35

C
Scientific and
Educational Exhibits
Abdominal Viscera (Solid Organs) ............. 322

Breast ......................................................... 335
Cardiac ....................................................... 346
Chest .......................................................... 358
Computer Applications ............................... 368
Contrast Media ........................................... 372
Genitourinary.............................................. 373
GI Tract ....................................................... 393
Head and Neck........................................... 410
Interventional Radiology ............................. 417
Molecular Imaging ...................................... 427
Musculoskeletal .......................................... 429
Neuro ......................................................... 449
Pediatric ..................................................... 459
Physics in Radiology .................................. 468
Radiographers ............................................ 476
Vascular ..................................................... 480
ECR Research Grant Winners ................... 493
321
Scientific and Educational Exhibits

Abdominal Viscera (Solid Organs)
Biliary Tract
C-001
Imaging findings of biliary and non-biliary complications following
laparoscopic surgery
J.-Y. Choi, M.-J. Kim, K. Kim, J. Lim, J. Kim, M.-S. Park, J. Lee, J. Han, B. Choi;
Seoul/KR (gafield2@gmail.com)
Learning Objectives: 1. Discuss the various imaging findings of laparoscopic
complications in affected patients. 2. Discuss the vascular anatomy that is important during laparoscopic procedures. 3. Discuss the appropriate imaging modalities to evaluate the postoperative complications after laparoscopic procedure.
Background: Laparoscopic techniques are evolving for a wide range of surgical
procedures although initially confined to cholecystectomy and exploratory laparoscopy. Recently surgical procedures performed with laparoscope include partial
or total colectomy, splenectomy, appendectomy, adrenalectomy, gastrectomy,
nephrectomy, hysterectomy. Because these laparoscopic procedures have been
introduced recently, several complications may occur during early stage of learning curve with these procedures.
Imaging Findings: Biliary complication following laparoscopic cholecystectomy
include bile ductal obstruction, bile leak with bile duct injury, dropped stones in
the peritoneal cavity, retained common bile duct stone, metastasis at the port
site. Nonbiliary complications are anastomotic leakage after partial gastrectomy,
gangrenous cholecystitis after gastrectomy, hematoma at the anastomotic site
following gastrectomy, gastric infarction after laparoscopy-assisted gastrectomy,
port-site metastasis after gastrectomy, hematoma after splenectomy, renal infarction after adrenalectomy, and active bleeding after myomectomy of the uterus.
Conclusion: Radiologists should be familiar with the typical and atypical features of complications after laparoscopic procedure, and provide appropriate information including further diagnostic work-up imaging modalities to the clinician.
C-002
Cholangiocarcinoma: Spectrum of radiological findings
L. Garca del Salto, B. Ramos, B. Snchez Cordn, F. Aguilera, M. Cruz,
I. Dez, E. Fraile; Alcal de Henares/ES (lauragsalto@yahoo.es)
Learning Objectives: To review and illustrate the spectrum of radiological findings of intra and extrahepatic cholangiocarcinoma with ultrasound (US), multidetector CT (MDCT) and MR imaging. To describe the imaging techniques and
evaluate their efficacy in the detection, characterization and staging of this tumor.
Background: Cholangiocarcinoma is the primary cancer of the bile ducts. It is
the second most prevalent hepatic tumor after hepatocellular carcinoma. It represents 10-15% of primary hepatic cancer but its incidence is growing. Most are
adenocarcinomas (95% of cases) and develop in patients with preexisting bile
ducts diseases, such as primary sclerosing cholangitis, liver fluke infestation and
choledochal cyst. Jaundice and abdominal pain are the most common presenting symptoms, and ultrasound is usually the first imaging study realized. MDCT
and MR imaging remain the methods of choice in the detection, characterization
and evaluation of cholangiocarcinoma for possible tumor resection.
Imaging Findings: We reviewed the imaging findings of the 34 biopsy-proven
cholangiocarcinomas diagnosed in the last five years in our hospital using US,
MDCT and MR imaging. Traditionally cholangiocarcinomas are classified as intrahepatic and extrahepatic disease according to its location in the biliary tree.
Intrahepatic cholangiocarcinoma is further classified as either peripheral or hiliar.
They can be further classified by their growth pattern as exophytic, infiltrative, or
polypoid.
Conclusion: The diagnosis of cholangiocarcinoma may be difficult, knowledge
of the spectrum of radiological presentations of cholangiocarcinoma may allow
an early recognition of this uncommon tumor.
C-003
Preoperative T-staging of the carcinoma of the gallbladder using MDCT:
Radiologic-pathologic correlation
S. Kim, J. Lee, J. Lee, S. Kim, J. Han, B. Choi; Seoul/KR
(yali75@radiol.snu.ac.kr)
Purpose: To evaluate the performance of MDCT in the preoperative T-staging of
gallbladder cancer.
Methods and Materials: 83 patients with gallbladder cancer, proven on subsequent surgical resection or biopsy, who underwent examination using two phase
322
MDCT (3-mm collimation and 3-mm reconstruction) and were included. Two abdominal radiologists retrospectively reviewed all axial images and the multi-planar reconstruction (MPR) images in 31 patients by consensus. The local spread
of the disease was evaluated according to the TNM system, and the results were
correlated to the pathologic findings. The statistical analysis was performed using Fisher's exact test. Results of the consensus interpretations were used to
calculate sensitivity, specificity, and accuracy of MDCT.
Results: The sensitivities of the consensus interpretations of T1, T2, T3, and T4
lesions were 75%, 77.8%, 81.5%, and 100%; specificities were 98.4%, 94.6%,
80.4%, and 98.7%, respectively (P < 0.05). Overall accuracy was 80.7%. In the
31 patients with MPR images, the combined reading of the axial and MPR images increased diagnostic accuracy of T-staging compared with axial image alone.
The sensitivities of the consensus interpretations of T1, T2, T3, and T4 lesions on
MPR images were 33.3%, 83.3%, 100%, and 100%; specificities were 100%,
79.6%, 89.5%, and 100%, respectively (P < 0.05).
Conclusion: MDCT provided 80.7% accuracy in the diagnosis of the local extent
of carcinomas of the gallbladder, showing acceptable sensitivity and specificity.
The addition of the MPR images to axial CT data was helpful for the differentiation of T3 from T2 lesion.
C-004
Evaluation of anomalous bile ducts by three dimensional drip infusion CT
cholangiography using multi-detector CT before laparoscopic
cholecystectomy
T.H. Kajiwara, T. Tsuda, T. Mochizuki, M. Hirata, S. Kumano, H. Tanaka,
T. Haraikawa; Toon/JP (neneth@m.ehime-u.ac.jp)
Learning Objectives: To understand anatomic variations of the biliary tree which
can cause bile duct injury in laparoscopic cholecystectomy by three dimensional
drip infusion CT cholangiography (3D DIC-CT) using multi-detector CT (MDCT).
Background: Laparoscopic cholecystectomy is a standard surgical procedure
for the patients with cholecystolithiasis. It is important to evaluate the bile and
cystic ducts prior to laparoscopic surgery to avoid bile duct injury. Recent development of MDCT can provide very precise 3D images. Since the introduction of
MDCT at our institute, 3D DIC-CT has been routinely examined prior to laparoscopic cholecystectomy.
Procedure Details: More than 500 patients underwent DIC-CT between October 1999 and August 2005. Of these, we could review 380 patient's images. After
drip infusion of iotroxate megulumine, images with 0.625 mm or 1.25 mm slice
thickness were acquired by MDCT (4- and 16-channel) to create 3D DIC-CT.
Aberrant bile duct and junctional anomaly of cystic duct were found in 3.6% and
2.1%, respectively. In this exhibit we will show representative cases of aberrant
bile duct and junctional anomaly of cystic duct with very precise 3D images. Although the complications of iotroxate meglumine occurred in 7.7% in our study,
severe complication were not experienced. We also show limitations of this technique, such as poor opacification of bile ducts due to poor hepatic function or
obstructive jaundice.
Conclusion: 3D DIC-CT provides precise images of bile duct and useful information to surgeons prior to laparoscopic cholecystectomy.
C-005
Malignant biliary obstruction: Multi-detector row CT cholangiography with
surgical and histopathological correlation
H. Han, M. Lee, J. Kim, K. Shin; Daejon/KR (solarad@yahoo.com)
Purpose: We evaluated the multi-detector row computed tomographic (MDCT)
minimum intensity projection (minIP) cholangiography in patients with malignant
biliary obstruction by comparing this noninvasive imaging technique with surgical
and histopathological results.
Methods and Materials: Thirteen patients (5 females, 8 males; mean age, 60
years) with clinical or sonographic findings suggesting malignant biliary obstruction were prospectively studied. A CT was performed with a 16-detector CT scanner (Sensation 16, SIEMENS, Germany), and a CT minIP cholangiogram was
performed without biliary contrast agents and using intravenous injection (100 mL
of iodinated contrast material at 3 mL/s). Axial, multiplanar, and minimum intensity projection reformatted images were evaluated. Surgery was performed with all
patients within 10-24 days after the CT scan.
Results: CT cholangiography accurately depicted the presence, site, and extent
of biliary obstruction in all patients: common bile duct (9), common hepatic duct
(1), ampullar of Vater (1), cystic duct (1), and gallbladder (1). In all patients, accurate surgical diagnoses were made by CT cholangiography, but pathologically,
one patient had chronic inflammation of the bile duct.
Conclusion: MDCT minIP cholangiographic findings of malignant biliary obstruction were well correlated with surgicopathologic findings.

C-006
Biliary drainage of the caudate lobe of the liver on three-dimensional direct
MDCT cholangiography: Normal anatomy and surgical significance in hilar
cholangiocarcinoma
H. Kim, D. Lee, J. Lim, Y. Ko; Seoul/KR (seonju98@hanmail.net)
Learning Objectives: To understand the technique of three-dimensional MDCT
cholangiography. To describe the normal biliary drainage of the caudate lobe of
the liver. To understand the clinical significance of the caudate lobectomy in patients with hilar cholangiocarcinoma.
Background: The caudate lobe has been regarded as one segment of the liver,
but little attention has been directed to it. Recently, the surgical significance of
caudate lobectomy in patients with hilar cholangiocarcinoma has received much
attention. Although direct cholangiography has been considered to be a gold standard in the evaluation of hilar cholangiocarcinoma, it has limitations in the evaluation of the bile duct anatomy of the caudate lobe because the majority of the
caudate lobe branches are located behind the hepatic hilum.
Procedure Details: Three-dimensional direct MDCT cholangiography is the combination of the direct cholangiography and MDCT. High contrast-to-noise ratio in
the direct MDCT cholangiography can provide the high quality volume data set.
Volume-rendering technique using various reformatted thicknesses and viewing
angles may show the bile duct anatomy of the caudate lobe without the overlapping bile duct.
Conclusion: In this exhibition, we will present the normal bile duct anatomy of
the caudate lobe in patients with extrahepatic duct obstruction, and also the bile
duct drainage of the caudate lobe in patients with hilar cholangiocarcinoma focused on the surgical significance.
C-007
Characterization of thickened gallbladder wall on MR imaging: Radiologicpathologic correlation with emphasis on enhancement pattern
S. Kim, J. Lee, J. Lee, S. Kim, J. Han, B. Choi; Seoul/KR
(yali75@radiol.snu.ac.kr)
C-008
Discrimination of suppurative from non-suppurative cholangitis with CT:
Preliminary results
D. Yeh, S. Kim, N. Lee, J. Lee, K.S. Choo, T. Moon, G. Kim; Busan/KR
Purpose: Suppurative cholangitis is characterized by obstruction, inflammation,
and pyogenic infection of the biliary tract, and is considered an emergency. The
purpose of this study is to compare CT findings of acute nonsuppurative and
suppurative cholangitis in patients with extrahepatic biliary duct stone.
Methods and Materials: Fifty patients with a stone in the extrahepatic bile duct
on ERCP were enrolled in this study. Findings at ERCP and CT were the standard of reference for patients with suppurative cholangitis (purulent discharge during ERCP or hepatic abscess at CT, n = 15). Two radiologists blinded to the results
C-009
Spilled gallstones as a cause of delayed and recurrent abscesses after
laparoscopic cholecystectomy
R. Zabala, G. Lecumberri, J. del Cura, A. Ibaez, M. Sarmiento,
D. Grande Icaran; Bilbao/ES (rzabala@seram.org)
Purpose: To study dropped gallstones as a cause of delayed complications of
laparoscopic cholecystectomy. To describe clinical and imaging presentation of
this pathology and propose a diagnostic and therapeutic approach.
Methods and Materials: We have reviewed the laparoscopic cholecystectomies
performed in our hospital, between 2003 and 2005 to look for delayed complications caused by dropped gallstones. Symptoms, imaging findings, treatment and
evolution of the cases found have been recorded.
Results: In our hospital, between 2003 and 2005, 802 laparoscopic cholecystectomies were performed. Twenty patients (2.4%) developed immediate postoperative complications (bile duct injury, leakage, postoperative abscess, hemorrhage).
In 6 more cases (0.7%) delayed peritoneal abscesses presented as a late complication (2-12 months after surgery). All were related to gallstones spilled during
cholecystectomy. In three cases, dropped gallstones were identified on CT or
ultrasound performed to guide the drainage procedure. The other three presented with recurrent abscesses that were treated several times by means of percutaneous imaging guided drainage. Dropped stones were not recognised on initial
episodes, but, finally, were identified after careful search inside the collections on
CT or US performed to guide successive drains.
Conclusion: The radiologist must be aware of the possibility of spilled gallstones
in every case of late abscess formation or relapse of abscesses in patients with
history of laparoscopic cholecystectomy. Careful search is indicated in these cases
to localise possible stones inside the collections. In case a stone was identified,
surgery is indicated because the possibility of recurrence after percutaneous drainage is very high.
C-010
Magnetic resonance cholangiopancreatography revisited: Techniques,
pitfalls and clinical applications
S.M. Dias, C. Pina Vaz; Porto/PT
Learning Objectives: To review the current techniques used for magnetic resonance cholangiopancreatography (MRCP). To describe MRCP imaging findings
of pancreatobiliary diseases. To discuss advantages, limitations and pitfalls of
MRCP.
Background: MRCP is a relatively recent imaging technique that takes advantage of the bright signal of stationary or slow-motion non-hemorrhagic fluid on
heavily weighted T2 sequences to depict the biliary and pancreatic ductal system. In many clinical settings, it is being increasingly used as an alternative to
endoscopic retrograde cholangiopancreatography (ERCP).
Procedure Details: The authors review the available techniques of MRCP and
present the most common manifestations of pancreatobiliary disease in MRCP,
based on the experience of our tertiary care hospital. Advantages, limitations,
pitfalls and clinical applications are discussed and illustrated.
Conclusion: MRCP is continuing evolving as non-invasive tool in the workup of
pancreatobiliary diseases. It can provide comparable results to ERCP, without its
inherent risks, and allows visualization of extra-luminal adjacent tissues. Recognized limitations include lack of functional information and limited resolution, but
technical advances are likely to result in diagnostic improvements, limiting the
use of ERCP to therapeutic procedures.
323
a (Solid Or
gans)
iscer
Abdominal V
Org
Viscer
iscera
Learning Objectives: To correlate MR findings of gallbladder (GB) disease causing GB wall thickening with pathologic findings, with special emphasis on enhancement pattern.
Background: In spite of vigorous efforts and much research, the differential diagnosis of GB disease that manifests as a wall thickening is difficult. MR imaging
can reveal a characteristic signal intensity and enhancement pattern of the gallbladder wall in a particular disease entity, which can be valuable for the differential diagnosis of gallbladder diseases.
Imaging Findings: We retrospectively evaluated the T1-, T2WI and gadobenate
dimeglumine enhanced dynamic images in 70 patients with pathological confirmation. On dynamic MR imaging, GB cancers show different enhancing patterns
depending on the type of growth pattern: mass replacing type; intraluminal polypoid type; and flat wall thickening type. All polypoid GB carcinoma had thickened
enhancing inner layer at their base. Adenomyomatosis shows multiple cystic spaces in a thickened wall. Chronic cholecystitis shows preserved smooth, layering
pattern, consisting of intense enhancement of inner thin mucosal layer and subtle outer layer enhancement. Acute cholecystitis shows a thicker outer layer with
little enhancement. Xanthogranulomatous cholecystitis shows irregular GB wall
thickening with peripheral weak enhancement in comparison to the strong peripheral enhancement of carcinoma. Tubular adenoma shows intense homogenous enhancement with a papillary shape.
Conclusion: Our results indicate that MR findings of GB disease are characteristic in each entity and correlate well with pathologic findings. Familiarity to the
enhancement patterns of various benign and malignant GB diseases on MR imaging may be valuable in daily practice.
of the ERCP retrospectively analyzed CT images. The following findings were

evaluated: degree of bulging of papilla, stone in the ampulla of Vater, early inhomogeneous enhancement of liver, the degree of bile duct dilatation, the degree of
wall thickening of extrahepatic bile ducts, and hepatic abscesses. Sensitivity and
specificity for each of the individual findings were calculated.
Results: Bulging with abnormal enhancement of the papilla showed 81.8% specificity, 76.5% sensitivity for suppurative cholangitis. Presence of inhomogeneous enhancement of liver or stone in the ampulla of Vater had a specificity of
94.1% or 87.9% respectively but a sensitivity of only 18.2% or 35.3% respectively. The combination of bulging with abnormal enhancement of the papilla and
early inhomogeneous enhancement of liver improved specificity (84.9%) and
sensitivity (70.6%). The other findings were not significant.
Conclusion: A combination of CT findings is helpful in making the early diagnosis of suppurative cholangitis in patients with extrahepatic bile duct stone.

C-013
Liver
The natural course of small intrahepatic low density areas without early
enhancement (LDA) in chronic liver disease: Evaluation with dynamic CT
using multidetector CT (MDCT) scanners
T. Takano, T. Kamura, S. Yamamoto, T. Ozaki, K. Sasai; Niigata/JP
(t-takano@med.niigata-u.ac.jp)
C-011
MRI of hepatic lesions in patients with hereditary hemorrhagic
telangiectasia (HHT) and arterio-venous malformations (AVM) of the liver
G.K. Schneider, A. Massmann, P. Fries, K. Altmeyer, R.M. Seidel,
U.W. Geisthoff; Homburg a.d. Saar/DE (ragsne@uniklinikum-saarland.de)
Purpose: To evaluate imaging characteristics of the liver in patients with HTT
and AVM of the hepatic circulation.
Methods and Materials: 215 HHT patients or first degree relatives were screened
for the presence of hepatic, pulmonary or cerebral AVM by means of MR imaging. In patients with signs of involvement of the liver further workup by CE-MRA
after bolus injection of Gd-BOPTA at a dose of 0.1 mmol/kg was performed. In 18
patients AVM were demonstrated and the liver parenchyma was further evaluated by dynamic and steady state imaging post injection of Gd-BOPTA (0.05 mmol/
kg BW).
Results: Two different findings were observed in patients with hepatic AVM. In 11
patients the liver was of a normal size and no liver lesions were demonstrated
whereas in the remaining 7 patients first an enlargement of the liver and second
multiple hyperplastic nodules were found. The nodules showed a contrast medium behaviour comparable to that of FNH and NRH especially in the hepatobiliary
phase of contrast medium uptake.
Conclusion: Because of the specific vascular blood supply of the liver it appears
that two different forms of AVM may be found in HHT patients. A hypertrophy of
the liver together with presence of hyperplastic lesions most likely results from
arterio-portal shunts with local overgrowth of hepatic tissue due to an increased
arterial blood supply. In contrast arterio-venous shunts do not seem to influence
the hepatic parenchyma since the arterial blood-flow from AVM bypasses the
liver and thus does not result in development of hyperplastic changes.
C-012
Automatic analysis of liver perfusion quantification with dynamic contrast
enhanced MR imaging (DCE-MRI) by a dual-input model and non-linear
sampling
D. Monleon1, D. Moratal-Perez 2, L. Marti-Bonmati2, I. Blanquer2, V. Hernandez2,
J. Carbonell2, B. Celda1; 1Burjassot/ES, 2Valencia/ES (daniel.monleon@uv.es)
Purpose: The hepatic artery and portal venous system derive the liver blood
supply jointly. The influence of breathing, the large number of pharmacokinetic
parameters and the fast variations in contrast concentration in the first moments
after the contrast injection reduce the efficiency of traditional liver perfusion quantification approaches. In this work we will present a tool for easy and automatic
analysis of liver DCE-MRI data.
Methods and Materials: Contrast agent concentration and bolus injection rate
were selected randomly between 0.2-0.3 ml/Kg and 4-5 ml/s respectively. Thirteen T1W-spoiled-GE MR dynamic-acquisitions (each one with 24 slices in 4 s
covering the whole liver) were acquired during 210 seconds using variable delays between acquisitions, according to perfusion theoretical curves. Images were
4D (XYZ+time) co-registered with the ITK-package in a GRID environment. A
one-compartment-two-input model was used for the pharmacokinetic characterization of the hepatic perfusion. A MATLAB-based tool for automatic analysis of
DCE-MRI data was developed.
Results: Liver DCE-MRI data were measured, co-registered and analyzed for 25
patients. Concentration/time curves obtained by non-linear sampling allowed the
capture of contrast concentration peaks, improving the accuracy of parametric
images and the correlation of the data to the pharmacokinetic models. The software allowed the analysis of these curves and correlation. Parametric images of
TTP, rBV and several pharmacokinetic constants were also created.
Conclusion: The developed software allowed the automatic semi-empirical pharmacokinetic analysis of the liver and upper abdominal organs with DCE-MRI data
with great consistency. This software may help in the diagnosis of diffuse liver
and kidneys diseases.
324
Purpose: To clarify the natural course of LDA, on dynamic CT in chronic liver

disease visualized frequently using MDCT.
Methods and Materials: We randomly selected 100 patients with chronic liver
disease who had undergone a dynamic study with 4-detector-row MDCT from
2000- 2002, and included LDA larger than 7 mm in diameter. The diameter was
determined as the maximum diameter at equilibrium phase. Two radiologists reviewed the findings in consensus. We excluded liver cysts and LDA which remained unchanged on follow-up within 1 year. According to the follow-up results,
we classified the LDAs into 4 categories: 1) hypervascularized, 2) enlarged more
than 3 mm in size, 3) no change, and 4) reduced more than 3 mm in size or
disappeared.
Results: Forty-one LDA were included. Twenty-three LDA were 7-10 mm in initial
diameter; among them, 3 (13%), 3 (13%), 5 (25%) and 12 (53%) LDAs were
classified into 1), 2), 3), and 4), respectively. Fifteen LDA were 11-15 mm initially;
2 (13%), 3 (20%), 0, and 10 (67%) were classified into 1), 2), 3), and 4), respectively. Three LDA were 16-18 mm initially; 2 (67%), 0, 1 (33%), and 0 were classified into 1), 2), 3), and 4), respectively. The percentage of clinically problematic
LDA categories 1) + 2) was 26% for 7-10 mm lesions, 33% for 11-15 mm lesions,
and 67% for 16-18 mm lesions.
Conclusion: Larger LDA tend to be hypervascularized or enlarged more frequently. More than half of the lesions which were less than 15 mm reduced or
disappeared.
C-014
Single breath-hold diffusion-weighted MRI of the liver with parallel imaging:
Initial experience
A. Oner, H. Celik, S. Ozhan Oktar, T.E. Tali; Ankara/TR (yusuf@tr.net)
Purpose: To evaluate the improvement in the signal to noise ratio (SNR), with the
use of parallel technique in single breath-hold diffusion weighted imaging (DWI)
of the liver and its affect on apparent diffusion coefficient (ADC) measurements.
Methods and Materials: Fifteen patients underwent single breath-hold DWI of
the liver with and without parallel imaging technique. SNR and ADC values were
measured over a lesion-free right hepatic lobe by two radiologists in both series.
When a focal hepatic lesion was present contrast to noise ratio (CNR) and ADC
were also measured. Student's t-test was used for statistical analysis.
Results: Mean SNR values of the liver were respectively 20.82 7.54 and
15.83 5.95 for DWI with and without parallel imaging. SNR values measured in
DWI using parallel imaging were found to be significantly higher (p < 0.01). Mean
ADC of the liver were respectively 1.61 0.45 x 10-3 sec/mm2 and 1.56 0.28 x
10-3 sec/mm2 for DWI with and without parallel imaging. No significant difference
was found among the two sequences for hepatic ADC measurement (p > 0.05).
Overall lesion CNR was found to be higher in DWI with parallel imaging.
Conclusion: Parallel imaging is useful in improving SNR of single breath-hold
DWI of the liver without compromising ADC measurements.
C-015
Three dimensional ultrasonography: Determination of the right lobe liver
volume in living donor liver transplantation (thesis)
A.S.C.N. Zan, M.C. Chammas, P.C.B. Massarollo, M.S. Rocha, L.F. Oliveira,
S. Mies, G.G. Cerri; Sao Paulo/BR (aszan@uol.com.br)
Purpose: To evaluate the right lobe liver volume in living donors by three dimensional ultrasonography (US3D) using VOCAL (Virtual Organ Computer-Aided
Analysis) software.
Methods and Materials: Between January 2003 and September 2004, 16 donors were prospectively studied. The mean age of patients was 33 years (range
23 to 50 years). We applied a new method to estimate right liver lobe grafts,
through US3D, in preoperative evaluation of living donors. Comparison was made
with actual weights of right lobe grafts that were determined after lobectomy and
back table flushing.
Results: Mean estimated right lobe liver volume determined by US3D was
758.4 cm 130.7 cm. Actual right hepatic lobe weight was 792.8 g 131.2 g.
The relationship between estimated graft volume and graft weight was linear
(r = 0.762; p = 0.001). A good agreement was observed between the two measurements based on graphical techniques by Bland-Altman. The discrepancies

ranged from 160.2 cm to 219.7 cm. The mean error ratio (discrepancy divided
by the estimated graft volume x 100) was 3.8% 11.8% (ranged-17% to 30%).
An R value = 0.5046 indicated a predictive strength between US3D volume and
actual volume. The regression equation was as follow: graft size (kg) = 1.038 kg/
cm 0.001 kg/cm (US3D). The analysis intra-observer measurements showed
Pearson's correlation coefficient = 0.886 (p < 0.001) and good agreement by
Bland-Altman.
Conclusion: The right lobe liver volume estimated by US3D using VOCAL software showed a linear relationship and good agreement with the actual graft size.
C-016
Detection of ruptured hepatocellular carcinoma with contrast-enhanced CT:
Emphasis on active contrast material extravasation
S. Heo1, Y. Kim1, Y. Jeong1, N. Chang1, S. Shin2, J. Seo1, H. Kang1;
1
Jeollanam-do/KR, 2Gwangju/KR (kym0808@hanmail.net)
Purpose: To evaluate the effectiveness of active contrast material extravasation
(CME) in patients with ruptured hepatocellular carcinoma (HCC) on contrastenhanced CT.
Methods and Materials: Seventy-six cases with spontaneous ruptured HCC
underwent helical or multidetector CT including pre-and postcontrast enhancement. All cases were confirmed by abdominal paracentesis. Of 76 cases, 52 cases underwent contrast arteriography (CA) within 48 hours after CT examination.
The presence of active CME was assessed with contrast-enhanced CT and compared with CA finding. Other CT findings of ruptured HCC, such as location, contour, margin, and sentinel clot sign, were also recorded.
Results: Of 52 cases undergoing both contrast-enhanced CT and CA, active
CME was demonstrated in 28 cases (53.8%) on contrast-enhanced CT and 21
cases (40.4%) on CA. Nineteen cases showed active CME on both contrastenhanced CT and CA. There were two false negative and nine false positive
cases in the detection of active CME on contrast-enhanced CT. In the detection
of active bleeding from ruptured HCC, contrast-enhanced CT had a sensitivity,
specificity, and accuracy of 90.5%, 71% and 80.4%, respectively. All of 76 cases
showed bulging contour and were located in subcapsular region. Disruption of
tumor margin was seen in 66 (86.8%) of 76 cases. Sentinel clot sign around
ruptured tumor was noted in 48 (63.2%) of 76 cases.
Conclusion: The useful CT findings in the diagnosis of HCC rupture were active
CME, disruption of tumor margin, and sentinel clot sign around HCC. Active CME
can be more frequently detected on contrast-enhanced CT than would be expected.
C-017
Purpose: Dynamic contrast enhanced MR imaging is a useful tool to detect hepatocellular carcinoma (HCC), the most frequent and critical hypervascular tumor
to arise within cirrhotic liver. However, recent evidence implicates that some hyperplastic nodules, developing in severe alcoholic liver disease, similarly show
hypervascularity on dynamic images. Histopathologically these nodules are named
focal nodular hyperplasia (FNH) like nodules, because the pathological features
resemble to FNH. The purpose of this study is to clarify MR imaging findings of
hypervascular hyperplastic nodules (HHN) developing within severe alcoholic liver
disease and try to depict the differences between HCC and HHN on MR imaging.
Methods and Materials: Nine cases of HHN and 9 cases of HCC, that arose
within severe alcoholic liver disease, were enrolled in our study. MR imaging findings including T1 and T2 weighted and superparamagnetic iron oxide (SPIO)
enhanced T2 weighted images were evaluated.
Results: On T1-weighted images, 5/9 HHN (56 %) showed hyperintensity, whereas
9/9 (100 %) HCC showed hypointensity (P=0.015). On T2-weighted images, 6/9
HHN (67 %) showed iso- or hypointensity, whereas 8/9 HCC (89 %) showed hyperintensity (P=0.024). On SPIO enhanced T2-weighted images, 4/4 HHN (100%)
showed increased uptake of SPIO, whereas 5/5 HCC (100%) showed no or decreased uptake of SPIO (P=0.008).
Conclusion: Our preliminary results indicate that HHN tends to show hypointensity on T2-weighted images and/or increased uptake of SPIO. Therefore, T2-weighted images and SPIO enhanced T2-weighted images have a potential to
differentiate HHN from HCC developing within severe alcoholic liver disease.
CT and MR findings of the various causes of hepatic capsular retraction: A

pictorial review
D. Yang, H. Kim, J. Kang, H. Kim, C. Park; Incheon/KR
(dmyang@gilhospital.com)
Learning Objectives: 1. To become familiar with the imaging appearance of various causes of hepatic capsular retraction. 2. To highlight points of differentiation
between the various causes of hepatic capsular retraction.
Background: Retraction of the liver capsule is an unusual CT or MR finding
associated with a variety of tumors. Capsular retraction is due to necrosis and
desmoplastic reaction within the tumor, which distorts the tumor margin and adjacent liver capsule. However, the retraction of the liver capsule is not a finding
specific to hepatic tumor. In this exhibit, we conduct a literature review and present
the CT and MR findings of various causes of hepatic capsular retraction.
Imaging Findings: A retrospective review was performed in patients with various causes of hepatic capsular retraction. All cases were confirmed by surgical
resection, biopsy, or radiological follow-up study. Various causes of hepatic capsular retraction were identified. Tumors associated with hepatic capsular retraction include hepatocellular carcinoma, intrahepatic cholangiocarcinoma, epithelioid
hemangioendothelioma, metastases, hemangioma, and post-treatment (Transarterial chemoembolization, radiofrequency ablation, and chemotherapy) of malignant tumor. Non-tumorous conditions with hepatic capsular retraction include
confluent hepatic fibrosis, oriental cholangiohepatitis, and bile duct necrosis.
Conclusion: Knowledge of CT and MR findings of various causes of hepatic
capsular retraction may be helpful for differential diagnosis.
C-019
The value of resistive index in renal artery: Association with esophageal
variceal bleeding in patients with alcoholic cirrhosis
J. Byun, J. Choi, D.-H. Kim, D. Kim; GwangJu/KR (kdhoon@mail.chosun.ac.kr)
Learning Objectives: To determine whether the resistive index of renal artery
(RIR) or splenic artery (RIS) can be used as a predictor of bleeding in patients
with alcoholic liver cirrhosis.
Background: Non-invasive parameters with US are needed to detect bleeding in
alcoholic cirrhosis.
Procedure Details: The study included 33 patients with alcoholic cirrhosis. According to variceal bleeding episode, all patients with cirrhosis were subdivided
into two subgroups, as bleeders (n = 17) and non-bleeders (n = 16). Five variables (age, spleen size, Child's score, RIS or RIR) were compared between two
subgroups. The correlations between bleeding episode and each variable were
analyzed. A multivariate logistic regression analysis was used to adjust for correlated variables. ROC curve was used to identify the cutoff value for prediction of
bleeders. The mean values of variables were higher in bleeders than those of
non-bleeders (p < 0.05). Except age, four variables were significantly correlated
with bleeders (r = 0.43 for spleen size; r = 0.36 for Child's score; r = 0.37 for RIS;
p < 0.05, respectively; r = 0.63 for RIR, p < 0.01). Of the variables, only RIR was
a significant variable for bleeders (adjusted Odds ratio=19.9; 95% confidence
interval: 1.3 -306.0, p < 0.05). RIR has sensitivity of 88.3% and specificity of 75.0%
with accuracy of 81.8% at the cutoff of 0.70 in identifying bleeders.
Conclusion: Higher RI values of renal artery appeared to be associated with
esophageal variceal bleeding in patients with alcoholic liver cirrhosis.
C-020
Improvement of image quality on low-dose multidetector CT by using a
novel adaptive noise reduction filter: Study in clinical hepatic images
K. Hiraishi1, S. Hori1, T. Sugiura1, Y. Hata1, K. Awai2, Y. Funama2, Y. Aoki3,
O. Miyazaki3, Y. Okazaki1; 1Izumisano/JP, 2Kumamoto/JP, 3Kashiwa/JP
(hiraishik@igtc.jp)
Purpose: To improve image quality of low-dose multidetector CT (MDCT), we
devised a novel adaptive noise reduction filter. Standard-dose and filtered lowdose clinical hepatic images were compared.
Methods and Materials: Sixty patients with known HCC were scanned with a 4detector row CT (ROBUSTO, Hitachi Medical Corporation, Tokyo, Japan) with
tube voltage, 120 kVp; detector collimation, 2.5 mm; reconstruction thickness/
interval, 5 mm and helical pitch, 1.25. Tube current and rotation time (mAs) was
set according to patient body weight (BW): BW [kg] 55, 140 mAs; 55 < BW
< 65, 160 mAs; 65 BW, 180 mAs. Low dose scan with 50 % mAs was added
immediately after standard dose scan. Low dose CT images were postprocessed
with a novel adaptive noise reduction filter. Three radiologists visually evaluated
CT images of 60 patients; graininess of liver parenchyma, sharpness of liver con-
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Hypervascular hyperplastic nodule in severe alcoholic liver disease and

alcoholic liver cirrhosis: Distinction from hepatocellular carcinoma with MR
imaging
S. Kobayashi1, O. Matsui1, T. Kamura2, N. Yoneda1, T. Gabata1, S. Yamamoto2,
K. Sasai 2, Y. Aoyagi2, S. Kaneko1; 1Kanazawa/JP, 2Niigata/JP
C-018

tour, conspicuity of liver tumors, and overall image quality by using 5-point scale.
Image noise (standard deviation of CT number) in liver parenchyma was measured in both standard and filtered low-dose images.
Results: In the visual evaluation, there was no statistical difference between standard-dose and filtered-low dose images (Wilcoxon signed-ranks test, P > 0.05). In
quantitative analysis, image noise in liver parenchyma was 11.35 HU at standard-dose and 12.80 HU at filtered low-dose, there was no difference between
standard-dose and filtered low-dose images (paired t-test, p = 0.35).
Conclusion: Low-dose CT with the adaptive noise reduction filter had comparable image quality as standard-dose CT in clinical hepatic images.
C-021
The perihepatic space: Comprehensive anatomy and CT imaging of
pathologic conditions
D. Yeh, S. Kim, N. Lee, J. Lee, T. Lee, S. Lee, J. Tae Yong; Busan/KR
Learning Objectives: To describe the normal anatomy of the perihepatic ligaments and there relationships to the other peritoneal folds. To list the various
pathologic conditions that involve the perihepatic spaces and ligaments and their
characteristic CT features. To understand intraperitoneal flow dynamics.
Background: The liver is covered by visceral peritoneum except at the bare area,
the bed of gallbladder and the porta hepatitis. The investing peritoneum becomes
contiguous with the adjacent structures such as diaphragmatic peritoneum, lesser omentum, and ligament teres. Inflammatory processes or tumors involving the
perihepatic space are usually affected by the intraperitoneal flow dynamics depending on anatomy of the recess as well as the gravity and negative subdiaphragmatic pressure.
Imaging Findings: Pathologic conditions in the perihepatic space appear as
abnormal air, fatty mass, fluid density or soft tissue mass on CT. Hepatic capsular
enhancement is an indicative finding of inflammation such as Fitz-Hugh-Curtis
syndrome. Invasion in or around the perihepatic ligaments can be by means of
direct invasion, subperitoneal extension, or extension along lymphatics.
Conclusion: We describe the anatomy, pathologic features of the perihepatic
structure, and common pitfalls, which can help the radiologist understand disease processes involving perihepatic space and interpret CT images.
C-022
Hepatic arterial buffer response and its clinical implications
D. Coy, M. Dighe; Seattle, WA/US (dighe@u.washington.edu)
Learning Objectives: To understand the hepatic arterial buffer response (HABR)
and its clinical implications.
Background: The primary intrinsic regulator of the hepatic artery is the HABR,
which is the inverse response of the hepatic artery to changes in portal vein flow.
Procedure Details: The liver receives a dual blood supply from two very different
sources. Low-pressure venous blood carried by the portal vein comprises two
thirds of total hepatic blood flow in the fasting state. Portal blood flow is not controlled by the liver but rather passively received. In contrast, flow of high pressure
blood carried by the hepatic arteries is actively regulated by the liver. When the
amount of portal flow changes, the liver alters flow through the hepatic artery in
an opposite direction. This compensatory mechanism has been termed the hepatic arterial buffer response (HABR). The HABR does not perfectly match changes in portal flow and hepatic flow, but rather buffers or lessens the effect of portal
blood flow changes on total hepatic flow. This article illustrates clinical manifestations of HABR by demonstrating alterations in hepatic arterial Doppler signals
that result from acute and sub-acute portal vein complications. Clinical manifestations of HABR in patients with cirrhosis and other causes of chronic portal
hypertension are more difficult to detect because of the presence of collateral
venous pathways.
Conclusion: Evaluation of the hepatic arterial Doppler signal can provide valuable insight in diagnosing acute portal vein complications and assessing portal
vein flow in liver transplant patients.
C-023
Lateral arcuate ligament of the diaphragm: Ultrasonographic demonstration
G. Pekindil; Manisa/TR (pekindilg@yahoo.com)
Purpose: Lateral arcuate ligaments (LAL) are occasionally observed anatomic
variation of the diaphragm abutting the lateral diaphragmatic surface and extending into the posterior pararenal space on computed tomographic (CT) scans.
However ultrasonographic features have not previously been described in scientific literature. Here the many ultrasonographic appearances of LAL will be presented for the first time.
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Methods and Materials: Fourteen cases which detected LAL on CT scans were
evaluated with ultrasonography using 3-5 MHz convex transducer. Localization,
dimensions, morphologic characteristics of LAL have been described.
Results: LALs are seen on ultrasonography as a hypoechoic structure that are
typically linear or nodular shaped and can be followed in continuity with the diaphragm in the pararenal space posterior to liver. Twelve cases had unilateral
whereas two had bilateral LAL. The LALs located on the left side have not been
demonstrated due to air artefacts. Morphologically LAL was linear in 9, nodular in
4, and mixt type in 1 cases. The thickness of LAL was less than 1 cm in all cases.
The LAL extended inferiorly to the mid kidney level.
Conclusion: LAL can be seen ultrasonographically as a hypoechoic structure in
continuity with the diaphragm especially in the right pararenal space posterior to
liver. The ultrasonographer should be aware of this variation and it should not be
misinterpreted as a pathological process such as peritoneal implant, lymph node
etc., on abdominal ultrasonography.
C-024
Diffusion-weighted MR imaging in differentiation of focal liver lesions
S. Han, S. Heo, Y. Jeong, S. Shin, J. Seo, H. Kang; Kwang Ju/KR
(lenzlight@hanmail.net)
Purpose: The purpose of this study was to obtain apparent diffusion coefficient
(ADC) values of focal liver lesion in echo-planar diffusion-weighted (DW) MR
imaging and to evaluate the usefulness of ADC values in differentiation of malignant from benign focal liver lesion.
Methods and Materials: In 32 patient with suspicious focal hepatic lesions, DWI
images was performed with b value of 1,000 sec/mm2 at 1.5 T MR scanner (GE
Healthcare, GE Signa Excite, USA). There were 38 focal hepatic masses (22
hepatocellular carcinomas [HCC], 4 cholangiocarcinomas, 4 metastatic diseases, 5 hemangiomas, 2 cysts, and 1 myolipoma). The diagnosis was confirmed by
pathology and imaging technique. The ADC values obtained in the lesions were
used to represent each lesion, and the ADC values of the disease groups were
compared.
Results: Mean ADC values were 1.11 0.24 in HCC, 1.21 0.16 in cholangiocarcinoma, 1.19 0.12 in metastatic disease, 1.64 0.30 in hemangioma,
1.78 0.55 in cyst, 1.70 0.013 x 10-3 mm2/sec in myolipoma. ADC values of
malignancy (1.10 0.28) were lower than those of benign focal liver lesion
(1.69 0.37). There were statistically significant difference between ADC values
of malignant and benign lesions (p < 0.05).
Conclusion: Calculated ADC values based on echo-planar DWI may be a useful
predictor in differentiating malignant from benign lesion in the liver.
C-025
Contribution of magnetic resonance in the evaluation of donors for living
right lobe liver transplantation
G. Warmbrand, M.S. Rocha, P.C.B. Massarollo, C.C. Leite, M.D. Almeida,
G.D. Bianca, S. Mies, G.G. Cerri; So Paulo/BR (gwarmbrand@hotmail.com)
Purpose: The preoperative evaluation of potential donors for living right lobe
liver transplantation by imaging methods and with the lowest risks is mandatory.
The value of the magnetic resonance imaging (MRI) in the evaluation of these
donors was analysed.
Methods and Materials: Liver steatosis; biliary anatomy; hepatic arterial anatomy, portal and hepatic venous anatomy, and lobar liver volume were compared to
liver biopsy results, intraoperative cholangiography, digital angiography and/or
surgical findings, and real graft weight, respectively. Thirty donors were included.
Statistical analysis of quantitative and qualitative variables were performed.
Results: In the detection of steatosis, MR imaging had a 52% negative predictive
value and 100% positive predictive value. The MR cholangiography had agreement in 25/30 donors (83%) and disagreement in 5/30 (17%). Considering secondary arterial branches, MR angiography reproduced digital angiography
completely. As for the artery to segment IV, optimal reproducibility between methods was obtained. In all donors the results of MR angiography were in agreement
with those of digital portography. In relation to hepatic veins, MR imaging findings
reproduced surgical findings, with 100% of sensitivity and specificity. There was
positive and significant correlation between right lobe volume measurements and
graft weight.
Conclusion: MR imaging has underestimated liver steatosis; it has identified
biliary anatomy with 83% agreement; it has 100% of agreement in the evaluation
of arterial, portal and hepatic venous anatomy and it overestimated with small
degree the lobar liver volume.

C-026
New techniques of liver transplantation: Imaging findings
S. Taifour, F. Bahlouli, D. Castaing, D. Azoulay, R. Adam, M. Bellin; Villejuif/FR
(marie-france.bellin@pbr.ap-hop-paris.fr)
Learning Objectives: Our purpose is to illustrate the most recent techniques of
adult liver orthotopic transplantation (LOT), including living donors, split liver transplantation, divided liver, and to review the normal postoperative imaging appearances as well as the main postoperative complications.
Background: New techniques of LOT are developing rapidly because of the shortage of cadaveric donors. They are associated with a higher risk of complications.
We reviewed the radiological files of 50 adult patients who underwent LOT during
the last 3 years, with one of the following techniques: living donors, split liver and
divided liver. All patients had serial ultrasonic color-Doppler examinations and
CT examinations (at least 1 week and 3 months after LOT); MR imaging was
performed on demand.
Imaging Findings: We will illustrate the normal postoperative findings using ultrasound, CT scan, and MR imaging (specifically surgical techniques and procedures, and vascular cartography) and the main complications (fluid collections,
haemorrhage, arterial stenosis and thrombosis, parenchymal ischaemia, biliary
complications, abscess). The occurrence and frequency of complications varies
depending on the type of transplantation. Regeneration of the hepatic parenchyma will be illustrated and quantified using hepatic CT volumetry.
Conclusion: Knowledge of the normal postoperative imaging findings and complications is essential in the assessment of patients after LOT. Radiologists play
a pivotal role in the diagnostic approach to postoperative LOT.
C-027
MDCT findings of various hepatic artery complications after living donor
liver transplantation: New insights beyond stenosis and thrombosis
S. Kim, K. Kim, A. Kim, S. Park, H. Won, M.-G. Lee; Seoul/KR
(soyeonie74@yahoo.co.kr)
C-028
Tumour seeding along the needle tract after liver biopsy in patients with
hepatocellular carcinoma
J.J. Noguera, E. De Luis, A. Alonso-Burgos, M.L. Daz-Dorronsoro,
A. Villanueva, A. Benito; Pamplona/ES (jnoguera@unav.es)
Purpose: To study the frequency of tumor seeding after US-guided percutaneous biopsy of hepatocellular carcinoma.
Methods and Materials: From January 1999 to June 2004, 1017 US-guided
hepatic biopsies were performed in our institution. In 56 patients (31 male, 15
female), 57 nodules of hepatocellular carcinoma were biopsied. A review was
performed, searching for tumour seeding after biopsy. Other potential procedures
for tumour seeding, such as radiofrequency ablation (RFA), fenolization and fine
needle puncture with diagnostic or therapeutic purpose were recorded.
Results: Four cases of tumour seeding were found 17, 20, 20 and 27 months
after biopsy. These cases were only observed in patients with additional procedures. In one case RFA was performed, and in the other three cases fine needle
aspiration was done in order to do a cytological study of tumoral occlusion of the
portal vein (one case) and to apply gene therapy (two cases). In these four patients, a median of 5 total punctures (range 3-6) was performed. No tumour seeding was detected in 18 patients with no additional interventions apart from the
C-029
Diffusion tensor hepatic MR imaging with parallel imaging technique for the
evaluation of focal hepatic lesions
H. Haradome1, T. Ichikawa2, A. Nakamura1, H. Soh2, T. Araki2; 1Tokyo/JP,
2
Yamanashi/JP
Purpose: To determine whether apparent diffusion coefficient (ADC) and fractional anisotrophy (FA) measurements obtained with diffusion tensor imaging (DTI)
was useful for the characterization of focal hepatic lesions.
Methods and Materials: DTI was performed with a parallel imaging technique in
52 patients with 67 hepatic masses and without a parallel imaging technique in
41 patients with 45 hepatic masses. All DTI was conducted using a b value of 0
and 400 sec/mm2. ADC and FA values were calculated on each map created
after the image acquisition using specific diffusion-analyzing software on the
workstation.
Results: Mean ADC values (10-3 mm2/sec) of benign (non-solid) hepatic lesions
(2.87 0.27) was statistically higher than that of malignant (solid) hepatic lesions (1.24 0.21) on DTI with the parallel imaging technique (p < 0.001). Mean
FA values of benign hepatic lesions (0.32 0.12) was significantly lower than
that of malignant hepatic lesions (0.67 0.15) on DTI with the parallel imaging
technique. When combined threshold values for the differentiation between benign and malignant hepatic lesions were established at less than 1.26 for ADC
values (10-3 mm2/sec) and over 0.4 for FA values, sensitivity and specificity for the
diagnosis of malignant hepatic lesions were 97% and 98%, respectively.
Conclusion: A combination of ADC and FA measurements with DTI were more
useful than ADC measurements alone for differentiating between benign and
malignant hepatic lesions. In addition, the parallel imaging technique improved
such efficacy of DTI for the diagnosis of hepatic lesions.
C-030
Cystic liver lesions: Differential MR imaging features
B.J. Op de Beeck1, R. Salgado2, C. Geniets1, K. de Jongh1, R. Salgado1,
B. Corthouts1, P.P. Parizel 1; 1Edegem/BE, 2Brussels/BE
(i.verhaeverbeke@skynet.be)
Learning Objectives: To familiarize radiologists with the imaging characteristics
of cystic focal liver lesions in the adult, with a special emphasis on the MR findings.
Background: Cystic lesions in and around the liver are common findings on abdominal US and CT. Although in most cases the diagnosis of a hepatic bile duct
cyst will be made, it is important to include in the differential diagnosis other less
frequent lesions, like autosomal dominant polycystic liver disease, biliary hamartoma, Caroli disease, undifferentiated sarcoma, biliary cystadenoma and cystadenocarcinoma, cystic subtypes of primary liver neoplasms, cystic metastases,
pyogenic and amebic abscesses, intrahepatic hydatid cyst, extrapancreatic pseudocyst, and intrahepatic hematoma and biloma.
Imaging Findings: Specific MR imaging findings that are important to recognize
are the size of the lesion; the presence and thickness of a wall; the presence of
septa, calcifications, or internal nodules; the enhancement pattern; and the signal intensity spectrum. The most important clinical parameters defined include
age and gender, clinical history, and symptoms.
Conclusion: Characterization of cystic focal liver lesions has always been a challenge for the radiologist. An understanding of the classic MR imaging appearances will allow more definitive diagnosis and shorten the diagnostic work-up.
C-031
Ultrasonography of diffuse and focal liver disease: A multimedia DVD-Rom
based educational tool and database
P.S. Zoumpoulis, I. Theotokas, I. Bechrakis, C. Belligiannis, K. Pahos,
I. Vafiadi; Athens/GR (echo@hol.gr)
Learning Objectives: 1. To review the role of ultrasound in the diagnosis of chronic
liver disease, portal hypertension and focal liver lesions using educational text,
selected images, case studies and video Cases. 2. To help derive a sonographic
diagnosis through correct algorithms. 3. To provide comparison of US images of
diagnostic difficulty to database.
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Learning Objectives: To present a comprehensive review of various hepatic artery (HA) complications after living donor liver transplantation (LDLT). To illustrate MDCT findings of various HA complications after LDLT. To discuss
consequences of HA complications after LDLT on serial follow-up.
Background: Although it is uncommon, HA complications including pseudoaneurysm, dissection, and flow steal phenomenon as well as stenosis and thrombosis may occur after. LDLT. A timely diagnosis is of utmost importance for graft
and patient survival, because it may result in serious complications, such as lifethreatening hemorrhage, severe graft dysfunction or even failure, bile duct necrosis or stricture.
Imaging Findings: Multidetector-row CT (MDCT), with superb spatial- and timeresolution, may facilitate the diagnosis of HA complications in LDLT recipients.
However, little attention has been paid to MDCT findings of various HA complications following LDLT. For an early recognition and accurate diagnosis of HA complications, radiologists should be familiar with their MDCT findings.
Conclusion: In this exhibit we present a comprehensive review of various HA
complications after LDLT, illustrate their MDCT findings, and discuss their consequences on follow-up.
biopsy, after a median observation time of 16 months (range, 2-72). In these

patients, a single puncture was sufficient in 11 cases and in 7 patients 2 punctures were performed to obtain histological sample.
Conclusion: US-guided percutaneous biopsy of hepatocellular carcinoma as a
sole procedure has a low risk of tumour seeding along the needle tract. This risk
possibly increases with total number of punctures and with the use of repetitive
procedures.

Background: The user-friendly interface provides the possibility of free navigation throughout multimedia data, comparative database including images, text,
videos and relevant bibliography.
Procedure Details: The educational DVD-Rom contains: instructions on ultrasonographic techniques (including video with voice instructions), analytical commentary of liver diseases, archived ultrasound images with captions, discussion
pertaining to the case, its ultrasonographic findings, interpretation of the findings, many interesting cases and bibliography links. The aim of this project, to
teach the US technique, is achieved mainly by a twofold video presentation. The
user will be able to view both a presentation of: a) the examiner and his manipulations with the transducer and b) a real-time ultrasound examination. Each chapter
contains articles with key words that correspond to ultrasound images. The image galleries contain a broad selection of ultrasound images and comments on
sonographic findings. A database of sonographic images is included to aid the
user in reaching the correct diagnosis of a lesion detected in the liver.
Conclusion: This multimedia DVD-Rom familiarizes the radiologist with CD-Rom
multi-media presentations, covers all major fields of US evaluation of focal and
diffuse liver disease and presents US-guided procedures of various focal lesions.
C-032
Ectopic liver lobes and other hepatic anatomical variants: A pictorial review
I. Vivas, E. de Luis, J.J. Noguera, I. Gonzlez, D. Cano, J.I. Bilbao;
Pamplona/ES (edeluis@unav.es)
Learning Objectives: To be aware of the presence of abnormal liver anatomy
when an unexplained abdominal mass is encountered. To understand liver segmentation and its possible variants. To be aware that abnormal liver anatomy may
affect surgical planning.
Background: Congenital abnormalities of the liver are rare. Although the majority of cases are not detected, it can give rise to various clinical symptoms. One of
the most atypical anomalies is the ectopic liver that may present as recurrent
abdominal pain and impaired liver function. Imaging and operative findings are
presented and a differential diagnosis is discussed in order to increase awareness of this rare condition.
Imaging Findings: We review described liver congenital abnormalities as agenesis of its segments, deformed lobes, decrease in size of lobes, lobar atrophy,
hypoplastic lobes and Riedel's lobe. We also present two unusual cases of ectopic liver (or choristoma) encountered during laparotomy (accessory liver torsion was found mimicking a pancreatic tumor) and during a routine MR. We show
the radiological findings (CT, Angio-CT, US, MR and angiography) of a wide variety of anomalies.
Conclusion: The presence of an accessory liver among other anatomical hepatic variants is rare and in most cases asymptomatic. They may cause serious and
life-threatening problems, and should therefore kept in mind in patients with acute
abdominal pain. It also of importance for the surgeon in planning biliary surgery
or a portosystemic anastomosis.
C-033
Hepatic arterial buffer response on cross-sectional imaging
M. Dighe, S. Vaidya; Seattle, WA/US (dighe@u.washington.edu)
Learning Objectives: To illustrate the hepatic arterial buffer response (HABR)
as seen on cross-sectional imaging.
Background: The primary intrinsic regulator of the hepatic artery is the HABR,
which is the inverse response of the hepatic artery to changes in portal vein flow.
The HABR is well seen in cross-sectional imaging as hypervascularity in areas of
reduced portal vein flow.
Procedure Details: The liver receives blood supply from two sources. Approximately two-thirds of the blood supply is provided through the portal vein. The
HABR is the compensatory mechanism between the portal vein and hepatic artery that buffers the effect of portal blood flow changes on total hepatic flow. The
changes in the HABR are seen in patients with portal vein complications on crosssectional imaging as areas of increased vascularity in the arterial phase in areas
of decreased portal flow. These areas of increased vascularity can be commonly
mistaken for pathologic areas if the portal vein changes are not taken into account. The increased arterial flow is also seen as increased size of the hepatic
artery. These changes can be correlated with changes seen in Doppler ultrasound and angiography.
Conclusion: Increase in the hepatic arterial flow due to decreased flow in portal
system is seen as area of increased vascularity in the arterial phase in CT and
MRI. This should be differentiated from a pathologic process by recognizing the
changes of HABR as seen on cross-sectional imaging.
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C-034
Complications of liver transplants- imaging correlation
R. Blasbalg, A.H.M. Caiado, A.S.Z. Marcelino, M.C. Pinho, M. Chammas,
C.C. Leite, G.G. Cerri; So Paulo/BR (angelacaiado@gmail.com)
Learning Objectives: To present an illustrated review of the main complications
after a liver transplantation. To discuss the advantages and limitations of imaging
studies as well as to correlate multimodality imaging findings.
Background: Liver transplantation is currently accepted as a first-line treatment
for patients with end-stage liver disease. The number of successful transplantations and rate of overall survival have been on the rise as a result of many factors,
such as improved surgical techniques, new immunosuppressive regimens and
early detection of medical and surgical complications. Among the most significant of these are graft rejection, failure of the arterial anastomosis, biliary leaks,
fluid collections and recurrence of tumors.
Imaging Findings: Ultrasonography, computed tomography and MR imaging were
used to illustrate the main complications of liver transplants, through a multimodality approach.
Conclusion: Imaging studies have a pivotal role in detection of the main complications in patients who have undergone orthotopic liver transplantation, each
method being well suited for particular clinical situations. The usefulness of each
will depend mainly on the patient characteristics, clinical hypothesis and expertise of the imaging professionals.
C-035
Focal hepatic lesions: Superparamagnetic iron oxide (SPIO)-enhanced MR
imaging at high-field-strength (3.0 T)
D. Chung, K. Kim, Y. Park, Y. Cho, H. Kim, J. Kim; Deajeon/KR
(bookdoo7@chollian.net)
Learning Objectives: To review how to use superparamagnetic iron oxide (SPIO)
particles in the diagnosis of focal hepatic lesions. To know optimization of pulse
sequence and imaging parameters. To discuss the usefulness of SPIO-enhanced
3 T magnetic resonance (MR) imaging for focal hepatic lesions.
Background: SPIO has recently been developed as a liver-specific particulate
MR imaging contrast agent that is taken up by the Kupffer cells of the liver. This
causes signal intensity loss in T2-weighted MR images owing to the susceptibility effects of iron. Higher magnetic fields promise to yield at least linear increases
in SNR and probably contrast-to-noise ratios. Theoretical considerations suggest
that maximum liver-to-lesion contrast would occur with high field strength sequences due to increased susceptibility from local field inhomogeneity. So high
field strength after SPIO enhancement may produce a pronounced signal loss of
liver and increase SNR of focal hepatic lesion.
Imaging Findings: All MR examinations were performed with a 3.0-T magnet by
using respiratory-triggered HASTE sequence, respiratory-triggered multi-shot fast
spin-echo (FSE) sequence and respiratory-triggered T2*-weighted GRE pulse
sequences. All sequences were performed before and after administration of the
SPIO contrast agent. Post contrast-enhanced MR imaging was performed 20 minutes after the administration of the contrast agent. Images were reviewed independently by two blinded observers.
Conclusion: 3.0-T SPIO-enhanced MR imaging is promising technique for the
diagnosis of focal hepatic lesion.
C-036
Differentiation of focal liver lesions using T2-weighted magnetic resonance
imaging and texture analysis
A. Gharbali, R. Bhat, S.J. Gandy, R.S. Nicholas, R.A. Lerski; Dundee/UK
(raj.bhat@tuht.scot.nhs.uk)
Purpose: To classify differences in texture parameters between cysts, haemangiomas and metastatic liver lesions on T2-weighted MRI images, using texture
analysis software.
Methods and Materials: Seventy-eight consenting patients underwent liver MR
imaging on a 1.5 T Siemens Symphony scanner, which included the acquisition
of T2-weighted half angle turbo spin echo (HASTE) images. Two radiologists independently reported the images, and cysts (n = 6), haemangiomas (n = 3) and
metastatic lesions (n = 14) were identified with texture analysis. MAZDA software (Technical University of Lodz, Poland) was used to perform texture analysis
on the HASTE images by initially training the software to identify the ten most
discriminate features (MDF) by Fisher or least probability of error criteria on an
example of each lesion type. The resultant linear discriminant functions were
then applied to the remaining liver lesions and the result of each texture classification was compared with the initial radiological assessments.

Results: The MAZDA software was able to correctly identify all cysts, and all
but one example of the metastatic lesions on the basis of their texture parameters. However it was not possible to reliably classify haemangiomas in this instance using the same technique.
Conclusion: This pilot study has demonstrated that it is possible to differentiate
between cysts and metastatic lesions on the basis of MR imaging texture differences. Texture analysis has the potential to aid radiological diagnosis of focal
liver lesions on MRI images.
C-037
Imaging diagnosis of hepatic metastases of pancreatic carcinomas:
Significance of transient wedge-shaped contrast enhancement mimicking
arterioportal shunt
T. Gabata, N. Terayama, S. Kobayashi, J. Sanada, T. Kobayashi, O. Matsui;
Kanazawa/JP (gabata@med.m.kanazawa-u.ac.jp)
Purpose: To evaluate imaging findings of hepatic metastases from pancreatic
carcinomas, especially wedge-shaped contrast enhancement.
Methods and Materials: Dynamic CT and MR imaging were performed in 87
patients of liver metastases from pancreatic carcinomas. Fifty-one of 87 patients
underwent CT during arterial portography (CTAP), and CT during hepatic arteriography (CTHA).
Results: Liver metastases were multiple in 84 patients (97%) and solitary in 3
(3%). In 44 of 87 patients (51%), all liver metastases showed ring-like enhancement compatible with metastatic adenocarcinoma on dynamic CT and MR imaging. In 37 patients, more than one metastatic lesions showed wedge-shaped
enhancement and wedge-shaped perfusion defect on CTAP adjacent to metastatic tumors. Six patients showed multiple wedge-shaped enhancement which
was initially diagnosed as multiple arterioportal shunts (AP shunts). However,
metastatic tumors appeared within the area of wedge shaped enhancement and
increased in size on follow-up CT and/or MR images. After all, 43 of 87 patients
(49%) had AP shunt like contrast enhancement adjacent to liver metastases.
One patient with a solitary liver metastasis (1.5 cm in diameter) associated with
wedge shaped enhancement, underwent hepatic tumor resection. Pathologically,
metastatic tumor showed invasion into the portal tract with tumor thrombus in the
portal venules. Based on this pathological finding, we supposed that the etiology
of this wedge shaped enhancement associated with liver metastases from pancreatic carcinomas was related to tumor invasion into the portal tract.
Conclusion: Liver metastases from pancreatic carcinomas frequently show transient wedge-shaped enhancement, and should not be misdiagnosed as non-tumorous arterioportal shunts.
C-038
Purpose: Many studies have looked at the optimum injection ratio and scanning
delay time, but few for best concentration of contrast material. The purpose of this
paper was to evaluate the efficacy between two different concentration of contrast material (300 mgI/mL and 370 mgI/mL) for hepatic tumor detection.
Methods and Materials: Two hundred forty-nine patients with known and suspected primary hepatic tumor or liver metastasis were enrolled in this prospective multicenter study. Patients were randomly divided into group A: iohexol
300 mgI/mL, 2 mL/kg or group B: iopamidol 370 mgI/mL, 1.6 mL/kg. The duration
of contrast material injection was fixed at 30 seconds. After contrast injection,
30 ml of saline was injected. The contrast enhanced scan began at 20, 50 and
180 seconds after the 100 HU of the aorta used bolus tracking technique. The CT
value of the liver parenchyma was measured for each phase as a quantitative
evaluation. Two radiologists made a blinded qualitative evaluation of the contrast
enhancement ratio and tumor detectability. Statistical significance was evaluated
using the Student's t-test.
Results: There were no statistically significant differences between the two groups
in contrast enhancement of the liver parenchyma at three phases. Statistical analysis revealed no significant differences in qualitative evaluation between the two
groups, except for contrast enhancement ratio at the second phase.
Conclusion: Concentration of contrast material does not change the detectability of the hepatic tumor under the same iodine value per time. These results suggest that using high concentration of contrast material can reduce flow rate needed
for hepatic tumor detection.
Detecting pathology in hepatic transplants with Doppler ultrasound: A

pictorial overview
H.M.V.F. Rodrigues, P.N. Belo Oliveira, J. Adelino, A. Costa, A. Correia Xavier,
E. Pinto, M. Gonalo, F. Caseiro-Alves; Coimbra/PT (henriquerds@sapo.pt)
Learning Objectives: Document the capacities of Doppler-ultrasound in the
management of patients submitted to liver transplantation with comprehensive
examples.
Background: Whole-liver transplantation is a successful method of treating endstage liver disease. In Coimbra university hospital, 604 liver transplants have
been performed in the last thirteen years. Doppler-ultrasound has a major contribution in the early and late evaluation of those patients.
Imaging Findings: Examinations were performed by several experienced radiologists with a real-time sector scanner. A 3.5 Mhz transducer was used for Bmode, pulsed and colour procedures. From our experience we illustrate with
examples vascular complications: hepatic artery, portal vein, hepatic veins and
vena cava stenosis and/or thrombosis. Biliary complications (leaks, strictures,
stones), parenchymal pathology (infarcts, arteriovenous fistulae, abscess, haematomas and focal masses) and perihepatic collections are also depicted.
Conclusion: Doppler ultrasonography has a major contribution in the evaluation
of hepatic transplants, detecting early and late complications. Morphological and
dynamic information is obtained with this technique, of particular value at the
vascular anastomosis.
C-040
Centrifugal (inside-out) enhancement pattern of liver hemangiomas on
contrast-enhanced US
T.V. Bartolotta, M. Midiri, M. Galia, G. Runza, A. Taibbi, F. Lo Re, R. Lagalla;
Palermo/IT (tv_bartolotta@yahoo.com)
Learning Objectives: To illustrate the atypical inside-out contrast-enhancement
pattern of hepatic hemangiomas on contrast-enhanced US (CEUS).
Background: In about 20-40% of cases liver hemangiomas will not show typical
features on B-mode US (homogeneous, hyperechoic mass with well-defined
margins and posterior acoustic enhancement), thus making correct diagnosis
difficult. Contrast-specific US techniques allow better characterization of these
lesions, but atypical imaging findings may also occur when contrast agents are
administered. For example, centrifugal (inside-out) enhancement pattern of hemangiomas is described on dynamic contrast-enhanced computed tomography
(CT) and magnetic resonance imaging (MRI).
Procedure Details: We retrospectively evaluated baseline and SonoVue-enhanced ultrasonography of 40 patients with 74 hepatic hemangiomas. All hemangiomas were atypical on B-mode US and were confirmed by CT and/or MRI. US
examinations were videotaped and reviewed by two experienced radiologists
searching for inside-out contrast-enhancement pattern, defined as the presence
of central enhancing foci in the arterial phase followed by a centrifugal enhancement in the portal-venous and delayed phases. Inside-out enhancement was found
in 11/74 (15%) of hemangiomas (size range: 1.3-5 cm; mean: 2.5 cm), which presented no statistically significant differences on conventional US when compared
with the remaining 63/74 lesions. 3/11 hemangiomas showed a hypoechoic central area surrounded by a thick hyperechoic rim and some tiny calcifications,
whereas 8/11 lesions were inhomogeneous. Doppler analysis revealed the presence of peripheral arterial blood flow in one case.
Conclusion: When performing CEUS of liver lesions radiologists should be aware
that centrifugal contrast-enhancement pattern is an unusual but possible feature
of hepatic hemangioma.
C-041
Post-mortem intrahepatic gas: Occurrence in forensic CT, etiology and
significance
C. Jackowski, M. Sonnenschein, M.J. Thali, E. Aghayev, K. Yen, R. Dirnhofer,
P. Vock; Berne/CH (christian.jackowski@irm.unibe.ch)
Purpose: Intrahepatic gas (IHG) is a more common finding in post-mortem CT
scans than in clinical CT investigations. The aim of this study was to investigate
the diagnostic significance of this finding.
Methods and Materials: 84 forensic corpses were CT scanned. The occurrence
of IHG, its location within the branches of the hepatic artery, portal vein, hepatic
vein, the biliary ducts or within the parenchyma were assessed. The volume of
IHG was segmented. The presence of systemic gas embolism, open trauma,
intestinal distension, signs of putrefaction and history of ante-mortem artificial
respiration were noted. Statistical analysis of the data was performed using the
contingency table and the chi square test.
329
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Evaluation of optimum contrast enhancement by MDCT for hepatic tumor

detection: A multicenter prospective clinical trial
T. Gomi, Y. Kawawa, M. Nagamoto, H. Terada, E. Kohda; Tokyo-Meguro/JP
(gomi@oha.toho-u.ac.jp)
C-039

Results: IHG occurred in 48 cases (55.8 %) and gas volumes ranged from < 1 ml
to 189 ml. Gas was found within branches of the hepatic artery in 22 cases, the
hepatic vein in 37 cases, the portal vein in 15 cases, and intraparenchymal in 3
cases with different combinations in the same corpse. Systemic gas embolism
was seen in 43 cases (50 %). Open trauma was diagnosed in 51 cases (59 %).
There was a significant correlation of the findings of IHG and systemic gas as
well as between IHG and an open traumatic cause of death. There was no correlation between IHG and intestinal distension.
Conclusion: Systemic gas embolism due to an open trauma is the most common cause of IHG in forensic post-mortem imaging. Artificial respiration may
cause systemic gas embolism and lead to hepatic arterial gas.
C-042
Intrahepatic arterioportal shunt: Color Doppler ultrasonography and MDCT
findings
F. Todua, G. Tsivtsivadze, R. Kharadze, D. Gachechiladze, G. Svanidze;
Tbilisi/GE (rkharadze@yahoo.com)
Purpose: To characterize the appearance of intrahepatic arterioportal shunting
(APS) on color/power Doppler ultrasonography (CDUS) and multidetector CT
(MDCT).
Methods and Materials: We retrospectively reviewed 31 cases of APS (19 secondary to HCC, 8 secondary to hemangioma and 4 secondary to liver cirrhosis)
diagnosed by CDUS and MDCT. Patients were examined by enhanced thin-slice
MDCT in early hepatic arterial phase (HAP), late hepatic arterial phase and portal venous phase.
Results: CDUS revealed APS in 23 (74.2%) cases (5 hemangioma, 14 HCC and
4 cirrhosis). In the cases with APS decrease of resistive index and pulsitivity
index was present relative to values in the other lobe. In all cases multiple intratumoral flow and large feeding arteries, also reverse portal flow and pseudo-pulsation within (11 cases) or around (9 cases) the tumors were diagnosed. In 25
(80.6%) cases we found earlier enhancement or stronger opacification either of
the main portal trunk and the first order branches compared with that of superior
mesenteric and splenic veins, or of the second order and smaller portal venous
branches compared with that of the main portal trunk. In 22 (71%) cases transient, peripheral, triangular parenchymal enhancement was depicted during the
HAP.
Conclusion: The complex use of Color Doppler and especially MDCT, with its
new reconstruction programs, enable us to identify and characterise complex
vascular alterations typical to intrahepatic APS.
C-043
Imaging of recurrent hepatocellular carcinoma after liver transplantation
J.A. Duarte, M. Zanotelli, A. Brando, C. Kalakun, G.P.C. Cantisani, C. Marroni;
Porto Alegre/BR (juavila2003@yahoo.com.br)
Purpose: To show the different forms of recurrent hepatocellular carcinoma (HCC)
in patients who underwent liver transplantation.
Methods and Materials: We reviewed 79 patients who underwent potentially
curative liver transplantation for HCC and presented with recurrence between
December 1997 to July 2005, from 500 patients who received liver transplantation. Pathological data as vascular invasion, tumor size, detection of additional
nodules and satellite nodules were observed.
Results: Among the main group, 11 patients presented recurrence (14%). The
survival rate was 92% in the 1 st month, 84% in the 6th month, 83% in the 12th
month, 75% in the 24th month and 48th month. Among the recurrence group, 10
(90.9%) had solitary tumor and 1 (9.0%) had two lesions; vascular invasion was
observed in 4 (5.1%) cases, and 2 (18.2%) of the recurrence group. The mean
time for recurrence was 13.8 months (range 6-36 months). The sites of recurrence were retroperitoneal and neck lymph nodes, bones, grafted liver and lungs.
Conclusion: The liver transplantation for patients who have HCC, using very
strict criteria, is the best treatment option. The recurrence is still the main problem. In our paper we concluded that the current imaging techniques used in our
population were not able to detect small premalignant lesions, and have a high
incidence of false-negative and false-positive results. The different imaging patterns of HCC recurrence is shown.
330
C-044
Diffusion changes in hepatic tumors treated with percutaneous
radiofrequency ablation
E. Szurowska, M. Studniarek, J. Pienkowska, E. Izycka-Swieszewska,
D. Zadrozny, I. Marek, A. Szrmach; Gdansk/PL (jpienkowska@amg.gda.pl)
Purpose: To describe the diffusion changes of hepatic tumors treated with percutaneous radiofrequency ablation (RFA).
Methods and Materials: Twenty-four patients with 30 tumors (20 metastases
and 10 HCC) treated with RFA underwent MR imaging examinations performed
before (maximum 7 days before) and one day after therapy. MR studies included
T1- and T2- weighted SE and TSE sequences without and with fat saturation
followed by diffusion-weighted imaging (DWI) with different b value (b = 30, 300,
900 and 2000 s/mm2). Apparent diffusion coefficients (ADC) were calculated for
each tumor and normal liver parenchyma before and after radiofrequency ablation. Prospectively observed lesions were evaluated by two independent observers according to ADC with different b value.
Results: Significant difference (p = 0.01) of ADC was observed between tumors
before and after therapy when the b value was 300 s/mm2. Mean ADC values in
tumor one day after therapy was significantly (p = 0.012) lower than before. Decreased ADC levels of tumors suggested decreased diffusivity due to tumor dehydratation.
Conclusion: Tumor ADC changes after radiofrequency ablation induced alterations in tumor diffusivity. The early changes after ablation are best visible on DWI
with b value = 300 s/mm2. Decreased ADC at one day after RFA can predict
treatment effect.

