Scientific Session 1 â Breast Imaging: Mammography

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Scientific Session 10—Genitourinary ImagingTuesdayObjective: To determine whether high spatial resolution ex vivo MRI acquiredat high field strength can aid pathologists and guide the developmentof improved imaging methods by improving correlation of in vivoMRI and histology.Materials and Methods: Unfixed excised prostatectomy specimens (n =8) were obtained and imaged immediately after radical prostatectomyunder an institutional review board–approved protocol and after patientsgave informed consent. The specimen size ranged from 5 to 7 cmin transverse and from 4 to 5 cm in the anteroposterior dimension. Thespecimens were imaged over their entire volume with a Bruker 9.4-Tresearch scanner using a Bruker 72-mm linear volume coil and a Bruker12-cm gradient insert. Axial fast spin-echo MR images (TR/effective TE= 5000/40 ms, slice thickness = 1 mm, RARE factor = 4, in-plane resolution= 137 μm, number of excitations = 2) as well as multi-slice diffusionweightedimaging (b value = 0, 1000, 3000 s/mm 2 ) and T2-weighted (16echoes) images were obtained. The DWI and T2-weighted images had aslice thickness of 2 mm with a 2-mm slice gap and in-plane resolutionof 274 μm. All patients also underwent multi-parametric 1.5-T MRI (includingT2-weighted, DWI, and dynamic contrast-enhanced MRI) priorto surgery. Prostatectomy specimens were sectioned with a whole-mounttechnique after MRI.Results: In all specimens imaged, high-resolution T2-weighted MRIshowed greater detail and contrast-to-noise ratio than clinical in vivo MRI.For example, in the high-resolution images obtained at 9.4 T, benign prostatichyperplasia, adenocarcinomas, curvilinear duct architecture distortiondue to adenocarcinomas, and normal radial duct distribution are more readilyindentified. The apparent diffusion coefficient (ADC) and T2 maps alsoprovide potentially useful diagnostic information. Cancers were generallycharacterized by low ADC (~40 × 10 –3 mm 2 /s) and T2 (~50 ms) values.However, low ADC and T2 values were not exclusive to cancers.Conclusion: High-resolution, high-field-strength MRI has the potentialto improve the detection and identification of prostate structures.Information derived from ex vivo MRI can guide the development of improvedin vivo MRI protocols and lead to more accurate interpretation ofin vivo MR images. In addition, the protocols and techniques developedin this study could be used to augment the routine pathological analysisof surgical specimens and guide treatment of prostate cancer patients.Ex vivo MRI can serve as a bridge between in vivo MRI and histology.High-resolution MRI may identify new architectural features that differentiatecarcinoma from benign hyperplasia.082. Local Staging of Prostate Cancer: Comparative Accuracy ofContemporary Endorectal MRI and Transrectal UltrasoundJung, A.*; Coakley, F.; Shinohara, K.; Carroll, P.; Kurhanewicz, J.;Cowan, J.; Westphalen, A. University of California San Francisco,San Francisco, CAAddress correspondence to A. Jung (adam.jung@radiology.ucsf.edu)Objective: To evaluate the staging accuracy of MRI and transrectal ultrasoundusing contemporary technology and experienced readers in thelargest single institutional series.Materials and Methods: The committee on human research approvedthis HIPAA-compliant study and waived written informed consent. Weretrospectively identified 101 men at our institution with biopsy-provenprostate cancer who underwent contemporaneous endorectal MRI andtransrectal ultrasound for local staging prior to radical prostatectomy.Three independent MR readers rated the likelihood of locally advanceddisease on each side of the prostate using a 5-point scale (1 = definitelyabsent, 5 = definitely present). A single highly experienced independentreader performed the same rating for transrectal ultrasound images.Results: Twenty-three of 101 patients (22.8%) had locally advanced disease,consisting of 16 patients with extracapsular extension, four withseminal vesicle invasion, and three with both. Local staging accuracy assessedusing area under the receiver operating characteristic curve (A z) andprostatectomy step-section histopathology as the standard of reference,was not significantly different between MRI (A z= 0.69, 0.70, and 0.70)and transrectal ultrasound (A z= 0.81, p > 0.05). Previous comparative seriesdemonstrated better accuracy of MRI (63–93%) when compared withtransrectal ultrasound (63–76%, p < 0.05) for experienced readers.Conclusion: Endorectal MRI is of comparable accuracy to transrectalultrasound interpreted by experienced readers in the local staging ofprostate cancer. Accordingly, patients undergoing transrectal ultrasoundprior to biopsy at experienced centers may not require endorectal MRIfor prostate cancer staging.083. Locally Advanced Cervical Cancer: MRI in Prediction ofResponse After Preoperative Chemoradiation TherapyRestaino, G.