and severe (15.1 mm) ventriculomegaly.Results: 30.6% of borderline, 19.4% of mild and 50.0% of severe ventriculomegalywere found. In the borderline group 76.3% associated malformations were found,70.8% associated malformations were detected in the group of mild ventriculomegaliesand the group of severe ventriculomegalies pointed out 83.9% malformations.We found 68.75% of pathological postnatal diagnoses in the group with borderline-VM, 75% in the group with mild-VM and 86% in the severe-VM group. The group ofisolated borderline-VM showed a normal development of the ventricular system in100% of the cases. Fetal MRI confirmed the ultrasonographic diagnosis in 92.2%of the cases, in 36.8% fetal MRI added additional informations and in 7.8% of thecases fetal MRI could not confirm the ultrasonographic diagnosis.Conclusion: Our results showed that borderline and mild ventriculomegalies areoften associated with malformations and the prognosis of fetal ventriculomegalydoes not only depend on the ventricular width but also on findings of other abnormalities.C-695Imaging findings of neurolymphomatosis in F-18 FDG PET/CT and MRIC. von Falck, T. Rodt, J.H. Lotz, H.-o. Shin, W.H. Knapp, M. Galanski; Hannover/DE(c.v.falck@gmx.de)Learning Objectives: To illustrate typical imaging findings of neurolymphomatosisin F-18 FDG PET/CT and MRI.Background: Neurolymphomatosis is an uncommon extranodal manifestation ofnon-Hodgkin’s lymphoma (NHL). Besides nerve biopsy, surrogate criteria for thediagnosis of lymphomatous nerve infiltration have been proposed based on MRIand CT findings. However, these morphologic modalities may suffer from a limitedsensitivity. F-18 FDG PET/CT is a metabolic modality that has recently provedpotential in the diagnosis of neurolymphomatosis. The typical imaging findings ofthis uncommon extranodal manifestation of NHL in FDG PET/CT are describedand illustrated.Imaging Findings: Typically, neurolymphomatosis presents in F-18 FDG PET/CT as an intense linear tracer uptake that can be anatomically located to neuralstructures such as nerve roots, cranial nerves or peripheral nerves. Morphologiccorrelatives of lymphomatous infiltration in CT or MRI may be subtle and usuallypresent as nerve enlargement and a pronounced uptake of contrast agents. InMRI, an increased signal in T2-weighted sequences is seen. Notably, neurolymphomatosisoften shows only segmental nerve infiltration and blind nerve biopsymay therefore be false negative.Conclusion: F-18 FDG PET/CT is a valuable imaging modality for the detectionof neurolymphomatosis. It allows determining the extent of the disease in a singlewhole-body examination. It may help to guide nerve biopsy in patients where definiteconfirmation is essential.C-696Findings of late radiation-induced brain necrosis on susceptibilityweightedimaging following radiotherapy for carcinoma of the nasalsinuses and nasopharynxH. Takahashi, N. Kashiwagi, Y. Tomida, K. Nakanishi, H. Tanaka; Osaka/JP(h-takahashi@radiol.med.osaka-u.ac.jp)Purpose: To report features of susceptibility weighted imaging (SWI) of lateradiation-induced brain necrosis. SWI is an imaging method that maximizes sensitivityto magnetic susceptibility effects. To our knowledge, there are no prior reportsdescribing the SWI features of this lesion.Methods and Materials: The patients were three males and three females, 53-71years old (mean=63 years). 4 to 8 years previously, all patients had undergoneradiotherapy with 50-70 Gy for carcinoma of the nasal sinuses or nasopharynx.In five patients, late radiation necrosis was diagnosed by follow-up MR studiesand clinical symptoms. In one patient, histological examination of the resectedring-enhanced brain lesion confirmed radiation necrosis. In all cases, SWI andconventional sequences (T1WI, T2WI, and post-contrast T1WI) were performedon a 3.0-T unit.Results: SWI showed a low signal intensity area within the brain necrosis and itsdistribution was classified into three patterns (ring pattern inside ring-enhancement,clustered nodular pattern, and branch pattern along the atrophic white matter). Thesepatterns were detected at different times during the course of necrotic change.Conclusion: The low signal intensity area within the brain necrosis on SWI was consideredto reflect mainly blood products due to vasculopathy associated with necroticchange, and microhemorrhage associated with disruption of the blood-brain-barrier(BBB). SWI features were classified into three patterns, reflecting differences in thetime courses or activities of late radiation-induced brain necrosis.C-697Bilateral transcerebral and cortical vein signs on gradient echo image:Another finding of brain deathJ. Park 1 , H. Chang 1 , E. Kim 1 , S. Sohn 1 , C.-H. Sohn 2 , J. Kwon 1 , S.-D. Yi 1 ;1Taegu/KR, 2 Seoul/KR (pjb-81@hanmail.net)Purpose: Gradient echo (GRE) sequence is becoming a routine protocol of brainMRI. MRI findings of brain death in conventional sequences are well known, butfindings of brain death on GRE have been rarely reported. We present imagingfindings of brain death, focusing on GRE.Methods and Materials: In a retrospective study, 7 consecutive brain deathpatients confirmed by clinical criteria and EEG (electroencephalogram) wereincluded. Demographic information and clinical findings were obtained. MRI studieswere reviewed.Results: Underlying cause of brain death were traffic accident (n=3), chronicsubcural hemorrhage with mass effect (n=1), asphyxia (n=1), embedding accident(n=1), cerebellar medulloblastoma tumor bleeding after radiation therapy (n=1).MR images showed typical findings of brain death such as loss of flow void in theintracranial arteries, tonsilar herniation and diffuse T2-weighted hyperintensitiesof both hemispheres. Another common feature was found on GRE. It was stronghypointensities of deep medullary and cortical veins throughout both hemispheres,so called bilateral transcerebral and cortical vein signs on gradient echo image.Conclusion: Our results suggest that GRE may be helpful to evaluate the braindeath.NeuroACB D E F G HS481

Scientific and Educational ExhibitsC-698Occurrence and serial changes of in-stent filling defect on multidetectorrowCT angiography following carotid artery stentingJ. Kashiwagi 1 , H. Kiyosue 2 , M. Okahara 1 , S. Ueda 1 , Y. Hori 2 , R. Shimada 2 ,Y. Kondo 2 , Y. Sagara 2 , S. Tanoue 2 , H. Mori 2 ; 1 Beppu/JP, 2 Oita/JP(jaykay@med.oita-u.ac.jp)Purpose: In-stent filling defect (ISFD) is often observed on CT angiography (CTA)after carotid artery stenting (CAS), which may grow to lead restenosis. However,occurrence and serial changes of the ISFD has not been reported. We investigatedthe frequency and serial changes of ISFD following CAS.Methods and Materials: 82 carotid arteries in 77 patients were examined by serialCTA at 7-14 days, 1-6 months, and every 6 months following CAS. Occurrence,locations and serial changes of ISFD at early (within 14 days), mid-term (1-12months), and late ( 1 year) periods were analyzed.Results: ISFDs were observed in 32 (39%) lesions at the early period, and all werelocated at the primary lesions. 29 of the 32 lesions were followed, and 25 lesionsdisappeared or diminished. For the mid-term period, ISFDs newly developed in 36 of69 lesions (52%), in which 28 were located at the primary lesions and 8 at the stentedges. The mid-term ISFDs enlarged in 11, unchanged or diminished in 18. For thelate period, ISFDs newly developed in 8 of 39 lesions (20%), in which 7 were locatedat stent edge. Four of the 8 lesions were followed, and three ISFDs enlarged.Conclusion: ISFDs developed in 39, 52 and 20% at early, mid-term and lateperiods, respectively. Early ISFDs develop at the primary lesion, and diminishor disappear. The mid-term ISFDs develop frequently at the primary lesion, andsometimes progress. The late ISFDs are frequently located at stent edge, andslowly progress.C-699Time-resolved 1H-MR spectroscopic investigations of cortical glutamatechanges during painful heat stimulationA. Gussew, R. Rzanny, H.-C. Scholle, W.A. Kaiser, J.R. Reichenbach; Jena/DE(alexander.gussew@med.uni-jena.de)Purpose: In vivo detection of neurotransmitter concentration changes associatedwith nociception is important to understand the biochemical fundamentals of painprocessing in the human brain as well as to aid improved diagnosis of chronic pain.In this study, glutamate concentrations were determined in the insular cortex (IC) fordifferent pain states by using time-resolved proton MR spectroscopy ( 1 H-MRS).Methods and Materials: Single-voxel spectra (PRESS, TR/TE=5000/30 ms,V=2.5 ml) were acquired at 3 T (Magnetom Tim Trio, Siemens) in six male healthyvolunteers (31.311.1 years) prior to (reference condition, NAS=128) and duringperiodic painful heat stimuli applied to the left forearm (stimulus length 1 s, rate:0.2 Hz; T baseline=32 °C, T stim=48 °C) with a Peltier-thermode (TSA-II, MEDOC, Israel).During thermal stimulation two groups of spectra (NAS=128), corresponding topain and resting states, were separately acquired by synchronizing the stimulustime-course and data acquisition using TTL-trigger signals. Spectra quantificationwas performed using the LC Model with a water intensity reference (grey matterwater concentration: 43.3 mol/l).Results: During stimulation, the mean glutamate concentration was significantlyincreased compared to the reference condition (20.211.9%, p=0.006). Relativelylarge differences of the glutamate level in the resting state were observed, however,between the subjects, indicating inter-individual variability.Conclusion: The observed glutamate increase may be due to an increasedglutamatergic neurotransmission in the IC during pain stimulation, whereas thedifferent glutamate levels during rest may be explained by individual differentlyperceived pain intensities or adaptation processes. Application of heat stimulirandomly may thus be more appropriate to reduce adaptation processes and willbe implemented in future studies.C-701Role of advanced MRI in the characterization of hypercellular non glialtumorsC.H. Besada, D. Santa Cruz, J.A. Funes, R. Garcia Mónaco; Buenos Aires/ARLearning Objectives: To show and illustrate the utility of advanced MR techniquesin the characterization and differential diagnosis of hypercellular brain tumors:specially focusing on diffusion-weighted imaging (DWI), perfusion images (PI)and spectroscopic pattern.Background: Non invasive tumor characterization has always been a challenge forneuroradiologists. It remains difficult to assure the diagnosis of non-glial tumors likelymphoma or PNET. Primary CNS lymphoma diagnosis may be suggested by images.This diagnosis is very important because it may be related to surgical decisionmaking.Normally, stereotaxic biopsy is preferred to conventional surgery.Imaging Findings: Functional MRI techniques as DWI bring very useful informationshowing restricted diffusion and low ADC values. PI and spectroscopy are importantto complete tumor characterization and may also show interesting findings suchas elevated lipids in primary CNS lymphoma.Conclusion: Advanced MRI techniques can provide additional information for thedifferential diagnosis between non glial tumors. DWI, PI and spectroscopy findingsmay help in tumor characterization. With recognition of its strengths and potentiallimitations, these techniques should be included into the presurgical evaluation ofbrain tumor patients in order to improve their management.C-702Radiological evaluation of ventriculoperitoneal shunt systemsT. Rodt, C. von Falck, C. Tschan, M. Diensthuber, J. Zajaczek, J. Krauss,M. Galanski; Hannover/DE (rodt.thomas@mh-hannover.de)Learning Objectives: To present important aspects in radiological evaluation ofventriculoperitoneal shunt systems.Background: Ventriculoperitoneal shunts are implanted for the treatment ofhydrocephalus using different neurosurgical techniques. Various valves, includingprogrammable and gravitation dependent valves, connectors and catheters arein use. When patients with a ventriculoperitoneal shunt present with neurologicalor even unspecific clinical symptoms, imaging is often performed to evaluatethe integrity of the system. Conventional radiological imaging and cranial CT areperformed to identify components, check the valve setting and for further assessmentin cases of assumed malfunction. The MRI compatibility of the material variesbetween different systems. However, for certain clinical questions MRI can becomenecessary in ventriculoperitoneal shunt patients.Imaging Findings: Normal post-operative findings and common causes of malfunctionare presented. The radiographic characteristics of the most widespreadused systems and their MRI compatibility are addressed.Conclusion: Imaging provides valuable information on the type of shunt system,the MRI compatibility, the pressure setting and causes of malfunction in evaluationof ventriculoperitoneal shunt systems.C-703Meckel’s cave lesions: Imaging differentialsV. Sindhwani, D.P. Mueller, D. Vaslow; Columbia, MO/US(sindhwaniv@health.missouri.edu)Learning Objectives: 1) Normal imaging anatomy and variants of Meckel’s cave.2) Differential considerations and hallmark imaging features of different lesions. 3)Stepwise sequential approach to diagnosis.Background: To our knowledge, no one before has tried to illustrate in a stepwise manner as to how to differentiate Meckel’s cave lesions. Lesions generallyencountered in the Meckel’s cave are : 1) Meningioma 2) Trigeminal nerve Schwannoma3) Metastasis 4) Perineural tumor spread 5) Granulomatous diseases likesarcoid and tuberculosis 6) Pseudotumor 7) Lipoma 8) Epidermoid 9) Arachnoidcyst & 10) Lymphoma.Imaging Findings: Axial T1W, T2W, diffusion & post contrast axial & coronal T1WFS(fat saturated) sequences are most helpful. Schwannomas are hypointense onT1, hyperintense on T2 and show gradual, steady enhancement. Menigiomas areisointense to brain parenchyma on T1 & T2, show rapid, intense enhancement, adural tail and hyperostosis. Perineural tumor spread is seen as enlarged enhancingnerve, enlarged foramen and Meckle’s cave. Neurosarcoid is seen as dural/leptomeningeal disease with abnormal CXR. Pseudotumor is seen as enhancing,infiltrating, meningeal mass. Lipomas follow fat signal on all pulse sequences. Epidermoidshave insinuating growth pattern and can be differentiated from arachnoidcysts by diffusion restriction. Lymphomas being highly cellular are relatively darkon T2, show diffusion restriction and enhancement.Conclusion: By the end, the readers will be able to organize their thoughts asto how different imaging findings can be used in a particular sequential order toreach diagnosis.C-704Mind of a clinician and eyes of a radiologist: Key to success in (neuro)radiologyD. Ganeshan, K. Das, R. Hanlon, J. Curtis; Liverpool/UK (drdakshin@yahoo.co.in)Learning Objectives: ‘The eyes see only what your mind knows’. The aim of thisposter is to enhance the knowledge of the radiology trainees in neuroradiology bytesting their anatomy and clinical skills in the form of a quiz.Background: Knowledge of the clinical and radiological features of the commonand important neurological disorders will help to increase the diagnostic accuracyof the radiologist. In particular, this will help him or her to look at specific reviewareas when characteristic clinical history is presented.CS482 A B D E F FG H

Scientific and Educational ExhibitsProcedure Details: In our poster, we have used a quiz format to help the traineestest and update their neuroradiology knowledge. For example, we provide a singleslice of normal MRI brain and ask the radiologists in which part of the brain theywould expect to find pathology if a patient with a known history of alcohol abusepresents with reduced consciousness and confabulation. A choice of four options isprovided and the single best option should be chosen and the corresponding areaon the image should be clicked. Once they answer that question, the correct answeris given with a detailed explanation. We aim to present about 20 such questions.Conclusion: At the end of this poster, the participants should be able to recognizeimaging findings of common and important neurological conditions whenever appropriateclinical history is provided.C-705Perfusion-MRI with calculation of standardized time-to-peak parameter inpreoperative diagnosis of idiopathic normal pressure hydrozephalus (INPH)S. Gentzsch; Vienna/AT (stephan.gentzsch@meduniwien.ac.at)Purpose: Patient selection for cerebrospinal fluid diversion by implantation of ashunt system is difficult, because idiopathic normal pressure hydrocephalus (INPH)mimics other neurodegenerative disorders and no findings reliably predict outcome.Overall, 59% of patients improve after shunting, and 29% of patients experienceprolonged improvement. Complications occur in 38% of patients, additional surgeryis required in 22% of patients, and there is a 6% combined rate of permanentneurological deficit and death.Methods and Materials: Perfusions-MRI with calculation of stdTTP parameterhas been used in 12 consecutive patients before and after shunt-implantationand the data had been compared to measurement of intraventricular pressure asgold standard as well as to clinical outcome (Stein-Langfitt Score, NPH-Scale andRapid Disability Rating Scale).Results: An impairment of perfusion in periventricular white matter before shuntimplantationand a significant improvement of perfusion afterwards (paired t-Test;n= 12; p 0.05) has been demonstrated. A significant correlation of the amountof perfusion improvement and clinical outcome after shunt-implantation has alsobeen shown. Thereby, a high grade of correlation with intraventricular pressuremeasurement has occurred.Conclusion: Perfusion-MRI with calculation of stdTTP demonstrates: impairmentof perfusion in periventricular white matter, improvement of periventricular perfusionafter shunting and differentiation of patients, who might benefit from a shunt-systemand who might not by the synopsis of impairment of perfusion and presence ofgliosis in periventricular white matter.C-706Correlation between “notches” on the surface of vestibular schwannomaand facial nerve described by diffusion tensor tractographyT. Taoka, T. Akashi, T. Miyasaka, M. Sakamoto, S. Kitano, H. Nakagawa,K. Kichikawa; Kashihara/JP (ttaoka@naramed-u.ac.jp)Purpose: There are some “notches” observed on the surface of vestibular schwannomasadjacent to medullo-pontine sulcus. The purpose of this study is to assessthe relationship between the location of the “notches” and the course of facialnerve, which is depicted on the diffusion tensor tractography and confirmed bythe surgical findings.Methods and Materials: The subjects were 12 cases with vestibular schwannomawho underwent surgical resection. Contrast enhanced sagittal images anddiffusion tensor images were obtained, and tractographies of facial nerve wereconstructed. We assessed: (1) existence and location of “notches” on the surfaceof schwannomas on sagittal images, and (2) agreement between the location ofthe “notches” and course of facial nerve, which was depicted by the tractographyand confirmed by the surgical findings.Results: We could observe more than one “notch” on the surface of the vestibularschwannomas in 10 cases out of 12 cases. Agreement between the tractographyand surgical findings were obtained in 9 cases. Within the cases in which the tractographyfinding agreed with surgical findings, there were “notches” at the location,which agreed with the course of the facial nerve tractography in 6 cases.Conclusion: The location of the “notches” on the surface of vestibular schwannomasadjacent to medullo-pontine sulcus agreed with the course of facial nervetractography in 6 out of the 10 cases in which “notches” were observed. The locationof the “notch” may be an aid to the preoperative prediction on the course ofdisplaced facial nerve in cases of vestibular schwannoma.C-707The effect of intracranial volume measurement on hippocampal volumetryand modulated voxel-based morphometry: Comparison between manualmethod and automatedK. Lee, S. Kim, W.-S. Tae, E. Nam; Chuncheon/KR (samskim@kangwon.ac.kr)Purpose: To investigate the effects of measurement methods of intracranial volume(ICV) for evaluating the hippocampal volumetry and modulated voxel-based morphometry(mVBM) in patients with chronic major depressive disorder (MDD).Methods and Materials: 21 chronic MDD patients and 21 age-matched psychiatricallyhealthy control subjects were enrolled. Coronal TFE 3DT1 MR images wereobtained with 1.3-millimeters thickness. ICVs were measured by a manual and anautomated method using FreeSurfer package. The volume of the hippocampus wasmanually measured, and the gray matter volume measured using SPM.Results: The ICV between manual and FreeSurfer method was similar in normalcontrols (p = 0.696), but different in MDD patients (p = 0.000002). Total gray mattervolume controlled by manual ICV was statistically significantly reduced in MDDpatients (p = 0.0015), but not significantly reduced by automated ICV. The hippocampalvolume controlled by manual ICV was significantly reduced in MDD (right:p = 0.014, left: p = 0.004), but the hippocampal volumes controlled by FreeSurferICV were not significant (p 0.05). The mVBM result controlled by manual ICVshowed significant findings after the correction for multiple comparisons by falsediscovery rate and familywise error correction.Conclusion: The sensitivity for detecting the hippocampal atrophy and the regionalgray matter volume change can be dependent on acquisition methods of ICV. Themethods of ICV measurement can affect results of the hippocampal volumetry andmVBM, which might be due to the over-segmentation of CSF space in the processof the automated method.C-708Reversible cerebral vasoconstriction syndrome: NeuroradiologicalimplicationsE. Wiener, J. Hoffmann, G. Bohner, U. Reuter, R. Klingebiel; Berlin/DELearning Objectives: To familiarise with the reversible cerebral vasoconstriction(Call-Fleming) syndrome (RCVS), an underdiagnosed entity mimicking subarachnoidalhemorrhage or cerebral vasculitis.Background: RCVS is used to describe a disorder characterized by prolongedbut reversible multifocal narrowing of the cerebral arteries, and sudden serverheadache with or without focal neurological deficits (FND). We present the clinicaland imaging features of a patient with sudden onset of thunderclap headache, FNDand severe cerebrovascular vasospasm, which was referred for neuroradiologicevaluation as cases of emergency because of clinically suspected subarachnoidalhemorrhage (SAH).Imaging Findings: Neuroimiging included cerebral CT and CT angiography, MRIwith diffusion-weighted images and time-of-flight cerebral MRA and conventionaltransfemoral catheter angiography. MRI and CT showed no hemorrhagic or ischemicevent. CTA, MRA and conventional angiography showed multisegmental,pronounced vasoconstriction, raising the suspect of cerebral vasculitis. In thecourse of the disease, arterial abnormalities disappeared in less than 3 months.SAH, vasculitis and drug-induced angiopathy could be ruled out based on repeatedcerebrospinal fluid (CSF), blood and urine analysis.Conclusion: RCVS is an underdiagnosed treatable and reversible vasonstrictionsyndrome that should be included in the differential diagnosis of patients presentingwith signs and symptoms of SAH or vasculitis. As vascular changes are pronounced,non-invasive angiography techniques like CTA and MRA seem appropriate for initialdiagnosis and follow-up.C-709MR imaging of Liliequist membraneG. Yilmaz Ovali, O. Kitis, Y. Ersahin, T. Turhan, C. Calli, N. Yunten; Izmir/TR(gulgun.yilmaz@bayar.edu.tr)Purpose: Liliequist membrane is an arachnoid membrane that extends throughdorsum sella and the anterior portion of mamillary body in the suprasellar sistern.Clinical importance of this membrane is the possibility of blocking the cerebrospinalfluid flow from the defect of the third ventricle floor, which may cause failure ofendoscopic third ventriculostomy (ETV). In this study, we defined the MRI findingsto detect Liliequist membrane and to correlate the findings with ETV findings.Methods and Materials: Preoperative MR examinations were evaluated in 19patients who were examined by ETV with different causes in Ege University MedicineSchool Neurosurgery department. We used sagittal 3D CISS sequence andaxial-coronal reconstructions. The visible segments of this membrane and ETVfindings were noted.NeuroACB D E F G HS483

Scientific and Educational ExhibitsResults: In 8 patients the membrane was demonstrated by MRI, CISS sequence.The comparison with the ETV findings revealed that 2 false negative results wereobtained.Conclusion: Liliequist membrane can be evaluated by 3D CISS sequence inMRI. Definning the extent of this membrane and the segments preoperatively isimportant for the ETV procedure.C-710Evaluation of brain metabolite ratios in systemic lupus erythematosuspatients with and without neurological symptoms: A prospective 2D-CSIMR spectroscopy studyG. Beyer, J.R. Perry, P. Cagnoli, R. Harris, S. Gebarski, J. Mccune, S. Rohrer,P.C. Maly Sundgren; Ann Arbor, MI/US (grbeyer@med.umich.edu)Purpose: To compare brain metabolite ratios in systemic lupus erythematosuspatients with acute neurological symptoms (NPSLE) to lupus patients without suchsymptoms (SLE) and healthy controls using 2D-CSI MR spectroscopy.Methods and Materials: Prospective study including 18 SLE (17 women, 1 man,mean age 38), 8 NPSLE (8 women, mean age 36), and 11 healthy controls (9women, 2 men, mean age 48) used conventional brain MRI and 2D-CSI spectroscopy(TE/TR144/2000 ms) on a 3 T scanner. Large volumes of interest (VOIs) wereplaced at the levels of the basal ganglia and supraventricular white matter. SmallVOIs (100 mm 3 ) were manually placed in several bilateral, normal appearing grayand white matter regions in addition to the insula, thalamus, and internal capsule.NAA/Cr, Cho/Cr, and Cho/NAA ratios were calculated for each voxel. Statisticalsignificance was set to p 0.05 using a Student's t-test.Results: Cho/Cr increased in the white matter in both NPSLE and SLE comparedto controls (p 0.03). In comparing NPSLE to controls: NAA/Cr in the thalamustrended upward (p 0.06); Cho/NAA decreased and Cho/Cr trended downward(p 0.03, p 0.07) in the right anterior insula; Cho/NAA increased (p 0.03) inthe left posterior insula. NAA/Cr was reduced while Cho/Cr trended downward inthe internal capsule in NPSLE compared to SLE (p 0.04, p 0.06). No othersignificant differences in metabolite ratios were present between NPSLE andcontrols or NPSLE and SLE.Conclusion: Preliminary data suggests SLE causes metabolic alterations irrespectiveor predating neuropsychiatric symptoms and may also support a demyelinatingmodel of injury.No Material Submitted to EPOSC-711Everything you always wanted to know about cerebral amyloid angiopathy(CAA) … but were too busy to look upA. Ghandi, H. Tanghe, M. Vernooij, A. van der Lugt; Rotterdam/NL(aghandi78@gmail.com)Learning Objectives: 1. To review the pathophysiology of CAA. 2. To discuss clinicalsymptoms and imaging findings in patients with CAA. 3. To explain the utility ofadvanced MRI techniques in the depiction of microbleeds in CAA. 4. To discuss andillustrate CAA “mimickers”. 5. To discuss clinical management of CAA.Background: Introduction: Pathophysiology of cerebral amyloid angiopathy (CAA);Differential diagnosis: Summary of CAA “mimickers”. Therapy: Clinical managementof CAA.Imaging Findings: Imaging findings and characteristics: “The black dots”. Descriptionof the most commonly encountered radiological signs of CAA. Usefulness ofadvanced T2* GRE MRI techniques in the detection of these signs.Conclusion: CAA is often not recognized as a cause in patients with strokeor dementia. Specific advanced MRI techniques are useful to depict cerebralsigns of CAA. After viewing this exhibition, the viewer will: 1. fully understand thepathophysiology of CAA. 2. receive a thorough description of the radiological signsof CAA. 3. appreciate the value of T2* GRE MRI technique in the evaluation ofCAA. 4. become aware of the differential diagnosis in CAA. 5. know the clinicalmanagement of patients with CAA.C-712Brain aging, white matter arteriolosclerosis and carotid stenting: A longtermMR follow-upR. Loffroy, B. Guiu, N. Méjean, J.-P. Cercueil, D. Krausé; Dijon/FR(denis.krause@chu-dijon.fr)Purpose: To systematically study the brain changes in elderly patients previouslytreated for severe carotid stenosis with angioplasty-stenting: analysis of age-relatedwhite matter changes (periventricular and deep locations), including the potentialaggravation hyperintense foci (number and size) due to stent placement.Methods and Materials: Between 2000 and 2007, 78 patients were treatedfor severe carotid disease. The aetiologies of the stenoses were: post-operativerestenoses (n=38); post-radiotherapy (n=17); EVA-3S protocol (n=15); stenosesin high-risk patients (n=8). Seventeen had a contralateral carotid stenosis and 14others had a carotid occlusion. All procedures were performed under cerebralprotection (Filter-Wire), before placement of the carotid stent. The mean follow-upwas 58 months for 52 patients (loss of view: 4; deaths: 22). A systematic MR scan(FLAIR, T2 WI, DWI, T1 WI) was performed every 12-15 months.Results: MR findings regarding white matter demonstrated during the follow-upfor 52 patients : status-quo: 32/52; aggravation (on the side of the stent): 6/52;contralateral aggravation: 10/52. The basal ganglia, the size of both subarachnoïdspaces and ventricles were unchanged (52/78). 2 leukoarioses were reported.On the contrary, the mortality rate (22/78) was high, due to a major co-morbidity(cardio-vascular and cancer).Conclusion: In this high-risk group of patients, the clinical neurologic state isunchanged and the long-term follow-up concerning white matter hyperintensitiesis not related to the presence of a carotid stent and, thus, rules out the problem ofthe normal brain aging in elderly patients.C-713Perfusion magnetic resonance imaging (MRI) of intracraneal tumoursC. Hernández, P.D. Domínguez, B. Zudaire, A. Alonso, R. Garcia de Eulate,J. Zubieta; Pamplona/ES (cbhernan@unav.es)Learning Objectives: To describe the role of perfusion MR imaging in improvingaccurate diagnosis and monitoring of intracraneal tumours. To show the behaviourof expansive intracraneal lesions studied by perfusion MR imaging. To describeour experience with perfusion MR imaging as part of our protocol for intracranealtumours management.Background: Conventional MR imaging relies only in anatomical aspects andblood-brain barrier (BBB) destruction for the characterisation and follow-up ofintracraneal tumours. It is a great tool, yet it lacks specificity in several grounds,like glioma grading, solitary metastases vs high grade glioma differentiation, radionecrosisvs high-grade recurrence differentiation, pseudotumoral lesions, tumourheterogeneity, etc. Dynamic contrast-enhanced MRI estimates tumour vascularizationas a marker of angiogenesis, providing very useful information that resolvesmost of those problems. After a concise review of the technique, a pictorial reviewof perfusion behaviour of intracraneal tumours is presented, focussing on the maincontributions of perfusion MRI.Imaging Findings: Perfusion MRI analysis, based on relative cerebral blood volume(rCBV) maps, of several tumour types are shown, differentiating glioma grades andareas of higher grade in an heterogeneous tumour, high-grade tumour vs radionecrosis,high-grade tumour vs solitary metastases, lymphoma or pseudotumorallesions. Also, some extraxial lesions and possible pitfalls are shown.Conclusion: Perfusion MRI offers very useful information about intracranealtumours and should be included in the initial evaluation and follow-up protocolswhen available. It helps differentiate tumour type and grade, high-grade tumourvs radionecrosis or high grade tumours vs inflammatory/infectious diseases orlymphoma.C-714Brain microhemorrhages in patients with post-traumatic diffuse axonalinjury: A comparison between susceptibility-weighted MR phase imagingand T2*-weighted gradient-echo imagingE.L. Gasparetto, C.S. Dias, L.H. da Cruz Jr, T. Doring, R.C. Domingues,R.C. Domingues; Rio de Janeiro/BR (egasparetto@gmail.com)Purpose: To compare the susceptibility-weighted MR phase imaging (SWI) andT2*-weighted gradient-echo (GRE) imaging for detection of hemorrhage in patientswith post-traumatic diffuse axonal injury (DAI).Methods and Materials: This study included 15 patients (mean age 20 years)with diagnosis of post-traumatic DAI. The MR imaging were performed in a 3 Tscanner using a conventional protocol and, in addition, isotropic T2*-weighted GREimages and 3D SWI. The two sequences were post-processed and analyzed withthe software ImageJ (version 1.38, National institutes of Health, USA) with a semiautomatedtechnique, to obtain the number and the volume of lesions. In addition,two experienced neuroradiologists assessed independently and subjectively thenumber of lesions in each sequence. The number and the volume of lesions in eachsequence were compared with the ANOVA test, followed by the nonparametricWilcoxon matched pairs test (p 0.01).CS484 A B D E F FG H