C-047
Pancreas
Pathologic-radiologic correlation of cystic and cystic-like tumors of the

pancreas
M.A. Cura1, A. Cura2; 1San Antonio, TX/US, 2Parana/AR
(marcocura@yahoo.com)
C-045
Ductal adenocarcinoma versus localized parenchymal fibrosis of the
pancreas: Evaluation with dynamic helical CT
Y. Yamada, H. Mori, S. Matsumoto, N. Hongo, H. Kiyosue; Oita/JP
(YASUNARI@med.oita-u.ac.jp)
Purpose: To define the enhancement behavior of ductal adenocarcinoma and
localized fibrosis of the pancreas during three-phase helical CT, and to differentiate between each pathology.
Methods and Materials: Eighty-six lesions with pathologically proven pancreatic diseases and fifty-three lesions with clinically diagnosis of pancreatic diseases
underwent three-phase helical CT (collimation, 5 mm; reconstruction, 2.5 mm;
scan delay, 30, 60, 180 sec). The mean attenuation of the foci of ductal adenocarcinoma (n = 91), parenchymal fibrosis (n = 48) and normal pancreas (n = 40) was
measured for each phase, and the time-attenuation slope for each pathology was
obtained.
Results: Mean enhancement of the normal pancreas was seen with a peak in
the first phase, while mean enhancement of the parenchymal fibrosis was seen
with a lower peak in the second phase. A mean enhancement of the ductal adenocarcinoma showed a gradually rising pattern without a peak. The difference in
the time-attenuation slopes between ductal adenocarcinoma and parenchymal
fibrosis was statistically significant (p < 0.05) between the second and third phases.
The diagnostic indices for the time-intensity curve between ductal adenocarcinoma and parenchymal fibrosis were: sensitivity, 93%; specificity, 84%; and diagnostic accuracy, 90%. A mean attenuation of the first phase was statistically
significant (p < 0.05) between the ductal adenocarcinoma and parenchymal fibrosis. The diagnostic indices for the first phase were: sensitivity, 82%; specificity, 71%; and diagnostic accuracy, 78%.
Conclusion: Differentiation between pancreatic ductal adenocarcinoma and localized parenchymal fibrosis was achieved by analysis of the time-attenuation
slopes between the second and third phases obtained during the three-phase
dynamic helical CT.
C-046
Lymphoplasmacytic pancreatitis and lymphoplasmacytic cholangiopathy:
Imaging and histologic features
E. Alonso, C. Valls, E. Andia, E. Merino, M. De Albert, T. Serrano, L. Aja;
Barcelona/ES (estherilla.a@ozu.es)
C-048
MDCT manifestations of acute necrotizing pancreatitis: Glandular necrosis,
inflammatory spreading and disease severity
B. Song, Y. Cheng; Chengdu/CN (anicesong@vip.sina.com)
Purpose: To evaluate the multi-detector row spiral CT (MDCT) manifestations of
acute necrotizing pancreatitis (ANP) and to investigate the relationship of glandular necrosis to retroperitoneal inflammatory spreading and ANP severity.
Methods and Materials: 90 patients diagnosed as ANP based on clinical, laboratory and ultrasound findings underwent contrast-enhanced dual-phase scanning of the abdomen with a 16-slice MDCT unit. Two radiologists through
consensus reading interpreted CT images. The area of pancreatic necrosis, the
extent of retroperitoneal inflammatory spreading and other associated findings
were recorded along with Balthazar's CT grading, CT severity index (CTSI) and
Ranson's clinical scoring. Statistical analysis was applied for the relationship of
CT findings with ANP severity.
Results: 1. 40 patients had glandular necrosis of less than 30%, 11 of whom
belonged to Balthazar's grade C, 22 grade D and 7 grade E. 23 patients had
necrosis of 30%-50%, of whom 1 was grade C, 12 grade D and 10 grade E. 27
patients had necrosis of more than 50%, of whom 8 were grade D and 19 grade
E. Correlation between glandular necrosis and inflammatory spreading was of
statistically significant ( < 0.05). 2. The degree of glandular necrosis was also
positively correlated with both CTSI and Ranson's clinical scoring ( < 0.05). 3.
Serial MDCT examinations revealed the dynamic evolution of glandular necrosis
in 15 patients.
Conclusion: The degree of glandular necrosis in patients with ANP correlates
closely with the extent of inflammatory spreading, and can be used as an important indicator of disease severity.
C-049
Mimics of pancreatic adenocarcinoma on CT imaging
C. Triantopoulou, N. Giannakou, P. Maniatis, I. Siafas, J. Papailiou,
C. Dervenis; Athens/GR (chatri@mycosmos.gr)
Learning Objectives: To demonstrate the spectrum of diseases that can mimic
pancreatic cancer on CT imaging and to present differential diagnostic criteria.
Background: Ductal adenocarcinoma represents approximately 90% of all tumors arising in the pancreas. There are many congenital, inflammatory, or periampullary lesions that may mimic pancreatic adenocarcinoma on CT imaging.
We retrospectively evaluated CT images of 60 patients with a pancreatic "mass
like" lesion and correlated them with surgical, CT-guided FNA or EUS-FNA findings, as well as with follow-up imaging studies. All examinations were conducted
on a helical scanner, using 3-5 mm collimation after i.v. administration of contrast
material.
Imaging Findings: 55 patients underwent a Whipple operation. In 51 cases pan-
331
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Learning Objectives: To review imaging findings to improve lesion characterization in patients with lymphoplasmacytic sclerosing pancreatitis (LPSP) and lymphoplasmacytic cholangiopathy.
Background: Lymphoplasmacytic pancreatitis and lymphoplasmacytic chronic
biliary tract disease are rare inflammatory conditions characterized by diffuse
fibro-inflammatory infiltrates of the biliary tract, the pancreatic ducts and acinar
parenchyma. LPSP is a distinctive form of chronic pancreatitis characterized by
fibro-inflammatory reaction centered around the major pancreatic ducts. The pathogenesis of LPSP is unknown but an autoimmune mechanism has been suggested. A characteristic form of biliary tract disease has been recently described
consisting of diffuse lymphoplasmacytic chronic inflammation. This is usually
associated to LPSP but can also been found alone. Its is likely that both entities
are part of a spectrum of biliary tract and pancreatic disease that includes strictures fibrosis and inflammation leading to either chronic pancreatitis or perihilar
bile duct stricture.
Imaging Findings: Nine patients with histopathologic diagnosis of LPSP and
lymphoplasmacytic cholangiopathy were evaluated. Features that suggest LPSP
includes diffuse or focal enlargement of the pancreatic gland without significant
pancreatic duct dilatation. In the focal form this disease may mimic pancreatic
cancer. Lymphoplasmacytic cholangiopathy shows periductal thickening of the
biliary tract wall with dense contrast enhancement simulating cholangiocarcinoma.
Conclusion: Awareness of LPSP and lymphoplasmacytic cholangiopathy is critical in order to improve the differential diagnosis of pancreatic and hilar lesions.
Learning Objective: To learn the spectrum of cystic lesions of the pancreas. To

recognize and categorize imaging findings of cystic lesions of the pancreas. Understand the diseases by correlating radiological and pathologic studies of cystic
lesions of the pancreas. Demonstrate the correlation between the radiological
manifestation of the cystic lesions of the pancreas and the pathology specimens.
To develop a differential diagnoses of cystic lesions of the pancreas.
Background: Pseudocysts, a sequelae of pancreatitis, are the most common
cystic lesion of the pancreas, but the differential diagnosis of cystic lesions in the
pancreas also include simple cysts, and benign or malignant cystic tumors. The
use of the available imaging modalities, ultrasound, CT and MR imaging help to
characterize the cystic lesion and the correlation of the imaging findings with
pathology specimens help to understand the disease process and its radiological
presentation. This exhibit correlates the pathology findings with the imaging appearances of different cystic lesions of the pancreas. Understanding the pathology of the diseases is essential when interpreting diagnostic studies.
Imaging Findings: The radiological findings of cystic lesion and cystic tumors
are reviewed, illustrated using plain films, CT, MR imaging and ultrasound. These
findings are correlated with histological and macroscopic pathological specimens.
Conclusion: When radiological and pathologic findings of cystic lesions of the
pancreas are put together in the proper format, they improve the understanding
of the diseases and the quality of the radiological diagnosis.

creatic adenocarcinoma was proven, while in the remaining 4 cases pathologic
evaluation showed groove pancreatitis, chronic pancreatitis, Brunner adenoma
and metastatic disease. In the patients did not undergo surgery 2/5 patients had
proven lymphoma, 2/5 had autoimmune pancreatitis and 1/5 chronic pancreatitis
within pancreatic divisum demonstrated on ERCP. All imaging findings will be
illustrated and discussed in conjunction with pathology results.
Conclusion: There is a large variety of conditions that may mimic pancreatic
cancer. Radiologists must be aware of these situations and subtle imaging differences so that unnecessary operations can be avoided.
C-050
CT of blunt pancreatic trauma
S.K. Venkatesh; Singapore/SG (dnrskv@nus.edu.sg)
Learning Objectives: To describe CT findings in acute pancreatic injury and its
delayed complications.
Background: Injury to pancreas is uncommon, occurring in less than 2% of blunt
abdominal trauma. Symptoms and clinical findings are often non-specific and
unreliable leading to a delay in diagnosis and therefore increased morbidity. CT
is the most widely used imaging technique in the assessment of major abdominal
trauma. CT detection of pancreatic injuries requires close attention to technique
and awareness of subtle changes produced by pancreatic injury.
Imaging Findings: The CT features range from a normal initial appearance to
active pancreatic bleeding. Active pancreatic bleeding is pathognomonic of pancreatic injury. The common CT signs of pancreatic injury are focal or diffuse pancreatic enlargement/edema, pancreatic haematoma, pancreatic laceration,
peripancreatic fat inflammation, fluid separating splenic vein from pancreas, thickening of left anterior and posterior para renal spaces, hemorrhage into peripancreatic fat, mesocolon and mesentery, pseudocyst formation, fluid surrounding
the superior mesenteric artery, free fluid, pancreatic ductal dilatation. The most
common pancreas related complications are pseudocyst, pancreatitis, pancreatic fistula, major duct stricture and abscess. Intensive care complications include
acute respiratory distress syndrome, multi-organ failure and pneumonia and abdominal complications (abscess, wound infection, ventral hernia, and enteric fistula). CT is useful in demonstrating complications and in follow-up.
Conclusion: Pancreatic trauma is uncommon and frequently missed diagnosis.
Knowledge of CT signs of pancreatic trauma and high index of suspicion is required in diagnosing pancreatic injury. CT is useful in evaluation of complications
which cause morbidity.
C-051
Imaging findings of pancreatic acinar cell carcinoma
Y.-Y. Chiou, C.-H. Yen, J.-H. Chiang, S.-H. Tsay, Y.-H. Chou, C.-Y. Chang;
Taipei/TW (yychiou@vghtpe.gov.tw)
Learning Objectives: To illustrate the imaging findings of pancreatic acinar cell
carcinoma (ACC) and to review its epidemiology, histopathology, clinical manifestations and differential diagnosis.
Background: ACC is a subtype of pancreatic neoplasm sufficiently rare that its
imaging has not been fully analyzed. The purpose of this exhibit is to evaluate the
CT and MR imaging features of 12 pancreatic ACCs at our hospital, correlating
the pathologic and surgical findings.
Imaging Findings: On nonenhanced CT ACC demonstrates a high frequency of
internal calcification and almost no intratumoral hemorrhage. On contrast-enhanced CT, the tumor margin is often well circumscribed and covered by a thin
well-enhancing capsule. ACC is generally hypoattenuating to the pancreas, with
variable amounts of focal hypoattenuation. In the portal venous phase of dynamic studies, most tumors have persistent enhancement, and some have progressive filling of contrast agent into part of the focal hypoattenuation. Some tumors
may have mild contrast washout. The tumor capsule is generally best enhanced
in the portal venous phase. MR imaging shows the capsule and intratumoral hemorrhage better than does CT; therefore, it has the potential to improve the ability
to diagnose ACC. Ultrasonography often shows nonspecific masses. These imaging features mentioned are helpful in differentiating ACC from other pancreatic
neoplasms.
Conclusion: ACC typically presents as a sizable pancreatic mass with a welldefined enhancing capsule and internal calcification. Significant central necrosis
is frequently present. Recognition of these features can provide clues to the diagnosis of ACC.
Miscellaneous
C-052
Contrast-enhanced sonography (CEUS) imaging for blunt abdominal
trauma (BAT): International multi-centre prospective study results
O. Catalano1, P. Sidhu2, M. Valentino3, V. Nazzaro3, A. De Marchi4, A. Ziosi3,
L. Barozzi3, A. Siani 1, A. Martegani5; 1Naples/IT, 2London/UK, 3Bologna/IT,
4
Turin/IT, 5Como/IT
Purpose: To evaluate the concordance between US and CEUS in the assessment of solid organ injury following BAT.
Methods and Materials: Patients presenting with a history of BAT at 6 centres
were enrolled. They underwent complete US survey and CEUS using low mechanical index and SonoVue, 2x2.4 mL injections (Bracco, Italy). Assessment of
kidneys (arterial phase), liver, and spleen (venous phase) was performed. Patients underwent contrast-enhanced CT (CECT) within 1 hour.
Results: CECT found 106 abnormalities in 91 patients: 26 kidneys, 38 liver, 43
spleen. At baseline US the distribution of abnormalities was: 12 kidneys, 29 liver,
37 spleen. Following CEUS distribution was: 19 kidneys, 33 liver, 41 spleen. Sensitivity, specificity and accuracy for kidneys at US were 25%, 98%, and 89%
respectively; after CEUS values increased to 69%, 100%, and 97%. For liver
baseline US values were 45%, 95%, and 85%; after CEUS were 78%, 98%, and
93%. For spleen, results were 67%, 83%, and 80% at baseline US and 90.5%,
97%, and 97% after CEUS. Per patient evaluation gave the following results in
terms of sensitivity, specificity and accuracy: 37%, 83%, 58% at baseline US;
84% 97%, and 89% following CEUS. A definite or possible diagnosis was reached
in 83, 138 and 149/156 patients undergoing US, CEUS, or CECT.
Conclusion: CEUS is more sensitive than US and almost as sensitive as CECT
in the detection of solid organ injury in BAT, potentially reducing the need for
further imaging. False negative CEUS results are due to minor injuries and do
not change patient outcome.
C-053
Anatomic-radiologic correlation of lymphatic pathways in malignant
hepatobiliary and pancreatic diseases on the multi-planar reformatted
isotropic CT images
S.-Y. Jung, W. Lee, S. Kim, S. Bae, S. Kim, H.K. Lim; Seoul/KR
(wjlee@smc.samsung.co.kr)
Learning Objectives: To understand the Japanese and AJCC classifications of
the abdominal lymph nodes (LN) and their anatomic-radiologic correlation on the
isotropic multi-planar reformatted (MPR) CT images. To understand the lymphatic pathways of malignant hepatobiliary and pancreatic diseases and the advantages of the MPR images in LN staging of these malignant diseases.
Background: Elucidation of anatomic-radiologic correlations of various abdominal structures on isotropic MPR images has become increasingly important to
radiologists, due to their prevalent use in daily practice. Fortunately, these structures proved to be better depicted on the MPR images than on the axial images
in our experience. Particularly lymphadenopathy was clearly found along their
lymphatic pathway on the MPR images in patients with malignant hepatobiliary
diseases. However, the nomenclature of the LN is complex and confusing, and
their anatomic location is not clearly defined on the MPR images.
Imaging Findings: Over a recent one-year period, we routinely obtained isotropic MPR images when performing abdominal CT in patients with suspected hepatobiliary and pancreatic diseases. Among these, many MPR images nicely showed
the precise location of various lymphadenopathies, which were equivocal on the
axial images. This enabled us to designate their precise nomenclatures according to the Japanese or AJCC classifications.
Conclusion: In this exhibit, we introduce the Japanese and AJCC classifications
of the abdominal LN, describe their anatomic-radiologic correlation, illustrate lymphatic pathways of malignant hepatobiliary and pancreatic diseases including on
the isotropic MPR images, and finally discuss their advantages in LN staging of
these diseases.
C-054
Angiosarcoma from head to toe with radiologic-pathologic correlation
V.V.R. Kandula, A. Donuru, H. Obaid, J. Entwisle, A. Mcgregor; Leicester/UK
(vinaykandula@hotmail.com)
Learning Objectives: 1. To illustrate the spectrum of biopsy proven or post-mortem confirmed cases of angiosarcoma seen on radiological investigations at our
332

institutions over the last 15 years. 2. To demonstrate that radiological findings in
angiosarcoma which are extremely variable and diverse.
Background: Angiosarcomas are uncommon malignant neoplasms characterised by rapidly proliferating, extensively infiltrating anaplastic cells derived from
blood vessels and lining irregular, blood-filled spaces. Angiosarcomas are aggressive and tend to recur locally, spread widely, and have a high rate of lymph
node and systemic metastases. The rate of tumor-related death is high.
Imaging Findings: Angiosarcomas arising at different sites and in different organs have some distinct features. Angiosarcomas may occur in any region of the
body but are more frequent in skin and soft tissue. Angiosarcomas also can originate in the liver, breast, spleen, bone, or heart. We illustrate examples of biopsy
proven or post-mortem confirmed cases of angiosarcoma seen on radiological
investigations in our institutions over the last 15 years with radiologic-pathologic
correlation. We illustrate CT and MR imaging features of angiosarcoma of soft
tissue, bone, breast, pleura, thorax, liver, spleen and heart.
Conclusion: Radiological findings in angiosarcoma are extremely variable and
diverse. It must be considered in the differential diagnosis in the areas illustrated
to enable appropriate patient management.
C-055
Contrast dose in abdominal CT: Advantages of weight adjusted dose
E. Arana, L. Mart-Bonmat, E. Tobarra, J. Forner, C. Sierra; Valencia/ES
(Luis.Marti@uv.es)
Purpose: To analyze the influence of weight-adjusted contrast dose (WACD)
compared to fixed contrast dose (FCD) in the quality and cost of abdominal CT.
Methods and Materials: A randomized, consecutive, parallel group study conducted in 150 patients (73 men and 77 women, age 55.5 16 years), studied
with the same CT helical protocol. Visipaque 320 mg/mL was administered at
1.75 mL/Kg in 101 subjects and in 49 patients a dose of 120 mL of same contrast
agent. Patients were similar regarding disease, gender, age and weight distribution. All were injected at 2.5 mL/sec at a fixed delay time of 55 sec. Attenuation
coefficient measurements were obtained at right hepatic lobe, superior abdominal aorta and inferior cava vein. Statistical analysis was made with ANOVA and
chi-square tests and patients divided by weight (< 60 kg, 61-70 kg, 71-80 kg and
> 81 kg).
Results: Aortic attenuation was significantly superior (p < 0.05) in the WACD
group. However, in the FCD vena cava attenuation was superior (p < 0.001). Under 80 kg there was no statistical difference between groups, however in patients
> 81 kg, hepatic attenuation was statistically superior in the WACD.
The average saving in the weight-adjusted contrast dose < 80 kg was 4 per
patient. In patients > 80 kg, there was and over-cost of 12 per patient.
Conclusion: In patients < 80 kg, an injection volume of 1.75 ml/kg offers an optimal diagnostic quality saving 160 in a 100 patients group with similar demographic criteria.
CT and MRI manifestations of pathologies with fatty components from head

to foot: Differential diagnosis and pitfalls
M. Takeuchi, K. Matsuzaki, H. Nishitani, H. Uehara; Tokushima/JP
(mayumi@clin.med.tokushima-u.ac.jp)
Learning Objectives: To demonstrate various imaging findings of pathologies
with fatty components from head to foot.
Background: Various tumors and tumor-like conditions may contain fatty components and detection of fat is useful for narrowing the differential diagnosis. In
this exhibit we demonstrate a broad spectrum of fat-containing pathologies including physiologic, metabolic, inflammatory, degenerative, and neoplastic lesions with pathologic correlation.
Imaging Findings: Neoplastic, hamartomatous, metaplastic, or degenerative fatty
components are observed in various tumors. Teratomas may arise from germ
cells in the body, with a predilection for ovary and mediastinum. Lipogenic tumors
such as lipoma, lipoblastoma, and liposarcoma usually involve soft tissues and
retroperitoneal adipose tissue. Hamartomatous or degenerative fatty components
may be observed in tumors such as renal angiomyolipoma, adrenal myelolipoma, hepatic adenoma and hepatocellular carcinoma, and angiolipoma of soft tissue. Fatty metamorphosis in uterine lipoleiomyoma, intraarticular fatty proliferation
in lipoma arborescens, lipomatous changes adjacent to osseous protrusion in
parosteal lipoma are rare but characteristic. Existing fat in surrounding tissues
may be trapped in elastofibroma and hemangioma. Detection of bone marrow fat
in exostosis, ligamentous ossification, or bone infarction, inflammatory fatty changes of mesenteric panniculitis, trapped fat of tumorous omental involvement (omental cake) are also important findings. CT and MR imaging may demonstrate mature
C-057
A new sonographic predictor of bleeding, the "black hole"
O. Catalano, M. Mattace Raso, F. Sandomenico, P. Vallone, A. Nunziata,
A. Siani; Naples/IT (tonikus@libero.it)
Learning Objectives: To illustrate the sonographic (US) finding of a small anechoic area within hemorrhagic abdominal processes. To correlate it with contrastenhanced US and CT images showing how the anechoic focus matches
extravasation site or pseudoaneurysm site. To highlight the practical value of detecting this anechoic focus in prompting further investigation.
Background: In published literature, some articles have anecdotally mentioned
a focal anechoic collection at the centre of an hemorrhagic process (hematoma,
bleeding mass, or traumatic injury). Nevertheless, this finding has never been
systematically described.
Imaging Findings: A small anechoic focus within a bleeding area relates to the
exact site of active blood extravasation or pseudoaneurysm formation. This relationship was confirmed with colour-Doppler (vorticious internal flow) or with contrast-enhanced US or CT (contrast pooling). We show how the anechoic "hole"
exactly matches the bleeding site. Differentiation between bleeding (undelimited
blood collection) and pseudoaneurysm (delimited blood collection) is difficult and
not always possible. This, however, has limited value since both conditions require treatment.
Conclusion: A small anechoic focus within a hematoma or a complex mass suspected hemorrhagic should prompt further investigation since it may indicate brisk
bleeding or pseudoaneurysm.
C-059
Perfusion CT: A pictorial review from head to prostate
G. Pekindil, G. Yilmaz Ovali, P. Bayindir, S. Serter, S. Tarhan, C. Goktan,
Y. Pabuscu; Manisa/TR (pekindilg@yahoo.com)
Learning Objectives: To present several examples of perfusion CT studies performed on different parts of the body. To describe specific perfusion CT findings
of many ischemic brain and tumoral pathologies. To understand the role of perfusion CT in evaluation of many diseases.
Background: Perfusion CT is an application in which a quantitative map of tissue perfusion is created from dynamic CT data and displayed by means of color
scale.
Procedure Details: During the last year we studied a total 43 cases. All studies
were performed using single-slice helical CT scanner (Siemens-Emotion). After
power injection of iodinated contrast media (5 ml/s), 30 scans were performed (1
scan/s) at a fixed table position during breathhold. Ischemic brain pathologies,
bronchial carcinoma, hepatocellular carcinoma (HCC), cavernous hemangioma
of the liver, post-chemoembolization of HCC, acute pancreatitis, retroperitoneal
plasmocytoma and paraganglioma, surrenal metastasis, renal cell carcinoma,
post-operative pelvic tumor evaluation, prostatic malignancy and osteoid osteoma were included the study. Blood flow (BF), blood volume (BV), mean transit
time (MTT), perfusion and peak enhancement values were calculated and coloured maps were created using software. Ischemic perfusion defects, typical
perfusions of HCC, hemangiomas, renal cell carcinoma are easily revealed. Postoperative fibrosis versus tumor recurrence can also be differentiated. Hypervascular nidus of osteoid osteoma can be detected.
Conclusion: Perfusion CT may be useful for quantitative analysis of perfusion
changes in many ischemic and tumoral pathologies. Therefore perfusion CT may
be helpful in oncology, providing a higher degree of diagnosis accuracy, differentiation of malignancy and for the therapeutical follow-up.
C-060
Klebsiella: An increasingly important pathogen
Z.Y. Joazlina; Kuala Lumpur/MY (joazlinazy@yahoo.com)
Learning Objectives: To be aware of the possibility and implications of Klebsiella as a both nosocomial and community acquired infection. To illustrate examples
of Klebsiella infection in different body systems.
Background: Klebsiella are aerobic Gram positive rods that colonise the gastrointestinal tract and are capable of causing a wide variety of clinical syndromes.
Klebsiella is an important cause of nosocomial infection particularly of the uri-
333
a (Solid Or
gans)
iscer
Abdominal V
Org
Viscer
iscera
C-056
adipose tissue clearly, and chemical shift MR imaging is useful to detect intracellular lipid components of adrenal cortical adenoma, or small volumes of intermingled fat in cystic teratoma or fatty infiltration of the liver.
Conclusion: To recognize various manifestations of fat-containing pathologies is
important for differential diagnosis.

nary tract, lower respiratory tract, biliary tract and surgical wounds. Important
risk factors are indwelling catheter in urinary tract infection, ventilation in respiratory tract infection and central venous lines in septicaemia. Community acquired
Klebsiella infection is most often seen in patients with pre existing conditions
such as diabetes or alcoholism. A worrying feature is the emergence of virulent
multi resistant strains of Klebsiella that produce extended spectra beta lactamase (ESBL) which needs treatment with carbapenam antibiotics. A high mortality results unless appropriate treatment is commenced early in the course of the
disease.
Imaging Findings: Examples of Klebsiella infection causing pneumonia; liver,
spleen, soft tissue, genitourinary and retroperitoneal abscesses; bone and joint
and central nervous system infection are illustrated.
Conclusion: Klebsiella infection and abscess formation can occur anywhere in
the body. Gas may be seen in an abscess but the abscesses do not have any
specific features to distinguish them from infection from other organisms. The
possibility of Klebsiella infection should be seriously considered in nosocomial
infections and in diabetic patients and those with other debilitating conditions so
that effective treatment can be instituted without delay.
C-061
Unusual extra-nodal lymphomatous involvement: A review
C. Cronin, D. Lohan, N. Gough, C. O'Riordan, J. Murphy, C. Roche,
P. McCarthy; Galway/IE (carmelcronin2000@hotmail.com)
Learning Objectives: To provide an educational exhibit of the radiological imaging findings, distribution and classification with pathological correlation, of the
rare extra-nodal, solid organ involvement of lymphoma. To illustrate the characteristics appearances and discuss differentials were appropriate, in particular
differentiating it from other neoplasms.
Background: Lymphoma classically presents in lymph node sites throughout
the human body. 80% of Hodgkin's and 65% of non-Hodgkin's lymphoma (NHL)
have a nodal presentation. Extra-nodal involvements include GIT of 10% in NHL
and 25% of Hodgkins disease. In a minority it occurs in lymphomatous tissue
glands such as those of Waldyers ring. Even more infrequently still is lymphoma
of solid abdominal organs such as the adrenal, spleen, pancreas, kidneys and
testes. Each has a number of distinct and sometimes classical patterns of involvement, the kidney in particular.
Imaging Findings: Through an institutional experience and a review of literature
we will provide a case by case pictorial review of the various presenting imaging
features (barium/ultrasound/CT/MRI/PET), classification, consequences and
guises of lymphoma involving the above glands, organs and gastrointestinal tract.
Conclusion: These are unusual sites of involvement and we pay attention to
there imaging features and progression. Through this review we hope to provide
an informative concise guide.
C-062
Utility of diffusion-weighted MR imaging of the abdominal lesions with unidirectional single shot echoplanar sequence
S.K. Venkatesh, F. Leung, C. Au; Singapore/SG (dnrskv@nus.edu.sg)
Purpose: To evaluate single-shot echo-planar diffusion-weighted MR sequence
with unidirectional diffusion gradient for characterization of various abdominal
lesions.
Methods and Materials: Diffusion-weighted MR imaging (DWI) was performed
in 60 clinical patients and 10 normal volunteers. DWI was performed with single
breath-hold sequence with TR/TE=6000/65; FOV 320-400 mm; 5 mm slice; 0
spacing; 128x128 matrix; gradient along z-axis and scan time 13-19 seconds.
Two sequences were performed with b=200 and 500. Apparent diffusion coefficients (ADC) were calculated for normal liver, gall bladder, spleen, kidney, pancreas in normal volunteers and cirrhotic liver (20) and focal lesions of liver including
hepatocellular carcinomas (46) metastases (50), pyogenic abscess (4), adenoma (1), cysts in liver and cysts (90), abdominal collections (6), leiomyoma (1) and
hemangioma (8) cystadenoma (1), infarcts (4), carcinoma of the stomach, gall
bladder, uterus and kidney (1 each) and other miscellaneous lesions (10).
Results: Most of the focal lesions were better demonstrated on DWI as compared to T2-W images. The signal intensity of normal organs and lesions was
lower with DWI b=500 as compared to b=200. The mean ADC values of malignant lesions (156.09 45; 131 41) was significantly lower than benign lesions
(308 84; 277 89) and normal organs (236 61; 166+62) (p < 0.001) with the
exception of abscesses which demonstrated the lowest ADC value (81 17;
60 15) among abdominal lesions.
Conclusion: Diffusion weighted MR imaging with uni-directional gradient is clinically applicable and may be useful to differentiate benign and malignant lesions
of the abdomen.
334
C-063
Primary retroperitoneal neoplasms: A pictorial review of CT findings with
histopathological correlation
C.M. Shetty, S.J. Andrews, A.R. Kambadakone; Manipal/IN
(drcmshetty@yahoo.com)
Learning Objectives: To study the spectrum of primary neoplasms affecting the
retroperitoneal space and to review the CT imaging characteristics of these neoplasms with histopathological correlation.
Background: Only 0.2% of the retroperitoneal tumours are considered to be
primary out of which 77-80% of tumours are malignant. These neoplasms are
generally derived from mesenchymal cells, neurogenic cells, or embryonic cell
rests. CT is the imaging modality of choice for patients with known or suspected
retroperitoneal masses. It not only estimates the size and extent of these tumours but also evaluates extension into adjacent structures. The CT appearances of these tumours generally correlate with the histopathological findings.
Procedure Details: We retrospectively reviewed the abdominal and pelvic CT
examinations performed in 25 patients. The CT findings of several retroperitoneal
tumours allowed diagnosis of a specific cell type to be made. Malignant fibrous
histiocytomas show calcification within a heterogenous lesion while liposarcomas show fat components. Large areas of necrosis are suggestive of leiomyosarcomas while hypervascularity is seen in hemangiomas. Homogenous low density
lesions characterize neurilemmoma while cystic lesions with septations characterize lymphangioma or primary mucinous cystadenoma. Para-aortic location with
calcification suggests ganglioneuroma while lesions at the same location with
catecholamine excess suggest paraganglioma. Mixed heterogenous appearance
indicates a teratoma.
Conclusion: CT plays an important role in the categorisation and characterisation of primary retroperitoneal neoplasms and in few cases, CT alone can make
a definitive diagnosis. CT also evaluates the extent of these tumours and involvement of adjacent structures.
C-064
Targets in life, targets in ultrasonography
A. Roque, X. Serres, C. Aso, E. Castell, R. Monmany, D. Sureda;
Barcelona/ES (albert_roque@hotmail.com)
Learning Objectives: 1. To illustrate the large variety of structures and processes that manifest as a target sign image on ultrasound study. 2. To show that analysis of a specific sign, in this case the target sign, leads to a deeper understanding
of sonographic semiology.
Background: This study is based on a compilation of sonographic images displaying the target sign. These include normal and pathological features in both
adults and children, covering several structures and organ systems (head and
neck, mediastinum, cardiovascular system, gastrointestinal tract and the hepatobiliary, genitourinary and musculoskeletal system).
Imaging Findings: Sonographic images are divided into normal and pathologic.
The entities within the pathological group are classified according to their etiology into congenital, inflammatory, infectious, tumoral, autoimmune and vascular
(including interventional procedures) processes.
Conclusion: Our aim is to provide a didactic overview that underscores the importance of this common radiological sign.
C-065
Whole-body MRI at 3 Tesla in staging cancer patients: A comparison with 64
channel multidetector row CT
E. Squillaci, S. Fabiano, M. Di Roma, M. Carlani, N. Fusco, G. Simonetti;
Rome/IT (ettoresquillaci@tiscali.it)
Purpose: To compare whole-body MR imaging (WBMR) and 64 channel multidetector volume CT (MDCT) in tumor detection and staging of cancer patients.
Methods and Materials: 62 patients with known primary tumors (colorectal,
breast, lung cancer, lymphomas, HCC) underwent prospectively WBMR and
MDCT for staging. The WBMR examinations were performed with a 3 T system
(Philips Achieva, Best, Netherlands) with a body coil and unlimited field of view.
A coronal STIR-sequence was used for imaging of the different body regions
before and after administration of 20 ml of GD-DTPA at 2 ml/sec. MDCT was
performed with 64 channel CT (Lightspeed VCT GE) with 2.5 mm thickness and
12 seconds acquisition time, before and after intravenous administration of 80 ml
of non-ionic iodinated contrast media. The findings of conventional WBMR and
MDCT were compared using region by region analysis evaluating the primary
tumor, lymph nodes and visceral metastases.
Results: In respect of tumor detection (n = 62), WBMR and conventional CT and

MR imaging concordantly revealed a tumor in 42 patients and in 15 patients both
imaging techniques excluded a tumor. In 4 patients MDCT was positive, whereas
WBMR was false negative. In only 1 patient WBMR was superior to CT by detecting the primary tumor. In tumor staging in comparison to MDCT, WBMR detected
only 8/14 visceral metastases, 12/30 lymph node metastases, 3/20 pulmonary
metastases. In 12 patients WBMR revealed new pathologies which were missed
by MDCT.
Conclusion: WBMR is an effective and fast method for examining cancer patients but cannot reach accuracy of MDCT.
C-066
Breast
Biopsy
C-068
Equivalent cross-relaxation rate image for sentinel lymph node biopsy in
breast carcinoma
S. Matsushima1, S. Era2, H. Iwata1, F. Sasaki1, K. Horita1, H. Yamaura1,
H. Ohsaki1, M. Uike3, Y. Kinosada2; 1Nagoya/JP, 2Gifu/JP, 3Hachioji/JP
(smts@aichi-cc.jp)
C-067
C-069
Spectrum of splenic diseases associated to siderotic nodules: MR

evaluation
A. Luna, L. Luna, L. Alcal; Jaen/ES (aluna70@sercosa.com)
The development and delivery of a postgraduate programme of study for

image guided interventional procedures of the breast
J.L. Horrocks; Leeds/UK (j.l.horrocks@leeds.ac.uk)
Learning Objectives: To review the different splenic conditions associated to

siderotic nodules. To describe the magnetic resonance (MR) features of the splenic
lesions which can show siderotic nodules. To discuss their differential diagnosis.
Background: Siderotic nodules, also known as Gamna-Gandy nodules, are due
to microhemorrhages in the splenic parenchyma. MR is the imaging technique of
choice for their detection, demonstrating characteristic susceptibility artefact on
gradient-echo sequences. Siderotic nodules occur most commonly in patients
with cirrhosis and portal hypertension. Other systemic conditions associated to
siderotic nodules are portal vein or splenic vein thrombosis, hemolytic anemia,
leukemia, patients receiving blood transfusions, acquired hemochromatosis or
paroxysmal nocturnal hemoglobinuria. Siderotic nodules can also be found in
cases of focal splenic lesions as lymphoma, metastasis and vascular lesions,
including larger cavernous hemangiomas, peliosis, diffuse hemangiomatosis,
angiosarcoma, litoral cell angioma and hemangioendothelioma.
Procedure Details: The recognition of the most typical MR features of these
conditions limits the differential. The use of an adequate protocol including T1weighted, HASTE and dynamic post-contrast sequence is necessary for their
characterization. The clinical picture is relevant in most of the cases.
Conclusion: Siderotic nodules appear associated with more pathological conditions than is usually appreciated. The knowledge of these conditions and their
MR characteristics limit this wide differential.
Learning Objectives: To discuss the developmental process of the content assessment and delivery of a postgraduate programme of study for image guided
interventional procedures of the breast. To discuss the experience and associated problems encountered in the delivery and assessment of such a programme
of study.
Background: Mammographers/ultrasonographers undertaking image guided
breast procedures was established practice in a small number of centres in the
UK early in this decade. The training for these mammographers/ultrasonographers were 'in house'. This training is not recognised nationally and concern was
expressed at the non-transferability of skills acquired and the level and content of
delivery of the underpinning knowledge to support these skills. The need for a
formal transferable academic programme of study input was now recognised.
Procedure Details: A programme of study was designed and developed by academic and clinical specialists to ensure academic rigour, whilst professional and
clinical requirements were met. Brainstorming sessions were initially undertaken
with mammographers/ultrasonographers/breast radiologists who had been involved with 'in house' programmes of study. These sessions focussed on the
requirements for programme content, delivery and assessment procedures for
confirment of competency.
Conclusion: Educational programmes of study must be designed and delivered
by clinical specialists and academics working in collaboration. Programme content and assessment of competencies in this very specialised evolving field must
be continuously evaluated and updated to ensure practitioners extending their
role in this field demonstrate fitness for purpose, fitness for practice and fitness
for award.
335
east
Br
Breast
Learning Objectives: To learn protocols that take maximum advantage of the

speed afforded by MDCT scanners, illustrated with relevant patient cases. To
review the principles related to the optimization of contrast enhancement in MDCT.
To compare differences in acquisition and reconstruction parameters among
MDCT scanner manufacturers.
Background: Increasing use of faster 16- and 64-row MDCT technology for abdominal imaging has required that protocols be developed that optimize the delivery of iodinated contrast media. Understanding the relationships between
contrast media injection parameters (e.g., total volume, iodine concentration, and
total iodine dose) are essential in the implementation of efficient protocols. In
addition, acquisition parameters such as scan delay, bolus tracking, and reconstruction parameters vary according to individual manufacturer platforms.
Procedure Details: Essential differences among MDCT scanners are highlighted, as are detailed abdominal 16- and 64-row contrast-enhanced protocols for
major CT vendors.
Conclusion: When contrast media delivery is optimized for the rapid acquisition
offered by 16- and 64-row MDCT, superior arterial and/or parenchymal enhancement may be achieved with better diagnostic results and a potential reduction in
total contrast media dose.
Purpose: In breast carcinoma patients, sentinel lymph node biopsy (SLNB) attracts attention as an important technique to detect axillary lymph node metastasis; however, the existence of false-negative cases is a problem. Equivalent
cross-relaxation rate image (ECRI) is a measurement method that can be used
to quantitatively evaluate a change in structural organization by magnetic resonance imaging (MRI). We performed axillary ECRI in order to decrease the false
negative cases of SLNB.
Methods and Materials: 30 patients with histologically confirmed invasive ductal carcinoma of the breast were studied. We adopted the off-resonance technique for preferential saturation of the immobile protons to evaluate the equivalent
cross-relaxation rate (ECR) values. The single saturation transfer pulse frequency was employed at the frequency 5 ppm downfield from the water resonance.
The ECR value was defined as the percentage of signal loss between unsaturated and saturated images. The ECRIs were constructed on the basis of the percentage of ECR.
Results: The lymph nodes with metastases showed a lower ECR in comparison
with the lymph nodes without metastases. A statistically significant difference
was observed between lymph nodes with metastases and those without metastases (p < 0.001). The ECRI was compared to a macroscopic image and the presence or absence of axillary lymph node metastasis could be evaluated.
Conclusion: It may be possible to decrease the number of false negatives in
SLNB by excluding metastatic axillary lymph nodes using ECRI from adaptation
of SLNB.
Optimized protocols for contrast-enhanced multidetector CT of the

abdomen and pelvis
P. Rogalla1, K.T. Bae2; 1Berlin/DE, 2St. Louis, MO/US (rogalla@charite.de)

Breast
Digital Mammography
C-070
Computer-aided-detection in screening mammography: Preliminary results
in a prospective study
S. Sanchez Gomez, M. Torres Tabanera, M. Sainz Miranda,
P. Martinez-Miravete, A. Baroja Mazo, E. Lag Asturiano, M. Ruiz Diaz;
Logroo/ES (ssanchezg@riojasalud.es)
Methods and Materials: From September 2003 to September 2005, CAD system was applied to 21855 screening mammographies. Mammograms were read
by one or two breast radiologists. Afterwards, findings from the CAD system and
the radiologists, were compared.
Parameters analyzed were: number of marks/case, change of attitude, false negative (FN) and false positive (FP) of the system, partial agreement and complete
agreement.
Results: 115 cancers (0.5%) were detected in 96 women (32 were multicentric).
Nine of them were not previously detected by CAD due to technical problems.
Number of marks/case was 2.7 (0.7 marks/film).
There was a change of attitude in 166 cases (0.8%): 81 (49%) were compared
with previous mammograms and only 85 (51%) complementary studies were
needed (one cancer was confirmed). Final recall rate was 7.6%.
FP of the system (artefacts, tissue superimposition and normal structures) were
16910 (77.4%). Three FP of the system were radiologist's FN (cancer was confirmed). FN of the system (lesions non-detected by CAD, but remarkable for the
radiologist) were 884 (4%). 18 were cancer (2%), 6 of them "second lesions".
In 16107 (73.7%) there was partial agreement and in 4716 (21.5%) the agreement was complete.
Conclusion: 1. In our experience, CAD system may be an useful tool for the
radiologist in a screening mammography program. 2. The "second lesion" is a not
resolved CAD's limitation. 3. Although a longer follow-up is needed, in our opinion some CAD's FP will be radiologist's FN.
C-071
Image quality and dose for digital mammography systems
J.M. Oduko, K.C. Young, J.J.H. Cook; Guildford/UK (jenny.oduko@nhs.net)
Purpose: European Guidelines for Quality Assurance in Breast Cancer Screening and Diagnosis specify minimum standards for dose and image quality for
mammography. This study compares the performance of different types of digital
mammography system to each other and to the standards.
Methods and Materials: Measurements were made as described in the European guidance using typical clinical settings. Image quality was measured for a
wide range of CR and DR systems, using a contrast-detail test object (CDMAM
type 3.4). For each system four images were evaluated independently by three
experienced readers and the average threshold contrasts determined for detail
diameters 0.1 - 2 mm. A curve fitting procedure was used to improve precision.
Mean glandular doses (MGD) to a standard breast model with thicknesses from
20 - 90 mm thick were calculated. The effect on threshold contrast of varying the
dose was also assessed.
Results: The most difficult standard for digital systems to meet was the threshold
contrast for the smallest detail size (0.1 mm) within the acceptable dose range
(< 3 mGy). The minimum dose required for different DR systems to meet the standard at this detail size ranged from 0.5 - 1.5 mGy. For CR systems it ranged from
1.6 - 7.3 mGy.
Conclusion: All the DR systems and one CR system met the European standards for both dose and image quality. Other CR systems failed to meet European
standards for the smallest detail size, even when dose was increased to the acceptable limit.
C-072
Performance evaluation and optimization of a dual side reading dedicated
mammography CR system
B. Canossi1, R. Battista1, S. Rivetti1, C. Danielli1, N. Lanconelli2, R. Romagnoli1,
P. Torricelli1; 1Modena/IT, 2Bologna/IT (canossi.barbara@policlinico.mo.it)
Purpose: The aim of this work is to determine the best expositive conditions for
mammography application of the dual side Fuji Computed Radiography system
FCR5000Ma.
Methods and Materials: The system's physical performances have been tested
through a quantitative analysis (MTF, DQE). Subsequently, the results have been
336
compared with those achieved using a screen-film system. Then, based on the
previous results, a ROC analysis has been laid out on 120 paired images (chosen amongst a set of 600) obtained in a cranio-caudal projection with a conventional SFM system in standard expositive conditions and also with a CR system
working with a 35% reduced dose (the average thickness of the tested breast
being 4.3 cm; ESAK mean: 5.3 mGy, Glandular Mean Dose 1.45 mGy).
Results: The ROC analysis showed that the performance of the two systems,
when compared, were nearly similar (p > 0.05): the diagnostic accuracy of the
two systems, when valued in terms of the area under the ROC curve, results in
0.74 for the SFM, 0.78 for the CRM (Hard Copy) and 0.79 for the CRM (Soft
Copy).
Conclusion: In order to optimize the performance of the computed radiography
system a deeper analysis of the physical features of the detector and of the postprocessing algorithms were developed. The outcome obtained from our experiments show that the use of the dual side computed radiography system is a very
good alternative to the film-screen system i.e. no loss of accuracy has been
achieved together with a 35% reduction of the dose.

Breast
C-075
Magnetic Resonance
Comparison of the diffusion-weighted images using STIR or CHESS as fat

suppression in patients with breast tumors
T. Kazama1, K. Nasu 2, Y. Kuroki2, S. Nawano2, H. Ito1; 1Chiba/JP, 2Kashiwa/JP
(kazamat@fg7.so-net.ne.jp)
C-073
Peripheral enhancement in breast lesion: Correlation of contrast-enhanced
MRI findings using a color-coded automated software with histologic
features and tumor angiogenesis
F. Pediconi1, C. Catalano1, M. Ercolani2, L. Carotenuto 2, F. Altomari1,
S. Padula1, A. Roselli1, E. Moriconi1, R. Passariello1; 1Rome/IT, 2Pomezia/IT
(federica.pediconi@uniroma1.it)
Purpose: To investigate the value of a new color-coded automated signal intensity-curve software package for CE magnetic resonance mammography (CEMRM) in determination of tumor diameter and peripheral enhancement in women
with breast cancer.
Methods and Materials: Fifty women with proved breast cancer at pathology
who preoperatively underwent CE-MRM were included in the evaluation. CEMRM was performed with a 1.5 T magnet using a bilateral surface coil. T2-weighted
STIR and dynamic 2D Flash Dynamic T1-weighted sequences in axial plane acquired pre and 2, 4, 6, 8 and 10 min post-contrast media administration were
performed. 0.1 mmol/Kg of Gd-BOPTA was administered at a flow rate of 2 mL/s
followed by 10 mL of saline. Images were analysed both with a new software
using a user-friendly interactive mechanism and separately with a standard display method. Tumor diameter and peripheral enhancement were evaluated with
false-color map and were compared with histo-pathological results.
Results: At pathology 11 DCIS, 6 LCIS, 16 invasive ductal, 12 invasive lobular, 2
medullary carcinoma, 3 intra-ductal papilloma, 3 ductal hyperplasia, 2 lobular
hyperplasia and 6 fibroadenoma were evaluated. The standard display evaluation showed an overestimation of lesion diameter compared to pathological specimens. Almost perfect agreement was seen regarding tumor diameter and
peripheral enhancement with software evaluation compared to histo-pathological specimens.
Conclusion: The novel color-coded signal intensity-curve software permits correct determination of lesion size. False-color maps permit to lesion enhancement
to be distinguished, thereby differentiating peripheral angiogenesis from the mass.
C-074
Contrast-enhanced breast MR and multiplanar imaging projections (MIPs):
Can vascular asymmetry help DCIS detection?
A. Cilotti, C. Marini, C. Iacconi, M. Moretti, D. Mazzotta, C. Giaconi,
C. Bartolozzi; Pisa/IT (c.iacconi@med.unipi.it)
C-076
High-b-value diffusion weighted MR imaging in the detection of breast
cancer
Y. Murakami1, K. Imoto1, M. Yamasaki2, A. Furukawa2, K. Murata 2,
T. Sakamoto1; 1Kohka/JP, 2Otsu/JP (yokomurakamikoka@yahoo.co.jp)
Purpose: To determine the potential ability of high-b-value diffusion weighted
MR imaging using single shot EPI sequence in the detection of breast cancer.
Methods and Materials: Since May 2003 to August 2004, breast MR imaging
was performed consequently in 38 patents (76 breasts), referred for further examination after screening mammography and/or physical examination by experienced breast surgeons. Multi-sliced coronal diffusion-weighted imaging (DWI)
using a high-b-value of 1000 s/mm2 was performed to include both breasts on
each image. The results were compared with the final diagnoses obtained by
pathology or clinical follow-up, and also with BI-RADS assessment categories for
their mammography.
Results: 28 patients underwent surgery and breast cancer was confirmed in 26
and fibroadenoma was diagnosed in 2 patients. The remaining 10 patients were
diagnosed as negative for breast cancer from biopsy results and clinical follow-up
for more than 12 months. DWI was positive in 37 breasts with false positive in 11,
and it was negative in 43 with false negative in 2. Sensitivity, specificity, and
positive predictive value of DWI in the detection and diagnosis for breast cancer
were 92.9, 77.4, and 70.3%, respectively. Category 3 group (BI-RADS assessment categories) was applied for 13 breasts and there were cancers in 6 where
DWI were truly positive in all.
Conclusion: High-b-value diffusion weighted MR imaging has a high potential in
the detection of breast cancer. This new technique will help in interpreting MR
imaging and mammography, in the diagnosis of breast cancer.
C-077
Value of magnetic resonance imaging for the work-up of invasive lobular
breast carcinoma: Prospective and retrospective study of 39 cases.
Comparison with physical examination, conventional imaging and histology
T. Caramella, C. Chapellier, F. Ettore, I. Raoust, E. Chamorey, C. Balu-Maestro;
Nice/FR (thomas.caramella@gmail.com)
Purpose: Determination of the value of MR imaging for invasive lobular carcinoma (ILC), which remains a diagnostic challenge for the radiologist.
Methods and Materials: 39 patients with histologically proven ILC were studied
between 1998 and 2005. All patients underwent physical examination, mammography, ultrasound and an MR imaging. All anomalies detected were graded using
the BI-RADS classification and careful research was made for the presence of
multifocal/multicentric disease. The histologic tumor size was compared with the
other techniques.
337
east
Br
Breast
Purpose: To evaluate the role of vascular asymmetry at contrast-enhanced MR

for the detection of Ductal Carcinoma in Situ (DCIS).
Methods and Materials: Retrospective analysis of 26 women (37-77 years; mean
age: 51years) with monolateral DCIS at histopathology (grading G1, G2, G3)
submitted to contrast-enhanced breast MR for BIRADS 3-5 microcalcifications
(19 cases) or for discharging breast with suspicious galactography (7cases). MR
was performed with standard technique using 0.2 mmol/Kg of MultiHance. Maximum Intensity Projections of subtracted images were evaluated for vascular asymmetry. Comparing the two breasts for vessel number, diameter and length, we
classified vascular asymmetry as V0: Bilateral absence of vascular enhancement; V1: Increased vascularity ipsilateral to neoplasm (< 25%); V2: Increased
vascularity ipsilateral to neoplasm (26-75%); V3: Increased vascularity ipsilateral
to neoplasm (> 75%).
Results: Vascular asymmetry was present in 73.07% of DCIS (100% of patients
with discharging breast, 63% of patients with microcalcifications). Considering
the histological grading, asymmetry was present in 25% of G1, 77% of G2 and
89% of G3. V0 was observed in 75% of G1, 23.07% of G2 and 11.1% of G3; V1 in
30.77% of G2; V2 in 25% of G1, 7.69% of G2 and 44.44% of G3; V3 in 38.46% of
G2 and 44.44% of G3. In all cases of increased vascularity there was correspondence between MR findings and the site of neoplasm at surgery.
Conclusion: In our study vascular asymmetry is an important sign in the diagnosis of DCIS. This finding correlates well especially with less differentiated forms
(G2 and G3) and in particular with DCIS detected in patients studied for discharging breast.
Purpose: The usefulness of diffusion-weighted images (DWI) in the detection

and characterization of malignant tumors has been reported. Excellent fat-suppression is essential for DWI in the body, however, chemical shift selective
(CHESS) pulse often fail to suppress fat signal in the breast. Recently DWI using
short inversion time inversion recovery (STIR) has been reported. The purpose
of this study was to compare DWI using CHESS and DWI using STIR in terms of
uniformity of fat suppression and accuracy of apparent diffusion coefficient (ADC)
obtained on DWI using STIR.
Methods and Materials: Thirty-three patients with malignant breast tumors underwent breast MR imaging. DWI using STIR, DWI using CHESS, T1-weighted
images, contrast-enhanced T1weighted-images, fat-suppressed T2-weighted
images were obtained. The number of excitation was 2 at DWI using CHESS,
and 4 at DWI using STIR. Uniformity of fat-suppression, ADC, signal intensities
and visualization of the breast tumors were evaluated.
Results: In 42% (14/33 cases), there were insufficient fat-suppression in the
breasts on DWI with CHESS, while 0% on DWI with STIR (p < 0.0001). There
was excellent relationship in ADC measurement (r = 0.92, p < 0.001). The signal
intensities of tumors on DWI using CHESS were 488 204, while those on DWI
using STIR were 384 141 (p < 0.001), however, the visualization of tumor was
not statistically significant between these sequences (p = 0.5).
Conclusion: DWI with STIR may be excellent in fat-suppression and the ADC
obtained in this sequence was well correlated to that obtained on DWI with CHESS.

Results: 77% of the tumors were palpable. The majority of the mammograms
presented had architectural distorsion (46%) or a mass (49%), most of them with
spiculated contours. Sonograms demonstrated an irregularly shaped mass. MR
imaging Results: 67% were visualized as masses and 21% corresponded to a
site of enhancement. Only 70% of the enhancements were typically malignant.
Size correlations, based on comparison with histology findings were: 0.90 (MR
imaging, p < 0.001), 0.56 (ultrasound), 0.45 (physical examination), and 0.31
(mammography).
The Kappa correlations for multifocal/multicentric disease were: 0.89 (MR imaging), 0.23 (ultrasound), and 0.14 (mammography). MR imaging had a sensitivity,
specificity and positive predictive value of 100%, 89% and 100%, respectively.
The therapeutic strategy was modified in 54% of cases.
Conclusion: MR imaging is unquestionably valuable for the management of ILC.
It provides the most accurate estimate of tumor size and is highly sensitive for
multifocal/multicentric disease. Its main drawback is a lack of specificity that requires preoperative histologic verification. MR imaging often justifies modification of the initial therapeutic strategy, generally by ruling out a conservative
procedure.
C-078
Role of MR mammography in women with dense breast
F. Pediconi, S. Padula, F. Altomari, A. Roselli, E. Moriconi, C. Catalano,
R. Passariello; Rome/IT (federica.pediconi@uniroma1.it)
Purpose: To evaluate the accuracy of MR mammography (MRM) in patients with
dense breast, compared with mammography, ultrasound and pathology.
Methods and Materials: 77 patients with dense breast and suspicious breast
cancer at other examinations underwent pre-surgery MRM. MRM was performed
with a 1.5 T magnet using a bilateral surface breast coil acquired in axial plane.
MRM protocol comprised a T2-weighted STIR sequence and a dynamic 3D Flash
T1-weighted sequence acquired before and at 2, 4, 6, 8 and 10 min after the
administration of Gd-BOPTA at 0.1 mmol/Kg. Mammographic parenchymal density was evaluated according to the Breast Imaging Reporting and Data System
lexicon as class 1 (fatty) to 4 (dense). Detection rates of mammography, sonograms and MR mammography were studied and the diameters of the lesions
were compared with histological findings. Statistical analysis were performed.
Results: Index tumor was identified in 55/77 patients at mammography, in 64/77
patients at ultrasound and in 75/77 patients at MR. Sensitivity in detection of
index lesion was 71% for mammography, 83% for ultrasound and 98% for MRM.
Mammography underestimated tumor extent in 28/77 cases (37%), ultrasound in
31/77 cases (40%) and MR in 9/77 cases (12.5%). In 29 patients (37%) MR
mammography showed an additional enhancing lesion (8 multicentric or multifocal and 21 contralateral lesion), with a false positive rate of 23%.
Conclusion: MR mammography is more accurate in assessing tumor extent and
multifocality in patients with dense breast. MRM is also able to detect additional
foci of carcinoma undetected with other examinations.
C-079
How to use a high T1-relaxivity contrast agent, gadobenate dimeglumine
(Gd-BOPTA), for breast MR imaging. Suggestions for dosage, sequence,
and evaluation of lesion dynamics and vascular mapping
F. Sardanelli 1, A. Fausto1, F. Pediconi2, M. Kirchin3; 1San Donato Milanese,
Milan/IT, 2Rome/IT, 3Milan/IT (f.sardanelli@grupposandonato.it)
Learning Objectives: 1) To illustrate structure and kinetics of Gd-BOPTA in terms
of higher contrast effect; 2) To define dosage and MR sequence to be used with
Gd-BOPTA; 3) To become familiar with dynamic curves and breast vascular maps
obtained with Gd-BOPTA.
Background: Gd-BOPTA (Bracco) is characterized by two-fold higher T1-relaxivity if compared with conventional two-compartment Gd-chelates due to a weak
transient interaction with serum albumin. Its application to dynamic breast imaging is advantageous. However, breast radiologists need to know how best to use
it.
Procedure Details: 1) Gd-BOPTA is effective at doses as low as 0.05 mmol/kg
but 0.1 mmol/kg (single dose) is optimal; a double dose could increase false positives; 2) A 3D T1-weighted gradient-echo sequence maximizes contrast enhancement but also 2D sequence can be used; 3) Thresholds of initial enhancement
(peak value during 1st-3rd minute) should be adjusted to higher values to minimize
the possibility of a false positive initial enhancement, taking into account field
strength, 2D/3D sequence, and temporal/spatial resolution; 4) On MIPs of subtracted images of the early phase (60-120 sec), the vascular (arterial and venous) map of both breasts is well depicted and asymmetry can be detected:
one-side increased vascularity is frequently associated with ipsilateral invasive
cancer; 5) Gd-BOPTA is effective also at low field strengths (0.2 T).
338
Conclusion: The possibility of using a high T1-relaxivity agent for breast MR

imaging is opened. Breast radiologist should be aware of tips and tricks in order
to get the maximum advantage from this agent.
C-080
Contrast enhanced breast MRI at high magnetic fields (3 T) compared to
1.5 T: Initial results
A. Orlacchio, E. Cossu, C. Ittiresu, A. Rotili, I. Tanga, F. Bolacchi, G. Simonetti;
Rome/IT (ila.dede@virgilio.it)
Purpose: To estimate features of enhancing lesions (morphology and enhancement kinetics) comparing 3 T to1.5 T standard.
Methods and Materials: 20 patients (mean age 55 years) were chosen from a
group with clinical, MX and US findings suggestive for breast cancer (tumor size
from 4 mm to 40 mm, mean16 mm)and scheduled for surgery. Our results were
confirmed by histologic findings (14 malignant and 6 benign lesions). All patients
were evaluated by c.e. dynamic bilateral breast MR imaging twice, once with
standard technique at 1.5 T and once with 3.0 T system. MR imaging of the breast
was performed with 1.5 Tesla magnet (Intera, Philips Medical System) using TSET2 weighted, STIR sequences and 2D dynamic FFE-T1 weighted sequences in
axial projection with TR\TE\FA 3800\140\90, FOV 350 mm, reconstruction matrix
512 x 512, thickness 3 mm, acquisition time for each dynamic scan (6 dynamic
scan) less than 80" in the axial projection. At 3.0 T (Philips, Achieva), the exam
was performed with TSE-T1, T2 weighted sequences and 3D FFE dynamic series with TR/TE/FA 5.1\2.4\20, reconstruction matrix 258 x 512, FOV 360 mm,
thickness 2.5 mm. With a SENSE-factor of 2, acquisition time was 46" for dynamic scan (8dynamic scan). In addition others 2 sequences were performed to have
very-high-resolution imaging: T2 TSE SPAIR for fat suppression with TR/TE 9023
\120, thickness 2.50 mm, FOV340, matrix 256x256, acquisition time 5.25' and
BLISS, dynamic sequences in sagittal projection to identify the enhancing lesions, with TR/TE 3.8\1.95, thickness1.25 mm, FOV 250, matrix 256 x 256, acquisition time 8:03'. Features of enhancing lesions at 3.0 T were compared to
1.5 T.
Results: All lesions were identified on both studies. The higher spatial resolution
and the higher temporal resolution especially of the dynamic series at 3.0 T improved the delineation of lesion's morphologic details compared to 1.5 T imaging. Enhancement kinetics were comparable but at 3.0 T, the image quality, with
unilateral high resolution and active fat suppression, was better than 1.5 T.
Conclusion: Our initial experiences with c.e. breast MR imaging at 3.0 T are
encouraging. In fact because of the higher spatial and temporal resolution MR
imaging at 3.0 T with SENSE improve the study of breast lesions.
C-081
Pseudoangiomatous stromal hyperplasia in men: Imaging findings with
diffusion-weighted imaging
J. Puig Alcantara, J. Pont Valles, E. Perez Gomez, G. Blasco Sola,
I. Pelez Hernndez, J. Rodriguez Hermosa, M. Casas Tarrus,
S. Pedraza Gutierrez; Girona/ES (jpuigalcantara@yahoo.es)
Purpose: To describe the mammographic, sonographic, and dynamic magnetic
resonance (MR) imaging findings, emphasizing on diffusion-weighted (DW) imaging of pseudoangiomatous stromal hyperplasia (PASH) of the breast in men.
Methods and Materials: A retrospective review for four patients identified as
having PASH was performed. We examined mammographic, sonographic and
dynamic magnetic resonance imaging studies, including DW imaging using multiple b values (maximum, 1000 sec/mm2). The apparent diffusion coefficient map
was constructed and value of lesions were calculated.
Results: All patients were men, ageing between 20-65 years old. All four patients
were evaluated palpable breast lumps and were asymptomatic. Mammography
was performed for three patients. The masses measured 2-2.7 cm. The border
characteristics were as follows; one was partly circumscribed and two were indistinct. On sonography, all lesions were solid, hypoechoic, and slightly heterogeneous. The margins were irregular in two patients, well-circumscribed in one
patient and spiculated in another one. Dynamic MR imaging was performed for
three patients. The time-signal intensity curves of all lesions shows a persistent
enhancing pattern, with early central enhancement. DW imaging of all masses
gradually showed low signal intensity as b-value diffusion factor was increasing
and apparent diffusion coefficient values were congruent with benign breast lesion (1.60+- 0.03x10-3 mm2/s).
Conclusion: Despite the varied mammographic and sonography appearances
of PASH, histopathological analysis is required to establish definitive diagnosis
and rule out malignancy, however DW imaging can be a helpful parameter in
characterizing tumoral pseudoangiomatous stromal hyperplasia in the differential diagnosis of breast masses.

C-082
Sense imaging of the breast: Comparison of conventional and parallel
imaging acquisitions
A. Orlacchio, E. Cossu, C. Ittiresu, A. Villatico, I. Tanga, G. Simonetti; Rome/IT
(ila.dede@virgilio.it)
Purpose: We report our initial experiences in the comparison between bilateral
contrast enhancement breast MR imaging with sensitivity encoding (SENSE) and
conventional technique to evaluate spatial and temporal resolution.
Methods and Materials: We selected 15 patients with 18 contrast enhancing
lesions (10 breast cancer, 6 fibroadenomas,1 intra-mammary lymph node and 1
inflammatory cyst) who already underwent once MR imaging with conventional
acquisitions and, another day, revaluated with SENSE technique. Both studies
were performed on 1.5 T MR imaging (Intera, Philips Medical System). The conventional technique was performed with 2Ddynamic study TR\TE\FA 3800\140\90,
FOV 350 mm, reconstruction matrix 512 x 512, thickness 3 mm, acquisition time
for each dynamic scan (6 dynamic scan) less than 80" in the axial projection.
Sense imaging was performed with 3D dynamic study TR\TE\FA3800\140\90,
FOV 370 mm, reconstruction matrix 512 x 512, thickness 2.50 mm, acquisition
time for each dynamic scan (8 dynamic scan) less than 50", using sense factor 2
in the axial projection. The SENSE technique, combined with "fat suppression
technique"(PROSET 1331), eliminated the necessity to any subtractions. The
results of both studies have been compared.
Results: All the lesions, malignant and benign, have been evaluated by both
techniques, however the SENSE imaging provides a better combination of high
spatial and temporal resolution. In fact high spatial resolution yields a superior
definition of lesion margins and internal architecture and the high temporal resolution enable us to detect the enhancement kinetics to better characterize lesions.
Conclusion: The use of SENSE factor reduces motion artifact (breathing and
cardiac motion), the duration of the study thus increasing patient throughput,
reducing costs and improving diagnostic specificity. Our initial experiences with
breast MR imaging with SENSE are encouraging, suggesting that MR imaging
will become a possible screening test.
C-083
Breast lesions: Evaluation in vivo with diffusion-weighted imaging (DWI) in
magnetic resonance
C. Marini, A. Cilotti, C. Iacconi, M. Giannelli, A. Vaccaro, M. Moretti,
D. Mazzotta, C. Traino, C. Bartolozzi; Pisa/IT (c.iacconi@med.unipi.it)
Purpose: To prospectively compare mean diffusivity of benign and malignant
breast lesions with MR echo-planar-imaging (EPI).
Methods and Materials: 44 women, (32-71 years, mean age 53 years) with 53
breast lesions were enrolled in a prospective trial. Gold standard was histology
(n = 37) and follow-up for at least 18 months (n = 16). All patients were examined
using a 1.5 T MR scanner (Symphony Siemens), with coronal and axial EPI sequences sensitised to diffusion along three orthogonal directions (TR/TE 6800/
101 msec, Nex 3, slice thickness 4 mm, interslice gap 0 mm, bandwidth 1260 Hz/
pixel, b-value 0/1000 sec/mm2). The average apparent diffusion coefficient (ADC)
value along three orthogonal directions (mean diffusivity) was calculated. Differences in mean diffusivity (MD) among cysts, benign and malignant lesions were
evaluated with non parametric two-tailed Mann-Whitney test with Bonferroni correction for multiple comparisons.
Results: Histopathological analysis revealed: 16 cysts, 12 benign lesions, 25
malignant lesions. The mean size of benign lesions, malignant lesions and cysts
was respectively: 1.45 cm, 1.98 cm and 1.70 cm.
MD values (mean SD) were for benign lesion (1.54 0.38x10-3 mm2/sec), for
malignant lesions (0.99 0.24x10-3 mm2/sec), for cysts (2.28 0.25x10-3 mm2/sec).
The MD was significantly higher in cysts respect to benign (p < 0.0003) and malignant (p < 0.0003) lesions. Mean diffusivity was significantly lower (p < 0.0003)
in malignant respect to benign lesions.
Conclusion: Diffusion weighted MR is a complementary quantitative and fast
analysis of breast lesions to differentiate benign from malignant lesions.
Segmentally-distributed mammary carcinomas on dynamic MR images:

Differential diagnosis
S. Yuen, T. Uematsu, M. Kasami, K. Yokoe, H. Ikuma, A. Seki, T. Aramaki,
H. Furukawa; Sunto Shizuoka/JP (yuen@ny.thn.ne.jp)
Purpose: To investigate the histopathological variations of segmentally-distributed mammary carcinomas on dynamic MR images and find out the imaging characteristics clues to their differential diagnosis.
C-085
A study of the accuracy of magnetic resonance imaging in diagnosing
silicone breast implant rupture
V.W.M. Tang, A. Jain; Manchester/UK (vwmtang@hotmail.com)
Purpose: To evaluate the accuracy of magnetic resonance (MR) in diagnosing
silicone breast implant rupture by correlating with surgical findings.
Methods and Materials: This retrospective study includes a review of radiology
records of 42 patients (69 silicone breast implants), presenting with symptoms of
implant rupture. All patients had MR breast imaging following a standard implant
protocol. The implants were classified as: 1) intact 2) intracapsular rupture 3)
extracapsular rupture 4) suspicious rupture. Surgical notes were reviewed, and
the surgical appearances were compared with the MR findings. The MR implant
status of the patients who did not undergo surgery was identified.
Results: Following MR, definite rupture was diagnosed in 14 implants (20.3%),
suspicious rupture in 8 implants (11.6%) and 47 implants (68.1%) were intact. 17
patients underwent explantation confirming 15 implant ruptures. 5 patients who
had MR diagnosed intracapsular rupture and suspicious rupture were not offered
surgery, despite all of their implants being over 10 years old. Surgical correlation
confirmed 83.3% (5/6) of the MR diagnosed extracapsular ruptures were correct.
There were 3 false positive and 7 false negative MR.
Conclusion: Our experience demonstrates that MR is highly specific but underestimates the incidence of implant rupture. The majority of the MR suspicious
rupture and false negative MR findings turned out to be extracapsular rupture at
surgery. Therefore surgeons should be reminded of this limitation, with a view to
having a low threshold to remove implants in symptomatic patients, particularly
when the implant is old or when MR shows only intracapsular rupture.
C-086
The relation between cellularity and apparent diffusion coefficient value
using diffusion-weighted magnetic resonance imaging in breast cancer
M.Y. Ikura, S. Ohsumi, H. Mogami, S. Takashima, K. Kikuchi, T. Mochizuki;
Ehime/JP (mihoyoshikawa@yahoo.co.jp)
Purpose: Recently, diffusion-weighted magnetic resonance imaging (DWMRI)
has been indicated as the correlation between tumor cellularity and apparent
diffusion coefficient (ADC) values. The purpose of this study was to estimate the
relationship between tumor cellularity and ADC values in breast cancer.
Methods and Materials: Fifty-one women underwent DWMRI, which detected
57 breast cancers. Histopathologic analysis revealed 45 invasive ductal carcinoma, 7 intraductal carcinoma, and 5 others. DWMRI was performed on a 1.5 T MR
unit. The data were acquired using a sequence of diffusion weighted single shot
EPI. ADC values were evaluated between various pathologic types. In analysis of
tumor cellulerity, five slides were obtained from different regions in each tumor
and were counterstained. After that, number of cancer-cell was counted using
Scion image in two fields of view, which were randomly chosen from each slide.
Results: In the evaluation of detectability using DWMRI between various pathologic types, 44 of 45 invasive ductal carcinoma, 6 of 7 intraductal carcinoma and
4 of 5 others were detected. Concerning ADC values in various histopathology,
mean ADC values (1000 mm/s) were 1.06 for invasive ductal carcinomas, 1.50
for intraductal carcinomas, 1.12 for others and 2.04 for normal mammary glands.
339
east
Br
Breast
C-084
Methods and Materials: We retrospectively reviewed 47 preoperatively performed

breast MR images with segmentally-distributed mammary carcinomas without a
dominant mass. We classified them based on their histopathology and assessed
their MR imaging findings as follows: absence or presence of 1) the surrounding
edema on T2-weighted images, 2) small ring-enhanced nodules reflecting intraductal components surrounded by fibrosis or inflammatory reaction, and 3) the
maximum size of enhanced nodules identified on the dynamic study.
Results: Among the 47 segmentally-distributed mammary carcinomas, 20 (44%)
were infiltrating mammary carcinomas (IMC): 5 of them were with marked lymphatic involvements, 7 were with tubulo- and/or lobular features, and 8 were with
extensive intraductal components. Others were 4 predominantly intraductal carcinoma, 16 ductal carcinoma in situ (DCIS), and 7 DCIS with multiple micropapillomas. The surrounding edema was seen in 4 of 5 IMC with marked lymphatic
involvements but none of 42 lesions in other histopathology. The small ring-enhanced nodules were identified in only 1 of 7 IMC with tubulo- and/or lobular
features but 37 of 40 lesions in other histopathology. There were no significant
differences in the nodule size of each histopathology.
Conclusion: 44% of segmentally-distributed mammary carcinomas were proved
to be IMC. The surrounding edema and enhanced nodules without small ringenhancement were the clues to diagnosis of segmentally-distributed IMC without
a dominant mass.