*; Occhionero, M.; Missere, M.; Macchia, G.; Ferrandina,G.; Danza, F.; Morganti, A.; Sallustio, G. Catholic University,Campobasso, ItalyAddress correspondence to G. Restaino (gennares@hotmail.com)Objective: The prognosis of locally advanced cervical cancer (LACC)is still disappointing, with a 65–70% survival rate. Concurrent chemotherapyand radiation therapy followed by surgery have been advocatedin order to improve patients’ prognosis. The need for surgery and itsradicality depends on tumor response to neoadjuvant treatments. Theevaluation of residual disease after chemoradiation therapy is crucialin subsequent treatment planning. Very few studies have correlatedMRI findings and histology in cervix cancer. The purpose of this studywas to assess the accuracy of MRI in evaluating the LACC response toconcurrent preoperative chemoradiation therapy, using qualitative andquantitative criteria.Materials and Methods: Pelvic 1.5-T MRI pre- and postchemoradiationtherapy (45–50 Gy) in 55 patients with LACC (age, 53 years; range,30–79 years), with fewer than 35 days between second MRI and surgery,were retrospectively qualitatively evaluated by consensus by tworadiologists with 10 and 7 years of practice in gynecologic MRI for presenceor absence of residual disease. Quantitative analysis was performedonly on cases judged as positive by qualitative evaluation in order toascertain whether any quantitative criterion may help in distinguishingtrue- from false-positive cases. The quantitative parameters included tumordiameters, tumor volumes calculated with ellipsoid method and with3D volumetry according Simpson’s modified formula before and aftertreatment, and fractional regression rate. The MRI findings were correlatedto histopathologic findings with Wilcoxon signed-rank test and withMann-Whitney U test.A32*Will present paper
TuesdayScientific Session 10—Genitourinary ImagingResults: Qualitative evaluation showed sensitivity, specificity, accuracy,positive predictive value, negative predictive value, positive likelihood ratio,and negative likelihood ratio: 93%, 53%, 63.6%, 42%, 96%, 1.965, and0.127. Quantitative analysis showed that the diameter of residual diseasemeasured by MRI was on average twice the true diameter measured athistology (18 mm vs 9 mm). No quantitative dimensional criterion showedsignificant differences between true-positive and false-positive cases.Conclusion: Qualitative MRI has very high sensitivity and negativepredictive value, but low specificity and positive predictive value forpredicting presence of residual disease after chemoradiation treatmentin LACC. Evaluation of quantitative dimensional parameters didn’t improvethe accuracy of the technique and was of no help in differentialdiagnosis between true- and false-positive qualitative evaluations.084. MRI Is Highly Accurate in Determining the Primary CervicalVersus Endometrial Cancer When Biopsy Results are InconclusiveHe, H.*; Bhosale, P.; Iyer, R. MD Anderson Cancer Center, Houston, TXAddress correspondence to H. He (hhe2@mdanderson.org)Objective: To evaluate whether MRI can determine the primary site of tumor(endometrial vs cervical) when the biopsy is inconclusive and to determinewhich MRI sequence(s) is most useful in making the diagnosis.Materials and Methods: After obtaining institutional review board approval,we reviewed the institutional database for all patients in the past13 years who had a total hysterectomy for suspected unknown primarytumor of the uterus (endometrial vs cervical). Fifty-one patients wereidentified. Based on endometrial biopsy, endocervical biopsy, or both,the primary site could not be identified. Pelvic MR images were availablein 48 patients, which were reviewed by two body radiologists specializingin gynecological oncologic imaging independently, blinded ofany clinical and pathological information. The two radiologists independentlymade decisions about the origin of the primary tumor. If therewas discordance between the two radiologists, a consensus was achievedafter rereviewing the images together at a separate session. The clinicalinformation and pathology were then reviewed and the final surgicalpathology was used as reference standard to confirm a cervical primaryfrom an endometrial primary.Results: The mean age was 57 years (range, 25–88 years). The biopsiesrevealed adenocarcinoma in all cases. In only 24% of the cases (12/51),the pathologists favored one primary site over the other. In 79% of thecases with MR images (38/48), both radiologists identified the primarysites correctly with a positive predictive value of 79%. The sensitivity,specificity, positive predictive value, negative predictive value, and accuracyto detect endometrial