Scientific and Educational ExhibitsResults: The semi-automated analysis showed a mean of 49 hemorrhagic lesions(mean volume 1182 cc) in the T2*-weighted images and 81 lesions (mean volume5700 cc) in the SWI, both differences being statistically significant (p 0.01).Similarly, the mean number of lesions assessed subjectively was higher in SWIcompared with T2*-weighted images (45 vs 72 lesions, respectively, p 0.01).Conclusion: The sensitivity of SWI in assigning the number of microhemorrhagesin patients with post-traumatic DAI is significantly higher than T2*-weighted GREimages. As the prognosis of these patients is related to the number of hemorrhagiclesions, the SWI can play a significant role in the evaluation of patients with DAI.C-715Contrast-enhanced MR neuroimaging protocols at 1.5 and 3 T: Results ofan expert consensus panelM.J. Kuhn 1 , H.A. Rowley 2 , L.N. Tanenbaum 3 , D.S. Enterline 4 ; 1 Springfield, IL/US,2Madison, WI/US, 3 New York, NY/US, 4 Durham, NC/US (mkuhn@st-johns.org)Learning Objectives: To develop contrast-enhanced MR neuroimaging protocolsoptimized for the specific examination and magnet field strength.Background: A multi-institutional panel of expert neuroradiologists was convenedto evaluate and discuss MR neuroimaging protocols at 1.5 and 3 T. The panelistsdeveloped protocols for commonly performed studies (whole brain, spine, neurovascular,acute stroke, and multiple sclerosis) as well as for more specializedindications (IAC & cranial nerve, orbits, pituitary, and seizures). For each technicalparameter (i.e., FOV, TR, TE, ETL, NEX, etc), an absolute value or range of valueswas specified. Each protocol also included recommended slice thickness and gap,plane (s) of reconstruction, and notes on special sequences recommended ordiscouraged (IR, fat saturation, magnetization transfer). Recommended protocolswere tested and further optimized as necessary.Procedure Details: Optimized neuroimaging protocols applicable at multiple institutionshave been developed. 3 T protocols were optimized to take benefit from thehigh SNR provided by while minimizing SAR issues. A standard gadolinium doseof 0.1 mmol/kg bodyweight was recommended for most protocols; however, thisdose may be reduced with the use of a high-relaxivity contrast agent. For certainexams at 1.5 T (eg, pituitary lesions and acoustic neuromas) and for most studiesperformed at 3 T, a half dose of 0.05 mmol/kg may be adequate.Conclusion: Neuroimaging protocols were optimized for the type of examinationbeing performed and for the coil and field strength of the scanner being used. Theuse of high-relaxivity contrast agent is recommended for optimal contrast enhancementat the lowest possible dose.C-716A voxel-based morphometric study in acute and chronic major depressivedisorder patientsK. Lee, S. Kim, W.-S. Tae, E. Nam, J. Park; Chuncheon/KR (samskim@kangwon.ac.kr)Purpose: To investigate the structural abnormalities of the brain in patients withacute and chronic major depressive disorder (MDD) using optimized voxel-basedmorphometry (VBM).Methods and Materials: 20 acute MDD (MDD A), 21 chronic MDD patients (MDD c),and 21 age-matched psychiatrically healthy normal control (NC) subjects wereenrolled. Coronal TFE 3DT1 MR images were obtained with 1.3-mm thickness. Allraw images was segmented and spatially normalized to own T1 template usingeach subject’s gray matter image to create normalization parameters, then normalizedby each subjects’ normalization parameter, and segmented into gray, whitematter and CSF images. Finally each partition images were smoothed by 12 mmFWHM isotropic gaussian kernel. The gray and white matter volume (G&WMV)was calculated in native space. The statistical significance was set to uncorrectedP 0.001, and extent threshold k E 200 voxels.Results: The GMV was statistically significantly reduced in MDD Aand MDD Cpatients(MDD A:638.1769.37, MDD C:624.0982.40, NC:663.0849.89, P=0.0001,ANCOVA), but the WMV not reduced among three groups. The GM concentration(GMC) reduced in both hippocampal head in MDD Apatients and in hippocampus,amygdalae, parahippocampal gyri, thalami, hypothalami, cingulate gyri, gyrirectus, insular cortex, and superior temporal gyri in MDD Cpatients, comparedto NC group. The GMC reduced in hypothalamus, gyrus rectus, cingulate gyrus,middle frontal gyrus, right insular gyrus, and left superior temporal gyrus in MDD C,compared to MDD A.Conclusion: The present study suggests that the significant brain anatomicalchanges are developed in terms of GMV and GMC in acute and chronic MDDpatients.C-717MR spectroscopic findings in delayed hypoxic encephalopathy aftercarbon monoxide poisoningY. Kubo, M. Ida, N. Yorozu, K. Hino, S. Sugawara, H. Doi; Tokyo/JP(yukoma123@yahoo.co.jp)Purpose: Delayed hypoxic encephalopathy (DHE) is one of severe complicationsafter carbon monoxide (CO) poisoning that is hard to predict in the earlystage. Almost all patients with DHE have a poor clinical outcome. The aim was toevaluate the clinical utilities of proton magnetic resonance spectroscopy (MRS)in diagnosing DHE induced by CO poisoning and to correlate MRS findings withclinical outcome.Methods and Materials: Single-voxel MRS or chemical shift imaging was carriedout using a PRESS sequence with a long echo time of 270 ms at 1.5-tesla. 34patients with CO poisoning were classified into acute reversible damage (ARD)(n=24) and DHE in the chronic stage (n=10). The obtained peak amplitude valuesof N-acetyl aspartate (NAA), creatinine (Cr), choline (Cho) and lactate (Lac) wereevaluated.Results: NAA/Cr ratio was lower in DHE than that in ARD, and Cho/Cr ratio wassignificantly higher in DHE. Note that although there is no evidence of Lac peakin ARD, an increased Lac peak was found in 5 patients with DHE who had a pooroutcome neurologically.Conclusion: NAA reduction indicates loss of neuronal integrity and increased Chosuggests membrane damage and synthesis of the neuron, glia and myelin. Lac peakrepresents anaerobic hypoglycolysis going on to neuronal damage. The elevationof Cho level and the presence of Lac peak are useful indicators in diagnosing DHEand likely correspond to clinical outcome in CO poisoning.C-718The diameter product of long-axis and short-axis of intracranial aneurysm:A simple model to predict the total coil length in endovascular coiling ofsmall and medium-sized intracranial aneurysms (7 mm)T.-C. Wu, Y.-K. Tsui, W.-S. Tzeng; Tainan/TW (porthoswu@yahoo.com.tw)Purpose: To provide a simple means to predict the total coil length (TCL) in endovascularcoiling of intracranial aneurysms.Methods and Materials: Between November, 2006 and August, 2008, 29 patients(eight males and 21 females) with saccular aneurysms (total 33 aneurysms; 16AcomA, nine PcomA, 4 MCA, two terminal ICA, two intradural VA) received coilingwithout stent/balloon assistance. Only GDC-10 or Matrix 2 coils (Boston Scientific)were used. By 3D rotational angiography or CT angiography, the long axis diameter(L), short axis diameter (S, perpendicular to L) and their product (LS) of eachaneurysm were recorded.Results: Thirteen small-sized, 16 medium-sized and four large-sized ( 10 mm)aneurysms are found. According to L/S ratio, two morphology groups are defined,i.e. elongated group (L/S 1.3; 21 aneurysms) and round group (L/S 1.3; 12 aneurysms).The mean of TCL and LS are 36.9/31.6 in elongated group and 63.5/51.5in round group. For aneurysms with L 7 mm, "TCL - LS 5" were found in 10 of12 aneurysms (83%, median: -1.41) of elongated group and 3 of 6 (50%, median:-3.645) of round group (P:0.213, Mann-Whitney U test). In simple regression modelwithout intercept for expectation of TCL by LS, the slope is 0.926 in the elongatedgroup (7 mm) and 0.696 in the round group (7 mm).Conclusion: For relatively small aneurysms 7 mm, LS value is an easy way topredict the total coil length deployed and might be helpful for the choice of coillength in the end of procedure.C-719Ultrasonographic evaluation of the globe with contrast enhancedultrasound (CEUS) and 3D imaging in comparison with conventional highresolutionultrasound (HRUS)F. Lacelli 1 , L.M. Sconfienza 2 , M. Bertolotto 3 , R. Padolecchia 1 , T. Bolelli 1 ,G. Serafini 1 ; 1 Pietra Ligure/IT, 2 San Donato Milanese/IT, 3 Trieste/IT(io@lucasconfienza.it)Learning Objectives: To illustrate the CEUS and 3D findings of a wide spectrumof pathologies affecting the globe compared with HRUS.Background: CEUS is a valid diagnostic tool in the assessment of several districts.In the pathology of the globe, there is a wide range of cases where CEUS can bedetrimental or very helpful.Imaging Findings: We present a wide range of traumatic lesions (retinal andchoroidal detachments, lesions of the anterior chamber, of the vitreous body, ofthe eye membranes, and of the posterior orbit soft tissues) as well as malignancies(choroidal melanoma, tumors inside and outside the muscle cone, and arterovenousNeuroACB D E F G HS485

Scientific and Educational Exhibitsmalformation) evaluated alternatively with CEUS and 3D. We compared those findingswith those obtained with HRUS. CT and MR comparison is presented in somecases. Dysthyroid orbitopathy is excluded from our presentation.Conclusion: CEUS plays a central role in the differential diagnosis between retinaldetachment (vascular) and vitreous membranes (avascular). In addition, CEUS ishelpful in the assessment of bulbar tumors, in the therapeutic program of choroidalmelanoma and in the evaluation of neovascularization of orbital masses. HRUSis highly effective in the detection of traumatic and non-traumatic lesions of theglobe but is not efficient in the assessment of the orbital wall lesions. The use of 3Dmodule has increased the diagnostic value of CEUS evaluation. In addition, CEUSis cost-effective and can be used when CT and MR cannot be performed.C-720Clinical usefulness of arterial spin labeling at 3 T for acute ischemic stroke:Comparison with dynamic susceptibility-weighted MR perfusion techniqueJ.-C. Ferré, B. Carsin-Nicol, T. Ronzière, M. Carsin, J.-Y. Gauvrit; Rennes/FR(jean-christophe.ferre@chu-rennes.fr)Purpose: To evaluate the clinical use of pulsed arterial spin labeling (PASL) cerebralperfusion technique at 3 T to study acute ischemic stroke in comparison to dynamicsusceptibility-weighted (DSW) MR perfusion.Methods and Materials: Nine consecutive patients (6 females, 3 males; medianage, 76 years) with acute ischemic stroke on middle cerebral artery (MCA) territorywithin 12 hours of symptom onset underwent PASL and DSW MR perfusiontechniques, and diffusion weighted imaging (DWI). All exams were performed ona 3 T system using only an 8-channel head coil with parallel imaging. Perfusionmaps were visually analyzed, comparing presence/absence of perfusion deficitson PASL CBF map to MTT and TTP maps from the DSW perfusion data. Sensitivityand specificity of PASL to depict hypoperfusion in deep and superficial territoryof MCA were calculated. The hypoperfusion in the MCA territory was ranked ineach map on a score from 0 to 4. Comparison between PASL and MTT/TTP wasperformed by means of the statistic. A “mismatch” between each perfusion mapsand DWI was searched.Results: PASL had a sensitivity of 92.3% and specificity of 95.7%. PASL and DSW(MTT and TTP) showed a good agreement between the maps: agreement 83%(15/18) and =0.73. ASL overestimated hypoperfusion in two cases compared toT TM and underestimated hypoperfusion in one case. A mismatch was present in 6patients using MTT, TTP or PASL.Conclusion: PASL at 3 T is useful to study acute ischemic stroke to depict hypoperfusionand mismatch on MCA territory.C-721Imaging and the expanded endonasal approach to the skull base: What theneurosurgeons need to knowN.J. Klitsch, V. Agarwal, W.T. Rothfus, M.M. Rahman, A.B. Kassam, P.A. Gardner,D.M.S. Prevedello; Pittsburgh, PA/USLearning Objectives: Provide an overview of the endoscopic expanded endonasalapproach (EEA) to the skull base and its applications. Examine the role of imagingin patients who are being considered for EEA. Highlight radiographic featurescritical for surgical planning and intraoperative guidance. Present unique findingson post-operative imaging studies after EEA.Background: The skull base has traditionally been one of the most challenginganatomic regions to access surgically. EEA is a rapidly evolving minimally invasiveneurosurgical technique that allows access to the skull base without disturbing theface or skull. Neuroradiologists play a key role in helping to identify important anatomiclandmarks that are critical for surgical planning and intraoperative guidance.We will briefly describe EEA and its current major applications. We will examinethe role of imaging in patients being considered for EEA and describe the uniqueradiographic details which need to be understood and recognized for surgicalplanning, intraoperative guidance and postoperative surveillance.Imaging Findings: CT and MRI are used in a complimentary fashion to evaluatethe relationship of skull base pathologies of important anatomic structures. Chiefamong these are the neurovascular structures entering and exiting the skull basethrough their respective foramina including the vertebral, basilar, carotid and videanarteries as well as cranial nerves II-VI.Conclusion: EEA is a new and rapidly evolving technique for treating skull basepathology. We will outline the critical radiographic details vital to assist neurosurgeonswith preoperative evaluation, intraoperative guidance and postoperativesurveillance.C-722Ten reasons to review the CT brain scan on bone windowsM. Bydder, S.P. Ramachandra, D.J. Wilcock; Stoke-on-Trent/UK(megan.bydder@btinternet.com)Learning Objectives: To emphasise the importance of reviewing all CT brain scanson dedicated bone windows. To present a range of pathological conditions that maybe missed if routine review of bone windows is not performed.Background: CT brain is widely used as the initial investigation for patients followinghead trauma or presenting with acute neurological symptoms or signs. Trauma CTscans are routinely reviewed using multiple windows (usually brain, bone and intermediatewindows), but it is important to review all CT brain examinations on bonewindows, regardless of the indication, to avoid missing significant pathology.Imaging Findings: Optimal evaluation of the bony structures included on the CTbrain examination requires reconstruction of data using a bone algorithm, followedby review of the images on bone windows, which are essentially wide windows(width 2000-3000 HU) centred at a higher window level (300-600 HU). Routinereview of all CT brain scans on bone windows offers the opportunity to diagnosebenign and malignant bone lesions, unsuspected trauma, inflammatory and infectiveconditions, and enables better characterisation of calcified parenchymal lesions.We present ten pathological conditions diagnosed on bone windows, which maybe unsuspected or difficult to interpret on brain windows alone.Conclusion: This exhibit emphasises the importance of reviewing all CT brainexaminations on bone windows to avoid missing significant pathology.C-723The role of magnetic resonance imaging in prenatal diagnosis of facial cleftsM. Mailath-Pokorny, E. Krampl, F. Watzinger, P.C. Brugger, D. Prayer; Vienna/AT(mariella.mailath-pokorny@meduniwien.ac.at)Purpose: To investigate the role of fetal MRI in prenatal diagnosis of facial clefts.Methods and Materials: During a 7 year period, in 23 pregnant women with amean gestational age of 27 weeks (range 21-35) who underwent in utero MRI,(1.5 T, cardiac coil, T2-weighted ultrafastspin-echo sequences, echoplanar sequences,steady-state free precession sequences, in 3 orthogonal planes, 2-4 mmslice-thickness) a facial cleft was diagnosed. Previous ultrasound had identifieda malformation in any part of the body. Clefts were classified into the followingcategories: cleft lip alone; cleft lip and alveolus; cleft lip and palate; midline cleft lipand palate. The postnatal diagnosis was assessed by the operating surgeon andcompared with intrauterine MRI findings.Results: We investigated 4 (17.4%) cleft lips, 2 (8.7%) cleft lip/cleft alveolus, 13(56.5%) cleft lip/palate, 2 (8.7%) clefts of the posterior palate and 2 (8.7%) midlineclefts. In 2 cases, the malformation was only suspected by ultrasound examination.Isolated clefts were not seen by ultrasound. 3 fetuses with a cleft lip and palate havenot yet been delivered. The MR classification of the cleft lip and palate correlatedwith severity of defect and postnatal diagnosis in all cases.Conclusion: Fetal MRI allows detailed prenatal evaluation of the upper lip andpalate, allowing a better staging of the malformation by detecting the degree ofinvolvement of the palate. In addition, isolated clefts of the posterior palate thatmay be not accessible by ultrasound can be visualized.C-724MR analyses of gliosis and glutamate excitotoxicity in a mouseneuropathic pain modelC. Cavaliere, G. Di Grezia, N. Pignatelli di Spinazzola, R. Grassi; Naples/IT(carlocavaliere1983@yahoo.it)Purpose: Analysis by imaging techniques of gliosis and neurotransmitters homeostasisfollowing sciatic nerve injury (SNI).Methods and Materials: 40 male mice, n=25 neuropathic and n=15 control, werescanned by micro-MR at 7 T, and confocal microscopy at 7 and 14 days followinginjury. In order to evaluate gliosis, a gradient echo T2-weighted scans were acquiredin the three orthogonal planes. The glutamate concentration was evaluated by aPRESS sequence on a ROI placed on lumbar spinal cord. Glutamate and glycineamount were also evaluated by HPLC analysis in lumbar spinal cord tissue.Results: MR signal intensity increases progressively up to the end of the study.This pattern is paralleled by spinal GFAP immunolabeling that increases on pd 7lasting up to pd 14. Simultaneously, the expression of glial transporters for glycineand glutamate (GlyT1, GLT1) was reduced on pd 7 and 14. Consistent with areduced expression of GlyT1 and GLT1, MR spectrum analysis of lumbar spinalcord showed an increase of Glx peak on pd 7 and 14. At the same time points,HPLC analysis revealed a net increase in glutamate and glycine concentration inlumbar spinal cord tissue from neuropathic mice.CS486 A B D E F FG H

Scientific and Educational ExhibitsConclusion: Gliosis, and the concurrent glial cytoskeletal rearrangement, correlateswith a marked decrease in glial aminoacid transporters, and determinesa net increase of neurotransmitters at spinal cord level, as revealed by MRS andHPLC analyses. We speculate that these phenomena could contribute, via NMDAreceptor overstimulation, to generate changes in synaptic functioning responsiblefor persistent pain maintenance.C-725White matter attenuated (WHAT) MR imaging in multiple sclerosis patientsat 7TS. Sammet, P.A. Wassenaar, P. Schmalbrock, K. Rammohan, M.V. Knopp;Columbus, OH/US (sammet.5@osu.edu)Purpose: To improve multiple sclerosis (MS) lesion depiction using inversionrecovery turbo spin echo sequences at 7T. FLAIR and WHite matter ATtenuated(WHAT) sequences were tested with a range of TR, TI and TE and compared to3 T MRI and additionally to numerical estimations of image contrast.Methods and Materials: In this ongoing study, 10 MS patients (33-48 y) and8 healthy volunteers (23-52 y) were scanned at 7T (Achieva, Philips MedicalSystems). Initial studies tested a range of parameters: TR=8000-10000 ms,TI=50-5000 ms, TE=14-145 ms, TSE-factor 10-24, refocus angle 120. Computersimulations were used to aid parameter selection. High resolution FLAIR (TR/TI/TE=10000/2600/140 ms, TSE-factor 24) and WHAT (TR/TI/TE=8000/500/14 ms,TSE-factor=10) images were acquired in 9 and 12 min (FOV 200x150 cm, matrix512x288, 2 mm, interpolated voxel 0.2x0.2x2.0 mm 3 ). Images were visually ratedfor overall image quality and lesion depiction, SNR was measured, and findingswere compared with 3 T using equivalent parameters.Results: Diagnostic image quality and high SNR/CNR were achieved with theWHAT sequence at 7T. Numerous hyperintense linear structures were seen in WM,possibly representing perivascular spaces or white matter tracts. FLAIR contrastwas achieved but varied locally due to flip angle variations. MS lesions were welldepicted with FLAIR and WHAT at 7T. SNR and image quality were significantlybetter in WHAT compared to FLAIR.Conclusion: 7T white matter attenuated MRI reveals additional contrast characteristicsand more detailed brain anatomy. WHAT MRI may give additional informationabout the lesion microstructure to achieve a better understanding of the disease.C-726Susceptibility-weighted image: Pickpocket guide for daily clinical practiceJ. Izquierdo, E. Marco de Lucas, A. Fernández Flórez, E. Ruiz, E. Sánchez,A. Gutiérrez; Santander/ES (alexferflo7@hotmail.com)Learning Objectives: To analyze the main technical fundaments of susceptibilityweightedimage (SWI) MR sequence. To describe the main clinical applications ofthis technique in daily clinical practice.Background: Susceptibility is a relatively new sequence that is a combination ofmagnitude and phase images. SWI can provide a higher differentiation of subtlechanges in susceptibility in brain tissues. This sequence is progressively beingincluded in new MR units’ routine and daily clinical protocols.Procedure Details: We review the main clinical applications from a series of 93selected patients with an MR study including SWI sequence performed at a 3.0 Tunit to be used in daily clinical practice and future possible applications. Thesecases includes oncologic cases, vascular lesions (detection of subtle hemorrhageafter fibrinolysis), improvement in detection of cavernomas, and other vascularmalformations, vein thrombosis, role in epilepsy imaging, and denerative diseases(analysys of magnetic deposition in gasal ganglia). We also analyze the maintechnical technical problems including a gallery of pitfalls.Conclusion: SWi is a very useful for detection of subtle hemorrhagic lesions thatcan provide a higher diagnostic rentability than traditional T2-gradient sequencein selected patients.C-727Spectroscopic MR imaging of the brain at 7TS. Sammet 1 , J. Murdoch 2 , M. Knopp 1 ; 1 Columbus, OH/US, 2 Cleveland, OH/US(sammet.5@osu.edu)Purpose: The purpose of this in-vivo feasibility study was to evaluate the requirementsfor the use of spectroscopic imaging (SI) at 7T for clinical applications.Methods and Materials: SI of the human brain was performed in 5 volunteers ona 7T whole body MR scanner (Philips) using a transmit-receive head-coil. After asecond order shim SI with transverse spin-echo slice localization was performedwith the following parameters: TR=1500 ms, field of view=250 mm; 28 x 28 matrix;slice thickness=20 mm; 1 average; 8 REST slabs and two different echo times: along echo time of TE=144 ms and a short echo time of TE=26 ms. STEAM CSIwas performed with: TR=1500 ms; TE=18 ms; TM =22 ms; 16×18 matrix, 1 averageand 10×10×15 mm voxels.Results: Spin-echo slice excitation and STEAM for SI imaging at 7T allows acquisitionof highly resolved brain MR spectra. STEAM SI excitation pulses with largerbandwidth reduce chemical shift displacement. PRESS localization is not applicablefor SI at ultra-high fields due to a large chemical shift displacement. In all volunteers,the resonances of Choline, Creatine, NAcetylaspartate and Myo-Inositol could bereadily identified in different SI voxels. CSI with short echo time resolved additionalresonances in the spectra like glutamate and glutamine.Conclusion: SI at ultra-high magnetic fields increases the sensitivity and spectralresolution in MRS. The tremendous gain in signal to noise ratio at 7T comparedto lower field strengths of today’s clinical MR-scanners facilitates more robust andadvanced clinical applications of ultra-high field MR spectroscopy.C-728Partial endovascular embolization of 6 vein of Galen aneurysmalmalformations (VGAMs) progressed to complete spontaneous closurefollowed up by transcranial color-Doppler sonography (TCDS)M. Piano, M. Rollo, A. Pedicelli, G. Tamburrini, C. Di Rocco, L. Bonomo,C. Colosimo; Rome/IT (mariangela.piano@gmail.com)Purpose: VGAMs are very rare and can lead to congestive cardiac failure andhydrocephalus in the neonatal period. Since 1996, we treated 12 patients withVGAM. Six choroidal type cases showed a spontaneous progression to completeobliteration after a single partial embolization. The aim of this work is to describethe angioarchitecture of these 6 VGAMs, the modality of treatment and to reportTCDS as a non-invasive technique for follow-up.Methods and Materials: All patients were 1 year old. Preliminary diagnosticimaging included TCDS, CT, MRI and DSA. Embolization with coils and glue wasperformed by trans-arterial approach. Together with clinical follow-up, TCDS wascarried out every 2 months, completed by CT a/o MRI after fontanel closure. DSAwas performed only after demonstration of thrombosis of the vein of Galen.Results: In all 6 cases, a single embolization caused a significant flow-reductionof the VGAM. Final angiographic control showed complete obliteration in all casesfrom 3 to 16 months after treatment. Only 1 patient had intracranial hemorrhagelikely due to sudden vein of Galen thrombosis, but showed no neurological abnormalitiesat follow-up.Conclusion: Trans-arterial embolization is the first-choice treatment for VGAMs.Staged endovascular therapy is finalized to cure or reduce the venous congestioncaused by the vascular malformation. TCDS represents a valid technique in orderto control the cerebral structures, size of the ventricular system and hemodynamicmodification of the VGAM. Our experience led us to avoid further embolizations incase TCDS shows a spontaneous progressive obliteration of the VGAM.C-729Dynamic imaging of a model of saccular intracranial aneurysms usingultra-high resolution flat-panel volume CTB. Reichardt 1 , A.P. Mitha 2 , E.A.Q. Mooyaart 2 , T.J. Brady 2 , C.S. Ogilvy 2 , P. Vock 1 ,R. Gupta 2 ; 1 Berne/CH, 2 Boston, MA/US (Benjamin.Reichardt@insel.ch)Purpose: Conventional multi-detector CT (MDCT) scanning is limited by theability to demonstrate intracranial aneurysm features such as perforating vessels,pulsatile blebs, and neck remnants after treatment because of clip or coil artifact.In this study, we have used a model of intracranial saccular aneurysms to clinicallyvalidate the ultra-high resolution and dynamic scanning capabilities of flat-panelvolumetric CT (fpVCT).Methods and Materials: Ten New Zealand White rabbits were imaged pre- andpost-clipping or coiling of surgically created aneurysms in the proximal right carotidartery (n = 20) using fpVCT and MDCT. Images were reconstructed into 3D anddynamic views, which were evaluated for their ability to demonstrate clinicallyimportant aneurysm features and for post-treatment clip and coil artifact.Results: FpVCT demonstrated surface features of pre-treatment aneurysms withmuch higher resolution. Metallic artifacts from clips and coils were significantly lessthan those associated with MDCT, yielding useful information about post-treatmentneck remnants. Dynamic sequences, which are viewed identical to conventionalangiography, revealed pulsating blebs on the aneurysm surface.Conclusion: The spatial resolution and artifact profile of fpVCT is superior toMDCT and yields clinically important anatomical information about the aneurysmand post-treatment neck remnants. Dynamic imaging, made possible by continuousgantry rotation, permits observation of temporally evolving processes, suchas pulsating blebs.NeuroACB D E F G HS487

Scientific and Educational ExhibitsC-730Selective visualization of peripheral nerves using diffusion-weighted MRneurography with unidirectional motion probing gradientsT. Takahara, T.C. Kwee, J. Hendrikse, F. Visser, P. Luijten, W.P.T.M. Mali;Utrecht/NL (tarorin@gmail.com)Purpose: Diffusion-weighted MR neurography (DW-MRN) allows visualizationof peripheral nerves, but also shows several surrounding structures. We recentlydiscovered that peripheral nerves are better visualized when using unidirectionalmotion probing gradients (MPGs) instead of applying MPGs in three directions.In addition, DW-MRN with MPGs along the anterior-posterior direction only (DW-MRN AP only) clearly visualize both peripheral nerves and surrounding tissue, whileDW-MRN with MPGs along the superior-inferior direction only (DW-MRN SI only) onlyvisualize the latter; this can be explained by the anisotropic nature of peripheralnerves and the isotropic nature of surrounding structures. We therefore hypothesizedthat selective visualization of peripheral nerves could be achieved by subtractingDW-MRN SI onlyfrom DW-MRN AP only.Methods and Materials: Five volunteers underwent MR imaging of the brachialplexus and three volunteers underwent MR imaging of the nerves of the knee, at1.5 T. In all volunteers, both DW-MRN AP onlyand DW-MRN SI onlywere performed. DW-MRN SI onlyimages were subtracted from DW-MRN AP onlyimages. Maximum intensityprojection images were created of DW-MRN AP onlyimages and subtraction images(DW-MRN AP only- DW-MRN SI only). Subtraction images were compared to DW-MRN APimages with regard to suppression of surrounding and superimposing structuresonlyand signal-to-noise ratio (SNR), by two radiologists independently.Results: Subtracted DW-MRN was inferior to DW- MRN AP onlywith regard to SNR,but effectively suppressed surrounding lymph nodes, bone marrow, and articularfluids.Conclusion: Subtraction of DW-MRN images obtained with two different MPGdirections can nullify signal from surrounding structures, and selectively visualizeperipheral nerves.NeuroSpineC-731A DTI study of the cervical spine in MS: Application of the fiber densityindexR. Longo, A. Montalbano, M. Ukmar, E. Makuc, C. Muscovich, M.A. Cova; Trieste/IT(majaukmar@alice.it)Purpose: To evaluate the cervical spinal cord (CS) in patients with multiple sclerosis(MS) by using MRI-DTI. Fractional anisotropy (FA) and fiber density index (FDI)were evaluated in order to characterize the three MS subgroups.Methods and Materials: Twenty-seven patients (8 patients with relapsing remittingcourse (RRMS), 9 with primary progressive course (PPMS) and 9 with secondaryprogressive course (SPMS)) and 19 healthy volunteers were enrolled. Images wereacquired using a 1.5 T magnet and 32 diffusion gradient directions were applied forDTI acquisitions. Forty axial slices covering a tract of 8 cm of the cervical spine wereacquired. The DTI analysis was performed using DTI Studio software. FA and FDI(index of the number of fiber paths traversing a ROI) values were calculated.Results: No significant differences were found for FA and FDI among the 3 MSsubgroups and the control group. None of the parameters were significantly correlatedwith the EDSS score or the age. Significant correlations were found betweenFA and FDI in each group (p 0.01) and the regression lines were significantlydifferent between PP and controls and between SPMS and controls (p 0.01).The FA-FDI regression lines were not significantly different between RRMS andcontrols, while the difference between SPMS and PPMS regression lines wasmarginally significant (p~0.05).Conclusion: Correlation between FDI and FA seems to be a promising tool in theevaluation of MS involvement of the cervical spine.C-732MR diffusion tensor imaging in spondylotic cervical spinal cordcompressionM. Kerkovský, J. Bednarík, A. Šprláková-Puková; Brno/CZ (mkerkovsky@fnbrno.cz)Purpose: An interpretation of conventional MR findings of the spondylotic cervicalmyelopathy (SCM) may be challenging because of frequent discrepancies betweenthe imaging and clinical findings. Diffusion tensor imaging (DTI) might have thepotential for more accurate myelopathy detection. In this paper, we present pilotdata aimed at evaluation of DTI parameters in assessment of myelopathic changeswith respect to compression and its clinical manifestation.Methods and Materials: 20 patients with MR findings of cervical spine compression(7 with symptomatic SCM, 13 asymptomatic) were examined on 1.5 T scanner,the protocol involved axial DTI slices (15 gradient directions, C2-7 level coverage).Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of the spinal cordcross sections were measured. We compared the C2/3 level without compression(NCL) and the level of maximal spinal cord compression (MCL) using parametrictesting (t-test). Moreover, we compared DTI values obtained from MCL betweensymptomatic and asymptomatic patients.Results: The average FA value was lower at MCL (0.503) compared to NCL (0.595)within the group of all patients (p=8x10 -6 ). The spinal cord FA values at MCL weresignificantly lower (p=0.02) comparing asymptomatic and symptomatic patients(0.533 and 0.448, respectively). Differences in ADC values were not significant.Conclusion: We found significant decrease of FA values at the level of spinal cordcompression, more pronounced in the group of symptomatic patients. The preliminarydata thus suggest the DTI to be a promising diagnostic tool for evaluation ofSCM reflecting also the clinical relevance of the spinal cord compression.C-733Failed back syndrome: What every radiology trainee needs to knowD. Ganeshan, R. Gurujala, K. Das; Liverpool/UK (drdakshin@yahoo.co.in)Learning Objectives: The aim of this pictorial review is to teach the trainees theimaging appearances of the most common causes of failed back syndrome.Background: Failed back surgery syndrome is a very important entity. Whilepsycho-social factors and associated co-morbidities may play a role, the singlemost important factor is early identification of treatable causes and addressingthose issues appropriately. In this sense, the radiologist has an important role toplay. Missing an important finding that may be a potentially treatable cause meanschronic disability to patient and can also lead to unnecessary litigations.CS488 A B D E F FG H