In breast cancer, the mean ADC values and cancer-cell-density were not correlated statistically.
Conclusion: Although it is difficult to immediately declare that there is no correlation between the ADC value and the number of cancer cells, only the number of
cells would not influence the ADC value at least.
Breast
Ultrasound
C-087
Ultrasound elastography: Results of a French multicentric prospective
study about 345 breast lesions
A. Tardivon1, A. Delignette2, V. Boussion3, B. Baratte4, L. Lvy1, P. David5,
C. Balu-Maestro6, A. Le Mouel7, B. Scheffer8; 1Paris/FR, 2Dijon/FR,
3
Clermont-Ferrand/FR, 4Amiens/FR, 5Albertville/FR, 6Nice/FR, 7Besancon/FR,
8
Nantes/FR (anne.tardivon@curie.net)
Purpose: To evaluate the performance of ultrasound elastography in breast masses.
Methods and Materials: 345 lesions (228 benign, 117malignant, 61% < 10 mm
in size) were analyzed with the EUB 8500 Logos ultrasonic unit (Hitachi, Japan)
and a linear array transducer of 7.5-13 MHz. Diagnosis was obtained by FNA,
core or surgical biopsies, follow-up or comparison with previous US studies (benign lesions). The elastic score was classified according a five-point color scale
(Ueno classification, 1-3 = benign and 4 -5 = malignant).
Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were respectively 79.5, 93, 85.3, 89.8 and 88.4%. There were
11 benign stiff lesions (fibrous mastopathy and sclerosis adenosis) and 22 soft
malignant lesions (DCIS, mucinous subtype, poor-differentiated IDC, and ILC). If
the11 soft malignant lesions categorized as BI-RADS category 5 were excluded,
the sensitivity of elastography was 88%. When the elastographic score 3 (central
part of the mass stiffer than the peripheral normal tissue) was considered as
malignant; sensitivity, specificity, positive predictive value, negative predictive value
and accuracy were respectively 90, 81, 70.5, 93.9 and 83.8%. When only masses categorized as BI-RADS category 3 and 4 were analyzed, the sensitivity of
US elastography was 90% (malignancy = scores 3-4-5) with a specificity of 72%.
Conclusion: US elastography is a valuable adjunct to increase the specificity of
the conventional B-mode, especially in breast masses categorized as BI-RADS
category 3 and 4 by adding new criteria for benignity and avoiding unnecessary
diagnostic procedures.
C-088
The spectrum of ductal abnormalities seen by high-resolution ultrasound of
the breasts
A.A. Al-Dabbagh, S. Ashour, S. Fathaddin, S. Sejeny, A. Merdad, F. AlThubaiti,
Z. AlGhaithi, A. Sawan, T. AlBaghdadi, N. Casalan, G. Lizardo; Jeddah/SA
(profasma@yahoo.com)
Learning Objectives: To demonstrate the spectrum of abnormalities seen by
high-resolution ultrasound of the breast ducts. To outline the advantages and
limitations of this technique on its own and by comparison with other modalities.
Background: Ultrasound is a recognized and important part of breast imaging
procedure. It is particularly useful in dense breasts and in young or pregnant
women. The ducts are usually clearly identified by ultrasound. Many woman who
have ductal abnormalities have no nipple discharge and in fact may have other
symptoms unrelated to ducts e.g. pain, lump, etc. Some of those women may
also be asymptomatic or have a family history of breast cancer. Many of the other
breast imaging modalities (e.g. mammography, galactography or MR imaging)
may be unhelpful, technically difficult or expensive. Ultrasound can additionally
enable localization or biopsy of the abnormal ducts.
Procedure Details: Over of 3000-patients were scanned using Esaote BIOMEDICA, AU4 idea and HDI 5000 SonoCT. 10-13 MHz linear transducers were used.
In the last 3 years 1072-patients had ductal abnormalities. The patients' age ranged
from 19 to 73 years. Some patients had additional mammogram, MR imaging or
galactography.
Conclusion: High-Resolution ultrasound of the breast can identify a spectrum of
ductal abnormalities e.g. hyperplasia or proliferation, intraductal lesions, ductectasia, spread of tumours to ducts. It can often replace galactography and is
superior to mammography or MR imaging in many respects. It can also be used
to localize or biopsy abnormal ducts.
C-089
Breast intraductal lesions: The role of ductal US technique in diagnosis
A. Chiorean, R. Roman, I. Agoston, M. Duma; Cluj Napoca/RO
(chiorean_angi@yahoo.com)
Purpose: To evaluate the role of ductal ultrasonography in detection, characterization and management of intraductal lesions (benign and malignant).
Methods and Materials: During a 12 months period, bilateral breast ultrasound
340

examination using the radial technique, with linear array high frequency transducer, in B-mode gray scale, color Doppler and Power Doppler, was performed
on 977 patients, having abnormal mammogram, normal mammogram but dense
breast type, nipple discharge or as the first examination in young patients. When
the suspect lesion was found, US-guided procedures such as FNA, core biopsy
and needle localization for surgical excision was recommended. Results were
correlated with histopathologic analysis.
Results: Ductal ultrasound technique used in all cases revealed six benign papillary lesions, one papillary carcinoma, three cases of 'ductal carcinoma in situ'
with or without calcification on mammogram and nine cases of associated intraductal component of an invasive carcinoma. The US features varied from mild
duct wall irregularity to intraductal mass, with one or more vascular structure.
Conclusion: Intraductal lesions cause diagnostic problems because papillary
structures are found in benign and malignant processes and sometimes the differences between them are subtle and difficult to assess. Papillary breast lesions
are an uncommon group of proliferative high risk breast lesions. US has advantages over ductography, being more sensitive and offering a better way to manage the lesion.
In patients with invasive and DCIS, ductal US is particularly useful for depicting
intraductal proliferative lesions, and evaluating the ductal extent of disease, being able to visualize millimetre lesions, some being mammographically occult.
Breast
Miscellaneous
C-090
Radio-pathologic characteristics of breast cancer detected in a population
based screening program by a computer-aided-detection system
S. Sanchez Gomez, M. Torres Tabanera, M. Sainz Miranda,
P. Martinez-Miravete, E. Lag Asturiano, A. Baroja Mazo, M. Ruiz Diaz;
Logrono/ES (ssanchezg@riojasalud.es)
Purpose: To compare radio-pathologic characteristics of cancers detected and
non-detected by a CAD system in a breast cancer mammography screening program.
Methods and Materials: From September 2003 to April 2005, 18,553 screening
mammographies were processed by CAD. 98 cancers were detected in 86 women. Six of them were not previously processed by CAD due to technical problems
and excluded; consequently, study population was 92 cancers in 80 women (14%
multiple foci). Study parameters were: marks per case, breast density, lesion type
and size, multiple foci, BI-RADS category and histology.
Results: Marks per case were 4.9. Fifteen cancers (16%) were non-detected by
CAD (9% multiple): nodule was the most frequent lesion (53%) with a middle size
of 12 mm and scattered fibroglandular pattern (53%). Classification by categories was 54% BI-RADS5; 40% BI-RADS4 and 6% BI-RADS3. In pathologic analysis 87% were invasive and 13% in situ. Seventy-seven cancers (84%)
were detected by CAD; nodule was again the most frequent type of lesion (49%)
with a middle size of 17.5 mm and scattered fibroglandular pattern (63%). Classification by categories was 48% BI-RADS5; 48% BI-RADS4 and 4% BIRADS3. In pathologic analysis 80% were invasive and 20% in situ. Three
cancers (3%) were detected by CAD but not by the radiologist (mammographies
were interpreted as normal and posteriously diagnosed as interval cancers).
Conclusion: 1. Middle size of CAD-detected cancer was superior to non-detected (17.5 mm). No other differences were found. 2. Rate of false negative was
superior for CAD (16%). 3. "Second lesion" is not yet a resolved issue for CAD
systems.
C-091
Primer of breast optical imaging with computed tomography laser
mammography (CTLM)
S. Gaudino, P. Belli, M. Costantini, R. Lombardi, M. Romani, L. Bonomo;
Rome/IT (sgaudino@sirm.org)
Learning Objectives: To understand the fundamental physical principles of computed tomography laser mammography scanning. To become familiar with the
normal superficial and deep, (previously un-revealed), venous anatomy of the
breast. To demonstrate a schematic approach for image interpretation. To provide
illustrative cases and to discuss clinical applications.
Background: CTLM is a innovative opportunity in breast imaging using laser
source. It images only blood-perfused structures within the breast, in dynamic
(fly-through) sequence and montage (all sections displayed simultaneously) projections providing a new way to see throughout the breast.
Imaging Findings: To obtain the best images and to accurate CTLM scans interpretation, we illustrated physical and physiopathological principles of computed tomography laser mammography. This knowledge allows the correct signs
and artefacts image interpretation to avoid confusion facing CTLM images. In our
experience artefacts, as well as normal finding, must be learned for the CTLM
reading. We illustrate our methodology for the CTLM image interpretation. Finally
we propose an image gallery of the most typical CTLM pattern to become familiar with normal anatomy and breast lesions.
Conclusion: CTLM is potentially useful as an adjunct to mammography (and/or
US) for improving the differentiation of breast cancer from benign lesions, but the
knowledge of physic principles and fundamental signs are mandatory.
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Multislice-CT angiography for preoperative planning of deep inferior

epigastric perforator flap: Imaging findings from a work-in-progress
A. Alonso-Burgos, J.J. Noguera, E. Garca-Tutor, G. Bastarrika, D. Cano,
L. Pina; Pamplona/ES (jnoguera@unav.es)
Purpose: The objective of this report is to emphasize the usefulness of multislice-computed tomography (MSCT) angiography for preoperative planning in
patients undergoing deep inferior epigastric perforator (DIEP) flap reconstruction. The initial experience and the imaging findings will also be described.
341

Methods and Materials: Six consecutive women were considered for breast reconstruction with DIEP flaps after previous mastectomy for breast cancer. Preoperative MSCT angiography was performed (following a target injection of 150 ml
contrast medium at a flow rate of 4 ml/sec) to localize the arterial perforators.
Axial images were processed and reformatted into multiplanar reconstructions
and 3D volume-rendered. Images were analyzed and findings were reported and
correlated with surgery.
Results: Accurate identification of the main perforators was achieved in all six
patients with perfect concordance between the MSCT angiography and the surgical findings. No unreported vessels were found. Location, course, anatomical
variations and relations of the superficial inferior epigastric artery were also reported. The very small perforators, not suitable for creating a flap, were equally
evaluated.
Conclusion: Preoperative Doppler and duplex ultrasound for the planning of
perforator flaps have been previously recommended. To our knowledge this is the
first report emphasizing the value of MSCT angiography for locating and evaluating DIEP vessels. This technique is extremely useful to accurately evaluate perforators and allow a global approach not only of the vascular anatomy but also of
the entire anterior abdominal.
C-093
Advanced breast cancer: Comparison between multidetector-row CT and
dynamic MR imaging
M.C. Cossu, P. Boraschi, F. Donati, A. Volpi, F. Falaschi; Pisa/IT
(mc.cossu@ao-pisa.toscana.it)
Purpose: To evaluate the usefulness of dynamic multidetector-row CT (MDCT)
for assessing the extent of advanced breast cancer and to compare MDCT with
dynamic MR imaging (MRI) findings.
Methods and Materials: Twenty-two patients with locally advanced breast cancer on the basis of clinical examination and/or US/mammography were studied
with MDCT and MR imaging before surgery and/or neoadjuvant chemotherapy.
CT was performed on supine position with a four-row scanner using the following
parameters: collimation, 1 mm; slice width, 1 mm; reconstruction interval, 0.5 mm.
Two scans of the breast were obtained at 60 seconds and 180 seconds after
starting contrast injection (5 ml/sec) and a further one after 6-8 minutes. MR imaging was performed on 1.5 T-system in the prone position. In all cases, after
unenhanced T1w and fat-suppressed T2w images, a gadolinium-enhanced 3D
SPGR sequence was repeated dynamically. Two observers in conference evaluated the local extent of breast tumor including the presence of multicentric/multifocal lesions. After resection, surgical results were correlated with MDCT and
MR imaging.
Results: In all cases MDCT and MR imaging enabled detection of breast cancer,
whereas 3 breast tumors were not identified on US/mammography. Multifocal
lesions were identified in 5/7 cases on MDCT and in 7/7 patients on MR imaging;
CT and MR imaging correctly detected 11/11 multicentric lesions. Besides, in 5/
22 patients CT revealed the presence of pulmonary metastases. The size of neoplasm on surgical specimen significantly correlated with CT and MR imaging
measurements (p < 0.0001).
Conclusion: MDCT is a promising diagnostic modality for evaluating advanced
breast cancer, particularly when MR imaging is not available.
C-094
Breast masses during pregnancy and lactation
A. Martin, M. Villajos, M. Sentis, L. Tortajada, S. Ganau, J. Branera;
Sabadell/ES (amartino@cspt.es)
Learning Objectives: To review the different pathologies that can appear during
pregnancy and lactation. To illustrate the radiological findings. To define our rationale for the evaluation and management of the pregnant or lactating patient
with a breast mass.
Background: The management of breast abnormalities during pregnancy and
lactation results difficult for examining clinician, radiologist and pathologist because of the physiologic changes that occur in the breast during this period. The
majority of breast masses that develop during pregnancy and lactation are benign in etiology but it is necessary for a prompt evaluation of them due to the
possibility of pregnancy-associated breast cancer.
Procedure Details: A review of breast masses that occur in pregnant or lactating
patients, including pregnancy-associated breast cancer, are discussed and the
corresponding imaging findings are presented. The conduct and resolution are
also described. In this pictorial review we are going to divide the different pathologies as inflammatory, benign neoplasm and breast cancer.
Conclusion: The majority of breast lesions encountered during pregnancy and
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lactation are benign in etiology. It is necessary for a prompt evaluation of them

due to the possibility of pregnancy-associated breast cancer.
C-095
Ductal carcinoma in situ of the breast (DCIS)
A. Mariscal1, J.J. Sanchez2, P. Puyalto1, M. Torre1, I. Guasch1, J.C. Quintero1,
D. Casas2; 1Badalona/ES, 2Barcelona/ES (jsanchezfern@uoc.edu)
Learning Objectives: To describe the mammographic findings of pure DCIS and
to establish radiologic-pathologic correlation.
Background: A retrospective review of 99 pure DCIS cases, pathologically confirmed and treated in our institution, was performed between October 1998 and
June 2004. Morphology and size of microcalcifications were correlated with histologic size and subtype.
Imaging Findings: 99 patients with mammograms and histological verified cases of pure DCSI were included in the study. Microcalcifications (66) were the
most common mammographic finding. Other findings were: Focal distortion (15),
nodule (11), nodule and microcalcifications (3), focal density (3) and galactography repletion defect (1). 34 DICS comedo subtype cases and 65 noncomedo
subtype were found in the histological confirmation. 33 out of the 34 comedo
subtype cases showed microcalcifications on mammography whereas only 33 of
65 noncomedo subtype did.
In DCIS comedo subtype casting calcification were present in 77 % and granular
calcification in 32.5% whereas in DCIS noncomedo subtype casting calcification
were shown in 23% of the cases and granular calcification in 67.5%.
Microcalcification size assessed by mammography was underestimated if compared to histologic size in 8 out of 66 (12%) of all the cases; 7 DCIS comedo
subtype and 1 non comedo DCIS.
Conclusion: There is an overlap between the morphologic appearance of microcalcification on mammography and the histopathologic subtype, although it is
moderate.
Tumor size assessed by mammography (extent of microcalcification) was smaller than that assessed by histology in a small percentage of the cases, mostly in
DCIS noncomedo subtype.
C-096
Influence of monitor luminance and room illuminance on soft-copy breast
phantom image interpretation
K. Shimamoto 1, K. Koyama2, H. Muramoto3, M. Ikeda1, H. Fukushima1,
T. Ishigaki1; 1Nagoya/JP, 2Toyoake/JP, 3Kasugai/JP
(simamoto@met.nagoya-u.ac.jp)
Purpose: To evaluate the influence of monitor brightness and room illumination
on soft-copy mammography reading in comparison with CRT and LCD.
Methods and Materials: 10 observers (7 radiologists and 3 radiological technologists) interpreted three types of breast phantom images using a 21" CRT (2560
x 2048) and a 21" LCD (2560 x 2048) under the 6 kinds of viewing conditions as
follows: monitor brightness was adjusted to 330 cd/m2 and 450 cd/m2; and room
illumination was also changed at 20 lux, 100 lux and 420 lux at the center of the
display surface. Observers were requested to determine the visibility of the objects (mass, calcification, and fiber) using a three-point scale. Each phantom
image was interpreted twice, and reproducibility of judgment was evaluated using the kappa statistics.
Results: In all types of objects, the score of LCD showed a significantly higher
value (p < 0.05) compared with CRT. However, no significant differences existed
among the six viewing conditions. Also, reproducibility of judgment was never
affected by type of monitor or viewing conditions.
Conclusion: The mammography phantom objects were better visualized on LCD
compared with CRT. However, the monitor brightness and room illumination could
not affect the performance score at the soft-copy reading.
C-097
Imaging of "non-glandular" disorders of the breast: A pictorial review with
pathologic correlation
R.M. Lorente-Ramos, Y. del Valle-Sanz, I. Gallego-Villaescusa,
M.J. Alcaraz-Mexa, E. Jareo-Dorrego; Madrid/ES
(yolandadelvalle@yahoo.es)
Learning Objectives: To illustrate a wide spectrum of pathologic disorders arising in structures of the breast different from the duct-lobular system. To know the
utility of each imaging modality that can be applied to the management of these
conditions. To emphasize pitfalls, diagnostic difficulties and differential diagnoses
of these entities.

Background: Lobules and ducts hold best known breast lesions, but anomalies
arising from different structures may also be present. Our aim is to illustrate a
wide spectrum of these entities and to evaluate the efficacy of mammography,
conventional and Doppler US, and MR imaging in the diagnosis and management of these conditions.
Imaging Findings: Specific topics addressed include lesions involving skin (epidermal inclusion cyst and calcification), vessels (malformations, hemangioma
and angiosarcoma), nerves (neurofibroma), lymph nodes (reactive and lymphoma), pectoral muscle tumours, fat (lipoma, oil cyst and fat necrosis), fibrous stroma (focal fibrous disease, pseudoangiomatous hyperplasia, sarcoma, foreign body
reaction and inflammatory pseudotumour) and a group of diseases involved diffusely; hematoma, mastitis (acute, chronic, idiopathic and foreign body granulomatous and lymphocytic mastitis), diabetic mastopathy, metaplastic carcinoma
and metastasis from extramammary tumours. The key findings at each imaging
modality are shown and compared with the underlying gross and microscopic
pathologic features when available. Pitfalls and differential diagnosis are emphasized.
Conclusion: We must know and be aware of breast lesions arising in structures
different from lobules and ducts in order to avoid confusion with those entities, as
they appear showing similar imaging findings.
C-098
Pictures of anatomical vessel structures can simulate malignant
angiogenesis in CT - laser mammography - diagnostic problem
K. Steinhof, L. Zarudzki, B. Bobek-Billewicz, A. Kozicz, E. Stobiecka;
Gliwice/PL (kasia_steinhof@tlen.pl)
Learning Objectives: 1. To become familiar with some anatomical variants which
can simulate malignant angiogenesis in CTLM. 2. To understand that not each
irregular area of higher absorption presented in CTLM shows malignant angiogenesis.
Background: CTLM is based on two phenomenons:
1. Each tissue has different ratio of laser rays absorption - laser rays used in
CTLM are more absorbed by hemoglobin than by surrounding tissue.
2. Malignant tumor is accompanied by angiogenesis.
So CTLM gives a picture of normal and pathological blood vessels. Distinguishing these structures plays a key role in diagnostics of breast abnormalities.
Imaging Findings: In CTLM normal vessels look alike pyramids radiate with its
top heading nipple and its bottom heading side of chest. The image in coronal
projection looks like the wheel spokes. Angiogenesis picture is irregular area of
higher laser beam absorption, located differently than normal vessels. Some variants of normal blood vessels can mimic pathological structures leading to false
diagnosis. In our exhibit we describe such structures as sub-areolar vessel plexus, vascular star, vessel redistribution, vessels bridging.
Conclusion: Some of irregular areas of higher absorption showed in CTLM are
anatomical vessel structures. It is important for radiologists to know various anatomical variants of CTLM pictures to avoid false positive diagnosis.
C-099
Metastasis to the breast: Spectrum of mammography and sonography
findings
A. Nunziata, O. Catalano, T. Petrosino, R. Rubulotta, M. Mattace Raso,
A. Siani; Naples/IT (tonikus@libero.it)
Are cancers detected by arbitration different from cancers detected without

arbitration?
A. O'Brien, L. McLean; Newcastle Upon Tyne/UK
(angelaobrien@doctors.org.uk)
Purpose: Arbitration was introduced into the Newcastle breast screening programme in 2000. Before this all screening films were scored 1- 5 with those with
2 or greater generating a recall for assessment. In 2000, a new score, A, was
introduced between 1 and 2. All films scored A or 2 are reviewed weekly at a
meeting attended by all screen readers and a consensus decision made regarding recall. Approximately 50% of women undergoing arbitration are recalled and
a 4% of these have a cancer. We were interested in comparing the cancers detected following arbitration (scores A-2) with those detected without arbitration
(scores 3-5).
Methods and Materials: From KC-62 records all screen detected cancers were
identified for year 2003-2004. Women whose films had undergone arbitration were
compared with those who had not. Comparison was made of the mammographic
morphology, tumour histology, size and NPI (Nottingham prognostic index) of the
cancers in both groups.
Results: 160 cancers were detected of which 24 had undergone arbitration. There
was no significant difference between the cancers detected by arbitration and
those that were not with regard to morphological mammographic features (7/24
presented with a mass compared to 47/136; p = 0.78), histology (13/24 invasive
ductal v 79/136; p = 0.89), average NPI (0.90 1.97 v 0.90 1.15; p = 0.28) or
average size (16.1 12.1 v 18.2 14.9; p = 0.56).
Conclusion: In our screening programme, cancers detected by arbitration are
very similar to those detected without the arbitration process.
C-101
Computed tomography laser mammography (CTLM) imaging in evaluation
response to neoadjuvant chemotherapy in breast cancer patients:
Correlation with mammogram, ultrasound and magnetic resonance imaging
S. Gaudino, P. Belli, M. Costantini, C. Malaspina, M. Romani, L. Bonomo;
Rome/IT (sgaudino@sirm.org)
Purpose: To compare computed tomography laser mammography (CTLM) findings with conventional imaging techniques (mammography and ultrasound) and
magnetic resonance imaging in determining response to neoadjuvant chemotherapy in breast cancer patients.
CTLM images only hemoglobin in the breast, detecting angiogenesis, and, potentially, monitoring vascularity response to neoadjuvant chemotherapy.
Methods and Materials: 6 Patients (ages 45-72) with palpable breast cancer (5
invasive ductal carcinoma, 1 invasive lobular carcinoma) underwent mammography, ultrasound, MR imaging and CTLM before and after neoadjuvant chemotherapy. Areas of high increased absorption at CTLM (areas clearly more shinning
than the surrounding parenchyma) was evaluated as positive for neoangiogenesis, and assessed for their morphology. CTLM images were compared with conventional imaging and MR imaging. Histopathological results allowed for an
objective assessment of the accuracy of imaging techniques in evaluating response to treatment.
Results: Pathological findings showed 1case of no response and 5 cases of
partial response.
In 2 cases of partial response MR imaging diagnosed a complete response (no
enhancement was found in tumour area), whereas CTLM and ultrasound correctly demonstrated presence of disease (area of high increased absorption at
CTLM and vascularized hypoechoic tissue at US). In the other cases a good
correlation was found between radiological imaging, CTLM and pathology.
Conclusion: Our study demonstrate the potential of CTLM for monitoring tumour
neoangiogenesis, a physiological parameter of breast lesions during and after
chemotherapy. This physiological parameters may be complimentary to the morphological information obtained by traditional breast imaging modalities.
C-102
Clinical usefulness of in-line FDG PET/CT for breast cancer: Benefits and
pitfalls on FDG PET
N. Ogasawara, Y. Honma, S. Morita; Fukuoka/JP (hal95780@rio.odn.ne.jp)
Learning Objectives: To show the cases of various types of breast cancer including subtypes, maybe false negative on PET or CT alone and diagnostic pitfalls of FDG PET.
Background: Recently, FDG PET has been indispensable for the diagnosis of
breast cancer as pre-operative and post therapeutic exanimation. However, we
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Breast
Learning Objectives: To offer a detailed pictorial review of metastasis to the

breast as shown by a wide spectrum of imaging modalities, including mammography, sonography (US), colour-Doppler, power-Doppler, and low-mechanical index, contrast-enhanced US. To discuss the related diagnostic difficulties and
differential diagnosis.
Background: Breast metastasis represents an uncommon but possible occurrence, with proper difficulties in assessment and management.
Procedure Details: We discuss the epidemiological, histologic, clinical and diagnostic aspects of breast metastasis. Findings on mammography, US, colourDoppler, power-Doppler, and low-mechanical index contrast-enhanced US are
illustrated. Clues to diagnosis include in a patient with previous or concurrent
history of extramammary cancer (especially melanoma), multifocal/multicentric
disease and intense, anarchic vascularization. Metastasis often have an appearance different from the typical one encountered in case of fibroadenoma and of
carcinoma. Recognising this non-carcinoma-non-fibroadenoma appearance may
be helpful.
Conclusion: By viewing this exhibit the radiologist will obtain a detailed essay of
clinical and imaging aspects of breast metastasis. He/she will increase confidence in mammographic and US differential diagnosis of mammary metastasis.
C-100

sometimes experience false negative or false positive cases on FDG PET. In-line
PET/CT is expected to solve the problems by reduction of the number of equivocal PET findings because of the accurate anatomic localization of PET abnormalities.
Imaging Findings: In our institution, 207 patients were investigated by in-line
PET/CT between January to September 2005, for differential diagnosis, pre-operative staging or suspicion of recurrence or metastasis of breast cancer. In this
study, we will present the cases of almost negative findings on FDG PET (e.g.,
small size of papillo-tubular carcinoma detectable on CT, scirrhous carcinoma
which CT, mammography and dynamic MR imaging showed typical findings, bone
metastasis detected by CT first because of the sclerotic findings), LN metastasis
of negative findings on CT but positive on FDG PET and inflammatory fibrosis/
granulation following radiotherapy/operation, positive on FDG PET but properly
diagnosed by CT morphologically.
Conclusion: In-line PET/CT was useful in detection of breast cancer and its
metastasis and reduction of diagnostic pitfalls. We believed that in-line PET/CT
should be regarded as a new modality and a comprehensive image diagnosis
using the morphological findings of CT is necessary.
C-103
Optical mammography: A new technique for breast cancer diagnosis
A. Athanasiou, L. Fournier, C. Dromain, C. Balleyguier, S. Delaloge, R. Sigal,
D. Vanel; Villejuif/FR (athanasiou@igr.fr)
Purpose: The purpose of this prospective study was to determine the diagnostic
accuracy of near-infrared breast optical absorption imaging in patients with BIRADS 3 to 5 classification lesions scheduled for biopsy, using pathology after
core or excisional biopsy as a reference.
Methods and Materials: The patient's breast was positioned onto a panel of red
light-emitting diodes (640 nm). A soft membrane was inflated to exert a uniform
pressure on the breast. Transmitted light was detected by a CCD camera. The
entire acquisition sequence took 1 minute. Image processing generated dynamic
images displayed in color scale to reveal time-dependent changes in the transmitted light intensity caused by the pressure change. Pixels were classified in
two categories: consistently increasing or decreasing intensity suspect for malignancy, and sinusoidal or absence of variation of intensity considered benign.
Results: One hundred fifty women consulting for non-palpable breast lesions
were included. Three consecutive studies were carried out; first we evaluated the
feasibility of the technique; then we analyzed the breast vessels comparing with
the gold-standard method currently being breast MR imaging; and finally for the
last 72 patients we had an imaging-histology correlation. We experienced an overall
sensitivity of 67% and specificity of 45% for the last study, the false negative
results being mainly small size (< 7 mm) DCIS and DIC cancers. False positive
results were seen in benign proliferative lesions.
Conclusion: Optical imaging is a novel, low-cost, non-invasive technique yielding a new type of information about the physiology of breast lesions. Absorption
of signal is due to methemoglobin, therefore reflects angiogenic status of breast
tumors.
C-104
False negatives among probably benign lesions recommended for short
interval follow-up
J. Magalhes Lamas, E.A. Sickles, G.W. Eklund, H.A. Koch; Brasilia/BR
(janicelamas@terra.com.br)
Purpose: To estimate the frequency of cancer among mammographically- detected, probably benign lesions, that were followed with mammography.
Methods and Materials: A cross-sectional and prospective study was carried
out, from February 1994 to July 2002, at a mammography facility in Brazil where
16448 women filled out a questionnaire, were examined mammographically and
underwent clinical breast examination. 8635 patients were symptomatic and underwent diagnostic mammography. The remaining 7813 were asymptomatic women.1206 asymptomatic women had underwent a diagnostic study that included
additional imaging or sonography for nonpalpable, probably benign lesions (BIRADS 3) for which mammographic surveillance was recommended (6 month
unilateral follow-up, followed by bilateral mammography 6 months later). They
were followed until July 2005.
Results: 825 women had not been screened previously. 325 (27%) women with
probably benign lesions were young women, age 49 years and under. 850 (70.5%)
women with probably benign lesions were monitored by one mammographic
follow-up (6/12-month), 563 (46.7%) had two follow-ups and 353 (29.3%) underwent all four examinations; nineteen (19) cases (1.7%) showed interval changes
that proved to be malignant: 5/19 were DCIS, 2/19 were T1N0M0 invasive cancer
344
0.5 cm; 6/19 were T1N0M0 invasive cancer > 0.5 1.0 cm; 2/19 T2N1M0 only
returned 2 years later. Among the mammographic findings, calcifications were
the most frequent feature of cancer (2.5%), followed by multiple circumscribed
masses (2.0%).
Conclusion: The low probability of malignancy among probably benign lesions
justified management by short interval mammographic surveillance.
C-105
High resolution scintimammography with dedicated miniaturized -camera
in the detection of small breast cancer
E. Cossu, P. Romano, C. Sanso', O. Buonomo, O. Schillaci, I. Tanga,
G. Simonetti; Rome/IT (ila.dede@virgilio.it)
Purpose: To evaluate the potential benefit of high resolution scintimammography
in the determination of the biological nature of suspected small breast lesions.
Methods and Materials: From March 2004 to April 2005, we studied 59 consecutive patients with mammographic and/or ultrasound suspected breast lesions,
(diameter inferior at 1 cm/BIRADS 3-4), underwent Technetium-99m Sestamibi
injection (740 MBq i.v). To acquire the images we used a small dedicated high
resolution (HR) -camera with 20x16 cm/CZT scintillator (LumaGEM 3200S,
Gamma Medica, Northridge, CA). This device is applied to an analogical mammographic system like a Potter-Bucky. This enables the camera to be positioned
close to the breast and to acquire scintigraphic HR images similar to mammographic views. The obtained images were compared with mammography and ultrasound examinations to verify a correspondence between the morphological
aspects and the biological activity of findings. If the lesion showed any uptake of
radiotracer the lesion was considered malignant, even if it showed low suspicion
at mammography. In the follow-up, we verify our finding with histological results.
Results: In our experience the comparison of diagnostic findings demonstrate
that all malignant lesions showed a radiotracer uptake, so the scintimammography helped to distinguish benign from malignant lesions in the case of suspected
small mammography and/or ultrasound breast lesions.
Conclusion: This technique is very promising and it is can became an useful
modality as a secondary imaging, especially in dense breast women, high risk
population or problem solving.
C-106
The effect of Hungarian organized breast cancer screening programme on
the number of screening and diagnostic mammography
I. Boncz1, A. Sebestyn2, R. Kvi1, I. Ember2; 1Budapest/HU, 2Pcs/HU
(boncz.i@oep.hu)
Purpose: A nation wide organized breast cancer screening programme was
launched in January 2002 in Hungary for women between the age of 45-65 with
a 2 year screening interval. The aim of the study is to analyse changes in the
number of screening and diagnostic mammography examinations before and after the introduction of organized breast cancer screening programme.
Methods and Materials: The data derived from the database of the National
Health Insurance Fund Administration contained routinely collected financial data
reported by the health care providers. The study included all the women aged 4565 having either screening or diagnostic mammography before (2000-2001) and
after (2002-2003) the introduction of organized screening. Patients were identified with the different outpatient care codes of mammography.
Results: Before the introduction of organized screening, in 2000-2001, there were
110.607 women with screening and 299.720 with diagnostic mammography examinations. After the introduction of organized screening, in 2002-2003, there
were 520.782 women with screening and 338.212 with diagnostic mammography examinations. Thus the ratio of screening mammography increased from
28.08 % in 2000-2001 to 63.51 % in 2002-2003. We found significant differences
among the countries. The lowest ratio of screening mammographies was around
43.69-48.41 %, and the highest was around 91.56-91.67 %.
Conclusion: The introduction of organized nation wide breast cancer screening
programme resulted in significant increase in the number of screening mammographies. We realized significant regional differences in the ratio of mammography
examinations. In order to reduce the within country differences, a better organization is needed.

C-107
Within country differences in the diagnostic procedure after positive
mammography in the Hungarian nation wide organized breast cancer
screening programme
I. Boncz1, G. Hoffer1, A. Sebestyn 2, R. Kvi 1, I. Ember2; 1Budapest/HU,
2
Pcs/HU (boncz.i@oep.hu)
Purpose: A nation wide organized breast cancer programme was introduced in
January 2002 in Hungary for women aged 45-65. The aim of the study is to analyse the differences in the diagnostic procedure after positive result of mammography screening in the Hungarian organized breast cancer screening programme.
Methods and Materials: The data derived from the database of the National
Health Insurance Fund Administration, contained routinely collected financial data.
The study includes all the women aged 45-65 having mammography screening
in the year of 2002. The starting point (T0) was defined as the time of the mammography screening. T1 denotes the time of the first diagnostic procedure (ultrasound examination of breast, axilla; another special mammography examination)
after the mammography screening.
Results: Altogether N=314.395 women were included into the study. The average diagnostic delay between T0 and T1 time was 20 days measured by the time
of ultrasound examination of axilla (N=17.303), 26 days measured by the time of
ultrasound examination of breast (N=23.249) and 26 days measured by the time
of another special mammography (N=13.090). The shortest time between mammography screening and breast sonography was 0 days (both done on the same
day) while the longest delay exceeded 30 days!
Conclusion: We realized significant regional differences in the diagnostic delay
after mammography screening, which result in large discrepancies in the equity.
There is a need for better organization and the more consistent application of
professional guidelines in order to reduce the within country differences.
Methods and Materials: RVS system (EUB-8500; Hitachi Medical Co., Tokyo,
Japan) displays real-time US image and corresponding MPR image of CT sideby-side at 10 frames/sec simultaneously. This system is composed of magnetic
sensor fastened to a high frequency linear array probe, the image-processing
workstation with a display, and US equipment. RVS system was used in 12 patients with 13 breast lesions. These were 6 cancers, 1 intraductal papilloma, and
6 no malignancies. All these were non-palpable lesions with abnormal enhancement on CT.
Results: In initial conventional US, six lesions revealed no abnormal findings,
and seven lesions showed some findings. Using RVS system, we were able to
identify all lesions and perform biopsy or surgery of the non-palpable lesions
safely and accurately.
Conclusion: Our study demonstrated the successful use of RVS for safe and
accurate diagnosis of non-palpable breast lesion. We thus conclude that the novel RVS system is a reliable navigation tool for breast biopsy.
C-108
Intracystic breast lesions: Radiological appearance and pathological
correlations
P. Belli, M. Costantini, S. Gaudino, C. Malaspina, A. Mul, R. Masetti,
L. Bonomo; Rome/IT (pbelli@rm.unicatt.it)
Learning Objectives: To illustrate a diagnostic approach to managing intracystic breast lesions. To describe its radiological features in mammography, sonography and MR imaging and correlate the imaging with histological patterns.
Background: Intracystic breast cancer has a low incidence but breast cysts are
a common disease and especially in the postmenopausal period, they should be
viewed with suspicion. Generally, patients with intracystic breast carcinoma, are
10 years older than the other breast cancer patients.
Imaging Findings: Intracystic breast carcinoma, at mammography, appear as a
single, well-defined and lobulated mass, without microcalcification, which are rare
findings in this kind of lesions. Sonography is the suitable test for distinguishing
simple cysts from solid lesions and for identifying intracystic growth tissue. MR
imaging can offer a new opportunity to identify malignant lesions by evaluating
the different enhancement patterns which correlates to various histological features. MR imaging shows different component of intracystic lesions; distinguishes hemorrhagic and/or necrotic tissue from encysted lesions and demonstrates,
by a characteristic enhancement, the invasion of the cysts wall. Sometimes cytological diagnosis is often hampered by sparse cellularity, abundant obscuring
blood, necrotic debris with a poor sensitivity. The diagnosis of intracystic breast
carcinoma is based on integration of radiological imaging and cytological results.
Conclusion: Correlation with clinical and radiological findings are essential in
the diagnosis and management of intracystic breast lesions. In our experience,
MR imaging, integrated with conventional imaging, can have a new role in preoperative diagnosis of intracystic breast carcinoma.
C-109
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The diagnostic usefulness of real-time virtual sonography (RVS) for nonpalpable breast lesions
A. Sawaki1, H. Satake1, S. Ishigaki1, K. Shimamoto1, T. Ishigaki1, K. Oda1,
T. Imai1, T. Nagasaka1, T. Mitake2; 1Nagoya/JP, 2Chiba/JP
Purpose: Ultrasound (US) and CT or MR imaging are essential modalities for
accurate study of the extent of breast cancer spread. However, it is difficult to
biopsy the non-palpable lesion with abnormal enhancement detected on CT or
MR imaging without the corresponding abnormal finding on US. To address this
difficult problem, we propose to use the newly introduced real-time virtual sonography (RVS) system with a high frequency linear array probe in conjunction with
CT. The purpose of this study is to evaluate diagnostic usefulness of RVS system
for breast imaging.
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Cardiac
Magnetic Resonance Imaging
C-110
Comparison between multislice phase sensitive inversion (PSIR) 2D single
shot (SS) trueFISP sequence and inversion recuperation turboFLASH
sequence for the assessment of myocardial viability after reperfused
myocardial infarction
E. Gerbaud, O. Corneloup, S. Brunot, P. Dos Santos, P. Coste, F. Laurent;
Pessac/FR (edouard.gerbaud@chu-bordeaux.fr)
Purpose: The aim of the study was to compare the diagnostic accuracy in viability imaging of the myocardium with a multislice phasesensitive inversions recovery (PSIR) 2 D single shot (SS) trueFISP sequence and an established IR
turboFLASH sequence.
Methods and Materials: 30 patients were examined between 3 and 6 days after
myocardial infarction at a 1.5 Tesla MR system (Siemens Symphony) 15 minutes
after administration of contrast material with a single shot 2D multislice technique (IR trueFISP), that allows imaging of the entire short axis during one breathhold, and with a segmented 3D single slice technique (IR turboFLASH), that
requires one breathhold per slice. The inversion time was optimized with a CINE
TI-Scout sequence for IR turboFLASH; the PSIR-SS trueFISP sequence was
used with a standard TI of 300 msec. The voxel size was 2.1 x 1.6 x 8 mm3 for
both MR techniques.
Results: Very small areas of delayed contrast enhancement detected with the
3D sequence were equally well visualized with the PSIR-SS trueFISP sequence.
The assessment of the area of infarction within one slice (r = 0.96, p < 0.003)
and qualitative evaluation of transmural extent is possible with excellent correlation of both techniques (2 = 2.99, p = 0.39).
Conclusion: PSIR-SS trueFISP sequence allows rapid evaluation of patients
with myocardial infarction for the area and transmural extent of hyperenhancement, with high agreement compared with results with the standard IR turboFLASH sequence.
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Cardiac MR imaging (CMRI) and 31-P spectroscopy (MRS) in surgical
ventricular restoration (SVR) of post-ischemic cardiomyopathy: Technical
procedures and clinical interpretation
M. Quarenghi, A. Esseridou, S. Castelvecchio, M. Di Donato, L. Menicanti,
F. Sardanelli; San Donato Milanese/IT (matteoq@tiscali.it)
Learning Objectives: 1) To know the principles, technique and results of SVR.
2) To became familiar with CMRI before and after SVR: morphologic imaging;
cine-MR and image segmentation; flow mapping; perfusion; delayed enhancement. 3) To learn how to do 31-P MRS in these patients. 4) To define principle of
clinical interpretation of CMRI and 31-P MRS before and after SVR.
Background: Post-infarction ischemic cardiomyopathy is the most frequent cause
of clinical heart failure in advanced countries. Even if early revascularization is
provided the shape and function of the left ventricle after myocardial infarction
may have consistent abnormalities. In these patients the risk of death and ischemic
events is high. SVR is a surgical option resulting in improvement of pump function, functional class and survival.
Procedure Details: Our aim is to illustrate methods and techniques of CMRI and
31-P MRS in patients with post-infarction ischemic cardiomyopathy, before and
after SVR. On the basis of our experience on more than 40 patients in the last 26
months. The protocol is a combination of ECG-gated: morphological examination
performed with T1w and T2w black blood TSE, HASTE and HIRM sequences;
cine-MR true-FISP real-time and high resolution; IR 3D FLASH performed 10 minutes after intravenous injection of contrast media for late-enhancement evaluation; MR spectroscopy procedures.
Conclusion: We will show how to deal with patient preparation, CMRI and 31-P
MRS acquisition and postprocessing (including software for manual, semiautomated, and automated image segmentation), and clinical interpretation of images and quantitative datasets. Common pitfalls and artefacts will be discussed.
C-112
Evaluation of aortic stenosis by cardiac magnetic resonance imaging:
Comparison with cardiac catheterisation
L. Klzo, J. Zizka, M. Solar, J. Bis; Hradec Kralove/CZ (ludek.klzo@seznam.cz)
Purpose: To compare whether direct planimetry of aortic valve area (AVA) measured by cardiac magnetic resonance (CMR) is reliable to determinate severity of
aortic stenosis and comparison with cardiac catheterisation (CAT).
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Methods and Materials: 24 patients with symptomatic aortic stenosis and no

more than minimal aortic insufficiency according to aortography were studied.
AVA was measured with CMR from high resolution (voxel size 1.1 x 1.2 x 5 mm)
steady state free precession (true fast imaging with steady state precession) by
planimetry. The Gorlin formula was used for the calculation of AVA from hemodynamic data.
Results: The correlation in the assessment of AVA between both methods was
good (r = 0.85). The mean AVAs determined by CAT and CMR were 0.96 ( 0.45)
and 1.13 ( 0.35) cm 2. The observed difference was statistically significant
(p = 0.0016) and the agreement in the diagnosis of severe aortic stenosis
(AVA < 0.5 cm2/m2) was poor (kappa = 0.3).
Conclusion: CMR planimetry is new promising technique, that can be used for
the assessment of aortic stenosis. It is reliable and reproducible method and our
results correlates well with CAT. However CMR underestimates AVA in comparison to hemodynamic method that results in poor agreement in identifying patients with severe aortic stenosis.
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Cardiac MR imaging: A pictorial illustration of left ventricular pathologies
S.B. Rai, R. Jones, R. Wellings, A. Anbarasu; Coventry/UK
(sbrai@hotmail.com)
Learning Objectives: 1. To demonstrate left ventricular anatomy with high spatial and temporal resolution. 2. Review basic interpretation of normal left ventricular morphology and function. 3. Illustration of the spectrum of left ventricular
pathologies encountered.
Background: Cardiac MR imaging demonstrates left ventricular pathology and
function with excellent spatial and temporal resolution. It has expanded our understanding of common pathologies such as ischaemic heart disease. In addition, it guides further specialist management in a more focused approach
compared to previous investigations such as 2D echocardiography.
Procedure Details: All examinations were performed on a 1.5 Tesla Siemens
Symphony magnet with dedicated cardiac software. Left ventricular pathologies
are categorised into: 1. Ischaemic disease: Cardiac MR imaging allows excellent
assessment of ischaemic myocardium using intravenous gadolinium to assess
myocardial viability. Classification of myocardial damage into definite necrosis,
hibernating myocardium and reversible ischaemia with high specificity and sensitivity; 2. Intrinsic muscle defects: Cardiomyopathies have been classified according to cardiac MR imaging findings; 3. Valvular dysfunction; 4. Cardiac masses:
Masses both intrinsic and extrinsic to the myocardium are illustrated including
mural thrombus.
Conclusion: Cardiac MR imaging has revolutionised our understanding of left
ventricular morphology and function. It has allowed us to accurately classify disease and guide specific management.
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Non-compaction cardiomyopathy magnetic resonance imaging
C. Barrera, C. Gervs, M. Izquierdo, J. Alustiza, E. Fernandez, J. Villanua;
San Sebastin/ES (mcbarrera@osatek.es)
Learning Objectives: To present: 1. Non-compaction myocardiopathy MR findings. 2. Potential of cardiac MR imaging in evaluation and diagnosis of this entity.
Background: Myocardial non-compaction is characterised by multiple prominent
ventricular trabeculations with deep intertrabecular recesses. This usually affects
left ventricle and occasionally the right. Clinical manifestations are highly variable. Familial occurrence has been observed. Diagnosis is made mainly on the
basis of cardiac imaging. Echocardiography has been the diagnostic procedure
of choice, but the diagnosis can be often missed. MR imaging may help in the
detection in nonconclusive echocardiographic studies and in subtle forms.
Imaging Findings: We present MR imaging findings of 19 cases collected between February 2004 and August 2005, 11 males and 8 females, five children
and 14 adults. Five cases showed familial link. In five cases, non-compaction was
associated with congenital cardiac anomalies. All studies included axial SE-T1
weighted and cine two-chamber, four-chamber and short-axis balanced-TFE
views. In all cases, morphological and functional ventricular analysis was done.
Cardiac MR imaging showed the typical appearance with deep intramyocardial
recesses and prominent trabeculations. In 8 of 19 patients, myocardial non-compaction was an unexpected feature.
Conclusion: MR imaging is a good tool to diagnose non-compaction. Cardiomyopathy, which is not so unusual. This pathology can be found in a wide range of
age. We found it more frequently as isolated form.
In same cases RV was also affected. Left ventricle function was not always depressed. Non-compaction cardiomyopathy can be an unsuspected finding. Techniques such as MR imaging may improve detection rates and provide new insights.

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The association of the localisation of myocardial infarction (MI) detected by
magnetic resonance imaging (MRI), and the quantification of calcium in the
coronary arteries detected with computed tomography (CT) and calcium
scoring software
G.S. Karlsdottir 1, A.E. Arai2, S. Sigurdsson1, M. Cang1, T. Aspelund1,
G. Eiriksdottir1, L. Launer3, J.J. Cao2, T.B. Harris 2, R. Detrano3, V. Gudnason 1;
1
Kopavogur/IS, 2Bethesda, WA/US, 3Torrance, CA/US (gyda@hjarta.is)
Purpose: To investigate potential association of myocardial infarction (MI) localized by gadolinium enhanced MR imaging, and the quantity of calcium in the
coronary arteries detected with multidetector CT (MDCT).
Methods and Materials: A total of 408 subjects (224 women (W), and 184
men (M)), aged 68-89 years (mean 76) were included. MDCT images of the heart
were acquired sequentially using a 4 detector scanner and prospective ECG
gating. Calcium scoring software was used to obtain Agatston scores (AS). Delayed enhancement images of the myocardium were obtained on a 1.5 T MR
imaging scanner. The transmural extent of MI was summarized using a 17-segment model of the heart.
Results: Ninety-three subjects had an MI localized by MR imaging, 55 men and
38 women. Geometric mean of AS (95% confidence intervals) for those with MI
was 593.2 (422.2-833.3) (M: 985.9 (747-1301.4) W: 284.3 (143.9-561.9)) and for
those without MI was 126.5 (97.2-164.54) (M: 276.0 (200.0-380.6) W: 73.5 (50.8106.1)). Patients with MI in all three coronary distributions (n = 24) have higher
calcium (1137.6 (718.1-1802.1), vs those with MI in only one (n = 42) coronary
territory 404.9 (219.5-747.2) (p < 0.05). Furthermore, those with one or two infarcted segments (n = 35) according to the 17-segment model had significantly
lower calcium; 326.4 (161.4-660.0), than those with infarct in three or more segments (n = 58); 850.6 (613.7-1178.7) (p < 0.05).
Conclusion: The study demonstrates a significant relationship between the extent of MI and amount of coronary calcium. Patients with MI in all three coronary
distributions have more calcium in the coronaries than those patients with fewer
infarcted coronary territories and smaller infarcts.
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Myocardial infarction in postmortem unenhanced cardiac MR imaging
C. Jackowski, M. Sonnenschein, M.J. Thali, E. Aghayev, R. Dirnhofer, P. Vock;
Berne/CH (christian.jackowski@irm.unibe.ch)
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CE cardiac MRI: From viability to diffuse cardiac diseases
G.K. Schneider, P. Fries, R.M. Seidel, A. Massmann, K. Altmeyer, M. Boehm,
I. Kindermann; Homburg a.d. Saar/DE (ragsne@uniklinikum-saarland.de)
Learning Objectives: To give an overview on the technique of CE imaging of the
heart; to learn about contrast enhanced imaging of the heart in ischemic and
non-ischemic diseases; to understand distribution patterns of enhancement in
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CMR evaluation in patients with high grade ventricular arrhythmias
A. Meduri, L. Natale, A. Bernardini, A. Porcelli, R. Fenici, L. Bonomo; Rome/IT
(lnatale@rm.unicatt.it)
Purpose: To assess by cardiac-MR the prevalence of myocardial alterations in
arrhythmic patients.
Methods and Materials: We examined 43 patients with non ischemic ventricular
arrhythmias. Premature ventricular complexes had left bundle branch block
morphology (LBBB) in 29 cases, in 7 a right bundle branch block contour (RBBB)
and 7 had polymorphic patterns (PV). US was negative in 78.4% of patients,
while CMR was negative in only 13% of patients. Studies were performed on a
1.5 MR scanner with Cine sequences (Fastcard or FIESTA), bb-FSE and IR-prep
FGRE 15 minutes after injection of 0.2 mmol/Kg of Gd-DTPA.
Results: CMR found a high prevalence of morphological, signal intensity and
functional myocardial abnormalities. RV dilatation was found in 85% of patients
with PV arrhythmias, 48.3% of patients with LBBB morphology, 12.5% of patients
with RBBB morphology. LV dilatation was present in 28.6%, 25% and 24.1 % of
patients with LBBB, PV and RBBB type arrhythmias respectively. RV wall motion
abnormalities were identified in 50% and 36.7 % of patients with PV and LBBB
pattern respectively; LV wall motion abnormalities in 25% and 10.3% of patients
with PV and LBBB pattern respectively. Free wall RV signal/thickness abnormalities were found in 23.3% of patients (18.6% with LBBB pattern and 4.7 with PV
pattern); LV signal abnormalities were found in 11.6% of patients (9.3% with LBBB
pattern and 2.3% with PV pattern). Seven patients underwent myocardial biopsy:
5 were positive for myocarditis, 1 positive for ARVD, and one had a negative
biopsy.
Conclusion: In patients with primary ventricular arrhythmias MR documented
high prevalence (87%) of morphological, signal intensity and wall motion abnormalities even with negative echocardiogram.
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Microvascular obstruction detected by cardiovascular magnetic resonance
in patients with first anterior AMI treated with primary PCI
D. Piotrowska, L. Kownacki, K. Filipiak, A. Cieszanowski, G. Opolski,
L. Krolicki; Warsaw/PL (dpiotrowska@plusnet.pl)
Background: Despite its prognostic importance, accurate assessment of microvascular reperfusion after primary angioplasty (PCI) in acute myocardial infarction (AMI) is difficult.
Purpose: Assessment of impaired microvascular reperfusion after successful
primary angioplasty of infarct related artery with cardiovascular magnetic resonance imaging (CMR).
Methods and Materials: 16 patients with first anterior AMI who underwent successful primary PCI were included into the study. CMR was performed on 1.5 T
scanner between 3 and 7 days after PCI. Myocardial perfusion was assessed in
stress condition by first-pass perfusion imaging. Hyperemia was induced by a 4min. infusion of adenosine (140g/kg b.w./min). before injection of Gd-DTPA. Microvascular obstruction ("no-reflow" region) was defined as hypoenhancement
seen 1 to 2 minutes after contrast injection on T1 weighted images. Infarct size
was assessed on contrast-enhanced images acquired with the use of an inversion-recovery segmented gradient-echo sequence 20 minutes after contrast injection.
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Purpose: To investigate the appearance of myocardial infarction stages in postmortem unenhanced MR imaging correlated to macroscopical and histological
staging.
Methods and Materials: 10 human corpses (age range 44 to 71 years, 2 female,
8 male) that presented with myocardial infarction were examined. Scanning was
performed on a 1.5 Tesla System. Short axis, horizontal and vertical long axis
cardiac images with T1, T2, stir, flair and true FISP sequences have been acquired. Imaging appearance was correlated to macroscopic autopsy appearance
using a section technique adapted to short axis. Histological staging (H&E, CAB)
was performed on slices covering the entire circumference of the left ventricle
allowing for a detailed correlation.
Results: Two cases with acute coronary occlusion and subsequent death (< 3 h)
showed no visible MR signal alteration within the myocardium or infarction signs
in routine histology. Earliest visible infarction (hypoperfused necrosis surrounded
by edema) was < 1 d and showed hypointense lesion with a hyperintense margin. This finding was increasingly obvious with survival times up to 1-2 weeks.
Later stages of myocardial infarction such as a fibrous transformation showed
local hyperintensity. Chronic infarction showed reduction of the diameter of the
local left ventricular wall with hypointensities correlating well with collagenous
tissue. All later stages of infarction showed a subendocardial layer of unaffected
myocardium of 1-2 mm.
Conclusion: Postmortem cardiac MR imaging allows the detection of myocardial infarction that already led to reactive histological changes. These vital reactions require a survival time after onset of ischemia of at least several hours to be
visible in MR imaging.
correlation with the underlying pathology; to learn about DDX in cardiac diseases
based on imaging findings in CE MRI.
Background: Contrast enhanced cardiac MR imaging is an established tool to
evaluate patients with ischemic heart disease and in combination with images
10-15 min post CM injection to differentiate between stunned, hibernating and
infarcted myocardial tissue. In addition to this widely accepted indication, dynamic and late CE images may as well be used to further characterize other forms of
myocardial disease.
Imaging Findings: The spectrum of diseases includes patients with different
forms of cardiomyopathies, involvement of the heart in systemic diseases like
sarcoidosis, involvement of the heart in muscular dystrophy, inflammation and
other changes that may result in a different contrast medium distribution and a
different CM kinetic including evaluation of cardiac masses. Distribution patterns
of contrast enhancement including subendocardial, midmyocardial or epicardial
location will be demonstrated and related diseases will be discussed. DDX will
be explained in flow charts based on imaging findings.
Conclusion: CE cardiac imaging is a technique not only of interest in imaging of
ischemic heart disease but also in patients with other forms of cardiomyopathies.
Based on distribution patterns of contrast enhancement DDX can be established
and together with clinical findings can point to the possible underlying disease.

Results: In all studied subjects subendocardial and larger perfusion defects were
found on first-pass images. Hypoenhancement was still visible 2 minutes after
contrast injection in 11/16 cases and in one subject persisted over 30 minutes.
The mean mass of "no reflow" region was 8.8 g (range 0 g to 28 g) and correlated with infarct size (r = 0.612, p = 0.012) and end diastolic volume (r = 0.540,
p = 0.031).
Conclusion: The prevalence of no reflow phenomenon revealed on MRI images
is frequent in AMI patients early after successful PCI. Its prognostic value needs
further evaluation.
Cardiac
Multidetector CT
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3D anatomical atlas of the heart based on isotropic data using 64-slice
MDCT
M. Funakubo, Y. Ogawa, Y. Kobayashi, K. Yagihashi, Y. Nakajima; Kawasaki/JP
(masakatu@gem.hi-ho.ne.jp)
Learning Objectives: 1) To understand the complex 3D structure of the heart by
the 3D anatomical atlas based on isotropic data using 64-slice MDCT. 2) To realize virtual dissection of the heart. 3) To understand the morphological and motional differences between normal and abnormal heart such as myocardial
infarction and cardiomyopathy.
Background: 64-slice MDCT can acquire the isotropic data of 0.5 mm slice within only 7-9 seconds using ECG-gated reconstruction. Previously, it was very difficult for medical students and radiology residents to understand the complex 3D
structure of the heart. This exhibit shows that the complex structure of the heart
can easily be understood with the 3D anatomical atlas consisting of MPR and 3D
images.
Imaging Findings: The anatomical atlas is expected to be used as Virtual Dissection indicating how to dissect the heart to observe four chamber views, long
axis and short axis views in dissection exercises. Furthermore, morphological
changes due to heart movement can be understood by showing MPR and 3D
images in different cardiac phases.
Conclusion: The anatomical atlas provides easy understanding of the morphological and motional differences between normal and abnormal heart, because it
can show MPR and 3D images of diseases such as angina pectoris, myocardial
infarction and cardiomyopathy.
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Coronary artery anomalies: A review of phylogeny, ontogeny and clinical
imaging appearance with multislice CT (MSCT)
T.M. El-Helw, D. Donovan, D. Fleischmann, F. Chan; Stanford, CA/US
(telhelw@stanford.edu)
Learning Objectives: 1. To review aortic root and coronary phylogeny and ontogeny; 2. To provide MSCTA techniques for evaluating coronary anatomy in children and adults; 3. To demonstrate the spectrum of 'malignant' vs 'benign' lesions;
4. To review surgical correction and post-operative imaging.
Background: Coronary artery anomalies are defined as abnormalities in the origin, course, or distribution of coronary arteries. They affect approximately 1% of
the population and 'malignant lesions' may be associated with sudden death in
the young. ECG-gated MSCTA allows robust diagnostic visualization of the aortic
root and proximal-to-mid segments of the coronary arteries, in both adults and
children.
Imaging Findings: Imaging findings of patients with coronary anomalies identified on MSCT (16- and 64-slice scanners) at our Hospital and Clinic, and Children's Hospital were reviewed. Correlation was made with echocardiograms,
coronary angiograms, and surgical findings when available. Post-surgical CTA
were also reviewed. Lesion Types: 1. Isolated coronary anomalies originating from
Aorta; 2. Coronary arteries arising from Pulmonary Artery (ALCAPA); 3. Coronary Fistulae; 4. Coronary anomalies associated with complex congenital anomalies: Tetrology of Fallot (TOF), Pulmonary Atresia with intact Ventricular Septum
(PA-IVS), Transposition of Great Vessels (TGA). The spectrum of coronary anomalies will be reviewed on the basis of phylogeny and ontology.
Conclusion: Radiologists interpreting MSCTA studies of the chest should have
an understanding of the spectrum of normal and abnormal coronary anatomy.
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Left ventricular volumes assessment using prototype 256-MDCT scanner
R.E. Kanza1, H. Higashino1, A. Kurata1, T. Kido1, T. Mochizuki1, S. Mori2,
S. Tanada2, K. Katada3, M. Endo2; 1Toon/JP, 2Chiba/JP, 3Nagoya/JP
(renekanza@yahoo.fr)
Purpose: To apply the prototype 256-MDCT in the 4D (2D/3D animation) cardiac
imaging and to investigate its potential to evaluate LV function using a cardiac
phantom.
Methods and Materials: We scanned a pulsating cardiac phantom with the prototype 256-MDCT (256 detectors along Z-axis) using the following protocol: 0.5 mm
slice thickness, gantry rotation speed= one sec/rotation, cone-beam continuous
mode covering 10 cm/rotation and temporal window= one sec/360-degree full
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reconstruction. By changing phantom heart rate (HR), we could adjust various
relative temporal resolutions over RR interval (=one beat). We adjusted the HR at
6 (relative temporal window=10% RR), 12 (20%RR), 18 (30%), 24 (40%), and
30 (50%RR). We reconstructed 10 cardiac phases; and 2D/3D animation was
generated. EDV and ESV were measured in each temporal resolution; and compared with the true EDV and ESV. Image quality of the 4D was visually evaluated.
Results: EDV (ml), ESV (ml) and EF (%) of true value, 10%, 20%, 30%, 40%,
and 50% temporal window were 105.7, 105.5, 104.2, 102.7, 100.0 and 98.3 for
EDV, 63.2, 63.3, 64.4, 65.7, 67.4, and 69.4 for ESV, 40.2, 40.0, 38.1, 36.0, 32.6,
and 29.3 for EF, respectively. EDV and EF were underestimated and ESV was
overestimated as the temporal resolution became worse. Temporal resolution
=< 20%RR provided accurate LV measurement (less than 5% error) and high
quality 4D image to assess wall motion and systolic thickening.
Conclusion: Requiring only one beat, the 256-MDCT-scanner can assess LV
function (temporal resolution=< 20%RR). Clinical experiences will be needed to
investigate fully its potential for cardiac imaging.
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Early parameters for coronary plaque vulnerability at 64-slice CT with IVUS
correlation
F. Pugliese, P. Malagutti, W.B. Meijboom, G. Rodriguez, P.J. deFeyter,
F. Cademartiri, G.P. Krestin; Rotterdam/NL (francesca.pugliese@libero.it)
Learning Objectives: 1. To recall the steps of atherosclerotic plaque formation
in coronary arteries focusing on findings that can be assessed with 64-slice MDCT
and IVUS. 2. To depict positive and negative remodeling processes as they appear at 64-slice MDCT to allow early noninvasive detection of vulnerable lesions,
matching the findings with those of IVUS.
Background: Advances in understanding the pathophysiology of coronary artery disease have established that over 75% of plaques that rupture and result in
acute coronary syndromes such as unstable angina and acute myocardial infarction (vulnerable plaques) are less than 50% occlusive. These types of plaque are
reported to be far more prevalent than occlusive plaques.
Imaging Findings: The 64-slice MDCT appearance of vessel compensatory enlargement, negative, positive remodeling processes and their location along the
coronary tree will be described with IVUS correlation. The feasibility of calculating a MDCT remodeling index will also be addressed.
Conclusion: The capability of early noninvasive assessment of the presence of
vulnerable lesions in coronary arteries is of clinical relevance. 64-slice CT allows
the depiction of positive and negative remodeling processes which correlate with
IVUS findings.
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Complex lesion stenting techniques as they appear at noninvasive coronary
angiography performed with 64-slice CT
F. Pugliese1, F. Cademartiri1, C. van Mieghem1, P. Malagutti1, M. Valgimigli1,
C. Martinoli2, P.J. deFeyter1, G.P. Krestin1; 1Rotterdam/NL, 2Genoa/IT
(francesca.pugliese@libero.it)
Heart transplant patients: Coronary artery evaluation by multi-detector

computed tomography (MDCT)
P.M. Carrascosa1, E. Martin Lopez1, G. Lev1, S. Perrone1, C. Capuay1,
J. Carrascosa1, M. Garcia2; 1Buenos Aires/AR, 2Cleveland, OH/US
(investigacion@diagnosticomaipu.com.ar)
Purpose: To determine the role of MDCT in the evaluation of endothelial proliferation of heart transplant patients in comparison with intravascular ultrasound
(IVUS).
Methods and Materials: Fifteen heart transplant patients were evaluated by IVUS
and MDCT using a 16-row CT scanner with 1 mm collimation thickness, 0.5 mm
reconstruction interval, pitch of 0.240, kV of 120 and mAs of 500. An enhanced
acquisition was performed following the administration of 100 ml of iodinated
contrast material in a dual-phase, using a power injector. Any stenosis between 0
and 50% were considered positive findings and were compared with IVUS for the
detection of intimal proliferation. IVUS were done using an Ultra Cross 3.2 F, 30MhZ coronary imaging catheter (Boston Scientific Corporation). A 17 segment
evaluation was performed. Sensitivity, specificity, positive predictive value and
negative predictive value of MDCT were calculated using the exact binomial
method.
Results: Intimal proliferation: there were 51 true-positive findings, 151 true-negative findings, 20 false-positive findings, 5 false-negative findings. The sensitivity
was 91.1% (79.6, 96.7), specificity 88.3% (82.3, 92.5), positive predictive value
71.8% (59.7, 81.6) and negative predictive value 96.8% (92.3, 98.8).
Conclusion: MDCT can provide accurate quantification of luminal stenosis and
can rule-out the presence of intimal proliferation in transplant coronary artery
disease.
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Coronary artery variants: A pictorial review of 64 slice multi-detector
computed tomography (MDCT) findings with conventional angiographic
correlation
S.L. Snape, R. vandenDreisen; Perth/AU (sonyasnape@hotmail.com)
Learning Objectives: To demonstrate the problem solving potential of 64 slice
MDCT multi-planar imaging in an area that has traditionally been difficult to assess by invasive catheter angiography alone. To recognise the 64 slice MDCT
appearances of normal coronary artery anatomy and common variants.
Background: Recent advances in multi-detector CT technology allow increased
temporal and spatial resolution such that MDCT images can now elegantly demonstrate detailed coronary artery anatomy non-invasively. A further advantage is
the ability to provide 3D reformats for surgical planning.
Variant coronary artery anatomy is a relatively neglected entity, yet life threatening complications such as arrhythmia, myocardial infarction or sudden death occur in up to 20% of cases.
Image Findings: We comprehensively illustrate multi-planar and 3D reformat
MDCT findings of normal coronary artery anatomy and anomalies with conventional angiographic correlation. Both incidental and clinically important examples
are depicted with review of current classification.
Conclusion: MDCT provides an excellent and accurate non-invasive alternative
or supplement to conventional angiography for depicting coronary artery variants.
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Predictions of ventricular tachycardia by detection of focal fibrosis in
hypertrophic cardiomyopathy by multislice computed tomography using
logistic regression models
N. Funabashi, M. Asano, I. Komuro; Chiba/JP (mikimaririn2036@yahoo.co.jp)
Purpose: We used ECG-gated MSCT to detect focal myocardial fibrosis (MF) in
subjects with hypertrophic cardiomyopathy (HCM) and attempted to predict occurrence of ventricular tachycardia (VT) in logistic regression models.
Methods and Materials: 26 subjects (18 males; 40-77 years old) with HCM detected by transthoracic echocardiogram (TTE) underwent enhanced MSCT. MF
was defined as myocardium with a lower CT intensity at 30s, and abnormally
enhanced at 8 min. Holter ECG was analyzed for VT.
Results: MSCT detected MF in 11 subjects. Age, male sex, presence of asymmetrical septal hypertrophy and presence of HOCM were not significantly different from those without MF. The median period between detection of myocardial
hypertrophy by TTE and CT acquisition was 12 and 7 years in subjects with and
without MF, respectively; the periods tended to be longer in the MF group. The
average maximum LV wall thickness with asymmetrical hypertrophy was 20 mm
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Learning Objectives: 1. To review the major techniques currently used to stent

complex atherosclerotic lesions in coronary arteries. 2. To depict the 64-slice CT
appearance of the different stent configurations that can be encountered at noninvasive coronary angiography.
Background: Although recently introduced drug-eluting stents have reduced the
occurrence of restenosis, still this phenomenon occurs in up to 20% of patients
with complex lesion characteristics. An accurate noninvasive coronary imaging
tool would thus be highly desirable for the follow-up of these patients.
Imaging Findings: CT examples of applied techniques such as provisional stenting, T, Y, culotte and crush stenting are provided with schematic explanations to
the purpose of helping the interpretation of the reshaped bifurcation anatomy
and evaluating the technical outcome of the procedure.
Conclusion: The high prevalence of previous PCI procedures in patients undergoing cardiac CT and the increased restenosis rates associated with complex
lesions compared to simple lesions requires knowledge of the expected stent
configurations (and related artifacts) at bifurcation points for reliable clinical interpretation of CT data.
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in subjects with MF and 16 mm in subjects without (p < 0.05). Furthermore the
degree of hypertrophy seemed to be greater in the subjects with MF. The percentage of MF-subjects with VT was 73% and significantly higher than without (20%,
p < 0.01). In a logistic model, the presence of MF in MSCT was associated with
increased incidence of VT (relative risks 39.5; p < 0.05).
Conclusion: Focal MF tended to occur in advanced HCM and caused VT with
significantly higher frequency, independently of the degree of wall thickness, or
the site of asymmetry. MSCT may be a useful independent tool for detection of
focal MF and prognosis of HCM.
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Utility of 256-slice cone beam tomography for real four dimensional
volumetric analysis without electrocardiogram gated acquisition
N. Funabashi, T. Tsunoo, M. Endo, I. Komuro; Chiba/JP
(funanobu2005@yahoo.co.jp)
Purpose: Current ECG-gated MSCT cannot acquire the whole heart in one scanning, and arrhythmias impair the quality of the images. We used a prototype 256slice cone-beam CT, with which the whole heart can be acquired in one scanning.
Methods and Materials: A pulsating device with contrast material (300 mgI/dl)
diluted 10x with saline was moved at 5-90 to-and-fro movements/min. Non ECGgated cone-beam CT with was performed during one to-and-fro motion at each
rate and each motion was divided into 20 frames, and each volume was measured and volumetric curves were constructed.
Results: The configuration of the pulsating device at any rate continued to the
through plane without any gaps. End-diastole (ED) volumes were 81.7, 70.3, 63.7,
68.3 and 65.9 ml, end-systole (ES) volumes were 30.9, 39.8, 62.7, 55.0 and
43.2 ml, and EF was 62, 43, 2, 19 and 34% at 5, 40, 60, 70, and 90/min, respectively. The ratios of ED volume, using the static state as the reference, were 100,
86, 78, 84 and 81%, those of ES volume were 177, 227, 358, 314 and 247%, and
those of EF were 78, 54, 3, 24 and 43% at 5, 40, 60, 70, and 90/min, respectively.
From the configuration of volumetric curves, only 5/min could be evaluated.
Conclusion: Even without ECG-gated acquisition, this new 256-slice cone-beam
CT achieved real 4D analysis of the pulsating device. The ED volume and the
configuration of volumetric curve could only be evaluated up to 5/min because of
its poor spatial resolution (One sec/rotation).
C-130
Predictors of non-calcified plaques of coronary arteries in 352 subjects by
multislice computed tomography using logistic regression models
Purpose: We detected non-calcified plaques (NCP) of coronary arteries using
multislice CT (MSCT) to determine predictors of NCPs in logistic regression
models.
Methods and Materials: 352 consecutive subjects (200 males, 17-91 years old)
underwent enhanced ECG-gated MSCT. Logistic models for predicting NCPs were
constructed using age, sex and coronary risk factors (RFs) (hypertension [HT],
diabetes mellitus [DM], hyperlipidemia [HL] smoking habits, and obesity).
Results: NCPs were detected in 128 subjects (95 males, 35-86 years old) whose
average number of coronary RFs was 2.5, 68% of whom had HT, 31% DM, 52%
HL, 59% smoking history, and 40% were obese. All were significantly higher in
subjects with NCPs than those without NCPs. The detection ratio of NCP by
decade of life showed that even in young subjects who were less than 50 years
old, the detection ratio ranged from 17 to 38% in males. The predictor variables
were used in logistic regression models with the incidence of NCPs as the dependent variable. Age, male gender, and obesity (relative risks 1.02, 2.90, and
1.81 [95% CIs: 1.00-1.05, 1.62-5.18, and 1.10-2.98, respectively]) were associated with increased incidence of NCPs. We made another logistic regression
model excluding male sex, and smoking habits and obesity (relative risks 2.47
and 1.69 [95% CI 1.56-3.91, 1.03-2.75], respectively) were associated with increased incidence of NCP.
Conclusion: In subjects with multiple coronary RFs, NCPs may be detected in
MSCT even in young males. The incidence of NCPs is significantly influenced by
the presence of obesity and smoking.
C-131
Anomalous coronary arteries in Chinese adult patients: Identified by 16detector row CT angiography
Q.J. Qiu; Beijing/CN (QJX2000@HOTMAIL.COM)
Purpose: To retrospectively analyse the imaging features of anomalous coronary arteries diagnosed with 16-detector row CT in 1073 Chinese adults.
350
Methods and Materials: 1073 Chinese adult patients undergoing 16-detector

row CT angiography from March 2003 to June 2005 were analysed retrospectively. CT scans were obtained with collimation 160.625 after injection of 100 ml
intravenous contrast material and rotation time of 500 msec. Retrospective electrocardiographic gating was used for image reconstruction, with 0.625 mm and
0.625 mm increment. The CT date set of each patient was evaluated by two thoracic radiologists using transverse scanning, curved planar reformation, maximum intensity projection, volume rendering, virtual endoscopic.
Results: 31 (2.9%) anomalous coronary arteries were detected with 16 detector-row CT angiography from 1073 consecutive coronary CT angiography studies, including 26 cases of anomalous origin of coronary artery and its branch, 4
cases of coronary fistulae, 1 case of coronary aneurysm. 10 coronary arteries of
anomalous origin crossed between the aorta and the main pulmonary artery,
among them 7 coronary arteries (70%) were detected with stenosis.
Conclusion: 16-detector row computed tomography angiography has high clinical value in the diagnosis and prognosis of anomalous coronary arteries.
C-132
Contrast-enhanced protocols for coronary CT angiography
M. Lell1, F.J. Rybicki2, K.T. Bae3; 1Erlangen/DE, 2Boston, MA/US, 3St. Louis,
MO/US (michael.lell@idr.imed.uni-erlangen.de)
Learning Objectives: To learn cardiac CT protocols optimized for rapid acquisition and high spatial resolution with MDCT, and illustrated for 16- and 64-row
technology. To review principles of contrast dose optimization. To compare differences in acquisition and reconstruction parameters among different MDCT manufacturers.
Background: The number of coronary CTA examinations performed has dramatically increased with the implementation of 16- and 64-row MDCT technology. It
follows that scanning protocols must be optimized to obtain the best results from
high concentration iodinated contrast media. Understanding the relationships
between contrast media injection parameters (e.g., scan delay, iodine concentration, and iodine delivery rate) is essential in the implementation of efficient protocols. In addition, while the principles of contrast delivery generally remain constant
across scanners, acquisition and reconstruction parameters vary across scanner manufacturers.
Procedure Details: Detailed contrast-enhanced 16- and 64-row protocols are
presented, and the differences between their respective images are illustrated.
Conclusion: Appropriate modifications in contrast delivery protocols coupled with
the speed offered by 16- and 64-slice MDCT will improve the magnitude of arterial enhancement during coronary CTA. As scan durations become shorter, these
modifications would include reducing the volume of contrast, increasing the injection rate, and using a high concentration contrast material.
C-133
Detection of patent foramen ovale using ECG-gated multidetector cardiac
CT angiography
E.E. Williamson, P.A. Araoz, L. Alvarez-Maluenda, W.B. Edmister,
D.A. Woodrum, D.K. Borgeson, J.F. Glockner, J.F. Breen; Rochester, MN/US
(ewilliamson@mayo.edu)
Learning Objectives: 1) Demonstrate the feasibility of ECG-gated, 64-row cardiac CT angiography for the detection of patent foramen ovale (PFO). 2) Describe the CT features of PFO, including common imaging pitfalls which produce
false positive and false negative results.
Background: PFO is a common congenital cardiac abnormality which is a clinically-important cause of cryptogenic stroke, particularly in young patients. The
use of cardiac CT angiography for the detection of PFO has not been previously
described.
Imaging Findings: CT criteria for the diagnosis of PFO were 1) presence of a
distinct "flap" in the left atrium in the expected location of the septum primum, 2)
presence of a continuous column of contrast connecting this flap to the right
atrium, and 3) presence of a "jet" of contrast from the column into the right atrium.
Of the 20 patients that had both a TEE and a cardiac CTA, 6 (30%) were found to
have a PFO by TEE. Using the presence of a left atrial flap as the primary diagnostic criterion, all 6 cases of PFO were detected using CT (sensitivity = 100%).
Of the 14 patients with no PFO seen on TEE, 12 of these were correctly identified
using CT (specificity = 86%).
Imaging findings that produced false positive CT results included "partial" or "incomplete" left atrial flaps without a continuous column of contrast linking the left
and right atria.
Conclusion: ECG-gated cardiac CT angiography performed with a 64-detector
CT scanner can be used to reliably detect patent foramen ovale.