adenocarcinoma and cervical adenocarcinomaby MRI are 87%, 89%, 97%, 62%, and 88% and 80%, 88%, 44%, 97%,and 88% respectively. The 95% CI for the accuracy in detecting both endometrialand cervical cancer is 0.75–0.95. Both radiologists found thatthe T2-weighted sequences in conjunction with dynamic enhanced sequenceswere equally helpful in delineating the primary site of the tumor.Conclusion: MRI is highly accurate in delineating the origin of a primaryneoplasm as cervical or endometrial when biopsy results are inconclusive.Sagittal T2-weighted fast spin-echo sequences and 2D and 3D T1-weighted dynamic enhanced sequences are most helpful.085. Use of MRI Apparent Diffusion Coefficient Values to EvaluateUterine Fibroids for Treatment Response Following Uterine ArteryEmbolizationWolfman, D.*; Bulman, J.; Ascher, S. Georgetown University Hospital,Washington, DCAddress correspondence to D. Wolfman (darcywolfman@yahoo.com)Objective: To determine if apparent diffusion coefficient (ADC) valuescalculated on MRI could be used to evaluate treatment response of uterinefibroids after uterine artery embolization (UAE).Materials and Methods: Retrospective review of all female pelvic MRimages was performed at Georgetown University Hospital betweenJanuary 2009 and December 2009 to identify patients with MRI examinationsboth before and after successful UAE. Thirty-two patients fulfilledthe inclusion criteria. One fibroid was evaluated for each patient.In the case of multiple fibroids, the largest dominant fibroid was chosenfor evaluation. All dominant fibroids demonstrated complete infarctionby conventional MRI. MR images were independently evaluated by tworadiologists for the qualitative assessment of the dominant fibroid to include:T2 signal, T1 signal, diffusion-weighted imaging signal, ADC signal,location, and percent enhancement postcontrast. Quantitative assessmentof ADC images was performed using the largest freehand regions ofinterest of the dominant fibroid and normal myometrium before and afterUAE. ADC value ratios of fibroid tissue/myometrium were calculated forpre- and post-UAE MRI.Results: Fibroid ADC values ranged from 184.05 mm –6 /sec 2 to 1320.20mm –6 /sec 2 before UAE and 107.49 mm –6 /sec 2 to 1703.25 mm –6 /sec 2 afterUAE. There was a statistically significant difference in fibroid ADC valuesbetween the pre- and post-UAE measurements (paired t test, p = 0.0019).ADC ratios of fibroid tissue to myometrium ranged from 0.17 to 1.18 beforeUAE and from 0.11 to 1.14 after UAE. There was a statistically significantdifference in ADC ratios of fibroid tissue to myometrium betweenthe pre- and post-UAE measurements (paired t test, p = 0.0028).Conclusion: As minimally invasive treatments of uterine fibroids continueto increase, radiologists will be increasingly called upon to evaluateuterine fibroids for treatment response. ADC values may provide a wayto reliably evaluate uterine fibroids after treatment without the use ofgadolinium contrast agents.086. Feasibility of MR Enterography for Evaluation of CrohnDisease in PregnancyGrand, D.*; Harris, A.; Beland, M.; Degli Esposti, S.; Mayo-Smith, W.Warren Alpert School of Medicine, Brown University, Providence, RIAddress correspondence to D. Grand (dgrand@lifespan.org)Objective: To present our preliminary experience using MR enterography(MRE) to evaluate gastrointestinal symptoms in pregnant patientswith known or suspected Crohn disease.Materials and Methods: Five pregnant patients with known or suspectedCrohn disease underwent seven MRE examinations without IV contrastmaterial. All patients presented with abdominal pain and/or diarrhea.Four of five patients had a c-reactive protein drawn at the time of MRE,all of which were elevated, ranging from 31.6 to 125 mg/L (normal, ≤ 8*Will present paperA33
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Page 8 and 9: Scientific Session 3—Genitourinar
Page 10 and 11: Scientific Session 4—Informatics
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Page 36 and 37: Scientific Session 11—Neuroradiol
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Page 42 and 43: Scientific Session 13—Gastrointes
Page 48 and 49: Scientific Session 15—General/Eme
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Scientific Session 25—Cardiopulmo
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Scientific Session 26—Gastrointes
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Scientific Session 26—Gastrointes
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Scientific Session 27—Pediatric I
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Scientific Session 27—Pediatric I
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Scientific Session 1 â Breast Imaging: Mammography

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Scientific Session 1 â Breast Imaging: Mammography