Scientific and Educational ExhibitsImaging Findings: MRI is the single most useful diagnostic test for this condition.MRI findings of recurrent disc prolapse, post-operative fibrosis, spinal stenosis,arachnoiditis etc are discussed. One of the common causes for failed back syndromeis operating at the wrong level. This can be easily prevented by clear communicationbetween the surgeons and radiologists. Additional procedures like markingthe correct level with a dye are also very useful. Further, the poster stresses theimportance of documenting important findings like sequestrated disc, prior tosurgery for optimum results.Conclusion: Failed back syndrome is a very difficult condition to manage. Awarenessof the common imaging findings of failed back syndrome is essential for allradiologists.C-734Magnetic resonance myelogram (MRM) by 3D fast imaging employingsteady state with phase cycled (3D-FIESTA-c) for diagnosis of nerve rootavulsion in brachial plexus injuryQ. Zhao, D. Geng, W. Yang, T. Xie; Shanghai/CN (zqf_ying@yahoo.com.cn)Purpose: To evaluate magnetic resonance myelography by 3D Fast Imaging EmployingSteady-state Acquisition with phase cycled (3D-FIESTA-c) in diagnosingbrachial plexus preganglionic injury.Methods and Materials: 24 patients with brachial plexus preganglionic injury underwentMR scanning before operation. The MRI protocol included fast spin-echo (FSE)T2-weighted sequencing in sagittal plane, and 3D-FIESTA-c in coronal and axialplane for MRM. All the patients had carried out exploration of the supraclavicularplexus and intraoperative electrophysiology exam. The accuracy, sensitivity andspecificity of MRM in diagnosing preganglionic injury were calculated with thestandards of surgical finds and intraoperative neurophysiology results. Also, theycalculated diagnosing accuracy of MRM for patients whose time interval betweeninjury and MRI scan were within 3 weeks and above 3 weeks, respectively.Results: The sensitivity, specificity and accuracy of MRM in diagnosing brachialplexus preganglionic injury were 86.7, 88.5, 87.1, and 52.4, 100, and 56.5% at C5level; 90, 100, and 90.9% at C6 level; 100, 100, and 100% at C7 level; 100, 75, and100% at C8 level; and 100, 90, and 95.8% at T1 level. The sensitivity and accuracyof MRM were lowest both at C5 level, and the specificity was lowest at C8 level.For patients, whose time interval between injury and MRI were within 3 weeks andabove 3 weeks, the accuracy of MRM were 84.0 and 87.9%, respectively.Conclusion: The MRM images of preganglionic injured brachial plexus by employing3D-FIESTA-c sequence are satisfactory, and can provide valuable data fordiagnosis, especially in the early stage (2-3 weeks) of injury when the preoperativeEMG is difficult to diagnosis precisely. But the accuracy of MRM is low at C5 level,and so the MRM and clinical information should be combined with each other.C-73564-row MDCT angiography in diagnosing spinal vascular malformations:An initial studyY. Yan g, Y. Liu, X. Du, L. Cao, Y. Gao, J. Liu, K. Li; Beijing/CN (yyh_wj@sohu.com)Learning Objectives: The purpose was to evaluate 64-row MDCT angiographyin diagnosing spinal vascular malformations.Background: 64-row multi-detector computed tomographic (MDCT) angiographyis a newly developed imaging technique that can clearly visualize small vesselssuch as medullary arteries.Imaging Findings: Twenty patients with clinical findings and/or magnetic resonanceimaging (MRI) suggestive of spinal vascular malformations (SVM) underwentMDCT angiography. The contrast medium is Ultravist (370 mgI/ml) and injected bya flow rate of 4.5 mm/s. Both MDCT angiography and catheter angiography wereperformed within 4 days in all these patients. The results of MDCT angiography inthese 20 patients were analyzed and compared with those of catheter angiographyby two neuroradiologists, respectively. All the 20 patients included 10 of spinal arteriovenousmalformation (SAVM), 6 of spinal perimedullary fistula and 4 of Cobbsyndrome. 64-row MDCT angiography revealed abnormal intramedullary vessels inall patients of SAVM and Cobb syndrome, and dilated perimedullary draining veinsand correctly localized the fistula of the perimedullary fistula. In Cobb syndromepatients, it also showed the masses of extramedullary-subdual and paravertebraldeformed vessels. The appearance and the region of the lesions detected by 64-row MDCT were as same as those showed by catheter angiography. The valuefor interobserver agreement of the MDCT angiography for detecting the feedingarteries and/or draining veins of the SVMs was 0.89.Conclusion: 64-row MDCT angiography correlated very well with catheter angiographyin diagnosing SVM. It could be a preferred method and should play a moreimportant role in diagnosing these diseases.C-736Foraminal corticosteroids infiltrations in cervical neuralgias under CTguidance: A long term analysis of clinical results (300 patients)B. Guiu, R. Loffroy, A. Lambert, N. Méjean, J.-P. Cercueil, D. Krausé; Dijon/FR(denis.krause@chu-dijon.Fr)Purpose: To demonstrate, through an 8 years experience, the feasibility, accuracyand efficacy of cervical foraminal corticosteroids injections under CT guidance, inthe case of a cervico-brachial neuralgia (CBN) due to a disk fragment.Methods and Materials: January 2000-December 2007: 300 patients were treated withcorticosteroids injections, directly in the middle part of the foramen, behind the painfulganglion, generally at the C5-C6-C7 levels. Under local anaesthesia, a 22-G needle wasadvanced under CT control, against the articular process. Before the corticosteroids injection(Cortivazol 0.75 mg), a systematic CT control with contrast (0.3 ml) verified the liquiddiffusion volume within the foramen, all around the ganglion and also in the intracanalarepidural space, so that the potential complications could be easily identified. Each patientwas given a scoring of pain, compared to baseline over the 15 following days based onan Analogic Visual Scale. All patients were reviewed at 6 weeks, 6 months and 1 year.Results: A good and durable pain relief was observed in 73% (219/300) duringthe first 2 weeks. Long-term results were identical (mean delay 58-68 months).The failure rate was 13% (39/300). After a 4-6 weeks delay, a second procedurewas performed in 36 others patients (12%). No complications or side effects wereobserved in this series.Conclusion: Cervical corticosteroids foraminal injection in ambulatory patientsallows a significant improvement of CBN, even in the case of a foraminal intricateduncarthrosis. At the expense of a rigorous controlled needle’s positioning withcontrast, this procedure is very safe.C-737Imaging lumbosacral plexus using CT and MR: Anatomic and clinicalcorrelationsS. Belião, Á. Almeida; Lisbon/PT (sara.beliao@clix.pt)Learning Objectives: To present the lumbosacral plexus regional anatomy usingCT and MRI. To make a pictorial review of the main lumbosacral plexopathy.Background: The lumbosacral plexus is composed of the ventral divisions of thelumbar and sacral spinal nerves with contribution from T12. The complex anatomyand the diverse disease processes that may affect this region are diagnosticallychallenging. Additionally, possible surgical management, operative technique andnecessity of medical treatment depend on an accurate determination of the specificstructures involved. Based on our clinical experience, we describe the applicationsof the imaging methods in the evaluation of lumbosacral plexopathy.Imaging Findings: Images of 100 patients examined at our institution withlumbosacral plexopathy of different etiologies were retrospectively reviewed. Wedescribe the abnormal radiologic findings and the anatomic-pathological correlationsin this population.Conclusion: There is a wide spectrum of pathologic processes involving the lumbosacralplexus. Because of the complex regional anatomy, it may be difficult tolocate clinically with precision the level of pathological involvement. We demonstratethe reliability of CT and MR in the detailed imaging of these patients.C-738Dynamic MR imaging of the cervical spine: Technique, applications, andadvantagesA. Mallouhi, S. Hiehs, H. Kostron, T. Gotwald, B. Czermak, W. Jaschke;Innsbruck/AT (Ammar.Mallouhi@i-med.ac.at)Learning Objectives: To provide a spectrum of cervical spine abnormalitiesrevealed on dynamic MR images. To illustrate the advantages of dynamic overroutine static cervical spine imaging. To demonstrate the impact of dynamic MRfindings on treatment planning.Background: MR imaging, performed in the neutral position, is a standard imagingtechnique of the cervical spine. Nevertheless, some patient’s symptoms may notcorrelate with MR findings.Imaging Findings: Dynamic MR imaging of the cervical spine in anteflexion,retroflexion, lateral flexion and/or rotation allows detection and quantification ofspinal and foraminal stenosis and to characterize neural and ligamentous involvement.The dynamic technique is particularly useful in evaluating morphologicalchanges of the degenerated spine (osseous and intervertebral disc), instability,posttraumatic injuries, postoperative mechanical changes, and some congenitaldeformities of the cervical spine.Conclusion: Dynamic MR imaging of the cervical spine may help in the diagnosisof some abnormalities that are not appreciated on routine static imaging.NeuroACB D E F G HS489

Scientific and Educational ExhibitsC-739Application of the diffusion tensor imaging to the spine: A single centerexperience in comparison with the literature dataP. La Montanara; Brescia/IT (montanara03@tiscali.it)Purpose: To assess the better MRI acquisition parameters in the study of spine withDTI (b-value, axial or sagittal acquisitions, isometric or anisometric voxel).Methods and Materials: Application of the DTI-sequence to 8 healthy subjects,male and female, III-IV decades. Scanner: Siemens Avanto 1.5 T and the sequenceis a single-shot echo-planar-imaging (SS-EPI). In each voxel, the DTI-softwarecalculated the diffusion tensor, the FA and the ADC. The track-count and the tracklengthfor each section were also calculated. Protocols: axial acquisitions, with thefollowing b-values: 700, 800 and 900; axial acquisitions (b700), with isometric andanisometric voxel.Results: We can confirm the difference between the acquisition in the axial versusthe sagittal plane acquisition: in the axial plane, we detected lower ADC and higherFA; b700 puts in evidence a higher number of white fibers than b900 the diffusionweightingis more evident in b900 than in b700 (FA higher and ADC smaller); theabsence of cardiac gating and of a navigation system is a great limit. Without cardiacgating there is a significant difference between the voxels centrally located and thevoxels peripherally located (probably because of motion of liquor).Conclusion: A low b-value is better for the identification of white matter fibers(maybe because there are few artifacts). A high b-value is better for the assessmentof the diffusion-parameters: FA and ADC. Sagittal acquisitions offer moreprecise FA and ADC values.C-740MRI of vertebral bone marrow: From physiology to pathology - pictorialessayL. Sánchez, G. González; Santiago/CL (ggonzalezt@alemana.cl)Learning Objectives: To show with MRI conversion through the life, from hematopoieticto fat bone marrow. Reviewing major diseases affecting vertebralbone marrow. Identifying principal radiological findings allowing the differentialdiagnosis.Background: Throughout life, bone marrow experiences a gradual conversion fromhematopoietic marrow to fat marrow, which reflects into chemical and structuraldifferences that determine the different patterns visible in MRI. The major diseasesaffecting the vertebral bone marrow can be grouped into traumatic, infectious,tumoral, ischemic and degenerative causes. All of them are expressed mainly byedema. Recognizing radiological patterns is essential to establish the differentialdiagnosis between them.Imaging Findings: Physiological conversion from red marrow to fat marrow determinesa normal and gradual increase in T1 signal of vertebral bodies. Regardinga pathological bone marrow, distribution of edema in the vertebral body, corticalmargins, enhancement contrast pattern, presence of soft tissue mass, characteristicsof the intervertebral disc, signal variations in different sequences in MRI andclinical history are examined to approach the final diagnosis.Conclusion: MRI assessment of the vertebral bone marrow requires knowing theirphysiological changes during the life and recognizing the major diseases that affectit. Radiological findings are powerful tools to get the final diagnosis.No Material Submitted to EPOSPediatricAbdominalC-741Ultrasound imaging of the pediatric pancreasM.G. Papadaki 1 , H. Moschouris 1 , C. Hadjigeorgi 2 , M. Khalili 1 , D. Matsaidonis 1 ;1Piraeus/GR, 2 Athens/GR (papadaki1@yahoo.com)Learning Objectives: To present normal appearances and congenital abnormalitiesof the pancreas in children. To highlight the role of ultrasonography in the evaluationof pancreatic disorders. To emphasize the importance of clinical grounds andfollow-up studies.Background: The pancreas is easily visualised in children. Pancreatic diseases arerelatively uncommon during childhood. A specific clinical context is often presentbut imaging may contribute significantly in the diagnosis and follow-up.Imaging Findings: The pediatric pancreas has usually a bulky appearance witha prominent tail. Its size and reflectivity increases with age. The pancreatic duct isvisualised in the center of the gland. An annular pancreas is difficult to confirm byultrasound. Acute pancreatitis presents a broad spectrum of features: normal, enlargement,reduced reflectivity, dilatation of the duct, and collections. An underlyingcause (e.g. cholelithiasis) is sometimes demonstrated. In pancreatic trauma findingsare variable. A fractured pancreas may be easily visualised but further imagingstudies are often required. Pseudocyst formation should be looked for in follow-upstudies. Chronic pancreatitis is present with shrinkage and increased reflectivityof the pancreas. Associated abnormalities should be looked for in patients withcystic fibrosis and haemosiderosis. Solid masses are extremely rare but secondaryinvolvement is more common.Conclusion: Ultrasonography is a valuable tool in the evaluation of the pediatricpancreas. Normal appearance varies with age and radiologists should be aware toavoid erroneous diagnosis. It can be used confidently as the first imaging approachin cases of pancreatitis. Complications may be detected in follow-up studies.C-742What’s new in hepatic hemangioma: Current classification and ongoingtherapeutic strategiesA. Díez Tascón, M. Parrón Pajares, A. Pérez-Vigara, J. Gómez-Patiño,J. López-Gutiérrez, C. Prieto; Madrid/ES (aureadiez@yahoo.es)Learning Objectives: To illustrate the spectrum of imaging findings of infantile hepatichemangiomas, emphasizing on key diagnostic features and on differential diagnoseswith vascular malformations and true neoplasms. To expose the current classificationand clinical management algorithm of vascular anomalies affecting the liver.Background: Hemangiomas are the most common hepatic vascular tumors ofinfancy. Most are asymptomatic, incidentally discovered, but some are associatedwith severe symptoms. The literature is confusing regarding the natural historyand therapy options. This fact may lead to an incorrect diagnosis and, therefore,an inappropriate treatment.Imaging Findings: Hepatic hemangiomas are classified into three types on thebasis of imaging findings: focal, multifocal, and diffuse. Each type demonstratesdifferent imaging appearances, pathologic features, and clinical behaviour, and mayrespond differently to various pharmacologic and invasive treatments. Sonographyis the most common and the first imaging technique used. MR, including dynamiccontrast-enhanced sequences, is probably the best technique for diagnosis. CTmay also be performed although radiation is a drawback. Angiography should bereserved in cases of symptomatic shunts and endovascular therapy is anticipated.Rapidly involuting congenital hemangiomas, venous malformations, arteriovenousmalformations, and true vascular neoplasms will also be discussed, stressing ontheir differential imaging features.Conclusion: This exhibit will provide a comprehensive overview of the imagingappearance of hepatic hemangiomas and help to distinguish hemangiomas fromother lesions whose natural history and therapy differ dramatically. We also give asubtype classification and therapeutic algorithm that will contribute greatly to theunderstanding of these potentially fatal tumors.CS490 A B D E F FG H

Scientific and Educational ExhibitsC-743Role of diffusion weighted MR imaging in abdominal mass of pediatricpatientsA.A.A. Abdel Razek, A. Sultan, R. Elashery; Mansoura/EG (arazek@mans.eun.eg)Purpose: To evaluate the role of diffusion-weighted magnetic resonance imagingin characterization of abdominal mass in pediatric patients.Methods and Materials: Prospective study was conducted on 37 consecutivepediatric patients (19 M, 18 F aged 4-14 ys: mean 7 ys) with abdominal mass. Theyunderwent single shot echo planar diffusion weighted MR imaging of the abdomenwith b-factor of 0.500 1000 sec/mm 2 . The scanning parameters were: TR= 10000 ms,TE=108 ms, bandwidth=125 kHz, slice thickness=5 mm. Apparent diffusion coefficient(ADC) maps were reconstructed. The ADC value of the abdominal masswas calculated and correlated with the surgical finding or biopsy.Results: The mean AC value of malignant tumors was 1.030.06X 10-3 mm 2 /secand of benign tumors was 1.660.07X 10-3 mm 2 /sec. There was significant differencein ADC value between benign and malignant abdominal mass in pediatric patients(p 0.001). When apparent diffusion coefficient value of 1.32X 10-3 mm 2 /sec wasused as a threshold value for differentiating malignant from benign renal mass, thebest results were obtained with an accuracy of 89%, sensitivity of 91%, specificity of87%, positive predictive value of 86% and negative predictive value of 93%.Conclusion: We concluded that diffusion weighted MR imaging is a new non invasiveimaging modality that can be used for characterization of pediatric abdominalmass and differentiation of malignant tumors from benign lesions.PediatricHead and NeckC-744Causes and patterns of cervical lymphadenopathy in pediatric patientsM.G. Papadaki, H. Moschouris, D. Kalikis, A. Spyridonos, D. Matsaidonis;Piraeus/GR (papadaki1@yahoo.com)Learning Objectives: To present the different causes of cervical lymphadenopathy(CL) in children. To highlight the specific characteristics of the cervical lymphnodes (CLN). To emphasize the importance of ultrasonography in the diagnosisand follow-up.Background: CL is a common problem in the pediatric population, largely inflammatoryin origin. When persistent, malignant involvement may be suspected. A clinicalcontext explaining the cause is sometimes difficult to define and ultrasonographycan help to narrow the differential diagnosis.Imaging Findings: Enlargement of CLN is usually connected to inflammatorydisorders, including granulomatous infections such as tuberculosis. Kawasaki diseaseis a common cause of CL during early childhood while sarcoidosis remainsrare. Malignant involvement is lymphomatous or metastatic. The neck is a commonsite for both non-Hodgkin lymphomas and Hodgkin disease. Neuroblastoma andrhabdomyosarcoma may involve CLN when evolving in the head and neck regions.Thyroid cancer may spread through CLN. Langerhans cell histiocytosis has a preferencefor CLN but its incidence remains low. When studying enlarged lymph nodes,specific characteristics should be examined: size and shape, presence or absenceand thickness of the nodal hilum, structural pattern of the cortex, and blood flowpattern. Ultrasonographic evaluation should include thyroid and salivary glandsfor evidence that may contribute to the diagnosis. Follow-up studies can monitorresponse to treatment and orientate to a diagnostic biopsy in selected cases.Conclusion: Knowledge of differential diagnosis in pediatric patients with CLand specific characteristics of the lymph nodes may contribute significantly to thecorrect diagnosis.C-745Imaging of neck lesions in children: A pictorial reviewL. Figueroa Nasra, B. Díaz, M. Parrón Pajares, B. Marín, E. Alonso Gamarra,M. Ruíz de Gopegui Andreu; Madrid/ES (lourdesfi@hotmail.com)Learning Objectives: To review congenital and acquired neck lesions in childrendescribing their distinctive imaging features. To evaluate the role of the differentimaging modalities, establishing the indications of each one.Background: Neck lesions are common findings in pediatric age and several imagingtechniques are used to evaluate them. Clinical data, as well as knowledge ofembryology and cervical anatomy, provide clues for accurate diagnosis.Imaging Findings: During the last 2 years, 224 children with cervical lesions werestudied (1day to 16 years-old). Images were retrospectively reviewed. All patientswere studied with US, CT, or MR. US was the initial technique in congenital, vascular,inflammatory, and tumoral benign diseases. In cases of large tumours of suspiciousmalignancy, CT or MR was the preferred modalities. Most of the radiologicaldiagnoses were histologically or surgically confirmed. Imaging findings of congenital(thyroglossal duct and dermoid cysts, teratoma, tracheal stenosis, branchial cleftanomalies), inflammatory (retropharyngeal abscess, cervical and mycobacterial adenitis),vascular (hemangioma, lymphangioma, venous malformations, aneurysms),benign and malign tumors (lymphoma, sarcoma, neurogenic tumors, salivary glandtumors), and tumor-like conditions (fibromatosis colli) will be shown.Conclusion: Imaging is helpful for an accurate diagnosis of neck lesions in childrenby means of a well-defined differential diagnoses. US is the election technique;nevertheless, in cases of large lesions or suspected malignancy, CT or MR imagingis required for diagnosis and follow-up. This exhibit shows the wide spectrum ofpediatric neck lesions, emphasizing the imaging findings on US, CT and MR andtheir differential diagnoses.PediatricACB D E F G HS491

Scientific and Educational ExhibitsC-746Ectopic intrathyroidal thymus in childhood: Sonographic patterns of a rarelittle-known entityM. Vakaki, A. Christopoulou, G. Pitsoulakis, A. Hountala, C. Koumanidou; Athens/GR(geopmar@gmail.com)Purpose: During gestation, the primordial thymus migrates from the pharynx tothe anterior mediastinum and thymic tissue can remain at any point along thispath. However, only few case reports in the literature describe the sonographicpatterns of the intrathyroidal thymic remnants. The main purpose is to present thesonographic appearance of ectopic intrathyroid thymus and to emphasize the roleof sonography to avoid misdiagnosis and errors in management.Methods and Materials: 21 children, 3.5 to 12 years old, were involved in thisretrospective study. They were referred for a sonographic examination of the thyroidgland due to positive family history or symptoms indicative of thyroid disease.Results: A fusiform intrathyroidal lesion, with no mass effect, homogeneouslyhypoechoic with diffuse bright internal echoes, was demonstrated. The similarity tothe characteristic sonographic pattern of the normal adjacent mediastinal thymuswas crucial for the diagnosis of ectopic intrathyroidal thymic tissue. In 3 cases, anormal elongated thymus was found connected to the thyroid with an accessorylobe embedded in the lower thyroid pole. The above sonographic appearancesmimicked a thyroid nodule. However, based on their similarity to the normal thymusechotexture, and their geographic distribution, it was decided not to proceed withany further investigation, recommending close sonographic follow-up. Repeatsonograms at 3, 6 and 12 months (12 children), confirmed the stability of thesonographic findings.Conclusion: Awareness of the sonographic patterns of the rare ectopic intrathyroidalthymus is mandatory to avoid misdiagnosis. We believe that further investigationis unnecessary and sonographic follow-up should be recommended.C-747Sonographic assessment of Hashimoto disease in childrenU. Zaleska-Dorobisz, D. Sokołowska, T.A. Dorobisz, K. Janczak; Wrocław/PL(atd@vassurg.am.wroc.pl)Purpose: To evaluate the usefulness of power Doppler ultrasonography (PDUS) indiagnosing the Hashimoto thyroiditis in children, in terms of the imaging features,degree of thyroid changes related to the disease duration, anti-thyroglobulineantibody (TGAb) level and in therapy monitoring.Methods and Materials: The study included 162 children (F/M ratio: 117/45),aged from 6 to 17 years, treated because of confirmed autoimmune thyroiditis.The diagnosis was made on the basis of the family history, clinical examination,ultrasonography findings, serum hormone levels, TGAb levels and fine needlebiopsy results. The PDUS were performed in every patient at time of diagnosisand several times during therapy. To achieve an optimal, objective and repetitiveassessment of the thyroid flow intensity in both thyroid lobes, computer-assistedquantitative analysis was performed.Results: The early stage of the disease was characterized by minimal echogenicitychanges with moderate hyperemia and mild thyroid enlargement. In moreadvanced stages the thyroid echogenicity was significantly decreased, with diffuseinhomogenicity of the structure, presence of nodule, vascular perfusion increasewith flow parameters disturbances, as well as a marked enlargement of the wholethyroid gland volume. In response to treatment the thyroid echogenicity changed,presenting features of fibrosis, the vascular flow reduction together with the thyroidvolume decrease.Conclusion: Power Doppler ultrasonography is very helpful imaging modalityin diagnosing children with autoimmune thyroiditis. Its significance is even moreevident in the disease course and therapy monitoring.PediatricLungC-748Fetal lung maturity assessed by approximative T2 relaxationmeasurementsM.M. Gatterer, G. Kasprian, P. Brugger, E. Krampl-Bettelheim, C.J. Herold,D. Prayer; Vienna/AT (melanie.gatterer@meduniwien.ac.at)Purpose: According to the observed significant variability, determination of absolutelung signal intensity values cannot be used to reliably detect signal changesassociated with pulmonary hypoplasia. The aim of this study is to explore an MRIbased method to non-invasively assess fetal lung maturity.Methods and Materials: Fetal MR using a 1.5 Tesla Philips scanner was performedin 78 fetuses without thoracic abnormalities (group 1: 15-21 th gestational week(GW) n=26, group 2: 22-29 th GW, n= 24 and group 3 30 th GW, n=28). Indicationswere: suspected cerebral (n=36), renal (n=8), gastrointestinal (n=6), non-specific(n=12) pathologies and others (n=10). T2-weighted and echo planar sequenceswith different T2 relaxation times (T2R) were acquired in the same orientation.Using Image J Software the T2R of the fetal lung was measured approximativelyby applying the formula signal = k/ln (s1/s2).Results: An increase of T2-weighted signal intensity between the 15 th and 37 th GWwas detected by subjective qualitative assessment. Significant differences of fetallung T2R between group 1 and 2 (Mann-Whitney-Test p=0.52) and group 2 and3 (p=0.23) were found. Approximative fetal lung T2R showed a significant linearcorrelation (r2=0.4) with gestational age and subjectively assessed increase insignal intensity (Pearson, p=0.005).Conclusion: As a result of the structural and chemical development, T2R of thefetal lungs increases during gestation. Apart from the subjective examiner dependentevaluation, this new MRI-based method holds the potential to quantify fetalpulmonary maturity non-invasively. In future the sensitivity and specificity of thismethod in detecting pulmonary hypoplasia will be elucidated.C-749Ecographic evaluation of pronation manoeuvre efficacy in neonatalrespiratory distress syndrome: Report of 15 casesF. Feletti 1 , G. Gardelli 2 , M. Mughetti 2 ; 1 Ferrara/IT, 2 Cesena/ITPurpose: When consolidated areas are present in respiratory distress syndrome(RDS), they are usually in the declivous regions of the lung and recruiting themby changing the patient’s position (in particular from supine to prone position) isa non-invasive way of increasing oxygenation. Unfortunately, accidental trachealextubation or withdrawal of vascular catheter may occur during pronation manoeuvreand there is a well-known association between the prone position andsudden infant death syndrome (SIDS). We report the use of lung echography inthe evaluation of the effectiveness of the above-mentioned therapeutic approachbefore it is employed.Methods and Materials: We report the cases of 15 premature neonates (9 males,6 females) affected by RDS, who were treated in the neonatal intensive care unit ofour hospital. The echographic evaluation (with transthoracic approach) of the resultsof the pronation manoeuvre were compared with variations in haemogasanalysis.A portable echograph with a 3.5-5 MHz convex probe was used.Results: Consolidating areas appear to be hypoechoic, with uncertain margins. Ifpronation is effective, recruited areas become similar to normal parenchyma, but arefull of B lines. Pronation was efficacious in 11 patients and not successful in 4. In allpatients, we found a complete correspondence between the results of echographicchanges and improvement in the partial pressures of O 2and CO 2.Conclusion: Lung echography could be useful in the evaluation of pronationmanoeuvre in RDS. A larger number of patients should be evaluated in order todefine the usefulness and limits of the methods employed.CS492 A B D E F FG H