C-134
Congenital heart disease: Image diary using 40 and 64 MDCT
D.M.E. Bardo, C.M. Cranford, Z. Hijazi, S. Sandhu, B. Mora, D. Bichell;
Chicago, IL/US (carolinecranford@gmail.com)
Learning Objectives: The radiographic evaluation and post operative follow-up
in children with complex congenital heart disease using 40 and 64 MDCT.
Background: Children with congenital heart disease (CHD) are routinely examined with echocardiography and cardiac catheterization. These exams, ordered
and performed by cardiologists, are the mainstay of the diagnosis of CHD and
the follow-up of surgical intervention. MDCT rapidly acquires high resolution images of complex CHD anatomy with less risk and less radiation exposure than
cardiac catheterization and with more detail than echocardiography.
Procedure Details: Forty children with a variety of complex CHD including ASD,
VSD, coarctation of aorta, tetralogy of Fallot, MAPCAs, pulmonary stenosis and
single ventricle, were examined with 40 and 64 MDCT (Philips, Cleveland, OH,
USA). Cardiac gated and non-gated, axial contrast-enhanced CT images were
acquired, depending upon the age of the child and anatomy of interest. Postprocessing of image data was performed on a Philips Brilliance workstation. Axial source images, off-axis 2 dimensional and 3 dimensional reformations were
viewed on this workstation and a universal PACS workstation. Post operative
exams have confirmed patency of vascular shunts and stents, position and caliber of pulmonary artery bands, and position of ASD, VSD and PDA occluder devices. CT imaging correlates with echo and cardiac cath data in all instances and
has shown additional pertinent findings.
Conclusion: Cardiac MDCT is an accurate, safe, nearly instantaneous method
of examining children with congenital heart disease. Cardiac MDCT can be used
to make many primary diagnoses and to follow post-operative changes.
C-135
Anatomical remodeling of left atria in subjects with chronic and paroxysmal
atrial fibrillation evaluated by multislice computed tomography
N. Funabashi, M. Asano, I. Komuro; Chiba/JP (funanobu2005@yahoo.co.jp)
Purpose: We used MSCT to evaluate and compare anatomical change to left
atria (LA) including left atrial appendage (LAA) in subjects with chronic and paroxysmal atrial fibrillation (CAF and PAF, respectively).
Methods and Materials: ECG-gated MSCT was performed in 16 subjects with
CAF and 17 with PAF. We evaluated: qualified observed morphology of pectinate
muscles (PM) in LAA (well/poorly/non- developed); absolute thickness of LA anterior wall; presence of abnormal late enhancement (LE) of LA wall suggesting
fibrotic changes; defect of contrast in LAA only in early phase and LAA enlargement; comparison of LA diameter evaluated by transthoracic echocardiogram.
Results: CAF group: well-developed PM (19% subjects), poor PM (44%), no PM
(38%). PAF group: well-developed PM (41%), poor PM (47%), no PM (12%). CAF
subjects with no PM had longer periods of CAF and larger LA diameter than
those with developed PM (P < 0.01). Incidence and mean thickness of abnormal
LE of LA wall was similar in both groups. There was a negative correlation in the
CAF group between thickness of LA wall and LA diameter (R2=0.19). Contrast
defect in LAA only in early phase and enlargement of LAA were observed in
56%, 88% (CAF) and 24%, 41% (PAF); ratios were higher in CAF group (p < 0.01).
Conclusion: There were anatomical differences between CAF and PAF groups
in MSCT. In CAF group, depending on the period of CAF or degree of LA diameter enlargement, anatomical remodeling may appear, which may cause blood
flow stagnation, seen as contrast defect in LAA in early phase.
C-137
Why we misinterpret lesions on cardiac CT while compared with catheter
coronary angiography? A critical review series collaborated with
cardiologists
T. Lee, I.-C. Tsai, W.-L. Lee, C.-T. Ting, M.-C. Chen, W.-C. Liao; Taichung/TW
(sillyduck@vghtc.gov.tw)
C-138
Normal cardiac anatomy at 64-slice multidetector row computed
tomography
J. Kim, C. Park, S. Choi, D. Yang, H. Kim; Incheon/KR
(ho7ok7@gilhospital.com)
Learning Objectives: To illustrate (1) the external cardiac anatomy, (2) the valvular anatomy, (3) the fibrous skeleton and septum, (4) the four chambers, (5) the
conducting system, (6) the coronary arteries and veins, and lastly (7) the pericardium using 64-slice multidetector row computed tomography.
Background: The advent of multidetector row computed tomography has emphasized the importance of detailed knowledge of the overall structure of the
heart.
Imaging Findings: We will use 3-D reconstruction images such as multiplanar
reformation, maximum-intensity projection, shaded-surface display, volume rendering and virtual endoscopic imaging.
Conclusion: Our aim of this presentation is to make the radiologist familiar with
the cardiac anatomy at CT and acquainted with various 3-D reconstruction images of CT.
C-139
64-slice multi-detector row CT evaluation of congenital heart disease
S. Leschka, E. Oechslin, L. Husmann, L. Desboilles, B. Marincek,
S. Wildermuth, H. Alkadhi; Zurich/CH (sebastian.leschka@usz.ch)
Learning Objectives: To describe optimised scanning protocols for 64-slice CT
evaluation of congenital heart disease (CHD) in pediatric and adult patients. To
familiarize with the relevant pre- and postsurgical imaging features and surgical
procedures in CHD.
Background: Although echocardiography is the preferred modality for diagnosis
in patients with CHD, it is sometimes limited by the small field of view, operatordependence, variable acoustic window, and difficulties in delineating extracardiac vascular structures entirely. Magnetic resonance imaging as an alternative
often requires long-time patient sedation and is limited in patients with claustrophobia, pacemakers, or metal implants. The development of 64-slice CT has increased its clinical application as an alternative means for evaluating patients
with CHD.
Imaging Findings: Based on the analysis of 30 patients, we present optimised
scanning protocols for 64-slice CT evaluation in pediatric and adult patients. We
illustrate the relevant normal anatomy and pathology of numerous common and
rare congenital cardiac disorders including extracardiac pathology (aortic coarctation, anomalous pulmonary venous return, patent ductus arteriosus), simple
cardiac defects (atrial and ventricular septal defect), abnormalities of cardiac
chambers (univentricular heart, cor triatriatum), trunco-conal defects (tetralogy
of Fallot, common aortic-pulmonary trunk), connection abnormalities (simple and
congenitally corrected transposition of the great arteries, double outlet ventricle),
and cardiac isomerism. The relevant CT findings are compared with findings from
echocardiography.
Conclusion: With increased scan speed, high spatial resolution, and simultaneous evaluation of cardiovascular structures and lung parenchyma, 64-slice CT
has become a helpful complementary imaging modality in the pre- and postsurgical evaluation of patients with CHD.
351
diac
Car
Cardiac
Learning Objectives: To understand limitations and artifacts of CT coronary

angiography. To understand when, how and why we misdiagnose in CT coronary
angiography. To understand the possible reasons for the discrepancy between
CT and catheter coronary angiography.
Background: CT coronary angiography is recently a hot topic. With the advance
of MDCT, this technique is gradually integrating into the clinical practice. But this
technique is so new that the standard of training, interpretation and clinical practice is not yet established. What are the basic requirements of an 'interpretable'
scan? When and why we misinterpret? Are the misinterpretations avoidable?
These are important questions we try to answer by this review series.
Procedure Details: We retrospectively review 72 cases that underwent both 40detector row CT coronary angiography and catheter coronary angiography. All
the initial reports and images are critically reviewed by collaboration of two cardiac radiologists and a senior interventional cardiologist. Using catheter coronary
angiography as reference, all the misinterpretations are critically discussed. All
the lessons learned are summarized with consensus. About the CT aspect, the
discussed topics include respiratory motion, heart rate, heart rate stability, arrhythmia, image noise, interpretation skill, post-processing technique, reconstruction phase selection and window settings. Some misinterpretations of catheter
coronary angiography are also found during the review process and will be demonstrated and discussed in the exhibit.
Conclusion: Most misinterpretations in CT coronary angiography are related to
the techniques in interpretation, image acquisition and processing. Most of them
are potentially avoidable.

C-140
Diagnostic accuracy of 64-slice spiral computed tomography in the
detection of significant coronary artery stenoses in consecutive patients
A.J. Reimann, T. Beck, M. Ohmer, C. Burgstahler, M. Heuschmid,
S. Schroeder, A.F. Kopp, M.P. Gawaz, C.D. Claussen; Tuebingen/DE
(anja.reimann@med.uni-tuebingen.de)
Purpose: Multi-slice spiral computed tomography (MSCT) is reported to be a
reasonable modality for non-invasive cardiac imaging. Due to rapid technical improvements, MSCT investigations have become more robust.
Methods and Materials: 102 (82 male/20 female, age 62 10 years) consecutive patients with suspected obstructive coronary stenoses scheduled for invasive coronary angiography (ICA) were additionally studied by ECG-gated 64-slice
computed tomography (Sensation 64, Siemens Medical Solutions, gantry rotation time 330 ms, detector collimation 64x0.6 mm). The coronary tree of each
patient was evaluated and screened for 50% diameter stenoses by two blinded
observers using a 13 segment model. The results were compared with ICA.
Results: All MSCT scans could be carried out successfully. 1326 segments were
analyzed. Sensitivity, specificity and positive and negative predictive values to
identify sgts with at least one lesion 50% were: 0.90, 0.99, 0.95, 0.98.
Conclusion: The diagnostic accuracy of cardiac MSCT could be furthermore
improved by the use of 64-slices. It was found to be a robust technique to visualize the entire coronary tree.
C-141
Assessment of myocardial infarction in patients with acute coronary
syndrome (ACS) by non-contrast ECG-gated CT following emergency PCI
T. Yamaguchi, Y. Kawai, Y. Nozaki, K. Sato, M. Sakurai; Higashi-ku,Sapporo/JP
(yamataka@eagle.ocn.ne.jp)
Learning Objectives: To determine the severity of acute coronary syndrome
(ACS) at a very early stage immediately after emergency PCI (ePCI). To evaluate
the myocardial infarction (MI) with non-contrast ECG-gated CT using the contrast medium injected during the preceding PCI procedure. To understand that
MSCT provides diagnostic capabilities equivalent to myocardial perfusion SPECT
(MPSPECT), permitting medical costs to be reduced.
Background: Currently, the MI in ACS patients who have undergone ePCI is
usually evaluated several days later using MPSPECT or delayed-contrast MR
imaging. In the present study, we focused on the enhancement effect of the residual contrast medium in the MI following PCI and investigated whether the MI
could be assessed by non-contrast ECG-gated CT alone when performed immediately after ePCI.
Procedure Details: The mean time from the final contrast enhancement in PCI
to the CT study of 13 patients was 22.6 7.8 min. Compared with normal myocardium (71.5 4.5 HU), regions of delayed contrast enhancement were seen
as high-contrast areas (150.7 40.0 HU). In addition, the scores for CT and subsequently performed MPSPECT showed a good correlation (r = 0.92, p < 0.0001).
The CT scores and the %uptake values in MPSPECT of the target region, also
showed a good correlation (r = 0.86, p < 0.0001).
Conclusion: Non-contrast ECG-gated CT images obtained using post-PCI residual contrast medium in the MI showed a high correlation with the results of
conventional studies. This method has the advantage of reducing the time required to determine the severity of ACS and also provides benefits from the viewpoint of healthcare economics.
C-142
Noninvasive coronary angiography with 64-slice spiral computed
tomography: Results in 360 patients
L. Song, Z. Jin, L. Kong, Y. Wang, Z. Zhang; Beijing/CN
Purpose: To evaluate the image quality of coronary angiography using a 64-slice
CT system with a rotation time of 330 ms, and investigate the reasons for nondiagnostic image quality.
Methods and Materials: We conducted a retrospective study of 360 patients
who were examined at our medical center over a period of 6 months with a 64slice spiral CT angiography scanner and retrospective electrocardiographic gating. Patients with pre-scan heart rates > or = 70 beats/min received oral
beta-blockers. The 15 coronary segments of the AHA classification were consensually reviewed by two radiologists. Image quality was classified for each segment as being good, adequate, and poor/non-evaluable. The reasons for
nondiagnostic image quality were analyzed.
Results: Sixty percent (215 of 360) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 65.3 7.6 beats/min. Mean scan time was
352
11.6 1.0 s. Visualization of the entire coronary tree with diagnostic image quality was achieved in all but 24 patients. 5,041 segments (> or = 1.5 mm diameter)
were analyzed; nondiagnostic image quality of MSCT was identified for only 4%
(210/5041) of these segments. Coronary motion artifacts (38%; 80/210), heavy
calcification (28%; 58/210) and respiratory effects (25%; 52/210) were the most
common causes for non-evaluable arteries.
Conclusion: Our results suggest that 64-slice spiral CT allows visualization of
coronary arteries with a low percentage of non-assessable segments.
C-143
Multidetector CT findings of abnormalities in cardiac valves
J. Jeong, Y. Choe; Seoul/KR (jiyoung.jeong@samsung.com)
Learning Objectives: To illustrate the capability of multidetector CT (MDCT) in
the imaging and functional evaluation of cardiac valves with various disease.
Background: Cardiac valves are important anatomical structures regulating blood
flow in and out of the cardiac ventricles. The delicate and moving nature of cardiac valves permitted only a limited access to imaging modalities other than echocardiography. Until now, echocardiography was commonly the primary diagnostic
tool to define cardiac valvular anatomy and function. However, it has some limits:
operator-dependence, problems relating to acoustic window, transesophageal
echocardiography is contraindicated in some patients. Also transesophageal
echocardiography is an invasive procedure. However, recent development of
MDCT enables the evaluation of valvular morphology as well as function.
Imaging Findings: 36 patients with various cardiac valvular disease including
aortic stenosis or regurgitation, Marfan syndrome, perivalvular abscess with infectious pseudoaneurysm, valvular vegetation, pseudoaneurysm associated
Behet's disease, valvular involvement of myxoma, malfunction of mechanical
valve underwent ECG-gated MDCT scan using 16 or 40 slice scanner with slices
of 0.6-0.7 mm thickness. Images of the dynamic motion of cardiac valves, mid
diastolic and systolic, end diastolic and systolic phase were reconstructed instead of the whole cardiac phase. Short and long axial images of cardiac valves
are reconstructed. Volume rendering navigation technique allowed endoscopic
view of cardiac valves. The assessment of morphologic and function of cardiac
valves was possible using MDCT.
Conclusion: Multidetector CT enables imaging and functional evaluation of cardiac valves, therefore it can detect various cardiac valvular diseases.
C-144
Bypass graft in MDCT: Doing a useful radiological report
J. Roldan Busto1, G. Fernndez Prez1, A. Gutierrez Zamora2,
C. Delgado Snchez-Gracin1, C. Trinidad Lpez1, M. Velasco Casares1;
1
Vigo/ES, 2Guadalajara/MX (jordi.roldan@telefonica.net)
Learning Objectives: To show findings to recognize different types of coronary
artery bypass grafts (CABG) used. To describe the most relevant information
prior to bypass surgery.
Background: Conventional angiography is the gold standard to evaluate CABG,
but MDCT is gaining acceptance. A complete report must include information
about CABG patency, and the different types of bypass grafts: 1. Free: graft origin
is connected to proximal aorta and distal end in coronary artery. 2. In situ: graft is
in its normal origin and distal end in coronary artery. 3. Sequential: an in situ or
free graft has a side to side anastomoses to connect a second coronary artery. 4.
Y or T: two conduits are connected laterally to permit a longer distance to revascularization. The radiologist must recognize patient candidate to CABG and give
a relevant information as supra-aortic atherosclerosis, abnormalities in proximal
aorta, internal mammary arteries (IMA) or aortic valve, and presence of myocardial bridge.
Procedure Details: Images were obtained with a 16-MDCT using an ECG retrospective reconstruction. The entire thorax was included to observe the IMA origin. 90 mL of contrast (Iopromide 769 mg/mL) was administrated IV at 4 mL/sec,
followed by 50 mL saline. Betablocker was administrated in patients with high
heart rate. Nitroglycerin sublingually was used in all patients to improve distal
anastomoses visualization. MPR, MIP and VRT images were analyzed.
Conclusion: MDCT obtain accurate information to study CABG. A complete knowledge about the technique and conduit types used is necessary to do a useful
report.

C-145
Superiority of synchrony of 256-slice cone-beam computed tomography for
acquiring pulsating subjects. Comparison with conventional multislice
computed tomography
N. Funabashi, S. Mori, S. Tanada, M. Endo, I. Komuro; Chiba/JP
Purpose: A prototype 256-slice cone-beam CT provides complete volumetric
data within a single gantry rotation (one second/rotation) with 0.5 mm slice-thickness.
Methods and Materials: Calcified phantoms (200-400 HU) were attached to the
balloon of a pulsating phantom and moved at a rate of 5-90/minute. Acquisition
was performed during one to-and-fro motion at each pulsation rate without ECGgating. Each period was divided into 10 phases, and compared to conventional
multislice CT scanning without ECG-gating.
Results: At 5-20/minute, the configuration of calcified phantoms continued to the
through-plane without gaps. At 60/minute, duplicated calcified phantoms at endsystole and end-diastole were observed without motion. At 90/minute, motion
could be observed without gaps but was more blurred, and total calcified volume,
Agatston scores, mean and peak CT values of three phantoms were almost equal
compared with those at static state. However, at 60/minute, total calcified volume, scores, mean and peak CT values of three phantoms were decreased to
64%, 37%, 80% and 56%, respectively, compared with those at static state. In
multislice CT, even at lower rates, there were gaps in the through-plane. At 60/
minute, total calcified volume, scores, mean and peak CT values of three phantoms were decreased to only 8%, 3%, 79% and 53%, respectively, compared
with static state.
Conclusion: This new prototype's unique character (synchrony) enables the acquisition of pulsating objects. These can be acquired without gaps in the throughplane even in the absence of ECG-gating. However, its present temporal resolution
only permits accurate quantitative evaluation of calcium up to 20/minute.
C-146
Changes in coronary artery characteristics in subjects with heterozygous
familial hypercholesterolaemia by MSCT using a multiple regression model
N. Funabashi, H. Bujo, K. Teramoto, M. Asano, I. Komuro; Chiba/JP
Purpose: To evaluate changes in coronary arterial characteristics at 1 yr in asymptomatic subjects with heterozygous familial hypercholesterolemia (FH), we measured coronary-arterial calcium, detected non-calcified plaque (NCP) with multislice
CT, and sought predictors which would influence the progress of arteriosclerosis,
using multivariate analysis.
Methods and Materials: 26 asymptomatic subjects (12 male, age 18-72) with
FH had a routine EKG-gated CT scan, repeated at 1 yr. End-diastolic data were
used to re-measure values for calcified volume (CV, mm3), Agatston calcified
score (CS); enhanced scanning was used to identify NCP.
Results: Median CV, CS were 53.4 mm3, 195.5 in the 1st, 53.8 mm3, 199.7 in the
2nd scan and CV, CS changes were 2.0 mm3, 5.8, respectively. A logistic model
was constructed to predict increased CV or CS, using age, sex, total cholesterol,
low density lipoprotein cholesterol (LDLC), statin use, presence of radiographically thickened Achilles tendon (AT+), increased intima-media thickness by ultrasound, CV, CS and presence of NCP and increased CV was influenced by age
only. Next all predictor variables were used in a multiple regression model with
change of CV or CS as dependent variables, which was refined to include 4
predictors: age, LDLC, male gender and AT+. Here, LDLC and age significantly
influenced the change in CV (p < 0.05) by the multiple regression formula
Y=1.8X1+0.8X2+45.8X3-47.7X4. (Y, CV change, X1=age, X2= LDLC, X3=male
gender, X4=AT+)
Conclusion: FH associated with severe coronary calcification, which correlated
with age. CV changes at 1 yr were significantly influenced by LDLC, age. LDLC
control is important in delaying arteriosclerosis.
Why and how to perform a CT before redo surgery with median sternotomy
in patients with congenital heart disease
D. Mandry, L. Mainard, G. Bosser, H. Lucron, F. Marcon, L. Mace, M. Claudon;
Vandoeuvre les Nancy/FR (d.mandry@chu-nancy.fr)
Learning Objectives: 1) To point out major complications on sternal re-entry
and their causes. 2) To suggest a CT procedure before redo surgery in patients
with congenital heart disease (CHD). 3) To illustrate its role in that purpose, and
depict major findings which would help the surgeon to better plan the procedure.
C-148
Assessment of pulmonary veins (PV) anatomic variations with three
dimensional EKG-gated CT-scan before atrial fibrillation (AF) ablation
S. Tissier, M. Andronache, C. De Chillou, C. Barbary, I. Magnin-Poull,
D. Mandry, D. Regent; Nancy/FR (tissier.s@wanadoo.fr)
Purpose: Catheter ablation of AF is becoming widely practiced with an ostial or
circumferential extra-ostial left atrial (LA) encirclement. PV have a crucial role in
the ablation strategy. The aim of the study is to analyze by 3D CT-scan the anatomy of the PV in order to detect structural variability that would impact the choice
of the ablation approach.
Methods and Materials: A PV and LA imaging study was performed for 69 patients undergoing radiofrequency ablation (group A) and for 65 control patients
(group B). Parameters analyzed included: maximal, minimal ostial diameters, distance between superior (SL), inferior (IL), right and left PV ostia, and respective
edges length, distance from left inferior PV to mitral valve, PV branching pattern,
and LA volume.
Results: Only 34 patients (49.27%) had typical pattern of 4 PV (4 separate ostia)
in group A and 45 (69.23%) in control group, the left common trunk is statistically
more frequent (46%) in group A (p < 0.01) than in group B (26%). There was no
difference between the two groups for additional ostia and or between male and
female for the anatomical distribution of PV. The LSPVs are the longest first branch
portion, the right PVs the most frequent ostial first branch and are rounder than
the left PV.
Conclusion: This imaging study demonstrates that CT scan is a precious tool
that allows detection of distinct anatomic variability of the PV. These findings
suggest that, at least in some patients, an extra-ostial approach may be preferable to ostial PV isolation.
C-149
Potential role of screening CT coronary angiography (CTCA) in screening
intermediate and high risk asymptomatic patients
J. Hoe, K.H. Toh, R. Kwok; Singapore/SG (jhoe@pacific.net.sg)
Purpose: To identify the prevalence and severity of coronary artery disease, in
asymptomatic patients by screening with CTCA, and to assess the potential to
further risk stratify and modify their management.
Methods and Materials: 324 patients referred for screening CTCA were reviewed.
All patients had at least 1, and most had 2 or more of the following risk factors:
diabetes, hypertension, elevated cholesterol, smoking or family history. Both 16
MSCT (25% of patients) and 64 MSCT scanners (75% of patients) were used.
Results: In 112 patients (34%), the calcium score was zero and the CTCA was
reported as normal. Significant disease was considered to be present when plaque
as identified in any coronary vessel causing > 50% stenosis. This was found to
be present in 51 patients (15%). Of these patients, the calcium score was 0 in
one patient, and the highest calcium score was 2475. Further evaluation with
MIBI scans or cardiac cath was recommended in those with significant disease.
In 7 patients, further evaluation was recommended because of large calcified
plaques obscuring the vessel lumen.
Conclusion: There are currently no studies to indicate if CTCA results, added to
calcium scoring, will enhance the ability to modify treatment regimens in asymptomatic patients. Our results seem to indicate that the incidence of significant
coronary artery disease in patients with intermediate to high risk factors, is high,
and that CTCA has the potential to significantly change the management of these
patients, with likely higher PCI procedures.
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C-147
Background: Redo surgery in order to change outgrown or degenerated prosthetic material or to complete the correction of a CHD is accompanied by increased morbidity and mortality. For instance, dramatic hemorrhage may occur
because of adherences of great vessels with the posterior side of the sternum.
Other complications include calcifications of prosthetic material or thrombosis of
iliac vessels required for extracorporeal circulation. Because preoperative multislice CT, thanks to fast acquisition and capabilities of reconstruction, can depict
precisely heart anatomy and previous assemblies. This can help the surgeon to
better plan the procedure and thus to avoid some dreadful complications. Nevertheless, it can detect an infection and lead to postpone surgery after treatment.
Procedure Details: More than 30 patients were imaged in our center before redo
surgery. All exams were performed on a multislice CT (Volume Zoom 4+, Siemens, Erlangen, Germany) and involved: exploration of the sinuses (4x2.5 mm),
pre- (4x2.5 mm) and post-contrast (2 mL/kg at 2 mL/sec) thoracic exploration
(4x1 mm or 4x2.5 mm, 80 kV, ECG-gating when possible) and late abdominopelvic acquisition (4x2.5 mm, 80 kV).
Conclusion: Performing a CT before redo surgery in patients with CHD can help
the surgeon and thus avoid some complications.

C-150
Morphologic analysis of pulmonary veins in southern Chinese by multidetector row CT
S.-L. Wang, C.-W. Siu, C. Pang, S. Cheung, C.-P. Lau, H.-F. Tse, C. Ooi;
Hongkong/HK (wangsilun@hotmail.com)
Purpose: To document anatomic variation of pulmonary veins (PV) in southern
Chinese using MDCT.
Methods and Materials: 45 consecutive southern Chinese [37 men, 52.7 14.1
years] with pre radiofrequency ablation cardiac MDCT scans were recruited. 3Dvolume rendered images were analyzed. PV ostium was defined by the intersection between tangents extending along either side of PV and that extending from
adjacent LA walls. PV diameter and inter PV orifice distances were measured
with digital calipers. The angle that each PV makes with LA longitudinal axis,
defined by a line traversing the centres of ipsilateral PV ostia on 2D MPR and
oblique images, was measured.
Results: 29 (64%) patients had 4 PVs [left superior (LS), left lower (LL), right
superior (RS), right lower (RL)], 12 (27%) had left common trunk, 3 (7%) had a
right middle PV, and one (2%) had right middle and RS accessory PVs. Mean
diameters of LSPV, LIPV, RSPV and RIPV was 23.8 5.9 mm, 17.2 4.3 mm,
22.2 5.5 mm, 17.9 4.5 mm respectively. Superior PVs were wider than lower
PVs (p < 0.0001). Inter-PV orifice distance was larger for RIPV-RSPV compared
with LSPV-LIPV (14.2 6.4 mm vs 10.6 7.1 mm, p < 0.0001). Distance between
RSPV LSPV orifice was smaller than that between LIPV RIPV orifices
(22.9 7.2 mm vs 39.3 9.2 mm, p < 0.0001). No significant difference was detected between sexes. The LSPV, RSPV, RIPV, LIPV enter the LA at: 36 12,
150 14, 225 11, 334 11 respectively.
Conclusion: This is the first imaging study to demonstrate anatomic variability in
PV diameter, inter-PV distance and angles in southern Chinese.
C-151
Assessment of the coronary sinus and myocardium enhancement in normal
myocardium with multi-detector row computed tomography
K. Koyama, N. Oriuchi, S. Ooshima, H. Hoshizaki, K. Taniguchi, K. Endo;
Maebashi/JP
Purpose: To quantify enhancement of normal myocardium and coronary sinus
(CS) during cardiac CT study in multi-detector row computed tomography (MDCT).
Methods and Materials: A total of 20 patients without significant coronary disease underwent MDCT. 100 ml of contrast material (CM) was injected intravenously at a flow rate of 4.0 ml/s followed by a 20 ml saline flush. Myocardial density
and density in CS were measured prior to injection of CM and at the time of
cardiac CT study (20-25 seconds after initial enhancement). Regions of interest
were defined along the intraventricural septum, the lateral wall and CS in axial
view.
Results: Average myocardial density (Prior to injection; septum: 45 HU, lateral
wall: 41 HU) increased after injection of CM and peaked at 40-65 HU above prior
to injection (Peak; septum: 115 HU, lateral wall: 108 HU). Density in CS (Prior to
injection: 44 HU) increased after injection of CM (Maximum density: 285 HU and
averaged density: 199 HU).
Conclusion: Normal myocardium enhanced rapidly during cardiac CT study. Local
myocardial perfusion may be estimated based upon the maximum slop of the
time density curve method. And CS enhanced strongly in heart without significant coronary disease. It may demonstrate the global myocardial blood flow because CS represents most of the myocardial blood flow of the left ventricle. MDCT
will be a more useful non-invasive modality for evaluating the local myocardial
perfusion and global myocardial blood flow.
C-152
Epidemiology of fat replacement of right ventricular myocardium by
multislice computed tomography using logistic regression model
Purpose: We frequently observe fat replacement (FR) of the anterior wall of the
right ventricular myocardium (RVM), but its epidemiological significance is not
clear.
Methods and Materials: 49 consecutive subjects (28 males, 36-83 years old,
median 67) underwent enhanced ECG-gated multislice CT (Light speed ultra 16,
General Electrics, WI) and we retrospectively analyzed the presence of FR of
RVM. A logistic model for predicting FR of RVM was constructed using age, sex,
hypertension [HT], diabetes mellitus [DM], hyperlipidemia [HL] smoking, obesity
(body mass index > 25.0) and calcified and non-calcified plaques of coronary
arteries (CA).
354
Results: FR of RVM was detected in 21 subjects (12 males, 51-78 years old,
median 67), 76% of whom had HT, 38% DM, 43% HL, 48% smoking history, 52%
were obese, and 76% had calcified and 24% had non-calcified plaques of CA.
Only obesity was significantly higher in FR (p < 0.05). Logistic regression model
showed obesity's association with increased incidence of FR was close to, but
did not reach significance (P=0.0515, relative risk 5.85).
Conclusion: Obesity is significantly more common in FR, and may influence FR
in RVM, despite a negative multivariable analysis. FR in obesity may occur independently of arrhythmia different from arrhythmogenic RV cardiomyopathy (ARVC).
Thus, even with FR, obesity must be considered before diagnosing ARVC.
C-153
The efficiency of combining of MDCT with electroanatomic map of left
atrium of pulmonary veins during radiofrequency catheter ablation in
patients with atrial flutter
A.E. Surmava, V.P. Kurbatov, A.V. Bakharev, A.V. Grishkov, V.V. Shigaev,
E.A. Pokushalov, A.N. Turov, M.E. Amelin; Novosibirsk/RU (surmava@mail.ru)
Purpose: To estimate exception of combining of multi-detector CT angiography
(MDCTA) of left atrium (LA) and pulmonary veins (PV) with image of electroanatomic mapping during radiofrequency catheter ablation (RFA) of pulmonary veins
origins.
Methods and Materials: MDCTA of LA and PV with next performing of RFA of
PV was performed for 89 patients (age range 39-68 years). The RF isolation was
performed in 3 patients by separated collectors, in 61 patients RFA was performed by method of C. Pappone, in 25 patients RFA was performed with fragmentation of the LA posterior wall. MDCT Siemens Somatom Sensation 4 was
used for visualization of LA and PV. 100-120 ml of non-ionic contrast agent (Visipaque-320) were injected with use of automatic syringe. RFA of PV was performed with the use of navigation system of 3-D mapping CartoMerge XP.
Results: In retrospective combining of MDCTA of LA and PV with intraoperative
electroanatomic map, the following results were reached: 15% of isolating lines
passed around origins of PV, 13% of isolating lines passed into PV; only 20% of
isolating lines lied in interspaces between LA auricle and left upper PV, 45% of
isolating lines passed by the origin of auricle of LA, in 35% - auricle of LA was
included in isolated region.
Conclusion: The routine procedure of RFA of PV based on electroanatomic
mapping leads to deviation of isolating lines from anatomic structures. Intraoperative combining of MDCTA of LA and PV with electroanatomic map makes it
possible to improve the quality of performing of RFA-procedure and to avoid complications.
C-154
Accuracy and reproducibility of gated blood pool SPECT for measurements
of left ventricular volumes and ejection fraction in patients with atypical
chest pain: Validation with multi-detector row computed tomography and
radionuclide ventriculography
K.S. Choo, H. Cho, J. Kim, S.-J. Kim, C. Kim; Pusan/KR
(kschoo0618@medimail.co.kr)
Purpose: To compare GBPS, MDCT, and PRNV for the determination of left ventricular ejection fraction (LVEF) and left ventricular volumes (LV) in subjects with
atypical chest pain.
Methods and Materials: 23 consecutive patients (14 men, 9 women; mean age
56.2 9.5 years) referred for MDCT for evaluation of atypical chest pain. All patients underwent PRNV, GBPS, and MDCT at the same day.
Results: The mean LVEFs calculated with PRNA (57.3 8.6 %), GBPS
(55.2 6.6 %), and MDCT (56 9.1 %) were not statistically different (F value
0.3374, p = 0.715). Comparison of LVEFs from GBPS and MDCT yielded correlation coefficients of 0.5238 (p = 0.0178, 95% CI=0.1057-0.7845). The correlation of LVEFs between GBPS and PRNV showed a correlation coefficient of 0.8073
(p < 0.0001, 95% CI=0.5676-0.9209) and 0.6190 (p = 0.0036, 95% CI=0.24310.8333) between MDCT and PRNV. The mean LV EDV calculated with GBPS
(82.7 17.5 ml) was significantly lower than MDCT (106.8 18.5 ml) (p = 0.0001).
The mean LV ESV calculated with GBPS (37.2 9.6 ml) was also significantly
lower than MDCT (48.1 15.8 ml) (p = 0.012). Comparison of EDV from GBPS
and MDCT yielded a correlation coefficient of 0.5220 (p = 0.0182, 95% CI=0.10330.7835). The correlation of ESV between GBPS and MDCT showed a correlation
coefficient of 0.6642 (p = 0.0014, 95% CI=0.3140-0.8553).
Conclusion: In conclusion, the LVEF, EDV, and ESV calculated by GBPS correlated significantly with those of obtained with 16-MDCT. In addition, there were
no statistical differences of LVEF calculated from PRNV, GBPS, and MDCT. However, with regard to LV, EDV and ESV from GBPS revealed statistically significantly lower than those of MDCT.

C-155
Diagnostic value of the combination of coronary MDCT and early and
delayed perfusion cardiac MR imaging in patients with clinical presentation
suggestive of myocarditis
A. Arjonilla, A. Franco, M. Orejas, J. Farr, J. Contreras, M. Tomas, E. Fontoira;
Madrid/ES (juliocon3@yahoo.com)
Purpose: To evaluate the usefulness of the combination of coronary MDCT and
early perfusion and delayed enhancement cardiac MR imaging for the diagnosis
of acute myocarditis and differentiation from acute coronary syndrome.
Methods and Materials: We prospectively studied five patients with strong presumption of acute myocarditis (history of recent flu-like symptoms, chest pain,
electrocardiographic changes and creatin kinase and troponin I and T elevations).
Coronary MDCT was performed on all of them with a 40 MDCT using ECGgating with 40 x 0.625 mm collimation and after the administration of 75 ml of
contrast medium. Reconstruction algorithms were obtained at 75% of the R-R
interval. Intravenous B-blockers were administered when the heart rate exceeded 75 bpm. Early perfusion and delayed enhancement cardiac MR was also performed to all of them.
Results: Coronary CT showed no significant stenosis in any subject.
Early perfusion cardiac NR imaging findings were normal in all the five cases.
Four patients demonstrated delayed enhancement abnormalities (transmural
apical and lateral in one, subendocardial anterolateral in two and transmural lateral in one) with associated segmental wall motion abnormalities. Delayed enhancement cardiac MR was normal in one patient. All patients recovered
completely with spontaneous resolution of clinical symptoms and normalization
of biochemical markers.
Conclusion: The combination of two non-invasive techniques such a coronary
MDCT and early perfusion and delayed enhancement cardiac MR is extremely
useful in the diagnosis of acute myocarditis and avoids the need for conventional
angiography to rule out coronary disease.
different heart diseases were included in the study. MSCT examinations were
performed between April 2003 and September 2005. Angiography of coronary
arteries was conducted with 8-row tomograph (collimation 1.25 mm; iv 120-150 ml
Ultravist, 4 ml/s; secondary reconstructions in phases 5-95% R-R).
Results: 324 MBs were found in 219 patients. In 141 patients (64.4%) a single
MB was found (LAD - 117 cases, DIA - 10, OM - 10, IM - 3, LCx - 1), 55 patients
(25.1%) - 2, 19 (8.7%) - 3, and 4 patients (1.8%) had 4 MBs found. The highest
incidence of MBs occurred over LAD (190 cases), followed by DIA1 (52), OM1
(49), IM (17), RCA (7), DIA2 (5) and LCx and OM2 - 2 cases each. Following
anomalies of origin of coronary arteries were found in 23 patients: origin of artery
from the opposite sinus (8 patients), separate origin of LCA branches (5), lack of
LCX (3), LCX arising from RCA (2) or RSV (2), RCA from LAD with transseptal
course (1), single coronary artery (1) and high origin of RCA (1). In 7 patients
MBs were found.
Conclusion: ECG-gated MSCT in patients with heart disease is a useful, noninvasive method to detect MBs of coronary arteries and anomalies of their origin
and course.
C-156
Quantification of coronary artery calcification with multi-detector spiral CT
(MDCT) in hemodialysis patients
C. lvarez, I. Diez, H. Bouriach, P. De Sequera, E. Fraile; Alcal de Henares
(Madrid)/ES (mcalsanz@yahoo.es)
Purpose: Coronary artery calcification (CAC) is an important risk factor for cardiovascular disease in patients undergoing hemodialysis. Our purpose is to quantify CAC in hemodialysis patients using multi-detector spiral CT (MDCT).
Methods and Materials: Prospective ECG-gated 16-detector spiral CT was obtained in 45 hemodialysis patients (24 males and 21 females). Mean age: 59.8 +11.7 years, and mean duration of dialysis therapy: 44.8 +- 69.4 (2-312) months.
The coronary calcium score (CCS) was computed according to Agatstone's technique using SmartScore 3.5 (General Electric). In addition, every patient's total
CCS was referenced to an age- and sex-stratified database to determine a percentile ranking and risk of cardiovascular disease. The results were correlated
with biochemical variables.
Results: Range CCS: 0-5977, and mean CCS: 1295.7 +- 1639.2. Patients were
classified in 4 groups according to the value of CCS: A) Low value CCS (10 units
and less), 8 patients; B) Moderate CCS (11-100 units), 6 patients; C) Mean CCS
(101-400 units), 5 patients; and D) High CCS (over 400 units), 21 patients. Linear
regression analysis indicated that CCS correlated positively with the duration of
dialysis therapy (r = 0.528), serum levels of creatinine and urea (r = 0.466 and
r = 0.524, respectively) and with the presence of hypertension (r = 0.511). We
did not find a significant correlation between CCS and parameters of mineral
metabolism.
Conclusion: CAC is common and severe in patients who are undergoing hemodialysis a long time. We believe that the quantification of CCS with MDCT is
useful to predict cardiac events in hemodialysis patients.
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Anomalies of origin and presence of myocardial bridges of coronary

arteries. Possibilities of detection and evaluation in ECG-gated multislice
CT
E. Czekajska-Chehab, G.J. Staskiewicz, A. Drop, J. Wojcik, J. Drozd,
A. Tomaszewski, M. Wojcik; Lublin/PL (czekajska@gazeta.pl)
Purpose: The purpose of the study was to evaluate the usefulness of ECG-gated
multi-slice computed tomography (MSCT) in detection and assessment of anomalous origin and myocardial bridges (MB) of coronary arteries.
Methods and Materials: 905 patients (mean age 51.8 15.5) with symptoms of
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C-158
Pericardial disease: A pictorial review
M. Caraballo, V. Gutirrez, J. Cuesta, J. Borreguero, M. Olivera, P. Caballero;
Madrid/ES
Learning Objectives: To illustrate the utility of CT and MR imaging in the evaluation of pericardial disease; to show how CT and MR imaging delineate pericardial anatomy and to illustrate examples where CT and MR imaging have assisted
in noninvasive evaluation of congenital anomalies, loculated or hemorrhagic pericardial effusions, constrictive pericarditis and pericardial masses.
Background: Both CT and MR imaging are being increasingly used either as an
adjunct or as a substitute to echocardiography as they provide a larger field of
view and allow visualization of the entire chest and associated abnormalities in
the mediastinum and lungs. The main advantage of CT and MR imaging is the
excellent soft-tissue contrast.
Imaging Findings: Using examples from our hospital archives, we illustrate various examples of pericardial pathology investigated by plain film, CT and MR
imaging. Anatomy of normal pericardium and associated cardiac structures are
explained followed by description of pathological entities and criteria for their
diagnosis on CT and MR imaging.
Conclusion: It is important to understand the normal anatomy and pathological
appearances of the pericardium even for the general radiologist as there will be
an increasing demand for imaging of the pericardium in the near future.
C-159
A systematic approach to the morphological analysis of the heart and the
great vessels in congenital heart disease
N.D. Abolmaali1, A. Esmaeili2, T.J. Vogl2, M. Baumann1; 1Dresden/DE,
2
Frankfurt a. Main/DE (Nasreddin.Abolmaali@OncoRay.de)
Learning Objectives: After studying this exhibit the reader will be able to: 1.
Perform a systematic analysis of the particular abdominal and thoracic conditions in congenital heart disease; 2. Identify the defining anatomic structures of
the cardiac cavities; 3. Specify the position of the great vessels in relation to other
organs; 4. Define the different forms of situs, and 5. Optimize the acquisition
technique in very young children.
Background: Many radiologists only incidentally encounter patients suffering from
congenital heart disease. Yet, the findings in these very young patients are occasionally difficult to obtain and to categorize. The correct definition of the morphological attributes is crucial for the adequate therapy and prognosis.
Procedure Details: During an interactive session, the reader will systematically
analyse the anatomical features of different thoraco-abdominal abnormalities
associated with congenital heart disease. The learner will by guided through the
cardiac cavities and the great vessels. These structures will be scrutinized and
categorized using clear-cut models. Additionally, the topography of the internal
organs in relation to the heart and the great vessels is explained.
Conclusion: Using clinical images and straightforward models and graphics, the
specific features of congenital heart disease as identified with MR imaging are
clarified.
C-160
Diagnostic reference levels for three common cardiac interventional
procedures: An all-Ireland investigation
C.J.I.S. D'Helft1, S.L. Mc Fadden2, A.M. Mc Gee1, L.A. Rainford1, C.M. Hughes2,
J.R. Winder2, P.C. Brennan1; 1Dublin/IE, 2Belfast/UK (catherine.dhelft@ucd.ie)
Purpose: The purpose of this work is to determine the range of radiation dose
received during cardiac radiological investigations. Collective dose for cardioangiography studies is the highest of all non-CT radiological investigations. The
dose per examination is large compared to other radiological studies with physical manifestation of deterministic effects including erythema, epilation and ulceration being reported on patients who have undergone these procedures. The
importance of optimizing radiation dose, whilst not compromising diagnostic efficacy is clear.
Methods and Materials: The study investigated radiation doses delivered to
patients for 3 common types of cardiac radiological examinations: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). Eighteen cardiac imaging suites participated in the study. Radiation
dose was monitored for 1400 adult patients using dose area product (DAP) me-
356
ters. Operational and examination details such as cardiologist grade, patient details, examination complexity and exposure factors were recorded for each examination.
Results: The results demonstrated intra and inter-hospital variations. Individual
patient DAP values ranged from 1.8-23101cGycm2, 3.8-41038cGycm2 and 817192cGycm2 for CA, PCI and PPI respectively, with Third quartile values of
5040cGycm2, 8458cGycm2 and 2220cGycm2. Screening times varied from 0.2252 mins, 1.8-98 mins and 0.5-77.3 mins respectively.
Conclusion: Due to risks associated with radiation exposure, doses should be
kept as low as reasonably achievable, however. Whilst setting reference levels for
these complex procedures is difficult, it is important that some guideline values
are available to inform the operators and departmental personnel. The third quartile values described above may offer such guidance.
C-161
Fat-containing lesions of cardiac imaging
V. Pineda, R. Domnguez-Oronoz, X. Merino-Casabiel, S. Gispert,
A. Evangelista, J. Cceres; Barcelona/ES (victor.pineda@idi-cat.org)
Learning Objectives: To identify and illustrate the imaging finding of different
types fat-containing lesions on cardiac imaging. We also describe different types
fat-containing pitfalls mimicking cardiac pathology.
Background: A variety of cardiac lesions contain fat, which is readily identified
with both computed tomography and magnetic resonance imaging. The radiologist should be aware of the characteristic appearance of these lesions, which is
very useful to narrow the differential diagnosis.
Imaging Findings: Fat-containing lesions in cardiac imaging include cardiac
neoplasms, lipomatous hypertrophy of the interatrial septum, arrhythmogenic right
ventricular dysplasia, pericardial fat necrosis and mediastinal neoplasms. Abnormal distribution of normal fat can sometimes simulate cardiac pathology, especially on plain films. It is important to recognize these pitfalls, such as diaphragmatic
hernia, post-surgical changes, juxtacaval fat collection and pericardial fat pad to
avoid misinterpreting them as pathological findings.
Conclusion: CT and MR imaging are very useful in the assessment of fat-containing lesions in the cardiac pathology. and often a definitive radiologic diagnosis can be made. Knowledge of these lesions is important to prevent misdiagnosis
and often a definitive radiologic diagnosis can be made.
C-162
Imaging features of cardiac paragangliomas
J.-J. Lu, F. Feng, Z.-Y. Jin; Beijing/CN (cjr.lujingjing@vip.163.com)
Learning Objectives: To describe the imaging features of cardiac paraganglioma. To find out the best imaging option for the disease.
Background: Cardiac paraganglioma (pheochromocytoma) is a kind of very rare
tumors. Its clinical presentations (palpitation, headache, sweating) are mainly
related with its excretion function. But the localization process of the tumor is
always a clinical puzzle. Between Sep. 2003 and Jun. 2005, 5 patients with cardiac pheochromocytoma were admitted to and operated on in our hospital. The
imaging findings and procedures are described and discussed.
Imaging Findings: The mean diameter of the 5 tumors was 5.8 cm, and the
tumors were located respectively in the roof of left atrium, in the interatrial septum in front of the base of ascending aorta, and in between the aortic arch and
the pulmonary trunk. Bilateral carotid body tumors were also seen in 1 case.
MIBG scintigraphy was positive only in 1 case. Somatostatin receptor scintigraphy showed all tumors. The tumors were of same CT attenuation as the heart and
were enhanced significantly in enhanced CT. All the tumors had central scar in
enhanced CT. The tumors were of shorter or iso-signal intensity in T1WI, and of
long signal intensity in T2WI. Coronary angiography depicted feeding arteries of
all 5 tumors.
Conclusion: Cardiac pheochromocytomas are rare tumors, typically located
adjacent to or involving the left atrium. For initial detection of multiple foci, MIBG
scintigraphy combined with somatostatin receptor scintigraphy is recommended.
MR imaging and enhanced CT imaging can then provide detailed anatomoic delineation before surgical resection.

C-163
Plain-film examination of congenital heart disease. Tales of the past or still
a valuable diagnostic tool?
A.N. Chalazonitis1, J. Tzovara1, G. Tsimitselis2, E. Protopapa1, N. Ptohis1,
E.E. Spathi1, A.A. Ghiatas1; 1Athens/GR, 2Larissa/GR (red-rad@ath.forthnet.gr)
Learning Objectives: 1. To cover the full range of congenital heart disease. 2. To
evaluate the pathoradiological changes in the heart silhouette, the great vessels,
the lung and its vasculature on the plain chest radiograph that form the basis for
the radiological differential diagnosis. 3. To provide a systematic approach on
how to examine and interpret these changes on the plain chest radiograph.
Background: Although the role of the plain chest radiograph has changed with
the development of the new more sophisticated heart imaging modalities, the
method still remains as the earliest points of departure in the evaluation of congenital heart disease. Furthermore it is frequently used to determine the severity
of known or suspected disease.
Imaging Findings: In this exhibit we illustrate a wide variety of congenital heart
diseases presented as a diagnostic quiz. Each case is followed by an extensive
list of morphological features concerning heart configuration, great vessels, lung
and its vasculature that are suggestive or diagnostic of this specific disorder. All
cases have been selected by reviewing our plain radiographs teaching files. For
each case, the correct diagnosis and differential diagnosis are also discussed.
Conclusion: We believe that any radiologist must be able not only to recognize
the presence of these heart diseases, but to identify the correct differential diagnosis, sometimes even before the appearance of clinical symptoms.
Imaging Findings: In our center T2 weighted sagittal and axial images of the
lumbosacral spine are obtained for all patients who undergo cardiac MR imaging
if a definite diagnosis of Marfan's syndrome has not been made on the clinical
features and standard radiological investigations. We present images demonstrating MR imaging of dural ectasia, as well as multisystem involvement seen
with radiological investigations ranging from plain films to MR imaging. We also
present images of aneurysms post endovascular stent graft repair.
Conclusion: Requiring a multidisciplinary approach, careful consideration of history, signs, and symptoms can direct vital radiological examination in order to
make the diagnosis of Marfan's using the Ghent nosology. MR imaging, with no
radiation risks plays a vital role in diagnosis, treatment planning and follow-up of
this condition.
C-164
The usefulness of contrast echocardiography in the evaluation of coronary
artery disease in patients with LBBB: Comparison with SPECT and
coronary arteriography
P. Brestas, A. Karavidas, A. Tsikinni, E. Matsakas, C. Baltas, M. Tsouroulas,
C. Drossos; Athens/GR (pbrestas@yahoo.gr)
Purpose: To investigate the diagnostic accuracy of myocardial contrast echocardiography (CE) with adenosine to detect coronary artery disease (CAD) in patients with LBBB and compare it with SPECT.
Methods and Materials: 45 patients with LBBB and chest pain underwent SPECT
imaging with adenosine and CE (using Levovist at rest and during infusion of
adenosine). CE perfusion was evaluated by means of the perfusion score index.
Perfusion obtained by SPECT in the same segments was evaluated as normal,
reduced or absent. Coronary arteriography (CA) was the "gold-standard" method
for CAD detection.
Results: The K index of concordance of CE and SPECT with CA was 0.37 0.13
and 0.77 0.10 respectively. Total sensitivity of CE and SPECT was respectively
91% and 73%; specificity was 92% and 72%; positive predictive value (PPV)
77% and 44%; negative predictive value (NPV) 97% and 90%; and accuracy,
calculated from areas under ROC curves, was 92% and 72% respectively. Significant CAD was present in 11 patients (23%). Left anterior descending artery (LAD)
was involved in 8 patients, circumflex in 2 and right coronary artery in 4. Concerning the LAD disease detection, SPECT had: sensitivity 75%, specificity 79%,
PPV 43%, NPV 94% and accuracy 79%. Correspondingly, in the case of CE the
parameters of diagnostic value were 100% for all variables.
Conclusion: CE with adenosine has higher global diagnostic accuracy compared
with SPECT for the detection of CAD in patients with LBBB. This is mainly due to
the poor specificity of SPECT concerning perfusion defect detection in the LAD
territory.
C-165
A multimodality approach to the diagnosis, treatment and follow-up of
Marfan's syndrome
N. Das, S. Chakrabharty, P. Wilde; Bristol/UK (neelan.das@gmail.com)
diac
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Cardiac
Learning Objectives: To outline various radiological techniques that can assess

Marfan's syndrome, with emphasis on magnetic resonance imaging. To demonstrate radiologically some specific treatment options of this condition.
Background: In the modern era, the inherited autosomal dominant pan-ethnic
connective tissue disorder with variable expression known as Marfan's syndrome
represents a spectrum of conditions affecting multiple organ systems including
the musculoskeletal, cardiovascular, respiratory, ocular, dermatological and central nervous systems. Diagnosis is based upon the Ghent diagnostic nosology
which is split into major and minor involvement criterion, as well as genetic testing. Plain films of the skeletal system are often only performed if a positive finding
would be made under the Ghent nosology. Similar consideration is given to lumbosacral MR imaging for dural ectasia.
357

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Lung
C-166
Reporting discrepancies in chest radiographs at Coventry hospitals, UK: A
pictorial review of six years experience
A.K. Shimal, R. Jones, A. Vohrah; Coventry/UK (amarshimal@hotmail.com)
Purpose: Since 1999, a monthly reporting discrepancy meeting has taken place.
We present a pictorial review of our experience. Current literature suggests that
erroneous radiology reporting is in the magnitude of 30%.
Methods and Materials: At Coventry, radiologists and clinicians who encounter
possible errors collect cases for review anonymously. These cases are displayed
at the monthly meetings and reported by the radiologists present (at least 10).
Discrepancies seen by more than 50% are classed as errors. The impact on
management is then assessed.
139 cases of chest radiograph reporting discrepancies were encountered in 6
years. 100 cases were reviewed, 39 were unavailable. Of 100 cases 46 were
previously classed as errors on anonymous peer review.
To assess how obvious these errors were, 10 radiologists were given 5 seconds
to review each film.
Results: 50% of the errors were picked up in the 5 seconds by 5 (50%) radiologists. 23% of the errors were seen by everyone. 14% of errors were not picked up
by anyone.
Distribution of errors is pictorially represented, and most occur in the right hilar
and paratracheal regions.
Conclusion: This review highlights reasons for optimism. If review areas were
scrutinised many lesions wouldn't have been missed. Discrepancy review doesn't
pick up all errors made but illustrates the pattern of error. It is important to remember that radiologists who report more films make more errors.
C-167
Differential diagnosis of pure ground glass opacities on high-resolution CT:
Comparison of findings between bronchioalveolar carcinoma and atypical
adenomatous hyperplasia
K. Awai, D. Liu, Y. Nakayama, K. Ito, T. Nakaura, Y. Hayashida, K. Kawanaka,
Y. Funama, Y. Yamashita; Kumamoto/JP
Purpose: Both bronchioalveolar carcinoma (BAC) and atypical adenomatous
hyperplasia (AAH) can show pure ground glass opacities (GGOs) on high-resolution CT (HRCT). However, the former is malignant and the latter is currently
supposed to be benign. In this study, we compared HRCT findings between BAC
and AAH, and investigated whether it was possible to differentiate the two diseases.
Methods and Materials: We evaluated 21 BACs and 13 AAHs showing pure
GGO on HRCT. All nodules were histologically confirmed. First, 2 experienced
chest radiologists selected HRCT findings which might be useful to differentiate
between BAC and AAH. The selected findings included maximum diameter, mean
CT number, sphericity, marginal irregularity, marginal clearness, vessel convergence, and pleural retraction. Then, the other 5 board-certified radiologists independently scored the HRCT findings in all cases. We adopted scores to which
more than two radiologists agreed as definitive scores in each case. The 5 radiologists also measured maximum diameter and mean CT number of nodules and
we averaged the measured values for each case. Fisher exact test for independence and Student's t-test were used to compare differences in HRCT findings.
Furthermore, linear discriminant analysis (LDA) for differentiation between BAC
and AAH was performed using all HRCT findings, patient age and sex.
Results: There was statistically significant difference between BAC and AAH in
age, size, mean CT number, and sphericity (p = 0.015, 0.018, 0.044, 0.0003). In
LDA, 88.2 % of GGO was correctly diagnosed.
Conclusion: It was possible to differentiate between BAC and AAH on HRCT.
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Idiopathic interstitial pneumonias: Pictorial review
C. Mueller-Mang, C. Grosse, L. Stiebellehner, K. Schmid, A.A. Bankier;
Vienna/AT (christina.mueller-mang@meduniwien.ac.at)
Learning Objectives: To review the morphological characteristics of the patterns included in the ATS/ERS classification. To describe the HR-CT features
most helpful in the differential diagnosis of the interstitial pneumonias. To provide
an algorithmic approach for the diagnosis of pulmonary fibrosis.
Background: In 2001, the ATS/ERS classification standardized the terminology
358
for idiopathic interstitial pneumonias (IIPs). The classification is based on morphological patterns and diagnosis requires a multidisciplinary approach by clinicians, radiologists, and pathologists. The key role that radiologists play in the
diagnostic work-up of IIPs necessitates a profound knowledge of these patterns
and an increased awareness of the multidisciplinary challenges involved in their
interpretation. This is emphasized by the fact that the patterns of IIPs are considered as prototypes for the more common secondary interstitial pneumonias encountered in sarcoidosis, vasculitis, and connective tissue diseases.
Procedure Details: The typical HR-CT patterns of IIPs are presented.
Conclusion: The purpose of this teaching file is to illustrate the morphological
characteristics of the patterns included in the ATS/ERS classification, to describe
the HR-CT features most helpful in the differential diagnosis of the interstitial
pneumonias, and to provide an easy-to-follow algorithm for the pattern-based
diagnosis of pulmonary fibrosis.
C-169
Breaking down the lung's defences: Pulmonary manifestations of inherited
immunodeficiencies
F.A. Gallagher, A. Chandra, D. Gopalan, P. Moyle, N. Screaton; Cambridge/UK
(ferdia.gallagher@doctors.org.uk)
Learning Objectives: 1. To demonstrate the spectrum of disease manifestations
of inherited immunodeficiencies. 2. To explain with pictorial examples how specific deficits in the immune system present. 3. To increase awareness of these rare
diseases by radiologists so that the suspicion of an underlying immunodeficiency
can be raised early in the appropriate context.
Background: Immunodeficiency can be either congenital or acquired. Inherited
immunodeficiency encompasses a spectrum of diseases of the humoral and cellular immune responses. Specific diseases include common variable immunodeficiency, hyper IgE and hyper IgM syndromes, chronic granulomatous disease
and severe combined immunodeficiency.
Imaging Findings: Using a range of radiological modalities we present the pulmonary findings in a cohort of patients with inherited immunodeficiency undergoing treatment at our quaternary referral centre. The thoracic manifestations of
these diseases vary widely and include atypical infections, bronchiectasis, diffuse infiltrative lung disease and tumours.
Conclusion: Radiological abnormalities may be the first clue to the possibility of
an underlying immunodeficiency. Therefore increased awareness of these conditions by radiologists can expedite diagnosis and treatment. We present the typical findings of each disease as an aid to differential diagnosis as well as some of
the more unusual presentations.
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Lateral chest radiograph: What should we see?
M. Ahn1, S. Je1, S. Park2; 1Suwon/KR, 2Seoul/KR (ami@catholic.ac.kr)
Learning Objectives: To illustrate how to check the proper image quality of lateral chest radiograph. To provide basic methods of approach to interpret normal
and abnormal findings on lateral chest radiograph.
Background: In daily practice, interpretation of lateral chest radiograph is less
emphasized and less educated than that of frontal chest radiograph, and we
often experience difficulties in reviewing lateral chest radiographs.
Imaging Findings: We suggest the criteria for ideal image quality of lateral chest
radiograph for interpretation: These are inclusion boundary of the thoracic structures, density of the lung field, posture of the patient, and artefact. Basic approach to interpretation of normal findings on lateral radiograph will be presented,
with special emphasis on density gradient of lung field and hilar and perihilar
shadows. Pathologic conditions on lateral chest radiographs are provided with
CT correlation. We also illustrate frequently encountered pseudolesions on lateral chest radiographs, including inferior pulmonary venous confluence, tortuous
descending thoracic aorta, pericardial fat pad, osteophytes along the thoracic
spine, and normal chest wall structures, with CT correlation.
Conclusion: With better understanding of lateral chest radiographs, the quality
of radiologic interpretation on lateral chest radiograph could be improved.
C-171
Northern scoring system: A rapid and reproducible system for scoring
chronic changes in chest radiographs
S. Ramamurthy, S. Rath; Lancaster/UK (satheesh_ramamurthy@yahoo.co.uk)
Learning Objectives: Overview of the Northern scoring system for scoring chronic
changes in chest radiographs.
Background: An objective and reproducible assessment of chest radiographs is

important in the follow-up and monitoring of chronic chest conditions like cystic
fibrosis. Scoring systems are used to compare chest radiographs of patients and
to follow-up respiratory disease in individual patients. The Northern scoring system is designed to allow one person to do the scoring in a simple, rapid and
reproducible manner.
Imaging Findings: The Northern score requires a plain chest film and is derived
by dividing the lungs into four quadrants. The film is scored based on changes
like increase in the linear markings, nodular cystic lesions, and collapse-consolidation. The score ranges from 1 to 20, a higher score reflecting more severe
radiological change.
Conclusion: Knowledge of the Northern scoring system will be useful in objectively assessing the chest radiograph changes and helps in monitoring and following up disease activity.
C-172
Paratracheal and parabronchial air cysts: Clinical and radiologic
significance
H. Rikimaru, Y. Chiba, M. Yanai; Ishinomaki/JP
Purpose: To determine the CT appearance and clinical significance of paratracheal and parabronchial air cysts.
Methods and Materials: We retrospectively evaluated 985 consecutive patients
who underwent chest CT at our institute between April 1 and August 1, 2005, and
evaluated reconstructed 1- to 2-mm CT images. The incidence of paratracheal
and parabronchial air cysts, and their location, size, and shape were analyzed.
Results: Five cases of traumatic pneumomediastinum were excluded. Air cysts
were seen in 176 (18%) of 980 cases. Paratracheal air cysts were located at the
right posterolateral aspect of the trachea in the thoracic inlet in 54 (5.5%) cases;
five were located elsewhere, such as in the neck (n = 3 (0.3%)) or just above the
tracheal bifurcation (n = 2 (0.2%)). In one case (0.1%) with a right aortic arch, the
paratracheal air cyst was located in the left posterolateral aspect of the thoracic
inlet. In 137 (14%) cases, there were parabronchial air cysts around the tracheal
bifurcation.
Thirty-eight cases out of 60 patients with paratracheal air cysts had undergone a
CT scan previously. Seven of them presented with different forms. In three cases,
the air cyst had disappeared, and in the other four cases, the air cyst contained
fluid, and looked like a lymph node. In one case of esophageal cancer, the air
cyst was misinterpreted as lymph node metastasis.
Conclusion: Paratracheal/parabronchial air cysts are incidental findings in many
cases. They have to be differentiated from lymph nodes or air due to an airway
injury.
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Analysis of three pathohistologic types of emphysema using ultra-highresolution CT
H. Ikura1, K. Shimizu2, H. Ebara1, Y. Senba1, I. Shinohara1, T. Mochizuki1,
T. Nagareda3, K. Umetani3; 1Ehime/JP, 2Kanagawa/JP, 3Hyogo/JP
(hikura@m.ehime-u.ac.jp)
Imaging of bronchogenic carcinoma: Application of MDCT

N. Nitta1, M. Takahashi1, R. Takazakura1, Y. Nagatani1, N. Ushio1, K. Murata1,
M. Tsudagawa2; 1Otsu/JP, 2Kusatsu/JP
Learning Objectives: New applications of MDCT regarding the imaging of bronchogenic carcinoma will be demonstrated.
Background: Multiplanar reconstruction (MPR) imaging, ECG-gating technique,
computer-aided detection (CAD) and sequential volumetry of pulmonary nodules
using the data obtained by MDCT all contribute to the process of diagnosis in
bronchogenic carcinoma.
Imaging Findings: 1) Visibility of lung nodule using ECG gating. We have recently developed a pulsating cardiac phantom and evaluated its usefulness in
improving the visibility of lung nodules. The effectiveness of ECG gating was also
evaluated in patients with lung nodules.
2) Detection of mediastinal and hilar lymph nodes on MPR images. It has been
reported by several researchers that the accuracy in diagnosing N-status by MPR
images without contrast is equivalent to the conventional contrast enhanced CT
images. We have re-evaluated this issue, focusing especially on the diagnosis of
hilar lymph node detection.
3) Sequential volumetry of lung nodules. We have assessed the volumetric functions of commercially available volumetric software using phantom nodules with
known volumes. The optimization of the scan protocol for the volumetry of nodules was also evaluated.
4) Detection of ground glass opacities (GGO) using special filters and neural
networks. We proposed using a new software program with modifications to the
"Genetic Algorithm Template Matching" method in order to increase the detection
rate of GGO by using Gabor filters and neural networks.
Conclusion: New applications of MDCT will be usefulness and effectiveness
regarding the imaging of bronchogenic carcinoma.
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Diseases of the trachea and main-stem bronchi in the adult: CT findings
M. Prenafeta1, E. Castaner1, X. Gallardo1, Y. Pallardo2, J. Mata1, J. Falco1,
A. Cabezuelo1; 1Sabadell/ES, 2Valencia/ES (mprenafeta@cspt.es)
Learning Objectives: Know the normal composition and appearance of the trachea and main bronchi at CT. Recognize the imaging features of abnormalities of
the central airways to help narrow the differential diagnosis. Know the different
reconstruction techniques that can aid in diagnosis, preprocedural assessment
and follow-up of some patients with stenosis.
Background: We illustrate the most common abnormalities of the trachea and
main bronchi, as well as the normal CT findings. We classify the abnormalities as
focal or diffuse. In the focal group we include: tracheal stenosis (postintubation,
postinfectious), iatrogenic injuries, and neoplasms (primary or secondary). In the
diffuse group we emphasize the importance of recognizing specific tracheal wall
abnormalities. Some entities in this second group cause circumferential wall thickening (Wegener's granulomatosis, amyloidosis, inflammatory bowel disease),
whereas others affect mainly the tracheal cartilage (relapsing polychondritis, tracheobronchopathia osteochondroplastica). Although standard axial CT images
are sufficient for evaluating most airway abnormalities, multidetector CT enables
multiplanar volume reformations, CT bronchography, and virtual bronchoscopy.
These techniques can be very useful in the preprocedural assessment and also
in follow-up.
Imaging Findings: We reviewed the radiological findings for these processes
including chest radiographs and CT scans from the last ten years. We correlate
the images with bronchoscopy and histopathologic findings.
Conclusion: Recognizing specific tracheal wall abnormalities is of primary importance because specific diseases tend to affect different components. Reconstruction CT images are of great value in planning procedures and in the follow-up
of patients with stenosis.
C-176
Pulmonary actinomycosis: CT findings
S.-W. Song, H.-J. Park, S. Hwangbo, H.-S. Kim, K.-J. Kim, M.-I. Ahn,
S.-H. Park; Uijongbu/KR (swsong7@catholic.ac.kr)
Learning Objectives: We illustrate and characterize the CT findings of pulmonary actinomycosis. We show the usefulness of CT in pulmonary actinomycosis.
Background: We retrospectively reviewed clinical records and CT scans in 9
patients with pathologically proven cases of pulmonary actinomycosis. Actinomycosis was diagnosed by surgery in seven, and PCNA in two. CT scans were
assessed for the pattern and distribution of lung abnormalities, pleural change,
chest wall invasion, and lymphadenopathy.
359
Chest
Purpose: Emphysema results in chronic respiratory failure with remodeling of

the peripheral lung structure, and the mortality has increased all over the world.
The objective of our study using synchrotron radiation CT (SRCT), which is one
of UHRCT, was to evaluate the early stage of peripheral remodeling in three
pathologic types of emphysema, which could not be detected with clinical HRCT.
Methods and Materials: Nine inflated and fixed lung specimens with emphysema were selected by HRCT findings, including three centrilobular, three panlobular, and three perilobular types. The SRCT images were obtained by a SRCT
system constructed in SPring-8 (Hyogo, Japan). 3-D images were reconstructed
with commercially available software. 2-D and 3-D images were estimated concerning pathologic features and S/N.
Results: SRCT two and three-dimensionally visualized alveolar walls with spatial resolution of 5.9 m. The FOV of 12 24 mm was enough to evaluate the
relation of secondary lobules and the location of lesions in the secondary lobule.
SRCT images showed different features of destructive dilatation of peripheral
airspaces in each pathologic type. Also, the dilated peripheral airspaces caused
balloon-like compression of contiguous bronchioles. The average diameter of
harmed bronchiole was 300 m, reduced from 450 m in normal. Therefore, this
might suggest that the changes cause check-valve mechanism in the lung periphery.
Conclusion: The SRCT image can show 3-D information of peripheral lung structure with nondestructive imaging. The morphologic findings of remodeling constitute an important pathophysiologic feature leading to chronic respiratory failure.
C-174

Imaging Findings: 7 (78%) of the patients were alcoholic men. Presenting symptoms were hemoptysis (n = 4), cough (n = 5), and pleuritic chest pain (n = 2). All
of the lesions were solitary. The lesions occurred in the upper lobe (n = 5, 56%),
and the lower lobe (n = 4, 44%). In only one patient (11%), areas of consolidation
crossed the fissure line, and later chest wall invasion occurred. The axial location
was peripheral (n = 7, 78%) or peribronchial (n = 2, 22%). Patchy air-space consolidation (n = 5, 56%) or a mass (n = 4, 44%) was seen. 6 (67%) of the 9 patients with consolidation (n = 4) or mass (n = 2) had central areas of low density
and peripheral enhancement. Pleural effusion was present in 3 (33%). Adjacent
pleural thickening was seen in 7 (78%). Hilar or mediastinal lymphadenopathy
was seen in 4 (44%).
Conclusion: Pulmonary actinomycosis was common in alcoholic men, and CT
showed solitary consolidation or mass with or without central low density areas
and peripheral enhancement. The majority showed peripheral location and adjacent pleural thickening. Transfissural extension or chest-wall invasion was seen
in the only one case.
C-177
Chest CT findings of non-tuberculous mycobacterial infection of the lungs:
Comparison with pulmonary tuberculosis
K. Ito1, Y. Koga1, K. Awai2, Y. Yamashita2; 1Nishi-goshi/JP, 2Kumamoto/JP
(kanako7330@yahoo.co.jp)
Learning Objectives: To illustrate spectrum of high-resolution CT findings of
non-tuberculous mycobacterial infection (NTM), especially mycobacterium avium
complex and mycobacterium kansasii. To compare HRCT findings on NTM and
pulmonary tuberculosis. To describe the role of HRCT in the diagnosis of NTM.
Background: The number of patients with non-tuberculous mycobacterial infection (NTM) is increasing as the AIDS population grows. In general, a diagnosis of
NTM and especially its differentiation from pulmonary tuberculosis is difficult and
may delay the start of treatment. Mycobacterium avium-intracellulare complex
(MAI complex) is the most common pathogen in Europe, North America, and
Japan.
Imaging Findings: To elucidate the spectrum of chest CT findings in NTM, we
reviewed 45 patients with NTM (MAI complex [MAC], n = 34; M. kansasii, n = 11)
and compared their CT findings with those in 40 patients with pulmonary tuberculosis. Bronchiectasis, nodular lesions, and consolidation were commonly seen
in either of MAC, M. kansasii, and tuberculosis. Lesions were predominantly distributed in the right middle lobe and the left lingular segments in 82.4% of the
patients with MAC and 41.7% of the patients with tuberculosis. Air space consolidation was seen in 55.9% of patients with MAC and 91.7% of patients with tuberculosis. In patients with M. kansasii, CT findings mimicked those of tuberculosis,
though cavitary lesions were more commonly seen in patients with M. kansasii
than in patients with tuberculosis (81.8% versus 58.3%).
Conclusion: CT provided insights into the extent and location of disease in patients with NTM.
C-178
Uncommon sites of thoracic lymphadenopathy on multi-detector row CT:
An electronic teaching file
C.M. Plank, T. Mang, A. Koller, A.A. Bankier; Vienna/AT
(christina.plank@meduniwien.ac.at)
Learning Objectives: 1. To map uncommon sites of thoracic lymphadenopathy
2. To propose a systematic search algorithm for these sites 3. To illustrate the
spectrum of normal and pathological features in benign and malignant diseases.
Background: The ATS classification of 1996 defines the hilar and mediastinal
lymph node (LN) stations relevant for cancer staging. Other thoracic LN stations,
however, are not explicitly mentioned in this classification. These include the parietal (sternal, intercostal, diaphragmatic, axillary, supraclavicular, and infraclavicular) and visceral (retrocrural, paracardial, and intrapulmonary) LN. Because
these LN have substantial importance in the staging of malignancies, radiologists should be familiar with their normal and pathological anatomy.
Imaging Findings: Both normal and pathological anatomy are of great interest
currently, since recent multi-detector CT units allow visualization of LN at a smaller
size and with higher precision.
Conclusion: The aim of this presentation is to map the anatomy of these uncommon sites of thoracic lymphadenopathy, to propose a systematic search algorithm for these sites, and to illustrate their spectrum of normal and pathological
features in benign and malignant diseases.
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C-179
Spectrum of findings in thoracic carcinoid tumors with pathologic
correlation: A pictorial review
M. Rebollo, E. Pea, R. Garca, J.M. Oliver, S. Hernandez Muiz, V. Cuartero,
S. Alonso, P. Olmedilla, A. Sonlleva; Madrid/ES (mrebollo@fhalcorcon.es)
Learning Objectives: To review current concepts about thoracic carcinoids including their epidemiology, histopathology and diagnosis approach. To show the
clinical and radiological features of thoracic carcinoids (bronchial and thymic carcinoids) and correlate them with histology.
Background: Carcinoids are malignant neuroendocrine neoplasms that can synthesize and secrete vasoactive substances. The respiratory tract is the second
most common location for carcinoids. Thoracic carcinoids can be divided in thymic
and bronchial carcinoids. Bronchial carcinoids present a wide range of clinical
behaviour and histologic differentiation, that include typical and atypical carcinoid. Thymic carcinoids are associated with a clinical hormone syndrome and an
aggressive behaviour.
Procedure Details: We retrospectively reviewed the clinical and imaging findings of thoracic carcinoid tumors from our pathology database. Findings were
correlated with pathology in all cases. This exhibit presents the spectrum of radiological manifestations of thoracic carcinoid tumor. Typical bronchial carcinoids
commonly presented as solitary lung nodules or as an endobronchial lesion, and
produced symptoms related to obstruction of central bronchi. Atypical carcinoid
appeared frequently as a large nonspecific hilar or perihilar mass, with imaging
characteristics that overlap bronchogenic carcinoma. Thymic carcinoids manifested as aggressive anterior mediastinal masses with an associated clinical
hormone syndrome.
Conclusion: Knowledge of the radiologic and pathologic characteristics of these
tumors and the profile and clinical manifestations of the patients, allow an appropriate diagnostic approach.
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Localized fibrous tumours of the pleura: Clinical, imaging and pathological
findings
S.S.C. Sousa Lima, H. Marques, I.M.B. Nobre, G. Correia; Lisbon/PT
(sandrasousalima@sapo.pt)
Learning Objectives: Review the clinical, imaging and pathological findings of
localized fibrous tumours of the pleura (LFTP).
Background: Localized fibrous tumors are rare mesenchymal neoplasms, representing less than 5% of all pleural neoplasia. They usually affect the pleura but
have also been described in other locations. Patients are typically adults over 40
years, presenting with local (thoracic pain, persistent cough and dyspnoea) or
systemic symptoms (hypoglycemia, digital clubbing and hypertrophic osteoarthropathy). They may also be asymptomatic.
Imaging Findings: Macroscopically, they present as well-circumscribed, lobular,
soft-tissue masses, sometimes pedunculated, which may grow to a large size. At
histology, they appear as low-grade neoplasms of variable cellularity. The exclusion of other tumors is made with immunohistochemical studies. LFTP are immunoreactive with CD34 and BCL-2 but lack expression for cytokeratin and S-100
protein. Criteria for malignancy depend mainly on histologic features. On chest
radiography they present as well defined, lobular, solitary nodules or masses,
affecting predominantly the middle and inferior hemithorax. When pedunculated
they might be mobile. On CT and MR studies they present as soft tissue masses,
with regular contours, homogeneous when small and heterogeneous when large,
sometimes with calcifications. They usually show rich vascularity. On MR when
small may present characteristic low signal intensity on T2-weighted images. Pleural effusion is frequently present.
Conclusion: LFTP are rare primary pleural neoplasms that may grow to a large
size. The diagnosis should be considered in symptomatic adults who present
with solitary, large, lobular heterogeneous intrathoracic masses without local invasion, lymphadenopathy, or metastatic disease.