Scientific and Educational ExhibitsPediatricMusculoskeletalC-750Traumatic injuries of the paediatric elbow: A pictorial reviewA.M. Veitch 1 , J. Harington 2 , K. Franklin 1 ; 1 Plymouth/UK, 2 Exeter/UK(amveitch@doctors.org.uk)Learning Objectives: To review normal paediatric elbow anatomy includingossification centres. To demonstrate a wide range of traumatic paediatric elbowfractures on plain film. To provide a systematic approach to evaluation of paediatricelbow X-rays in trauma.Background: Fractures of the elbow joint are common in children, accounting for15% of all paediatric fractures. The elbow comprises both hinge and pivot joints,making patterns of injury complex. In addition, the multiple ossification centresdevelop at different ages and can be misinterpreted by the less experiencedradiologist. Complications of elbow fractures include mal-union, non-union, elbowstiffness and neurovascular injury, and confident diagnosis is essential to enableadequate management of these injuries.Imaging Findings: We illustrate the normal anatomy of the paediatric elbowincluding apophyseal appearances. The wide range of fractures, avulsions anddislocations of the elbow illustrated include: supracondylar, lateral condylar, medialepicondylar, olecranon and radial head fractures, Monteggia fracture-dislocation anddislocation of the elbow. We also offer an approach to interpretation of paediatricelbow X-rays in trauma, including consideration of non-accidental injury.Conclusion: This pictorial review of elbow fractures in children aims to provide apractical aide-memoir to both trainee and general radiologists involved in reportingpaediatric trauma plain films.C-751Infantile fibrosarcoma: Magnetic resonance imaging findings in 6 casesS. Canale, D. Vanel, D. Couanet, C. Caramella, C. Dromain; Villejuif/FR(canalesandra@yahoo.com)Purpose: To retrospectively review magnetic resonance (MR) imaging features ina series of six infantile fibrosarcomas to find out if MR can suggest this unusualdiagnosis.Methods and Materials: The records of 6 cases of histologically proven infantilefibrosarcoma were retrieved from the files of our cancer center. All imaging dataavailable were consensually reviewed by two radiologists.Results: There were five females and one male (mean age 6 months). The mostcommon finding was a well-circumscribed single mass arisen on limbs in 5 patients.The masses were 9 cm large in mean diameter. The initial tumor signal was isointenseto muscle on T1-weighted and hyperintense on T2-weighted sequences. Allmasses were well-circumscribed, internal signal was heterogenous in 5 patientsand intense enhancement was seen in all 3 contrast-enhanced exams available.Osseous erosion and distant metastasis was observed in only one patient. Aftertreatment (chemotherapy and very limited surgery), tumors had totally disappearedleaving limited area of fibrosis; muscle and subcutaneous impressive fat infiltrationwas seen in two patients.Conclusion: Our series provides additional images of this rare childhood tumor inthe literature. Although imaging findings are not specific of infantile fibrosarcoma, thisdiagnosis must be suggested when MR imaging depicts a large well-circumscribedmass arising in a limb at birth or during the neonatal period. This mass exhibitsan isointense T1- and hyperintense T2-weighted heterogeneous signal and isstrongly enhanced.PediatricNeuroC-752Migration disorders and heterotopia: A pictorial reviewM. Reiss-Zimmermann, J. Fuchs, L. Schomerus, A. Merkenschlager, D. Weber,I. Sorge, W. Hirsch; Leipzig/DELearning Objectives: To illustrate the spectrum of migration disorders. To outlinethe advantages and limitations of MRI. Short up-to-date excursion on treatmentconcepts.Background: Migration disorders (MD) are increasingly recognized as an importantcause of epilepsy and developmental delay. Up to 40% of children with refractoryepilepsy have a cortical malformation. MD encompasses a wide spectrum withunderlying genetic etiologies and clinical manifestations. Research in delineatingthe genetic and molecular basis of these disorders has given a greater insight intopathogenesis of not only the malformation, but also the process involved in normalcortical development. Diagnosis of MD is important, since patients who fail threeantiepileptic medications are less likely to have their seizures controlled with additionaltrials of medications and therefore epilepsy surgery should be considered.Imaging Findings: With recent advantages in neuroimaging, there is a significantincrease in the recognition of MD. Findings can be subdivided in disorders due toabnormal neurogenesis, neuronal migration, neuronal migration arrest and neuronalorganization resulting in different malformations like microcephaly, lissencephaly,schizencephaly and heterotopia. The examination protocol should include T1- andT2-w sequences in adequate slice orientation. Turbo-inversion recovery (TIR) sequencescan be helpful in diagnosing heterotopia. Contrast agent is only neededto exclude other differential diagnoses.Conclusion: High resolution MRI dramatically improved diagnosis of MD, whichis of importance in the treatment of epilepsy and developmental delay. The maincerebral malformations as well as a diagnostic algorithm will be presented.C-753Cystic lesions in foetal brain MRIS. Ramamurthy, Z. Jibri, S. Morris A. Liu; Cardiff/UK(satheesh_ramamurthy@yahoo.co.uk)Learning Objectives: Abnormalities of the foetal brain are not uncommon inantenatal ultrasound evaluation. MRI is becoming an important modality used forfurther evaluation of these lesions. The poster illustrates the imaging characteristicsof various intra and extra axial cystic lesions in the foetal brain.Background: Cystic lesion of the foetal brain can range from normal variantsto life threatening anomalies. We have identified the antenatal MRI scans thatshowed cystic brain lesions in our institute over a 5 year period. The lesions couldbe supra-tentorial or infra-tentorial. These anomalies, for instance, could includearachnoid cyst, porencephalic cyst, encephalocoele, Dandy-Walker malformationand megacisterna magna. We have also illustrated vascular malformations that,although are not strictly cystic, can appear so on ultrasound.Procedure Details: An overview of the technique of performing foetal MRI isprovided along with few normal examples. We have then illustrated the differentcystic abnormalities with MRI and corresponding ultrasound images.Conclusion: The understanding of the normal variants and the differentiation ofvarious cystic lesions in foetal brain MRI is important as it can have significantconsequences. The poster provides an overview of the cystic lesions and correlativeimaging findings in foetal MRI and antenatal ultrasound.PediatricACB D E F G HS493

Scientific and Educational ExhibitsC-754Imaging of brainstem abnormalities in childrenI. Delgado, E. Vazquez, N. Mayolas, M. Roig, L. Gros, G. Enriquez; Barcelona/ES(idelgadoalvarez@gmail.com)Learning Objectives: To identify and describe the key imaging features of a varietyof pathologic conditions that involves the brainstem. To describe the validityof magnetic resonance (MR) imaging in establishing the precise diagnosis anddiscuss the role of the new techniques of diffusion-weighted imaging (DWI), MRspectroscopy and diffusion tensor imaging (DTI).Background: Although brainstem lesions in pediatric age include mainly gliomas,this region is susceptible to be involved by a variety of processes. CT and US playa role in the initial diagnosis, but MR imaging is the modality of choice for finalevaluation of this area.Imaging Findings: For educational purposes, we will show diverse pathologicconditions involving the brainstem, classified into the following categories: congenitaldiseases (hypoplasia, Moebius syndrome, “molar tooth” syndrome, rhombencephalosynapsis,mesencephalics clefts); inflammation (histiocytosis, encephalitis,abscess, demyelination, tuberculosis); tumors (glioma, ganglioglioma, medulloblastoma,ependymoma); traumatic lesions; vascular disorders (infarct, hypoxic-ischemicdamage, cryptogenic vascular malformation); toxic/metabolic diseases (radiationnecrosis, Leigh’s syndrome, Kearn-Sayres syndrome, Krabbe’s disease, Hallevorden-Spatzdisease, Wilson’s disease) and phakomatoses (neurofibromatosis-I,Von Hippel Lindau, tuberous sclerosis). We present a pictorial review of all of theseabnormalities collected from our experience in a tertiary pediatric hospital.Conclusion: MR imaging differential diagnosis may be based on signal intensity ofthe lesion and contrast enhancement pattern. DWI, proton MR spectroscopy andDTI were in our experience helpful to discriminate among various types of brainstemlesions. Some key imaging features, correlated with child’s age and clinical aspects,are emphasized as most useful for differential diagnosis in brainstem lesions.C-755Doppler sonography of terminal veins in premature neonates withintraventricular-periventricular haemorrhagic diseaseM. Vakaki, E. Alexopoulou, C. Boursiani, G. Pitsoulakis, C. Koumanidou; Athens/GR(geopmar@gmail.com)Learning Objectives: To present the usefulness and prognostic value of color andpulsed Doppler sonographic examination of the terminal veins in preterm neonatesat high risk for germinal matrix, intraventricular hemorrhage and periventricularhemorrhagic infarction.Background: Several studies have suggested that periventricular hemorrhage ofprematurity is actually hemorrhagic venous infarction resulting from compression orobstruction of terminal veins that drain the white matter via the medullary veins, byan adjacent germinal matrix hemorrhage. The role of gray-scale brain sonographyin the morphologic study of the above types of hemorrhage is well-known.Imaging Findings: The anatomy of germinal matrix and terminal veins, as wellas the pathophysiology of germinal matrix, intraventricular hemorrhage andperiventricular hemorrhagic infarction are reviewed. The technique of color andpulsed Doppler sonographic examination of the terminal veins is described. Therole of color and pulsed Doppler sonographic examination of the terminal veinsin the evaluation, follow-up and especially prognosis of hemorrhage (effect ofhemorrhage on terminal vein position, patency and velocities) is emphasized.Sample cases from our data base of 30 premature neonates with various types ofhemorrhage are presented.Conclusion: Gray-scale brain sonography supplemented by color and pulsed Dopplerexamination of terminal veins is particularly valuable in preterm neonates withsubependymal or/and intraventricular hemorrhage or periventricular hemorrhagicinfarction, improving the diagnostic and prognostic accuracy of sonography. Themost interesting prognostic sonographic finding that should be highlighted is thatdisappearance of flow in the terminal vein precedes the sonographic demonstrationof periventricular hemorrhagic infarct.PediatricVascularC-756Multidetector computed tomography for congenital heart disease inchildren: A novel technique for evaluating the direction, location, and sizeof shunt flowY. Peng, J. Li; Beijing/CN (ppengyun@yahoo.com)Purpose: To demonstrate the utility of multi-detector computed tomography (MDCT)in the evaluation of the direction, location, and size of shunt flow in congenitalheart disease.Methods and Materials: We retrospectively reviewed 58 children scanned withMDCT angiography to evaluate congenital cardiovascular anatomy associatedspatial defects. All enhanced CT scans were performed at pulmonary artery phaseat 5-8 s and aorta phase at 15-25 s after injecting contrast material. The findings ofshunt flow included direction, location as well as size and the results were comparedwith echocardiogram retrospectively.Results: 23 out of 58 patients (15 boys, 8 girls, age 5 months to 4.9 years) hadbenefited from MDCT scans for detection of the direction and location of shunt flowwith spatial relationship to other organs. The presentation of shunt flow included leftto-rightshunt in 5 children with the shunt located in ventricular septal defect (n=3),atrial septal defect (n=2); right-to-left shunt in 12 children with the shunt locatedin ventricular septal defect (n=5), atrial septal defect (n=7); and bilateral shunt in6 patients. The sensitivity of shunt flow determination with MDCT that could beobtained non-invasively was 100% (23/23) compared with that of echocardiogram.There were excellent correlation and agreement in size measurements betweenMDCT and echocardiogram as well.Conclusion: MDCT could be used non-invasively to provide blood flow information,especially the presence of left-to-right and right-to-left shunt, in addition tomorphological information for children with congenital heart disease.C-757Congenital heart disease in pediatric age: 64-slice multi-detector row C,the new frontiersA. Díez Tascón, M. Bret-Zurita, G. Gallardo Madueño, E. Cuesta-López,Á. Aroca Peinado, L. García-Guereta Silva; Madrid/ES (aureadiez@yahoo.es)Learning Objectives: To assess the utility of 64-multidetector-computed tomography(MDCT) in the evaluation of patients with congenital heart disease (CHD) in thepediatric age. To establish reasonable indications of this technique. To present ourprotocol, emphasizing dose adjustment and advantages of different reformations.To illustrate the most frequent pathologic conditions in patients with CHD.Background: Echocardiography is the first-line modality for the investigation ofCHD. Cardiac catheterization is usually performed if echocardiography fails toprovide a confident evaluation of the lesions. However, conventional angiography isan invasive procedure with high doses of ionizing radiation and iodinated contrastmaterial as well as occasional morbidity. Because of the risk, several noninvasiveexamination methods have been proposed with the aim of decreasing the use ofdiagnostic cardiac catheterization. The new 64-MDCT is a valuable diagnostic toolthanks to its higher availability, increased scanning speed and spatial resolution.Procedure Details: Our study includes 62 patients with previous diagnosis of CHD,whose age varied between hours/days of life and 14 years in a 64-MDCT (Aquillion64, Toshiba Medical Corporation). EKG gating was employed depending on suspiciouspathology. 62 scanners were obtained (n=62), 13 with intracardiac pathologicconditions (coronary malformations, univentricular heart and complex CHD) and 49with extracardiac conditions (aortic and pulmonary arteries anomalies, pulmonaryand systemic venous anomalies). A CT workstation was used for reformations.Conclusion: 64-MDCT has become a useful imaging modality for pre- andpostsurgery evaluation of CHD in children and it can replace diagnostic cardiaccatheterization in some of these lesions.CS494 A B D E F FG H

Scientific and Educational ExhibitsC-758MDCT evaluation of a total anomalous pulmonary venous connection:Comparison with echocardiographyS. Lim 1 , K. Choo 2 , H. Lee 2 , S. Sung 2 ; 1 Kyoung Nam/KR, 2 Busan/KR(kschoo0618@medimail.co.kr)Purpose: To compare the diagnostic value of MDCT and echocardiographyin the diagnosis of a total anomalous pulmonary venous connection (TAPVC)and evaluate the advantages of MDCT in the evaluation of a TAPVC relative toechocardiography.Methods and Materials: Twenty-three patients with surgically-proven TAPVC wereenrolled. The echocardiography and MDCT findings were independently interpretedby a pediatric cardiologist and cardiac radiologist, respectively. The drainage siteof the common pulmonary vein, stenosis of the vertical vein, the course of thecollateral pathway into the systemic vein in the case of vertical vein stenosis, andindividual pulmonary vein stenosis were analyzedResults: In all patients, MDCT correctly depicted the drainage site of the commonpulmonary vein, stenosis of the vertical vein, the course of the collateral pathwayinto the systemic vein in the case of vertical vein stenosis, the individual pulmonaryvein stenosis drainage site of the vertical vein, and the developed collateral pathway.The detection rates by echocardiography, however, were 20/23, 5/7, 0/1, and 0/1 inevaluating the drainage site of the common pulmonary vein, stenosis of the verticalvein, the course of the collateral pathway into the systemic vein in the case of verticalvein stenosis, and individual pulmonary vein stenosis, respectively.Conclusion: MDCT can facilitate the diagnosis of infracardiac TAPVC involvinga vertical vein with a long and tortuous course, TAPVC with an intrapulmonarycoursing vertical vein, collateral vessels in the case of vertical vein stenosis, andindividual pulmonary vein stenosis.PediatricMiscellaneousC-759Prenatal and postnatal assessment of conjoined twins: RadiologicadvancesM. Tagliabue 1 , D.L. Bulas 2 ; 1 Monza/IT, 2 Washington, DC/US(mariannatagliabue@gmail.com)Purpose: Over the past decade, survival rates of conjoined twins have improvedas a result of more accurate pre and postnatal imaging studies and advances inanaesthetic and operative techniques. The aim of this presentation is to describethe spectrum of imaging modalities in the assessment of conjoined twins and toevaluate the impact of imaging results on delivery planning, surgical managementand outcome.Methods and Materials: From January 2004 to July 2008, seven sets of conjoinedtwins were evaluated at our institution: 3 thoraco-omphalopagus, 1 pyopagus, 2ischiopagus and 1 parapagus.Results: The diagnosis was initially evaluated prenatally by US (6), fetal echocardiography(5) and fetal MRI (5). Postnatal anatomical assessment prior to separationincluded a combination of radiographs (4), fluoroscopic contrast studies (2), US(4), CT (3) and MR (3). Custom 3-dimensional anatomical models derived fromCT/MR data were fabricated using rapid prototyping in two cases. One ischipagusset died in-utero at 27 weeks gestation. One parapagus set died at delivery. Twothoraco-omphalopagus conjoined twins had complex cardiac defects that were notamenable to separation. Three conjoined twins (thoraco-omphalopagus, pyopagus,ischiopagus) survived delivery and were successfully separated.Conclusion: Advanced imaging techniques have markedly improved the ability toevaluated complex anatomy of conjoined twins allowing for more accurate pre andpost delivery assessment of potential separation strategies.C-760Evaluation of catheters in neonatal intensive care unit: The role of theradiologist and imaging findings of potential complicationsC. Serrano García 1 , E. Domenech Abellán 1 , A. Gilabert Úbeda 1 ,A. León Hernández 1 , I. Solís Muñiz 2 , F. Valero García 1 ; 1 Murcia/ES, 2 Madrid/ES(ernesto-rx@hotmail.com)Learning Objectives: 1. Explain the role of the radiologist in the evaluation ofproper catheters placement in neonatal intensive care unit (ICU). 2. Show someexamples of possible complications resulting from their use.Background: Arterial and venous catheters, endotracheal tubes, and nasogastrictubes are routinely used in neonatal ICU. Proper placement of these cathetersconstitutes an essential part in the management of premature infants. Radiologistsplay an important role in evaluating proper placement of catheters and tubes andidentifying potential complications.Imaging Findings: From 2006 to 2008, we have reviewed 200 premature patientsin neonatal care unit with different types of catheters. We illustrate their correctposition on radiographs and ultrasound, and show some examples of malpositionedcatheters and tubes. We also demonstrate possible complications using differentimaging techniques as ultrasound and computer tomography apart from plane films.Frequent complications include arterial and venous thrombi and their sequelae,vessels calcifications, cavernomatosis of the portal vein, and pneumoperitoneumsecondary to gastric perforation.Conclusion: Optimal placement of catheters and tubes is critical, and malpositioncan lead to many complications. With plain radiographs, US, and computertomography the radiologist can evaluate these catheters and detect complicationsdue to their malposition.PediatricACB D E F G HS495

Scientific and Educational ExhibitsC-761Imaging features in paediatric heamoglobinopathy crisis with implicationsfor acute chest syndromesE.U.G.O. Onyekwelu; Banjul/GM (euonyekwelu@hotmail.com)Learning Objectives: Verifying using incidental chest X-ray in identifying clinicallysignificant unsuspected ACS in HbSS patients.Background: HbSS children handle hypoxia better than normal because of modifiedoxygen dissociation coefficients, making infective/infarctive respiratory difficultyclinically covert. Febrile responses could be blunted by overenthusiastic analgesia/antipyretics, making undertaking chest X-rays worthwhile in revealing new onsetinfiltrates suggesting ACS. Aetiology/pathology could be infarction preceded byinfection or the reverse. Younger children are thought to have more infections thaninfarctions with temporal/chronological reversal. Why insist on making the diagnosisof ACS earlier? Because missed diagnosis would encourage progression toacute persistent chronic capillary plastic bronchitis, pulmonary hypertension, corpulmonale, and death.Imaging Findings: Standardised X-rays review of 231 HbSS children 119 males122 females below 15 years admitted for VOC 175, hyperhaemolyis 55, priapism5, acute dactylitis 11, hepathopathy 7, sequestration crisis 9 and mixed crisis 51.CVA 5 features of respiratory difficulty was present in 77. Febrile responses werevariable. Radiological features: Infiltrates 171, central pneumonia 57, right middlelobar consolidation 23, left, middle lobar consolidations 17, right lobar consolidations13 and left lobar consolidations 11. Parapneumonic effusions 5. All casesreceived analgesia/antibiotics.Conclusion: This review identified a high yield of ACS in the HBSS in this serieson the basis of case definition. X-rays suggests this diagnosis though exact andbetter definitions could be achieved at pulmonary ventilation perfusion scintigraphyscans/diagnostic/thearapeutic bronchoscopy in detecting/management plasticbronchitis. We decided to highlight this aspect because previous series looked atfebrile cases as a group but we felt this symptom could be blunted or modified byoverenthusiastic analgesic use in these groups.C-762Fungal infections in immunocompromised children: The spectrum of theradiological findingsE. Kuleta-Bosak 1 , E. Kluczewska 2 , K. Gruszczynska 1 , J. Machnik-Broncel 1 ,G. Sobol 1 , A. Janik-Moszant 1 , J. Baron 1 ; 1 Katowice/PL, 2 Zabrze/PL(kgruszczynska@poczta.onet.pl)Learning Objectives: To become familiar with the most common fungal opportunisticinfections in immunocompromised children. To illustrate the possible radiologicalfindings by CT and to discuss diagnostic pathways.Background: Invasive fungal infections are common, life-threatening eventsin immunocompromised children. Most common pathogens are Candida andAspergillus species. Modern, aggressive oncology treatment increases possibilityof such infections due to iatrogenic neutropenia. Diagnosis is based on clinicalsymptoms, laboratory findings and imaging modalities. However, fungal isolationis time-consuming, and so radiological suspicion in early stage of disease couldhelp in proper clinical management.Imaging Findings: Imaging findings in 9 children with opportunistic fungal infectionstreated due to acute leukemia and solid tumors (rhabdomyosarcoma, NBL,germinoma, ependymoma) will be presented. Respiratory tract was invaded inall children; additional liver infection was diagnosed in two. Lung symptoms inCT were: parenchymal segmental and subpleural wedge-shapes consolidation,perihilar infiltration, multiple small nodules, pleural effusion or abscess. In twochildren invasion of liver with abscess formation and spleen involvement was alsorecognized. CT depicted mediastinal lymphadenopathy in details, but was not ableto differentiate between its fungal or neoplastic origin. Rebound thymic enlargementafter chemotherapy was misleading in older children. Another source of diagnosticproblems was co-existing lung metastases. In some cases regression after specifictreatment was observed in control exams.Conclusion: Radiological symptoms of invasive opportunistic infections are notspecific. However, they should be included into radiological differential diagnosis,especially during post-treatment neutropenia.C-763Quantification of the subcutaneous fat layer with MRI in normallydeveloped fetusesV. Kulemann, P.C. Brugger, M. Reisegger, M. Weber, D. Prayer; Vienna/ATPurpose: The aim of this study was to assess the age-dependent fetal subcutaneousfat layer (SCFL) of normally developed fetuses with MRI.Methods and Materials: There were 114 MRI examinations of fetuses, with normalgrowth and no history of (maternal) metabolic disease, performed on 1.5 T(Philips) at gestational week (GW) 28 to GW 39, evaluated retrospectively. Thefetal SCFL was measured in mm at the upper arm, upper and lower back, abovethe belly button, and at the hip and the thigh using T1-weighted images in thesagittal and axial planes.Results: Measurements ranged from a minimum of 2 mm at GW28 at all measuredpoints, up to 4 mm at the truncus (upper and lower back, above the belly button)and 6.5 mm at the extremities at GW39. The SCFL increased continuously fromGW28 until GW30, showed a plateau phase between GW30 and GW34, andincreased again until GW39. The measurements showed high consistency andallow the establishment of a standard of reference to determine the developmentalstatus in fetuses.Conclusion: The SCFL of normally developed fetuses is easily detectable fromGW28 in T1-w images, and increases depending on the gestational age. Thesedata may provide physiological benchmarks to evaluate fetal size and help in theprenatal diagnosis of fetal growth restriction and macrosomia, as frequently occurringin diabetic and adipose mothers.C-764The apparent diffusion coefficient value of pediatric mediastinal mass: Apilot studyA.A.A. Abdel Razek, R. Elashery; Mansoura/EG (arazek@mans.eun.eg)Purpose: To assess the role of diffusion weighted MR imaging in mediastinalmass in pediatric patients.Methods and Materials: Prospective study was conducted on 37 consecutivepediatric patients (19 M, 18 F aged 5-15 ys) with mediastinal mass. They underwentsingle shot echo planar diffusion weighted MR imaging of the mediastinum withb-factor of 0.300 & 600 sec/mm 2 . The scanning parameters were: TR= 10000 ms,TE=108 ms, bandwidth=125 kHz, slice thickness=4 mm. Apparent diffusion coefficient(ADC) maps were reconstructed. The ADC value of the mediastinal masswas calculated and correlated with the surgical finding or biopsy.Results: The mean ADC value of malignant mediastinal tumors was 1.180.17X10-3 mm 2 /sec and of benign lesions was 1.480.04X 10-3 mm 2 /sec. There wassignificant different in ADC value between benign and malignant mediastinalmasses (P 0.003) and within mediastinal malignancy (P 0.002). When apparentdiffusion coefficient value of 1.25 X 10-3 mm 2 /sec was used as a threshold valuefor differentiating malignant from benign mediastinal mass, the best results wereobtained with an accuracy of 95%, sensitivity of 93%, specificity of 90%, positivepredictive value of 86% and negative predictive value of 98%.Conclusion: Diffusion weighted MR imaging can differentiate benign mediastinalmass from malignant tumor in pediatric patient and offer useful information forassessment of the histologic type of mediastinal malignancy.CS496 A B D E F FG H

Scientific and Educational ExhibitsPhysics in RadiologyC-765Does a flat-panel detector reduce the skin radiation dose in interventionalprocedures?K. Chida 1 , Y. Inaba 1 , H. Masuyama 1 , M. Kato 2 , H. Saito 1 , T. Ishibashi 1 ,S. Maruoka 1 , M. Zuguchi 1 ; 1 Sendai/JP, 2 Akita/JP (chida@mail.tains.tohoku.ac.jp)Learning Objectives: To clarify whether the radiation dose during interventionalradiology (IVR) is lower or higher in flat-panel detector (FPD) systems comparedto image intensifier (II) systems. To explain the methods that can be used to reducethe radiation dose in FPD systems used in IVR. To understand the performanceof FPD systems used in IVR.Background: A primary disadvantage associated with IVR procedures is patientradiation exposure. Currently, IVR X-ray equipment tends toward the use of anFPD instead of an II. Although FPDs have good fundamental performance (spatialresolution and detective quantum efficiency: DQE) compared to IIs, the radiationdose from a FPD during IVR is not clear.Procedure Details: Dose measurement in many IVR X-ray systems that usedFPDs or IIs: The surface doses received by a phantom during cineangiographyand fluoroscopy were measured. The X-ray conditions used in the measurementswere those normally used in facilities performing percutaneous coronary intervention.The entrance doses of systems using a FPD were compared with those ofsystems using an II. Reducing the dose in FPD systems: Technical actions involveusing a lower-dose mode, lower recording speed, additional spectral beam filter,and optimal beam collimation.Conclusion: The average surface doses received during digital cineangiographyand fluoroscopy using the FPD and II systems were similar. FPDs did not reducethe radiation dose, although FPDs possess good DQE. To reduce the radiation dosefor IVR systems, even in FPD systems, a lower-dose mode (including an additionalfilter) is necessary in digital angiocardiography and pulsed fluoroscopy.C-766Improvement of CNR measuring method based on theoretical value of SNRin MRI systemsY. Wada 1 , T. Hara 1 , T. Miyati 2 ; 1 Nakatsugawa/JP, 2 Kanazawa/JP(y-wada@ob2.aitai.ne.jp)Purpose: In the past, many measuring methods for contrast-to-noise ratio (CNR)in magnetic resonance imaging (MRI) have been proposed. However, it is notclear which is a better measuring method in MRI. We calculated some measuringmethods of CNRs and evaluated change of the actual measured value from thetheoretical value of signal-to-noise ratio (SNR) in the MRI systems. In addition, wepropose the improvement CNR measuring method in this study.Methods and Materials: The 1.5-Tesla MRI system (Symphony: Siemens MedicalSystems) was employed. The phantom for CNR measurement was made using thecopper-sulfate solution (Cuso4) with which concentration differs. In order to evaluatethe difference in the characteristic of each CNR, we compared the relative value ofnumber of signal averaged (NSA). From these data, we analyzed the relationshipbetween the NSA and the actual measured value of CNR.Results: The consistency to a theoretical value of CNR changed at each measuringmethods by the fluctuation of the low frequency region of MRI image. However, theresult from using subtraction processing has been independent of it. The improvementmeasuring method of CNR that we propose was almost in agreement withthe theoretical value of SNR.Conclusion: We supposed that measuring method of CNR was dependent on themeasuring positions of noise and the region of interests (ROI) size in phantom.Measuring method of CNR in MRI systems, it was suggested that the measuringmethod using a subtraction image processing is better.C-767Optimal method for precise modulation transfer function measurement incomputed radiography systemsR. Higashide 1 , K. Ichikawa 2 , Y. Shibamoto 1 , H. Kunitomo 1 , K. Ohashi 1 ,M. Kawano 1 ; 1 Nagoya/JP, 2 Kanazawa/JP (raryo@med.nagoya-cu.ac.jp)Purpose: Modulation transfer function (MTF) is a useful measure to assess theresolution property of digital radiographic systems. We found that the popular MTFmeasuringmethod using slit and edge images caused misestimation in computedradiography systems (CRs). The purpose of this study was to investigate reasons forthe misestimation and the optimal method for precise MTF measurement of CR.Methods and Materials: We constructed two computer-simulated radiographicsystems, which are assumed as CR and flat-panel detector (FPD). SimulatedX-ray projections of a slit, edge and square-wave test pattern were inputted intorespective systems. The presampled MTFs were measured from respective outputimages. The measured values were compared with the true values configured to thesimulated systems numerically. Further, we performed the actual measurementsby using a CR (Konica Regius Model 170).Results: In the laser scanning direction of the data acquisition in the CR, resultantMTFs obtained from the slit and edge method showed significant errors. Weconfirmed that the reason for the misestimation was the change of frequencybandwidth on the profiles of the slit and edge, caused by log-conversion in theCR. Only by the square-wave method the correct results were given, not beingaffected by the log-conversion.Conclusion: By both the computer-simulation and actual measurements, it wasproved that the optimal method that can derive the precise MTF for the CR was themethod using the square-wave test pattern. This fact is very important to evaluatedetective quantum efficiency (DQE) that requires correct MTF results.C-768Synchrotron radiation mammography: Dependence of image quality anddelivered dose on the energyR. Longo, G.C. Jaconelli, A. Abrami, F. Arfelli, E. Castelli, D. Dreossi, E. Quai,L. Rigon, T. Rokvic, M. Tonutti, G. Tromba, F. Zanconati; Trieste/IT(renata.longo@ts.infn.it)Purpose: The dependence of dose and image quality on the beam energy isinvestigated using monochromatic X-ray beams and breast tissues.Methods and Materials: The SYRMEP mammographic beamline at the synchrotronradiation facility Elettra in Trieste (Italy) allows performing mammography using a monochromaticbeam in the range of 16-21 keV. Images of 7 breast tissues were acquiredusing a mammographic film/screen system in this energy range. Tissues were fresh,unfixed, and the compressed thicknesses were in the range of 2-4 cm. Three sampleshave been studied again after fixation with formalin. Lesion contrasts were measured.In image quality assessment, the radiographs of the same sample were ordered accordingto their quality by a radiologist with experience in mammography.Results: The lesion contrast decreases increasing the beam energy. Comparingimages obtained with an energy difference of 1 keV, the radiologist always preferredthe image acquired at lower energy. On the other hand, when the differencein energy was 0.5 keV, the radiologist frequently evaluated the two images asequivalent. All images acquired with energy lower than 19.5 keV were evaluatedas good quality for diagnostic purpose. The dose decreases increasing the beamenergy: about 8% every 0.5 keV. Images acquired from fixed tissues are slightlybetter than the corresponding ones with the fresh sample: in particular, lesionmargins are better defined.Conclusion: The use of monochromatic beams allows a quantitative evaluationof dose and contrast dependence on energy: these are important information forthe optimization of mammography.C-769Dual energy subtraction imaging for diagnosing vocal cord palsy with flatpanel detector radiographyH. Machida 1 , T. Yuhara 1 , T. Mori 1 , E. Ueno 1 , M. Fujimura 1 , K. Suzuki 1 , S. Morita 1 ,A. Masukawa 1 , J. Sabol 2 ; 1 Tokyo/JP, 2 Waukesha, WI/US (machira@dnh.twmu.ac.jp)Purpose: We investigated the clinical feasibility of dual energy subtraction (DES)using flat panel detector (FPD) to improve delineation of vocal cords and diagnosevocal cord palsy on the anterior-posterior view of neck radiography by eliminatingthe overlap of cervical spine opacity.Methods and Materials: For 122 consecutive patients (66 men, 56 women; meanage 59 19 years) who underwent both direct laryngoscopy and conventional/DESneck FPD radiography, 2 blinded readers in consensus retrospectively gradedradiographs during phonation and inspiration from 1 (poor) to 5 (excellent) fordelineation of vocal cords, employing as a reference the diagnosis of vocal cordpalsy using laryngoscopy. We compared vocal cord delineation and accuracy ofvocal cord palsy diagnosis by both conventional/DES techniques using statisticsand area under the receiver operating characteristic curve (AUC).Results: Delineation of vocal cords by DES (mean, 4.93 0.29) was significantlyhigher than by conventional method (mean, 4.33 0.94) (P 0.0001). We confirmedvocal cord palsy in 8 patients (6.6%) by laryngoscopy. Sensitivity for diagnosingvocal cord palsy by conventional technique was 25% and specificity 94%. Sensitivityby DES technique was 75% and specificity 96%. Diagnostic accuracy wassignificantly better by DES technique ( = 0.60, AUC = 0.909) than by conventionaltechnique ( = 0.18, AUC = 0.852).Conclusion: DES technique is better than conventional FPD neck radiography fordelineating vocal cords and accurately diagnosing vocal cord palsy.ACB D E F G HS497Physics in Radiology

Scientific and Educational ExhibitsC-770Clinical feasibility of digital tomosynthesis in flat panel detectorradiography for orthopedic patientsH. Machida 1 , T. Yuhara 1 , T. Mori 1 , E. Ueno 1 , M. Fujimura 1 , K. Suzuki 1 , S. Morita 1 ,A. Masukawa 1 , J. Sabol 2 ; 1 Tokyo/JP, 2 Waukesha, WI/US (machira@dnh.twmu.ac.jp)Learning Objectives: To describe the digital tomosynthesis (DT) technique in flatpanel detector (FPD) radiography. To illustrate the clinical feasibility of DT for orthopedicpatients using a broad variety of clinical images and experimental data.Background: DT of FPD radiography is novel and used easily and swiftly to acquirevolume data of patients with arbitrary posture and to reconstruct arbitrarilymultiple tomographic images of every region of the body. These characteristicsmake the technique extremely advantageous for orthopedic patients from a wideperspective.Imaging Findings: Compared to conventional tomography, DT of FPD radiographyeasily provides multiple high quality tomographic images as a series of routineradiography examinations. For orthopedic patients, DT is more sensitive thanconventional radiography for detecting subtle fracture of various bones and betterthan computed tomography (CT) for delineating bony architecture surroundingimplanted metallic prostheses. DT allows accurate evaluation of joint space, alsoon stress test and arthrography. Furthermore, radiation exposure of patients, whichis necessary for correct diagnosis, is less with DT than CT. We will present clinicalimages and experimental data that demonstrate these advantages.Conclusion: Based on the understanding of the advantages of DT in FPD radiographyover conventional radiography, tomography, and CT, its effective use isclinically feasible for orthopedic patients. Its use can improve workflow, especiallyin radiology departments, and lead to cost-effectiveness.C-771Female breast dose of chest CT by 3D and Z-axis automatic tube currentmodulation techniquesK. Matsubara 1 , K. Koshida 1 , T. Takata 1 , T. Shimono 2 , M. Suzuki 1 , O. Matsui 1 ;1Kanazawa/JP, 2 Hirakata/JP (matsuk@mhs.mp.kanazawa-u.ac.jp)Purpose: In chest CT examinations, it is important to consider reduction of radiationdose, particularly to the mammary gland. This study was designed to assessbreast doses of chest CT examination between 3D and Z-axis automatic tubecurrent modulation (ATCM) techniques.Methods and Materials: Absorbed dose to the breast, lung, mediastinum, and skinwas evaluated with anthropomorphic phantom and radiophotoluminescence glassdosimeters (RPLD) on two different CT scanners. The RPLDs were placed in theanatomic location of each organ. The phantom was scanned using 3D and Z-axisATCM techniques after scanning localizer radiographs. The statistical differences oforgan doses between both ATCM techniques were determined by two-sided pairedt tests, and difference with P 0.05 was considered significant.Results: Compared with Z-axis ATCM, 3D ATCM reduced right frontal breast doseby 4.0-11.9%, right internal breast dose by 0.7-3.6%, left frontal breast dose by16.0-18.6%, left internal breast dose by 3.4-8.1%, lung dose by 3.4-11.7%, mediastinumdose by 10.5-13.6%, and skin dose by 10.7-13.3%. Excluding internalbreast and lung doses, there were statistically significant differences between bothtechniques. In terms of internal breast and lung doses, a trend of decreasing dosewith the use of 3D ATCM was observed.Conclusion: 3D ATCM could reduce absorbed doses to breast when compared withZ-axis ATCM. Dose reduction rate in the left breast was larger than that in the rightbreast, and that of the frontal breast was larger than that of the internal breast.C-772Characterization of brain tumors by means of multiparametric mapsR. Sghedoni, A. Nitrosi, G. Borasi; Reggio Emilia/ITPurpose: More and more magnetic resonance imaging modalities are available inthe study of brain tumors, giving anatomical and metabolic information. The aim ofthis work is the creation of a single map that combines data from these modalitiesand describes subregions of the pathology with specific metabolism (for example,vascularization, hypoxia, necrosis). This image is called multiparametric map.Methods and Materials: Images from the exams of 4 patients with brain tumorswere retrospectively considered. Acquisitions were performed with a GE Signa1.5 T using a standard protocol. Four sets of images were considered: T1-weightedsequence after contrast agent administration, FLAIR, diffusion imaging, perfusionimaging. These images were synthesized in the multiparametric map according toa method that is inspired by McMillan (Med.Phys. 34 (3), 2007) except for somechanges in the segmentation process.Results: A multiparametric map was created for each patient. The map allows recognizingand differentiating the tumor from the peritumoral oedema and describesthe necrotic subregions or tissues featured by high vascularization inside tumors.Conclusion: The multiparametric map allows combining images from differentmethods into a single image. This helps to identify different metabolic subregionsin a tumor and displays them in a single image. Radiotherapy treatment planningcan benefit from this map, since it can help in the definition of a biological targetvolume (BTV). Tumor characterization can take advantage of the integration withadditional modalities into the map, such as chemical shift imaging or positronemission tomography.C-773Characteristics of a dual-source CT scanner in dual energy and singlescan mode: Comparison of dose and image quality in a phantom studyY. Katsuma 1 , S. Kitano 1 , T. Itoh 2 , N. Marugami 1 , T. Taoka 1 , K. Kichikawa 1 ;1Nara/JP, 2 Tokyo/JPPurpose: To compare dose and image quality of a 64 slice dual-source CT (DSCT)scanner in dual energy (DE) and single energy (SE) mode.Methods and Materials: A water phantom and a low-contrast phantom werescanned by 64 slice DSCT (SOMATOM Definition, Siemens, Germany) in theDE mode with parameters of 140 kV/80 kV tube voltage, 1:4 tube current ratio,64x0.6 mm collimation, 0.5 sec rotation time. SE tube voltages were 80, 100, 120,140 kV. Tube current-time products were 50 to 300 mAs in step of 25 mAs. CTDIvolwas recorded. Surface dose was measured using commercial dosimetry films fixedon the phantom surfaces. Composite images were generated by fusing DE 80 and140 kV data, 80 kV data fractions 0 and 1, in steps of 0.1. Standard deviation (SD),signal to noise ratio (SNR), contrast to noise ratio (CNR) in ROIs in composite andoriginal image were measured.Results: DE 0.3 and 0.5 composite images had lower SDs but 20% higher surfacedoses compared to 120 and 100 kV SE images (same CTDIvol). In the DE mode,CTDIvol could be decreased by 28% and surface dose by 12% for the same CNRsin DE 0.3 composite images as in 120 kV SE images, and by 4 and 15% for thesame CNRs in DE 0.5 composite images as in 100 kV SE images.Conclusion: CNR is higher in DE 0.3 composite images than 120 kV SE images(same CTDIvol). DE CT requires less dose than SE CT for similar image quality.C-774Mis-operation of CT automatic tube current modulation systems withinappropriate patient setupK. Matsubara 1 , K. Koshida 1 , M. Suzuki 1 , T. Takata 1 , T. Miyati 1 , K. Ichikawa 1 ,T. Shimono 2 , O. Matsui 1 ; 1 Kanazawa/JP, 2 Hirakata/JP(matsuk@mhs.mp.kanazawa-u.ac.jp)Purpose: Improved automatic tube current modulation (ATCM) systems havebeen introduced in modern CT scanners to facilitate the optimization of imagequality and radiation exposure. However, inappropriate patient centering on thegantry changes the size of localizer radiographs, thus influencing the operation ofATCM. This study was designed to examine the influence of inappropriate patientcentering on ATCM.Methods and Materials: An elliptical urethane phantom was scanned using fourATCM techniques on different two scanners after obtaining localizer radiographsfrom horizontal and vertical directions with the phantom center shifted from 50 mmabove to 50 mm below the gantry isocenter. After scanning, the magnificationrates of the frontal localizer radiographs, tube current-time products (mAs), andimage noise were examined. One-way analysis of variance and Tukey’s multiplecomparisontest were performed to assess whether there was an associationbetween the vertical deviation of the phantom and the amount of image noise.Difference with P 0.05 was considered significant.Results: Magnification rates of the frontal localizer radiographs showed linearrelationships to the vertical deviation of the phantom. From 50 mm above to50 mm below the gantry isocenter, mAs values ranged from 75 to 141% comparedwith those at the gantry isocenter. In addition, there were significant differencesbetween the vertical deviation of the phantom and the amount of image noise forall ATCM techniques.Conclusion: Inappropriate patient centering causes mis-operation of ATCMsystems that control the tube current based on the localizer radiographs, causingincreases in tube current or image noise.CS498 A B D E F FG H

Scientific and Educational ExhibitsC-775Optimization of a digital chest X-ray protocol using a semi-anatomicalchest phantomA. Raaum 1 , E. Førde 2 ; 1 Oslo/NO, 2 Bergen/NO (aud.raaum@sri.no)Learning Objectives: To gain insight into optimization of digital chest X-ray protocolsusing a semi-anatomical phantom.Background: National and international legislations require X-ray protocols to beoptimized regarding image quality and patient dose. Collection of data from 5 laboratoriesusing the same X-ray equipment (Siemens AXIOM Aristos) showed relativelylarge differences in parameter settings and patient doses. An optimization andstandardization of the chest protocol on this X-ray unit was therefore desirable.Procedure Details: A semi-anatomical chest phantom was imaged using differentsettings for tube filtration, kV, mAs and image processing parameters. The phantomhas test objects built into the lung, heart, and subdiaphragm equivalent regions.The images were analysed by subjective scoring of low contrast detectability andresolution, as well as by assessments of contrast to noise ratio (CNR). CNR squareddivided by entrance dose was used as a figure of merit (FOM) to compare beamquality and image processing settings.Conclusion: The results of the subjective scoring of low contrast detectability andresolution indicate that this method might not be sensitive enough for protocoloptimization. Evaluation of the FOM showed that FOM increases with additionalCu filtration up to 0,2 mm. There were no significant difference in FOM betweenthe two tested kV-values; 125 kV and 133 kV. The use of an image processingsoftware (DiomandView) lead to significantly higher FOM in all anatomical regions.The results should be compared with evaluation and ranking of clinical imagesproduced at the laboratories using different parameter settings.C-776Is radiography justified for the evaluation of patients presenting withcervical spine trauma?N. Theocharopoulos, G. Chatzakis, J. Damilakis; Iraklion/GRPurpose: To determine if the use of radiography is justified for the evaluation ofcervical spine trauma patients in the era of multi-detector CT scanners.Methods and Materials: A decision analysis model for the determination of theoptimum imaging technique was developed. The sensitivity and specificity of CT andradiography were obtained by dedicated meta-analysis. Lifetime attributable risk ofmortal cancer from CT and radiography was calculated using updated organ-specificrisk coefficients and doses. Patient doses from radiography were calculated usingMonte-Carlo techniques. A prospective patient study was performed regardinghelical CT scans of the cervical spine. Patient doses were calculated based onthe dose-length-product values.Results: Effective dose from radiography amounts to 0.050 mSv and from a typicalscan to 3.8 mSv. The use of CT in a hypothetical cohort of 10 6 patients preventsapproximately 130 incidents of paralysis in the low risk group, 500 in the moderaterisk group and 5100 in the high risk group. The expense of this CT-based preventionis 15 to 32 additional radiogenic lethal cancer incidents. According to the decisionmodel calculations, the use of CT is more favourable over the use of radiographyby a factor of 13, for low risk 20 year old patients, to 23, for high risk patients.Conclusion: Regardless of patient age, sex, and fracture risk, the higher diagnosticaccuracy obtained by the CT examination counterbalances the increasein dose compared to plain radiography, renders CT utilization justified and plainradiography redundant.C-777The influence of ECG-driven X-ray current modulation on image qualityand exposure dosage of 64-slice cardiac CTZ. Ma, W. Quan, H. Cao, Y. Shen; Beijing/CN (huizhi.cao@ge.com)Purpose: To evaluate the effect of ECG-driven X-ray current modulation on imagequality and radiation exposure reduction in coronary 64-slice CT angiography.Methods and Materials: The cardiac pulsating phantom was set at 50, 65, 75 bpmto simulate different heart rates. The phantom was scanned with ECG-driven X-ray current modulation turned on and off, and the exposure dosage of each scansequence was documented. CT values and their corresponding standard deviationsat uniform areas on the images were measured. 80 consecutive patients who underwentCCTA were also selected in this study, and were divided into three groups:group A (heart rate 65, high mA at 70~80% phase), group B (65 heart rate 70,high mA at 40~80% phase) and group C (heart rate 70, high mA at 30~90%).The image quality and radiation dose was analysed.No Material Submitted to EPOSResults: As far as phantom was concerned, under the same level of heart rate, theexposure dosage was significantly reduced when the ECG modulated mA was onthan when it was off. Statistical analysis showed no significant difference (P 0.05)between the images of the two groups. The radiation reduction at 50, 65, 75 bpmwas 52, 43, 34%, respectively. In patient study, there was no statistical differencein image quality of group A, B and C, and the radiation dose was decreased by62, 15 and 9%, respectively.Conclusion: The application of ECG-driven X-ray current modulation can effectivelyreduce the exposure dosage without sacrificing the image quality in coronary64-slice CT angiography especially when heart rate 65 bpm.No Material Submitted to EPOSC-778Dual energy substraction chest radiography technique: What is it?J. Calatayud, D. Castellón, C. Delgado, R. Prada, E. Santos, F.M. Tardáguila;Vigo/ES (julimuse@yahoo.es)Learning Objectives: 1. To describe the physical principles of dual energy. 2. Toanalyse the two different acquisition forms in dual energy systems: single anddual exposure approaches to chest imaging. 3. To describe implementation of dualenergy with flat panel detectors.Background: Dual energy is a useful technique in evaluating lesions in the lungand ribs. It is of utmost importance to know physical bases in order to get a correctinterpretation of images.Procedure Details: A straightforward description of techniques used to obtain imageswith dual energy subtraction is explained. Two methods have been developedto obtain images with dual energy: single and double exposures. In the first, a singleshot crosses two detector panels separated by a copper filter. Double exposuretechniques use a single detector with two separated X-ray beams. Advantagesand drawbacks of each technique as well as clinical applications of flat panelsystems are described.Conclusion: Currently, dual energy represents an important imaging tool that hasimproved the ability of radiologist to accurately detect several thoracic pathologies.Therefore, it is useful to understand the physical bases for achieving a correctdiagnosis.C-779Regional delta-diffusion analysis of the brain during cardiac cycle inidiopathic normal-pressure hydrocephalusN. Ohno 1 , T. Miyati 1 , M. Mase 2 , H. Kasai 2 , M. Hara 2 , Y. Shibamoto 2 , K. Yamada 2 ,M. Kawano 2 , H. Kan 1 ; 1 Kanazawa/JP, 2 Nagoya/JPPurpose: Diagnosis of idiopathic normal-pressure hydrocephalus (I-NPH) withouta known cause of communicating hydrocephalus is more difficult, and it has beenreported that supplemental tests could increase the predictive accuracy of theprognosis. To evaluate regional mechanical properties of the brain in I-NPH, wedetermined the change in the regional apparent diffusion coefficient (ADC) of thebrain during cardiac cycle (delta-ADC).Methods and Materials: On a 1.5-T MRI, ECG-triggered single-shot diffusionecho planar imaging was used with sensitivity encoding and half-scan techniquesto minimize the bulk motion. Then, delta-ADC image was calculated from maximumminus minimum ADC value of all cardiac phase images on a pixel-by-pixel basis.We assessed ADC and delta-ADC in regions of frontal, temporal and occipitalwhite matters (WM) in healthy volunteers (control group; N=12) and patients withI-NPH (N=5).Results: Delta-ADC values in I-NPH were significantly higher than those in thecontrol group in all regions. This result shows that the water molecules in extracellularspace in I-NPH are easily agitated by intracranial volume change, due todecreased cerebrospinal fluid resorption. While ADC values in I-NPH were significantlyhigher than those in the control only in frontal WM, no significant differencein ADC values was found between I-NPH and control in temporal and occipitalWM. The significant difference of delta-ADC between these groups in frontal WMexceeded those of ADC.Conclusion: Delta-ADC analysis makes it possible to noninvasively obtain moredetailed information on the regional mechanical properties in I-NPH and therebyassist in the diagnosis.Physics in RadiologyACB D E F G HS499

Scientific and Educational ExhibitsC-780Application of international standards to diagnostic radiology dosimetryI.D. McLean, A. Meghzifene, F. Pernicka; Vienna/AT (i.mclean@iaea.org)Purpose: An international dosimetry protocol on dosimetry in diagnostic radiologyhas recently been developed by the IAEA. The practical application of this protocolto both calibration and the clinical workplace will be reported on.Methods and Materials: A coordinated research project, over the last 3 years,had two main directions. First, to investigate the effectiveness of standards andprotocols used to calibrate dosimetric instruments through secondary standardsdosimetry laboratories (SSDLs), including detectors for mammography, CT andKerma area product (KAP) meters. The second was to investigate the clinical applicationof dosimetry protocols. These investigations took place at 11 locationsthroughout the world, including sites in Austria, Czech Republic, Finland, Greece,Hungary and the UK.Results: The standards and protocols developed for most radiographic applications,including plane X-ray and mammography proved suitable and transferableto SSDLs. More complexity was encountered with the calibration of KAP meters,where new beam qualities may be required for accurate calibration in conditionsappropriate to the high dose areas of interventional radiology. The clinical applicationwas successful; however, more work is still required in implementation for effectiveuse in the countries that contributed. The area of CT dosimetry was found to besatisfactory for most contemporary needs; however, continuing developments inequipment design pose ongoing challenges.Conclusion: The IAEA publication for diagnostic radiology dosimetry gave usefuldirection for the provision of standards for instrument calibration and as aframework for implementation in clinical dosimetry. Work is continuing on KAPmeter protocols.C-781The low-dose 64-slice CT coronary angiography with prospective stepand-shootmodeW. Qi, X. Du; Beijing/CN (cyanage8@gmail.com)Purpose: To evaluate the radiation dose and image quality of 64-slice computedtomography coronary angiography (CTCA) in the prospective step-and-shoot (SAS)mode for the diagnosis of coronary artery disease.Methods and Materials: 80 patients of two groups (40 in each group) withsuspected coronary artery disease and heart rates less than 65 bpm underwentprospective SAS and retrospective ECG-gated CTCA, respectively, by Siemens64-slice scanner. Two radiologists independently assessed the image quality (1,excellent; 2, good vessel with minor motion artifacts; 3, diagnosable vessel withsome motion artifacts and minimal structural discontinuity; 4, not evaluative) of 12coronary segments classified with American Heart Association method. Effectiveradiation doses were calculated with CTDI volmultiplied by the standard scan lengthof 12 cm. The scores of image quality and radiation doses of two groups werecompared with nonparametric test and T test method, respectively.Results: 469 segments with retrospective gating examinations and 459 segmentswith prospective SAS mode were assessed. The amount of segments with score 4 ofthe prospective SAS group (12/459) was more than that of retrospective ECG-gatedgroup (3/469), but the scores of all segments of two groups were similar (P 0.05).In the meantime, the mean effective dose of the prospective group (1.770.04 mSv)was 14.5% of that of the retrospective group (12.230.69 mSv).Conclusion: The prospective SAS mode CCTA provides the similar image qualitybut 85.5% lower patient radiation dose comparing with retrospective CTCA, withheart rate less than 65 bpm.C-782Dose simulation for computed tomography in view of an application forcontrast enhanced radiotherapy (CERT)P. Lengsfeld 1 , G. Jost 1 , H. Pietsch 1 , P. Deak 2 , W.A. Kalender 2 ; 1 Berlin/DE,2Erlangen/DE (philipp.lengsfeld@bayerhealthcare.com)Purpose: Dose simulations were performed to optimize the radiation parametersfor CERT using a standard clinical CT scanner, and to evaluate the respective photoelectricdose enhancement for I-, Gd-, and Fe-based contrast agent classes.Methods and Materials: Monte Carlo dose calculations (ImpactMC VAMPGmbH, Erlangen, Germany) were performed for a standard 4-row CT scanner(Somatom, VolumeZoom, Siemens, Germany) using a head phantom aiming forthe radiotherapy of head tumours. Key scan parameter such as tube voltage, collimation,fan beam angle, filters were evaluated. The dose enhancement factor wasdetermined for various concentrations (1 - 20 mg/ml) in the tumour, and comparedto theoretical calculations.Results: Higher tube voltage reduces the absorbed dose in cortical bones atsimilar dose values like in the tumour (e.g. 90% reduction for 140 kV comparedto 80 kV). With a reduced fan angle ( 7°) the beam can be focused resulting insignificant dose differences between the dose in the isocenter and the surroundingtissue up to a factor of 4. Gd and I resulted in similar dose enhancement atequal volume concentration (x2 for 10 mg/ml). Dose enhancement is increasedby decreasing tube voltage (e.g. 30% higher enhancement by decreased voltagefrom 140 to 80 kV).Conclusion: Dose enhancement depends on the type of contrast agent, concentration,and scan and scanner parameters used. A set of promising parameters forCERT using clinically available CT scanners was identified. Iodine-based contrastagents are the most promising candidates for CERT.C-783Dual energy subtraction angiography: A simulation study using the threematerial approachA. Toutountzis 1 , G. Fountos 2 , A. Samartzis 2 , C. Michail 1 , I. Kandarakis 2 ,G. Nikiforidis 1 ; 1 Patras/GR, 2 Athens/GRPurpose: The purpose of this study was to evaluate a theoretical model describingthe attenuation of X-rays under conditions found in angiographic applications andto develop a dual energy algorithm for either cancellation or enhancement of thevisualization of soft tissue, bones, and iodine, which is used as a contrast agent,in the final image.Methods and Materials: Most dual energy reconstruction algorithms assumethat the irradiated parts of the human body consist of two types of material. In thepresent study, the three-material approach is presented in order to remove from thefinal image not only one of the materials referred above, but also combinations ofthem by weighting subtraction of high and low energy images. The three-materialalgorithm was evaluated for a software phantom consisting of plexiglass, hydroxyapatite- which simulate soft tissue and bone, respectively - and iodine, beingirradiated in a variety of exposure conditions. Dual energy images are presentedcomparing the three-material with the two-material algorithm.Results: Results showed that using the three-material approach, the weightingfactors differ significantly than the two-material, thus leading to successful nullificationof soft tissue and bones and high contrast Iodine visualization. Suggestedrecommendations for optimal dual energy imaging exposure conditions and implementationare also provided.Conclusion: The three-material approach for dual energy image reconstructionseems to be a more effective algorithm, when using the weighting subtraction,than the two-material technique. This method can be used in order to improve theexisting techniques of dual energy angiography.C-784A new temporal resolution measuring method using a metal ball phantomfor multi detector-row CTS. Terakawa 1 , K. Ichikawa 2 , T. Hara 3 , I. Fujimura 4 , Y. Miura 1 , Y. Hamada 1 ,M. Inoue 1 ; 1 Osaka/JP, 2 Kanazawa/JP, 3 Nakatsugawa/JP, 4 Izumi-sano/JP(shoichidna@nike.eonet.ne.jp)Purpose: Multi detector-row computed tomography (MDCT) images provided highimage quality. However, their temporal resolutions have not been investigated indetail, because precise measurement method had not been ever proposed, andtherefore relation of the temporal resolution and scan parameters had not beenwell understood. We developed a new measuring method of the temporal resolutionwith high precision, and investigated the temporal resolution of various scanparameter of MDCT.Methods and Materials: The temporal resolutions of CT images were evaluated bytemporal sensitivity profiles (TSPs), which were impulse responses in time domain.We obtained the time impulse signal using a metal ball with diameter of 11 mm,which passes thorough scanning plane at very high speed. The CT images withsmall time interval were reconstructed and the TSPs were obtained from their ROIvalues. We employed a 64 slice MDCT for TSP measurement and evaluation ofactual images of a motion phantom.Results: The inherent temporal resolution of this method was sufficient (less than8 ms) for 64 slice MDCT. The shapes of TSPs were irregularly changed depending onthe helical pitch. Rotation speeds affected the temporal resolution directly and slicethickness did not affect. The images of motion phantom well demonstrated the temporalresolution of respective scan parameters corresponding to the TSP results.Conclusion: The measurement results obtained by this method were significantlyuseful to understand relation of the temporal resolution and scan parameters, andto obtain optimal scan parameters for patients unavailable for breath holding andunmoving.CS500 A B D E F FG H

Scientific and Educational ExhibitsC-785Estimation of radiation dose surplus due to slope-up and slope-downof tube current in retrospectively ECG-gated dual-source CT coronaryangiography with different dose modulation algorithms: A phantom studyC. Martini 1 , M.L. Dijkshoorn 2 , E. Maffei 1 , A.A. Palumbo 1 , C. Saccò 1 ,A.C. Weustink 2 , N.R. Mollet 2 , F. Cademartiri 1 ; 1 Parma/IT, 2 Rotterdam/NL(erimaffei@libero.it)Purpose: To estimate surplus radiation dose in retrospectively ECG-gated dualsourceCT coronary angiography (DSCT-CA) using prospectively ECG-triggeredtube modulation, due to the slope-up & slope-down of the tube current.Methods and Materials: We used an anthropomorphic phantom with an ECGgatedretrospective protocol and a DSCT scanner (Definition, Siemens). We used4 tube current modulation algorithms: Narrow Pulsing Window, with tube currentreduction to 20% (A 1) and 4% (A 2) of peak current; Wide Pulsing Window, withtube current reduction to 20% (A 3) and 4% (A 4). Each algorithm was applied at 5heart rates (HR = 45-60-75-90-120 bpm) with adaptive pitch values (0.2 to 0.5).Datasets were reconstructed in 5% steps from 0-95% of R-R interval. Noise wasmeasured at each R-R step in order to identify: low noise (=100% dose), mediumnoise (=slope-up/down), high noise (=4/20% dose). The width of the transitionwindow (slope-up/down from 4/20 to 100% dose) was calculated. The surplus dosedue to slope-up/down was calculated.Results: The surplus dose is 18% (A 1), 34% (A 2), 14% (A 3), 20% (A 4). The transitionwindow lasts 10+10% (slope-up+down) for HR 75 bpm and all HR in A 3(exceptfor 120 bpm; 25+15%), 15+15% for HR 90 bpm (A 1). For A 2and A 4, instead, theslope-up increases with progressively higher HR (10 to 25% of the R-R interval,except for 90 bpm; 10%), while the slope-down remains constant to 5% (exceptfor 120 bpm; 10%).Conclusion: Adaptive ECG-pulsing windows provided an increment of the surplusdose with increasing HR. The transition window is a constant source of surplusradiation dose in the range 14-34%.C-786A new image processing for precise image reproduction in high-resolutionCT imagesS. Terakawa 1 , K. Ichikawa 2 , T. Hara 3 , I. Fujimura 4 , Y. Miura 1 , Y. Hamada 1 ,M. Inoue 1 ; 1 Osaka/JP, 2 Kanazawa/JP, 3 Gifu/JP, 4 Izumi-sano/JP(shoichidna@nike.eonet.ne.jp)Purpose: High-resolution computed tomography (HR-CT) images generally provideedge-enhanced images. However, their image quality difference between differentCT systems was discussed as an issue. Moreover, undershoot and overshoot appearingat edge were often treated as artifacts that distort the objects’ shape andCT number distribution. The purpose of this study was to investigate the imageprocessing that realized both the artifact reduction and preservation of the originalhigh-resolution of HR-CT.Methods and Materials: We devised an image processing to limit the excessiveresponse functions of the HR-CT causing the artifacts, and to equalize the imagequality. The frequency processing functions that achieved the artifact correctionwere calculated from the original modulation transfer functions (MTFs) of the HR-CT images and target MTFs. We employed two models of CT system. Phantomimages and clinical images processed by the function were compared with originalimages analytically.Results: The undershoot and overshoot artifacts were reduced effectively, and theoriginal high-resolution property (more than 0.25 at 1.0 cycles/mm) was preserved.Because the objects’ shape and CT number were reproduced precisely, the imageappearance became more natural. The comparison of processed images andoriginal images demonstrated that the original HR-CT images contained significantCT number errors of more than 100 HU.Conclusion: The image processing method to realize precise image reproductionin the HR-CT was derived. The frequency property we obtained in this study will beuseful to develop reconstruction kernels of the HR-CT, which provide less artifactsand equalized better image quality.C-787Let’s diffuse diffusionC. de Bazelaire, C. Farges, M. Albiter, P. Bourrier, A. Zagdanski, J. Frija,E. de Kerviler; Paris/FR (cedric.de-bazelaire@sls.aphp.fr)Learning Objectives: To exhibit the wide spectrum of indications of whole-bodydiffusion weighted imaging. To outline limits of echoplanar (EPI) sequences forimages quality optimization. To learn how to interpret diffusion images dependingon acquisition parameters.Background: Recently, whole Body MRI techniques were developed allowingcomprehensive exploration with a single examination. However, whole-body analysisis time consuming due to the large amount of information. Diffusion helps detectingabnormalities, which are in most case secondarily seen on T1 and T2 weightedsequences. However, EPI sequences have a low signal to noise ratio and manyartifacts. By selecting appropriate sequence parameters, it is possible to dramaticallyimprove image quality and diagnostic performances.Imaging Findings: Whereas coronal plans are faster in whole-body MRI, axialplans provide better results with fewer artifacts especially on neck and shoulders.The combination of spectral fat saturation and short inversion time inversion recoveryEPI gives uniform fat suppression. When lesions are bright in T2 weightedsequence, diffusion should be interpreted using ADC map to eliminate the T2 effect.In oncology, ADC changes are also useful for treatment monitoring. ADC calculationrequires 2 or more b values. In addition, low b values provide perfusion information,while higher ones reduce motion artifacts. Whereas whole body diffusion composingimages are attractive, screening should be performed segment by segment.Conclusion: The diffusion sequence facilitates analysis in whole-body MRI.However, diffusion requires careful settings to avoid a number of artifacts thatmask lesions.C-788Ultra-wideband (UWB) as imaging tool for diagnostic purposesC. Geyer 1 , M. Helbig 2 , U. Schwarz 2 , J. Sachs 2 , M. Hein 2 , W. Kaiser 1 , I. Hilger 1 ;1Jena/DE, 2 Ilmenau/DEPurpose: In order to assess the basic potential of a method called ultra-wideband(UWB) for diagnostic purposes, the feasibility for the discrimination of biologicaltissues on the basis of water contents was investigated.Methods and Materials: Oil concentration of nine cylindrical oil-in-gelatine phantoms(diameter 6 cm, height 3 cm) varied between 0 and 80% to obtain materials with differentpermittivity values ´-j´´. For two-dimensional imaging, phantoms were placedin a scanner consisting of a box (80 x 80 x 75 cm), closed at all sides except for thetop surface. Measurements were performed using an M-sequence radar (MEODATGmbH ® ) with a frequency bandwidth up to 4.5 GHz, and two pyramidal horn-antennas(10 x 8 x 23 cm). Backscattered signals were analyzed using MATLAB.Results: Permittivity of the oil-in-gelatine phantoms decreased for increasingpercentage of oil (´ from 8 to 64; ´´ from 0.5 to 17 at 1 - 4GHz). Intensity ofbackscattered signal from phantoms could be mapped into a two-dimensionalcolour coded image. Phantoms could be localised as round structures. Intensityof backscattered UWB-signal was found to scale with the oil-concentration of thephantoms (highest intensity = ~0.16 arbitrary units) and with the dielectric contrast,which decreased from 8.1-j6.4 to 2.3-j1.5 for increasing oil-concentrations betweentwo corresponding phantoms.Conclusion: This study demonstrates that different dielectric materials can beidentified and imaged by a remote low-power UWB technique. UWB imaging indiagnostic radiology could become feasible upon improving image reconstructionand identifying the UWB signatures of biological tissues.Physics in RadiologyACB D E F G HS501