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Typical and atypical radiological manifestations of pulmonary sarcoidosis:
A pictorial review
C. George, C. Gupta, M. Puthuran, G.R. Avery, N.M. Kennan; Hull/UK
(cheriangeorge@hotmail.com)
Learning Objectives: To illustrate both typical and atypical radiological manifestations in patients with biopsy proven pulmonary sarcoidosis.
Background: Thoracic sarcoidosis is a common disease and its pulmonary and
extra-pulmonary radiographic manifestations are well described in the literature.
About 90% of patients will have an abnormal chest radiograph at some stage.
Although high resolution computerized tomography (HRCT) is the imaging modality of choice for pulmonary diseases, the chest radiograph remains the initial
radiological examination for these patients whose diagnosis is unknown at the
time of clinical presentation.
Imaging Findings: This pictorial review illustrates both typical and atypical chest
radiographic and HRCT manifestations of biopsy proven pulmonary sarcoidosis.
A spectrum of findings that includes the common bilateral hilar lymphadenopathy
to the uncommon large pulmonary nodules is presented.
Conclusion: Recognising the various chest radiographic manifestations of pulmonary sarcoidosis plays an important role in diagnosis, which can be inconclusive or confusing in the first instance. Familiarity with chest radiographic and
HRCT appearances of pulmonary sarcoidosis will aid the radiologists and chest
physicians in making a speedy and accurate diagnosis.
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The spectrum of imaging findings in pulmonary aspergillosis
N. Bharwani, J. Raja, G. Munneke, S. Grubnic; London/UK
(nishatbharwani@gmail.com)
Learning Objectives: 1) Description and illustration of the clinical, histological
and imaging findings seen with the spectrum of Aspergillus infection. 2) Recognize the high-resolution computed tomography (HRCT) findings of both saprophytic and invasive pulmonary aspergillosis.
Background: The Aspergillus fungus causes a spectrum of pulmonary infections ranging from saprophytic to invasive forms. The clinical and radiological
manifestations of pulmonary aspergillosis vary according to the fungal load, organism virulence and patient's immune status. Aspergillosis is mainly seen in
immunocompromised hosts; however, it is described in immunocompetent hosts
where there has been greater diagnostic dilemma and the radiologist plays a
major role in diagnosis.
Imaging Findings: The saprophytic form of aspergillosis can present as an aspergilloma in pre-existing cavities or as airway colonization. Airway colonization
can in turn induce allergic bronchopulmonary aspergillosis, a condition most often seen in patients with long-standing asthma. The invasive form is generally
seen in immunocompromised patients. Invasive aspergillosis can be subdivided
according to the progression of clinical signs and the structures invaded. The
main groups are semi-invasive (chronic necrotizing), airway-invasive and angioinvasive aspergillosis.
Conclusion: We will describe cases in both immunocompromised and immunocompetent hosts. The chest radiograph may be normal and differentiation is made
on the basis of HRCT. This comprehensive pictorial review aims to provide the
practicing radiologist a summary of the imaging diagnostic criteria for this clinically significant diagnosis.
C-183
Multidrug-resistant pulmonary tuberculosis (MDR-TB): Spectrum of
computed tomography (CT) findings
A. Guerra1, J. Calha1, L. Carrilho1, I. Pereira2, J. Castao 1; 1Lisbon/PT,
2
Santarm/PT (gisaguerra@hotmail.com)
tion, tree-in-bud, centrilobular opacities and bronchial wall thickening) and "atypical" (diffuse and lower opacities, pleural effusion, mediastinal adenopathy, miliary pattern and normal chest examination) CT presentations of MDR-TB, with
cases we selected from our hospital. Usually, MDR-TB tends to be more aggressive in behaviour as well as more "atypical" in presentation than non-MDR-TB.
Conclusion: The radiologist must be familiar with such a broad range of CT findings, "typical" and "atypical" which can be present in TB. Also, CT examinations
allow an early identification of the disease.
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Radiologic findings of posttransplant lymphoproliferative disorder (PTLD)
after lung transplantation
S. Espejo Prez, P. Segui Azpilcueta, R. Ysamat Marfa, A. Cano Sanchez,
J. Martos Becerra, J. Espejo Herrero; Crdoba/ES (simonaespejo@seram.org)
Purpose: Posttransplant lymphoproliferative disorder (PTLD) after solid-organ
transplantation is a relatively infrequent but devastating complication.
The purpose of this study is to describe radiologic findings of PTLD after lung
transplantation.
Methods and Materials: We retrospectively reviewed the medical and imaging
records of patients who developed PTLD after lung transplantation at our institution. Among 206 lung transplant recipients, 7 cases of PTLD (3.39%) were identified. The distribution, timing and imaging features were analyzed.
Results: Diagnosis of PTLD was made a median of 1008 days after lung transplant (range, 60 to 2007 days). Patients presented with thoracic involvement (2 of
7 patients, 28%), extrathoracic disease (3 of 7 patients, 42%) or both (2 of 7
patients, 28%). Intrathoracic PTLD manifested as multiple pulmonary nodules
(n = 2), alveolar infiltrates and nodules (n = 1), and/or extraparenchymal disease
as lymphadenopathy (n = 2), pleural effusion (n = 1) and bronchial obstruction
(n = 1). Extrathoracic disease involved the abdomen (n = 3), the brain (n = 1),
the oral mucous layer (n = 1), and the skin (n = 1). In the abdomen, PTLD presented as hepatic lesions (n = 2), splenic lesions (n = 1), and lymphadenopathy
(n = 1). Extranodal disease in the abdomen was more common than nodal disease.
Conclusion: Presentation and radiologic features of PTLD varies considerably
following lung transplantation. Knowledge of the wide spectrum of radiologic findings and a high level of suspicion of this disease are critical for early detection
and treatment.
C-185
Drug induced lung disease - a pictorial review of HRCT findings
R. Dey, F.H. Wong, N. Kennan, G.R. Avery; Hull/UK (ramitadey@hotmail.com)
Learning Objectives: The diagnosis of drug-induced pulmonary toxicity can be
facilitated by an understanding of its appearances on high resolution CT (HRCT).
Our pictorial review aims to display the range of radiological manifestations of
pulmonary changes seen in association with the use of a variety of drugs.
Background: Drug induced pulmonary disease is relatively common and is seen
to occur with the use of a very broad range of medications. Changes can be
acute or progress to chronic pulmonary shadowing. However, these changes are
often nonspecific and difficult to identify on plain radiographs. HRCT has been
shown to be a much more sensitive imaging modality in demonstrating these
appearances and indeed has led to the recognition of distinct patterns of involvement, which have some role in predicting outcome and response to treatment.
Imaging Findings: HRCT appearances include pleural changes, airspace or interstitial patterns and may be acute or chronic.
Conclusion: We aim to present, through a pictorial review of HRCTs, the various
radiological manifestations of drug-induced lung disease.
Chest
Learning Objectives: To review and illustrate the chest CT findings in patients

with MDR-TB strains of Mycobacterium tuberculosis confirmed by lab.
Background: The incidence of MDR-TB has been increasing in recent years.
The major risk factor for MDR-TB is the co-infection with HIV. Assessing our
patients with MDR-TB (132 patients between January 2000 and June 2005) the
majority were HIV positive. The range of imaging findings in MDR-TB is the same
as in non-MDR-TB. The main difference is in their aggressiveness. The radiological manifestations of HIV-associated pulmonary TB also depend on the individual level of cellular immunity depression (CD4).
Imaging Findings: Classically, authors describe "typical" and "atypical" findings
in pulmonary TB, depending on those findings' frequency.
We illustrate "typical" (lobular consolidation, cavitation, ground glass attenua-
361

Chest
Chest
Pathology
Positron Emission Tomography
C-186
C-187
Radiologic-pathologic correlations between intratumoral macroscopic and

microscopic components in lung neoplasms
E. Quaia, M. Belgrano, S. Cernic, S. Bruni, M. Cova; Trieste/IT
(equaia@yahoo.com)
Combined F-18 fluorodeoxyglucose (FDG) PET/CT imaging in the chest: An

atlas of benign and inflammatory causes of FDG accumulation
T. Blodgett, S. Thomas, B.M. McCook; Pittsburgh, PA/US
(sthomas@hotmail.com)
Learning Objectives: To describe those intratumoral components in lung neoplasms which are depicted by imaging.
Background: Different intratumoral components in lung neoplasms, evident at
macroscopic and/or microscopic analysis, may be recognized on non-enhanced
and contrast material-enhanced computed tomography (CT) images.
Procedure Details: Fifty-six lung neoplasms (4-8 cm in diameter) in 56 patients
(32 male, 24 female, mean age SD, 65 15) were imaged by CT before and 25
seconds after intravenous administration of iodinated contrast agent (iodine
300 mg/mL; 150 mL; i.v. bolus injection). Surgical/biopsy/autoptic specimens were
analysed by macroscopic and microscopic/histologic analysis (hematoxylin and
eosin staining, x20 - x40 magnification), and 2 observers identified in consensus
those intratumoral components which are depicted by CT images. Macroscopic
components: 1) internal liquefactive necrosis in squamous cell carcinomas (n = 21)
appearing hypodense at non-enhanced CT, and without enhancement after contrast injection; 2) fibrotic component in adenocarcinomas (n = 5) manifesting as
irregular peripheral strands; 3) bronchiolo-alveolar carcinomas (n = 2) presenting diffuse/confluent parenchymal consolidation; 4) coagulative necrotic and haemorrhagic changes in small cells (n = 15) and anaplastic carcinomas (n = 9) which
appeared respectively hypodense and hyperdense at non-enhanced CT, and without enhancement after contrast administration; 5) fat component in hamartomas
(n = 4) presenting < - 25 HU at non-enhanced CT. Microscopic components: a)
cellular component with diffuse contrast enhancement due to vessels in extracellular stroma; b) fibrotic extracellular stroma revealing absent enhancement; c)
calcific component appearing hyperdense with > 130 peak HU at non-enhanced
CT.
Conclusion: Different intratumoral components in lung neoplasms are depicted
by CT images.
Learning Objectives: There are many causes of benign FDG uptake in the body
that may mimic disease. Our goal was to develop an atlas of the most common
and atypical benign causes of FDG uptake in the chest using combined PET/CT
scanners.
Background: There are many causes of benign uptake in the chest including
radiation pneumonitis, inflammatory pseudotumor, sarcoidosis, silicosis, focal
retrocrural brown fat, tuberculosis, hamartomas and calcified lymph nodes causing an attenuation correction artifact. Many of these benign causes of uptake
could easily been mistaken for malignancy.
Procedure Details: All anatomical (CT), functional (PET) and fused anatomical/
functional (PET/CT) images were acquired and selected from combined PET/CT
scans of approximately 15,000 patients scanned at our institution on 5 different
PET/CT scanners since 1998. Patients were referred for a variety of malignancies. All abnormal findings were confirmed by histopathology or follow-up imaging. Several patients included in this atlas were misdiagnosed as having primary
or recurrent malignancy. Some patterns mimicked malignant patterns of FDG
uptake, while others mimicked physiologic or benign patterns.
Conclusion: We present an atlas of common and atypical non-malignant causes
of FDG uptake in the chest using combined PET/CT. Recognition of these patterns and an awareness of the overlap between benign and malignant causes of
FDG uptake is essential for interpreting physicians to avoid misdiagnosis.
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Early detection of lung cancer with spiral low-dose CT and FDG-PET:
Baseline results in 1095 asymptomatic smokers
G. Bastarrika, J.J. Noguera, M.D. Lozano, I. Vivas, L. Montuenga, J.J. Zulueta;
Pamplona/ES (bastarrika@unav.es)
Purpose: To present baseline prevalence data from a lung cancer screening trial
with low-dose spiral computed tomography (LDCT) and positron emission tomography (FDG-PET) in a population of asymptomatic smokers.
Methods and Materials: From September 2000 to August 2005, 1095 asymptomatic smokers (mean age 54.8 years, SD: 8.84, mean tobacco consumption 34.5
pack-years) were included in a LDCT early lung cancer detection program. FDGPET scanning was recommended in non-calcified pulmonary nodules (NCPN)
10 mm or potentially malignant nodules. NCPN < 10 mm were followed-up with
high-resolution CT in order to exclude growth. In FDG-PET positive cases biopsy
was recommended.
Results: 395 NCPN were found in 573 (36 %) smokers. The diameter of the
largest NCPN was: 5 mm in 220 (20.1 %) participants, > 5 - < 10 mm in 137
(12.5 %). FDG-PET exam was performed in 38 (3.5%) NCPN 10 mm or potentially malignant nodules (15 positive, 22 negative). Among the FDG-PET positive
NCPN fourteen were resected (lung cancer), one underwent fine needle aspiration cytology (non-specific/necrosis). One subject refused further work-up. CT
follow-up was decided for the other NCPN. Results will be updated at the time of
presentation.
Conclusion: A prevalence of 14 lung cancers in a population of 1095 (1.3 %)
asymptomatic subjects at high risk, all with surgical stage T1N0M0 was demonstrated in this LDCT based early lung cancer detection program. As shown, addition of FDG-PET to the protocol might reduce the number of invasive procedures
for histologically benign pulmonary nodules.
C-189
Lymph node staging of lung cancer: Assessment of variable SUV-related
parameters on PET/CT
J. Chung1, M. Ahn1, J. Baik1, H. Park2, S. Kim2, Y. Park1, S. Park2; 1Suwon/KR,
2
Seoul/KR (jinoow@catholic.ac.kr)
Purpose: To evaluate diagnostic accuracy of PET/CT using variable parameters
related to standard uptake value (SUV) in evaluating lymph node (LN) metastasis in the lung cancer patients.
Methods and Materials: 107 pathologically confirmed mediastinal and hilar LNs
in 24 patients who underwent CT, PET/CT, and surgical LN dissection for lung
362

cancer were included in this study. Imaging studies were retrospectively analyzed based on pathological data. Peak SUVs of primary tumors and LNs on
initial (iSUV) and delayed (dSUV) PET/CT scans were measured, and retention
index (RI (%)=(dSUV-iSUV)/iSUV X100) were calculated. The ratio between SUVs
of individual LN and primary tumor was measured on initial (N/T iSUV) and
delayed (N/T dSUV) PET/CT scans. Relationships between each parameter and
presence of LN metastasis were explored in a receiver operating characteristic
(ROC) analysis.
Results: In PET/CT, iSUV, dSUV, and RI were statistically significant parameters
in predicting LN metastasis (p = 0.015, p = 0.009, and p = 0.04). The best thresholds to distinguish benign from malignant LNs were 4.4, 4.7, and 13%, for iSUV,
dSUV, and RI. The sensitivity, specificity, accuracy, positive predictive value, and
negative predictive value in diagnosing LN metastasis were 75%, 97%, 94%,
75%, and 97%, with iSUV; 75%, 98%, 95%, 82%, and 97% with dSUV; and 83%,
92%, 91%, 56%, and 98% with RI.
Conclusion: The best SUV threshold to distinguish benign from malignant LNs
is 4.4 on initial PET/CT. It is not necessary to measure SUV on delayed PET/CT
for LN metastasis evaluation. There is no relationship between SUVs of primary
tumors and those of metastatic LNs.
C-190
Mesothelioma staging as demonstrated by MDCT and PET-CT
Z. Viney, F. Alyas, R. Tappouni, E. Woo, S.F. Barrington, S. Rankin; London/UK
(poliov@hotmail.com)
Learning Objectives: 1. Show the MDCT appearances of chest wall, mediastinal and diaphragmatic invasion as well as peritoneal disease and the changes
seen after extrapleural pneumonectomy. 2. Show the use of PET-CT in detecting
extrathoracic disease and guiding biopsy. 3. Appreciate the value of MDCT, with
its multiplanar capability and isotropic voxels in T3 versus T4 disease.
Background: Malignant mesothelioma is a rare tumour usually associated with
asbestos exposure. It most commonly affects the pleura. Although the prognosis
is poor, the use of chemoradiotherapy may improve this. The potential for surgical
treatment with extrapleural pneumonectomy (EPP) makes accurate staging essential, particularly to differentiate between resectable and unresectable disease
(T3 versus T4). MDCT with its wide availability, multiplanar capability and isotropic voxels could replace MR imaging in detecting for example chest and diaphragmatic invasion.
Imaging Findings: We demonstrate with multiplanar reconstructions the MDCT
appearances of chest wall, mediastinal and diaphragmatic invasion, as well as
nodal and peritoneal disease. The changes associated with EPP are illustrated.
Furthermore we show that PET-CT has advantages in detecting extrathoracic
disease and guiding biopsy in multifocal pleural disease.
Conclusion: We have demonstrated the value of MDCT in the staging of mesothelioma. We have shown how PET-CT is of particular use in detecting extrathoracic disease and in guiding biopsy.
Chest
Vascular
C-191
Pitfalls in non-invasive assessment of pulmonary vascular disease:
A pictorial essay
E.J.R. van Beek1, C. Elliott2, N. Woodhouse2, J.M. Wild2, D. Kiely2;
1
Iowa, IA/US, 2Sheffield/UK (Edwin-vanbeek@uiowa.edu)
Learning Objectives: 1. Be able to apply the most commonly used non-invasive
imaging modalities in pulmonary vascular disease. 2. Be able to recognize major
pitfalls in interpretation. 3. Be able to diagnose pulmonary hypertension based on
imaging findings.
Background: Pulmonary hypertension (PH) is a rare condition with a poor prognosis if left untreated. New treatment modalities have improved patients' quality
of life and survival. PH has many causes, which are classified according to clinical and pathological features. Management critically depends on adequate diagnosis and assessment of disease severity. Diagnostic management of PH has
relied on invasive cardiac catheterization. However, non-invasive imaging tools
are being developed and applied. These include echocardiography, lung scintigraphy, CT and MR imaging-based assessment of pulmonary vessels and cardiac
function.
Imaging Findings: This presentation will highlight the benefits of a multi-modality approach to imaging PH, give examples of typical findings and illustrate common pitfalls including: 1) Not considering pulmonary hypertension as a cause of
breathlessness, 2) Mis-classification of the etiology of PH, 3) Assuming "right
heart failure" is due to PH, 4) Lack of appreciation of the value and limitations of
different non-invasive imaging modalities, and 5) Over reliance on a single modality.
Conclusion: Imaging of pulmonary hypertension should be approached using a
multidisciplinary and multimodality approach tailored to the individual patient.
Knowledge of common pitfalls in imaging are essential.
C-192
Hemoptysis evaluation in the emergency room: Can MDCT present a
comprehensive evaluation?
D. Kim, H. Oh, D. Kim, J. Byun; Gwangju/KR (kdhoon@chosun.ac.kr)
Learning Objectives: 1. To evaluate bronchial and nonbronchial arteries at 16detector row CT compared with conventional bronchial angiography in hemoptysis patients. 2. To exhibit images made by various MDCT techniques.
Background: With recent advances, MDCT helps to predict the arteries causing
hemoptysis and gives important information for therapeutic decision making.
Procedure Details: Forty consecutive patients (28 men, 12 women; mean age
58years, range 28-84 years) with hemoptysis underwent 16-detector row CT scanning prior to embolization. Various imaging techniques were used such as multiplanar reformation, maximal intensity projection and 3-dimensional technique.
Observers analyzed bronchial and non bronchial arteries, and ability to detect
bleeding arteries. 35 patients showed detailed bronchial and non bronchial anatomy at CT, which correlated with bronchial angiography. MDCT presented good
anatomic detail prior to conventional angiography.
Conclusion: MDCT angiography provides precise depiction of bronchial and non
bronchial arteries in hemoptysis patients, and has an important role in localising
arteries causing hemoptysis.
C-193
Evaluation of peripheral lung perfusion using principal component analysis
and independent component analysis on the basis of time attenuation curve
of perfusion CT
J. Nakanishi1, K. Kodani1, Y. Shimatani2, M. Ametani1, T. Ogawa1; 1Yonago/JP,
2
Tottori/JP (tenten22@mac.com)
363
Chest
Purpose: The purpose of this study is to assess characteristics of temporal pattern of lung perfusion using perfusion CT with principal component analysis (PCA)
and independent component analysis (ICA).
Methods and Materials: Lung perfusion CT images were acquired from 30 normal controls and 20 patients (15 emphysema, 5 pulmonary artery stenosis) using multidetector row CT. All of the studies were performed after informed consent.
PCA and ICA were applied to time attenuation curves (TAC) for every pixel and
distribution of score was compared with CT images. Cross correlation analysis
was performed between average TAC of high score areas and TAC of the pulmonary artery (PA).

Results: In PCA, 95% of temporal variation of lung TAC could be explained with
3 factors corresponding to overall, delayed, and early enhancement. The ICA
factors corresponding to the PCA factors could be extracted. The ICA factors
which represent early enhancement were well correlated with TAC of PA than
PCA (p < 0.01), and score distribution was well correlated with CT images. In
patients with pulmonary artery stenosis, the decrease of pulmonary arterial blood
flow on apparently normal areas on CT images could be clearly demonstrated. In
emphysema, delayed enhancement score of peripheral lung area was significantly higher than that of central area (p < 0.01).
Conclusion: We could assess the temporal pattern of lung perfusion using perfusion CT with PCA and ICA. Especially, pulmonary arterial blood flow in pathological state was easily evaluated. Delayed enhancement significantly increased
in pathological lung areas.
C-194
Resolution of thrombi in acute pulmonary embolism at two weeks
follow-up: Correlation with blood gas values
Z.M. Metafratzi, F. Katzioti, G. Maglaras, S. Panagiotopoulou, N. Kollaitis,
M. Vassiliou, S. Constantopoulos, S.C. Efremidis; Ioannina/GR
(zafmet@otenet.gr)
Purpose: To study the evolution of CT pulmonary angiography obstruction index
(CTPAOI) and the blood gas values (BGV) at two weeks follow-up after acute
pulmonary embolism (APE).
Methods and Materials: 43 patients with clinical and laboratory findings of APE
were referred to the radiology department and diagnosis was confirmed with CT
pulmonary angiography (CTPA). Amongst them, 17 underwent a follow-up CTPA
two weeks after the initial diagnosis. CTPAOI was quantified according to the
location of the emboli and degree of obstruction with standard method and was
evaluated for each patient at the initial and follow-up CTPAs. Blood gas values
(PaO2, PaCO2, SaO2, and P (A - a) O2) were also obtained at the initial and at two
weeks follow-up. Alterations of blood gas values and CTPAOIs between first and
follow-up examination were analyzed using statistical method (paired t-test), with
statistical significance at the p < 0.05 level.
Results: Initial CTPAOI (mean SD, 53.7 25.6%) vs 15 days CTPAOI
(23.0 20.7%) and initial BGV (PaO 2 :63.8 15.7, PaCO 2 :32.35 5.7,
SaO2:90 10.7%, and P ( A - a) O2:45.7 19.6) vs 15 days BGV (PaO2:76.8 9.9,
PaCO2:37 3.8, SaO2:95.3 1.8%, and P (A - a) O2:26.4 8) were statistically significant (p < 0.05). Furthermore, we found that the 15 days' CTPAOI can be strongly
predicted by the initial percentage of obstruction with a very strong correlation
(r = 0.8, p < 0.005).
Conclusion: A significant improvement in CTPAOI and blood gas values at two
weeks follow-up was observed. Additionally, the degree of obstruction of the arterial tree at the initial CTPA can be a strong predictor of the two week CTPAOI.
C-195
CT imaging of pulmonary hypertension: An electronic interactive teaching
atlas
A. Dirisamer, D. Wagner, I. Lang, A.A. Bankier; Vienna/AT
(albert.dirisamer@meduniwien.ac.at)
Learning Objectives: To clarify the pathogenesis of pulmonary hypertension. To
illustrate the spectrum of CT findings associated with pulmonary hypertension.
To demonstrate the diagnostic potential of CT in differentiating the pathogenetic
entities underlying pulmonary hypertension.
Background: According to recent nomenclatures, pulmonary hypertension is
classified as arterial hypertension, venous hypertension, hypertension associated with disorders of the respiratory system, hypertension due to chronic thromboembolic disease and hypertension due to disorders directly affecting the
vasculature. For each of these subgroups, CT provides diagnostically relevant
information.
Procedure Details: By complementing and/or replacing echocardiography and
angiography, CT has evolved as a crucial non-invasive diagnostic method in the
management of patients with pulmonary hypertension. Because these patients
require therapy that is tailored to the disease underlying pulmonary hypertension, radiologists should be aware of the various CT manifestations of this group
of disorders.
Conclusion: This presentation will provide radiologists with an interactive approach to the CT manifestations of pulmonary hypertension and will propose
diagnostic algorithms for patients who present with elevated mean pulmonary
pressure.
364
C-196
Role of CT venography and CT pulmonary angiogram in detecting
thromboembolic disease
S. Nair, A. Sebastian, C. George, R. Mannion; York/UK (drsnnair@hotmail.com)
Purpose: Multislice CT pulmonary angiography (CTPA) has become the investigation of choice in patients with suspected pulmonary embolism (PE). The association of PE and deep vein thrombosis (DVT) is well known. Recent research
has shown that in patients suspected of having PE, a reasonable number of patients had DVT in the absence of PE. Combining CTPA and CT venography (CTV)
supposedly increases the detection rate in these cases and thus has a significant effect on patient management. The purpose of this study was to evaluate
whether the addition of CTV provided any additional diagnostic value over and
above CTPA.
Methods and Materials: Retrospective review of all consecutive cases Dec 2004April 2005.
Results: 160 consecutive patients (M:F 68:92, mean age 66.1 yrs, range 2197 yrs) underwent CTPA and CTV from Dec 2004- Apr 2005. PE was detected in
31/160 (19.3%) patients at CTPA, and DVT was detected in 7/160 (4.37%) patients at CTV. Among 7 patients with DVT, PE was detected in 6 patients at CTPA.
Combining CTV to CTPA resulted in only 0.7% incremental increase in thromboembolic disease detection compared with that at CTPA alone. Incidental findings included bladder carcinoma (n = 1) and distal colonic colitis (n = 1).
Conclusion: Combining CTV with CT PA does not add any significant value in
the diagnosis of thromboembolic phenomena. It increases the effective dose to
the patient and the cost.
C-197
Direct visualization of the shunt flow on vascular disorders of the chest:
Usefulness of two-phase contrast-enhanced CT with a saline flush
M. Miyazaki, O. Hasegawa, H. Honjo, T. Tameda, N. Hashimoto, F. Shishido;
Fukushima/JP
Learning Objectives: 1) To illustrate the ability of two-phase contrast-enhanced
(CE) CT of the chest in the depiction of both vascular anatomy and shunt flow in
detail. 2) To explain the importance of the injection of saline solution following
contrast material to separate pulmonary and systemic vascular system. 3) To
emphasize the advantage of this low-invasive protocol.
Background: Conventionally, CT angiography of the chest to diagnose vascular
disorders is performed by uniphasic scanning, with contrast-enhancement of
pulmonary arteries only or all thoracic vessels. On the other hand, pulmonary
arteries and systemic vessels filled with contrast material can be separately seen
in two-phase contrast-enhanced scans using 16/64-detector row helical CT with
saline flush.
Procedure Details: Two-phase CECT was performed with 60 ml of contrast material at a rate of 4 ml/s followed by flushing saline solution (30 ml, 4-6 ml/s). The
first scan delay was 7-8 seconds, followed by a 20-22 second delay, sequentially.
We show that both left-to-right and right-to-left shunt flow was depicted clearly by
existence of contrast material inside vessels of lower density.
Conclusion: Two-phase CECT of the chest with a saline flush can depict not
only vascular anatomical image but also shunt flow. The information obtained
from this protocol compares favourably with combined pulmonary angiography
and thoracic aortography, but CT is minimally-invasive and provides more anatomical information.
C-198
Reproducibility of multi-detector spiral computed tomography in detection
of sub-segmental acute pulmonary embolism
O. Corneloup, S. Brunot, V. Latrabe, M. Montaudon, F. Laurent; Pessac/FR
(olivier.corneloup@chu-bordeaux.fr)
Purpose: The aim of this study was to evaluate the inter and intra-observer agreement of the diagnosis of subsegmental acute pulmonary embolism (PE) in an
inpatient population explored by 16 slice multidetector spiral computed tomography (MDCT)
Methods and Materials: Four hundred consecutive inpatients were referred to
MDCT for a clinical suspicion of acute PE. One hundred and seventy seven (44.2%)
had a known cardio-respiratory disease at the time of examination. Inter and
intra-observer agreement for the diagnosis of acute PE and of sub-segmental
acute PE were assessed blindly and independently by 3 experienced readers,
using kappa statistics.
Results: Seventy five patients were diagnosed as having acute PE (19.5%), and
clots were located exclusively within sub-segmental arteries in 9 patients (12%).

When clots were limited to sub-segmental or more distal branches of the pulmonary arteries, Kappa values were found moderate (0.56) to very good (0.85) for
the diagnosis of sub-segmental acute PE, whereas for the diagnosis of acute PE
in the whole population, kappa values ranged from 0.84 to 0.97. Intra-observer
agreement was perfect (Kappa = 1).
Conclusion: MDCT is a reproducible technique for the diagnosis of subsegmental acute PE as well as for acute PE. In this inpatient population, subsegmental
acute PE was not a rare event.
C-199
Audit on computer tomographic pulmonary angiography (CTPA) requests in
patients with suspected acute pulmonary embolism (PE)
D. Subedi1, T. Rogerson 2, B. Hope-Gill2, M. Crane2; 1Edinburgh/UK, 2Cardiff/UK
(deepaksubedi@aol.com)
Purpose: To investigate the practice of clinical risk stratification prior to requesting CTPA in patients with suspected acute pulmonary embolism (PE).
Methods and Materials: A prospective audit of 20 case notes of patients who
underwent CTPA for suspected acute PE was done. Documentation of relevant
clinical information and clinical probability assessment was investigated.
Results: Major risk factors for PE were present in 9, absent in 10 and not recorded in 1. Clinical features were incompletely assessed or documented in 4 patients. Chest X-rays had been taken in all, but 2 of them were of poor quality.
X-ray findings were not recorded in 3. Clinical probability assessment was not
done in any of the patients. Only 3 CTPAs were positive for a PE.
We performed a retrospective clinical probability assessment in 19 out of 20 patients with the clinical information already documented in the notes. Of the 19
patients, 7 had low probability and all of them had a negative CTPA. Nine had
intermediate probability and 8 of them had a negative CTPA. Of the 3 with high
probability, 2 were positive for PE.
Conclusion: This audit demonstrated an incomplete clinical assessment and
documentation and no use of clinical probability assessment. Retrospective assessment showed that the majority (16 out of 19) were in low and intermediate
probability groups, and PE was diagnosed in only one patient in this group. Use
of a separate imaging request form incorporating clinical probability scores was
recommended.
C-200
Congenital pulmonary venolobar syndrome: Spectrum of helical computed
tomography and magnetic resonance angiography findings
I. Torres, M. Parron, F. Baudraxler, J. Fernandez Cuadrado, M. Pardo,
T. Berrocal; Madrid/ES (isabel.torresanchez@mi.madritel.es)
Comparison of standard axial MDCT with reformatted paddle-wheel

technique for the detection of pulmonary embolism
P. Brader, P. Reitner, F. Thimary, H. Schllnast, M. Wehrschtz,
H.A. Deutschmann; Graz/AT (peter.brader@meduni-graz.at)
Purpose: The purpose of the study was to assess the value of rotated paddlewheel reformations for the detection of central and peripheral PE compared to
standard axial MSCT images.
Methods and Materials: 35 patients (22 male, 13 female; mean age 61 16;
age range: 27 - 91) with PE were reviewed by 3 independent readers for the
detection of pulmonary embolism using standard axial CT scans and reformatted
paddlewheel technique. Axial CTs and reconstructed images were evaluated in
random order. All axial examinations were performed with a collimation of 1.25 mm,
a pitch of 6 and a reconstruction interval of 0.8 mm. For each patient MPR were
reformatted by using a paddlewheel arrangement with 5 mm slab thickness. Gold
standard for PE was consensus reporting of all readers.
Results: The overall sensitivity for the axial images for the 3 readers was between 91% and 96% (reader 1: 93%, reader 2: 96%, reader 3: 91%); that of the
paddlewheel reformations 78% - 83% (reader 1: 80% reader 2: 83% reader 3:
78%); the specificity for both methods was between 98% and 99% (reader 1 axial
and paddlewheel: 98%; reader 2 axial 99% and paddlewheel 98%; reader 3 axial
99% and paddlewheel 98%).
Conclusion: There was no significant difference for the detection of central PE,
whereas for the detection of peripheral emboli standard axial images showed a
significant higher percentage of overall detection than did paddlewheel reformations.
C-202
The absent pulmonary vein sign. A reliable indicator of post lobectomy
anatomy
J.W. McCann, S. McNally, J. Sheehan, V. Young, J.F.M. Meaney; Dublin/IE
(jwjmccann@hotmail.com)
Purpose: Bronchial anatomy post lobectomy is inconsistent and difficult to evaluate on computerised tomography (CT). We propose that such bronchial anatomy can accurately be determined by correlating with pulmonary venous anatomy.
Methods and Materials: Surgical and radiological data were examined of 155
consecutive patients, treated by surgical lobectomy at our institution between
January 2001 and December 2004. 47 patients were subsequently imaged with
helical CT and comprised our study group. In total, 53 lobes were removed in this
group. CTs (Somatom, Siemens) were examined on a work station (MV300, Siemens), by a 3rd year pre-fellowship radiology trainee. All CTs, except 4, were
performed with intravenous contrast (Iomeran 300, Bracco). Initially the examiner
evaluated the anatomy as they would normally, with 3 questions to be answered.
What side was operated on? Which lobe was removed? and the degree of certainty. Subsequently, the examiner was asked to examine vascular anatomy by
documenting the presence or absence of the pulmonary arteries and veins associated with the 5 major lobes.
Results: 26 out of 53 (49.06%) lobes removed were correctly identified prior to
examination of the vascular anatomy, although the degree of certainty was low.
When vascular anatomy was examined, the accuracy increased to 43 out of
53 (81.11%), with a greater degree of certainty.
Conclusion: Post operative bronchial anatomy is difficult to determine by examining the airways only. We propose that accurate and prompt determination of
anatomy post lobectomy can be performed by examination of the vascular structures, particularly by identifying an absent pulmonary vein.
Chest
Learning Objectives: To describe and show the spectrum of anomalies associated with congenital pulmonary venolobar syndrome (CPVS). To understand the
embryology, pathology, radiological features and differential diagnoses. To evaluate the utility of magnetic resonance angiography (MRA) and helical computed
tomography (HCT) in the diagnosis and management of this condition.
Background: Congenital pulmonary venolobar syndrome refers to a spectrum of
pulmonary developmental anomalies that may appear singly or in combination.
Although some of the patients may have clinical symptoms, most of them are
asymptomatic and incidentally diagnosed. Imaging studies are mandatory for identification of these anomalies. Recently, HCT and MRA have become suitable imaging modalities for noninvasive demonstration of the components of CPVS, mainly
vascular abnormalities.
Imaging Findings: The MRA and HCT studies performed in patients diagnosed
with CPVS were retrospectively reviewed from our database of thoracic pathology. This teaching exhibit illustrates and analyses practical aspects of the usual,
unusual, and exceptional components of CPVS including hypogenetic lung (lobar agenesis, aplasia, hypoplasia), partial anomalous pulmonary venous return
or meandering pulmonary vein to the left atrium (scimitar sign), hypoplasia or
agenesis of the pulmonary artery, systemic arterialization of the lung, and pulmonary sequestration. Cardiovascular and tracheobronchial associated anomalies will also be shown. Embryology, pathology, and radiological features will be
emphasized.
Conclusion: MRA and HCT combined with advanced postprocessing graphic
workstations allow improved noninvasive delineation of these anomalies. This
exhibit will help the training radiologist to better understand and recognize the
characteristic imaging features and differential diagnoses of CPVS.
C-201
365

Chest
Technical Aspects
C-203
Phase contrast X-ray microradiography using polychromatic synchrotron
radiation: Application to the imaging of lung
H. Yong1, O. Woo1, J. Je2, C. Oh 1, E.-Y. Kang1; 1Seoul/KR, 2Pohang/KR
(yongtoki@hanmail.net)
Purpose: To explain the simple concept of phase contrast X-ray radiology and to
compare phase contrast X-ray images with optical microscopic images of lung
tissue from rabbits induced with pulmonary fat embolism.
Methods and Materials: Using white rabbits, pulmonary fat embolism was induced. After CT imaging to confirm the presence of lung abnormality, rabbits
were sacrificed and then lungs were removed immediately. After specimen were
embedded in a paraffin block, all tissues were cut into 10 m sections and then
adhered to the glass cover and deparaffinized. Experiments on these sections of
rabbit lung tissue were performed at the ICPCIR beamlines of the Pohang Light
Source in Korea. Individual snapshots were taken with an exposure time of 1020 ms. Real time fluoroscopic review was used as a valuable tool to find the
region of interest. Correlation between the phase contrast X-ray images and optical microscopic images was determined by radiologist and pathologist.
Results: Phase contrast X-ray microradiographs of thin slice lung samples of
rabbit showed individual microstructure of lung such as alveoli, bronchioles, and
vessels on a submicron level of resolution. Abnormal areas with inflammation or
infarction were clearly differentiated from unaffected normal areas. All these phase
contrast X-ray images corresponded to the optical microscopic images.
Conclusion: Phase contrast X-ray microradiography produces images of very
high resolution on a submicron level. So, this technique may have useful applications in medical diagnostics.
C-204
The morphologic corroboration for pulmonary pathophysiology using ultrahigh-resolution CT
H. Ikura1, K. Shimizu2, H. Ebara1, Y. Senba1, I. Shinohara1, T. Mochizuki1,
K. Umetani3, T. Nagareda3; 1Ehime/JP, 2Kanagawa/JP, 3Hyogo/JP
(hikura@m.ehime-u.ac.jp)
Learning Objectives: 1) To illustrate the morphologic changes formed by remodeling in chronic lung diseases using 2-D and 3-D ultra-high-resolution CT
(UHRCT). 2) To correlate the morphologic findings of UHRCT to pathophysiologic mechanism. 3) To understand the morphologic suggestion for pathophysiology
that cause chronic respiratory failure.
Background: Remodeling is induced in the course of many chronic lung diseases and changes the gas kinetics in lung periphery. Therefore, respiratory failure
is caused by remodeling. Some previous studies showed that UHRCT demonstrates alveolar walls clearly and can show the peripheral lung structure in 3-D
with non-invasive imaging.
Procedure Details: The SRCT images were obtained by a SRCT system constructed in SPring-8 (Hyogo, Japan). UHRCT can provide 3-D information of lung
periphery of an inflated and fixed lung specimen that keeps inflation like in vivo.
In pulmonary fibrosis, the gas-exchanging area is definitely decreased due to the
traction dilatation and destruction. In addition, it is assumed that the compliance
of peripheral airway is decreased due to surrounding fibrosis. In perilobular emphysema, UHRCT demonstrates that the peripheral airways and airspaces beyond respiratory bronchioles were dilated and destroyed. It showed peripheral
remodeling of emphysematous change on a microscopic level. The most peripheral terminal bronchioles and first branched respiratory bronchioles were narrower than normal.
Conclusion: The morphologic findings suggested that the peripheral check-valve
mechanism worked in those peripheral airways. We will discuss the relation between morphologic and pathophysiologic changes with 2-D and 3-D imaging provided by UHRCT.
C-205
3 T MR imaging of pulmonary parenchyma: Initial experience
S. Umeoka, T. Koyama, M. Kataoka, K. Tamai, T. Saga, A. Kido, Y. Nakamoto,
K. Togashi; Kyoto/JP (umeoka@k5.dion.ne.jp)
Purpose: To assess the feasibility of high-resolution 3 T MR imaging of the lung
parenchyma with fast spin-echo images in comparison with 1.5 T MR imaging,
and to compare image quality with different echo times (TE).
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Methods and Materials: Study population included eleven normal healthy volunteers (8 males, 3 females, age 23-40). The participants were scanned using
both 1.5-T (Symphony; Siemens) and 3-T MR (Trio; Siemens) scanners. The MR
images were obtained with axial T2-weighted or proton-density weighted images
focusing on the right lower lobe of the lung combined with prospective acquisition
correction. The scan parameters included repetition time of 2000 ms, a slice thickness of 1.6 mm, field of view of 264 mm, and multiple TEs including 8.1, 32,
49 msec (3 T), 11, and 55 msec (1.5 T). Two radiologists independently evaluated the MR images regarding overall image quality, visualization of central and
peripheral pulmonary vessels, and segmental airways. Quantitative analysis was
performed by comparing SNR in the peripheral lung parenchyma with different
TEs.
Results: The overall image quality and visualization for peripheral vessels and
segmental airways were better at 3 T imaging than those at 1.5 T, and better in
shorter TE sequences. Among MR images with a 3 T imager, the SNR was significantly greater with TE of 8.1 msec than that with TE of 32 and 49 msec
(p < 0.01). At 1.5 T imaging, the SNR with shortest TE was also greater than that
with longer TE (p < 0.01).
Conclusion: 3 T MR imaging may improve the image quality of the lung compare
with that in 1.5 T imager. MR images with shorter TE can provide higher SNR.
C-206
Pleuro-pulmonary paragonimiasis: Protean imaging findings and clinicopathological evaluation
Y.-H. Kim, S.-K. Kim, H.-J. Seon, S.-H. Kim, J.-G. Park, H.-K. Kang;
Gwangju/KR (yhkim001@jnu.ac.kr)
Learning Objectives: To illustrate the protean imaging findings with diverse imaging modalities and clinico-pathological manifestations of pleuro-pulmonary
paragonimiasis (PPP).
Background: Paragonimiasis has been re-emerging as a parasitic disease within endemic areas of Southeast Asia. Sometimes it is difficult to differentiate it,
radiologically and clinically, from other pleuroparenchymal diseases including
granulomatous inflammations.
Procedure Details: 59 patients (34 men and 25 women; mean age of 41 years)
with clinico-pathologically confirmed PPP were retrospectively studied. 34 patients (57.6%) had a history of eating raw fresh-water crab. Mild leukocytosis was
noted (mean 10,280; range from 4,500 to 20,300/ml). 52 patients (88%) had peripheral blood eosinophilia. On chest CT there were parenchymal abnormalities
of peripheral consolidation (88.9%), burrow-like subpleural line (69.4%), nodular
opacities with cavities (30.6%), pulmonary nodularity with small satellite nodules
(25%); pleural changes of effusion (77.8%; unilateral 36.1% and bilateral 41.7%),
pleural thickening (22.3%), pneumothorax (41.7%; unilateral 36.1% and bilateral
41.7%). Pleural or subpleural nodules were noted on chest US (n = 2), and nodules with intense FDG uptake, like malignant nodule on PET scan (n = 3).
Conclusion: PPP had protean imaging findings. However it must be considered
in the differential diagnosis of thoracic abnormalities, in the appropriate clinical
history of taking raw fresh-water crab, peripheral blood eosinophilia, peripheral
pulmonary consolidation, or pleural effusions.
C-207
Efficacy of ECG gating for lung CT imaging in evaluating pulmonary nodule:
Fundamental experiment with a newly developed pulsating cardiac
phantom
N. Nitta1, M. Takahashi 1, R. Takazakura1, Y. Nagatani1, K. Murata1, K. Ishimoi2,
M. Kimura2; 1Otsu/JP, 2Kyoto/JP
Purpose: To evaluate the efficacy of ECG-gating in lung imaging and influence
on the volumetric analysis of pulmonary nodules using a newly developed pulsating cardiac phantom.
Methods and Materials: The pulsating cardiac phantom, made by KyotoKagakuCo., Ltd., was used. By using this instrument, a simulated lung with mounted
artificial lung nodules (0-10 HU, were 5.8 and 10 mm in diameter) was scanned
by SensationCardiac (Siemens) at the following equipped modes: ECG-gated
lung imaging mode (L-mode), ECG-gated heart imaging mode (H-mode) and nonECG gated lung imaging mode (C-mode). Images were taken at heart rates of
60, 70, 80 and 90 bpm in L- and C-mode and 70 bpm in C-mode. H-mode images
were reconstructed at 75% (diastolic phase) and 30% (systolic phase) of RR
interval. Two radiologists independently evaluated the visualization of the lung
nodules using a 5 points scoring system. The volumetric analysis of nodules was
also executed in each imaging mode using commercially available post processing software (LungCARE, Siemens).
Results: L- and H-mode did not show a significant improvement of visualization

score for the nodules compared to C-mode. Average scores of L- and H-mode
visualization compared to C-mode visualization were 2.98 0.23, 2.96 0.20 at
5 mm in diameter, 3.12 0.33, 3.20 0.25 at 8 mm diameter, and 3.17 0.35,
3.15 0.24 at 10 mm diameter. The difference in the volume measurement of
nodules between the L- and H-mode was limited within 5% regardless of the
heart rate. At 70 bpm, the difference of the volume among L-, H- and C-mode did
not exceed 5%.
Conclusion: ECG-gating technique probably is not necessary in lung CT imaging, except for the evaluation of nodules close to the heart and large peri-hilar
blood vessels.
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Virtual bronchoscopy using data sets from PET/CT
M.D. Seemann1, J. Schfer2, A. Jovanovic 1, K.-H. Englmeier1; 1Munich/DE,
2
Tuebingen/DE (englmeier@gsf.de)
Purpose: To perform virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT).
Methods and Materials: 10 consecutive patients with primary lung tumors were
examined. Whole-body PET was performed with a glucose analogue ( 18F-FDG)
using a 3D PET scanner of a PET/CT. Whole-body CT was performed with a
venous-dominant contrast-enhanced phase using the 16-slice CT of the PET/CT.
The structures of interest, the tracheobronchial system and pathological changes of the chest were segmented using an interactive threshold interval volumegrowing segmentation algorithm and visualized with a transparent color-coded
surface rendering method. The structures of interest were then superimposed
with the data sets from PET.
Results: Virtual PET/CT-bronchoscopy facilitates the accurate fusion and qualitative and quantitative assessment of the intraluminal airways of the tracheobronchial system and the adjacent extraluminal anatomical and pathological
mediastinal structures using data sets from CT with molecular aspects and metabolic alterations of the disease using data sets from PET.
Conclusion: Hybrid PET/CT imaging is a highly valuable oncological diagnostic
modality for the decades to come, and probably will be very important for use in
cancer screening. Hybrid virtual PET/CT-bronchoscopy uses the advantages and
complementary effects of PET and CT and is expected to improve confidence in
the detection and staging of endotracheal and endobronchial diseases and assessment of tumor stage in comparison to PET and CT alone. It offers a useful
alternative to virtual CT-bronchoscopy and fiberoptic bronchoscopy and is particularly promising for patients in whom fibreoptic bronchoscopy is not feasible, contraindicated or refused.
C-209
Quantitative evaluation of dose reduction on image noise using dual energy
subtraction system
M. Kiguchi, Y. Kitagawa, F. Fujioka, M. Ishifuro, T. Furukawa, J. Horiguchi,
K. Ito; Hiroshima/JP (kiguchi@hiroshima-u.ac.jp)
CT-guided transthoracic needle aspiration biopsy of intrapulmonary

lesions: Utility of thin-prep cytopreparatory techniques
G.-Y. Jin, Y. Lee, Y. Han, G. Chung; Jeon-ju/KR (dr-lys0828@hanmail.net)
Purpose: To prospectively assess the usefulness of the fine-needle aspiration of
intrapulmonary lesions using Thin-Prep cytopreparatory techniques when a cytopathologist was absent at the time of biopsy.
Methods and Materials: Ninety-two patients (59 men and 33 women, aged 2685 years) underwent CT-guided transthoracic needle aspiration biopsy. The fineneedle aspiration specimen was prepared by Thin-Prep cytopreparatory technique
for cytological evaluation. Diagnoses rendered independently on masked slide
from each intrapulmonary lesion were compared with clinical follow-up and the
final histologic diagnoses based on pathologic material from cutting needle biopsy, bronchoscopic biopsy, and surgical excision. On this basis, a definitive diagnosis of benignity or malignancy was analyzed using Fisher's Exact test.
Results: All transthoracic needle aspiration biopsies yielded sufficient cells for
cytological evaluation. There were 36 benign lesions and 56 malignant lesions
(53 primary lung cancers, 3 metastases from other organs). The overall diagnostic accuracy was 91.3% (84 of 92 lesions). The sensitivity, specificity, positive
predictive value, negative predictive value for the diagnosis of the malignancy
were 85.7%, 100%, 100% and 81.8%, respectively.
Conclusion: CT-guided transthoracic needle aspiration biopsy using Thin-Prep
is easy and shows good diagnostic accuracy without a cytopathologist present at
the time of biopsy. In addition, this technique is useful when aspirate has entered
the syringe and is bloody because it produced less air-drying artifact and could
separate cells and blood clot on the needle aspiration biopsy slides.
C-211
Subpleural "button" and pneumothorax incidence during percutaneous CTguided radiofrequency ablation of lung tumor
R. Dore, V. Vespro, S. Rossi, A. Cascina, F. Bosoni, D.M. Savulescu; Pavia/IT
(v.vespro@smatteo.pv.it)
Purpose: Although CT-guided radiofrequency ablation is considered in untreatable lung tumors, this procedure is associated with potential life-threating complication, such as pneumothorax. The aim of this study is to evaluate feasibility and
tolerance of subpleural space expansion during percutaneous radiofrequency
ablation, and its possible role in preventing pneumothorax.
Methods and Materials: Between February 2002 and August 2005 we treated
35 patients with 40 pulmonary lesions, 10 to 50 mm in diameter (mean 22 8 mm),
in 45 radiofrequency ablation procedures. The patients received superficial local
anaesthesia at the site of puncture, and a 22 gauge fine-needle was introduced
in the subpleural space. At this level, injection of lidocaine 2% (5 ml) and saline
solution (10-20 ml) were performed. This manoeuvre expanded the subpleural
space in front of the lesion, reducing the thickness of normal lung parenchyma
that separated the lesion from parietal surface. A CT scan was obtained to confirm the correct development of the subpleural "button", then the procedure continued as usual.
Results: The subpleural "button" was successfully obtained at first attempt without any complication and/or patient discomfort. The incidence of pneumothorax
was 11.9%, with no difference between deep and peripheral lesions. None of the
pneumothoraces necessitated invasive treatment. Other immediate complications
were pleural or phrenic pain (3.5%), hyperthermia (9.5%), bloody expectoration
(4.7%) and pneumonia (9.5%).
Conclusion: Subpleural "button" is feasible and safe during percutaneous pulmonary radiofrequency ablation, and it may reduce the incidence and/or the severity of pneumothorax.
Chest
Learning Objectives: To show maintaining image quality on low-dose two-exposure dual energy subtraction chest radiography.
Background: Little is known about the relationship between dose reduction and
image noise in two-exposure dual energy subtraction radiography with flat panel
detector imaging. Therefore, we investigated the effect of dose reduction on the
image noise using such a system.
Procedure Details: Images were obtained using GE Revolution XR/d with 60 kV
and 130 kV. Four types of relative speed; RS100, 160 and 250 (for a small focus
250 mA) and RS400 (for a large focus 320 mA/500 mA) were set. For a phantom
and normal volunteers, the motion artifact and image noise were compared between the parameters. The relationship between the exposure dose and image
noise was assessed. Motion artefact and noise in the subtraction images were
quantitatively assessed. Noise in subtraction images was analyzed by signal-tonoise ratio, coefficient of variation, and frequency components of noise power
spectrums.
Results: In the lung subtraction images without motion artefact, the image noise
decreased as the dose increased. On the other hand, in the images with motion
artefact, the image noise was slightly but significantly decreased with a low dose
system. The scale values of absorbed doses without and with motion artifacts
were 0.790 mGy (0.54 vs. -0.17), 0.506 mGy (0.08vs0.50), 0.328 mGy (0.08vs0.21) and 0.209 mGy (-0.70vs-0.13), respectively. The significant difference was
accepted.
Conclusion: These results suggest that dose reduction decreased the noise in
the images with motion artifact in dual energy subtraction radiography method
using flat panel detector. This dose reduction technique may be useful in improving the image quality using this method.
C-210
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Computer Applications
C-212
E-learning and medical imaging: A web-based interactive course about
basic principles of magnetic resonance imaging
D. Hoa, G. Gahide, A. Micheau; Montpellier/FR (denis.hoa@gmail.com)
Learning Objectives: To teach radiology residents with a web-based interactive
e-learning module about principles of magnetic resonance imaging. To illustrate
the use of a SCORM compliant advanced HTML website with interactive content
in creating pedagogical programs, structuring activities in learning paths, interacting with students and following their progress.
Background: Information and communication technologies (ICT) act as a catalyst for innovation in learning, giving access to relevant, contextualised, high quality
content. Teaching medical imaging can take advantage of interactivity. For example, simulations can help in understanding complex mechanisms. Learning management systems allow wide diffusion of structured courses and follow-up of test
results.
Procedure Details: We developed an interactive web-based radiological teaching module on magnetic resonance imaging basic principles, with free access at:
http://www.e-MRI.com/. The site contains text, interactive diagrams, feedback
areas, video, a flash slideshow, simulations, interactive images frame and self
test with automated feedback. For example, the student will be able to interact
with a diagram by changing MR parameters (TR, TE, TI, flip angle) of a basic MR
sequence (Spin-Echo, Gradient) with automatic MR image feedback. All parts of
the program include information links with textbooks and examples. The e-learning management system is based on HTML documents and advanced flash content, compliant with SCORM standard.
Conclusion: Based on high quality, structured, interactive content, e-MRI.com
demonstrates the potential of the latest advances in e-learning and pedagogy,
applied to teaching of medical imaging.
C-213
Russian teleradiology server: Creating a national teleradiology network
O.S. Pianykh1, V. Sinitsyn1, D. Ustyuzhanin1, M. Miltchenko2, S. Ternovoy1;
1
Moscow/RU, 2Baton Rouge, LA/US (opiany@gmail.com)
Purpose: Regional and national PACS networks should expand the limited departmental PACS, allowing physicians to share their expertise, and improving the
quality of radiology. We implemented a national Russian teleradiology server,
which is already used by several leading national hospitals and physicians.
Methods and Materials: It is essential to design a global teleradiology network
as a robust and secure extension to the traditional PACS. Therefore DICOM standard was used as the main imaging and networking engine, which permitted seamless integration into different PACS and imaging devices. Web extensions to
DICOM have been developed, to encapsulate DICOM transactions in XML format for browser-based image viewing. Advanced image compression has become an essential tool for dealing with unpredictable network bandwidths and
"last mile" problems. System security was implemented with state of the art encryption and digital signature algorithms.
Results: Russian Teleradiology Server was successfully launched in late 2004.
In December 2004 it was used at RSNA 2004 exhibit (Chicago, US) to read patient images from the Cardiology Research Center in Moscow, Russia. The patient studies were reviewed real-time, soon after they were produced, in the original
DICOM format. Currently, the server is successfully used to integrate several
Russian hospitals, as well as for individual physicians.
Conclusion: The development of the Russian Teleradiology Server proved the
concept of a nationwide clinical network, and substantially facilitated many radiology projects. The server is available at http://www.tomography.ru/teleradiology,
and its international version at www.iTelerad.com. If you are interested in teleradiology projects, please contact us at opiany@gmail.com.
C-214
www.PedRad.info: An interactive, open-source, multilingual, inter- and
intradisciplinary publication and communication platform in the internet
R. Talanow1, W. Hirsch2, M. Paetzel1; 1Cleveland, OH/US, 2Leipzig/DE
(pedrad@talanow.info)
Learning Objectives: To create an open-source case-oriented publication platform in the internet with an easy-to-use case submission system, which publishes peer reviewed radiology cases, exchanges radiological knowledge in an open
discussion, and is available free of charge, everywhere and at all times for laypersons, students and professionals, multilingual for a world wide audience.
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Background: In the internet, there are only a few pediatric radiology platforms,
which are either not available for free or at all times, don't allow exchange of
radiological knowledge in an open discussion, or which don't own their own databases.
Procedure Details: We created PedRad.info as an open-source, case-oriented
publication platform. PedRad.info makes it possible to publish validated, peerreviewed pediatric radiology findings over the internet. This project is freely available, and offers an easy-to-use fast case submission system. The cases are
integrated in this project and are presented in different modes for teaching purposes. The platform and cases are available in a multilingual format for a broader,
world-wide audience. This project allows exchange of radiological knowledge in
an open discussion for laypersons and professionals.
Conclusion: A comparable online program, even for adult radiology, does not
exist as of yet. An extension to other radiological subspecialties is possible. Therefore, we present an online tool to the radiological community, which may be seen
as a pioneer in the area of the web-based IT for various radiological sub-specialties.
C-215
A "one-button solution" to the task of reporting digital radiographs,
integrating RIS and PACS
K.W. Hausegger1, F. Sulzer1, B. Streitmayer1, G. Ztsch 2, A. Lukas3;
1
Kapfenberg/AT, 2Graz/AT, 3Mrzzuschlag/AT (hausegger@radiolog.at)
Learning Objectives: To demonstrate the advantages of integrating RIS and
PACS into the radiologist's workflow when issuing reports; to consider all the
necessary steps in this workflow, and to present our solution in the context of a
busy private practice.
Background: PACS is widely used to report CT and MR scans, but the digital
reporting of radiographs is not as well accepted due to the multiple interactions
often needed on the workstations. Instead of concentrating on the findings on the
radiographs, which have been prepared on a lightbox by a technician, the radiologist has to perform multiple actions by himself on the computer, thus losing a lot
of time. This exhibit demonstrates a solution we created to automate all the necessary steps by integrating RIS and PACS.
Procedure Details: The purpose of integrating RIS and PACS is to minimize the
radiologists actions during reporting. A "one button solution" opens the patient's
file in RIS and PACS, including old exams for comparison, and activates the dictation system. At the end of the reporting session, another press of the button
starts the next process, such as text processing by the computer or by the secretary. Then, after proof reading, the text is digitally signed by the radiologist. This
leads to the automatic distribution of pictures and reports to the referring physicians and the archiving of the pictures.
Conclusion: Our "one-button solution", integrating RIS and PACS, produces the
best results and achieves the optimal workflow in radiographical reporting, as we
show.
C-216
The e-ERM system for e-learning in medical radiation physics
M. Stoeva1, S. Tabakov2, K. Velkova1, A. Cvetkov1, A. Litchev1; 1Plovdiv/BG,
2
London/UK (ms_stoeva@yahoo.com)
Learning Objectives: Distance learning has made good progress during recent
years, especially in the field of medical physics where some of the most successful projects have been implemented. The objective of this paper is to present the
e-ERM e-learning system, which is an integrated online solution for remote MSc
education in medical radiation physics.
Background: The e-ERM e-learning system has been developed as a part of the
educational process in the Inter-University Medical Physics Centre, Plovdiv, Bulgaria, under the EU Project TEMPUS S-JEP 09826 - a consortium of six universities: King's College London (UK), University of Florence (I), University of Dublin
(IR), University of Plovdiv (BG), Medical University, Plovdiv (BG) and Technical
University, Plovdiv (BG). The teaching materials cover 12 modules. The e-learning system is a server-based application available through a dedicated website
www.emerald2.net/eERM.
Procedure Details: The system is a virtual model of the educational process in
the Inter-University Medical Physics Centre, Plovdiv, Bulgaria. e-ERM has three
different access levels - trainee, professor and administrator, each of them providing specific priority, functionality, resource access and management. The system is based on a standard MS Windows platform and uses MS IE 5.0+ and
Acrobat Reader 4.0+ as the client side working environment. No additional software or hardware resources are required in order to access and/or maintain the
system.