Scientific and Educational ExhibitsRadiographersC-790The use of radiological ID card (RIDc) in gastrointestinal and abdominalradiologic examinationsP. Sklavounos, M. Zisaki, S. Adamopoulos, S. Karambali, E. Bletsa, S. Kouveli,E. Pontikaki, S. Rizos; Piraeus/GR (paolosklavounos@yahoo.gr)Purpose: The increasing use of radiation in modern medical practices and the observationthat many patients visit very often the radiological laboratories in order to be submittedto the same examinations have motivated the Radiological Laboratory of IKA KaminionPiraeus for the experimental application of the Radiological ID card (RIDc) to patients.Methods and Materials: Representative sample of 457 patients during the periodof 01/09/2005 to 31/10/2005 who were given RIDc to record their gastrointestinalexaminations. Trial period was set from 01/11/2005 to 30/6/2008. The statisticalmethod of the stratified random sampling was followed. For data elaboration theSPSS was used and for the evaluation the x 2 -test.Results: From the 457 patients who were supplied with the RIDc, 364 visited againour laboratory during the trial period. From those patients, 254 were submitted to abarium meal examination and 111 to a barium enema. These 254 patients were nowsubmitted to an endoscopy from which a percentage of 2.6% were found to sufferfrom gastric cancer that had not been detected originally. The results concerning the111 patients who were submitted now to a colonoscopy were estimated to be 2.7%in whom gastrointestinal cancer was first diagnosed and 19.82% for polypoide.Conclusion: Use of the RIDc contributes to faster and more effective services forboth patients and their doctors, easier filling and also workload and operation costreduction in the radiological laboratories.C-791Avoid hurting the women in mammographyC.M. Matscheko, G. Matscheko, M. Rosenborg; Kalmar/SE(ChristinaMa@ltkalmar.se)Purpose: A significant fraction of the women offered mammography screeningdo not attend. Some of them are believed to decline the service due to the hardcompression (15 - 20 daN) normally used. Lowering this fraction by making theinvestigation less unpleasant is essential.Methods and Materials: 100 women undergoing mammography screening wereselected for the study. In these women, one breast was compressed with thetraditional force and the other substantially softer. The compression force variedfrom 4 to 18 daN. By shifting from “normal” pressure to “low” or vice versa eachwoman became her own reference. All X-ray parameters, compressed breastthickness and AGD were recorded. From PACS, the diameter of the compressedbreast, image quality and radiological opacity were estimated. The breast volumewas calculated and classified as “small”, “intermediate” or “large”. The radiologicalopacity was classified according to BI-RADS ® .Results: Breast thickness versus compression force showed no significant correlation.The same holds for AGD as well as for image quality. Sub grouping onradiological density classes showed no significant difference in compressibilitybetween the classes.Conclusion: The high compression force traditionally used is far from optimal; 5 to10 daN is enough. The reason is that the elasticity/compressibility of the breasts islimited. Higher pressure neither gives better images nor lower AGD. This also holdsfor all subgroups investigated. It is recommended to never use more than 8 - 10daN compression force. This could reduce the fraction of women not attending theoffered investigation.C-792Radiography science as a new academic field: Challenges andopportunitiesS.-M. Ahonen, E. Liikanen; Oulu/FI (sanna-mari.ahonen@oulu.fi)Learning Objectives: To describe the opportunities and challenges faced byradiography science as a new academic field in Finland.Background: Radiography science is one of the youngest fields among healthsciences in Finland, and is actively developed towards the status of an independentacademic field. It is purposed to provide expertise for research-based radiography,education, administration and research.Procedure Details: A new academic field usually comes up on the grounds ofdevelopmental needs either in science or in practice, through internalism or externalism.Master’s program in radiography has been running in Finland since 1999 inorder to meet both of these needs. By the scientific community, radiography scienceis challenged to meet focal academic criteria, such as clarification of the researchfocus, perspective, and philosophical arguments, as well publication and researchactivities. Other challenges are caused by the young age as an academic field,and the number of human resources (e.g. small number of journals, conferences,research projects, active researchers and academic posts). Special attention hasbeen paid to facilitation of radiography research, academic curriculum developmentand clarification of the profile of radiography science. Publication and researchactivities have also been activated (e.g. national journal, research society andpost-graduate education).Conclusion: Available resources are still limited, but radiography science in Finlandhas already achieved many of those criteria set on independent academic fields.Challenges could be concerned as inspirational opportunities and takeoff for thedevelopment of radiography science. For this, the contribution of radiographers andinternational collaboration are essential.C-793Quality assurance and dose optimisation in dental radiographyA. Henner, A. Servomaa; Oulu/FI (anja.henner@oamk.fi)Learning Objectives: To find the importance justification, optimisation and qualityassurance in dental radiography. Although individual risks in dental radiographyare small, the risks in the young age groups, often having follow-up X-rays, areabout 3-fold greater.Background: Optimization of imaging techniques and practice decrease dose andincrease image quality. Quality assurance (QA) and audits help in realising the highquality. Equipment factors may have an effect on dose by a factor of 0.5-2. Digitaldetectors (charge-coupled devices and photostimulable storage phosphor) arecapable of operating optimally at lower doses and to achieve high image quality.The Med. Dir requires the establishment of national dose reference levels (DRL).All those involved in radiography should have received adequate theoretical andpractical training in radiation protection.Procedure Details: The volume of dental radiology in Finland is large: 4575 intraoraland 673 panoramic units, about 1,300,000 intraoral and about 200,000 panoramicexaminations. The QA measurements for panoramic units are made by the authorities.For intraoral units, the QA measurements are performed by authorities witha postal QA system. It includes e.g. dose measurements with TL-dosimeters andsome quality measurements. The DRL for intraoral examination is 5 mGy and forpanoramic examinations 120 mGycm 2 . The regular follow-up of doses decreasesdose and especially highest doses.Conclusion: The Med. Dir (97/43/Euratom) and European guidelines (RadiationProtection 136) on radiation protection in dental radiology show the principles. Byadopting them, the optimized protection level in dental practice can be reached.C-794How a model for evidence based practice is used in radiography in breastdiagnostic centre at Ullevaal University HospitalR. Gullien, H. Strømme, A. Haakull, E. Rostad, I. Schou-Bredal; Oslo/NO(raul@uus.no)Learning Objectives: How a model for evidence based practice (EBP) developedfor nursing can be transferred to the field of radiography.Background: The Ullevaal model for evidence based practice was originally designedas a guideline for EBP-work in nursing at Ullevaal University Hospital. It is nowalso used in developing new protocols and updating existing ones within the field ofradiography. Working in accordance with this model ensures that the protocols arebased on the best available evidence, and therefore of the highest quality.Procedure Details: Fundamental components specific to the Ullevaal model:small groups of radiographers trained in EBP. Groups have a masters or doctoralprepared facilitator. The Ullevaal model is inspired by the 5-step model of EBP:1. Question is asked using a PICO form. 2. Systematic literature search is facilitatedby a medical librarian. All relevant databases are searched; the search isdocumented so that it can be replicated. 3. Group members critically appraise theliterature retrieved. 4. Protocols for radiography are written/updated based on theevidence found and the group members’ clinical experience and then approvedby the head of department (radiologist). 5. The protocols/guidelines are evaluatedand updated every two years.Conclusion: The Ullevaal model can be used in developing and updating protocolswithin radiography even though it was originally designed for nursing.CS502 A B D E F FG H

Scientific and Educational ExhibitsC-795The reviewing of a different image filter in case of cardiac-CTT. Kobayashi, S. Nishimura, M. Yuasa, S. Suzuki, K. Uehara, H. Yanaihara;Minatoku,Tokyo/JP (kobataka@insti.kitasato-u.ac.jp)Learning Objectives: We compared Cardiac-Filter and Neuro3D-filter and reviewedwhich was more useful to inspect a cardiac-CT.Background: 1. We scanned QA Phantom of the CT equipment attachment and dideach filter processing in the CT image. Next, we subtracted each filter processingimage from the original image and did visual evaluation. 2. We measured a noiseindex in the water-phantom, changing a tube current to 200-700 mA and processinga filter in the image obtained. The noise index used standard deviation (SD) of theCT number. We used a 32-detector CT scanner (LightSpeed VCT select).Procedure Details: We could observe that both filters were proportional to the filterstrength from the subtraction image and that the noise reduction ability was increasingvisually. We observed an afterimage in the subtraction image of the processingimage by Cardiac-Filter, but in the subtraction image of the processing image byNeuro3D-Filter we did not observe an afterimage. We observed a maximum of35.1% of noise reduction in Cardiac-Filter and a maximum of 40.1% of noise reductionin Neuro3D-filter from the measurement of the noise index. The noise reductioneffect of Neuro3D-filter is high compared with that of Cardiac-filter.Conclusion: To keep a spatial-resolution in cardiac-CT is important. Also, the scandose should be suppressed to the utmost. Neuro3D-filter can suppress the scandose without decreasing the spatial-resolution more than Cardiac-Filter. Therefore,Neuro3D-filter is more useful in cardiac CT.C-796Main factors influencing the use of testes shields during X-rayexaminations in major hospitals in Norway and DenmarkE. Stranden, D.A. Andersen, E. Bergwitz-Larsen, J.A. Eriksen, J.B. Hydal;Drammen/NO (erling.stranden@hibu.no)Purpose: In certain diagnostic X-ray procedures, the patient’s gonads receiveradiation doses from primary or scattered radiation. The purpose of the presentstudy was to demonstrate the effectiveness of a testes shield and to investigatefactors influencing the use of testes shields at three major Norwegian and oneDanish hospital.Methods and Materials: Phantom measurements were performed with and withouta testes shield. 359 PACS images of male patients younger than 50 years werescrutinized. A questionnaire was presented to the radiographers and they wereobserved during the types of examinations in question.Results: Measurements illustrated that scrotum shields are highly effective evenwhen scrotum is not in the primary radiation field. Shields would have been feasiblefor all the 359 PACS images, but were only applied in 63 cases. Twenty-nine of 70Norwegian radiographers never applied testes shields. Twenty-five of them foundit embarrassing to ask the patient to use the protection. Lack of time was anotherreason. All Danish radiographers used the shield whenever feasible and none ofthem found it embarrassing to ask the patients to use the protection.Conclusion: Testes shields were seldom used at the three Norwegian hospitals.Embarrassment and lack of time were given as the main reasons for not using theshields. These factors were not considered important at the Danish hospital, probablydue to better routines, and shields were used almost in all cases there.C-797Image quality assurance and dose reduction with CT-AEC in low-contrastresolution: CT machines with no image-quality setting optionK. Osawa 1 , S. Nakahira 2 , S. Terakawa 2 , I. Fujimura 2 , Y. Kataoka 3 , T. Mito 4 ,Y. Ueda 2 , N. Niwa 5 , Y. Muramatsu 6 ; 1 Abe Sakurai Nara/JP, 2 Osaka/JP,3Toyoake/JP, 4 Minoh/JP, 5 Kyoto/JP, 6 Saitama/JP (alfa-k155@t-kadomatsu.net)Purpose: The purpose of the current study was to demonstrate the correlationbetween image quality and radiation exposure in different levels of low-contrastresolution with computer tomography auto exposure control (CT-AEC) to proposean effective dose control in CT-AEC application.Methods and Materials: A CT-AEC system without image-quality setting options(CAREDose4D, Siemens, Germany) was used with the following phantoms: CTDIphantoms, Elliptical and Apollo phantoms, and MHT-type phantoms. With CTDIphantoms in 6 diameters (100-400 mm), CTDI and image noise standard deviations(SDs) were obtained with and without CT-AEC to evaluate CT-AEC effectsfor different subject diameters. Using Elliptical and Apollo phantoms, changes incorrelation between subject diameter and SD were evaluated under varied referencemAs. The feasible images qualities (SD 7-16) obtained with MHT phantomswere statistically evaluated and the qualities with different SD levels were comparedwith their visual evaluation results. Using the phantom diameter-SD table, clinicaltests were performed.Results: CTDI values with CT-AEC were approximately 50% lower than thosewithout until a diameter of approximately 246 mm and nearly equal at 320 mm.Elliptical phantom had a smaller gradient than Apollo at a reference mAs 200.Visual evaluation resulted in a significant difference (P 0.001) at the target 15 HUcolumn among SD, 7; SD, 8-11; and SD, 12-16. The clinical tests for 218 casesyielded good results.Conclusion: CT-AEC without image-quality setting may achieve the target imagequality (SD values) while assuring minimal dose by setting reference mAs valuesin small steps using a diameter-SD table.C-798Evaluation of effectiveness of CT-auto exposure control (CT-AEC) inensuring image quality and reducing exposure dose based on low-contrastresolution using 3 CT systemsK.O. Oosawa 1 , S. Nakahira 2 , S. Terakawa 3 , I. Fujimura 2 , Y. Kataoka 4 ,T. Mito 5 , Y. Ueda 3 , N. Niwa 6 , Y. Muramatsu 7 ; 1 Hase Sakurai Nara/JP,2Izumi-sano/JP, 3 Osaka/JP, 4 Toyoake/JP, 5 Minoh/JP, 6 Kyoto/JP, 7 Wako/JP(alfa-k155@t-kadomatsu.net)Learning Objectives: Low-contrast resolution with CT-AEC was evaluated toclarify the relationship between image quality and exposure dose as well as effectiveusage.Background: CT-AEC operation was verified in Control #06-C-707-ECR. The effectivenessof CT-AEC in ensuring image quality based on diagnostic capabilitiesand exposure dose reduction was evaluated in this study. At present, the operatoris the present situation, which is inspecting as the one which is putting on the imagequality to estimate by the collateral.Procedure Details: Evaluation was performed using 3 CT systems: Aquilion64,(VolumeEC, Toshiba), LightSpeed-VCT, (3D mA Modulation, GEMS), Sensation64,(CARE Dose4D, Siemens). A. CTDI and SD were measured with CT-AEC on/offusing Body Dose CTDI phantoms (6 sizes). The effectiveness of CT-AEC wasevaluated for each target object diameter. B. CT-AEC evaluation (Apollo, Elliptical)were scanned while varying the reference mAs, and SD variation in the slice planeaccording to the target object diameter was evaluated. C. A MHT phantom (KyotoKagaku) was scanned to obtain the practical image quality (SD7-SD16), significantdifferences at each SD value were identified, and relationships with visual assessmentresults were evaluated.Conclusion: Visual assessment showed significant differences in the range SD10-SD12 for a 15-HU cylinder. If the visual assessment results were equivalent regardlessof SD value variation such as 8-11, diagnostic capabilities could be ensuredwhile reducing the exposure dose by setting SD11. Even without SD setting, thetarget SD could be obtained by finely adjusting the reference mAs using the targetobject diameter-SD curve table obtained in B.C-799Current concepts of polytrauma managementC. Bernal Lafuente, J.M. Artigas Marín, F. Jiménez Aragón, M. Beltran Marín,E. Cañete Celestino; Zaragoza/ES (celiaku@hotmail.com)Purpose: To investigate the effects in polytrauma patients of two different protocols:the new MSCT whole body protocol vs. the classic ATLS protocol.Methods and Materials: We present a comparative study designed to evaluatetwo different protocols used in the handling of polytrauma patients in a universitytrauma center, the classic Advanced Trauma Life Support protocol (ATLS) employeduntil 2006, and the current MSCT whole body protocol. Data were collected fromclinical recordings of patients with serious injury (ISS 17) admitted in the ICUduring first semester of 2008 (handled according to MSCT whole body protocol)and compared to historical data from the first semester of 2006 (handled accordingto the classic protocol ATLS). Mortality, stay in the ICU and possible missed lesionswere the main data collected for all patients.Results: Our results showed that early use of MSCT reduces the length of stay inthe ICU, (24.8 days in 2006 vs. 21.56 in 2008), the mortality of more severe patients(25% in 2006 vs. 8% in 2008), and the mortality due to abdominal injury (25% ofmortality vs. 13.6%). Overall mortality fell from 30% in 2006 to 26.9% in 2008. Theseverity index was similar for both groups.Conclusion: The new algorithm for severe trauma patient care integrating MSCTin the early diagnostic protocol allows a rapid therapeutic intervention in severetrauma patients and reduces mortality, length of stay in the ICU, and the numberof initially missed injuries.RadiographersACB D E F G HS503

Scientific and Educational ExhibitsC-800Patient positioning and exposure dose in CT studiesK. Nomura 1 , F. Shimizu 1 , Y. Muramatsu 2 , K. Takahashi 1 , K. Shimizu 1 , S. Kitou 1 ,K. Hanai 1 ; 1 Chiba/JP, 2 Saitama/JP (cyberimura@hotmail.com)Learning Objectives: To understand that misalignment of the center of rotationand the center of the object increases the exposure dose. To understand the adverseeffects of increased exposure dose due to such center misalignment whenCT-AEC is used.Background: The scan range is extended in MDCT, making it practically impossibleto match the rotation and object centers over the entire scan range. In addition,recently introduced CT-AEC with an image quality setting function allows the tubecurrent to be adjusted to obtain the preset image quality based on a positioningimage. The effects of these two factors on exposure dose were investigated.Procedure Details: In accordance with IEC standards, nCTDIc, nCTDIp, andnCTDIw were measured using a trunk phantom (320-mm diameter), with theheight of the patient couch on which the phantom was placed varied by 50 mmfrom the rotation center (0 mm) in 25-mm steps. CTDI was similarly measuredusing CT-AEC with the image quality setting function (Toshiba Aquilion 16M). Thepositioning image was an AP image at a tube position of 0°.Conclusion: Displacement of the phantom increased CTDIp by up to approximately30% (50 mm) at the 12-o'clock and 6-o'clock positions relative to the patient couch.With CT-AEC, CTDIp was increased by up to approximately 85% (50 mm) at the12-o'clock and 6-o'clock positions. The reasons were the wedge filter shape andincorrect recognition due to a magnified positioning image. Center misalignmentfurther increases the exposure dose and variation in image quality.VascularCTC-801Multidetector-row CT of popliteal entrapment syndromeR.L. Hallett, J.E. Roos, G.D. Rubin, D. Fleischmann; Stanford, CA/USLearning Objectives: To review the pathophysiology, diagnosis, and treatment ofpopliteal entrapment syndrome (PES). To review pertinent classification systems.To explain a simple method for diagnosis and classification utilizing dynamicmultidetector-row CT angiography (CTA).Background: PES is a common syndrome, typically involving young patients whopresent with claudication in the calves, which occurs when climbing or walkingbut not during maximal exercise. PES is caused by anatomic compression of thepopliteal artery and/or vein by aberrant or accessory muscle slips, tendons; or byfunctional narrowing via the soleus sling. Affected patients suffer effects rangingfrom ischemia to embolic disease and aneurysm formation. Previously reportedimaging evaluation has included ultrasound, MRI, routine CT, and catheter angiographywithout or with provocative maneuvers. CT offers improved spatial resolutionversus MR and US, but, like other cross-sectional imaging techniques, requires asimple and reliable method for imaging during provocative maneuvers.Procedure Details: We will describe a simple procedure to obtain reliable CTAimages of the popliteal vascular region, at rest and with consistent forced plantarflexion.The procedure utilizes simple technique and readily available supplies. Awide spectrum of pathologic findings will be presented. Visualization of aberrantmuscle groups and slips will be enhanced by concomitant 3D display. Surgicalcorrelation and treatment considerations will also be presented.Conclusion: Fast, reliable, and robust evaluation for suspected PES can be performedwith dynamic multidetector-row CTA.C-802The characteristics of paraesophageal varices: A study with 64-rowmultidetector computed tomography portal venographyL. Zhao, W. He; Beijing/CN (zhaolqzr@sohu.com)Purpose: To identify the characteristics of morphology, location and collateralcirculation involved in paraesophageal varices (para-EV) of portal hypertensionpatients with 64-row multidetector computed tomograghy (MDCT).Methods and Materials: Fifty-two of 501 patients with portal hypertensive cirrhosiswere selected for 64-row MDCT examination after the observation of para-EV. TheCT protocol included unenhanced, arterial and portal phases with a slice thicknessof 0.625 mm and a scanning field of 2 cm above the bifurcation to the lower edge ofkidney. The CT portal venography (CTPV) was reformatted on AW4.3 workstation.The characteristics of origination, location, morphology and collateral circulationin para-EV were observed.Results: Among the 52 cases of para-EV, 50 showed the originations from theposterior branch of left gastric vein, while the others from the anterior branch. 50demonstrated their locations close to the esophageal-gastric junction, and the othertwo cases were extended to the inferior bifurcation of the trachea. The circuitouspattern was observed in 16 cases, while reticulated pattern was seen in 36. Collateralcirculation identified as 4 cases of single periesophageal varices (peri-EV)communication, 3 of single hemiazygous vein, one of single inferior vena cava, 41of mixed type (collateral communications of at least 2 of above mentioned types)and 3 of undetermined communications.Conclusion: 64-row MDCTPV could display the location, morphology, origin andcollateral types of para-EV, which provide important and referable information forclinical management and disease prognosis.CS504 A B D E F FG H

Scientific and Educational ExhibitsC-803MDCT of congenital anomalies of the inferior vena cavaM.-T. Chuang, H.-M. Tsai, Y.-S. Liu, C.-H. Lu, C.-K. Wang; Tainan/TW(u8501122@gmail.com)Learning Objectives: To review the embryogenesis of the inferior vena cava (IVC).To learn the role of MDCT in the evaluation of congenital anomalies of the IVC. Todiscuss the clinical significance of anomalies of IVC.Background: Many IVC anomalies do exist in daily practice. However, we oftenfail to recognize them based only on axial images. After the introduction of MDCT,it becomes much easier to get MPR and 3D images. These images undoubtedlyhelp radiologists make diagnosis more easily and confidently.Procedure Details: Our presentation is designed based on the following structures:1. Illustrate the embryogenesis of the IVC; 2. Demonstrate various types of IVCanomalies; 3. Introduce the roles of MDCT in evaluation of IVC anomalies; 4. Casedemonstrations of clinically significant IVC anomalies; and 5. Show some specialconditions regarding interventional procedures of IVC anomalies.Conclusion: Using MDCT, we can obtain MPR and 3D images of IVC and itstributaries easily. This will help us in making correct diagnosis more easily andavoid diagnostic pitfalls.No Material Submitted to EPOSC-804Ultra-fast carotid CT-angiography: Initial results with a 128-slice CT-systemF.M. Hinkmann, H.L. Voit-Hoehne, M.M. Lell, K. Anders, U. Baum, W. Bautz;Erlangen/DEPurpose: To evaluate an optimized scan protocol for carotid CT-angiography (CTA)using a 128-slice-spiral-CT.Methods and Materials: 30 consecutive patients underwent CTA of the carotid vesselswith a 128-section scanner. 15 patients were examined with a standard protocol(group A): 80 ml contrast material (CM), flow 5 ml/s, test bolus method to assessindividual transit time. Another 15 patients were examined with an optimized lowvolume CM protocol (group B): 30 ml CM, 4 ml/s, bolus tracking. Contrast administrationwas always followed by a saline flush. Image quality, segmental enhancement aswell as the presence and degree of arterial stenosis were independently evaluatedby two radiologists. Venous overlay as well as streak artifacts at the thoracic inletdue to highly concentrated CM in the subclavian veins was evaluated in both groups.Pearson’s correlation coefficient was used to quantify interobserver variability, andstudent’s t-test to investigate differences between the groups.Results: All studies were of diagnostic quality in both groups. Interobserver variabilitywas excellent (r 0.9). Mean enhancement values were slightly higher ingroup A, but without statistical significance averaged for all segments (p = 0.06). Thelow contrast protocol proved to be the more robust method with constant arterialenhancement, less streak artifacts at the thoracic inlet (impairing adjacent vesselevaluation in 1 vs. 13 patients) and less venous enhancement (p = 0.04).Conclusion: Using the latest CT technology, optimal depiction of the craniocervicalarteries can be archived with a robust and user friendly low volume (30 ml)CM protocol.C-805Failed hemodialysis arteriovenous fistula - is there a role for multidetectorCT? Our experienceG. Regine, C. Parola, M. Atzori, C. Pace, A. Cortese, L. Adami, A. Carnabuci;Rome/IT (g.regine@tin.it)Purpose: To evaluate the diagnostic impact of multidetector CT in the evaluationof patient with failed arteriovenous fistula.Methods and Materials: Between September 2007 and July 2008, 72 patientshave been evaluated with arteriovenous fistula for hemodialysis. The patientshave been enrolled basing on clinical evaluation and on echocolordoppler findingspositive or suspicion for failed A-V fistula. The examinations were performed with16 mulitidetector-row CT using a specific acquisiton protocol after contrast mediaintravenous injection, with Smart-Prep function. The CT axial data were integratedwith 3D MIP and volume rendering reconstructions. The entire examination time,door to door, was about 10 minutes.Results: The technique identified 42 cases of variable degree stenosis withpreferential localization in perianastomotic site: 19 in arterial compartment and 23in venous, 18 cases of aneurysm dilatations, 4 cases of thrombosis in superiorcava system identified 8 cases of graft pathology (occlusion or perianastomotichematoma). All cases were confirmed by conventional phlebography.Conclusion: The technique shows good diagnostic accuracy particularly if the patientsevaluated are positive and or suspicious in preventive clinical or color-Dopplerultrasonography examination. Moreover evaluate specifically the arteriovenousanastomosis and graft situation with optimal management of patient in less timeand without NSF risk; for this reason may be preferred to MR. For these reasons itmay be added in protocol fistula evaluation with diagnostic time reduction.C-806Adrenal vein CT angiography with 64 multi-detector row CTW. Liu, H.D. Xue, X. Wang, H. Sun, Z.Y. Jin; Beijing/CN (lw.pumch@hotmail.com)Purpose: To estimate if CTA mapping can demonstrate bilateral adrenal veins,which may be helpful in planning adrenal vein sampling.Methods and Materials: Sixty patients (M:F=26:24, 53.4 yrs old) with normal adrenalappearance were retrospectively reviewed for CTA vascular mapping. They wereexamined on a 64 multi-detector row CT. In each patient, venous phase volumetricdata sets were acquired 60 seconds after intravenous injection of 100 cc of nonioniccontrast material. Two radiologists reviewed the data sets at a free-standingworkstation with the application of multiplanar reformation (MPR) software andreached a consensus on whether the bilateral adrenal veins were visualized and,when seen, its position relative to the inferior vena cava (IVC).Results: The left adrenal vein was clearly found in 96% of the 50 patients. Thelength of the central vein averaged 2.2 cm (from 1.2 to 3.4 cm). The junction ofthe left adrenal vein and left renal vein averaged 3.2 cm (from 1.4 to 4.6 cm) fromthe left lateral wall of the IVC. The right adrenal vein was found in 78% of the 50patients. The average length of the central vein was 0.5 cm (from 0.2 to 1.3 cm).The junction of the right adrenal vein and the IVC averaged 4.9 (from 2.7 to 7.9 cm)below the second porta hepatis. 3 of 50 right adrenal veins were found drained tothe accessory hepatic vein rather than directly into the IVC.Conclusion: CTA with the application of MPR permits satisfactory localization ofthe bilateral adrenl veins in most cases, especially the left one.C-807Hereditary hemorrhagic telangiectasia (HHT): Radiological spectrum andclinical overviewH. Kiyosue 1 , Y. Sagara 1 , S. Tanoue 1 , Y. Hori 2 , S. Matsumoto 1 , H. Mori 1 ; 1 Yufu/JP,2Oita/JPLearning Objectives: 1. To be familiar with the clinical and radiological manifestationsof HHT. 2. To illustrate various radiological findings in various organs affectedby HHT. 3. To understand the conditions including gene mutations associated withHHT. 4. To demonstrate the management of arteriovenous malformation associatedwith HHT.Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominantdisease with various clinical presentations. A comprehensive knowledge ofboth clinical and radiological findings of this multi-systemic disease is importantfor the proper management of affected patients.Imaging Findings: We demonstrate clinical signs and symptoms, etiology/epidemiology,diagnostic criteria for HHT with literature review. And also we reviewimaging findings in different organs of HHT: brain, head and neck, lung, liver andabdominal viscera, and gastrointestinal. The management and/or treatment of HHTwill be discussed in this exhibit.Conclusion: In this exhibit, we will demonstrate the various radiological spectrumsof HHT with clinical correlation. Treatment options and interventional techniquesfor vascular lesions in each organ are also discussed.C-808Prevalence of splenic artery aneurysms by interactive 3D CT angiographyusing image viewer provided with MIP and MPR softwareT. Tsuda, T. Hyodo, M. Hirata, Y. Okizuka, M. Murakami, T. Mochizuki; Ehime/JP(ttsuda@m.ehime-u.ac.jp)Purpose: To confirm the prevalence of splenic artery aneurysms (SAA) by 3D CTangiography (3D CTA) in patients with or without chronic liver diseases.Methods and Materials: 574 consecutive patients (M:F=325:213) underwent multiphasecontrast enhanced CT for the purpose of assessment of liver diseases. Weretrospectively screened SAA by 3D CTA from the isotropic data using 16-channelMDCT. Patients were divided into two groups: patients with chronic liver diseases(Group A, n=422) and patients without chronic liver diseases (Group B, n=116).All cases were analyzed by 16 mm-thick slab maximal intensity projection (MIP)images in different plains interactively using image viewer (SYNAPSE and Obliquus,FUJIFILM). Volume rendering images were reconstructed in suspected cases forthe confirmation of SAA using 3D imaging software (Advantage Workstation, GEHealthcare).VascularACB D E F G HS505

Scientific and Educational ExhibitsResults: 63 patients (14.9%) in Group A and 7 patients (6.0%) in Group B hadSAA, respectively. Prevalence of SAA was significantly higher in Group A. In GroupA, the prevalence of SAA in female and male patients was 22.8 and 10.0%, respectively.In Group B, they were 11.8 and 1.5%, respectively. Prevalence of SAAwas significantly higher in female patients in each group. 63 patients had total of85 SAAs in Group A. Clinically significant SAA of which diameter was more than20 mm was only found in 5 patients with liver cirrhosis.Conclusion: Prevalence of SAA in the patients with chronic liver disease was14.9%, which is relatively higher than previous reports. We believe interactive 3DCTA is an essential tool for vascular abnormality.C-809Deep inferior epigastric perforator (DIEP) flaps for breast reconstruction:Preoperative imaging - experience on 18 consecutive patientsA. Pellegrin, M. Bertolotto, M. Belgrano, F. Pozzi-Mucelli, Z.M. Arnež, M.A. Cova;Trieste/IT (xpelle@gmail.com)Learning Objectives: To illustrate the vascular anatomy of DIEP flaps and the roleof imaging in preoperative planning of the procedure, which represents the state ofthe art in breast reconstruction with autologous tissue after mastectomy.Background: The DIEP flap procedure relies on microdissection of perforatorsarising from inferior epigastric artery, which supply the skin and fatty tissue ofthe abdominal wall. A single perforator is anastomosed to the internal mammaryartery. Since perforating arteries have a variable anatomical distribution, dissectionis time consuming.Procedure Details: Patients are studied preoperatively with color Doppler US, CW-Doppler, and MDCT. To differentiate venous from arterial perforators, duplex Dopplerinterrogation is performed measuring peak systolic velocity (PSV), average speedof blood (MV), resistive (RI) and pulsatility index (PI). Arterial vessels are markedon the skin, and their position checked also with CW-Doppler analysis. MDCT isperformed during the arterial phase. Suitable reconstructions are obtained usinga dedicated workstation marking position, length and orientation of intramuscularcourse perforators. Few perforators are chosen properatively based on position andimaging features suggestive for higher blood flow: visibility at MDCT; high PSV andMV, low PI and RI. Only these vessels are preserved during surgical dissection, whilethe rest are sacrificed. Eventually, only one vessel is chosen to supply the flap.Conclusion: In our hospital, preoperative imaging planning reduced DIEP flap dissectiontime from more than 4 h to an average of 2 h. Shortening the surgical timeis essential to reduce patient morbidity, overall complications and global costs.C-810What referring physicians need to know: Multidetector computedtomography angiography in patient surveillance after stent-graftplacementP. Szopinski, M. Terlecki, E. Pleban, M. Biesiadko-Matuszewska, J. Iwanowski,M. Stryga; Warsaw/PL (materleck@wp.pl)Learning Objectives: 1. To present different stent-graft systems. 2. To highlightimaging strategies, protocols and post-processing evaluations. 3. To illustrate imagingfindings associated with different endoleak types and other complicationsthat may occur.Background: Since 1991 when endovascular aortic repair (EVAR) was first performedit has been used as an alternative to open surgery. From the moment ofits introduction, EVAR has required lifelong imaging surveillance to select patientswith complications and therefore the highest risk of aneurysmal growth and rupture.Multidetector CT-angiography (CTA) is a well accepted imaging modality afterEVAR procedure. According to EUROSTAR (European Collaborators on Stent-graftTechniques for Abdominal Aortic Aneurysm Repair) CTA should be done in 1, 3,6 and 12 months after the procedure and then yearly. We present our experiencewith 519 examinations in 163 patients evaluated by 8- and 32-slice CT.Imaging Findings: Standard, uniiliac, custom made devices with supra- andinfra-renal fixation systems and fenestrated stent-grafts are illustrated. We alsopresent findings in different types of endoleaks and other complications such asstent-graft thrombosis, migrations, stent-graft leg bending and infections. We showpossible pitfalls as well.Conclusion: CTA is a primary diagnostic method for evaluation of complicationsafter EVAR. Knowledge of different endovascular devices and possible pitfalls arecrucial for accurate stent-graft assessment and for defining treatment strategies ifany complications are visualized.C-811Body artery evaluation of dual energy CTA (DE-CTA) with dual source CT(DSCT): Initial applicationR. Ma 1 , C. Liu 1 , J. Chen 2 ; 1 Jinan/CN, 2 Beijing/CN (mary.03@163.com)Purpose: To define if DE-CTA is safe, reliable or not for evaluation of body artery.Methods and Materials: Lung/chest phantom (Flupe,Model RS-330) was scannedwith standard sequence for body vessel and abdomen of DSCT and 64 spiral CT,respectively. The radiation dose (Dose-Length Product, DLP) of each sequencewas compared. DE-CTA was done with DSCT on 30 patients who were suspectedof body vascular disease. 3 groups of axial images with 1.5 mm thickness (1.0 mmincrement) were acquired, which were 80 Kv, 140 Kv and merged images. MIP, VRimage was generated through dual energy postprocessing (DE group, used 140 and80 Kv images) and In Space (non-DE group, used merged images), respectively.Time spending were compared. Another 30 cases (64 group) of body CTA with 64slice spiral CT were reviewed retrospectively. Image quality of 64 group and DEgroup were compared by two doctors who were skilled in image postprocessing.Contrast medium injection rate 4.5 ml/s (350 mgI/ml, 80-100 ml iohexol), bolustracking on abdominal aorta with trigger threshold value 100 Hu.Results: DLP of DE-CTA was not more than that of 64 spiral CT. There was nodifference of image quality between DE and 64 groups. The time spending of acquiringbone removal MIP/VR image of DE-CTA was less than non-DE group forabdominal artery, but no difference for chest-abdominal artery (p 0.01). DE-CTAwas simple, with image generated automatically through DE postprocessing, andno more manual steps was needed compared to non-DE group.Conclusion: DE-CTA was a safe, reliable technique for imaging and evaluation ofbody arteries, as well as 64 spiral CT; additionally, DE-CTA needed less postprocessingtime spending or steps than 64 spiral CT.C-812One breath-hold coronary and carotid DSCT angiography with and withoutdual energy: Comparison of examination quality and durationJ. Neuwirth 1 , J. Veselka 2 , T. Adla 2 , V. Suchánek 2 , M. Polovincák 2 ;1Hradec Králové/CZ, 2 Prague/CZPurpose: To evaluate the quality and duration of CT angiography in two regions- coronary (CTCA) and carotid (CTA) with one bolus of contrast media using dualsource CT (DSCT) with/without dual energy.Methods and Materials: 48 patients (65% male, 65.47.9 years) were examinedwith DSCT angiography (100 ml Iomeron 400, 40 ml saline chase, 4 ml/s, automatedbolus tracking) in one breath-hold. The same protocol was performed for coronaryangiogram (two tubes, both 120 kV). The first 32 patients were examined in neckregion with single energy (SE)-one tube (120 kV), the second group of 16 patientswith dual energy (DE)-two tubes (140 kV, 80 kV). Densities were measured in 9locations: left ventricle, aortic root, aortic arch and bilaterally at origin of carotidarteries, bifurcation and below the skull base. Non-optimally enhanced regions (lessthan 200 HU) were counted. The quality of the examinations was graded (A- excellent,B- sufficient, C- invaluable). The procedure time was measured.Results: The average density in all measured region was 390119 HU in SE and408124 HU in DE group. Non optimal density was achieved in 8 (2.8%) regionsresp. 3 (9%) patients in SE group and in 3 (2.8%) regions resp. 3 (18%) patients inDE group. Quality of examination (A, B, C) were for SE (84.0, 12.5, 3.1%), DE (68.8,31.2, 0%) for carotids. SE (75.0, 25.0, 0%), DE (75.0, 25.0, 0%) for coronaries. Thetime of examination was 253 sec (SE) resp. 273 sec (DE).Conclusion: The homogeneity of enhancement is individual but the average densityin arteries is sufficient using both methods. More non-optimal enhanced segmentsin DE are most likely caused by longer duration of examination.C-813Anomalies of the inferior vena cava and left renal vein: Types and findingsin 602 patientsA. Buzzi, R. Trueba, B. Rowstron, A. Gaser, S. Eduardo, L. Santamarina;Buenos Aires/AR (alfredo.buzzi@diagnosticomedico.com)Purpose: 1. To describe the embryological development and the malformationmechanism of the inferior vena cava (IVC) and left renal vein (LRV). 2. To determinethe frequency of appearance of the different malformations of the IVC andthe LRV. 3. To illustrate the characteristics in CT of the most common anomaliesof IVC and LRV.Methods and Materials: 6257 CT studies of abdomen performed during 1 year(January 2007 to January 2008) in search of malformations of the IVC and theLRV were analyzed retrospectively. They were classified according to their malformativemechanism.CS506 A B D E F FG H

Scientific and Educational ExhibitsResults: Of a total of 6257 studies we found these malformations in 602, whichrepresents 9.62% and that agrees with the literature. The frequency of each type isthe following one: Left IVC 19 patients (0.30%), Double IVC 156 patients (2.50%),Retroaortic left renal vein 144 (2.30%), Circumaortic left renal vein 257 patients(4.10%), Azygos continuation of the IVC 25 patients (0.40%), and absence of IVC1 patient (0.02%). In no case the malformation was responsible for the patientsymptoms.Conclusion: The congenital anomalies of the IVC and LRV are recognized in TC,more frequently like findings. Its identification is important to avoid the diagnosticerrors of retroperitoneal and mediastinic adenopathies or masses, and also to avoidcomplications during surgical and radiological procedures. The understanding ofthe embryological development of the IVC is necessary to understand the originof these anomalies and their anatomical variants.C-81464-slice multidetector CT angiography of the mesenteric circulation:Normal anatomy, anatomic variants and pattern-based assessment ofpathologic findingsJ. Martin Cuartero, L. Miranda Orella, I. Tolosa Arrieta,M.R. Cozcolluela Cabrejas, M.T. Martinez-Berganza Asensio,J.M. Mellado Santos; Tudela/ES (jmcuar@hotmail.com)Learning Objectives: To review and illustrate the normal anatomy and anatomicalvariants of the mesenteric circulation. To briefly review and discuss, in a patternbasedapproach, the various pathologic conditions that may involve the mesentericcirculation.Background: The increased speed of 64-slice multidetector CT equipments allowsshorter acquisition time and decreased motion artifacts. Also, the routine use of0.5 mm collimation generates isotropic 3D voxels and optimal three-dimensionalrenderings, which are particularly suitable for a comprehensive assessment of themesenteric circulation.Imaging Findings: In this pictorial exhibit, we review the normal anatomy andanatomic variants of the mesenteric circulation as seen in 64-slice multidetectorCT angiographic studies. We also illustrate and briefly discuss, in a pattern-basedapproach, the differential diagnosis of various pathologic conditions involving themesenteric circulation. Four major pathologic cathegories are evaluated, including:(1) segmental or diffuse vascular engorgement, (2) vascular displacement or distortion,(3) intrinsic or extrinsic stenosis, and (4) thrombotic or embolic occlusion.Conclusion: 64-slice multidetector CT angiography is an adequate modality fordepiction of the normal mesenteric circulation. Moreover, it may be used as anoptimal tool for a pattern-based approach to differential diagnosis of abnormalitiesinvolving the mesenteric circulation.C-815Pulmonary arteriovenous malformationsM.D. Schmidt, V. Prabhudesai, M.E. Faughnan; Toronto, ON/CA(michaeldavidschmidt@gmail.com)Learning Objectives: To describe and explain the optimum use of radiologicalservices in the diagnosis and management of pulmonary arteriovenous malformations(PAVMs). To illustrate these concepts with a series of images from patientsattending a specialized hereditary haemorrhagic telangiectasia (HHT) clinic.Background: A PAVM is an abnormal communication between a pulmonary arteryand vein. First described at autopsy in 1897, PAVMs are right-to-left shunts. PAVMsincrease demand on the heart, cause oxygen desaturation and increase the riskof embolic phenomena by limiting the ability of the lungs to act as a natural filter.Most PAVMs are congenital and associated with HHT, while acquired PAVMs occurin hepatic cirrhosis, schistosomiasis, actinomycosis, mitral stenosis, trauma,Fanconi’s syndrome and metastatic thyroid carcinoma. This exhibit will describe thenatural history of PAVMs and the use of the radiological service in their diagnosisand management.Imaging Findings: Chest radiographs, CT scans, MRIs and angiographic imagesare included to show the diagnosis and management of PAVMs within the radiologyservice. PAVMs classified as simple, complex and atypical are demonstrated anddiscussed along with progression of disease and the rare outcome of spontaneousthrombosis. Exclusion of bronchogenic cysts and lung tumours from the differentialdiagnosis is also highlighted.Conclusion: PAVMs are not a common clinical problem, but complications suchas cerebrovascular accidents, brain abscesses, haemothorax, life threateninghaemoptosis, pulmonary hypertension and congestive heart failure warrant earlydiagnosis, management and follow-up by radiology departments.C-816Quantification and perceptibility of in-stent stenosis with six peripheralarterial stent types in vitro: Comparison of 16-slice CT, 64-slice CT and MRM.B. Schernthaner, D. Berzaczy, G. Edelhauser, F. Wolf, J. Lammer, M. Funovics;Vienna/ATPurpose: To evaluate and compare the perceptibility of 75 and 95% in-stentstenoses with CT angiography (CTA) and MR angiography (MRA) using six stenttypes in a phantom model.Methods and Materials: Six different stent types were placed into tubes filled withcontrast agent (ioversol or gadoteric acid) and nylon-cylinders (8 mmØ), bored inthe central axis (2 and 4 mm) to mimic 75 and 95% stenoses, were inserted intothe stents inside the tubes. CTA (16-slice and 64-slice scanners, three differentkernels, 120, 140 kV) and MRA (1.5 T) were performed. On 2 mm coronal sections,signal-intensities in the stenosed stents were compared to unstenosed segments.Perceptibility of the residual lumen was assessed using a subjective score.Results: 16-slice-CTA showed relative in-stent signal-intensities of 72-87%;64-slice-CTA of 63-99%. 64-slice-CTA showed nearly no difference between 75and 95% stenoses in the subjective scores. The high-contrast-kernel tended to besuperior to intermediate- and low-contrast-kernels. MRA showed the relative instentsignal-intensities of 57-98%. The presence of localized artifacts and resultinginhomogeneous luminal signal caused lower subjective perceptibility ratings thanthe objective score would suggest.Conclusion: CTA was superior in the differentiation between 95% stenoses andocclusions. 64-slice-CTA tends to be superior to 16-slice CT, especially with highcontrast-kernels.MRA was more useful for the differentiation of 75% stenoses andunstenosed segments.C-817Whole-body CT angiography: Insight on emerging application in clinicalsurveillance of patients with metabolic syndrome and acceleratedatherosclerosisB. Cavallo Marincola, A. Napoli, D. Geiger, P. Di Paolo, C. Catalano,R. Passariello; Rome/IT (beacm@libero.it)Purpose: Evaluate the correlations between location, extent and severity of arterialsteno-occlusive disease with 64-MDCT angiography (CTA) and Framingham riskindex (FRI) in patients with metabolic syndrome (MetS).Methods and Materials: 300 patients with MetS underwent whole body 64CTA(Sensation Cardiac, Siemens). Two image data sets were acquired using a64×0.6 mm detector configuration with contrast [Iomeprol-400; 400 mgI/mL] injectionprotocol. ECG-gated coronary scanning was performed first, followed by anultra-low dose (80 kVp) scan of the entire arterial system. Coronary artery andwhole body arterial districts were divided into 15 and 32 segments and assessedfor vascular pathology. In all patients, FRI was correlated to location, extent, andseverity of coronary and/or extra-coronary lesions.Results: A total of 4946 coronary and 9415 extra-coronary arterial segmentswere considered diagnostic. On a per segment basis, atherosclerotic lesions wereobserved in 720 coronary and 1044 extra-coronary segments. Sensitivity and specificityfor detection of severe stenosis was 80 and 95% in 34 patients who neededcoronary angiography. Patients categorized as mild-risk ( 10; 20%) accordingto FRI demonstrated a similar extent (p=0.94) of arterial involvement and location(p=0.49) as those at high-risk. There was a relationship between severe stenosisand high-risk FRI (r=0.35, p=0.002).Conclusion: 64CTA is an emerging non-invasive modality for imaging atherosclerosisin both coronary and extra-coronary arteries. Early detection of atherosclerotic diseasein patients with mild cardiovascular risk has potential for preventive therapy.C-818Quantification of atherosclerosis severity and total cardiovascular burden:Non-invasive coronary and extra-coronary whole-body assessment -evolving role of 64-row CT angiographyC. Zini, A. Napoli, B. Cavallo Marincola, M. Anzidei, C. Catalano, R. Passariello;Rome/IT (zini.chiara@gmail.com)Purpose: To validate whole-body CT angiography (WB-CTA) and to assess totalatherosclerosis burden in patients indicated for coronary CT.Methods and Materials: 78 patients were evaluated at 64-slice CTA using a64x0.6 mm detector configuration and an adapted injection protocol. Two imagesdata sets were acquired. Coronary and extra-coronary arteries were divided into16 and 32 segments, respectively. Attenuation measurements in each patientwere recorded at the 16 extra-coronary arterial locations for arterial enhancementquantification. Images were assessed by two readers for vascular pathology. TheVascularACB D E F G HS507

Scientific and Educational Exhibitsdiagnostic performance of coronary CTA for detection of significant disease wascompared to conventional coronary angiography (CCA) in 52 patients.Results: The mean arterial attenuation was 32120 HU. Enhancement differencesacross arterial sites were not significant (p 0.5; one-way analysis of variance usingpost-hoc Bonferroni correction). The mean arterio-venous attenuation difference(209 HU) was significant across all anatomic regions (p 0.001). Atherosclerosiswas observed in 238/995 (24%) coronary and 368/2441 (15%) systemic arterialsegments. Significant stenosis and occlusions were present in 214 (21%) and 24(2.5%) coronary segments, respectively, whereas asymptomatic 50% stenosis waspresent in 49 extracoronary segments. Treatment strategy was modified in 19 (24%)patients based on WBCTA results. The sensitivity, specificity, and positive and negativepredictive values of coronary CTA were 78, 94, 78 and 94%, respectively.Conclusion: Comprehensive cardiovascular imaging can be performed effectivelywith WB-CTA. Pre-clinical assessment of total cardiovascular burden can havesignificant outcome on secondary prevention.C-819Intracranial arterial fenestration: Frequency on CT angiography in patientswith and without aneurysmA. Hasanefendioglu Bayrak, H. Öztürkmen Akay, C. Akgül Özmen, S. Sentürk,H. Nazaroglu; Diyarbakır/TR (aylin_has@yahoo.com)Purpose: The frequency of intracranial fenestration is reported as lower than 1%in previous studies with conventional angiography. Our goal is to determine thefrequency of fenestration on CT angiography in patients with and without cerebralaneurysm, and to search co-existing vascular variants with fenestration.Methods and Materials: Between September 2007 and May 2008, CT angiographiesof 145 patients, performed by 64-sliced CT, were retrospectively reviewed foraneurysm, fenestration and other vascular variants. Nine of the 145 examinationswere excluded from the study due to improper technique. The remaining patients(age range 4-96 years, mean 49.318) were divided into two groups: 44 patientswith aneurysm (group A), and 92 patients without aneurysm (group B). Both groupswere investigated for frequency of fenestration and co-existing vascular variants.Results: Fenestration was determined in 6 patients (13.6%) in group A, and in 7patients (7.6%) in group B. However, the difference was not statistically significant(p: 0.355). We observed that localization of fenestration was close to aneurysmin two patients, whereas other fenestrations were all remote from the aneurysms.In patients with fenestration, we did not observe any variations in anterior circulation;however, 3 patients had variations in posterior circulation. Interestingly, thefenestrations of these patients were also in posterior circulation.Conclusion: There is no significant relationship with presence of aneurysm andfenestration. The frequency of fenestration observed in this study is higher thanprevious studies with conventional angiography, probably due to scope of CT angiographysuch as thin sliced images and post-processing procedures.C-820Increased subclinical atherosclerosis in patients with metabolic syndrome:Whole-body CT angiography for quantitative arterial involvement - resultsfrom a comparative study with a control populationA. Napoli, D. Geiger, P. Di Paolo, F. Zaccagna, C. Catalano, R. Passariello; Rome/IT(alessandro.napoli@uniroma1.it)Purpose: Investigate the association between metabolic syndrome (MetS) andsubclinical atherosclerosis determined by 64-row whole body CT angiography(WB-CTA) in comparison with a matched control group (non-MetS).Methods and Materials: 64-row WB-CTA was performed in 50 consecutive patientswith known MetS and 50 consecutive non-MetS subjects with high cardiovascularrisk indices (CI) for total atherosclerotic burden. A 64x0.6 mm detector configurationwith an adapted contrast [400 mgI/mL] injection protocol was used. Coronaryand extracoronary arteries were divided into 15 and 32 segments, respectively. CIwas defined as the cumulative arterial involvement severity at all locations in eachpatient. CI, MetS, and non-MetS were evaluated with multivariable regression andarea under receiver-operator characteristic curve (AUC-ROC) analyses.Results: 612 coronary and 1566 extracoronary arterial segments were evaluatedquantitatively in the MetS group compared with 548 coronary and 1595 extracoronarysegments in the non-MetS control. Subclinical atherosclerotic lesions wereobserved in 121 (20%) coronary and 208 (13%) extracoronary segments in MetSpatients while 59 (11%) and 156 (10%) asymptomatic atherosclerotic lesions werenoted in coronary and extracoronary vessels, respectively, in non-MetS patients.CI values were higher among MetS patients. CI increased with the number of riskcomponents present (MetS: r=0.991, p 0.001; non-MetS: r=0.896, p=0.059). MetSbetter predicted the cardiovascular index 75 th percentile than non-MetS (AUC =0.539 [95%CI: 0.513 to 0.601).Conclusion: 64-row WB-CTA is an emerging non-invasive modality for imagingatherosclerosis in coronary and extracoronary arteries. Subclinical detection oftotal atherosclerotic burden in patients with high cardiovascular risk has potentialfor preventive therapy.C-821Growth characteristics of the aortic aneurysms: Three-dimensional CTassessmentH. Naito 1 , Y. Hori 1 , T. Watabe 1 , T. Nakazawa 1 , A. Kohno 1 , S. Kanzaki 1 , T. Fukuda 1 ,M. Higashi 1 , N. Yamada 1 , S. Yoneyama 2 ; 1 Osaka/JP, 2 Tokyo/JP(hnaito@hsp.ncvc.go.jp)Purpose: To evaluate directional heterogeneity of wall extension in the growth ofaneurysms using volume data of the aorta obtained by follow-up MDCT.Methods and Materials: Eleven male patients aged 46 to 83 years, with atheroscleroticaortic aneurysms (10 thoracic/8 abdominal, middle-sized, fusiform)received 38 contrast-enhanced MDCT including follow-up examinations. FromCT images, 3D-reconstruction of whole aorta was performed in workstation withintelligent software (Amira TM , MERCURY Computer systems, USA). Then, meancircumferential length (CL) and longitudinal height (H) of aneurysmal aortic wallwere calculated from computer-measured length, external volume and surfacearea of the aneurysm. Extension rates (%/year) of CL and H calculated in each of79 follow-up CT pairs were compared with maximum diameter (D-max), volumeof wall calcification, and ruggedness of the aneurysm assessed by color displayof curvature radius.Results: Extension rates of H were greater significantly than CL in aneurysms ofunder 5 cm in D-max (1.08% vs. 1.01%, p 0.0001), whereas in aneurysms withD-max 5 cm no statistical difference between both extension rates and linearincrease of CL rates along with D-max increase (R=0.91) were observed. Markedlyrugged aneurysms showed significantly greater extension rates of CL (p 0.0001)and no different H rates compared to those values of smooth-surfaced aneurysms.Calcification volume had no correlation with extension of aneurysmal aortic wall.Conclusion: This study suggested the growth and remodeling processes of aorticaneurysms, initial longitudinal extension of the wall followed by circumferentialextension, accelerated and exaggerated with widening and focal protrusion ofthe aneurysm.C-822Evaluation with CT-angiography of aortic and supraaortic emergenciesafter blunt traumaE. Zabía Galíndez, M. Pérez Núñez, S. Borruel Nacenta, M. Castaño Reyero,A. Robles Alonso, R. Carrera Terrón; Madrid/ES (elenazabia@hotmail.com)Learning Objectives: To illustrate the imaging spectrum of aortic and supraaorticvascular lesions after blunt trauma, with particular emphasis on thoracic inlet andneck vascular injuries. To review the proper CT-angiography protocol and postprocessingtechniques in the evaluation of suspected vascular lesions, especially ofthe supraaortic vessels.Background: Imaging assessment of vascular injuries has traditionally relied oncatheter angiography. Vascular lesions are a clinical emergency and a high suspicionindex is required for their accurate and rapid diagnosis. Recent developmentsin MDCT and postprocessing techniques are making CT-angiography a fast andexcellent imaging modality for patients with blunt trauma and for initial supraaorticvessels evaluation.Imaging Findings: Imaging findings are presented based on our Level I Traumacenter experience. We review the radiologic appearance of the main aortic andsupraaortic vascular injuries after blunt trauma, excluding arteriovenous fistulasbecause of their low frequency with this injury mechanism. Vessel response toinjury is limited to either partial wall damage or total wall disruption. Specific signs ofarterial injury include intramural hematoma, arterial narrowing, occlusion, contained(pseudoaneurysm) or free (active bleeding with or without arterial transection)contrast extravasation, intimal flap and dissection.Conclusion: CT-angiography is noninvasive and allows prompt and accuratediagnosis of traumatic vascular and extravascular lesions. Conventional angiographyremains the gold standard to confirm vascular injuries but is invasive, timeconsumingand not optimal as a screening technique. With improved multiplanarand three-dimensional postprocessing techniques, MDCT images can be moreaccurately reproduced, similar to the familiar angiographic display.CS508 A B D E F FG H

Scientific and Educational ExhibitsC-823Interest of 4D angio-CT in the thoracic outlet syndromeA. Moisei, R. Detreille, D. Roch, M. Louis, T. Batch, A. Blum; Nancy/FR(andreeamoisei@yahoo.com)Learning Objectives: To show the anatomy of the three anatomic spaces thatmight be responsible for a TOS. To explain how to perform CT-scan for the detectionof TOS. To illustrate the impact of the different maneuvers. To highlight themost relevant findings.Background: Thoracic outlet syndrome (TOS) is a broad term that refers to compressionof the brachial plexus (95%), subclavian vein (4%), and subclavian artery(8%). The entrapment may occur in three anatomic spaces: the interscalenic triangle,the costoclavicular pinch and the retropectoralis minor space. Different maneuvershave been described to detect vascular stenosis or compression of the brachialplexus; however, they have to be combined to reach the diagnosis. CT-angiographyhas been advocated by some authors to confirm the diagnosis. We modify thetechnique after an evaluation of the accuracy of the different maneuvers.Procedure Details: With 64 MDCT, a first acquisition is obtained in anatomic position.Then two acquisitions are obtained in bilateral ABER positioning of the armwith the head rotated on the right and on the left. Using large detector CT, onlyone acquisition is obtained during the arterial phase while the patient is rotatinghis head. Contrary to the findings of previous articles, most TOS (55%) occursin the interscalenic space. 45% of the TOS occurs in the costoclavicular pinch.Compression in the retropectoralis minor space is very uncommon.Conclusion: CT-angiography with different maneuvers helps to diagnose a TOSand to precise location and the cause of the entrapment.C-824Hereditary hemorrhagic telangiectasia (HHT): Whole body imaging findingswith emphasis in central nervous system involvementJ. Cortes Vela, J. Hoz Rosa, J. Gallego León, J. Arenas Jiménez,J. Irurzun López, J. Ballesteros Herráiz; Alicante/ES (jo.hozr@coma.es )C-825Visual vs automatic bolus tracking in 320-slice MSCT-angiography foracute chest pain triage with a triphasic single-injection protocolV.C. Romano, P.A. Hein, A. Lembcke, B. Hamm, P. Rogalla; Berlin/DE(valentina.romano@charite.de)Purpose: To assess the influence of visual bolus tracking and consequent patientadaptedscanning timing with respect to pulmonary, aortic and coronary attenuationin 320-slice MSCT-angiography.Methods and Materials: 60 patients (23 female, 37 male, mean age 63.9 13.6y.o). with acute chest pain underwent MSCT-angiography including a non-spiral,non-gated CT of the chest followed by a non-spiral, electrocardiography-gatedcardiac CT acquired within one breath-hold. A triphasic single-injection protocolwith 90 mL of iodinated contrast material was used: 45 mL at 3 ml/sec and 45 mLat 5 ml/sec followed by a 30 mL saline chaser at 5 mL/sec. In a first group (G1:N=30 patients), images were acquired after automatic (HU-treshold based) bolustracking in the pulmonary trunk. In a second group (G2: N=30), bolustracking wasperformed visually. Image quality was defined as diagnostic for vessel attenuation250 HU. Pulmonary (trunk, right + left pulmonary artery), aortic (ascending,arch + descending) and coronary attenuation (left + right main artery) in HU wererecorded. T-Test was used to compare the mean attenuation in G1 and G2.Results: Both groups reached diagnostic image quality in all measured vesselsegments in all patients (HU 250 in all segments). Mean attenuation in the aorticarch was significantly higher for G2 (p 0.05). No differences were assessed inall other vessel segments (p 0.05).Conclusion: 320 volume CT allows for reliable diagnostic image quality for chestpain triage. The results suggest that visual bolus tracking delivers slightly betterenhancement especially concerning the attenuation of the aortic arch.Learning Objectives: 1) To illustrate the spectrum of imaging abnormalities inHHT; 2) To understand the pathogenia in development of central nervous systemlesions; 3) To determine the role of computed tomography, magnetic resonanceimaging and digital substraction angiography in their detection, characterizationand treatment.Background: HHT or Rendu-Osler-Weber (ROW) disease is an autosomal dominantdisorder with variable penetrance caused by mutations of endoglin or activinreceptor-like kinase1. Diagnostic criteria for a definite diagnosis include at least threeof the following four: recurrent and spontaneous epistaxis, multiple mucocutaneoustelangiectases, visceral lesions such as gastrointestinal or pulmonary arteriovenousmalformations (AVM) and a first-degree relative with ROW.Imaging Findings: Although in this disease epistaxis and mucocutaneous telangiectasesare the most common clinical manifestations, visceral AVM lead to the mostserious complications. The most commonly affected organs are lung, brain, liver andgastrointestinal tract, although virtually any body system can be affected. Centralnervous system findings may be directly related to complication of brain or spinalvascular malformations, but most commonly are complications due to pulmonaryAVM with paradoxical embolism (ischemia, brain abscess, medular abscess) andhepatic AVM by porto-systemic shunt (hepatic encephalopathy).Conclusion: Although HHT is a rare disease and usually the most commonclinical presentations are related with peripheral hemorrhage such as epistaxis orgastrointestinal bleeding, its imaging spectrum includes central nervous systemlesions, which are being recognized with increasing frequency. Radiologists needto be familiar its wide spectrum of general and neurologic findings, which may leadto potentially life-threatening complications.VascularACB D E F G HS509