Conclusion: The dedicated teaching materials, the minimum server requirements
and the standard client side environment turn the system into a good, cost-effective and easy to support solution for remote education in medical radiation physics.
C-217
Does the use of a voice recognition dictation system linked to electronic
report distribution significantly speed up the process of X-ray reporting?
S.J. Howling, F. Peters, D. Murray, D. Grant, C.A. Allum; London/UK
(drfran@doctors.org.uk)
Purpose: To assess the impact of installing a 'voice recognition' digital dictation
package linked to a new electronic distribution system (Soliton-e), on the speed
of X-ray reports reaching general practitioners (GPs) from a London hospital.
Methods and Materials: 400 GP patient X-ray reports were retrospectively selected at random from the radiology information system. Group A: 200 which had
been reported by consultants using the old dictation system, linked to secretarial
typing and the postal service. Group B: 200 were reported by consultants experienced in using a voice recognition system (Soliton-e), which enables reports to
appear on screen at dictation with immediate authorisation and electronic distribution. Data relating to the time interval from X-ray acquisition to distribution of
authorised report to the GP was collected.
Results: Each group of 200 reports contained the same number of films performed each day, to ensure no 'Friday bias'. The mean (range) time from X-ray
acquisition to report distribution using Soliton-e was 4.5 (1-72) hours compared
to 204 (24-696) hours for the conventional system. Subgroup analysis revealed
no significant difference in the time taken for the radiology consultants to dictate
and authorise individual reports.
Conclusion: Use of a voice recognition dictation system linked to electronic distribution of results effects a significant reduction in time taken for radiological
reports to reach the referring GP. This increases clinician satisfaction and is likely
to have a beneficial impact on patient management.
C-218
Stereoscopic abdominal 3D-CT angiography of the collateral vessels as an
efficient tool for medical education
T. Yamagishi1, K.H. Hhne2, K. Abe1; 1Tokyo/JP, 2Hamburg/DE
(yamagishi@uke.uni-hamburg.de)
C-219
Functional CT imaging with assessment of tumor-induced angiogenesis:
The full-solution of Patlak two-compartmental modelling using a computerdiscretization approach
T. Ueda1, H. Suito2, M. Minami1; 1Tsukuba/JP, 2Okayama/JP
(takueda-rad@umin.ac.jp)
C-220
Detection of pulmonary nodules with CT: Comparison of axial images, axial
maximum intensity projection (MIP) images and a computer aided detection
(CAD) system
P. Kersemans, J. Verschakelen, W. De Wever; Leuven/BE
(walter.dewever@uz.kuleuven.ac.be)
Purpose: To compare 3 different methods for detection of lung nodules with lowdose multidetector spiral CT.
Methods and Materials: Fifty consecutive patients undergoing a low-dose 16row multislice CT scan were included. Axial CT images of 1 and 5 mm and axial
5 mm MIP images were evaluated for pulmonary nodules. These nodules were
compared with those detected with an automatic CAD system (Siemens). The
volume of the nodules was calculated using the Siemens "Lungcare" program,
and were divided into three categories (cat).: cat. I < 10 mm3 or calcified nodules,
cat. II 10 <> 50 mm3 and cat. III > 50 mm3. Two experienced chest radiologists
decided for each detection method by consensus which nodules were true positives.
Results: Evaluation of axial and MIP images resulted in detection of 155 and 168
lung nodules respectively. CAD detected 486 nodules of which 152 were categorized as true nodules. Axial CT scans detected 30 cat. I nodules not seen with
MIP or CAD while 13 cat. I nodules were seen which were also detected with
CAD but not with MIP. Twenty two nodules (5 cat. I, 15 cat. II, 2 cat. III) were only
seen on MIP images; 36 (28 cat. I, 7 cat. II, 1 cat. III) were seen on MIP images
and detected with CAD too. CAD detected 41 cat. I nodules not seen with the
other two methods.
Conclusion: Axial MIP images should always be included when CT scans are
evaluated for the presence of lung nodules. The tested CAD system detected
many nodules but showed a lot of false positive lesions and missed an important
amount of the nodules detected on the axial and MIP images.
C-221
Impact of JPEG 2000 part 2 multi-component transformation of volumetric
medical data and DICOM supplement 105
A. Tzannes, L. Weisfeiler, M. Serafino; Bedford, MA/US (serafino@aware.com)
Purpose: To investigate the impact of JPEG 2000 part 2, multi-component transformation (MCT) and DICOM supplement 105 on the compression, quality, and
transmission of volumetric medical imagery for teleradiology purposes.
Methods and Materials: A volumetric 3-D data set of 429 CT images were compressed, both lossy and losslessly, using JPEG 2000 parts 1 (independent 2-D
image compression) and MCT to take advantage of inter-image correlation. Comparisons confirmed positive results of using multi-component transformation for
increased compression ratio as well as higher overall quality.
Results: For losslessly compressed images, using multi-component transformation achieved compression ratios that were 15-18% higher than independent image compression. Using lossy compression with MCT increased the average
quality, in pSNR, by 5-18 dB, translating to an increase in the compression ratio
by a factor of 2 to 3 for a given pSNR value.
Conclusion: By applying JPEG 2000 Part 2, MCT, to take advantage of interimage correlation inherent in volumetric data, images can be more highly compressed without loss, or lossy compressed with much higher resultant quality
and compression of images. This results in less storage, faster transmission, and
less wait-time for radiologists and physicians when viewing complex 3-D imagery
over constrained networks and the web.
Purpose: To establish a method for analyzing functional computed tomography

(CT) imaging with a view to assessing tumor-induced angiogenesis.
369
tions
Computer Applica
Applications
Purpose: It is often difficult for medical students and residents to understand

three-dimensional (3D) anatomy of the collateral vessels. Recently isotropic voxel data acquisitions with short breath-holding, even on the entire abdominal section, have been realized by multi-detector CT. This paper shows an efficient
educational tool for understanding the abdominal vascular system by a combination of high-resolution clinical data and stereoscopic viewing.
Methods and Materials: Clinical image data of 20 patients with portal hypertension and collateral vessels were obtained. A "General Electric Light Speed Ultra
8" scanner was used. Data sets were imported into the VOXEL-MAN program,
developed at the Institute of Medical Informatics, University Hospital Eppendorf,
Hamburg, Germany. Stereoscopic surface-rendered images were created from
the segmented volume data. The panoramic sequential 3D-stereoscopic images
of the collateral vessels were evaluated for their educational benefits by questionnaire surveys, which was done by 54 medical students and 20 residents.
Results: Ninety-eight percent of the students and all residents evaluated the
resultant images as excellent for medical education. The most advantageous
benefit of the sequential stereoscopic images was a continuous observation of
the vascular structures of interest. Most observers pointed out that which structure is in front, or which is in the rear, can easily be grasped by stereoscopic
viewing.
Conclusion: The presented method yielded an exact anatomical understanding
of the collateral vessels such as spleno-renal shunt, gastro-renal shunt and so
on. Using the clinical data gave an impact on medical trainees, and an improved
educational outcome could be achieved.
Methods and Materials: Functional CT imaging was performed for 15 renal cell
carcinomas with a multidetector-row CT. Functional CT imaging was analyzed by
means of the full solution of Patlak two-compartmental modelling with bidirectional exchange of contrast medium incorporated into the model using the computational discretization approach. The correlations between microvessel density
(MVD) and vascular endothelial growth factor (VEGF), and functional CT parameters (rbv, Pm1, Pm2) were statistically analyzed.
Results: Modelling was successfully performed, showing similarity between the
measured time-density curve and the mathematically simulated solution curve.
There were significant correlations between MVD and Pm1 (p = 0.01), and between VEGF and Pm2 (0.035).
Conclusion: Functional CT imaging by means of the full solution of Patlak twocompartmental modelling may be a useful tool toward the assessment of tumorinduced angiogenesis.

C-222
Automated detection of lung nodules in multidetector CT: Influence of
different reconstruction protocols on performance of a software prototype
J. Gurung, A. Maataoui, F. Khan, M. Harth, M. Shiemann, V. Jacobi, T.J. Vogl;
Frankfurt a. Main/DE (neesej76@hotmail.com)
Purpose: To evaluate the accuracy of software for computer-aided-detection
(CAD) of lung nodules using different reconstruction protocols in multidetector
CT.
Methods and Materials: Image data of 15 patients who had undergone 16-rowmulti-detector CT (MDCT) for known pulmonary nodules were reconstructed at
5.0, 2.0 and 1.0 mm thickness, with 1.5, 1.0 and 0.5 mm reconstruction increments respectively. The "Nodule-Enhanced-Viewing" (NEV) tool for computeraided detection of lung-nodules was applied to reconstructed images.
Reconstructed images were also evaluated by radiologists (A and B) after being
blinded. Data from radiologists and CAD were matched against an independent
reference standard established using the consensus of 2 independent experienced chest radiologists. Eligible nodules were grouped according to size (diameter > 10, 5-10, < 5 mm). Statistical analysis was performed using "receiver
operating characteristic" (ROC) curve analysis.
Results: Performance of CAD was lower than readers at 5.0 mm reconstruction
thickness (AUC=0.522, 0.517 and 0.497 for A, B and CAD, respectively). At 2.0 mm
slices, performance of CAD was better than readers (AUC=0.524, 0.524 and 0.614
for A, B and CAD, respectively). CAD was significantly superior to radiologists at
1.0 mm slices (AUC=0.537, 0.531 and 0.675 for A, B and CAD, respectively).
Sensitivity at 1.0 mm thickness was 66.99%(A), 68.93%(B) and 80.58%(CAD).
Time required for detection was shortest for CAD at 1.0 mm slices (mean t = 4 min).
Performance of radiologists was greatly enhanced using CAD: Sensitivity 91.26%
and 94.17% for CAD+A and CAD+B, respectively (AUC=0.889 and 0.917). CAD
was most advantageous in detection of nodules < 10 mm.
Conclusion: High sensitivity and ability of CAD to detect nodules < 10 mm at
1.0 mm thickness in a short time makes it a good candidate as second reader.
tool in detection of pulmonary nodules. The efficacy is very high by using it together with the radiologist. The problem that has to be solved is high false positive rates.
C-225
Integration of advanced three-dimensional visualization into a standard
PACS workstation
P.M.A. van Ooijen, M. Oudkerk; Groningen/NL (p.m.a.van.ooyen@rad.umcg.nl)
Learning Objectives: 1. To make advanced three-dimensional visualization at
the radiologists desktop feasible. 2. To obtain an optimal workstation with integration of multiple components. 3. To convince vendors to set up a multi-vendor workstation with interconnection of different software components.
Background: With increasing resolution of CT and MR acquisition, data production and post-processing have expanded dramatically. Commonly, advanced postprocessing is available only on high-end, high priced, 3D workstations, although
reporting of the radiological images is performed on separate diagnostic workstations. In our institution, advanced post-processing tools are integrated into all
thirty diagnostic workstations. A small amount of stand-alone 3D workstations
are also available for educational and scientific purposes and for comprehensive
editing and evaluation.
Procedure Details: The advanced post-processing at our workstations is a commercially available, web-based, 3D visualization package fully integrated with
the standard PACS viewer of our PACS vendor. A series is selected in the standard PACS viewer and by pushing one button, the data are requested from the
PACS by the 3D server. Within a very short time, the default rendering and MPR
are displayed. Use increases, with a current average number of jobs per week of
1150.
Conclusion: The integration of interactive post-processing into the normal radiological workstation allows for the easy use of techniques such as multi planar
reformation and 3D volume rendering during reporting. The proposed solution
simplifies this and is therefore easily accepted and used by our radiologists.
C-223
C-226
3D JPEG 2000 compression of volumetric MDCT images: PACS archiving

and teleradiology advantages
D. Gardeur, H. Baekeland, S. Moulinet; Paris/FR (plantwild@wanadoo.fr)
Teach (www.learn-radiology.com/teach/): An internet based, user tailored

and free of charge teaching file server for creating interactive radiological
teaching files
R. Talanow; Cleveland, OH/US (teach@talanow.info)
Purpose: Isotropic series with hundreds of millimetric images are routinely performed on MDCT. The data information volume is so high that these series are
usually not archived on PACS nor sent in teleradiology. 3D JPEG 2000 uses the
similarities of adjacent thin images to increase the compression ratio. We compared 3D JPEG 2000 and 2D JPEG 2000 wavelet compression ratios for images'
similar qualities.
Methods and Materials: 100 patients with isotropic MDCT series were evaluated with 3D JPEG 2000 and 2D JPEG 2000 wavelet compressions. The image
qualities of axial, MPR, and MPVR reformations are compared at different compression ratios.
Results: For lossy compression, 3D JPEG 2000 increases the compression ratio 2 to 3 times up to 50:1. For lossless compression, 3D JPEG 2000 allows a
compression ratio 15% to 20% higher than 2D compression.
Conclusion: 3D JPEG 2000 is well adapted to the challenge of volume MDCT
with hundreds of millimetric images. It is now possible to adequately archive isotropic series on PACS. Teleradiology with volume analysis from isotropic MDCT
and 3D JPEG 2000 is feasible.
C-224
A meta-analysis of the literature about pulmonary nodules computer-aideddetection in CT
L. Saba, G. Caddeo, G. Mallarini; Cagliari/IT (lsaba@sirm.org)
Purpose: The purpose of this study was to evaluate the role and the diagnostic
efficacy of the pulmonary nodules computer-aided-detection (CAD) in CT. We
made a meta-analysis in the literature, and we observed CAD sensitivity and
efficacy. We evaluated if CAD plus radiologist determines a real efficacy in detection of pulmonary nodules.
Methods and Materials: We used as data sources the medical literature database of PubMed, Medline, and Cochrane, where we looked for articles published
in English language from January 2001 to September 2005.
Results: 14 studies met the inclusion criteria and contained a total of over 500
patients and 1500 pulmonary nodules studied by CAD. We observed an overall
sensitivity of 80.25% for the CAD and of 92.1% for CAD plus radiologist.
Conclusion: Results of our study suggest that CAD technique is an accurate
370
Learning Objectives: To develop a program for creating and changing interactive teaching files in realtime, available anytime and anywhere, free of charge,
user tailored, easy to use, with no programming skills and no additional program
file download needed. To be used in different modes by individuals and institutions to share cases from multiple users in a single database.
Background: At this time there is no program available which creates interactive
teaching files in realtime, is user tailored, accessible from every computer worldwide and free of charge.
Procedure Details: We developed the online program "Teach", which allows creation of interactive teaching files for presentations and teaching purposes. It is
made available over the internet and accessible worldwide from every computer
with an internet connection. We made this program easily usable, even for authors who are not experienced computer users. The special effects for enhancing
the learning experience, as well as the linking and the source code are created
automatically by the program. The created website is immediately available worldwide over the internet. The author can change the teaching files at any time and
the changes will be done on-the-fly. There is no need for a file transfer after each
change. The program can be tailored for the individual author's needs.
Conclusion: "Teach" is an easy to use automatic teaching file program which
may be used by well or less experienced users, in different modes, and by individuals or institutions.
C-227
Virtual dissection of whole body using isotropic data from 64 slice MDCT
Y. Kobayashi1, M. Funakubo1, Y. Ogawa1, K. Yagihashi1, T. Morimoto1,
Y. Kurihara1, O. Tanaka2, Y. Nakajima1; 1Kawasaki, Kanagawa/JP, 2Saitama/JP
(yasukoba@marianna-u.ac.jp)
Learning Objectives: 1) To understand the complex 3D structure of the body by
virtual dissection based on isotropic data using 64-slice MDCT. 2) To realise the
efficacy of virtual dissection of the body.
Background: 64-slice MDCT is a volume scanner that can acquire the isotropic
volume data of the whole body within only 10-20 seconds. The purpose is to
show the potency of virtual dissection using MPR/3D/4D images, reconstructed

from isotropic volume data, ranging from the head to the lower extremities, taking
advantage of the state-of-the-art workstation.
Imaging Findings: Virtual dissection provides many advantages such as repeatability and easy understanding of human body structures. It enables us to understand anatomical diversity including anomalous and chronological changes, as
well as the motion of internal organs such as respiration and heartbeat. Virtual
dissection appears useful for the comprehensive understanding of human body
structures and the confirmation of anatomical knowledge, and as a complementary tool for conventional anatomical lectures.
Conclusion: Virtual dissection is a very effective tool for medical students and
radiology residents to master human anatomy.
Procedure Details: The fundamentals of network protection through firewalls,

data encryption and authentication for image transmission are described. General strategies of network security architecture are shown through a visual-based
approach. This review will show how complexity, protection strategies, management and access modalities of network and software affect security.
Conclusion: The keys to understanding the security criteria of radiological devices and networks are provided.
C-228
Development of an automatic determination system for the amount of
contrast medium injection
K. Tsujioka, Y. Uebayashi, S. Enomoto, Y. Okubo, T. Takaki, M. Anzui;
Toyoake-city Aichi/JP (tsujioka@fujita-hu.ac.jp)
Purpose: The image contrast shown by the contrast medium in the CT is determined by the size of the subject in the image. We have developed an automatic
determination system for the amount of contrast medium injection.
Methods and Materials: We obtained an X-ray absorption value for a target cross
section using a plane CT image. By applying the resultant value to the standard
curve, we found how much contrast medium injection was necessary to obtain
the CT value we required.
Results: We discovered that using the value of a subject's X-ray absorption in
the image allowed us to anticipate the amount of contrast medium we required
before actually injecting it.
Conclusion: The automatic determination system of the amount of contrast medium injection that we propose here is useful in preventing the administration of
too much contrast medium to patients.
C-229
Towards standardization of "cross-enterprise document sharing for medical
imaging" (XDS-I) workflow
E. Avraham; Plano, TX/US (eli@kodak.com)
tions
Computer Applica
Applications
Learning Objectives: To demonstrate limitations in sharing health imaging information in regional health information organizations (RHIO's). To present the new
IHE based standards for "cross-enterprise sharing medical imaging information"
(XDS-I) workflow. To demonstrate XDS-I use cases for sharing medical images,
diagnostics reports and evidence documents in EMR/EHR. To extend XDS-I workflow and add support for cardiology documents.
Background: The patient health record (PHR) is composed from various information types: Imaging data, structure reports, lab results, pharmacy, continuity
care record and CDA documents using different standards (DICOM, HL7 and
ASTM). Patient imaging information is managed by the imaging systems: PACS
and RIS, which are located in the hospital departments (radiology, cardiology,
surgery, etc). The PHR for the same patient might be distributed across multiple
information systems and medical centers. This variety of the PHR, using different
formats, standards, and being located on multiple systems and imaging centers,
means we need to define an interoperable workflow for archiving, sharing, locating and accessing imaging documents on RHIO's.
Procedure Details: This educational exhibit includes but isn't limited to: 1) Demonstrating current limitations on sharing imaging information on RHIO's. 2) Presenting the new IHE XDS-I workflow. 3) Demonstrating use cases for sharing
imaging information in the EMR/EHR. 4) Extending XDS-I workflow for sharing
specific cardiology documents (ECG).
Conclusion: XDS-I workflow is a foundation in the EHR for integrating imaging
health data and PHR in RHIO's. The improvement in imaging information sharing
improves patient health practices generally.
C-230
Security of radiological networks and transmission devices
G. Luccichenti1, N. Ngo Dinh1, F. Cademartiri2, G. Evangelisti1, U. Sabatini1,
S. Bastianello3; 1Rome/IT, 2Rotterdam/NL, 3Pavia/IT (g.luccichenti@email.it)
Learning Objectives: 1) To understand the fundamentals of network security. 2)
To identify which are the security requirements of PACS and teleradiology systems. 3) To define simple criteria to assess a network security level.
Background: In this last decade, the development of networking systems improved dramatically the radiological workflow. On the other hand, the accessibility to patients data and images put at risk confidential information.
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Contrast Media
C-231
An experimental study on differentiation of hyperplastic from metastatic
lymph nodes using a lymph node specific MR contrast agent Gadofluorine M
J. Cha, W. Moon; Seoul/KR (jhcha@radiol.snu.ac.kr)
Purpose: To evaluate the capability of interstitial MR lymphography using Gadofluorine M for the differentiation of hyperplastic and metastatic lymph nodes in
rabbits.
Methods and Materials: This study included 24 rabbits. In 9 animals, hyperplasia of lymph node was induced by injection of egg yolk or feces of rat in the calf
muscles. In 15, metastasis of lymph node was induced by implantation of VX2
tumor. We performed T1-, T2-weighted and dynamic SPGR imaging (before, 15,
30, 60 and 90 minutes after injection). Gadofluorine M (5 mol/ml, total amount
4 ml) was injected subcutaneously into the dorsal foot pad. The number, size and
location of popliteal and iliac lymph nodes was evaluated. Three readers assessed
the state of lymph nodes as hyperplastic or metastatic according to the pattern of
enhancement. We also compared the imaging results with histopathological findings.
Results: Histopathologic evaluation of 117 lymph nodes revealed 28 metastatic
nodes. Out of 102 lymph nodes larger than 5 mm size, MR enabled detection of
101 lymph nodes (99.1%). The sensitivity, specificity, positive and negative predictive values in the diagnosis of lymph node metastasis were 97.6% (82/84),
98.2% (215/219), 95.3% (82/86), and 99.1% (215/217) (p < 0.05).
Conclusion: Interstitial MR lymphography using Gadofluorine M showed excellent results in differentiating hyperplastic from metastatic lymph nodes.
C-232
Microbubble contrast agents in ultrasound: Diagnostic usefulness in
depicting non-hepatic disease
R.A. Fernando, M. Shah, M.E.K. Sellars, P.S. Sidhu; London/UK
(rashika.fernando@kingsch.nhs.uk)
Learning Objectives: 1. To establish the usefulness of microbubble ultrasound
contrast media outside applications in the liver. 2. To understand and interpret
findings in a number of disease processes in order to establish a diagnosis without the need for further imaging.
Background: Ultrasound is the most commonly used abdominal imaging modality. Grey scale ultrasound has limitations in the detection and characterization of
liver lesions, and the findings are often non-specific. Microbubble contrast agents
and technical developments have improved visualisation and characterization of
focal liver lesions and is now well established. However the role of microbubble
contrast outwith the liver is less appreciated. There is a role for microbubble contrast in the evaluation of other abdominal organs with an increase in operator
confidence.
Imaging Findings: The aim of this pictorial review is to describe the findings of
microbubble contrast ultrasound in the depiction of renal disease, gallbladder,
bladder, splenic and pancreatic abnormalities. The utility of microbubble contrast
in depicting renal infarction, complex cystic change and normal variants (column
of Bertin) is demonstrated. The depiction of gallbladder disease (e.g. wall inflammatory change, debris vs. tumour) is also demonstrated. Within the spleen, focal
tumours, infarction, trauma and abscesses are clearly demonstrated to aid the
diagnostic process. The abnormal vascularity in pancreatic tumours is also well
seen.
Conclusion: The role of microbubble contrast outside the focal liver lesion is
clearly useful and should encourage the operator to resort to microbubble contrast before requesting further imaging with CT or MR.
C-233
A comparison of the cytotoxic effects of an iodinated radiographic contrast
medium with gadolinium-based MRI contrast agents on renal tubular cells
in vitro at doses used for angiography
M. Heinrich1, S. Kohlbacher1, M.K. Kuhlmann1, M. Scheer1, A. Grgic1,
M. Heckmann1, M. Uder2; 1Homburg a.d. Saar/DE, 2Erlangen/DE
(ramhei@uniklinik-saarland.de)
Purpose: To compare cytotoxic effects of an iodinated radiographic contrast
medium (RCM) with different gadolinium chelates at doses used for angiography
on renal tubular cell cultures.
Methods and Materials: LLC-PK1-cells were incubated with iomeprol, gadopentetate dimeglumine, gadobenate dimeglumine, gadoterate meglumine, gado-
372
diamide and corresponding mannitol-solutions at equi-attenuating and equimolar concentrations. Cytotoxicity was assessed with MTT assay, trypan-blue test
and an assay to detect apoptosis and necrosis. Data were analysed by analyses
of variance followed by post-hoc tests.
Results: At equi-attenuating concentrations, iomeprol-300 and iomeprol-150 (10274% and 100-74%, at 2.34-18.75 mg I/ml) induced a significantly smaller inhibition of MTT conversion than the gadolinium-based agents (p < 0.001 above
2.34 mg I/ml; 80-48%, 87-50%, 95-60% and 92- 56% for gadopentetate, gadobenate, gadoterate and gadodiamide at 15.63-125 mM).
At equimolar concentrations, gadopentetate and gadobenate induced a stronger
inhibition of MTT conversion than gadoterate, gadodiamide and iomeprol (63%
and 64% vs. 71%, 70% and 69% at 62.5 mM, p < 0.001). There were significantly
more dead cells after incubation with gadopentetate than after incubation with
iomeprol, as assessed by the trypan blue test (57% vs. 19% at 125 mM, p < 0.001).
Gadopentetate and gadobenate induced significantly more necrosis and apoptosis than gadoterate, gadodiamide and iomeprol (p < 0.001; difference to control
for necrosis: +124%, +95%, +17%, -6% and +3%; for apoptosis: +34%, +35%,
+13%, +4% and +5% at 125 mM).
Conclusion: Gadolinium chelates induce significantly stronger cell injury than
an iodinated RCM, at doses providing the same X-ray attenuation. Gadopentetate and gadobenate induce more pronounced cell injury than gadoterate and
gadodiamide.
C-234
Detection of tissue vascularity with contrast enhanced ultrasound in
lesions located out of solid abdominal viscera
S.D. Yarmenitis, A. Bakantaki, N. Skoulikaris, T.G. Maris, N. Gourtsoyiannis;
Iraklion, Crete/GR (sdy@med.uoc.gr)
Learning Objectives: To present clinical cases in which contrast enhanced ultrasound (CEUS) detected the presence of vascular patterns in several pathologies at various anatomical sites other than solid abdominal viscera. To emphasize
its usefulness in refining diagnostic criteria and/or tailor-up further decisions.
Background: CEUS is now a well-established sonographic technique that can
detect and characterize focal lesions in the liver parenchyma. Furthermore, second-generation contrast agents and very sensitive contrast detection protocols
can illustrate the presence of macro or microvasculature in any sonographically
accessible area. The detection of ultrasound contrast material denotes the existence of vascular structures and this is achieved due to the fact that these agents
are blood-pool agents exclusively.
Imaging Findings: Over a period of a year 80 patients have been examined
sonographically and 120 lesions were detected. They were lesions of the: chest
or abdominal wall (including pleural, lung or peritoneal masses in contact with
the walls) (n = 75), gall-bladder (n = 15), renal pelvis (n = 8), ureters (n = 2), urinary bladder (n = 10), neck (n = 2) and limbs (n = 8). CEUS was done with SF6
(SonoVue, Bracco) and CadenceCPS protocol on a Sequoia512 (Acuson, Siemens) machine. It was feasible to discriminate tumors from granulomas, clots,
biliary sludge. It was possible to locate the live tumor parts for needle biopsy
procedure. The detection of postoperative vascular leaks was also achievable.
Conclusion: CEUS is a convenient and sensitive procedure to depict the presence, extent and pattern of vascular structures in several pathologies throughout
the body. In several cases has been proved decisive to put the diagnosis or to
modify further actions effectively.
C-235
General considerations for optimizing contrast-enhanced multidetector CT
imaging technique
K.T. Bae; St. Louis, MO/US (baet@mir.wustl.edu)
Learning Objectives: 1. To review the basic principles of image resolution and
factors affecting radiation dose during contrast-enhanced MDCT. 2. To describe
how patient variables like weight and cardiac output affect the timing and degree
of contrast-enhancement. 3. To explore contrast-injection and scanning variables
that affect contrast enhancement.
Background: With the advent of faster 16- and 64-row MDCT scanners there is
an urgent need to develop optimized protocols to obtain the best results from
iodinated contrast media (CM). The goal in optimizing contrast delivery is to achieve
the greatest enhancement with the lowest required volume of contrast material.
Many factors influence contrast enhancement that are related to the patient, the
scan, and the injection parameters.
Imaging Findings: This exhibit reviews general considerations and principles for
improving contrast-enhanced MDCT images, and provides numerous mathematical models of hepatic and arterial enhancement for illustration.

Conclusion: There is no single approach to contrast delivery that is effective for
all uses and indications. Therefore CT scanning protocols, overall, need modification and optimizing before they may be applied to the latest, fastest MDCT
scanners.
C-236
Magnetic nanoparticles as novel tools for magnetic targeting in
combination with hyperthermia: An in vitro study on breast tumor cells
M. Kettering1, J. Winter1, M. Zeisberger1, C. Alexiou2, I. Hilger1, W. Kaiser1;
1
Jena/DE, 2Erlangen/DE (melanie.kettering@med.uni-jena.de)
Purpose: The therapeutic properties of magnetic nanoparticles (MNP) offer wide
minimal-invasive application profiles. Therefore, we assessed if additive therapeutic effects could be obtained when tumor cells are selectively loaded using
drug-labelled MNP piloted by an external magnetic field (magnetic targeting) and
subsequently exposed to an alternating magnetic field (magnetic hyperthermia)
for cell destruction due to heating.
Methods and Materials: Human adenocarcinoma cells (BT-474) were incubated
with Cisplatin-labelled and -unlabelled MNP while exposed to an external magnetic field (56 mT and 83 mT; controls: cells without magnetic targeting). The
combination effects of both magnetic targeting and hyperthermia were assessed
by the determination of the specific absorption rate (frequency, 400 kHz; amplitude, 24.6 kA/m) and temperature increase. The amount of iron and cisplatin was
determined by atomic absorption spectrometry.
Results: An increased MNP cell uptake due to magnetic targeting (e.g. 1.17 and
1.97 mg iron per 5 x 107 cells) could be observed as compared to controls (e.g.
0.65 mg iron per 5 x 107 cells), showing a selective MNP accumulation. For this
reason an increased temperature during magnetic heating of targeted tumor cells
was observed, for example, a temperature raise of 6.2 and 14.8 K after magnetic
targeting compared to 4.2 K in non targeted cells.
Conclusion: An additive, cytotoxic effect on tumor cells in vitro was observed
due to the combination of magnetic hyperthermia and magnetic targeting. Therefore, it could be shown that this method combination is a promising tool for a
highly localized non-invasive treatment of tumor cells.
Genitourinary
Female
C-237
The differential diagnosis of endometriosis: MR imaging characteristics
K. Kishimoto, M. Hellstrm; Gteborg/SE (keiko.kishimoto@gmail.com)
Learning Objectives: 1 To define an algorithm for the differential diagnoses of
endometriosis on MR imaging. 2 To highlight features of adnexal masses that
appear hyperintense on T1WI and show how to differentiate from endometriosis.
Background: Endometriosis is a common and important disorder affecting women of childbearing age. The confident US differentiation of endometriotic cysts
from other adnexal masses may be difficult at times. MR imaging can be a helpful
adjunct for evaluation of adnexal masses because of the advantage of excellent
soft tissue contrast resolution. Lesions containing blood products including methemoglobin, concentrated protein and fat, appear with high signal intensity on T1weighted image. We demonstrate various ovarian conditions that appear
hyperintense on T1WI and show how to differentiate from endometriosis.
Imaging Findings: Lesions that appear with high signal intensity on T1WI include dermoids, hemorrhagic cysts, ovarian hemorrhage, mucinous cystic neoplasms, hemorrhagic masses. Fat-containing lesions such as dermoids are
eliminated from the differential diagnosis by the presence of chemical shift artefact and signal loss on the T1-weighted fat-suppression images. Hemorrhagic
corpus luteum cysts and ovarian bleeding are usually unilocullar and not exhibit
adhesion or shading on T2WI. Hemorrhagic masses include ovarian cancer with
solid components and septations, granulosa cell tumor, yolk sac tumor, and metastatic tumor. We should be aware of malignant transformation of endometriosis
such as clear cell and endometroid ovarian cancer.
Conclusion: It is important to recognize that various conditions appear hyperintense on T1WI for the differential diagnosis of endometriosis.
C-238
Functioning ovarian tumors: Spectrum of imaging findings with clinicalpathological correlations
N. Faye, J. Akakpo, A. Jaafar, B. Lauratet, C. Genestie, J. Lefranc, F. Capron,
P. Grenier; Paris/FR (jean-paul.akakpo@psl.aphp.fr)
C-239
Pelvic endometriosis: Usual, unusual imaging manifestations and pitfalls
Learning Objectives: To demonstrate imaging findings of pelvic endometriosis
and their complications with pathological correlation.
Background: Endometriosis is a common disease of women of reproductive age.
Typical ovarian endometriomas may be easily diagnosed by MR imaging, but
occasionally endometriosis with atypical imaging manifestations may be encoun-
373
ast Media / Genitourinary

Contr
Contrast
Learning Objectives: To illustrate the spectrum of US, CT and MR imaging features of functioning ovarian tumors. To correlate the imaging findings with clinical
and pathological data. To provide examples of differential diagnosis.
Background: Functioning ovarian tumors are uncommon lesions. They include
primary functioning ovarian lesions such as granulosa cell tumors (3 in our series), Sertoli-Leydig cell tumors (3), sclerosing stromal cell tumor (0), fibroma
and fibrothecoma (4) and ovarian tumors with functioning stroma producing oestrogen or androgen (benign and malignant): Cystadeno-fibroma (2), Brenner tumors (2) and Krukenberg from gastric cancer (2), and ovarian tumor-like lesions
such as ovarian dystrophy (4). This is a retrospective review of twenty patients
who underwent US (20), CT (15), MRI (15) imaging. We analysed morphological
aspects (size, homogeneity, margins), degree of color Doppler flow and enhancement. Quantitative data curves were also analysed in dynamic MR imaging. Only
15 patients underwent surgery.
Imaging Findings: The adult granulosa cell tumors appeared as solid tumors
embedded with micro or macrofollicular lesions and or hemorrhagic cysts with a
honeycomb pattern (at US and CT scan); associated with endometrial thickening. Sertoli-Leydig cell tumors were solid hypoechoic tumors with a relatively increased color Doppler flow at US and enhancement after injection.
Fibroma and fibrothecoma appeared as solid hypoechoic lesions with marked
sound-wave attenuation and a relatively low signal intensity on T1W and T2W
MRI images with delayed enhancement pattern.
Conclusion: The combination of clinical and imaging data enables the accurate
diagnosis of functioning ovarian tumors.

tered. In this exhibit we demonstrate usual and unusual imaging manifestations
of pelvic endometriosis and their complications.
Imaging Findings: Multiple hyperintense cysts on T1-WI (multiplicity), or a hyperintense cyst on T1-WI exhibited hypointensity on T2-weighted images (shading) are typical MR findings of ovarian endometrioma. The additional fat saturated
T1-WI may be useful to detect small peritoneal implants and to differentiate endometrial cysts from dermoid cysts. Diffusion-WI may be sensitive for hemorrhagic changes of endometriosis. Extraovarian endometriosis such as abdominal
wall, bladder and colon involvements may show characteristic imaging manifestations. Peritoneal or ligamentous infiltration of endometriosis may present as
solid masses (solid endometriosis) simulating malignant tumors. Decidual changes
of the ectopic endometrium in the endometrioma during pregnancy may mimic
malignant mural nodules. Clinical presentation and imaging manifestations of
complications of endometriosis such as malignant transformation, torsion, infection, rupture, and adhesive peritoneal inclusion cysts are demonstrated. Hyperintense hemorrhagic fluid on T1-WI may mask the contrast-enhancement of mural
nodules of endometrioma with malignant transformation and subtraction contrastenhanced images are effective for the diagnosis.
Conclusion: To recognize various imaging findings of pelvic endometriosis is
important to make the correct preoperative diagnosis to avoid excessive surgical
intervention and to preserve the patient's fertility.
C-240
Imaging of abnormal vaginal bleeding in the post-adolescence woman
Y. del Valle-Sanz, R.M. Lorente-Ramos, F. Salazar-Arquero,
M.J. Alcaraz-Mexa, I. Gallego-Villaescusa; Madrid/ES (rlorenter@yahoo.es)
Learning Objectives: To discuss the causes of abnormal vaginal bleeding in
post-adolescence patients. To know the utility of each imaging modality that can
be applied to the diagnosis of these conditions. To emphasize pitfalls and differential diagnosis of these entities.
Background: Most cases of abnormal vaginal bleeding in post-adolescence
women are caused by a few entities, but there are also unusual diseases that can
be the origin of the bleeding, which we must keep in mind in order to recognize
them. We illustrate the spectrum of imaging findings of all these entities and evaluate the efficacy of US (transabdominal, transvaginal), sonohysterography and
MR imaging in the diagnosis and management of these conditions.
Imaging Findings: Topics addressed include infection, foreign bodies, trauma,
tumours (polyps, leiomyoma, carcinoma) and disorders in premenopausal women with negative pregnancy test (endometriosis, adenomyosis), with positive pregnancy test (ectopic pregnancy, abortion, placental conditions including abnormal
position, subchorionic hemorrhage, gestational trophoblastic disease), postpartum complications (retained products of conception, uterine rupture and atony),
and post-menopausal patients (endometrial atrophy, hyperplasia and estrogen
therapy). The key findings of each imaging modality are shown and compared
with the underlying pathological features when available. Pitfalls and differential
diagnoses are emphasized.
Conclusion: A wide variety of both usual and unusual entities can cause abnormal vaginal bleeding in post-adolescence women. US and MR are the most useful diagnostic tools in uterine and vaginal pathology.
C-241
USPIO-enhanced GRE T2*W sequence versus TSE T2W sequence in Tstaging evaluation of uterine malignancies: A comparison study with
surgical and histological staging
P. Paolantonio1, F. Iafrate1, M. Rengo2, M. Anzidei2, V. Vergari2, M. Celestre2,
R. Ferrari2, A. Laghi1; 1Latina/IT, 2Rome/IT (paolantoniopasquale@hotmail.com)
Purpose: To compare the accuracy on T-staging of uterine carcinoma of USPIOenhanced-GRE T2*W sequence versus TSE T2W sequence.
Methods and Materials: Thirty consecutive female patients referred for gynecological carcinomas, 19 with corpus uterine cancer and 11 with cervical carcinoma underwent MR examination. TSE T2W sequence (TR/TE/matrix/acq time:
3000 msec/132 msec/230x512/5.3 min) were acquired on axial and sagittal planes
and GRE T2*W sequences (TR/TE/FA/matrix/acq time: 1800 msec/15 mesc/30/
230x512/13.51 min) were acquired on axial and sagittal planes before and 24
hours after iv administration of 2.6 mg/kg of body weight of USPIO (Sinerem,
Guerbet, Paris, France). Image analysis was performed by consensus with two
radiologists assessing the T-staging of uterine malignancies on both USPIO-enhanced-GRE T2*W and TSE T2*W images and results were compared with the
surgical and histological staging. Tumor-to-myometrium CNR values were calculated on both TSE T2W and USPIO-GRE-T2*W images and were compared by
means of the Willcoxon-test.
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Results: No differences between the T-Staging obtained on USPIO-enhancedGRE T2*W and TSE T2W images were observed. MR T-stage was confirmed in
28 cases after surgery. In two patients the T-stage obtained on both USPIO-enhanced-GRE T2*W and TSE T2W sequences resulted underestimated at histology. Tumor-to-myometrium CNR was statistically significantly higher on
USPIO-GRE-T2*W images at Wilcoxon-test (p < 0.001).
Conclusion: T-stage of uterine malignancies obtained on USPIO-enhancedGRET2*W images was comparable with the one obtained on TSE T2W images.
Therefore in patients with uterine malignancies that undergo iv USPIO administration for the N-staging assessment the T-stage may be obtained by only acquiring USPIO-enhanced-GRE T2*W sequence.
C-242
MRI of adenomyosis
J.E. van den Bergh, F.J.W. ten Kate, L. Lubsen-Brandsma, J. Stoker;
Amsterdam/NL (j.e.vandenbergh@amc.uva.nl)
Learning Objectives: To illustrate the MR imaging characteristics of adenomyosis. To demonstrate the differential diagnosis and pitfalls of MR imaging of adenomyosis. To outline the clinical relevance of diagnosing adenomyosis.
Background: Adenomyosis is a uterine disorder characterized by the presence
of ectopic endometrium within the myometrium and hypertrophy of the adjacent
smooth muscle. Symptoms of this uterine disorder include menorrhagia, dysmenorrhoea and abnormal bleeding, but these symptoms are non-specific and
often seen in other disorders. Because treatment of the variety of these disorders
can differ, exact diagnosis is mandatory to avoid inappropriate treatment. Although
ultrasonography is the initial imaging modality for evaluation, MR imaging is a
more accurate (non-invasive) modality mainly because of its capability of tissue
characterization. Mostly adenomyosis is asymptomatic, so it often is an incidental finding at MR imaging of the female pelvis.
Imaging Findings: MR imaging characteristics of adenomyosis will be demonstrated, including diffuse or focal thickening of the myometrial junctional zone
showing an illdefined area of low signal intensity. Within this zone bright foci are
embedded representing ectopic endometrial tissue. Histopathology of adenomyosis is presented to increase understanding of the imaging findings. Pitfalls and
differential diagnosis (e.g. leiomyoma) will be discussed as well as the clinical
relevance. The imaging protocol comprises primarily T2-weighted sequences, at
least in the sagittal and an orthogonal plane.
Conclusion: Knowledge of the MR imaging characteristics and differential diagnosis of adenomyosis is important for MR imaging of the female pelvis in symptomatic and asymptomatic patients.
C-243
Dynamic MRI in the assessment of female pelvic organ prolapse: Baseline
and post-surgical evaluation
A. Catalucci, L. Zugaro, C. Bultrini, M.P. Di Bartolomeo, E. Di Cesare,
C. Masciocchi; L'Aquila/IT (alessiacat@tiscali.it)
Learning Objectives: To assess the diagnostic role of MR imaging in the evaluation of female urinary incontinence and pelvic organ prolapse using dynamic
MR imaging, as a baseline assessment and after surgery using "Patch and Plug"
technique.
Background: Dynamic MR imaging examination of pelvic prolapse is a good aid
in the evaluation of both the type and degree of the female pelvic organ prolapse,
representing a diagnostic confirmation of the clinical assessment. It is also useful
to demonstrate prolapse has disappeared after surgery. MR imaging provides a
complete evaluation of the pelvic organs by both static and dynamic imaging; it
may also allow evaluation of the muscular and ligamentous structures of the pelvic floor.
Procedure Details: 44 patients with genuine stress urinary incontinence and
genital prolapse were investigated by standard and dynamic MR imaging, using
a 1.5 Tunit. Patients were placed in a supine position with the legs slightly flexed
and abducted; 250 ml of Gd-DTPA water solution were instilled into the bladder,
20 ml of Gd water-gel solution was injected into the vagina and 50 ml into the
rectum. Dynamic images were obtained at rest and during Valsalva manoeuvre,
using T1-FFE sequences on sagittal plane. Dynamic MR imaging was analyzed
to determine the presence and extent of cystocele and vaginal vault prolapse.
Conclusion: Dynamic MR imaging provided a good demonstration of genital prolapse during Valsalva manoeuvre in all cases; a good correlation with the clinical
evaluation of both genital prolapse type and degree was found in the baseline
assessment and after surgery.

C-244
Sonohysterography (SHG) versus conventional transvaginal imaging
(TVUS) of endometrial pathology and submucosal myomas: A pictorial
essay with hysteroscopic correlations
G. Serafini1, F. Prefumo2, N. Gandolfo1, D. Dibilio1, L. Dogliotti2, L.E. Derchi2;
1
Pietra Ligure/IT, 2Genova/IT (giovanni.serafini@ospedalesantacorona.it)
Learning Objectives: To illustrate the technique and indications for SHG. To define
the SHG appearance of uterine synechiae and malformations, endometryal polyps, submucosal fibroids and endometrial cancer. To define the role of SHG in
the preoperative staging of fibroids. To compare SHG with hysteroscopic findings.
Background: The traditional approach to the diagnosis of intracavitary uterine
pathology suspected at TVUS has been hysteroscopic investigation. However
diagnostic hysteroscopy is a relatively invasive and time-consuming procedure,
frequently requiring patient sedation. In the last years SHG has increasingly replaced hysteroscopy in the triage of uterine intracavitary lesions. More recently
SHG has also proved effective in the preoperative staging of submucosal fibroids,
allowing to correctly choose the optimal surgical approach for their treatment
(resectoscopy vs. laparoscopy/laparotomy).
Imaging Findings: SHG is performed by perfusing the uterine cavity with saline
through a catheter passed into the cervical canal. The SHG appearance of the
most common uterine intracavitary abnormalities (uterine synechiae and malformations, endometryal polyps, submucosal fibroids and endometrial cancer) is
displayed, together with its hysteroscopic correlates, based on over 1,000 examinations. The role of SHG in the preoperative staging of fibroids is also demonstrated in 48 cases.
Conclusion: SHG has an increasingly important role in the assessment of intracavitary uterine pathology. It can efficiently replace diagnostic hysteroscopy in
the majority of cases, allowing correct diagnosis of the conditions and to plan the
optimal approach if surgical treatment is needed.
C-245
Role of magnetic resonance imaging in evaluating mullerian anomalies
S. Nair1, U. Agarwal2, C. George1, M. Putharan1, C. Huaff1; 1Hull/UK,
2
Peterborough/UK (drsnnair@hotmail.com)
Learning Objectives: To illustrate the role of magnetic resonance imaging (MRI)
in evaluation of mullerian anomalies. To outline the advantages of the technique
and compare with other modalities of imaging.
Background: Prevalence of congenital anomalies of mullerian system has been
estimated to be between 0.1% and 3%. One fourths to two thirds of women with
mullerian anomalies have some type of reproductive dysfunction including sterility, habitual abortion, low birth weight, premature delivery and abnormal fetal
presentation. In evaluation of infertility or recurrent miscarriage, imaging of uterine and vaginal morphology is of paramount importance both to detect anomalies
and select treatment options.
Procedure Details: Fast spin echo (FSE) T2 weighted images are most useful
for evaluating mullerian anomalies. Using sagittal images as a guide, oblique
coronal and axial FSE T2 weighted images can be performed parallel and perpendicular to long axis of the uterus.
Conclusion: MR imaging is arguably the best imaging modality for evaluating
women with suspected mullerian anomalies. Clinicians should therefore not hesitate in utilizing this valuable technique.
C-246
Ovarian teratomas: Usual, unusual imaging manifestations and pitfalls
K. Matsuzaki, M. Takeuchi, H. Nishitani, H. Uehara; Tokushima/JP
(kenji@clin.med.tokushima-u.ac.jp)
C-247
An MRI based pictorial review of pelvic disorders associated with female
infertility
A.N. Chalazonitis1, G. Tsimitselis2, J. Tzovara1, N. Ptohis1, P. Porfiridis1,
V. Nikolaou1, A.A. Ghiatas1; 1Athens/GR, 2Larissa/GR (red-rad@ath.forthnet.gr)
Learning Objectives: 1 To briefly present the spectrum of pelvic disorders associated with female infertility and review their MR imaging findings. 2 To suggest
dedicated MR imaging examination protocols for their evaluation. 3 To illustrate
the potential pitfalls and MR imaging artefacts which complicate their diagnosis.
Background: Female infertility is a problem that affects more and more women.
A great majority of these cases are evaluated with MR imaging. Radiologists are
more commonly facing the challenge than previously to diagnose the specific
disease responsible for the problem.
Imaging Findings: The aim of this exhibit is to augment the participant's experience in the evaluation of the spectrum of diseases that present mainly with female infertility as a symptom. A great number of these diseases will be pictorially
depicted in our exhibit. All cases come from our teaching files. Cases like congenital anomalies of the vagina and uterus, neoplasms including leiomyomas
and polyps, adenomyosis, endometriosis, will be depicted as well as their differential diagnoses. In addition various examination protocols will be suggested. All
the potential pitfalls and artefacts that complicate their diagnosis will be depicted.
Conclusion: The augmenting role of MR imaging in the evaluation of female
infertility, requires an augmenting number of experienced medical personnel to
deal with. We believe that this exhibit will augment the participant's experience in
the evaluation of this spectrum of diseases.
C-248
MR features of malignant myometrial tumors in the uterus with pathological
correlation
N. Morisawa, T. Koyama, K. Tamai, S. Umeoka, T. Itoh, T. Saga, Y. Mikami,
S. Fujii, K. Togashi; Kyoto/JP (nobuko-ky@umin.ne.jp)
Learning Objectives: To know MR features in malignant myometrial tumors of
the uterus with pathological correlation. To recognize key clinical and MR findings for differentiating malignant myometrial tumors from benign tumors.
Background: The majority of myometrial lesions of the uterus are benign leiomyomas, followed by adenomyosis. MR imaging is an excellent modality for evaluating myometrial lesions because of its inherent tissue contrast and usually allows
specific diagnosis of these benign tumors. Meanwhile primary malignant tumors
are very rare and include leiomyosarcomas, endometrial stromal sarcomas (ESS),
malignant lymphomas, and secondary tumors such as metastatic uterine tumors
and adenocarcinomas arising from pre-existing adenomyosis. Since most of these
myometrial malignancies can not be approached by hysteroscopic biopsies it is
important to consider these conditions by their imaging findings.
Imaging Findings: Leiomyosarcoma commonly occurs in elderly patients, presenting as a rapidly enlarging mass showing heterogeneous intensity due to hemorrhage or necrosis. ESS commonly presents as an infiltrative mass in young
females and typically contains bands of low intensity, representing preserved
myometrial bundles within the lesion. Malignant lymphoma is usually an infiltrative process involving the entire uterus, causing diffuse and symmetrical enlargement of the myometrium. Metastatic uterine tumors can form either an ill-defined
nodular mass or a diffusely infiltrative lesion. Adenocarcinoma arising from adenomyosis can present as either a nodular myometrial mass closely simulating
cellular leiomyoma or an infiltrative lesion within adenomyosis.
Conclusion: Recognition of MR features in malignant myometrial malignancies
is important to detect these tumors and advise on appropriate patient management.
375
Genitourinary
Learning Objectives: To demonstrate imaging findings of ovarian teratomas and

their complications with pathological correlation.
Background: Teratomas are the most common ovarian tumors and diagnosis of
typical mature cystic teratoma is easily done by detecting calcification and adipose tissue. But occasionally teratomas with atypical imaging manifestations may
be encountered. In this exhibit we demonstrate usual and unusual imaging manifestations of teratomatous tumors of the ovary and their complications.
Imaging Findings: To detect the fatty components of a typical mature cystic teratoma, both CT and MR imaging are sensitive, and measuring CT values or using chemical shift MR imaging may helpful to diagnose the lesions with scant
fatty components. Unusual mature cystic teratomas such as a pure cystic mass
in young patients, lesions with intracystic fat balls, and hemorrhagic dermoid cysts
due to co-existing endometriosis may show characteristic imaging manifestations.
Malignant transformation may occur in older patients and administration of contrast medium is useful for the diagnosis. Lactate detection by MR spectroscopy
may be also helpful to suggest their malignant nature. Immature teratoma may
occur in young patients and is shown as a huge heterogeneous solid mass with
scattered fat, small cysts, and calcifications. Imaging findings of monodermal
teratomas such as struma ovarii and carcinoid are also presented. Clinical presentation and imaging manifestations of the complications of teratomas such as
torsion, infection, rupture, peritonitis and disseminated peritoneal seeding are
demonstrated.
Conclusion: It is important to recognize the various imaging findings of ovarian
teratomas to make the correct preoperative diagnosis and avoid unnecessary
surgical intervention and preserve the patient's fertility.

C-249
Spectrum of CT and MR features in secondary tumors of the ovary;
correlation with pathological findings
T. Koyama, Y. Mikami, K. Tamai, S. Umeoka, T. Saga, S. Fujii, K. Togashi;
Kyoto/JP (montpeti@kuhp.kyoto-u.ac.jp)
Learning Objectives: To review CT and MR features in a variety of secondary
tumors of the ovary in correlation with pathological findings, with emphasis on
differentiation from primary ovarian tumors.
Background: The ovaries are one of the preferential sites for metastatic disease.
Common primary sites for metastatic ovarian tumors include stomach, colon,
breast, pancreas and appendix. The ovaries are also frequently affected by hematological malignancies including lymphoma and leukemia. Although these secondary ovarian tumors are seen in patients with known primary malignancy, ovarian
lesions can occasionally be an initial manifestation of the disease. Accurate radiological diagnosis is crucial since misinterpretation of these tumors may cause
significant adverse consequences for the patients. This review describes spectrum of CT and MR features in a variety of secondary tumors of the ovary in
correlation with pathological findings.
Imaging Findings: Metastases from gastric cancer, known as Krukenberg tumors, are typically bilateral and solid tumors showing marked enhancement, frequently with peripherally located cysts. Metastases from colon cancer are
commonly unilateral, multilocular cystic tumor with solid components of variable
size, and may be associated with hemorrhage and/or necrosis. Typically metastatic tumors from breast and pancreas are heterogeneously solid and cystic.
Metastases from appendix may present as ruptured mucinous ovarian tumors
associated with pseudomyxoma peritonei. Ovarian involvement by hematological malignancies is typically bilateral and characterized by homogeneously solid
masses.
Conclusion: CT and MR features of secondary ovarian tumors differ according
to primary malignancies. Recognition of radiological features in secondary ovarian tumors is beneficial for accurate diagnosis.
C-250
Right ovarian vein drainage variant: Is there a relationship with pelvic
varices?
Z. Koc, S. Ulusan, L. Oguzkurt; Yregir / Adana/TR
(zaferkoc@superonline.com)
Purpose: The aim of this study was to determine the association of the right
ovarian vein draining into the right renal vein with the formation of pelvic varices.
Methods and Materials: Routine abdominal MDCT scan of 324 women were
analysed for the presence and type of the right ovarian vein (ROV) variations.
Diameters of the right and left ovarian vein (LOV) and the parauterine veins were
measured. Presence of the pelvic varices, presence and degree of the ovarian
vein reflux were noted. These data were then compared between the women with
and without ovarian vein variants. Chi-square test and Pearson correlation test
were used for statistical analysis.
Results: Thirty-two (10%) of 324 patients had ROV variants draining into the
right renal vein, whereas others (90%) had a normal drainage pattern draining
directly into the inferior vena cava. Pelvic varices were identified in 59 (18%)
patients, in 56 of the patients the ROV was draining normally into the vena cava.
Fifty-eight of the 59 patients with pelvic varices had LOV reflux and only one had
ROV reflux which is considered to be important contributor to pelvic varices formation. There was no significant relationship between the presence of a ROV
draining into the right renal vein and pelvic varices.
Conclusion: Although right sided pelvic varices associated with right ovarian
vein drainage variation may be seen on rare occasions, there is not a significant
relationship between the right ovarian vein draining into the right renal vein and
pelvic varices formation.
C-251
Value of diffusion-weighted MR imaging in gynecological malignancies; its
applications and limitations
T. Koyama, K. Tamai, T. Saga, S. Umeoka, S. Fujii, K. Togashi; Kyoto/JP
(montpeti@kuhp.kyoto-u.ac.jp)
Learning Objectives: 1) To review the value of diffusion-weighted images (DWI)
and fusion images with DWI onto conventional MR images in evaluating a variety
of gynecologic malignancies. 2) To discuss applications and limitations of DWI.
Background: MR imaging is an excellent modality for diagnosis and local staging of gynecological malignancies. DWI can provide tissue contrast based on
diffusion motion of water molecules, different from conventional MR images. The
376
utility of this technique has been reported in various kinds of malignancies. In

gynecological malignancies, fusion images with DWI onto T2WI compensate for
its poor spatial resolution. Additionally ADC values calculated from DWI may provide additional information concerning tissue characteristics. In this exhibit we
review the value of DWI in evaluating gynecological malignancies and discuss its
applications and limitations.
Imaging Findings: DWI can demonstrate a variety of gynecological malignancies as foci of increased signal intensity. Fusion images with DWI onto T2WI can
successfully depict not only primary tumors, but also small peritoneal implants or
recurrent cancers that may be easily overlooked on conventional MR images. In
corpus cancers, ADC measurement may allow prediction of histological grade
since ADC values of high-grade cancers tend to be lower than those of low-grade
cancers. However there are some situations in which abnormal signal intensity
on DWI should be carefully distinguished from benign conditions such as normal
nodes or hemorrhagic cysts.
Conclusion: Knowledge of applications and limitations of DWI is beneficial for
the accurate localization of tumors and careful interpretation of the images.
C-252
Bright ovary on T1-weighted MR images
Y.-M. Sohn, K.-A. Kim, C.-H. Lee, J.-W. Choi, C.-M. Park; Seoul/KR
(sonyumee@naver.com)
Learning Objectives: The purpose of this study is to correlate tissue characterization of ovarian disease with pathological findings.
Background: Diagnosis of ovarian disease can be performed through various
modalities such as CT, ultrasonography and MR imaging on the basis of attenuation, echogenicity and magnetic susceptibilities. MR imaging provides additional information on the composition of a lesion, thereby enabling characterization
of ovarian disease and identification of features associated with disease.
Imaging Findings: Ovarian diseases can show variety of signal intensities on
MR imaging by their tissue components. Of these, tissue components seen as
high signal intensity on T1-weighted image are blood, fat and mucin. In this exhibit we will illustrate the various ovarian diseases that show high signal intensity
("Bright Ovary") on T1-weighted MR images. Blood product cases include endometriosis, hemorrhagic cyst and tumor with hemorrhage. Fatty component cases
include mature and immature cystic teratoma. Mucin containing cases include
mucinous cystic tumors (cystadenoma, cystadenofibroma, cystadenocarcinoma
and borderline mucinous tumor).
Conclusion: The knowledge of these tissue characteristics on MR imaging will
be helpful for accurate diagnosis of ovarian disease.
C-253
Changes of apparent diffusion coefficient (ADC) and signal intensity in
normal uterus during the menstrual cycle
A. Seko1, S. Kanasaki1, M. Tatsumi1, S. Kitahara2, K. Murata2; 1Kyoto/JP,
2
Otsu/JP (sekoayumi@yahoo.co.jp)
Purpose: To evaluate the changes of ADC and T2 weighted signal intensities of
the uterus during the menstrual cycle.
Methods and Materials: Pelvic MR imaging was performed on 22 female volunteers who had a normal menstrual cycle. They underwent MR imaging once a
week for four continuous weeks. Diffusion weighted images (b=1000 s/mm2) and
T2-weighted images (T2WI)were obtained. The exams were classified into 4 categories according to the duration from the first day of menstruation; group 1;
day1-6 (as menstrual phase), group 2; day 7-14 (as follicular-periovulatory phase),
group 3; day 15-21 (as periovulatory - luteal phase) and group 4; day22- (as late
luteal phase). ADC and T2-signal intensity ratios (T2-ratio, defined as the signal
ratio of the uterus to subcutaneous fat on T2WI) were calculated and analysed
each group by Wilcoxon signed-rank tests.
Results: The mean ADCs of endometrium were 0.991+-0.21.1.25+-0.19, 1.38+0.2, 1.33+-0.20 and 1.27+-0.24 mm2/sec*10-3. (group1, 2, 3, 4, and total data).
ADC of endometrium increased from group1 to 2, group 1 to 3, group1 to 4,
group 2 to 3, group 2 to 4 and there was no statistical difference between group
3 and 4. T2-ratio of endometrium changed with ADC. There was no statistical
change in the ADC of myometrium. However there were significant increases in
T2-ratio in groups 2 to 4 and groups 1 to 4. There was a correlation between ADC
and T2-ratio of the uterus.
Conclusion: The ADC of endometrium revealed a significant change along with
the menstrual cycle. There was no statistical change throughout the cycle in the
myometrium. ADC of the uterus had strong correlation with T2-ratio. We should
consider the changes of uterine ADC values when evaluating gynecological lesions.

C-254
Deep pelvic endometriosis: MR appearance with laparoscopic correlation
C. Del Frate 1, R. Girometti1, M. Pittino1, G. Del Frate2, M. Bazzocchi1,
C. Zuiani1; 1Udine/IT, 2San Daniele del Friuli/IT (chiara.delfrate@med.uniud.it)
Learning Objectives: To review MR findings in deep pelvic endometriosis. To
correlate MR imaging with laparoscopic features.
Background: Deep pelvic endometriosis is defined as subperitoneal infiltration
of the implants in uterosacral ligaments, followed by rectum, rectovaginal septum, vagina and bladder, responsible for severe pelvic pain. Accurate preoperative assessment of disease extension, which is required to plan complete surgical
excision, is difficult with physical examination. Various sonographic approaches
(transvaginal, transrectal, endoscopic transrectal) have been used for this purpose, but do not assure panoramic evaluation of this entity. Furthermore, exploratory laparoscopy presents limitations in detecting deep locations of endometriosis
hidden by adhesions or located in subperitoneal space.
Imaging Findings: Despite some limitations, MR imaging is able to directly depict deep endometriosis. The aim of the exhibit is to review the MR findings of
deep endometriosis correlating with the laparoscopic features.
Conclusion: Pelvic MR imaging is extremely relevant in the pre-operative assessment of deep pelvic endometriosis.
C-255
Imaging of benign ovarian conditions with pathological correlation
C. Vasconcelos, T. Cunha, A. Flix; Lisbon/PT (catarina14@netcabo.pt)
Learning Objectives: To illustrate the spectrum of imaging features of benign
conditions of the ovary in correlation with pathological features.
Background: Benign adnexal diseases greatly outnumber malignant ones and
present a special diagnostic challenge. Various benign conditions which develop
in reproductive women are physiological and shouldn't be confused with pathological ones; but may even mimic malignancies. Ultrasound (US) is the initial
imaging modality preferred and computed tomography and magnetic resonance
(MR) imaging are used in those cases that require further assessment. The superior soft tissue contrast and the multiplanar facility offered by MR sequences
are advantageous in the evaluation of adnexal lesions. The imaging and pathologic features of benign ovary conditions are reviewed.
Imaging Findings: There is a wide spectrum of benign ovarian conditions.
Benign ovarian cysts are typically well defined with a thin wall. Corpus luteum
cysts tend to have thicker walls with increased intensity on T1WI than other functional cysts. Fat-saturation T1WI help to distinguish between hemorrhage and fat
allowing the differentiation between teratoma and hemorrhagic ovarian cyst or
endometrioma. Hyperreactio luteinalis, ovarian hyperstimulation syndrome and
polycystic ovary syndrome may simulate cystic neoplasm.
MR imaging demonstrates an infiltrative outer margin in tubo-ovarian abscess
which is a potential complication of pelvic inflammatory disease and Doppler US
is useful for diagnosis of ovarian torsion. Solid components in benign Brenner
tumors and sex-cord stromal tumors typically show low-intensity on T2WI.
Conclusion: The knowledge of imaging features and clinical behavior of benign
ovarian conditions enables the diagnosis and may suggest an adequate treatment.
C-256
Clinical and radiological findings in uterine sarcomas: A seven year
retrospective study
N. Costa, T. Cunha, A. Flix; Lisbon/PT
C-257
Spectrum of MR features in ectopic pregnancy
K. Tamai, T. Koyama, T. Saga, S. Umeoka, Y. Mikami, S. Fujii, K. Togashi;
Kyoto/JP (tamaiken@mbox.kyoto-inet.or.jp)
Learning Objectives: To illustrate MR features of ectopic pregnancy with emphasis on key findings to establish accurate diagnosis.
Background: Ectopic pregnancy (EP) is a potentially life threatening condition
associated with rupture and subsequent massive bleeding. EP commonly occurs
in the fallopian tube, but rarely in unusual sites including the interstitium, cervix,
Cesarean scar, anomalous rudimentary horn of the uterus and abdominal cavity.
EP is usually suspected by a positive pregnancy test and the empty uterus on
sonography. However sonography may occasionally fail to demonstrate the focus
of EP. Meanwhile, the presence of a gestational sac in the uterine cavity does not
always exclude EP. Extrauterine EP and concomitant intrauterine pregnancy, more
frequently encountered in women with in-vitro fertilization, may masquerade as a
normal pregnancy and are a diagnostic challenge. MR imaging is an excellent
modality for demonstrating EP when sonography is inconclusive. In this review,
we discuss the spectrum, roles and pitfalls in MR imaging of EP.
Imaging Findings: Key MR features for detecting EP include hematoma of distinct low intensity on T2WI and fetoplacental tissue that typically appear as a
cystic structure containing papillary projections. In tubal pregnancy, an enhanced
tubal wall on postcontrast images may be another clue for detecting the focus.
Ruptured EP is inevitably associated with acute hematoma outside these structures. In intrauterine EP, recognition of placental tissue and its relationship to the
myometrium can differentiate this condition from normal pregnancy and determine the precise location of EP.
Conclusion: Recognition of the spectrum of MR imaging in EP is essential for
accurate diagnosis of this condition.
C-258
Usefulness of diffusion-weighted MR imaging in the diagnosis and
evaluation of uterine lesions
Y. Inada, M. Matsuki, F. Tatsugami, M. Tanikake, I. Narabayashi; Takatsuki/JP
(rad068@poh.osaka-med.ac.jp)
Purpose: To assess the usefulness of diffusion-weighted (DW) imaging in distinguishing between the benign and malignant uterine tumors and in evaluating the
malignant tumors on DW images.
Methods and Materials: 41 normal volunteers and 54 patients with known uterine lesions (20 myoma, 9 adenomyosis, 15 endometrial cancer, 10 cervical cancer) underwent MR imaging by using a 1.5 T superconductive magnet. Axial T1-,
fat suppressed axial and sagittal FSE T2- weighted images were acquired in
each patient. DW images were obtained in the axial plane under free breathing
scanning with a SE EPI single shot sequence using a body coil or phased array
multi-coil (TR/TE=7500/64 ms, BW 142.86 kHZ, FOV 48 cm, slice 5-6 mm, spacing
0 mm, matrix 128128, excitations 4-7, fat suppression: STIR) with b value of
800 s/mm2. The ADC (apparent diffusion coefficient) was measured in a ROI within
the normal endometrium, myometrium, cervical mucosa, stroma and uterine lesions.
Results: ADC values (10-3 mm2/s) in endometrial and cervical cancer were
0.98 0.18 and 0.99 0.29, which were lower with significant differences compared to the normal or benign lesions. On DW images, malignant tumors and
lymph nodes showed high signal intensity under background suppression. Moreover, high resolution maximum intensity projection and multi-planar reconstruction images could be made from the data set of 5 mm slice thickness, which was
useful in evaluating the extent of malignant tumors.
Conclusion: ADC values seem to be an effective parameter in distinguishing
between benign and malignant uterine tumors. Moreover DW images can be useful in the evaluation of T and N stage of those tumors.
377
Genitourinary
Purpose: To find the main features associated with clinical and radiological findings of primary uterine sarcomas.
Methods and Materials: A seven year retrospective study was performed and
only histologically proven uterine sarcomas were included. Data of 53 patients
admitted to our institution between 1998 and 2004 was reviewed. We collected
clinical and radiological findings (US, CT and MRI) and the histological diagnosis.
Results: Mean age of presentation was 58.7 years (range 38-88). Vaginal bleeding (62.2%), pelvic mass (16.9%) and pelvic pain (15%) were the main clinical
manifestations. Preoperative radiological data was retrieved in 28 patients. Uterine enlargement (100%) and heterogeneous uterus (82.1%) were the main imaging findings. Other aspects such as endometrial abnormalities, irregular uterine
margins and enlarged lymph nodes were also described. Sarcoma was suspected in only 3 patients. Leiomyosarcoma (52.8%) was diagnosed in the majority of
patients. Follow-up data was available in 51 patients until June 2005, twentyseven patients died from this condition.
Conclusion: Uterine sarcoma diagnosis is made on a histological basis. Imaging

findings are nonspecific and can be found in other conditions. Uterine sarcomas
should be suspected in older women with uterine enlargement and vaginal bleeding.

C-259
Comparison of contrast-enhanced ultrasound (CEU) and colour Doppler
(CD) in uterine adenomyosis
G. Serafini1, F. Prefumo2, N. Gandolfo1, L. Dogliotti2, L.E. Derchi2;
1
Pietra Ligure/IT, 2Genova/IT (giovanni.serafini@ospedalesantacorona.it)
Purpose: To compare CEU and CD findings in cases where a diagnosis of uterine adenomyosis was suspected on conventional transvaginal ultrasound (TVUS).
Methods and Materials: In a total of 41 patients uterine adenomyosis was suspected at TVUS based on the following findings: asymmetrical thickening of the
uterine wall, myometrial dyshomogeneity with fluid-filled areas, broadening of
the endo-myometrial junction. All cases were evaluated by CD and CEU (4.8 mL
SonoVue, Bracco, Italy). The final diagnosis was obtained with a combination of
magnetic resonance imaging (38/41), hysterectomy (12/41) and or surgical resection (6/41). There were 14 confirmed cases of adenomyosis and 27 confirmed
cases of fibroids.
Results: Both CEU and CD detected a diffuse hypervascularity of the involved
portion of the uterine wall in 14/14 cases of adenomyosis and 6/27 cases of
uterine fibroids. In all cases of adenomyosis, CEU demonstrated a homogeneous pattern of vascularisation, with blood vessels uniformly distributed within the
lesions. In contrast, basket macrovascularity was demonstrated in 18/27 fibroids
by CD and 24/27 by CEU. The late phase of CEU showed contrast uptake also in
the central area of the fibroids. The wash-in time in CEU was significantly shorter
in adenomyosis than in fibroids, with a mean difference of 4 seconds.
Conclusion: CEU appears superior to CD in the diagnosis of adenomyosis suspected at conventional TVUS. With CEU, adenomyosis consistently shows a homogeneous vascular pattern, as opposed to the basket macrovascularity typical
of fibroids. The wash-in time at CEU is also significantly shorter in adenomyosis
than in fibroids.
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Foetal MR imaging: Experience in a district general hospital
S. Avula, U. Hughes; Liverpool/UK (drashivaram@doctors.org.uk)
Learning Objectives: This poster illustrates the use of MR in foetal imaging as
an adjunct to routine antenatal ultrasound imaging in a district general hospital
(secondary level - health care centre).
Background: MR imaging is emerging as a useful tool in prenatal diagnosis
especially in complex malformations where ultrasound imaging is suboptimal,
giving rise to diagnostic difficulties. With advances in MR technology and quicker
imaging techniques MR is proving to be a useful supplement to ultrasound in
selected cases. In this poster we discuss the indications and illustrate a few clinical cases in our district general hospital where foetal MR proved to be a useful
diagnostic tool.
Procedure Details: We reviewed all foetal MR scans performed during a two
year period. Balanced FFE sequence scans were performed on a Phillips Intera
1.5 Tesla scanner. Scans were performed in cases where congenital malformations were suspected and ultrasound imaging was inconclusive. The clinical information and salient imaging findings have been presented in our poster. The
abnormalities identified include, arachnoid cyst, posterior fossa haematoma, spinal dysraphism, diaphragmatic hernia and cardiac dextroversion.
Conclusion: Foetal MR imaging is feasible in a district general hospital setting
and is a useful tool for specific clinical scenarios where ultrasound imaging has
been inconclusive.
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Nongynecological lesions mimicking gynecological diseases. Radiological
differential diagnosis
I. Pereira, T. Cunha, A. Flix; Lisbon/PT (inesmafaldagp@hotmail.com)
Learning Objectives: To review the spectrum of imaging features of nongynecological lesions that mimic gynecological pathology.
Background: There is a wide spectrum of abdominal and pelvic nongynecological lesions that simulate gynecological pathology, mainly inflammatory and neoplastic conditions. In their diagnostic evaluation appropriate clinical, laboratory
and radiological studies are needed. Plain radiographs, transabdominal and transvaginal ultrasound, CT and MR are good radiological modalities to evaluate these
entities.
Imaging Findings: In this presentation we illustrate the different imaging findings that aid in the differential diagnosis of abdominal and pelvic lesions that
mimic gynecological pathology. Gastrointestinal, appendiceal, retroperitoneal
pelvic, mesenteric and omental tumors must be considered.
Inflammatory conditions such as appendicitis and periappendiceal abscesses,
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as well as peritoneal inclusion cysts, pelvic lymphoceles and other peritoneal

and miscellaneous lesions are other conditions to be considered.
Conclusion: Many different abdominal and pelvic lesions can present with similar and non-specific symptoms mimicking gynecological pathology. Therefore
radiologists should be aware of these entities and include them in the differential
diagnosis of gynecological lesions.
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Benign and malignant germ cell tumors of the ovary: Radiological and
pathological correlation
Learning Objectives: To demonstrate imaging findings of benign and malignant
germ cell tumors of the ovary with pathological correlation.
Background: Tumors of germ cell origin are common ovarian neoplasms in children and young women. In this exhibit we demonstrate the various imaging manifestations and pitfalls of benign and malignant germ cell tumors with pathological
correlation.
Imaging Findings: Mature cystic teratoma is the most common benign germ cell
tumor and detection of calcification and adipose tissue is diagnostic. Administration of contrast medium is effective in the evaluation of malignant transformation
in older patients and immature teratoma in young patients. In monodermal teratomas struma ovarii is shown as a multilobulated solid and cystic mass with hypointense portion on T2-WI. Carcinoid shows hypervascularity on a dynamic study.
Ependymoma may be observed as a huge pelvic mass with intraperitoneal dissemination. Other malignant germ cell tumors are generally large with solid and
cystic masses. Dysgerminoma are seen as a large mass with prominent hypointense fibrovascular septa on T2-WI. Yolk sac tumors demonstrate a hypervascular mass with massive intratumoral hemorrhage and elevation of serum AFP.
Choriocarcinomas are typically a large solid mass with hemorrhage and necrosis
accompanied by elevated serum HCG level.
Conclusion: It is important to recognize the various imaging findings of ovarian
germ cell tumors to make the correct preoperative diagnosis to avoid unnecessary or excessive surgical intervention and preserve the patient's fertility.
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Pathologies of the uterine myometrium: Usual and unusual manifestations
and pitfalls on magnetic resonance imaging
K. Matsuzaki, M. Takeuchi, H. Nishitani, H. Uehara; Tokushima/JP
(kenji@clin.med.tokushima-u.ac.jp)
Learning Objectives: To recognize usual and unusual magnetic resonance imaging (MRI) findings of the uterine myometrium with pathological correlation.
Background: The uterine myometrial pathologies may demonstrate various imaging manifestations by normal, reactive, and benign and malignant neoplasms.
Imaging Findings: Enlarged myometrium or myometrial masses included adenomyosis, leiomyomas, sarcomas and secondary involvement of various malignant tumors. Hormonal abnormality may affect both normal myometrium and
pathologies such as leiomyoma and adenomyosis. Exogenous (associated with
tamoxifen) or endogenous (associated with functional ovarian tumors) hormonal
stimulation caused diffuse endometrial swelling with preservation of internal structures and endometrial thickening. Typical adenomyosis shows focal or diffuse
widening of the junctional zone with or without small cysts or hemorrhagic foci,
and hormonal stimulation may cause signal increase on T2-WI resulting in mimicking malignancy. Adenomyotic cyst representing intramyometrial endometrial
cyst, and malignant transformation of adenomyosis are rare complications. Leiomyomas, sarcomas and metastatic tumors may present as solitary or multiple
intramyometrial masses, but some malignant tumors such as lymphoma or breast
cancer may show diffuse myometrial infiltration without definite mass formation
but diffuse myometrial thickening. Leiomyomas are typically demonstrated as
hypointense nodules but calcification, cystic degeneration, edema, red degeneration, and lipomatous metaplasia may cause a complicated appearance resembling malignancy. Sarcomas usually show a heterogeneous appearance reflecting
massive necrosis and hemorrhage, but low grade endometrial stromal sarcoma
may show characteristic intramyometrial spread.
Conclusion: It is important to recognize the various imaging findings of the uterine myometrium to make a correct preoperative diagnosis to avoid unnecessary
or excessive surgical intervention and preserve the patient's fertility.

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Genitourinary
3 T imaging of endometriosis
F. Fiocchi, N. Caproni, S. Ferraresi, A. Barberini, G. Ligabue, P. Torricelli;
Modena/IT (ffiocchi@sirm.org)
Kidney
Learning Objectives: To show 3 T magnetic resonance imaging of endometriosis.

Background: Fifteen patients (mean age 26.6 4.9 years) with chronic pelvic
pain and clinical-echographic suspicion of endometriosis underwent MR imaging
(3 T, Philips Medical Systems, Best, The Netherlands) from January to August
2005, using an external phased array coil. The sequences used were the following: axial T1/TSE, axial T2/TSE SPIR, sagittal T2/TSE, sagittal/coronal T1/TSE
SPIR; full bladder was requested. Contrast administration (Gadolinium-DOTA)
was not done except in a few cases of doubt.
Imaging Findings: Ovary localization of endometrosis (endometrioma) may be
unilocular or multilocular and displays predominantly high signal on T1 and low
or mixed signal on T2-weighted images. On T2-weighted images, intermediate
signal shading, caused by T2 shortening of blood products, is often seen within
the mass (shadowing). To detect bladder localization of endometriosis is important that the patient has a full bladder, especially because small or posterior foci
can be difficult to see. If the ureteral ostium is involved, hydronephrosis can be an
accessory sign. Intestinal endometriosis can bleed and bowel loops may be distorted and tethered creating adherences and leading to 'frozen pelvis' condition.
Conclusion: 3 T MR imaging can be a useful II level non invasive tool to improve
the diagnostic accuracy especially in young patient with chronic pelvic pain of
unknown cause.
Diagnosis and staging of upper tract transitional cell carcinomas by

multidetector CT urography: A one phase study?
F. Cornud, M. Bienvenu, H. Gurini, C. Andreux, X. Poittevin, A. Chevrot;
Paris/FR (frcornud@wanadoo.fr)
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Purpose: To describe upper tract TCC features on a single phase MDCTU with
split bolus injection and furosemide induced hyperdiuresis.
Methods and Materials: 36 patients (mean age: 69, range 56-88, 23 men) with a
histologically proven TCC were reviewed. A 3 phase protocol with hyperdiuresis
(furosemide 20 mg) was used in all patients (unenhanced, corticomedullary and
combined nephrographic-excretory phase after reinjection of 50 ml of contrast
medium). Ability of the third phase to detect the tumor and assess pT stage was
evaluated.
Results: 54 lesions were detected on the 3 phase CTU. All of them were detected on the combined nephrographic-excretory phase. 51 were histologically proved
TCCs and 3 were false positive cases. Four CTU patterns were observed: Non
obstructive filling defect (32 cases), obstructive mass (7 cases), wall thickening
(6 cases) and infiltrative mass (6 cases). Mean tumor attenuation value was similar on the corticomedullary and combined nephro-excretory phases (86 HU, range
68-110 versus 95 HU, range 74-129); Correlation with the final pT stage showed
a 88% and 100% specific CT staging.
Conclusion: Upper tract TCCs can be accurately detected and staged on a single phase MDCTU with split bolus injection and induction of a hyperdiuresis.
Accuracy of one phase MDCTU should be further assessed to reduce radiation
in the evaluation of patients presenting with symptoms of the urinary tract.
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Functional renal MR imaging: An overview
H.J. Michaely, K. Bauner, H. Kramer, S. Wagner, M.F. Reiser, S.O. Schnberg;
Munich/DE (henrik.michaely@med.uni-muenchen.de)
Learning Objectives: To explain and illustrate the spectrum of findings of functional renal magnetic resonance imaging and to foster the application of these
sequences in the MR community.
Background: Renal disease comprises a wide variety of different etiologies ranging from purely vascular disease to parenchymal including also combined diseases. This is why conventional MR imaging is not able to differentiate between
the different entities. In this case functional MR techniques are often very helpful.
In the previous two years more than 150 patients with suspected renal disease
underwent a comprehensive renal MR examination at our institution. This exhibit
will demonstrate typical functional imaging findings in a variety of diseases.
Imaging Findings: All imaging procedures were performed on a 1.5 T scanner
(Siemens Sonata and Avanto). The functional techniques presented include contrast enhanced (standard Gd-chelates) techniques such as time-resolved MRA
(TREAT), renal perfusion measurements (TurboFLASH) and renal function studies (TurboFLASH). Imaging findings of renal transplant dysfunction, ischemic
nephropathy, chronic renal infection, medullary sponge kidney and renal artery
stenosis therapy monitoring are demonstrated. The possible applications for future non-invasive functional techniques such as arterial spin labeling techniques
and blood oxygenation level dependant (BOLD) techniques are demonstrated as
well.
Conclusion: Functional MR imaging of the kidneys allows better characterization of renal disease and enhances conventional MR examinations of the kidneys. Therefore these techniques should be applied more often.
Hereditary forms of renal cancer: A pictorial essay

S. Puppala, C. O'Donnell, C. Evans; Cardiff/UK (puppalasapna@hotmail.com)
Learning Objectives: 1) To be familiar with the occurrence of hereditary forms of
renal carcinoma. 2) To illustrate their broad spectrum of usual and unusual imaging features. 3) To understand the significance of radiological imaging on the
clinical management.
Background: Hereditary forms of renal carcinoma (HRC) occur in a small number
of patients. Familiarity with their occurrence is important, due to their multifocal
nature and involvement of other organs such that further comprehensive imaging
of the kidneys as well as other organs can be undertaken. The diagnosis of HRC
also has a significant implication on the later management and follow-up of these
patients.
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Genitourinary
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Imaging Findings: We describe the usual, unusual and associated imaging features of hereditary forms of renal carcinoma such as hereditary papillary renal
carcinoma (HPRC), vonHippel-Lindau (VHL), hereditary leiomyoma renal cell
cancer (HLRCC) and Birt-Hogg-Dube' syndrome.
Conclusion: A review of the above conditions emphasises the importance of
awareness of the occurrence and role of imaging in hereditary forms of renal
carcinoma.
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MDCT including multi-planar reformatted CT images in evaluation of renal
infection in the adult and various conditions mimicking renal infection in
the adult
S. Ko; Jeonju, Chonbuk/KR (drksw6213@kornet.net)
Learning Objectives: 1 To illustrate the typical and various MDCT findings of
renal infection including pyelonephritis, emphysematous pyelonephritis, tuberculosis and renal abscess. 2 To illustrate various conditions mimicking renal infection in the adult including renal infarction, renal trauma, urinary tract obstruction,
renal neoplasms and artifact.
Background: Contrast enhanced CT is a sensitive diagnostic tool for the detection of renal infectious disease, for defining its accurate extent and for identifying
various complications. Contrast enhanced CT scans can also monitor progression or resolution of renal infection and guide interventional procedures. Especially in immunocompromised patients or diabetes mellitus, urinary tract infection
can be a life-threatening disease, therefore early and precise detection and treatment is very important.
Imaging Findings: In this exhibit, we will illustrate the typical and various MDCT
findings of renal infections in the adult including acute and chronic pyelonephritis, emphysematous pyelonephritis, tuberculosis and renal abscess. We will show
various conditions mimicking renal infection on MDCT including vascular disease, trauma, tumor and artifact.
Conclusion: MDCT can help to differentiate various renal infections in the adult
and also it can help to discriminate from various conditions mimicking renal infection.
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Usefulness of MDCT urography after excretory urography in obstructed
kidneys
C. Sebastia, S. Quiroga, A. Soldevila, H. Cuellar, A. Miranda, R. Boye;
Barcelona/ES (mcsebastia@vhebron.net)
Learning Objectives: To depict multiplanar and volume-rendered reconstructions by MDCT urography of obstructive lesions causing a dilated pelvicalyceal
system. To describe our excretory urography and associated MDCT urography
protocol. To demonstrate the diagnostic value of MDCT urography in patients
with delayed opacification and a dilated pelvicalyceal system at excretory urography.
Background: Excretory urography (EU) findings may be inconclusive in patients
with obstructive pelvicalyceal and ureteral lesions because the urinary system is
insufficiently contrasted. Study of patients in whom EU is inconclusive can now
be completed with MDCT urography for fast detection of the underlying obstructive lesion.
Imaging Findings: Since January 2004 MDCT urography has been used in all
cases of delayed enhancement and dilated pelvicalyceal system detected with
EU. MDCT urography was performed immediately after EU in 68 patients, with a
correct diagnosis in all cases.
In this exhibit we describe the EU-MDCT urography protocol and show the obstructive lesion by means of MDCT urography reconstructions (multiplanar, shaded
surface display and volume rendering). We present cases of ureteral stones, ureteral and bladder tumors, primary and metastatic retroperitoneal tumors that encompass the ureter, ureteropelvic junction obstruction, pelviureteral clots,
postoperative or postradiation ureteral structures, retroperitoneal fibrosis, retrocaval ureter, acute and chronic infections (e.g., tuberculosis and xantogranulomatous pyelonephritis) and papillary necrosis.
Conclusion: In patients with delayed contrast excretion and pelvicalyceal dilatation at EU study, MDCT urography performed immediately after EU is useful for
detecting the underlying obstructive cause and reduces the time required to attend the patient.
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Pictorial review of unusual renal tumours with radiologic-pathologic
correlation
A. Donuru, V.V.R. Kandula, H. Obaid, A. Mcgregor; Leicester/UK
Learning Objectives: This poster presents the radiological findings of a wide
range of unusual renal tumours, with pathological correlation to help develop an
imaging algorithm in making a specific diagnosis.
Background: We reviewed imaging findings in 360 cases of renal neoplasms
diagnosed in our institution between January 2000 to June 2005, and identified
cases of unusual renal neoplasms.
Imaging Findings: The common tumours were renal cell carcinoma (237), adenocarcinoma (162) and transitional carcinoma (53). Less common tumours included myeloma (32), oncocytoma (21) and Wilms' (18). Cases illustrated include,
sarcomas, non-osseous Ewing's primitive neuroectodermal tumour, neuroendocrine tumour, metastatic carcinoma, melanoma, myeloma, squamous carcinoma, collecting duct carcinoma and multifocal TCC. We believe that
radiological-pathological correlation can help the radiologist understand the imaging features better. Patient management can be better directed by pre-operative differentiation.
Conclusion: Cross-sectional imaging plays an important role in the diagnosis
and staging of renal tumours. Although renal cell carcinoma, transitional cell carcinoma and adenocarcinoma comprise the majority of renal tumours, it is important to identify less common renal neoplasms as they have different prognoses
compared to the common renal tumours.
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The nephrogram: How to understand renal and perirenal abnormalities
through the pathophysiology of contrast media renal transit
A.L. Valentini, F.M. Danza, A. Bernardini, A. Magistrelli, C. Di Stasi, L. Bonomo;
Rome/IT (alvalentini@rm.unicatt.it)
Learning Objectives: To help the reader in understanding various renal and perirenal pathological conditions by explaining the underlying pathophysiological
changes of contrast media (CM) intra-renal transit. To explain normal and abnormal findings and to introduce atypical conditions such as "disturbed" and "cortical" nephrogram and their possible pathophysiological interpretation.
Background: Iodinated intravascular CM are normally excreted by passive glomerular filtration. Different phases are easily recognizable within the kidney during
CM administration. As CM fills capillaries, peritubular spaces and cortical tubular
lumina, "parenchymogram phase" develops and renal cortex is clearly distinguishable from the medulla. As CM enters loops of Henle and collecting tubules, differentiation between cortex and medulla is lost ("nephrographic phase"). With CM
excretion into collecting tubules the "pyelogram" becomes clearly visible. Alterations of these three phases can be used to detect and to understand several
renal and peri-renal pathological conditions.
Imaging Findings: The onset and type of parenchymogram, nephrogram and
pyelogram as well as the presence of renal or peri-renal pathology are analyzed.
Focal or diffuse alterations in CM delivery and excretion result both in quantitative (increased, decreased or persistent density) and qualitative abnormalities
(striation, cortical rim) of renal enhancement phases. Special attention is paid to
the nephrographic phase and "cortical nephrogram" where a particular interpretation for CM pathophysiology can be proposed (excretion of CM by the tubular
cells).
Conclusion: Parenchymogram, nephrogram and pyelogram alterations can be
related to different pathologies. To correctly interpret these signs understanding
the physiopathology of CM renal transit and excretion is mandatory. Their correlation with renal and peri-renal diseases is an useful diagnostic tool.
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MR imaging of benign renal masses
A.E. Mahfouz, T. Salem, H. Sherif; Doha/QA (mahfouzae@yahoo.com)
Learning Objectives: To learn the imaging features of the different benign renal
masses on MR imaging.
Background: Benign renal masses need to be recognized on imaging studies in
order not to be managed by radical surgery. The present exhibit illustrates the
MR imaging findings in wide variety of benign renal masses.
Imaging Findings: The spectrum of lesions presented include typical and atypical renal cysts, giant Mullerian duct cyst adherent to the kidney, angiomyolipoma, oncocytoma, renal abscess, renal infarction, subcapsular renal hematoma,
multilocular cystic nephroma, juxtaglomerular renin-secreting tumor, and renal
pseudotumor due to giant column of Bertin.

Conclusion: Due to its multi-planar capability and sensitivity to different types of
tissue components, such as fluid, blood degradation products, fat, and fibrous
tissue, MR imaging may be useful in diagnosis of benign renal masses.
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Effects of ascorbic acid on prevention of contrast-induced nephropathy
(CIN) in patients receiving low osmolar versus isosmolar iodinated contrast
media
K. Spargias, E. Alexopoulos, S. Kyrzopoulos, A. Manginas, V. Voudris,
G. Pavlides, D. Cokkinos; Athens/GR (spargias@ocsc.gr)
Purpose: To evaluate the effects of ascorbic acid (AA) on CIN prevention in renally impaired patients undergoing coronary angiography or intervention with lowosmolar or iso-osmolar contrast media (CM).
Methods and Materials: 231 patients with baseline serum creatinine (SCr)
1.2 mg/dL were randomised to AA or placebo. Iodixanol (iso-osmolar CM) was
utilized in 144 patients: 69 received 3 gm chewable AA and 75 placebo 2 hours
pre- procedure, then 2 gm AA or placebo the night and morning after. The remaining 87 received low-osmolar non-ionic (iomeprol, n = 40; iobitridol, n = 30;
iopentol, n = 8) or ionic CM (ioxaglate, n = 9): 49 received AA, 38 placebo. All
patients received 50-125 mL/h saline iv from randomization to 6 hours post-procedure. Mean CM and saline volumes were similar between groups. CIN was
defined as absolute rise of SCr 0.5 mg/dL or relative rise 25% from baseline
within 2-5 days post-procedure. Chi-square test was used for categorical variables, independent or paired t-tests for continuous variables.
Results: Overall CIN incidence was 14.6% for iso-osmolar iodixanol vs 14.1%
for low-osmolar CM (iomeprol 10%; iobitridol 10%; iopentol 50%); 22.2% for
ioxaglate. In patients receiving AA, overall CIN was 9.3% vs 20.4% in patients
receiving placebo. For iodixanol, the incidence of CIN was 7.4% for patients given AA vs 21.6% for placebo (p = 0.02). The corresponding incidences for low
osmolar CM were 9.1% and 21.2%, respectively (p = 0.19). No patients required
dialysis postprocedure.
Conclusion: No differences in CIN incidence were apparent among patients receiving iodixanol and low osmolar CM. The preventative effect of AA was similar.
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Imaging spectrum of diseases associated with the renal pelvis
Y.-W. Kim, H.-S. In, S. Choi, S.S. Han; Busan/KR (sunny-star@hanmail.net)
Learning Objectives: To describe the normal anatomy of and around the renal
pelvis. To list a broad spectrum of lesions that involve the renal pelvis. To review
and illustrate the spectrum of pathology affecting the renal pelvis.
Background: The renal pelvis is part of the urinary system and is surrounded by
the kidney parenchyma, adipose tissue, lymphatics, nerve fibers, fibrous tissue
and vessels. Various pathological conditions can occur in these structures in the
renal pelvis and surrounding renal parenchyma.
Imaging Findings: Pathological conditions of the renal pelvis are divided into
several categories: 1 Inflammatory lesions including pyogenic abscess, granulomatous infection, xanthogranulomatous pyelonephritis and emphysematous
pyelonephritis. 2 Cystic lesions including parapelvic cyst. 3 Neoplasms originating from the renal pelvis such as transitional cell carcinoma and extending from
renal parenchyma such as renal cell carcinoma, Wilms' tumor and hematogenous metastases. 4 Congenital lesions including ureteropelvic junction obstruction and renal pelvis duplications. 5 Calculi including staghorn stones and renal
pelvis stones associated with duplications and horseshoe kidneys. 6 Vascular
lesions including renal artery aneurysm and arteriovenous malformation.
Conclusion: This exhibit will present the characteristic radiological features of
various renal pelvis lesions on ultrasound, CT and MRI.
Value of preoperative MSCT imaging of venous spread of renal cell

carcinoma (RCC)
R. tern Padovan, D. Perkov, R. Smiljanic, V. Duspara, I. Sjekavica,
B. Oberman; Zagreb/HR (drazen.perkov@zg.t-com.hr)
Purpose: To analyze the findings of MSCT in venous spread of RCC, to determine the superior extent of tumor thrombus and to compare MSCT with surgical
findings.
Methods and Materials: A prospective study was performed on 31 patients (19
males and 12 females; age range 39 - 80 years; mean age 62.6 years), in a 3 year
period, who were diagnosed with venous spread of RCC on multislice CT. RCC
was previously detected by US in all patients and afterward they were preoperatively scanned with triphasic MSCT protocol. All images were read by two independent radiologists. MSCT diagnosis was compared with surgical findings.
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Pearls and pitfalls in imaging pelvi-ureteric junction (PUJ) obstruction
C. Cronin, D. Lohan, N. Gough, E. Kelliher, C. Roche, P. McCarthy; Galway/IE
(carmelcronin2000@hotmail.com)
Learning Objectives: Review the clinical, pathological and imaging manifestations of PUJ Obstruction. To diagnose PUJ obstruction, both anatomic and functional studies are necessary. As no single investigation is without fault, we will
discuss the associated imaging difficulties and dilemmas encountered (false positive and negative results, imaging limitations). Provide a concise diagnostic algorithm to manage (conservative and interventional) this dynamic disease process.
Background: Complications of PUJ obstruction can have serious outcomes
should they go untreated. The major morbidity is progressive renal injury due to
relative ischemia from the compensatory response of decreased renal blood flow
and GFR. Long-term squelae include glomerular sclerosis, proteinuria, hypertension and chronic renal failure. Timely and accurate diagnosis is therefore paramount.
Imaging Findings: We will provide a pictorial and educational exhibit of the radiological appearances of this condition on a variety of imaging techniques, from
intravenous and retrograde pyelography, DTPA renography, ultrasound, noncontrast and contrast enhanced CT, MR imaging and angiography. Highlighting the
specific sources of difficulty in each e.g. the effect of obstruction on assessment
of DTPA renograms, false positive IVP results due to dilated, non-obstructed systems that are slow to drain, value of delayed films revealing an intermittent obstruction and in CT, erroneous results as a result of dilated collecting systems
without true functional obstruction. We will illustrate the value of each particular
imaging technique, in the arrival at a confident diagnosis.
Conclusion: Awareness and early identification allows for appropriate management and significantly reduced patient morbidity. We provide an interesting, informative and concise radiological guide.
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The diagnostic value of unenhanced helical CT urography in acute renal
colic
W. Chmielewski; Warsaw/PL (wlodekch@hotmail.com)
Learning Objectives: To illustrate the diagnostic value of unenhanced CT urography in patients with acute renal colic when plain X-ray of the urinary tract as
well as ultrasonography (US) are negative or unclear.
Background: 520 patients with acute unilateral renal colic were diagnosed in
our department between January 2004 and September 2005. Unenhanced CT
urography with coronal multiplanar reconstruction (MPR) was performed in 182
cases when calculi in the urinary tract were not visible on plain X-ray or US (various grade hydronephroses were found in 102 cases in US). CT protocol and
findings are described and illustrated.
Imaging Findings: Calculi were present in the proximal, mid and distal ureter in
12, 19 and 127 cases respectively. Concurrent renal calculi were seen in 59 cases with ureteric stones, hydronephrosis in 122 cases. In 12 patients pararenal
inflammatory changes with fluid but without calculi in the urinary tract were found
(slight dilatation of collecting system was observed in 7 cases). Alternative causes of pain were found in 9 cases (acute appendicitis 3, acute cholecystitis 3,
pleuritis 1, bowel strangulation 1, bleeding from an abdominal aortic aneurysm
1). CT was negative in 3 cases (1.7%). CT reports were compared with ureterography, ureteral endoscopy and clinical findings.
Conclusion: Unenhanced helical CT urography is a useful modality for diagnosis of patients with acute renal colic. CT is more sensitive in visualisation of calculi in the urinary tract than plain X-ray and US.
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Genitourinary
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Results: MSCT findings showed right-sided tumor in 19 (61%) patients and leftsided in 12 (39%) patients. Tumor thrombus extension into renal vein only (T3b
stage) was found in 13 (42%) patients, into the infradiaphragmatic level of the
inferior vena cava (IVC) (T3c stage) in 14 (45%) patients and supradiaphragmatic level of the IVC (T4b stage) in 4 (13%) patients. 27 patients underwent surgery
and in 4 patients surgery was not performed. 25 patients were correctly diagnosed by MSCT in comparison with the intraoperative report (93% accuracy) and
2 patients were falsely diagnosed by understaging the extension.
Conclusion: MSCT is presently the best and the fastest technique for evaluating
the venous spread of RCC, as well as for planning the surgical procedure. After
US screening, triphasic MSCT gives enough information about abdominal and
venous tumor spread. Surgery is required as soon as possible for MSCT finding
to be valid.

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Cystic renal neoplasms: Conventional and urographic magnetic resonance
(MR) patterns
G. Cardone, A. Cestari, G. Guazzoni, P. Mangili, G. Balconi; Milan/IT
(cardoneg@tin.it)
Learning Objectives: To illustrate conventional and pyelo-urographic MR patterns in the evaluation of cystic renal neoplasms. To evaluate the effectiveness of
MR sequences in the diagnosis of cystic renal neoplasms.
Background: 16 pts with cystic renal cell carcinomas were analysed. All patients
underwent conventional MR morphologic GRE T1w and TSE T2w sequences,
ce-dynamic GRE FS-T1w MR sequences and urographic 3D ce-GRE FS-T1w
sequence. ce-T1w images were also evaluated before and after digital subtraction. The urographic images were subsequently post-processed with an independent workstation and multiplanar reconstructions as well as 3D reconstructions
using MIP algorithm were obtained.
Imaging Findings: Renal cystic neoplastic lesions were visualised as a cyst
with small solid papillomas on the cyst wall in 25% of the cases, as a cyst with
thick septa in 31% of the cases and as a multilocular cyst in 44% of the cases.
Lesions appeared more evident on TSE T2w, ce-FS-GRE T1w and in particular
on subtracted ce-FS-GRE T1w images. Lesions resulted as quite vascularized;
nevertheless, vascularization was more evident on subtracted ce-FS-GRE T1w
images.
Conclusion: In conclusion, the most significant MR patterns in the evaluation of
renal cystic neoplastic lesions were the presence, the appearance and the vascularity of septa and or inner wall irregularities of the cysts. The most effective
MR techniques were TSE T2w and subtracted ce-FS-GRE T1w sequences.
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Laparoscopic cryoablation (LC) of small renal masses: Postoperative
complications evaluation by multi detector row computed tomography
(MDCT) imaging
G. Cardone, A. Cestari, L. Nava, G. Guazzoni, P. Mangili, G. Balconi; Milan/IT
(cardoneg@tin.it)
Learning Objectives: To report the spectrum of postoperative complications in
patients treated with laparoscopic renal cryoablation. To illustrate the MDCT findings for postoperative complications in patients treated with laparoscopic renal
cryoablation.
Background: MR is an effective tool for imaging follow-up of renal lesions treated with laparoscopic cryoablation (LC). Nevertheless in some cases, such as
patients affected by claustrophobia or patients with absolute contraindications to
MR, CT can be a second choice. Here we report the multidetector computed
tomography (MDCT) imaging findings during the follow-up of patients who underwent laparoscopic renal cryoablation for small renal lesions.10 pts with 11 renal
masses, treated with renal LC, underwent MDCT follow-up 24 hrs after surgery
and at 1, 3, 6, 12 and 18 months. MDCT examinations were performed using
unenhanced and postcontrast axial scans with multiplanar reconstructions.
Imaging Findings: After surgery retroperitoneal fluid and pleural effusions were
found in all cases. Early postprocedure MDCT images showed incomplete
ischemia of cryolesions in 20% of the cases, with small intralesional enhancement, which disappeared afterwards in the following months. In all the cases a
small perilesional haematoma was present until 3 months after surgery.
Conclusion: Our experience suggests that LC is a safe and minimally invasive
therapy for small renal masses and MDCT can be used as an alternative choice
to MR in the evaluation of lesions treated with LC in patients with relative or
absolute contraindications to MR imaging.
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Retroaortic left renal vein and its relationship with pelvic varices
Z. Koc, S. Ulusan, L. Oguzkurt; Yregir / Adana/TR
(zaferkoc@superonline.com)
Purpose: To investigate the possible association of pelvic varices and the presence of retroaortic left renal vein (RLRV).
Methods and Materials: Routine abdominal multidetector row CT scans of 324
women (mean age 56 years) were analysed. The presence of RLRV was recorded, diameters of the LRV, the ovarian veins and the para-uterine veins were measured. The ratios of left renal vein (LRV) diameters between the two portions (lateral/
aortomesenteric or retroaortic) were obtained. Presence and degree of the ovarian vein reflux were noted. These data were then compared to women with and
those without RLRV. Chi-square test and Pearson correlation test were used for
statistical analysis.
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Results: Fifty-nine (18%) of 324 patients had pelvic varices. RLRV was identified
in 19 of these patients. Pelvic varices were identified in 7 (37 %) of the 19 patients with RLRV. There was a correlation between the diameter ratio of the LRV
with the pelvic varices (P < 0.001) and left ovarian vein reflux (P < 0.001). If the
diameter ratio was 2, this association was stronger. Pelvic varices were found
more frequently in patients with RLRV (P = 0.03).
Conclusion: This study revealed that diameter ratio of the left renal vein was well
correlated with the pelvic varices and left ovarian vein reflux. Pelvic venous congestion was more frequently seen in patients with retroaortic renal vein.
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< 4 cm) solid or complex
Contrast enhanced ultrasonography of small (<
cystic renal lesions
H. Moschouris, D. Kalikis, I. Kornezos, P. Gialias, I. Katsimilis, A. Spyridonos,
M. Khalili, D. Matsaidonis; Piraeus/GR (hipmosch@in.gr)
Learning Objectives: To illustrate the findings of contrast-enhanced ultrasonography (CEUS) of small renal lesions other than simple cysts. To underline the
advantages and limitations of CEUS in the delineation and characterization of
the lesions.
Background: The frequency of detection of small renal lesions has rapidly increased with the wide use of modern cross-sectional imaging methods. Nevertheless, problems regarding the detection and the differential diagnosis of these
lesions are still common. This exhibit is based on the findings of CEUS of 21
renal lesions (mean diameter 3.6 0.3 cm). 11 of them proved to be renal cell
carcinomas (RCCs), 4 angiomyolipomas (AMLs), 3 hemorrhagic renal cysts
(HRCs) and 3 pseudolesions (PLs). The lesions were studied before and after i.v.
administration of a last generation ultrasound contrast agent (SonoVue, Bracco).
Imaging Findings: 9 of the RCCs enhanced to the same degree as renal parenchyma but 7 of them showed some indicative features (small necrotic areas, pseudocapsule, abnormal vasculature). 2 RCCs enhanced considerably less than the
kidney and were better outlined. HRCs lacked enhancement and could be differentiated from neoplasms. AMLs could not be differentiated from RCCs on the
basis of enhancement characteristics. PLs followed the enhancement of normal
renal parenchyma.
Conclusion: CEUS is potentially useful in the diagnosis of some PLs and HRCs
which may mimic neoplasms. It may provide additional information regarding the
architecture of RCCs and facilitate the detection of a small percentage of them.
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Static fluid and contrast enhanced magnetic resonance urography in the
evaluation of renal transplant patients with urological complications
D. Blondin, A. Kster, G. Hetzel, K. Andersen, A. Saleh, U. Mdder,
M. Cohnen; Dsseldorf/DE (blondin@med.uni-duesseldorf.de)
Purpose: To retrospectively assess image quality, sensitivity and specificity of
static fluid MR-Urography (T2-MRU) and contrast enhanced T1-weighted MRU
(CE-MRU) in the evaluation of renal transplant patients with urological complications.
Methods and Materials: From 01/2000 to 12/04, 55 MRU were performed in 47
patients with decreasing renal transplant function. Examinations were performed
on a 1.5 T MR scanner (Magnetom Vision, Siemens Medical Solutions, Germany) including axial T2w and coronal T1w images before and after intravenous
gadopentetate dimeglumine (Magnevist, Schering, Germany). Retrospective
evaluation of T2-MRU (coronal 512-matrix) and CE-MRU (512-Matrix, Flash3D)
was done by two blinded readers in consensus. MIPs of both sequences were
rated according to image quality and diagnostic reliability on a subjective 5 pointscale. MR findings were related to sonography, operative reports or clinical
follow-up.
Results: A total of 35 patients with 43 MRU were evaluated. Hydronephrosis was
found in 29 MRU (22 patients) due to lymphoceles (n = 10), urinoma and anastomotic leak (n = 2), ureteric obstruction or stenosis (n = 16), or hematoma (n = 1).
These results were verified by operation (N=16), by sonography or clinical follow-up.
Urinary bladder (p < 0.005) was better visualized at T2-MRU, while the pelvicalyceal system (p < 0.002) and ureter (p < 0.003) were more clearly seen on CEMRU. T2-MRU showed less correlation to clinical findings than CE-MRU. Using
the complete dataset, sensitivity and specificity reached 95%, respectively.
Conclusion: MRU has a high sensitivity and specificity in the evaluation of renal
transplant patients with urological complications. However, T2-MRU or CE-MRU
alone are not sufficient to safely establish a definite diagnosis.

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Genitourinary
Stepwise approach to renal masses

M. Kim, J. Kim, S. Park, K. Cho; Seoul/KR
Male
Learning Objectives: To know the advantages and limits of various imaging techniques. To discuss how to approach the renal mass in various imaging modalities.
To demonstrate specific imaging findings crucial for diagnosing various renal
masses.
Background: Detection and differentiation of renal masses is very important to
establish a treatment strategy. First great care should be taken in selecting imaging modalities for detection and diagnosis of renal masses. Secondly appropriate
imaging acquisition protocols should be applied. Thirdly qualitative and quantitative analysis should be performed to decide whether surgical treatment should
be given or not.
Imaging Findings: There are various imaging modalities for renal mass evaluation including ultrasonography, CT and MR imaging. In each modality imaging
acquisition protocol may be variable but heavily affect the diagnostic performance. Some specific protocols in MR imaging and specialized quantitative analysis of CT and US imaging may be helpful to allow accurate diagnosis. Furthermore,
wide understanding of the artefacts and pitfalls of these various modalities is
also important in imaging interpretation.
Conclusion: In this exhibition, we will introduce both the advantages and disadvantages of various imaging modalities for renal mass evaluation and then suggest the correct way to evaluate renal masses. Also some specific imaging findings
and protocols to improve diagnostic performance will be illustrated.
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Sarcomatoid type renal cell carcinomas: Multidetector CT findings in nine
patients
K. Kim, K. Kim, C. Lee, J. Choi, C. Park, I. Cha; Seoul/KR
(rudals97@hanmail.net)
Purpose: Sarcomatoid type renal cell carcinoma (RCC) is not a distinct histological entity and represents high-grade transformation in different subtypes of RCC.
The presence of a sarcomatoid component in a RCC is widely considered to be
a poor prognostic sign. The purpose of this work is to evaluate multidetector CT
(MDCT) findings of this malignancy with clinicopathological features.
Methods and Materials: MDCT images and clinical histories of nine patients
with pathologically proven sarcomatoid type RCC were retrospectively studied.
The patients included seven men and two women, mean age 67 years (range 4383 years).
Results: The mean size of the tumor was 7.4 cm with a range of 3.5 - 11 cm.
Sarcomatoid RCC involved the left kidney in seven (78%) of nine cases and the
right kidney in the other two cases. Cortical involvement was present in eight
cases (89%). The reniform contour of the kidney was preserved in four cases
(44%). Tumor showed an infiltrative appearance in six cases (67%), but an expansile component was also present in three of these cases. A cystic component
was present in seven cases (78%). Tumor showed poor contrast enhancement in
six cases (67%). Follow-up CT within one year after operation showed local recurrence in two and distant metastasis in five.
Conclusion: Infiltrative appearance, cystic component and hypovascularity are
characteristic findings of sarcomatoid type RCC on MDCT, although different types
of RCC cannot be reliably distinguished with imaging studies. They showed an
aggressive clinical course including early local recurrences and distant metastases.
Transrectal ultrasound (TRUS) of prostate cancer (PRCA): A multimedia

DVD-Rom-based educational tool and database: Sonographic-pathological
correlation
P.S. Zoumpoulis, D. Alexopoulos, A. Plagou, D. Leli, P. Karavitis, E. Tako,
K. Pahos, A. Filippidou; Athens/GR (echo@hol.gr)
Learning Objectives: To demonstrate the role of TRUS in diagnosing prostate
lesions. To present TRUS prostate echoanatomy, semiology and haemodynamics of PrCa. To reach a sonographic diagnosis using algorithms. To provide comparison of an US image with images of the database.
Background: Since TRUS is the most efficient way to detect prostate cancer
(PrCa) this e-book aims to teach the TRUS procedure in detection and staging of
PrCa and correlate it with the histological findings emphasizing the use and effectiveness of USCA and local anesthesia prior to biopsy sampling.
Imaging Findings: This medical e-book is a multimedia DVD-Rom based teaching file featuring 2500 US prostate images, 150 US video demonstrations, 400
video cases presenting clinical data and detailed description of TRUS techniques;
chapters on prostate anatomy, TRUS technique for the detection and staging of
PrCa (based on over 10,000 cases), Color Doppler, the technique of US-guided
biopsies. The proper TRUS technique is demonstrated step by step. Its educational role is based on video cases and double video presentations. The latter
consist of a simultaneous presentation of the real time ultrasound exam and the
examiner's technique. A database is included, aiding the user to reach the correct diagnosis and to compare his sonographic image to histologically proven
images of the database.
Conclusion: User-friendly DVD-Rom based teaching file on the prostate with
chapters on anatomy, pathology, ultrasound physics, sonographic appearance of
the normal prostate, TRUS morphology, detection and staging of PrCa, local anesthesia, USCA and comparative database.
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MR imaging and H MR spectroscopy in the evaluation of prostate cancer
G. Regine1, M. Atzori1, A. Cortese 1, M. Prata 2, C. Pace1, L. Adami1, V. Buffa1;
1
Rome/IT, 2Sora/IT (g.regine@tin.it)
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Prostate carcinoma and transrectal ultrasound: A crash course for the
radiologist
N. Ramachandran, J. Raja, G. Munneke, U. Patel; London/UK
(navin1976@gmail.com)
Learning Objectives: 1. Identify the zonal anatomy of the prostate gland and its
anatomical relations. 2. Differentiate the appearances of the prostate gland on
TRUS, MR imaging and CT. 3. Recognise the signs of prostate cancer on TRUS.
4. Describe novel approaches to improving the diagnostic accuracy of TRUS.
Background: Prostate cancer is the most common cancer in British males. However, the prostate remains an enigma to many radiologists. Computed tomogra-
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Genitourinary
Purpose: To evaluate the diagnostic performance of MR and MR spectroscopy in

the evaluation of prostate cancer.
Methods and Materials: Between April-September 2005 MR and MR Spectroscopy were performed in 38 patients enrolled on the basis of PSA value, rectal
exploration and transrectal ultrasound. The examinations were performed with a
1.5 T imager with endorectal coil, without intravenous contrast injection, using
the following sequences: Axial and coronal T2 FSE, from seminal vesicles to the
prostate apex, axial T1 SE with the same spatial coordinates as the T2, axial T1
SE from aortic bifurcation to the prostate apex and PRESS 3D CSI (spectroscopy sequence).
Results: The MR imaging detected 25/38 positive cases for carcinoma, the integrated imaging (MR+MR Spectroscopy) improved the total positive cases up to
32, the transrectal biopsy confirmed 29/38 cases (in the three false positives at
MR Spectroscopy the biopsy demonstrated prostatitis), 8 cases were negative
for carcinoma. The results of MR Spectroscopy showed a linear correlation with
tumour grade (Gleason score).
Conclusion: Our experience confirms the optimal diagnostic accuracy of integrated MR imaging in the diagnosis and staging (based on local extension) of
prostate cancer; moreover the technique offers the possibility of optimizing treatment planning.

phy (CT) and magnetic resonance imaging (MRI) may visualize the gland, but the
most widely used imaging modality is currently transrectal ultrasound (TRUS).
The sonographic appearance of prostate cancer varies greatly however, ranging
from hyperechoic to hypoechoic and isoechoic lesions, leading to some diagnostic difficulty.
Imaging Findings: This pictorial review provides a refresher of prostate zonal
anatomy and its anatomical relations using a combination of 3-dimensional raytraced models, CT, MR imaging and TRUS images. The various appearances of
prostate cancer on TRUS are discussed, as are novel approaches to improving
its diagnostic accuracy.
Conclusion: The diagnosis of prostate cancer by imaging alone remains challenging, but recent advances in TRUS imaging may improve diagnostic accuracy.
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Prostatic masses with high signal intensity on T2-weighted MR images:
Differential diagnosis
J. Chae, S. Kim, S. Kim, D. Jung; Seoul/KR (sunhk@radiol.snu.ac.kr)
Learning Objectives: 1) To understand the pathological categories of prostatic
masses that show T2-high-signal-intensity on MR images. 2) To learn the MR
imaging features that help with the differential diagnosis.
Background: We know that carcinoma of the prostate shows low signal intensity
(SI) in the background of high-SI-peripheral zone on T2-weighted MR images.
This SI pattern helps radiologists to localize the tumor and to correctly T stage it.
However many prostatic masses, even adenocarcinomas, can show high SI on
T2-weighted images. They usually show low SI on T1-weighted images, which is
common in cystic masses, but some solid tumors also show similar signals. In
such cases, tumors can mimic non-neoplastic cysts, and vice versa. Furthermore this interferes with correct T-staging of malignant tumors.
Imaging Findings: Of the variants of adenocarcinomas of the prostate gland,
mucinous adenocarcinomas and carcinomas with endometrioid feature can show
this SI pattern. Various sarcomas also manifest as T2 high and T1 low SI masses,
among which rhabdomyosarcoma is the most common. Benign tumors of the
prostate are rare but cystadenoma, hemangioma and lymphangioma can show
cyst like MR signals. Cystic change of benign prostatic hypertrophy is sometimes
difficult or can even be impossible to differentiate from tumors with T2 high SI.
Abscesses are representative of non-neoplastic masses with T2 high SI and prostatic cysts, usually from congenital or infectious origin are also included in this
category.
Conclusion: Various tumors and non-neoplastic masses, solid or cystic, can show
T2-high SI. Knowledge of these entities can help to make the correct diagnosis
and manage patients properly.
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How to efficiently perform transrectal ultrasound (TRUS) and TRUS guided
biopsy of the prostate: Step by step DVD-Rom based visual guide
P.S. Zoumpoulis, D. Alexopoulos, D. Leli, E. Tako, H. Tragea, K. Pahos,
P. Karvitis; Athens/GR (echo@hol.gr)
Learning Objectives: To teach a physician who does not know ultrasound how
to use TRUS in diagnosing prostate lesions. To present TRUS prostate echoanatomy, semiology and haemodynamics of PrCa. To underline the significance of
procedural methods such as probe, probe protection, probe manipulation and
anesthesia administration. To establish a safe and credible procedure that minimizes complications and ensures true positive results.
Background: This e-book aims to teach the TRUS procedure in detection and
staging of PrCa, since TRUS is the most efficient way to detect prostate cancer
(PrCa).
Procedure Details: This medical e-book is a multimedia DVD-ROM based teaching file that illustrates the steps taken to perform a transrectal ultrasound exam
and a transrectal guided biopsy. A detailed description of TRUS techniques, TRUS
technique for the detection and staging of PrCa (based on over 20,000 confirmed
cases), color Doppler, as well as the technique of US guided biopsies is provided
in a user friendly manner. The proper TRUS technique is demonstrated step by
step. Educational double video presentations of both techniques including a simultaneous presentation of the real time ultrasound exam and the examiner's
technique from the beginning of the exam till the end. A database is included,
aiding the user to reach the correct diagnosis and to compare his sonographic
image to histologically proven images of the database.
Conclusion: User friendly DVD-ROM based visual guide with step by step instructions on how to perform a TRUS examination of the prostate and attain biopsy samples by using TRUS guidance.
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Testicular microlithiasis: A prospective study. Is ultrasound follow-up
necessary?
L. Siddique, J. Richenberg; Brighton/UK (Jonathan.Richenberg@bsuh.nhs.uk)
Purpose: Testicular microlithiasis (TML) has been reported to have high association with testicular cancer. Our aim in this study is to show that following up TML
patients with ultrasound on a yearly basis to monitor development of testicular
cancer is unnecessary.
Methods and Materials: In Brighton and Sussex University Hospitals NHS Trust,
2656 men were referred for scrotal ultrasound over the period January 2000 to
December 2004. Of the 2656 men, 51 had TML. The 51 men were followed up by
a single radiologist on a recommended yearly basis. The results were recorded
as TML grade at presentation, unilateral or bilateral, any adjunct pathology found
on the scan and whether there was any change on follow-up, especially whether
any developed testicular cancer.
Results: 51 out of 2656 men (1.92%) had TML on presentation. Their age range
at presentation was 15 to 83 years (mean 41 years). The number of ultrasounds
performed on each patient ranged from 1 to 8 (mean 3.33). They were followed
up between 3 to 76 months (mean 33.29 months). During the time period of
follow-up none developed testicular cancer.
Conclusion: This prospective study has shown that regular sonographic surveillance is not required for patients with TML.
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Combined endorectal morphological MR and 3D MR spectroscopy in the
evaluation of prostate cancer
R. Chrzan, A. Urbanik, Z. Dobrowolski; Krakow/PL (rchrzan@mp.pl)
Purpose: The aim of the study was to assess the value of 3D MR spectroscopy
combined with endorectal morphological MR in the evaluation of prostate cancer.
Methods and Materials: MR imaging and 3D MR spectroscopy were performed
in 25 patients with a suspicion of prostate cancer on the basis of DRE, TRUS and
or the PSA levels, verified by biopsy after MR. The examinations were performed
with a 1.5 T GE Signa Excite scanner using an endorectal coil. We used axial
and coronal T2 FSE sequences, axial T1 SE sequences and PROSE (PROstate
spectroscopy and imaging examination) 3D sequences. In morphological assessment the criterion for cancer was low signal intensity within the peripheral zone
on T2-weighted images. In combined morphological and spectroscopic assessment the criteria for cancer were low signal intensity within the peripheral zone
on T2-weighted images and ratio of metabolites (Cho+Cr)/Cit > 0.86 in the lesion. The accuracy of combined morphological and spectroscopy imaging was
compared to the accuracy of morphological MR only.
Results: Specificity - 83%, PPV - 93%, NPV - 83% of combined morphological
and spectroscopy MR assessment in the detection of prostate cancer were higher than corresponding values of morphological MR only (specificity - 50%, PPV 81%, NPV - 75%).
Conclusion: The 3D MR spectroscopy improved the reliability of endorectal MR
in the diagnosis of prostate cancer. It may expand the application of MR to: Cases negative in initial TRUS/sextant biopsy (second biopsy of focus suspicious in
MR), relapse after radiotherapy.
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Diffusion-weighted imaging of prostate cancer
R. Shimofusa1, H. Fujimoto2, K. Motoori1, S. Yamamoto1, H. Ito1; 1Chiba/JP,
2
Numazu/JP (mofu@indigo.plala.or.jp)
Purpose: The purpose of this study was to assess whether T2-weighted imaging
with diffusion-weighted imaging could improve prostate cancer detection as compared with T2-weighted imaging alone.
Methods and Materials: The subjects consisted of 37 patients with prostate cancer and 23 without cancer undergoing magnetic resonance imaging. Using a 1.5T superconducting magnet, all patients underwent T2-weighted and
diffusion-weighted imaging with parallel imaging. Images were independently
reviewed by three readers to determine the detectability of prostate cancer. The
detectability of T2-weighted with and without diffusion-weighted imaging was
assessed by means of receiver operating characteristic analysis.
Results: Mean areas under the receiver operating characteristic curve for T2weighted imaging alone and for T2-weighted imaging with diffusion-weighted
imaging were 0.87 and 0.93, respectively. The receiver operating characteristic
analysis showed that the addition of diffusion-weighted imaging to conventional
T2-weighted imaging significantly improved tumor detection (P = 0.0468) compared with T2-weighted imaging alone.

Conclusion: The addition of diffusion-weighted imaging to conventional T2-weighted imaging provides better detection of prostate cancer.
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Scrotal high resolution ultrasound (HRUS) imaging: Identifying normal and
abnormal epididymis and vas deferens
L. Rocher, A. Giuria, C. Phan, A. Lesavre, A.-S. Rangheard, B. Bessoud,
A. Miquel, Y. Menu; Le Kremlin-Bictre/FR (laurence.rocher@bct.aphp.fr)
Learning Objectives: To learn the settings for HRUS. To learn normal anatomy
and variants of the epididymis and the vas deferens using high resolution ultrasonography. To recognize the main diseases affecting the intra scrotal genital
tract.
Background: 1500 scrotal HRUS were performed for different indications: Infertility, acute or chronic scrotal pain and palpation of a mass. Careful settings and
examination technique are crucial and will be detailed. Main diseases found were
related to infection, tumors, congenital or genetic abnormalities and previous
vasectomy.
Imaging Findings: Post infection findings were identified as echoic nodes associated with retrodilatation of the head and the tail, echoic moving sperm on dynamic images, as depicted on cine mode. Echoic inclusions of the wall of the vas
deferens were also found. Genetic or congenital malformations such as absence
of the vas deferens were visualized as a brutal interruption of the epididymis
associated with a multilocular pattern of the head. After vasectomy, the vas deferens is dilated with smooth contours, dilatation of rete testis and abrupt disruption of the vas deferens. Tumors and tumor like lesions are rare. The most common
is the benign adenomatoid tumor, which is a hypoechoic spherical lesion, with
intra tumoral vessels identified on color Doppler. Other lesions are epidermoid
cysts and schwannoma. Malignant tumors are exceptional.
Conclusion: HRUS requires some technical skills and dramatically improves
imaging of the epidymis and vas deferens, with basic anatomical knowledge and
adequate US technique. Most diseases of this organ can be clearly identified and
characterized by HRUS.
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Prostate cancer: Subtracted dynamic contrast-enhanced MR imaging
G. Cardone, C. Iabichino, L. Nava, M. Freschi, G. Guazzoni, P. Mangili,
G. Balconi; Milan/IT (cardoneg@tin.it)
Purpose: To evaluate the usefulness of digital subtraction procedure in the study
of prostate cancer using ce-dynamic MR imaging.
Methods and Materials: 30 patients with prostate cancer (Gleason score range
6-9) underwent MR evaluation before surgery. Corresponding pathological interpretation demonstrated 10% lesions located in the central zone and 90% lesions
located in the peripheral gland. All neoplastic lesions were bilateral. MR examinations were performed using TSE T1w, TSE T2w and dynamic ce-GRE T1w
sequences; ce-GRE T1w images were also evaluated after digital subtraction. All
examinations were performed using a dedicated endorectal coil.
Results: On conventional T2w MR images neoplastic lesions were evident in
80% of the cases; lesions were hypointense relative to surrounding prostatic tissue. On conventional dynamic ce-GRE T1w MR images neoplastic lesions were
evident in 85% of the cases. On subtracted dynamic ce-GRE T1w MR images
neoplastic lesions were evident in all the cases. On ce-T1w MR images 63% of
the lesions showed focal early enhancement compared with surrounding tissue;
37% of the lesions showed multifocal enhancement.
Conclusion: In conclusion subtracted dynamic ce-GRE T1w MR imaging can be
helpful in prostate cancer MR evaluation, allowing a better qualitative evaluation
of prostatic neoplasm contrast enhancement.
Imaging of testicular and paratesticular masses

L. Oleaga, J. Boyra, A. Angulo, M. Isusi, D. Grande; Bilbao/ES
(lauraoleaga@wanadoo.es)
Learning Objectives: 1) To review the US and MR imaging findings of testicular
and paratesticular lesions. 2) To demonstrate the various benign and malignant
testicular and paratesticular conditions.
Background: The majority of testicular lesions are germ cell tumors. Seminomas are generally well defined homogeneous lesions, whereas the nonseminomatous tumors have a much more varied appearance. Nonprimary tumors such
as leukemia, lymphoma and metastases can also manifest as testicular masses.
There is a variety of benign conditions that may mimic neoplasms including a
dilated rete testis, intratesticular cysts, epidermoid cysts, congenital adrenal hy-
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Significance of scrotal calcifications
C. Pozuelo1, O. Pozuelo2, L. Mones1, Y. Roca1, J. Quintero1, A. Torramilans2,
M. Romero1, D. Mulattieri1; 1Badalona/ES, 2Viladecans/ES
(crispozuelo@hotmail.com)
Learning Objectives: Evaluate the clinical and pathological significance of scrotal calcifications.
Background: We reviewed retrospectively 832 patients from our records between
January 2002 and September 2005. High resolution ultrasound examination was
performed with a high-frequency transducer. Scrotal calcifications were diagnosed
by sonographic criteria in 79 patients. Size, number and especially localisation
(testicular or extratesticular) were determined.
Imaging Findings: 54 extratesticular calcifications were found (15 in the epididymis, 33 in the tunica vaginalis and 6 in the appendages). These calcifications
are more frequently encountered and may be large, solitary or multiple and considered benign. In 25 patients calcifications were located within the testicular
parenchyma:16 cases of testicular microlithiasis, 7 tumors (1 seminoma, 1 teratoma, 1 teratocarcinoma, 2 embryonal carcinomas, 1 testicular fibrosis, 1 epidermoid cyst) and 2 ruptured testes with old hematoma or abscess.
Conclusion: Extratesticular calcifications are more frequently encountered. They
are usually benign and related to previous inflammatory disease. No changes
were seen in follow-up examinations. Calcifications within the testicular parenchyma, particularly if multiple and grouped were considered highly suspicious for
malignancy and surgery was mandatory.
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The male pelvis: A pictorial review by organ system of the anatomy and
radiological characterization of common and uncommon male pelvic
masses
M.A. Gonzalez, J. Szklaruk, P.M. Silverman, M. Patnana; Houston, TX/US
Learning Objectives: To illustrate the anatomical spaces and appearance of
normal anatomy of the male pelvis utilizing CT and MR imaging. To learn the CT
and MR imaging appearance of common and uncommon male pelvic masses.
Background: CT and MR imaging are commonly used for the evaluation of the
male pelvis. Understanding the anatomical spaces (i.e. peritoneal vs. extraperitoneal), tissue planes, and accurate localization to the organ of origin is of paramount importance in diagnosis and treatment planning. Knowledge of the staging,
clinical presentation, and the CT and MR appearance of common and uncommon pelvic masses are essential factors to reach the correct diagnosis.
Imaging Findings: This interactive electronic exhibit will present the MR and CT
appearance of common (i.e. adenocarcinoma of the prostate) and uncommon
male pelvic masses (i.e. cystosarcoma phylloides of the prostate) categorized by
organ system. The exhibit will also present radiological landmarks needed for
correct localization. The participant will select from a master menu a specific
organ of interest (i.e. prostate) and will then select from a list of topics that include anatomy, common, and uncommon pelvic masses. A brief description of
relevant clinical information including staging will be presented. The CT and MR
characteristic imaging features required for correct diagnosis will be discussed.
Conclusion: Upon completion of this exhibit the attendant will learn the importance of the anatomical landmarks for correct localization of pelvic masses and
the characteristic imaging features that will aid in reaching the correct diagnosis.
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perplasia and sarcoidosis. The paratesticular lesions are more frequently benign;
we can find cysts, spermatoceles, inflammatory lesions or hernias. Primary solid
neoplasms of the paratesticular tissues are rare, the most common spermatic
cord tumor is a lipoma and other tumors that can be found are adenomatoid
tumors of the epididymis, leiomyomas, hemangiomas and fibromas.
Procedure Details: Ultrasound (US) is currently the primary imaging modality of
choice to diagnose testicular and paratesticular masses. However US findings
are often variable and nonspecific and do not usually allow definitive characterization of the lesions. Magnetic resonance imaging (MRI) provides better anatomical detail of the adjacent structures to localize the tumors, the morphological
features and tissue characteristics can aid as well in the evaluation of the mass
and help narrow the differential diagnosis.
Conclusion: We present the US and MR imaging findings on a variety of benign
and malignant conditions involving the testicle and paratesticular tissue.

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Slicing box for orientation and sectioning of radical prostatectomy
specimen according to MR imaging plane: Accuracy of radiologicalpathological correlation
C.H. Thng, H.Y. Ma, P.H. Tan, L. Phee, D. Xiao, J.S.P. Yuen, S.P.J. Tan,
W.S. Ng, C.W.S. Cheng; Singapore/SG (judytsp@hotmail.com)
Purpose: To describe a device that enables radical prostatectomy specimens to
be orientated and sliced according to magnetic resonance (MR) images and to
validate the accuracy of this device.
Methods and Materials: Nine patients had pre-operative MR performed and radical prostatectomy with subsequent pathological sectioning done by a slicer device. Based on pre-determined landmarks, the prostate specimen was orientated
in the device in the same orientation as MR and sliced in the same thickness.
Prominent nodules identified on both modalities served as internal landmarks to
assess accuracy of sectioning. The accuracy of the sectioning was evaluated
qualitatively. Based on the number of sections showing direct correlation of internal landmarks, the overall accuracy was considered good (more than 75% of the
sections showed direct correlation), fair (50 to 75%) or poor (< 50%).
Results: The slicing device was considered easy to use by the pathologists.
Qualitatively good and fair correlations were seen in 8 out of 9 specimens.
Conclusion: The prostate slicing device is qualitatively accurate and has promise in the providing direct histopathological correlation of current and future MR
imaging techniques.
C-301
Sonographic findings after vasectomy
C. Pozuelo1, O. Pozuelo2, Y. Roca1, L. Mones1, J. Quintero1, A. Torramilans2,
M. Romero1, D. Mulattieri1; 1Badalona/ES, 2Viladecans/ES
(crispozuelo@hotmail.com)
Learning Objectives: The aim of this study is to evaluate the sonographic changes
in the scrotum after vasectomy.
Background: Following vasectomy spermatogenesis continues, the human epididymis, ductus deferens and vas deferens may distend and leak. Obstructive changes and increased intraluminal pressure may occur and the extravasated
spermatozoa stimulate formation of a sperm granuloma.
We performed a retrospective study of 483 patients with a history of vasectomy
between January 2002 and September 2005. High resolution ultrasound examination with a Toshiba power vision 6000 was performed with a high-frequency
transducer in 42 patients with symptoms after surgery.
Imaging Findings: We divided the pathological findings depending on their location: intratesticular or extratesticular (epididymis, appendages, cordon)
The sonographic appearance of the testis was practically unchanged after vasectomy. However (50%) there were persistent changes in the epididymis. These
consisted of enlargement (21 patients), development of cysts (4), inhomogeneous echo pattern (16 patients) and presence of calcifications (7 patients). Sperm
granuloma were found in 3 patients. The presence of these sonographic changes
was unrelated to symptoms.
Conclusion: We found a significantly higher incidence of thickened epididymides, epididymal tubular ectasia, and sperm granuloma in the patients after vasectomy. The history of vasectomy in men referred for scrotal sonography should
be noted so that the altered sonographic appearance of the epididymis may be
interpreted properly.
C-302
MR imaging in the histological characterization of testicular neoplasms
A.C. Tsili, C. Tsampoulas, C. Vlachos, M. Ioannidou, E. Arkoumani,
N. Sofikitis, S.C. Efremidis; Ioannina/GR (athinatsili@in.gr)
Purpose: To investigate the potential role of magnetic resonance (MR) imaging
in the preoperative characterization of the histological type of testicular neoplasms.
Methods and Materials: Sixteen patients with histologically proven germ cell
testicular tumors underwent MR imaging of the scrotum. The examinations were
performed on a 1.5-Tesla unit with T2-weighted and T1-weighted sequences before and after intravenous administration of gadolinium chelate were obtained.
MR image interpretation included tumor detection and lesion characterization.
An attempt was made to differentiate between seminomatous from nonseminomatous testicular tumors, based on signal intensity of the lesions, homogeneity
and heterogeneity of the signal, presence of fibrovascular septa, tumor encapsulation and patterns of contrast enhancement. A tumor that was detected as multinodular, homogeneous, of low signal intensity on T2-weighted images and with
fibrovascular septa was characterized as a seminomatous tumor. Testicular tu-
386
mors that were detected as heterogeneous masses, with areas of necrosis or

hemorrhage and heterogeneous enhancement were characterized as nonseminomatous tumors. The MR findings were correlated with the histopathological
diagnosis.
Results: MR imaging enabled the correct preoperative histological characterization of 15 (94%) out of 16 testicular neoplasms (eight seminomas and seven
nonseminomatous testicular tumors).
Conclusion: MR features can be closely correlated with the histological characteristics of testicular neoplasms, providing a preoperative classification of the
histological type of testicular tumors.
C-303
MR imaging of scrotal masses
A.C. Tsili, C. Tsampoulas, C. Vlachos, X. Giannakopoulos, N. Sofikitis,
S.C. Efremidis; Ioannina/GR (athinatsili@in.gr)
Learning Objectives: To describe the MR imaging features of scrotal masses,
with emphasis placed on testicular neoplasms.
Background: In the evaluation of a scrotal mass a precise localization, whether
the lesion is extratesticular or intratesticular is extremely important. The diagnosis of testicular malignancies is also important, since benign intratesticular lesions may mimic carcinoma, both clinically and sonographically. MR imaging with
a wide field of view, high spatial resolution and multiplanar imaging capabilities
allows the precise localization of a scrotal mass, an accurate estimation of the
local extent of the disease in cases of malignancy and may be accurate in the
differentiation between benign and malignant testicular masses.
Procedure Details: MR examination of the scrotum included T2 and T1-weighted sequences, before and after intravenous administration of gadolinium chelate.
MR imaging was fairly accurate in defining the precise location of scrotal masses. The technique was accurate when local staging of testicular malignancies
was analysed and could be used in the preoperative characterization of the histological type of testicular neoplasm. Differentiation between seminomatous from
nonseminomatous testicular tumors, based on signal intensity of the lesion, homogeneity or heterogeneity of the signal, presence of fibrovascular septa, tumor
encapsulation and patterns of contrast enhancement might be possible.
Conclusion: MR imaging may be an additional tool in the preoperative evaluation of scrotal masses.
C-304
Unusual and rare manifestations of testicular disease: A pictorial review
V.R. Stewart, J.D. Berry, M.E.K. Sellars, P.S. Sidhu; London/UK
(victoria.stewart@kingsch.nhs.uk)
Learning Objectives: 1. To illustrate the appearances of normal variants and
rare pathology of the testes on ultrasound. 2. To allow confident appreciation of
the appearances of normal variations. 3. To raise awareness of the rare diagnoses that may be encountered.
Background: Ultrasound is the modality of choice in imaging the scrotum providing detailed imaging with no radiation exposure. Ultrasound usually yields diagnostic information but occasionally to the untrained sonographer the ultrasound
appearance of normal variants within the testes and rare pathology may cause
confusion. The ultrasound appearances of these and many more are reviewed in
this pictorial essay.
Imaging Findings: Normal variants such as rete testes and the 'two tone testes'
are detailed. Equally more bizarre pathologies, such as spleno-gonadal fusion,
poly-orchidism, intra-testicular varicocele and testicular arterio-venous malformation, can often only be diagnosed when the radiologist or sonographer is aware
of their existence. Further abnormalities such as venous infarction, segmental
infarction, oedema, haematoma and testicular calcification will be demonstrated.
Conclusion: Ultrasound of the testis will depict many subtle abnormalities that
other imaging modalities will not. Awareness of these many disease types and
variants of normal anatomy is crucial to a competent interpretation of findings.
C-305
Current state-of-the-art in the detection of localised prostate cancer: Is focal
ablation feasible?
A. Kirkham, I. Hoh, M. Emberton, C. Allen; London/UK
(alexkirkham@yahoo.com)
Learning Objectives: To understand the potential of various imaging modalities
in the detection of localised prostate cancer and how a combination of these
might guide minimally invasive ablative techniques.
Background: In many cases, clinically significant prostate cancer is focal and

thus amenable to focal ablation - in particular by High Intensity Focused Ultrasound (HIFU) treatment. Although such an approach would reduce morbidity, it
depends critically on the ability to detect localised tumour, both for accurate diagnostic biopsy and to direct treatment.
Procedure Details: We describe the potential of several different imaging modalities - in particular MR (including contrast-enhanced, BOLD, spectroscopy and
diffusion-weighted) and ultrasound (grey-scale, Doppler and elastometry) to detect local tumour. We discuss the possibility that although no single technique is
sufficiently reliable, a combination may be sufficient to guide HIFU or other focal
techniques (cryotherapy, microwave or photodynamic treatment). We also discuss their potential to assess the extent and completeness of treatment and to
detect recurrent disease.
Conclusion: Focal treatment of prostate cancer presents many imaging challenges and it may be that a combination of techniques is necessary to plan and
assess treatment.
C-306
Real-time multi planar reconstruction MR image of prostate: Initial
experience of assisting ultrasound guided needle biopsy
T. Tachikake, K. Marukawa, K. Mita, K. Ito; Hiroshima/JP
(tachika@hiroshima-u.ac.jp)
Purpose: To report the application of transrectal ultrasound guided needle biopsy using real-time multi planar reconstruction (MPR) MR images of prostate.
Methods and Materials: 5 patients, with elevated prostate specific antigen and
or abnormal digital rectal examination, underwent 10-core biopsy (n = 4) or 3core biopsy (n = 1) using real-time virtual sonography (RVS) that displays MPR
MR images corresponding to the transrectal ultrasound image in real-time. Transverse T2-weighted thin sectional endorectal MR images were obtained and were
transferred to RVS. Instantaneously RVS made MPR images from the MR imaging dataset and position data of a magnetic position sensor attached to the ultrasound probe. MPR images corresponding to ultrasound images were obtained in
real time. A urologist performed transrectal prostate needle biopsy using RVS.
Results: 43 biopsy specimens were obtained in 5 patients. Prostate biopsy revealed prostate cancer in 12 sites in 2 patients. Prostate cancers were suspected
in 2 patients on MR images. It was confirmed that all biopsy procedures were
successful at these cancer suspicious sites using RVS. Of two patients with suspected prostate cancer, one was subsequently found to have prostate cancer
and the other not. There were no significant complications.
Conclusion: This technique may be useful for ultrasound guided needle biopsy.
It has the potential to increase the number of correct diagnoses and decrease rebiopsy.
C-307
US appearances of scrotal calcifications of various etiologies
A.T. Turgut, E. Ozden, E. Olcucuoglu, P. Kosar, U. Kosar; Ankara/TR
(ahmettuncayturgut@yahoo.com)
The role of TRUS in the evaluation of the anechoic lesions of the prostate
and the adjacent structures
A.T. Turgut, E. Ozden, E. Olcucuoglu, P. Kosar, U. Kosar; Ankara/TR
Learning Objectives: To illustrate the imaging features of the anechoic lesions
of the prostate and adjacent structures in regard to localisation (inner gland and
peripheral zone of the prostate, seminal vesicle), internal echotexture (purely
anechoic, mixed with internal echoes) and etiology (congenital, acquired) and to
evaluate the value of TRUS findings for differential diagnosis.
Background: TRUS enables the visualization of the prostate gland and its neighboring structures. It reveals the imaging features of the detected lesions in regard
to the size, localisation, distribution and echotexture. It also guides the aspiration
of the cysts for diagnostic and therapeutic purposes. In our study performed with
a Hitachi EUB 500 US machine equipped with a 6.5 MHz biplane endorectal
transducer examples from anechoic lesions detected in the prostate and the adjacent structures are illustrated.
Procedure Details: TRUS findings of cases with Mllerian duct cysts, utricular
cyst, cyst of ejaculatory duct, solitary or multiple inner gland cysts secondary to
benign prostatic hyperplasia, prostatic urethra diverticulum, uni and multiloculated seminal vesicle cysts, cystic prostatic abscess and retention of distended Foley
catheter along the prostatic urethra mimicking intraprostatic pathologies. The
impact of the imaging properties for differential properties are emphasized.
Conclusion: TRUS is very helpful for the definitive diagnosis and characterization of anechoic lesions of the prostate and adjacent structures. Besides it enables an efficient clinical management of the spectrum of the lesions described
above
C-309
Local anesthesia before TRUS-guided prostate biopsy: Performance,
technical results and side effects on image quality. Indications and side
effects on patients
P.S. Zoumpoulis, A. Filippidou, A. Plagou, D. Alexopoulos, S. Prapavessis,
I. Theotokas; Athens/GR (echo@hol.gr)
Purpose: 1. To discuss the indications for the use of local anesthesia prior to
TRUS. 2. To demonstrate the procedure of TRUS guided local anesthesia before
prostate biopsy. 3. To estimate the efficacy of TRUS guided local anesthesia before prostate biopsy.
Methods and Materials: Administration of local anesthesia prior to TRUS-guided biopsy efficiently eliminates patient discomfort allowing for a greater number
of biopsies. 7000 TRUS-guided prostate biopsies have been performed following
local periprostatic anesthesia from 2000-2005. The procedure begins by injecting 8-15 cc of Xylocaine and 2% Adrenaline through the biopsy needle. The technique, its effects on the US image, complications and side effects were compared
to 8000 US-guided biopsies performed between the years 1994-2005, without
local anesthesia.
Results: There was a significant difference between the number and severity of
complications in the group with local anesthesia compared to the group without
anesthesia. There were a few side effects caused by the infusion of the anesthesia drug. Air bubbles are sometimes infused with the drug causing a "fuzzy" image, which results in a degree of difficulty in guiding the needle. A thorough TRUS
examination of the prostate prior to the anesthesia helps the radiologist guide the
needle to the appropriate area, even through a "fuzzy" image.
Conclusion: US-guided local anesthesia, before TRUS biopsy, assures patient
cooperation and is essential for a large (more than 10) number of biopsies.
C-310
Assessment of the value of contrast enhanced MRI of the prostate for
additional pathological findings
K. Kubin; Vienna/AT (klaus.kubin@meduniwien.ac.at)
Purpose: Aim of the study was to assess the value of contrast enhanced MR
imaging of the prostate with surface and endo-rectal coils for additional pathological findings apart from prostate cancer and findings correlated with prostate cancer.
Methods and Materials: In 110 patients MR imaging of the prostate was performed on a 1.5 T unit (Vision, Siemens, G) with combined surface and endorectal coils (Prostate-Coil, Medrad, USA). Transverse and coronal T2-weighted
TSE and dynamic Gd-DTPA enhanced (Magnevist, Schering, G) T1-weighted
3D-FLASH (8.1/4; 01 min 35 s; FOV 160) transverse images of the prostate were
acquired. Additional T1-weighted images of the pelvis (bifurcation of abdominal
387
Genitourinary
Learning Objectives: Scrotal calcifications are rare US findings the localisation,

extent and distribution of which are useful for specific diagnosis. In this study we
aimed to overview the sonographic appearances of scrotal calcifications and to
reveal the predictive value of the findings for distinguishing intra and extratesticular calcifications and for determining the etiology.
Background: US examination performed with a high frequency (7.5-10 MHz)
linear transducer has been the preferred imaging method for the evaluation of
intra and extratesticular scrotal pathologies including calcifications. It is the only
way for detecting the calcifications in the asymptomatic population. Although extratesticular calcifications are generally regarded to represent benign conditions,
they would raise concerns about malignancy if they are palpated. Intratesticular
calcifications which are multiple and grouped are suggested to be highly suspicious for malignancy. In our study samples from the calcifications detected during scrotal US examinations performed in our clinic are demonstrated.
Procedure Details: Gray scale and color Doppler US findings of cases with intratesticular vascular calcifications, testicular microlithiasis of limited and classic
subtypes, testicular macrocalcification and microlithiasis associated with testicular teratoma, tunical calcification, calcifications located within the head and the
tail of epididiymis, epididymal cyst having calcification within the rim and scrotolith are presented. The findings described above are correlated with clinical findings.
Conclusion: US examination is a valuable method for the illustration and characterization of scrotal calcifications which may be helpful for recognizing the imaging features for differential diagnosis.
C-308

aorta to pelvic floor) were acquired. Data of additional pathological findings were
collected. Secondary pathological findings due to prostate cancer, like infiltration
of the neurovascular bundle or the seminal vesicles and enlarged suspicious
lymph nodes were not included in the analysis.
Results: Additional pathological findings were found in 81/110 (73.6%) patients.
Benign prostate hyperplasia appeared in 70/110 (63.6%), postinterventional haematoma after biopsy of the prostate in 16/110 (14.5%). Calcifications of the prostate, diverticulosis of the sigmoid colon, inflammation of the ejaculatory duct and
seminal vesicles, diverticulum of the urinary bladder, lesions of the bones and an
aneurysm of the iliac artery were other additional diagnoses.
Conclusion: Preliminary results show that contrast enhanced MR imaging is not
only accurate in the assessment of prostate cancer but also in giving additional
pathological findings and leads to further treatment.
C-311
Utility of diffusion-weighted MR imaging in identification of cryptorchidism
K. Tamai1, S. Umeoka1, T. Koyama1, T. Saga 1, T. Kamoto1, O. Ogawa1,
S. Kawakami2, K. Togashi1; 1Kyoto/JP, 2Hikone/JP
(tamaiken@mbox.kyoto-inet.or.jp)
Purpose: To evaluate the value of fusion images of diffusion-weighted MR imaging (DWI) onto T2-weighted images (T2WI) in the detection of cryptorchidism, in
comparison with ultrasonography and T2WI alone.
Methods and Materials: Study population included 14 clinically suspected cryptorchidism in 9 patients (age 1~48, mean; 22). Four patients had unilateral gonads in the normal site. In one patient, physical examination revealed one palpable
testis in his groin. DWI was performed with echo planar imaging (EPI) (TR/
TE=5400/95-99 msec, and SENSE factor = 2, section thickness = 4-5 mm, bvalue = 0, 500, 1000 s/mm3). A fusion image of DWI (b=1000) onto T2WI was
composed, to confirm anatomical locations. Both fusion images and T2WI alone
were evaluated regarding identification of the cryptorchidism by two radiologists,
independently. The reviewers also recorded location, if cryptorchidism was identified. The results were compared with surgical and clinical findings. Additionally,
one of the readers measured the apparent diffusion coefficient (ADC) value of
the cryptorchidism and the normal gonads.
Results: Of 14 gonads, ultrasonography demonstrated 5 inguinal gonads. T2WI
alone demonstrated 9 gonads (scrotum 2, inguinal 5, intraabdominal 2), while
fusion images successfully demonstrated 13 gonads (scrotum 2, inguinal 5, intraabdominal 6). One missed gonad on the fusion image was clinically considered as a "vanishing testis". Mean ADC value of the detected abnormal 13 gonads
was 1.49 0.43x10 -3 mm 2/sec, whereas that of the 4 normal gonads was
0.93 0.29x10-3 mm2/sec.
Conclusion: Fusion images of DWI onto T2WI can be useful for detecting cryptorchidism, especially for intraabdominal gonads.
Genitourinary
Miscellaneous
C-312
Ultrasound in Peyronie's disease: Something more than a plaque
E. Santos Armentia, C. Rivas Barros, F. Tardguila Montero, F. Romero Cique,
C. Delgado Sanchez-Gracian, C. Martinez Rodriguez; Vigo/ES
(eloisa_sa@hotmail.com)
Purpose: To perform the correct surgical treatment in Peyronie's disease requires
not only a knowledge of the location and extension of the plaque, but also the
existence of dorsal penile to cavernosal artery perforators that cross the albuginea to anastomose between both arteries. These branches can be interrupted
during surgery, causing treatment failure. The purpose is to describe the essential aspects that the radiologist should evaluate in the US study of a patient with
Peyronie's disease, with special attention to the normal variants of the penile
circulation.
Methods and Materials: 102 patients with Peyronie's disease underwent US
evaluation. Mean age was 57 years. The study was performed with Toshiba power Vision 6000, with a multifrequency transducer of 6-9-12 MHz. The US was
performed after the injection of 20 micrograms of prostaglandin E1 (Caverject
20 mcg). Gray-scale evaluation of the penis was performed during the maximum
erection phase. Then B-mode, color and Pulse Wave Doppler techniques were
used. The fibrous plaques were identified, describing their extension and the presence of calcification. The penile arteries were studied searching for perforator
branches.
Results: In all patients the fibrous plaques were identified and their extension
could be measured. In 46 patients (45%) the plaques were calcified. In 31 patients (30%) perforator arteries were found crossing the albuginea towards the
corporus cavernosum.
Conclusion: US allows the surgeon to recognise the relevant aspects of Peyronie's disease. The identification of perforator arteries is essential because if they
are resected it can cause postoperative vascular complications.
C-313
The new radiological anatomy of the retroperitoneum and the doors of
intercommunication with the peritoneum: Role of fascial planes
F.M. Danza, A. Magistrelli, A. D'Amico, M. Cirillo, A.M. Ierardi, L. Bonomo;
Rome/IT (fmdanza@rm.unicatt.it)
Learning Objectives: To discuss the intercommunications between the retroperitoneum (RP) and the anterior compartment of the abdomen (classically called
peritoneum) to better understand the spread of diseases.
Background: The classic anatomy of RP doesn't consider the "doors" of intercommunication between RP and peritoneum. A careful review of embryology
explains how these connections are formed, during human development, by mesia
adhesion and bowel/parenchymal organs ligaments.
Imaging Findings: We retrospectively reviewed CT/MR imaging to explain the
real way of diffusion of infections, neoplasm and some particular fluid collections.
Our sight of the RP, previously proposed, includes 4 retroperitoneal spaces [perirenal spaces, posterior perirenal spaces (true RP), supramescolic-anterior pararenal spaces, undermesocolic- anterior pararenal spaces (acquired RP)] and
multiple fascial planes (FP), previously known as fasciae. FP resulted from adhesions of primitive mesia, so that they are potentially expandable spaces. We identify
in the undermesocolic lodge, the retromesenteric and retrocolic plane, retrorenal
and lateroconal space, lateroconal fascia, fascial trifurcation, combinate plane
and in the supramesocolic lodges, the retropancreatic and retroduodenual plane.
Bare area of the liver, peri-cardial space, hepatic hilum and mesenteric and mesosigmoid root constitutes the doors between these compartments and the anterior, properly peritoneal, spaces.
Conclusion: CT and MR accurately stages spread of pathological collections
(blood, pus, gas) and neoplasm either in retroperitoneal spaces and FP, either in
the peritoneal cavity, along anatomical communications. We show many cases of
sectional imaging of this way of diffusion showing their physiopathology.
C-314
Imaging of the normal and abnormal inguinal canal
A.E. Mahfouz, H. Sherif; Doha/QA (mahfouzae@yahoo.com)
Learning Objectives: 1. To learn the anatomical details of the inguinal canal on
the different imaging studies. 2. To learn the different abnormalities involving the
inguinal canal and their imaging features.
388