Scientific and Educational ExhibitsVascularMRIC-826The importance of magnetic resonance ovarian venography in thediagnosis of pelvic congestion syndromeK. Mason, D.C. Kinsella; Exeter/UK (k.mason@doctors.org.uk)Learning Objectives: Magnetic resonance ovarian venography (MRV) using anintravascular blood pool agent is a valuable non-invasive technique for evaluatingthe ovarian veins, prior to ovarian vein interventional procedures.Background: Pelvic congestion syndrome (PCS) is a problematic cause of pelvicpain in women. PCS is thought to result from retrograde flow in an incompetentovarian vein. Patients describe a variety of symptoms including pelvic pain, dyspareunia,bladder irritability and vulva, buttock and lower limb varicosities. Catheterbased venography has been the Gold Standard in the assessment of ovarian veinincompetence; however, this is an invasive technique. The use of MRV enablesnon invasive imaging with no exposure to ionising radiation. In addition, potentialtechnical challenges and vascular anomalies can be identified prior to embolisation.MRV can facilitate an appropriate access route and avoid unnecessaryvenous puncture.Procedure Details: We describe and illustrate evaluation of the ovarian veins usingan enhanced three-dimensional fast gradient echo sequence. The high resolutionimages that result allow accurate multiplanar image reformats to be constructed.We review the benefits of imaging the ovarian veins during a valsalva manoeuvreand provide a pictorial review of the abnormalities identified.Conclusion: With increasing numbers of women seeking medical attention forthe symptoms associated with ovarian vein incompetence, it is important thatradiologists and vascular surgeons are aware of the techniques and potentialbenefits of ovarian MRV. This will enable appropriate patient selection for ovarianvein embolisation and improve patient experience.C-827Chronic lower extremity lymphedema: Findings at high-resolutioninterstitial MR lymphangiography versus heavily T2-weighted imageQ. Lu, N. Liu, J. Xu; Shanghai/CN (luqingshan@sjtu.edu.cn)Purpose: To assess the role of heavily T2-weighted image and interstitial MRlymphangiography (MRL) for the visualization of lymphatic vessels in patients withdisorders of the lymphatic circulation.Methods and Materials: Forty lower extremities in 31 patients (9 bilateral, 22unilateral) with primary lymphedema were examined by heavily T2-weighted imageand indirect MRL. Maximum-intensity projection was used to reconstruct theimages of the lymphatic system. Two experienced radiologists analyzed the imageswith regard to the differences in image quality, number of lymphatic vessels, itsmaximum diameter and two other findings: accumulated lymph fluid in the tissueand honeycombing pattern.Results: The beaded appearance of the affected vessels in 73 leg segments of 40lower extremities were present on both modalities 3D MIP. Larger amount of thedilated lymphatic vessels were visualized on heavily T2-weighted image than thaton MRL (p=0.003) and the maximum diameter of it was 4.281.53 mm on heavilyT2-weighted image, whereas 3.411.05 mm on MRL (p 0.01). The lymphaticvessels on MRL showed better image quality and greater SNR and CNR than thaton heavily T2-weighted image (p 0.01). The regions of accumulated lymph fluidand the honeycombing pattern extent identified on heavily T2-weighted imagescored statistically higher than that on MRL (p 0.01).Conclusion: The heavily T2-weighted imaging has greater sensitivity and theMRL image has higher legibility for detecting the pathologically modified lymphaticvessels and accompanying complications non-invasively. Combining these two MRtechniques can accurately access the pathological changes in the lower extremitywith lymphedema.C-828Evaluation by high-spatial-resolution MR angiography and fast perfusionMR imaging for the differential diagnosis of primary and thromboembolicpulmonary arterial hypertensionF.P. Junqueira, A.C. Coutinho Jr., F.V. Magalhães, F.F.C. Morais, V.M. Sardenberg,D.B. Parente, I.R. Kuroki, E.L. Gasparetto, R.C. Domingues; Rio de Janeiro/BR(albuquerque.fj@gmail.com)Purpose: We tested whether magnetic resonance (MR) derived pulmonaryperfusion (PP) and pulmonary artery angiography (PA-Ang) allows for the correctdiagnosis of primary and thromboembolic pulmonary arterial hypertension (PAH)using computed tomography pulmonary angiography (CTA) as the gold standard.Methods and Materials: Twenty primary and secondary PAH patients (meanage 44.5 years) were submitted to CTA and MR. MR studies were done using a1.5 T system (Avanto-Siemens) and PA-Ang acquired using GRE 3D sequences.The “freeze frame” technique after injection of 0.2 mmol/kg of gadolinium at 5 cc/sec was used for the PP analysis. CTA was acquired in a 64-detector scanner(Brillance, Philips) using standard protocols. The vascular abnormalities relatedto PAH were evaluated.Results: Seven patients had a diagnosis of thromboembolic PAH by CTA and MRPA-Ang identified all of them (sensitivity=100%) but misclassified 2 patients asfalse positives (specificity=85%). Among patients classified as positive by MR, 6had thrombus adhered to the vascular wall and 5 had abrupt vessel interruption.Non-occlusive findings of PAH were found in 11 patients, the most frequent of thembeing vascular tortuosity (10/20 patients). PP was abnormal in 11/20 patients, 6 ofwhom presented with diffuse heterogeneous pattern and 5 with focal or completedefects in at least one of the lungs.Conclusion: MR offers excellent sensitivity and good specificity for the diagnosisof PAH secondary to thromboembolism. This method may present a reasonablealternative to CTA due to its lack of ionizing radiation and iodinated contrastexposures.C-829Steady state free precession magnetic resonance angiography (MRA) hasbenefits over contrast enhanced MRA for renal donor assessment prior torenal harvestI. Laurence, B. Ariff, R. Quest, S. Moser, A. Glover, V. Papalois, D. Taube,P. Gishen, C. Juli; London/UK (isabellaurence@doctors.org.uk)Purpose: In potential renal donors, contrast enhanced MRA (CE-MRA) is widelyused to detect anomalous renal vascular anatomy and exclude renal artery stenosis(RAS). Free breathing steady state free procession MRA (SSFP-MRA) avoidscontrast administration and has an excellent negative predictive value for RAS. Wecompared CE-MRA and SSFP-MRA in potential renal donors.Methods and Materials: 17 healthy potential renal donors (11 female, medianage 45 years, range 24-62 years) were studied using 1.5 T Achieva MRI system(Philips Medical Systems, Best, The Netherlands). Post-processing and imageanalysis were performed using Viewforum Cardiac Package V3.4 (Philips MedicalSystems, Best, The Netherlands). Data were analysed using Wilcoxon matchedpair and Fisher’s exact tests.Results: SSFP-MRA and CE-MRA identified an equal number of main renal arteries,including 5 accessory arteries. No subject had any degree of RAS. SSFP-MRAbetter resolved the distal renal artery, mean total length of artery identified was77.3 mm SSFP-MRA vs. 59.1 mm CE-MRA (p 0.001). Whilst there was no differencein the distance of the first branch from origin of the main renal arteries withboth techniques (p=0.45), 4/34 of the first branches could not be clearly identifiedwith CE-MRA compared to SS-MRA (p= 0.12).Conclusion: SS-MRA provided better visualisation of the renal arteries, with agreater length of artery demonstrated. Our data suggests SS-MRA can be usedas an alternative to CE-MRA for vascular assessment and surgical planning inpotential renal donors, avoiding the need for intravenous contrast.C-830Evaluation of aortic plaques in stroke patients using MRIA. Merkle, A. Harloff, S. Brendecke, J. Simon, J. Hennig, M. Markl;Freiburg/DE (annette.merkle@uniklinik-freiburg.de)Purpose: Novel MRI techniques permit the evaluation of aortic plaques in acutestroke patients. Recent advances include complete coverage of the entire thoracicaorta (AO) and information on hemodynamic relevance of the plaque.Methods and Materials: Measurements in 56 patients were performed (3 T-MR-System, Siemens, Germany). High ECG quality was ensured by carefullychecking the signal inside the magnet. The protocol included 3D time-resolvedCS510 A B D E F FG H

Scientific and Educational Exhibitscontrast-enhanced MRA and ECG synchronized flow sensitive 4D MRI of the AOwith respiration control (navigator gating of the right diaphragm). Next, shim volumewas carefully adjusted to cover the AO. During diastole an ECG gated gradientecho 3D T1w bright-blood sequence was used for plaque detection. Additional TSET2-black-blood was employed for multi contrast plaque analysis.Results: Total examination time was between 45 and 95 min. Of 56 patients includedin the study, the entire protocol could be completed in 43 subjects. The remaining13 patients had incomplete data due to limited patient cooperation. Image gradingrevealed high quality in 90% of the patients for flow sensitive 4D MRI and poorquality in 10% of the cases. 3D T1w bright-blood and TSE T2 black-blood weregraded as high quality (49/42%), sufficient to detect aortic plaques (40/42%) andpoor quality (11/16%).Conclusion: The present study established a high quality protocol able to evaluatethe whole AO and providing valuable information for diagnosis and detectionof aortic plaques in stroke patients. Examination time should decrease for routinework and avoid incomplete data.C-8313 T whole body magnetic resonance angiography: Perfection and pitfallsP. Beddy, J.F. Meaney; Dublin/IE (pbeddy@eircom.net)Learning Objectives: 1. Detail a successful 3 T whole body (WB) contrast enhancedMRA protocol. 2. Highlight benefits and problems of WB MRA at 3 T. 3.Review the quality of rapid 3 T vascular imaging.Background: One of the greatest barriers to whole body contrast enhanced MRangiography is the speed of imaging required. WB angiography at 1.5 T is limitedby a trade off between speed and resolution. This is overcome with 3 T imagingthat has inherently higher signal, enabling the operator to keep up with the contrastbolus and perform a one stop whole body study. This is at least the theory, and wedetail the problems associated with WB MRA imaging at 3 T.Procedure Details: 1. Protocol for 3 T WB MR angiography. 2. How to avoid venouscontamination. 3. Suppressing dielectric effects and susceptibility artefacts. 4. Theend product of “beautiful” 3 T whole body vascular images. 5. Gallery of normalvariants and pathologic cases.Conclusion: 3 T whole body contrast enhanced MRA is an evolving technique.We present a robust and rapid technique that produces high quality diagnosticimages.C-832Non-contrast MRA of the finger and toe using time-spatial labelinginversion pulse (time-SLIP) techniqueJ. Isogai 1 , T. Shimada 1 , H. Hatakeyama 1 , T. Yamada 1 , M. Takeuchi 1 , S. Maejima 1 ,K. Yodo 2 , T. Miyata 2 , M. Miyazaki 3 ; 1 Hasuda/JP, 2 Saitama/JP, 3 Vernon Hills, IL/USLearning Objectives: 1. To visualize small arteries of the finger and toe using timespatiallabeling inversion pulse (time-SLIP) with fresh blood imaging (FBI) technique.2. To describe the advantage of this technique compared with other non-contrastMRA methods based on 20 healthy volunteers. 3. To display several clinical casesincluding Raynaud’s syndrome and arteriosclerosis in which non-contrast MRA ofthe whole hand and foot was performed.Background: Due to the recent concerns of gadolinium-related nephrogenic systemicfibrosis, non-contrast MRA solutions have gained interest. The time-SLIP withFBI technique enables us to visualize small and slow-velocity arteries selectivelywithout the use of contrast media.Procedure Details: 1. Basic principles of time-SLIP and optimization of examinationparameters and positions. 2. Efficacy of time-SLIP for the depiction of the arterialarch and digital arteries in the finger and toe compared with other non-contrastMRA techniques - 2D time-of-flight - MR digital subtraction angiography usingECG-gated 3D half Fourier FSE applied with flow-spoiled gradient pulses (FlowspoiledFBI). 3. Clinical cases in which non-contrast MRA of the whole hand andfoot was useful.Conclusion: The time-SLIP with FBI technique enables us to image small andslow velocity arteries of the fingers and toes selectively, and will be effective in thediagnosis and management of the patient without the use of contrast media.C-833The effects of administration of superparamagnetic iron oxide particleson MR portography using spin labeling technique with 3D true SSFPsequenceR. Ochiai, H. Sugimura, T. Kodama, T. Jinnouchi, E. Furukouji, T. Sakae,S. Tamura; Kiyotake/JP (ryu31007@fc.miyazaki-u.ac.jp)Purpose: Arterial spin labeling used for MR angiography can be combined with afast imaging method such as true SSFP. A superparamagnetic iron oxide particle(SPIO), which has a high R2/R1 relaxivity ratio, can be used as a blood pool contrastmaterial. The purpose of our study was to evaluate the effects of administration ofSPIO on the quality of spin labeling portography.Methods and Materials: 31 patients (20 men, 11 women, mean age 63.4 yrs) wereexamined with a respiratory triggering 3D true SSFP (TR/TE/FA=5 ms/2.5 ms/120°,Black-blood TI=1,300 ms) using a 1.5 T system (EXCELART Vantage; TOSHIBA).The spin labeling pulse was placed to mark both splenic vein and superior mesentericvein, which flows directly into the portal vein. We measured contrast-to-noiseratios (CNRs) of the portal trunk and its branches. The image quality of the portalvein in maximum intensity projection was graded into five levels.Results: The CNR before administration of SPIO were 2.251.46 in portal trunk,2.271.40 in the right branch, 3.051.12 in the left branch, which changed to5.311.57, 4.181.15, 4.771.81 after administration of SPIO, respectively. Thequalitative analysis to depict the portal vein and branches indicates spin labelingportography with SPIO was better than that without SPIO.Conclusion: MR portography using the spin labeling technique with SPIO providesbetter quality images of the portal vein and branches than those without SPIO. Thistechnique is easy to apply to the MR portography and serves as a useful tool forscreening procedures.C-834Correlation of laminar appearance in human atherosclerotic carotidarteries between ex vivo MR imaging and corresponding histologyH.-L. Zhao, J.-R. Xu; Shanghai/CN (drwilliamshaw2001@yahoo.com.cn)Purpose: To investigate the correlation of laminar appearance in ex vivo humancarotid arteries of atherosclerotic lesions between MR imaging and histologicalfindings.Methods and Materials: Seventeen carotid specimens with atherosclerotic lesionsobtained from human organ donors were studied. High-resolution MRI wasperformed with a 3.0-Tesla MR system by T1-, T2-weighted imagings. MR slicesand corresponding histological sections were obtained to compare the area measurementsof lumen, intima (plaque size) and media. Correlation analysis betweenhistology and MR measurements and ROC-analysis were performed to determinewhether the vessel wall changes and plaque size can correctly identify with MRI.Intra-class correlation coefficients (ICCs) were computed to determine intra-readerand inter-reader reproducibility.Results: The areas of vessel lumen and intima measured on T1-, T2-weightedimages showed a strong correlation with the corresponding histological measurements(r = 0.896; 0.914). However, for the media thickness, there was no correlationbetween MRI and histological measurements. Moreover, sensitivity for detectionof plaques was 86.4% with T2-weighted imagings. Intra-reader and inter-readerreproducibility was good to excellent for the area measurements, with ICCs rangingfrom 0.73 to 0.95.Conclusion: MRI-based quantification of carotid artery intima is accurate andreproducible. In an experimental ex vivo setting, clinical MRI at 3.0 Tesla of thehuman arterial vessel wall may accurately visualize the atherosclerotic plaquecompositions.C-835Non contrast-enhanced MR angiography in patients at high risk fornephrogenic systemic fibrosis: Review of techniques, interpretation andcorrelation with contrast-enhanced MRAR. van Stiphout, M.W. de Haan, J.E. Wildberger, T. Leiner; Maastricht/NLLearning Objectives: 1. To gain awareness that non contrast-enhanced MR angiography(MRA) techniques can be used successfully to depict the vasculaturein patients at high risk of developing NSF (grades 4 or 5 end stage renal disease(ESRD)) 2. To review different non contrast-enhanced MR imaging techniques thatcan be used to depict the vascular system.Background: NSF is a potentially life-threatening disease affecting patients withESRD. Administration of gadolinium-containing contrast media should be avoidedin these patients whenever possible and non contrast-enhanced alternatives areurgently needed.VascularACB D E F G HS511

Scientific and Educational ExhibitsProcedure Details: Phase-contrast and time-of-flight MRA are useful alternativesto contrast-enhanced MRA in the brain. Balanced FFE techniques are useful forthe aorta. Of particular interest for peripheral vessels are techniques that utilizeboth a systolic and diastolic acquisition in combination with subtraction. Systolicflow voids lead to low signal in arteries, while the laminar flow in both systole anddiastole in the venous system cancels out signal after subtraction.Conclusion: 1. It is possible to use non contrast-enhanced MR angiographytechniques to depict the vascular system with high quality in patients in whomthe use of contrast medium is contra-indicated. 2. Combined systolic and diastolicsubtraction imaging is especially promising when compared to standard contrastenhancedMR imaging and can avoid a false-positive diagnosis of stenosis orocclusion in most patients.C-836Reconsider MR angiography in the brain: From basics to clinicalapplicationsN. Shiraga, M. Hori, H. Mori, S. Aoki, M. Shimada, A. Yamaguchi, K. Ohtomo;Tokyo/JP (n.shiraga@nifty.com)Learning Objectives: To present a pictorial on the basics of several MR angiographies(MRAs) in the brain. To learn advantages and disadvantages of each MRAtechnique. To show MRA clinical applications.Background: Several MR imaging techniques have been introduced for MRA inthe brain. Recently, improvement hardware and software, intracranial vessels arevisualized more clearly than those in the past with old MRA technique (e.g. time-of-flight MRA). Moreover, MR digital subtraction angiography (MRDSA) with hemodynamicinformation without contrast material using arterial spin labeling (ASL) isnow available. Therefore, the technique, clinical indications and limitations of MRAtechniques should be revisited.Imaging Findings: Time-of -flight MRA shows more clearly visualized intracranialvessels thanks to higher static magnetic field, improvements of receiver coil designand sequence optimization. Contrast-enhanced MRDSA at 3 T show higher SNRand temporal resolution and is useful in evaluation of cerebrovascular disease,such as AVMs. MRDSA using ASL technique provides hemodynamic informationand X-ray angiography-like images without contrast material.Conclusion: MRA techniques were changed and different from those in the past.These clinical applications should be reconsidered.C-837MRA of the hand at 3 Tesla: Technical considerations and spectrum offindingsT.M. Carr III, A.P. Crane, P.T. Norton; Charlottesville, VA/US(tmc6w@virginia.edu)Learning Objectives: To describe important technical considerations in performingand interpreting MRA examinations of the hand and review demonstration ofthe spectrum of MR imaging findings seen in an array of vascular pathologiesaffecting the hands.Background: Vascular diseases of the hand are clinically important as they maybe associated with significant functional impairment. Effective treatment reliesupon accurate diagnosis on imaging. Advances in MR imaging capabilities haveenabled improved visualization of small vessels in the hand, and MR angiographyis a sensitive tool for the detection of vascular pathology in the hand.Imaging Findings: A series of patients with known or suspected vascular diseaseof the hands were imaged on a 3 Tesla MRI scanner. Technical considerations-- appropriate positioning, coil use, imaging sequences and use of contrast -- inperforming MRA examinations of the hand in these patients are discussed anddemonstrated. MRA images demonstrating normal anatomy and a range of vascularpathology such as vasculitis, atherosclerosis, embolic disease, chronic occlusivedisease and trauma in these patients are then presented with correlative digitalsubstration angiography images where available.Conclusion: MR angiography at 3 T allows for excellent depiction of the vascularanatomy of the hands and when performed appropriately is highly sensitive fordetecting a wide array of vascular pathology in the hands.VascularMultimodalityC-838Intima-media thickness: How to study it by using different imagingmodalities?L. Saba 1 , R. Sanfilippo 1 , C. Urigo 2 , M. Atzeni 1 , R. Mon 1 , G. Mallarini 1 ; 1 Cagliari/IT,2Latina/IT (lucasaba@tiscali.it)Learning Objectives: The learning objectives of this exhibit are: 1) To reviewhistology and physiopatology of intima-media thickness (IMT). 2) To discuss thevalue of different imaging modalities (sonography, computed tomography, magneticresonance) in the IMT quantification. 3) To analyze limits and pitfalls of the differentimaging modalities in the IMT analysis. 4) To understand the correct parametersto use in MDCT and MR.Background: A correct characterization and measurements of IMT may playan important role, because the increase of IMT is correlated with coronary andcerebrovascular complications. The use of high-resolution ultrasound imaging isnowadays considered the gold standard but new MDCT and MR technologies andprotocols are giving promising results.Imaging Findings: 1. Histology and physiopatology of IMT. 2. Presentation of differentimaging modalities in the IMT evaluation. 3. Limits and pitfalls of the differentimaging modalities in the IMT analysis. 4. Presentation of relevant cases.Conclusion: Carotid intimal media thickness (IMT) is an independent predictorof vascular events independently of conventional vascular risk factors. Sonographyand MDCT are optimal techniques to study the IMT. In the MDCT, in orderto obtain optimal results, it is necessary to pay attention to the correct technicalparameter setting.C-839The evaluation of stenosis degree in the atherosclerotic carotid arteryL. Saba 1 , R. Sanfilippo 1 , M. Di Primio 2 , R. Montisci 1 , G. Simonetti 2 , G. Mallarini 1 ;1Cagliari/IT, 2 Rome/IT (lucasaba@tiscali.it)Learning Objectives: 1. To discuss current indications for performing MDCTA inthe study of atherosclerotic carotid artery. 2. To review the different measurementmethods of carotid artery stenosis, as well as their rationale, strengths and weaknesses.3. To learn the MDCT technical parameter to be used. 4. To show whichpost-processing techniques can be used and their indications. 5. To compare MDCTApotentialities with the other imaging methods.Background: Stenosis degree is considered the leading parameter for the choiceof therapeutic option. The correct evaluation of stenosis degree depends on severalconditions as the correct intraluminal HU value, the correct measurement planeorientation and the correct windows level and window width.Imaging Findings: We will present several examples of carotid artery stenosislocated in different topographical position and determined by different type of plaque.We will demonstrate benefits and pitfalls of several post-processing procedures asMIP, MPR, CPR, SSD and VR by underlining their potentialities, applications andlimits. We discuss moreover the near-occlusion condition and how to distinguish itfrom a complete carotid artery occlusion.Conclusion: MDCTA is an optimal technique for the identification and quantificationof the stenosis degree of carotid artery. Moreover, MDCTA allows apart fromstenosis quantification, an optimal carotid plaque characterization.CS512 A B D E F FG H

Scientific and Educational ExhibitsVascularUSC-841Stenosis of renal graft arteries: Clinical and Doppler ultrasoundparameters evolution according to their severity and treatment - role ofother imaging proceduresJ.J. Gomez Herrera, E. Zabia Galindez, A. Marín Toribio, A. Robles Alonso,E. Castaño Reyero, A. Sanchez Guerrero; Madrid/ESPurpose: To study the clinical behavior of the stenosis of renal graft arteries accordingto their severity and their treatment, as well as the evolution of the initialDoppler ultrasound parameters. To value the role of CT and MR in the follow-upof these patients.Methods and Materials: We checked 2981 Doppler ultrasound studies realized in1673 patients with renal grafts between 1997 and 2007 in our institution. We valuedthe Doppler peak systolic velocity, resistance indexes and wave morphology of theirprincipal arteries. We followed the evolution of the stenosis of renal graft arteries,and took a note of invasive procedures and possible complications, as well as theinformation that CT and MR provided.Results: We found a link (p 0.5) between the development of stenosis and theinitial Doppler peak systolic velocity, as well as between the loss of the graft andthe initial Doppler peak systolic velocity, the morphology of the wave (parvus ornot) and the need or not for invasive procedures. CT and MR helped to locate thestenosis and to value the degree of atheromatosis of the vascular branches.Conclusion: Doppler ultrasound is the suitable method for the initial assessmentand the follow-up of stenosis of renal graft arteries, as well as for the indicationof other radiological techniques or invasive procedures with a view to therapeuticdecisions.C-842Aortic stiffness and carotid arteries atherosclerosis in patients withendstage renal diseaseA. Drelich-Zbroja, A. Jaroszynski, T. Zapolski, A. Ksiazek, A. Wysokinski,T. Jargiello, M. Szczerbo-Trojanowska; Lublin/PL (zbroanna@interia.pl)Purpose: End-stage renal disease (ESRD) is associated with extreme risk forcardiovascular disease. The aim of study was to assess relationship betweenelastic properties of aorta and carotid arteries (CA) atherosclerosis in patientswith ESRD.Methods and Materials: Study population consisted of 61 patients with ESRDtreated with haemodialysis. Physical examination was performed including measurementof systolic (SBP) and diastolic (DBP) pressures using Korotkow method. In allpatients trans-thoracic-echocardiography was performed to assess parameters as:Aomax, Aomin. Aortic stiffness index (SA) was calculated using formula: SA=log(SBP/DBP)/(Aomax-Aomin)/Aomin. Measurement of common carotid artery (CCA)and internal carotid artery (ICA) number of plaques and intima-media thickness(IMT) was done by ultrasound. Plaque score was calculated.Results: On right side: CCA IMT was 0.905 (0.129) mm, ICA IMT was 1.005(0.117) mm, number of plaques in CCA was 1.165 (1.076), thickness of plaquesin CCA was 2.7 (2.64) mm. On left side: CCA IMT was 0.906 (0.165) mm, ICAIMT was 0.993 (0.177) mm, number of plaques in CCA was 0.883 (1.059), thicknessof plaques in CCA was 1.98 (2.47) mm. Plaque score was 4.742 (1.928)mm. The Pearson test showed significant correlation between SA and number ofplaques in left CA (R=0.376, p=0.003), thickness of plaques in left CA (R=0.320,p=0.006), number of plaques in right CA (R=0.320, p=0.012), thickness of plaquesin left CA (R=0.294, p=0.025) and plaque score (R=0.426, p=0.001). There was nocorrelation between SA and IMT in CA.Conclusion: In patients with ESRD, there is strong correlation between SA andnumber and thickness of plaques in CA.C-843Detection of ulcerated atheromtic carotid plaques with contrast-enhancedultrasound using 2 nd generation agents (Sonovue)D. Triantafyllou, G. Kyriakopoulou, G. Anastopoulos, M. Trakaniari, E. Chalatsi,P. Christopoulos, V. Poulantzas; Athens/GR (triantafylloy_dhm@yahoo.gr)Purpose: The objective of this study was to analyze whether contrast-enhancedultrasound with 2 nd generation contrast agents (Sonovue) is a useful tool in detectingulcerated carotid plaques. Literature suggests that ulcerated carotid plaques aredangerous as they can provoke ischemic incidents.Methods and Materials: In 100 patients who were evaluated with color Dopplerultrasound, we selected 10 patients who were in risk for the presence of ulcerationin the atheromatic plaque. We investigated these patients with contrast-enhancedultrasound using HDI 5000, Phillips, linear array probe 4-7 MHz, after the injectioninto a peripheral vein using a 20 gauge venous catheter, of a bolus of 2.4 mL ofSonovue, followed immediately by a 5 mL saline flush.Results: In all carotid plaques but one we visualized the presence of ulceration.In 5 patients, we illustrated the presence of a small vessel under the ulceration,as it is suggested by other studies.Conclusion: Carotid contrast-enhanced imaging turns to be a reliable techniquefor the evaluation of ulcerations and can become a method comparable withangiography. Moreover, it has the advantages of a low cost, non invasive, widelyavailable method that can also evaluate the carotid walls.C-844Inguinal artery pseudoaneurysms following percutaneous cardiac andvascular interventionsR. Patel, N. Tahir, D. Kessel, A. Nicholson, S. Mcpherson, J. Patel, S. Puppala;Leeds/UKPurpose: To audit ultrasound detected inguinal pseudoaneurysm (PA) followingfemoral artery catheterisation and assess their management in a large teachinghospital.Methods and Materials: Review of patients undergoing inguinal ultrasound forsuspected PA following femoral arterial catheterisation over a 12 month period.The cause, location, size and treatment were noted.Results: 5593 coronary and 2957 peripheral arterial catheterizations were performedduring the audit. 149 suspected patients were scanned. 50 (34%) had PA,51 (34%) had haematoma, 48 (32%) had no abnormality. 45 (90%) PA followedcardiac and 5 (10%) peripheral vascular intervention. PA location: common femoralartery (CFA) 30 (60%), superficial femoral artery (SFA) 6 (12%), CFA/SFA junction2 (4%), other 3 (6%) and unidentified 9 (18%). Initial treatment: conservative 16(32%), guided compression 7 (14%), thrombin injection 24 (48%) and surgery 3(6%). Initial success: bed rest 8 (50%), compression 5 (71%), thrombin 21 (88%)and surgery 3 (100%). The incidence of PA was 0.17% for peripheral and 0.80%for cardiac procedures. The higher numbers after cardiac catheterization might beexplained by the use of antiplatelet medication and larger sheath sizes. Most PAwas satisfactorily managed by conservative or minimally invasive therapy. A smallnumber of complex PA required surgery.Conclusion: PA complication rates for peripheral and coronary interventionsare less than 1%. This is lower than the proposed RCR and BSIR standards forperipheral procedures. Similar standards for coronary intervention are unavailable.Contemporary practice has improved outcomes and the standards should beregularly revised and established where not available.VascularACB D E F G HS513

Scientific and Educational ExhibitsCS514 A B D E F FG H