Background: The inguinal canal may be the site of various abnormalities, particularly in males, being a potential channel between the abdominal cavity and the
scrotum. The present educational exhibit illustrates the normal anatomical features and the imaging features of abnormalities of the inguinal canal.
Imaging Findings: High resolution MR imaging, ultrasonography, and CT images of the inguinal canal will be presented to demonstrate its normal anatomy with
illustrating diagrams. A wide range of lesions of the inguinal canal will be presented including inguinal hernias, hydrocele of the spermatic cord, lipoma of the
spermatic cord, retroperitoneal lymphangioma with spermatic cord extension,
vascular malformation of the spermatic cord, undescended testis, herniating ovary,
and undescended testis in the phenotypical female suffering from testicular feminization syndrome, as well as patent processus vaginalis demonstrated on multi-detector CT peritoneography as the cause of dialysis-related scrotal swelling.
Conclusion: Awareness of the anatomical and pathological features of the inguinal canal on the different imaging studies is essential for the proper diagnosis
of diseases of the inguinal canal.
C-315
Imaging of disorders involving the urethra in children and adulthood
M. Allona, C. Sanchez Almaraz, I. Marquez, T. Berrocal, J.A. Gomez Patio,
J. Gutierrez; Madrid/ES (mariaallona@yahoo.es)
Learning Objectives: To understand the embryology, pathology, and imaging
features of a wide spectrum of congenital and acquired abnormalities involving
the urethra in children and adulthood. To understand the utility of each imaging
modality that can be applied to the management of these conditions. To emphasize pitfalls and differential diagnoses.
Background: Congenital and acquired disorders affecting the urethra are a significant cause of morbidity in children and adults. This teaching exhibit analyzes
and illustrates practical aspects of a wide spectrum of usual, unusual, and exceptional disorders affecting the urethra, with particular emphasis on radiological
manifestations. The efficacy of the different imaging modalities in the diagnosis
and management of these conditions will be evaluated.
Imaging Findings: Specific topics addressed include congenital and developmental abnormalities (posterior urethral valves, anterior urethral valves, Cobb's
collar, syringocele, hypospadias, epispadias, complete and incomplete urethral
duplications in the coronal and sagittal planes, megaurethra, congenital urethral
diverticulum and fistula, lacuna magna), urethral stricture, infectious diseases,
neoplasms and urethral trauma. Pitfalls, diagnostic difficulties and differential diagnoses are emphasized. The embryology and pathological basis of the radiographic findings are discussed. The key findings in each imaging modality are
shown and compared with the underlying pathological features when available.
Conclusion: This exhibit provides an overview of the pathological processes
affecting the urethra as well as of the utility of the various imaging techniques
available. Because many of these disorders have a characteristic appearance,
this exhibit will help the practicing radiologist to better understand these disorders.
C-316
Diagnosis of adrenal masses at spiral CT: Test your knowledge
G.I. Mac, C.M. Cucu, C.S. Giurca, B. Delemer, C. Marcus; Reims/FR
(gratiela_m@hotmail.com)
C-317
Evaluation of the success of surgical treatment by preoperative and
postoperative imaging findings in children undergoing augmentation
ileocystoplasty
E. Ozden, A.T. Turgut, T. Soygur, S. Fitoz; Ankara/TR
Learning Objectives: To assess the role of imaging modalities for pre and postoperative evaluation of patients undergoing augmentation cystoplasty.
Background: Augmentation ileocystoplasty is an established salvage procedure
which is routinely used for the treatment of inadequate bladder capacity and reduced bladder compliance secondary to infectious, inflammatory, neurogenic and
congenital disorders refractory to conservative management including behavioural and medical treatment. US, which enables the determination of the presence or absence of hydroureteronephrosis, renal pyelonephritic scarring, and
nephrolithiasis has replaced intravenous urography completely as the baseline
examination of choice for the patients. Voiding cystourethrography can be utilized
for the evaluation of the bladder for size and contour, the presence of any diverticulae, the anatomy of the bladder neck, and the presence of vesicoureteral reflux. MR urography being an operator-independent, non-ionizing imaging technique
without the use of iodinated contrast media application has an additional advantage of visualizing the ureteral anatomy, particularly in poor and non functional
kidneys, which is not an uncommon manifestation of the disease.
Procedure Details: The records of 35 patients following augmentation ileocystoplasty were reviewed. Imaging studies performed within pre and postoperative
period including voiding cystourethrography, US, intravenous urography and MR
urography as well as intraoperative findings are illustrated. The indications, advantages and limitations of the aforementioned techniques are discussed.
Conclusion: Imaging techniques play a crucial role in the preoperative planning,
the evaluation of the outcome of the surgery and long term results of the pediatric
augmentation ileocystoplasty procedure.
C-318
US as a problem solving tool in challenging scrotal lesions
H. Ozcan, E. Ustuner; Ankara/TR
Learning Objectives: To describe the differentiating clues and key imaging points
in high resolution US imaging of scrotal mass lesions combined with power and
color Doppler US and illustrate findings that would correctly identify scrotal masses
and differentiate benign and malignant cases.
Background: A retrospective search of US archives from September 2002 to
July 2005 was made for rare scrotal mass lesions in which sonographic patterns
or imaging findings led to correct diagnosis or differentiation of malignant tumor
from benign in challenging cases. In this exhibit we will show these cases with
special emphasis on the US findings including color and power Doppler imaging.
Imaging Findings: Gray-scale US with 7.5 to 15 mHz probes by characterizing
lesions and CDUS by demonstrating perfusion has led to recognition of benign
entities that simulate malignant disease like testicular prostheses, trauma, ectopic testis, complex hydrocele, spermatocele, pyocele, hematomas, hernia, epididymal cysts, thrombosed varicoceles, epididymal and testicular abscesses and
unusual inflammatory masses of the testis and epididymis, appendiceal, epididymal torsion, hematomas and also malignant lesions that are usually non-specific
and hard to differentiate like epididymal tumors, burn-out testis tumors, seminomas, teratomas, yolk sac tumors, and embryonal carcinomas, sex-cord stromal
tumors, metastases and lymphoproliferative diseases which will all be presented.
Conclusion: Ultrasound is a powerful tool in characterization of scrotal mass
lesions and especially when specific imaging clues are recognized.
C-319
Radiological and clinical correlation of genitourinary tuberculosis (GU TB)
N. Takeyama, T. Gokan; Tokyo/JP
Learning Objectives: To describe TB infection route (hematogenous, and transurinary tract) into each GU organ bacteriologically. To correlate the various clinical findings and the radiological imaging of GU TB.
Background: In developing countries, changing patterns of population migration
and the development of large pools of immunocompromised individuals, largely
due to the AIDS epidemic, reversed the downward trend of TB infection. Although
the incidence and prevalence of GU TB has remained constant, it can cause a
389
Genitourinary
Learning Objectives: To review the main spiral CT findings observed in patients

with adrenal masses. To analyse the clinical background and to discuss the results of biochemical screening tests performed in suspected hyper functioning
lesions.
Background: The adrenal gland is a common site of disease and detection of
adrenal masses has increased with the widespread use of high-resolution anatomical imaging techniques. CT has become the study of choice to differentiate a
benign adenoma from a metastasis by analysing the morphological imaging features, the attenuation values on unenhanced CT scans and the washout characteristics following contrast media injection.
Imaging Findings: Prevalence, clinical aspects, functional status and mostly CT
appearance of pathologies found in patients with adrenal masses are reviewed.
Exercises consist of a combination of clinical and biochemical information associated with CT images followed by multiple choice questions. The first part of the
exhibit reviews the main diagnosis observed in patients with adrenal masses.
Lesion attenuation, enhancement and washout characteristics are discussed. CT
findings allowing to differentiate adrenal adenomas from other adrenal masses
are detailed. Quiz images are presented in the second part to highlight features
of the management of patients with adrenal masses.
Conclusion: CT is essential in both detection and characterization of an adrenal
mass. Certain features can be used by the radiologist to establish a definitive

diagnosis for an adrenal mass based on imaging findings alone.

variety of clinical patterns and mimic other diseases, or malignant tumor. For
example adrenal insufficiency, renal disease, obstructive uropathy, and chronic
cystitis are not uncommon with TB. Urethral stricture due to granuloma cause
dysuria, and female genital tract infection can cause infertility.
Imaging Findings: We reviewed 9 types of TB infection which included adrenal,
renal, ureter, bladder, anterior urethra, seminal vesicle, testis, prostate, and tuboovarian TB. We correlated clinical findings with radiological images including IVP,
US, CT, MRI, retrograde cysto-urethrography (RUG). CT findings demonstrate
calcification and wall thickening, MR imaging findings demonstrate granulomatous tumor, but other radiological features are not specific.
Conclusion: Radiological features are not pathognomonic, but can be strongly
suggestive when considered along with the clinical presentation, immune status,
and demographic background of the patient.
C-320
Spectrum of tumors involving the urinary tract in children: Imaging and
pathological findings
B. Marin, M. Allona, T. Berrocal, F. Baudraxler, J. Gutierrez, L. Picazo;
Madrid/ES (begona_marin@yahoo.es)
Learning Objectives: To illustrate the spectrum of tumours involving the urinary
tract in children. To evaluate the efficacy of the various imaging techniques currently available in the diagnosis, staging and management of these tumours. To
show the key findings in each imaging modality and to compare them with the
underlying pathological features.
Background: In the first year of life only 20% of renal masses are neoplastic. In
an older child, primary tumors of the kidney become more common. Knowledge
of the clinical history and characteristic imaging findings can help suggest a specific diagnosis. Duplex Doppler sonography is the method of choice for the initial
evaluation of a renal mass in a child. CT and MR imaging may provide additional
information regarding the characteristics or extent of the disease.
Imaging Findings: Reviewed tumors include primary and metastatic renal neoplasms (Wilms' tumor, nephroblastomatosis, mesoblastic nephroma, clear cell
sarcoma, rhabdoid tumor, renal cell carcinoma, multilocular cystic nephroma,
angiomyolipoma, juxtaglomerular cell tumor, metanephric stromal tumor, renal
medullary carcinoma, cystic papillary epithelial renal neoplasm, lymphoma and
leukemia) and tumors along the urothelium (rhabdomyosarcoma, transitional cell
carcinoma, fibroepithelial polyps). Associations with specific syndromes and diseases are discussed. The key findings of each imaging modality are shown and
compared with the underlying gross and microscopic pathological features. Pitfalls and diagnostic difficulties are emphasized.
Conclusion: Although a renal neoplasm cannot always be diagnosed or staged
on the basis of imaging alone, radiological evaluation of a patient with a renal
mass will help in the differential diagnosis.
C-321
Multidetector CT urography and CT virtual endoscopy in the detection of
urological diseases
M. Ulla, E.B. Martin Lopez, P.M. Carrascosa, C.M. Capuay, J.M. Carrascosa;
Buenos Aires/AR (investigacion@diagnosticomaipu.com.ar)
Learning Objectives: To be familiar with novel CT techniques. To illustrate the
spectrum of MDCTU findings. To outline the advantages of this non-invasive technique.
Background: The introduction of MDCT has changed the evaluation of patients
with urologic diseases. The objective of this exhibit is to show the usefulness of
multidetector CT urography (MDCTU) and CT virtual endoscopy (CTVE) in the
detection of urological diseases.
Procedure Details: Twenty five patients (17 male, 8 female; age range between
25-70 years old), with suspected renal and/or urological diseases were studied
with MDCTU. The scans were performed using a 16 row CT scanner (Brilliance
16, Philips Medical Systems) with slices of 2 mm thickness and 1 mm reconstruction interval. An unenhanced acquisition, followed by a second one after the
injection of 100 ml of contrast material using a power injector were performed.
Finally a third acquisition during the excretory phase was performed. Images
were sent to a workstation and post-processing volume rendering reconstructions, MPR, MIP and virtual endoscopy images were obtained.
Conclusion: Urinary tract and bladder diseases can be accurately detected by
MDCTU and CTVE, given the necessary presurgical information and adequate
staging of the disease. The most common diseases in our series included: renal
neoplasms, ureteral stenosis, ureteral calculi, ureteral neoplasm and bladder
390
neoplasms. MDCTU and CTVE have proven to be noninvasive and reliable diagnostic techniques in the evaluation of urological diseases and gave more information than conventional methods. CTVE can serve as a supplementary method
to ureteroscopy or fibreoptic cystoscopy.
C-322
Adrenal MDCT imaging in primary hyperaldosteronism
T. Ishibashi 1, R. Tamura2, A. Sato1, T. Yamada1, T. Matsuhashi1, K. Takase1;
1
Sendai/JP, 2Fukushima/JP (ishibashi@rad.med.tohoku.ac.jp)
Learning Objectives:b1) To study adrenal CT images of aldosterone-producing
adrenal adenoma (APA) and bilateral hyperplasia (BAH). 2) To know the new
differential diagnostic criterion between APA and BAH. 3) To know the limitation
of CT from radiological-pathological cases.
Background: Primary hyperaldosteronism (PA) is the most common form of secondary hypertension. PA affects 5-13% of patients with hypertension. The two
most common causes of PA are an APA and BAH. The treatment of APA in most
patients is surgical adrenalectomy, whereas that of BAH is medication and potassium-sparing diuretics. A correct diagnosis is, therefore, highly important in
the selection of patients for adrenalectomy. CT is widely used to differentiate
between the two entities, however, the sensitivities and specificities of CT were
not satisfactory.
Imaging Findings: In 100 cases, contrast-enhanced MDCT imaging of the adrenal glands were reviewed by two radiologists blinded to the bedside data. Subtype of PA was judged by adrenal venous sampling (AVS) after ACTH stimulation
in all cases. In 90% cases of APA, there were ipsilaterally nodules in same side
by AVS. However, in 4 % cases, there were no finding on CT because of small
APA.
Conclusion: In patients with primary hyperaldosteronism, adrenal nodule or thickening on CT is in differentiating BAH from APA. However, in 10% cases, there are
no finding, or contralateral nonfunctional adenoma.
C-323
Ischiorectal fossa. Normal anatomy and pathology. Imaging findings
J. Quintero1, F. Tous 2, A. Mariscal1, M. Torr 1, C. Pozuelo1, Y. Roca1;
1
Badalona/ES, 2Santa Coloma de Gramanet/ES (jquintero@bsa.gs)
Learning Objectives: To discuss the normal anatomy and the pathological processes affecting the ischiorectal fossa. To review the computed tomography (CT)
and magnetic resonance (MR) imaging findings of the pathology affecting the
ischiorectal fossa and to review the literature.
Background: We reviewed all of the abdominal CT and MR reports in the last
three years in our institutions. We selected the cases with ischiorectal fossa pathology and they were reviewed by two radiologists who were unaware of CT and
MR findings. From July 2002 to July 2005 we encountered twenty five cases
involving the ischiorectal fossa.
Imaging Findings: We exhibit cases of normal anatomy of the ischiorectal fossa
and their components. The pathological cases demonstrated are: Congenital lesions (rectal duplication cyst, Gardner's duct cyst), inflammatory (fistula in ano),
traumatic and hemorrhagic conditions; primary tumors (sarcoma, lymphoma, lipoma, perineal angiomyxoma, GISTs, melanoma); and pathological processes outside the ischiorectal fossa with secondary involvement (recurrent rectal tumor).
Both CT and MR imaging are useful in the definitive diagnosis of these pathological conditions, with MR imaging being the modality of choice because of its superior contrast resolution and multiplanar capability.
Conclusion: Familiarity with the imaging features and differential diagnoses of
various ischiorectal pathological processes will facilitate prompt accurate diagnosis and treatment. The anatomy of the ischiorectal fossa and its relationship to
other pelvic organs is well demonstrated with high-resolution computed tomography scans as well as by magnetic resonance imaging.
C-324
MRI spectrum of unusual large pelvic masses
M.D. Crema, C. Hoeffel, M.D. Marra, L. Azizi, L. Arriv, J.-M. Tubiana; Paris/FR
(michelcrema@hotmail.com)
Learning Objectives: To illustrate the MR imaging features of various unusual
large pelvic masses. To identify the clinical and pathological findings of these
unusual large pelvic masses. To review the current role of MR imaging in the
assessment of pelvic masses.
Background: Pelvic MR imaging is often used in the detection and staging of
large pelvic masses. Large pelvic masses may originate from the genitourinary
tract, rectum, pelvic soft-tissues, peritoneum, or retroperitoneum. The differential

diagnosis for pelvic masses is extensive. The diagnosis can be suggested on the
basis of tumor location and anatomical landmarks. We reviewed the patients with
unusual large pelvic masses examined at our institution from September 2002 to
July 2005 with external phased-array high resolution 1.5 T pelvic MR. The site of
origin, MR imaging characteristics, and clinical history may all help narrow the
Imaging Findings: Analysis of the anatomical landmarks including the organ of
origin (genitourinary tract, intestinal tract, etc)., relationship with vasculature,
peritoneal or extraperitoneal involvement, and lateral pelvic wall involvement, was
helpful in the workup of such masses. We discuss and illustrate the MR imaging
features of unusual large pelvic masses, either of uterine origin (sarcoma, endometrial stromal sarcoma), ovarian origin (fibrotecoma, metastasis), rectal origin (cavernous hemangioma, lymphoma, stromal tumor, adenocarcinoma),
prostatic origin, and soft-tissue masses (desmoid tumor, schwannoma).
Conclusion: Unusual large pelvic masses may arise from various pelvic organs
and structures. Familiarity with the clinicopathological and MR imaging features
of these lesions is important for diagnosis and treatment.
C-325
Imaging of the ureter
B. Marin, E. Fernandez Canabal, I. Marquez, T. Berrocal, F. Guerra, P. Cortes;
Madrid/ES (begona_marin@yahoo.es)
features of a spectrum of congenital and acquired alterations involving the ureter
in children and adulthood. To evaluate the efficacy of plain radiographs, excretory
urography, voiding cystourethrography, ultrasonography, computed tomography
(CT) and magnetic resonance (MR) imaging in the diagnosis and management
of these conditions.
Background: We retrospectively reviewed the imaging findings of patients with
disorders involving the ureter from our database of genitourinary pathology. Ultrasound and conventional studies (VCUG or excretory urography) were performed
in all patients, while CT or MR were performed whenever conventional studies
were not conclusive. The embryological and pathological basis of the imaging
findings are discussed in appropriate cases. The key findings at each imaging
modality are shown and compared with the underlying pathological features when
available. Pitfalls, diagnostic difficulties and differential diagnoses are emphasized.
Imaging Findings: Specific topics addressed include duplex systems and related anomalies (bifid collecting system, bifurcation of the ureter, complete duplication of the ureter, blind ending ureter, ectopic opening of one ureter, lower pole
ureteropelvic junction obstruction), other congenital and developmental anomalies (triple ureters, ectopic opening of a single ureter, ectopic ureterocele, ureteral valves, ureteral diverticula, retrocaval ureter), cystic ureteritis, primary and
metastatic tumors, ureteral trauma (haematoma and perforation), and postsurgery complications.
Conclusion: Since many of these disorders have characteristic imaging appearances, this exhibit will help practising radiologist to better understand and recognise pathological processes affecting the ureter.
C-326
CT detection of iatrogenic urinary tract lesions
M. Hrabak, R. Stern Padovan, M. Lusic, M. Kralik, M. Prutki, K. Potocki;
Zagreb/HR (maja.hrabak@zg.t-com.hr)
C-327
Abnormalities of the cul-de-sac
A.E. Mahfouz, N. Almulla, H. Sherif; Doha/QA (mahfouzae@yahoo.com)
Learning Objectives: To learn the different abnormalities, which involve the culde-sac and their imaging features.
Background: The cul-de-sac is the most dependent part of the peritoneal recesses. Abnormalities of adjacent pelvic organs may extend into the cul-de-sac
and abnormalities related to other abdominal organs may express themselves by
"dropping" their content into this peritoneal recess. The present educational exhibit illustrates some of the different abnormalities of the cul-de-sac.
Imaging Findings: The abnormalities of the cul-de-sac illustrated in the present
educational exhibit include endometriosis, metastases, pseudomyxoma peritonei,
dropped cholecystectomy clips, dropped gall bladder stones, pedunculated fibroids, and pelvic splenosis caused by traumatic rupture of the spleen. Imaging
modalities used include ultrasonography, multi-detector CT and MR imaging.
Conclusion: Modern imaging modalities may be useful in demonstration of abnormalities of the cul-de-sac.
C-328
16-slice CT urography in the investigation of painless hematuria
A.C. Tsili, C. Tsampoulas, C. Vlachos, D. Giannakis, D. Dristiliaris, N. Sofikitis,
S.C. Efremidis; Ioannina/GR (athinatsili@in.gr)
Purpose: To assess the accuracy and safety of 16-slice CT urography in the
evaluation of the urinary tract in patients with painless hematuria.
Methods and Materials: Ninety six patients referred for painless hematuria underwent CT urography. The CT protocol included unenhanced images obtained
with a detector configuration of 16 X 1.5 mm and a pitch of 1.2. After intravenous
administration of iodinated contrast material and 250 ml of saline solution, nephrographic-phase and excretory-phase images were obtained, with collimation
thickness of 16 X 0.75 mm and pitch of 1.2. Axial and coronal reformatted images were evaluated. Three-dimensional reformatting of the excretory phase images was performed using the volume rendering technique. The standard of reference
included clinical and imaging follow-up, cystoscopic, surgical and histological findings. Patient radiation dose was measured and the results were compared with
reported doses for 4-detector row CT scanners.
Results: In 57 of 75 (76%) patients, the cause of hematuria was identified. Multislice CT urography demonstrated a sensitivity of 97%, a specificity of 92%, a
positive predictive value of 97% and a negative predictive value of 92 % in the
identification of the cause of hematuria, when compared to the methods used as
a standard of reference. The effective dose was 29 mSv.
Conclusion: 16-slice CT urography is a highly accurate technique in the assessment of patients presenting with painless hematuria. It can demonstrate a wide
spectrum of disease.
C-329
Differential causes of loin to groin pain as diagnosed on multi-detector CT
KUB
F. Alyas, E. Woo, V. Raman, Z. Viney, R. Tappouni, G. Rottenberg; London/UK
(faisal.alyas@gmail.com)
Learning Objectives: To illustrate with examples the wide variety of clinically
significant alternate diagnosis in patients presenting with loin to groin pain. To
show the relative advantages of MDCT especially its multi-planar reformatting
capabilities in demonstrating these disease processes.
Background: CT KUB has established itself as an excellent investigation for
acute renal colic with a high sensitivity (> 95%) and specificity (> 98%). We currently perform approximately 40 of this examination a month at our institution, a
central London teaching hospital. 10% of these examinations yield a significant
non renal cause to explain the patient's symptoms.
Imaging Findings: We perform low dose unenhanced scans which are reviewed
by a radiologist axially and if necessary reformatted. Examples include surgical
causes: Cholecystitis, pancreatitis, appendicitis, diverticulitis, perforated duodenal ulcer. Clinically significant causes that do not require surgical intervention
such as panniculitis and mesenteric adenitis are also included.
391
Genitourinary
Learning Objectives: 1) To show the role of CT imaging in early detection of

iatrogenic urinary tract lesions. 2) To define appropriate acquisition protocols
according to the suspected type of lesion.
Background: Iatrogenic trauma is a frequent cause of urinary tract lesions which
are usually clinically silent, and therefore associated with delay in diagnosis and
significant morbidity. Ultrasonography is the primary method in screening for iatrogenic lesions which must be suspected if localized fluid collections or ascites
is detected. Traditionally the diagnosis was established using conventional radiological methods: Excretory urography, antegrade or retrograde urography, and
cystography.
Imaging Findings: Urinary tract lesions were found after urological, gynecological/obstetric and surgical procedures. The most frequent pathological findings
were fluid collections, including urinomas, hematomas, seromas, and abscesses. Renal injuries were caused by blunt (ESWL) and penetrating (renal biopsy)
trauma, with formation of subcapsular, perinephric and paranephric hematomas.
Renal vascular pedicle changes were seen on CT angiography after kidney transplantation. CT urography revealed extravasation of contrast material from the
pelvicalyceal system after nephron-sparing surgery, from the ureter of the trans-
planted kidney and from the urinary bladder after cesarean section. The tear of
posterior urethra was diagnosed after bladder catheterization.
Conclusion: Iatrogenic urinary tract damage should be suspected in any patient
with a free or localized fluid collection on sonographic examination. CT angiography and/or CT urography are primary modalities for assessment of suspected
urinary tract lesions, because they enable fast and accurate diagnosis for planning of interventional or surgical treatment.

Conclusion: CT KUB has the advantage over conventional IVU of detecting many
alternative conditions, without appreciably increasing the radiation burden or the
need for contrast medium. Radiologists should be aware that these alternate diagnoses occur with significant incidence. Where possible, we recommend CT
KUB rather than intravenous urography is the first line investigation of loin to
groin pain.
C-330
The role of MR urography in the diagnostic workup of uncommon pediatric
urinary tract pathologies
E. Ozden, A.T. Turgut, T. Soygur, S. Fitoz; Ankara/TR
Learning Objectives: To assess the usefulness of MR urography in the evaluation of various uncommon urinary tract pathologies and to discuss its potential to
replace currently used imaging modalities like sonography, DMSA scintigraphy,
voiding cystourethrography, and excretory urography.
Background: MR urography has been successfully utilised for the evaluation of
the pediatric urinary tract even in neonates and infants. By means of the improvements in the technique providing increased spatial and temporal resolution, MR
urography has a superior diagnostic potential which results in better depiction of
renal and ureteral anatomy even in poorly or nonfunctioning systems or multicystic dysplastic kidney. It also provides information regarding renal perfusion,
excretion and drainage. Despite having limitations such as high cost, limited availability, necessity for sedation and poor ability to evaluate vesicoureteral reflux, it
has the additional advantages of being an operator independent, non-ionizing
imaging technique performed without the use of iodinated contrast media.
Procedure Details: MR urography findings of patients with multicystic dysplastic
kidney, megaureter, ureteric ectopia, ureterocele, transverse folds of the ureter,
calyceal diverticulum and megacalycosis are illustrated.
Conclusion:, MR urography, showing good correlation with surgical findings, can
have a potential impact on the diagnostic algorithms related to uncommon pediatric urinary tract disease.
C-331
Virtual endoscopy in the urinary tract
G.C. Kagadis, C. Kalogeropoulou, I. Tsota, V. Haronis, K. Katsanos,
A. Diamantopoulos, P. Katsakiori, T. Petsas, G.C. Nikiforidis; Patras/GR
(kagadis@med.upatras.gr)
Learning Objectives: To familiarize imaging scientists with the application of
virtual endoscopy (VE) in the long-term follow-up of patients with ureteropelvic
junction obstruction, urinary bladder tumors, ureteral and/or urethral strictures.
Background: Virtual endoscopy (VE) is a non-invasive technique providing precise spatial relationships of pathological regions and surrounding structures. Technological breakthroughs have advanced temporal and spatial resolution of
diagnostic imaging, and 3-dimensional reconstruction techniques have been introduced into everyday clinical practice. It enables exploration of the urinary tract
whenever conventional endoscopy is contra-indicated or the endoscope is unable to pass a stenotic segment.
Procedure Details: A variety of computer algorithms can be utilized to generate
3-dimensional images, taking advantage of the information inherent in either spiral computed tomography or magnetic resonance imaging. VE images enable
endoluminal navigation through hollow organs, thus simulating conventional endoscopy. Several clinical studies have validated the diagnostic utility of virtual
cystoscopy, which has high sensitivity and specificity rates in the detection of
bladder tumors. Its principal limitations are the inability to provide biopsy tissue
specimens for histopathologic examination and the associated ionizing radiation
hazards (unless MR imaging is utilized). Preliminary data regarding virtual exploration of the renal pelvis, the ureter and the urethra are encouraging, but still
scarce. Nevertheless, in cases of endoluminal stenosis or obstruction, VE permits virtual endoluminal navigation both cephalad and caudal to the stenotic segment.
Conclusion: VE provides a less invasive and more perceptive method of evaluating the urinary tract, especially by clinicians who are less familiar with crosssectional imaging than radiologists.
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C-332
Dynamic MR imaging of perineal descent syndrome and incontinence
findings in patients with pelvic floor disorders
A. Salzano, G. Cavallo, G. Balsamo, G. Pagano, P. De Feo, A. Nunziata,
E. Montemarano, V. Nocera; Naples/IT (tonikus@libero.it)
Learning Objective: To describe the role of dynamic MR imaging in the study of
the anatomy and function of the pelvic floor, and its ability to recognize the findings of perineal descent syndrome (PDS) and incontinence in order to assess
the dynamics and activity of the bladder and puborectalis muscle during evacuation.
Background: In our experience 24 females (mean age of 49 years, range 38-77
years) were investigated with dynamic MR imaging. It was carried out in the supine patient at rest, under squeezing and during evacuation. Fast MR imaging
T2-weighted sequences allowed us to rapidly demonstrate the dynamic excursions of perineum and anorectum. A contrast agent made mixing potato starch
(50%) and echo gel substance (50%), and the previous filling of the bladder allowed radiological evaluation of the pelvic floor.
Imaging Findings: Dynamic MR imaging showed PDS in all cases as movement
of the anorectal junction from the ischial tuberosities and the sacral apex; in addition, 21 rectoceles, 16 cystoceles and 6 rectal intussusceptions were detected.
5 had anal canal dilatations while straining, 3 inhomogeneities of anal sphincters
and 2 cases of reduced thickness of levator ani muscle (faecal incontinence findings) and 4 urethro-cystoceles, 3 cases of hypotonia of bladder neck (urinary
incontinence findings), all associated with PDS.
Conclusion: Dynamic MR imaging can be considered a complementary method
to defecating proctography in patients suffering from faecal and urinary incontinence. It provides an accurate measure of perineal descent, adding further information about the anterior perineum and anorectal area, giving the clinician useful
parameters for treatment options.
C-333
CT urography as a supplement to contrast-enhanced CT of the abdomen
and pelvis in multitrauma patients and in patients with non-traumatic
urinary system pathology
W. Wawrzynek, A. Siemianowicz, M. Trzepaczynski, B. Koczy, S. Kasprowska,
A. Koczy, R. Majer; Piekary Slaskie/PL (ww69@wp.pl)
Purpose: To evaluate the role of CT urography performed as a supplement to
contrast enhanced CT of the abdomen and pelvis in multitrauma patients and in
patients with non-traumatic urinary system pathology.
Methods and Materials: 21 multitrauma patients and 6 patients with other urinary system pathology aged 34-72 years: In all cases the CT examination was
performed in the Radiology Department of Trauma Surgery Hospital in Piekary
Slaskie. An 8-slice CT scanner Light Speed Ultra GE Medical System was used.
The following examination conditions were applied: Slice thickness 2.5-3.75 mm;
pitch 0.875; 175 mA, 120 kV. After transferring the axial slices to the workstation
a volume-rendered 3D urogram was done.
Results: In some cases we observed more than one pathology. In multitrauma
patients we also found non-traumatic urinary system pathology. In 3 patients we
found subcapsular renal hematomas without traumatic lesions of the pyelo-calyceal system and ureter. Renal tumor was observed in 2 patients, parenchymal
cysts in 9 patients, parapelvic cysts in 4 patients, bilaterally dilated renal pelvis in
1 patient, ureter stenosis in 1 patient and flexed ureter in 1 patient. Focal lesions
of the kidney caused pyelo-calyceal modelling in 2 patients.
Conclusion: Application of CT urography as a supplement to contrast enhanced
CT of the abdomen and pelvis in multitrauma patients and in patients with other
urinary system pathology extends the possibilities of precise radiological diagnosis of urinary system pathology and in some cases may replace excretory urography.

GI Tract
Colon
C-334
Diffusion-weighted MR imaging of ulcerative colitis with the sensitivity
encoding technique for monitoring inflammatory activity: Initial experience
H. Haradome, A. Nakamura, T. Nitatori; Tokyo/JP
Purpose: The purpose of this study was to evaluate the usefulness of diffusionweighted MR imaging with the sensitivity encoding technique (SENSE-DWI) for
detecting and monitoring colonic inflammatory activity in patients with ulcerative
colitis (UC).
Methods and Materials: 21 patients with histopathologically-confirmed 60 colonic UC segments were included in this study. The degree of inflammatory activity of UC was classified in four grades (normal, mild, moderate, severe) based on
endoscopic colonoscopy scoring by three endoscopists in consensus. Two abdominal radiologists evaluated the wall conspicuity, degree of wall signal intensity (SI) with a three-grading system (high, moderate, hypo), and mural thickening.
The apparent diffusion coefficients (ADCs) on the each colonic segment were
also measured at the workstation.
Results: The 17 segments classified as severe (16/17, 94%) showed high SI
with marked mural thickening. The 16 segments classified as moderate showed
moderate SI with mild mural thickening in 12 (12/16, 75%) and mixture of high
and moderate SI with marked mural thickening in 2 (4/16, 12%). The 12 segments classified as mild showed moderate SI with mild mural thickening in 7 (7/
12, 58%), however, rest of segments showed hypo SI without mural thickening
and were not distinguished from normal segments. Mean ADCs (10-3 mm2/sec) of
the segments as severe (1.09 0.12) was statistically lower than those of the
segments as moderate (1.45 0.09), mild (1.80 0.11), and normal (2.24 0.07)
(p < .05).
Conclusion: SENSE-DWI enables to estimate site and degree of active inflammation in UC and may be useful for monitoring UC activity or assessing its therapeutic effectiveness.
C-335
CT colonoscopy using electronic cleansing: Technique and pitfalls with
primary 3D evaluation
T. Ichikawa, Y. Imai, T. Yamashita, S. Kawada; Isehara/JP
(tamaki-i@mars.sannet.ne.jp)
Learning Objectives: To learn the technique and pitfalls of electronic cleansing
in primary 3D evaluation of CT colonoscopy.
Background: Residual fluid in colon is one of the most problematic obstacle in
CT colonoscopy. To further increase the diagnostic ability of CT colonoscopy,
electronic cleansing (digital removal of intraluminal residual fluid) with the preparation of oral contrast material is used. Although electronic cleansing offers certain diagnostic advantages, there are some unique pitfalls.
Procedure Details: CT colonoscopy using 64-detector row CT (SOMATOM Sensation 64, Siemens, Forchheim) with 0.6 mm collimation in the supine and prone
position was performed in 60 patients. A bowel preparation using polyethylene
glycol electrolyte and contrast material combined was administered orally and
patient-controlled rectal insufflations with CO 2 was performed prior to scanning.
We reconstruct virtual colonoscopic images using workstation Viatronix V3D (Viatronix Inc, Story Brook, NY) for polyp detection. We review pseudopolyps and
artifacts to distinguish them from true lesions by using uncleansed axial and optimal MPR images.
Conclusion: There are various pseudopolyps and artifacts due to electronic
cleansing. The major pseudopolyps and artifacts are seen at air-fluid level interface. In the primary 3D evaluation of CT colonoscopy, understanding of the technique and knowledge of pitfalls on electronic cleansing is essential.
C-336
C-337
Recognising patterns of recurrence in colorectal cancer using CT and MRI
K.C. Potter, S. Houghton, J. Husband, G. Brown; London/UK
(gina.brown@rmh.nhs.uk)
Learning Objectives: To demonstrate characteristic recurrence patterns in colorectal cancer patients.
Background: An audit of colorectal cancer patients who have undergone 18FDGPET-CT for suspected recurrence was performed. 3 radiologists reviewed the CT
and MRI of 50 such patients. Studies where visible confirmed recurrence was
described as equivocal or missed by at least one reader were identified.
Imaging Findings: Characteristic patterns of recurrence were observed in these
patients. These will be analysed according to frequency for specific sites. A checklist for reporting these patients will be provided to minimise radiological misses.
Potential pitfalls are illustrated.
Conclusion: Colorectal cancer recurrences are usually visible on CT and MR
imaging. A knowledge of typical sites warranting dedicated review should improve diagnostic accuracy.
C-338
Whole-body MRI vs whole-body PET/CT in staging colon cancer
E. Squillaci, M. Di Roma, A. Nisini, O. Schillaci, R. Danieli, G. Simonetti;
Rome/IT (ettoresquillaci@tiscali.it)
Purpose: To assess the accuracy of whole-body MR imaging (WBMR) in comparison with whole-body [18 F]-2-Fluoro-2-deoxy-D-glucose (FDG) PET/CT (WBPET) for staging newly diagnosed colon cancer.
Methods and Materials: 20 consecutive patients with previously diagnosed colon cancer underwent WBMR at 3 T (Philips Achieva, Best, The Netherlands)
and whole-body [18 F]-2-Fluoro-2-deoxy-D-glucose (FDG) PET/CT (GE Discovery ST 16) for staging of lymph node (N) and distant (M) metastases after resection of the primary tumor. Evaluation was done according to the American Joint
Committee on Cancer Staging classification. MR images were evaluated by two
radiologists while PET/CT images by one radiologist and one nuclear physician.
Histology and a mean clinical follow-up of 12 months served as the standards of
reference. Differences between the imaging procedures were tested for statistical significance and sensitivity and specificity values for both modalities were
determined for N and M staging.
Results: The mean follow-up time was 186 days. Regional lymph node involvement was correctly determined in 15/20 cases as N-positive for both modalities
(75%, p < 0.05) while overall M stage was diagnosed correctly in 14/20 (70%)
patients for WBMR in comparison with 18/20 (90%) in PET/CT (p < 0.05). Nstage was overstaged with WBMR in 2 patients (10%) and with PET/CT in no
patients and understaged in 3 patients with WBMR and in no patients with PETCT. Distant metastases were overstaged with PET/CT in 2 and understaged in 3
patients with WBMR in 3 and 7 patients respectively.
Conclusion: WBMR is an effective and fast method for examining colon cancer
patients but cannot reach accuracy of PET-CT.
Purpose: In this study, we assessed T- and N- stage and evaluated a mesenteric

vascular anatomy using MDCT before laparoscopic colorectal surgery.
Methods and Materials: The study involved 51 cases scheduled for laparoscopic colorectal surgery for the treatment of colorectal cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was performed before the surgery.
393
GI T
Trract
Comprehensive study using MDCT for colorectal cancer before

laparoscopic surgery
M. Matsuki, T. Kanamoto, F. Tatsugami, M. Tanikake, I. Narabayashi;
Takatsuki/JP (rad053@poh.osaka-med.ac.jp)
Evaluating items were as follows; 1) A local invasion of the cancer was evaluated
on MPR, 2) Lymph nodes detected at the venous phase were evaluated by shortaxis and short/long diameter ratio. These CT findings and histopathological results of local invasion and lymph nodes were compared, 3) Visualization of 3D-CT
angiography of the branches of mesenteric artery was evaluated in comparison
with the operative findings.
Results: 1) In the evaluation of local invasion, for the cut-off of T3, sensitivity,
specificity and accuracy were 96.8%, 90.0%, and 94.1% respectively and for the
cut-off of T4, 100%, 67.7%, and 98.0% respectively. 2) At the cut-off point of
4 mm in short axis diameter, sensitivity, specificity and accuracy in the diagnosis
of metastasis were 78.7%, 79.1% and 79.0% respectively. At the cut-off point of
0.85 in short/long diameter ratio, sensitivity, specificity and accuracy in the diagnosis of metastasis were 80.3%, 84.8%, 84.2% respectively. 3) 3D-CT arteriography demonstrated correctly a feeding artery of the colorectal cancer and a
variation of branches of the mesenteric artery.
Conclusion: Comprehensive study using MDCT is effective for preoperative evaluation of local invasion of the colorectal cancer, lymph node metastases and
vascular anatomy before laparoscopic surgery.

C-339
Pitfalls in MDCT colonography: A systematic approach to technical failures,
perception and interpretation errors
T. Mang, A. Maier, C.M. Plank, P. Peloschek, C. Mueller-Mang, W. Schima;
Vienna/AT (thomas.mang@meduniwien.ac.at)
Learning Objectives: 1. To illustrate the spectrum of common and uncommon
pitfalls in MDCT colonography. 2. To propose multidetector signs and criteria to
distinguish between true colonic lesions and pseudolesions. 3. To emphasize the
value of different evaluation strategies to reduce the number of false positive and
negative findings.
Background: CT colonography offers new opportunities for imaging of the large
bowel. Using thin collimation, isotropic imaging of the colon is possible and provides high quality multiplanar reformations and 3D reconstruction of the organ. In
clinical practice, inadequate data acquisition impairs image quality. Perception
and interpretation errors of colonic lesions increase the number of false positive
and negative findings, and decrease the diagnostic performance of CT colonography. Because these pitfalls have substantial impact in patient evaluation, radiologists should be familiar with their appearance and morphology.
Imaging Findings: We describe the range of different pitfalls and pseudolesions
at MDCT colonography and present problem solving techniques to differentiate
between definite colonic lesions and pseudolesions.
Conclusion: MDCT colonography is an accurate tool for the detection and evaluation of colonic lesions. The knowledge of various pitfalls as well as problem
solving techniques is of utmost importance to achieve high detection and low
false positive rates.
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Is virtual colonoscopy an acceptable method for detecting Crohn's disease
in small and large bowel simultaneously?
G. Tth, L. Tth, P. Magyar, E. Turupoli, E.K. Mak; Budapest/HU
(totgez@freemail.hu)
Purpose: We tried to assess the usefulness of virtual colonoscopy for the assessment of pathological changes in small and large bowel Crohn's diseases.
Our goal was to reach a good distension in small and large bowel simultaneously
by virtual colonoscopy.
Methods and Materials: In 42 patients with known Crohn's disease CT virtual
colonoscopy was performed. We were searching for typical CT features of inflammation by two radiologist by consensus.
After 2-5 days colonoscopy was performed. Results of CT colonoscopy were
compared with colonoscopy, enteroclysis and surgery. Colonoscopy and surgery
were considered as a gold standard.
Results: Good small bowel distension was obtained in 35 cases, sufficient in 4,
insufficient in 3 cases. Large bowel distension was good in 39 cases, sufficient in
2 and insufficient in 1 cases. In 37 cases the thickness of the wall in all segments
of the small and large bowel were correctly evaluated. In 8 cases we found a
minimal, in 19 cases a medium and in 7 cases a strong small bowel wall thickening. In 5 cases only colonoscopy showed an aphthoid ulcerations in terminal
ileum. Virtual enteroscopy showed skip lesions in small bowel in 9 cases. Virtual
colonoscopy detected 94 % of mucosal abnormality and all strictures in comparison with colonoscopy. Virtual colonoscopy showed 8 abscesses, 10 extraintestinal fistulas all confirmed at surgery.
Conclusion: Virtual colonoscopy can be a good tool in detecting intramural and
complicated Crohn's disease in small and large bowel simultaneously, but we
don't advice in early Crohn's disease.
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Is it possible to suggest a surgical-radiological classification of enterocele
based on its behaviour in the obstructed defecation syndrome (O.D.S.)?
C. Morandi, G. Di Chiacchio, M. Foresti, F. Baroni, P. Torricelli; Modena/IT
(clafra.301@tin.it)
Purpose: To describe a new classification of enterocele based on the role it plays
in Obstructed Defecation Syndrome (O.D.S). An enterocele is defined as a prolapse of the small bowel into the rectogenital space.
Methods and Materials: Since November 2001, 495 patients (95% female) were
evaluated with cine roentgen defecography for O.D.S. using a standard technique;
one hour before the examination 300 mL of barium suspension were given orally.
Results: The enterocele was present in 111 female (23%) while only 1 was individuated in 25 male patients. Cine roentgen defecography allows to recognise
two different kind of enterocele, basing on its behaviour. Functional enterocele
(75 %) is part of the syndrome of the descending perineum (without compressing
394
the rectum). In the other condition - the ansa causes a real compression of the
rectum (80%) - the ampulla keeps its function independently from the presence
of the enterocele; otherwise (20%) the enterocele, since the initial phase of defecation, causes a compression of the recto-ampullary system, causing itself O.D.S.
Conclusion: The enterocele is usually defined as idiopathic (unknown causes,
remarkable deepness of the Douglas) and secondary (post hysterectomy). The
rate increases dramatically after hysterectomy (34% vs 15%). Functional enterocele does not require any treatment. When enterocele itself causes O.D.S. (i.e.
obstructing enterocele) only surgical approach (suvrapubic laparotomy) can eliminate this condition.
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Spectrum of normal findings, anatomic variants and pathology of ileocecal
valve at CT colonography. Radiologic-endoscopic correlation
F. Iafrate1, P. Paolantonio1, M. Anzidei 2, M. Rengo2, R. Ferrari1, F. Vecchietti1,
A. Laghi1; 1Latina/IT, 2Rome/IT (francoiafrate@tin.it)
Learning Objectives: Our purpose was to review the normal anatomy of ICV
and the anatomic variants, the most frequent pathologic conditions and some
pitfalls encountered during CT colonography with endoscopic correlation.
Background: CT colonography is a new emerged tool that allows the evaluation
of the entire colon. However, pitfalls in CT colonography are numerous. Amongst
them, prominent ileocecal valve can be misdiagnosed as tumor. A good familiarity with spectrum of different appearances, site and dimension of ICV is necessary to distinguish a normal from abnormal ICV.
Imaging Findings: The endoscopic appearance of ICV, simulated also by CTC
endoluminal views, has been classified, according to its morphology, into three
types: papillary with a domelike protrusion having its mouth at the apex, labial,
appearing as a slit-like opening, or round. Following the terminal ileum into the
caecum on 2D images is helpful to confirm the diagnosis of normal ICV or pathologic one.
Possible etiologies producing enlargement of ICV include idiopathic and posttraumatic edema, submucosal fat accumulation, herniation of ileal mucosa, tumor (benign and malignant) and inflammatory lesions involving the valve. The
correlation between endoscopic appearance and CT Colonography is high.
Conclusion: ICV is a normal structure, with several anatomical variants, possibly involved by different pathological conditions, either neoplastic or inflammatory. Awareness of these different diagnostic possibilities is mandatory for
radiologists evaluating CT Colonography data sets. Combined analysis of 2D
axial and reformatted slices and 3D endoluminal views provides the highest level
of diagnostic accuracy.
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Dark lumen MR colonography with fecal tagging. A comparison between
water enema and air methods of colonic distension in the detection of
colonic neoplasms: Work-in-progress
S. Rodriguez Gomez, M. Pags Llins, M. Sanchez Gonzalez, A. Castells,
J. Bordas, C. Ayuso Colella; Barcelona/ES (33849srg@comb.es)
Purpose: To compare MRC using air (AMRC) and water (WMRC) as method of
colonic distension, with conventional colonoscopy (CC) in the detection of colonic neoplasms.
Methods and Materials: 50 patients were evaluated with MRC and CC. Patients
underwent a low fiber diet and a barium based preparation in the 48 hours before
the examination of MRC. Patients were randomly assigned into 2 groups AMRC
(n = 22) and WMRC (n = 28).
True-FISP and a baseline and post-gadolinium (75 sec) VIBE sequences were
performed in all MRC, classifying the findings into malignant neoplasms, polyps
>/= 1 cm, 6-9 mm and 5 mm. The quality of fecal tagging and distension were
evaluated in each colonic segment.
Results: In the AMRC group FT was considered good in 65 of the 132 colonic
segments (49%). It was found that 9 patients in the AMRC group (40%) were
excluded. AMRC detected 2/2 malignant neoplasms. Detection of polyps was:
10 mm: 1/1; 6-9 mm: 0/1; 5 mm: 1/6.
In the WMRC group FT was considered good in 130 of the 168 colonic segments
(77%). 1 WMRC was excluded. WMRC diagnosed 0/0 malignant neoplasms.
Detection of polyps was: 10 mm: 4/4; 6-9 mm: 5/9; 5 mm: 0/14.
Conclusion: WMRC and AMRC detected all the malignant neoplasms and polyps 1 cm, but a high number of patients were excluded in AMRC because of
bad tagging, poor distention or artifacts.

C-344
Imaging of acute appendicitis and its impact on diagnosis: The Vancouver
experience
W. Chooi, J. Brown, P. Zetler, S. Wiseman, P. Cooperberg; Vancouver, BC/CA
(jochooi@yahoo.com)
Purpose: Pre-operative imaging of acute appendicitis is widely practiced. The
frequency of its utility has raised many debates between surgeons, emergency
physicians and radiologists. The aim of this study is to determine the prevalence
of pre-operative imaging of acute appendicitis in our institution and its effect on
the negative appendectomy rate (NAR) and perforation rates.
Methods and Materials: All patients who underwent appendectomy from January 2000 to December 2004 were reviewed retrospectively. Patients who underwent incidental appendectomies where excluded from this study. All available
pre-operative ultrasound (US) and computed tomography (CT) were reviewed.
Results: A total of 380 appendectomies were performed over this time period for
the pre-operative diagnosis of acute appendicitis. 59 patients had histologically
normal appendices giving an overall NAR of 15.5%. 70.4% of patients with histologically proven appendicitis had preoperative imaging versus 52.6% for those
with histologically normal appendices. Therefore patients who underwent preoperative imaging had a lower NAR. Also demonstrated is a definite trend towards increased usage of pre-operative CT as opposed to US as the only
pre-operative imaging modality. This is associated with a reduced NAR and perforation rates over the observed 5 year period. The overall sensitivity of CT and
US for the diagnosis of appendicitis at our institution was 93.6% and 87.3% respectively.
Conclusion: The overall NAR and perforation rate at our institution has decreased
during the study period due to increased utility of pre-operative imaging particularly CT.
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Review of virtual colonoscopy
A.M. Papadopoulou, G. Madani, N. Woodward, P. Cowley, P.N. Wylie, J.R. Bell;
London/UK (anthiekennedy@gmail.com)
Learning Objectives: We present a comprehensive, illustrated review of CT virtual colonoscopy (VC) giving a step-by-step guide to the technique and optimization of each stage, from stool tagging through to primary 3D image review. This
exhibit will equip the reader with the essential tools for the delivery of a first-class
VC service.
Background: Virtual Colonoscopy (VC) has gained widespread acceptance as
a reliable, non-invasive technique of complete colorectal examination. Since its
advent, continual developments have improved the efficacy of this imaging technique.
Procedure Details: Bowel preparation, faecal tagging, the use of balloon catheters and muscle relaxants and CT protocols are discussed. A wide range of artefacts and pitfalls, and the means to avoid them, are demonstrated. We highlight
the relative merits and limitations of primary reliance on the two-dimensional versus three-dimensional data and the latest developments and trends in VC, including minimal preparation CT, ultra-low dose procedures and screening
programmes.
Conclusion: VC is a reliable study with sensitivities and specificities which approach those of conventional colonoscopy.
C-346
Multimode radiological approach to colorectal neoplasms. From
conventional radiology to MR colonography
M. Pags Llins, S. Rodriguez, M. Sanchez, A. Gines, F. Gimeno, C. Ayuso;
Barcelona/ES (pages@clinic.ub.es)
C-347
Performance of CT colonography based on multiple primary 3D
stereoscopic displays: ColonDex
E. Neri, F. Vannozzi, A. Bardine, P. Vagli, C. Bartolozzi; Pisa/IT
(neri@med.unipi.it)
Purpose: To evaluate the efficiency and the diagnostic accuracy of a CT colonography system based on multiple primary 3D stereoscopic displays.
Methods and Materials: A CT colonography system based on primary 3D stereoscopic display (ColonDex; Volume Interactions/Bracco; Singapore) was tested
for feasibility and for accuracy in detecting polyps. The system provides a standard endoscopic view simulation coupled with a so called "Lumen Viewer" (LV)
display, designed to provide a single undistorted view of the colon segment under inspection, and a tissue transition projection panoramic view of the colon
(TTP).
Thirty endoscopically controlled cases, consisting of 5 with colorectal cancer, 13
with polyps and 12 with no colorectal lesions (control group), were randomly
evaluated. Among 24 polyps (in 13 patients), 18 were sessile and 6 pedunculated.
Results: The global per patient sensitivity was 94% (1 FN; polyp < 6 mm). The
per patient specificity was 66% (4 FP; polyp < 6 mm) for 3D viewing alone but
corrected to 83% (2 FP) when axial views were integrated.
Lesions location was mistaken in 4 polyps by standard endoscopic view and
corrected by LV, TTP and axial images. Polyps morphology was correctly characterized by endoscopic view and LV (sensitivity and specificity 100%).
Colorectal cancers were precisely defined for morphology, location and extension by endoscopic view (along the colon centreline), LV and TTP.
Conclusion: ColonDex showed a high sensitivity and specificity for polyp detection, segmental location and shape depiction.
C-348
Feasibility and reliability of automatic measurements in CT-colonography
using a colonic specimen
A. Jerebko1, P. Lefere2, S. Gryspeerdt2, S. Lakare1, L. Bogoni1; 1Malvern,
PA/US, 2Roeselare/BE (Luca.Bogoni@siemens.com)
Purpose: To assess the feasibility of automated polyp measurement in CT
colonography using a colonic specimen.
Methods and Materials: A patient with colonoscopically proven numerous polyps was scanned at 140 kV-10 mAs in supine and prone position using a 64 slice
scanner. The resection specimen of this colon was photographed with a calliper
scanned at different settings: 80, 100, 120, 140 kV and 10, 12, 14, 30 & 50 mAs.
Seventeen polyps were measured and compared on the original exam and the
scanned and photographed specimen.
Results: The polyps measured between 2.48 and 7.52 mm on the photograph.
The automated measurements were reliable with a difference < 0.75 mm compared with the photograph. The automated measurements on the specimen
showed a mean difference of < 1 mm and 1.3 mm compared with supine and
prone respectively. These differences were caused by distortion and pooling of
liquid at the polyp's border in the phantom. There was an insignificant average
difference < 0.6 mm compared to the photograph with different kV values at
50 mAs or different mAs values at 120 kV. Prone and supine correlation of the in
vivo polyp measurement was < 0.86 mm on average with a maximum of 2.4 mm.
Conclusion: The automated polyp measurement tool reliably measured polyps
in the 6 mm clinical threshold at different kV and mAs. The difference between
prone and supine measurement of the same polyp was larger, underscoring the
importance of performing polyp measurements in both supine and prone position.
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Learning Objectives: 1. To show the wide range of imaging procedures used to

diagnose a colorectal neoplasm, discussing the advantages and limitations of
each one. 2. To design a diagnostic algorithm for colorectal neoplasm through
these imaging techniques to avoid unnecessary studies. 3. To describe the signs
of colorectal neoplasms in each imaging technique.
Background: Current methods used to diagnosis colorectal neoplasms can be
achieved by a wide spectrum of radiological techniques. A colorectal neoplasm
diagnosis can be reached with a barium enema, ultrasound, CT, CT-enema, CTcolonography, endoscopic ultrasound, abdominal MR, MR-colonography or PET
study. Questions regarding the necessity to perform additional imaging procedures to obtain a confident diagnosis or to get a complete staging are not uncommon.
Procedure Details: We have designed a diagnosis algorithm which enables these
goals to be achieved avoiding unnecessary explorations, despite whatever has

been previously performed. The advantages and limitations of all these techniques
are demonstrated.
Conclusion: Although some of the techniques mentioned above require a learning curve, it should be kept in mind that the radiologist should be able to recognize the main signs of colon neoplasms in all the imaging procedures. Sometimes
a colonic mass is an incidental finding under another clinical suspicion.

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Role of MRI in the clinical management of patients with ulcerative colitis

F. Maccioni, S. Parlanti, F. Siliquini, G. Luppi, F. Carrozzo, M. Marini; Rome/IT
(francesca.maccioni@uniroma1.it)
Esophagus
Learning Objectives: 1. To illustrate the main MRI findings of ulcerative colitis

(UC), including disease extension and complications and assessment of disease
activity. 2. To illustrate the role of MR imaging in differential diagnosis with Crohn
disease. 3. To illustrate the potential role of MR imaging in the clinical assessment of disease.
Background: UC is an inflammatory bowel disease with a predictable cranial
spread from rectum to cecum involving the mucosa and submucosal layers, usually completely assessed by associating endoscopy biopsies and laboratory tests.
MR imaging has emerged as a valuable technique in assessing inflammatory
bowel disease, being valuable in detection of wall inflammation.
Procedure Details: Our experience is based on 40 patients with UC studied with
MR imaging at 1.5 T, with endoscopic and/or surgical correlations. MR imaging
detected most of the specific signs of UC, such as lost of haustrations, wall thickening, enhancement, submucosal oedema or fat, pseudopolyps and widening of
rectosacral space.
Conclusion: In patients who could not undergone complete endoscopic assessment, due to severe strictures or severe mucosal disease, MR imaging was able
to give a panoramic view of involved colon-rectum, also assessing disease activity on the basis of the degree of wall enhancement and T2 wall signal.
Prediction of the response to chemoradiation therapy in esophageal

squamous cell carcinoma with perfusion CT
K. Hayano, S. Okazumi, K. Shuto, N. Yanagawa, T. Kazama, T. Ochiai;
Chiba/JP (k-hayano@graduate.chiba-u.jp)
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Purpose: The purpose of this study is to evaluate perfusion CT in predicting

response to chemoradiation therapy (CRT) in patients with esophageal squamous cell carcinoma.
Methods and Materials: Twenty patients (19 men, 1 woman; median age 65.8
years old) with esophageal squamous cell carcinoma underwent perfusion CT
before CRT, using the commercially available CT perfusion 3 software (GE Medical Systems, Milwaukee, WI). The response to treatment was assessed according to the RECIST criteria. We investigated correlations between perfusion
parameters and the response to CRT. Statistical analysis was performed with the
Mann-Whitney U test for comparison of two data sets, and the spearman-rank
correlations were used to assess the relationship between perfusion parameters
and the tumor contraction rate. P < 0.05 was considered to indicate a statistically
significant difference.
Results: According to the RECIST criteria, responders were thirteen, and nonresponders were seven. Responsive tumors had significantly higher pre-CRT blood
flow (P = 0.0004), and had significantly shorter pre-CRT mean transit time
(P = 0.001) than non-responsive tumors. Tumor contraction rate had a significant
correlation with blood flow (r = 0.66, P = 0.004) and mean transit time (r = 0.52,
P = 0.02), but no relationship with blood volume (r = 0.24, P = 0.30) and permeability surface area product (r = 0.06, P = 0.79).
Conclusion: Perfusion CT may help to identify patients with advanced esophageal squamous cell carcinoma who will benefit from CRT, and may be an excellent modality for the evaluation of response to CRT in esophageal squamous cell
carcinoma.
C-351
Efficacy of 16- row multidetector CT (MDCT) in the preoperative staging of
esophageal cancer in comparison to endoscopical ultrasonography (EUS)
using the histopathological findings as the gold standard
A. Ba-Ssalamah, K. Pinker, S. Trattnig, M. Uffmann, J. Zacherl, A. Puespoek,
W. Schima; Vienna/AT (ahmed.ba-ssalamah@meduniwien.ac.at)
Learning Objectives: To demonstrate a modern approach for the evaluation of
esophageal tumors using multidetector row CT. To become familiar with the broad
spectrum of CT appearance of a large variety of esophageal tumors. To discuss
the key elements to stage esophageal cancer and to emphasis the role of MDCT
in the non invasive staging of esophageal tumors.
Background: Multidetector computed tomography (CT) offers new opportunities
for imaging of gastrointestinal organs. When thin collimation is used, imaging of
esophagus becomes possible and allows high quality, multiplanar reformation
and three-dimensional visualization. This article reviews the applications of multidetector CT in a large variety of esophageal tumors. Specific topics discussed
are CT technique, esophageal carcinoma, other esophageal malignancies, benign esophageal tumors, and the clinical value of multidetector CT.
Procedure Details: Adequate distention of the esophagus by using water and
gaseous as a negative contrast agent is a prerequisite for assessing the esophageal wall. Because of a substantial decrease in scanning time, optimization of
intravenous contrast material injection is necessary with multidetector scanning.
Proper contrast material injection techniques offer improved differentiation of tumor tissue from normal mucosa. Thus, the combination of water-enhanced CT
with near-isotropic multidetector imaging offers improved diagnosis of a large
variety of esophageal tumors.
Conclusion: It can be expected that multidetector CT will be helpful in deciding
between conservative and surgical therapy in selected patients.
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Virtual thoracoscopy by 16-detector row CT for preoperative assessment of
thoracoscopic esophageal surgery
Y. Morita, K. Takase, T. Matsuhashi, T. Yamada, A. Sato, S. Takahashi;
Miyagi/JP (morita@rad.med.tohoku.ac.jp)
Learning Objectives: To know what anatomical structures are important on virtual CT thoracoscopy for thoracoscopic esophageal surgery. To learn MDCT scan-
396

ning protocol and technique for generating "multi-volume fusion image" for surgical simulation.
Background: Thoracoscopic surgery for esophageal cancer has been advanced
as minimally invasive surgery. However, this approach has difficulty in obtaining
the entire view of operation field. Especially, bronchial arteries are occasionally
damaged during surgery due to its variation, which leads to complication such as
tracheal necrosis. Therefore, accurate 3D simulation is crucial to perform the
appropriate surgical procedure.
Procedure Details: 3D volume-rendering images were obtained using the images by 16-detector row CT. At first, thoracic CT angiography of the arterial systems (aorta and its main branches, especially bronchial artery), venous systems
(including azygos vein) and pulmonary hilum (pulmonary artery and vein) were
reconstructed changing the threshold of CT attenuation number. In all cases,
bronchial arteries and azygos veins were correctly identified and accurately rendered when compared with intraoperative findings. Multiple anatomical structures
such as trachea, swollen lymph node, bone and esophagus were fused together
with CT angiography as surgical simulation. Then, radiologist and surgeon identified each anatomical structure by fused 3D images using virtual endoscopy
technique similar to the view during the actual operation. 3D images were utilized
as preoperative assessment and intraoperative navigation of thoracoscopic esophageal surgery.
Conclusion: 3D simulation using MDCT gives a clear visualization as preoperative information before thoracoscopic esophageal surgery and enables surgeons
to improve safety and prompt performance during operation.
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Drug-induced esophagitis: Radiographic findings
S. Merola, C.H. Gotta, S. Ballester, M. Landi, G. Allasia Piccilli, G. Socolsky;
Buenos Aires/AR (cesar_gotta@yahoo.com.ar)
Learning Objectives: To show the different radiological aspects of this unusual
and not-well known esophagitis.
Background: Esophageal mucosal injury from the noxious effect of gastric contents refluxing up the esophagus is a common condition. Much less common is
esophagitis from injurious agents. Drug-induced esophagitis has become an increasingly common condition in today's pill-oriented society.
In the past 10 years, over 1800 esophagitis were diagnosed in our department,
36 cases (2%) were drug induced; 28 women and 8 men with a mean of age of 68
years were studied with double-contrast barium exam and endoscopic correlation.
Imaging Findings: The drug- induced esophagitis, were divided in two separate
groups, based on the action mechanism of the drug:
a) Pill-induced injury to the mucosa: 10 cases caused by alendronate, doxycycline, tetracycline and aspirin.
b) Indirect injury: 26 cases of herpetic and candidiasis esophagitis induced by
citostatic agents (65%); broad spectrum antibiotics and high dose corticosteroids therapy (35%).
Conclusion: Drug-induced esophagitis is almost always suggested by the temporal relationship between ingestion of the offending medication and the development of esophagitis.
C-354
Pneumo esophageal CT (PN-CT): New technique for characterization of
esophageal cancer
M. Sturla, A. Seehaus, J. Ocantos, J.L. San Romn, E. Levy Yeyati,
R. Garca Mnaco; Buenos Aires/AR (mariano.sturla@hospitalitaliano.org.ar)
C-355
The technical challenges of external surface coil high resolution T2weighted MR imaging of the oesophagus
A.M. Riddell, C. Richardson, E. Scurr, G. Brown; London/UK
(Angela.Riddell@rmh.nhs.uk)
Purpose: To describe development of this innovative MR imaging technique using an external surface coil, to overcome the problems associated with endoluminal imaging. To describe methods used to optimise signal to noise ratio (SNR)
and to assess the effect of cardiac gating.
Methods and Materials: Four volunteers were imaged using a 1.5 T magnet
(Philips Intera, Andover MA) and an external 5 channel surface coil (Philips Sense
CardiacTM). A T2-weighted Fast Spin Echo sequence was used, as has previously been established as optimum for delineating oesophageal wall layers. Systematic changes in field of view (FOV), matrix size, slice thickness, number of slice
acquisitions (NSA), and TR/TE were made to optimise SNR whilst maintaining
spatial resolution with and without cardiac gating. Workstation images were scored
on the ability to visualise: individual oesophageal wall layers; perioesophageal
fat; the azygos vein and wall of the descending aorta, giving qualitative evaluation of image clarity.
Results: With and without cardiac gating the optimum FOV and slice thickness
were 250 mm and 4 mm respectively giving an in-plane resolution of 0.5 x 0.8 mm.
Smaller FOVs degraded image quality so individual oesophageal wall layers could
not be depicted and noise within the image impaired visualization of posterior
mediastinal structures. Using these parameters an acceptable scan time of 7 minutes for 22 slices was achieved. Addition of cardiac gating enabled clearer depiction of posterior mediastinal structures without significant increase in scan duration.
Conclusion: High resolution imaging of the oesophagus is challenging but can
depict anatomic structures clearly. Cardiac gating improves image clarity.
C-356
Palliative self expanding oesophageal stents: A five year district general
hospital experience
A.J. Sebastian, S. Nair, R.A.J. Mannion; York/UK (arunsebastian@hotmail.com)
Purpose: To determine the immediate and long-term complications of fluoroscopy guided oesophageal stent (OS) insertion for malignant oesophageal obstruction.
Methods and Materials: The hospital database of all patients who had OS insertion between January 2000 and April 2005 were retrospectively reviewed. The
stents were inserted under conscious sedation and lignocaine topical anaesthesia. The stents used were Flamingo, Ultraflex and Niti-S (Taewoong). The results
of any further investigations or interventions were assessed and all complications were documented.
Results: 116 oesophageal stents were inserted in 107 patients during the 64month study period. All procedures were performed for oesophageal malignancy,
except for four patients who had extrinsic oesophageal compression.
82% patients had distal oesophageal obstruction and the Flamingo stent was
used in 56 (52%) patients. The median patient age was 76 years. 2 patients died
from haematemesis within a month and 9 patients required further stent insertion
to treat tumour overgrowth. There was one episode of stent migration. 45 (42%)
patients died within a month after OS insertion and the reasons for this will be
discussed. 10 patients were alive at the time of the data collection (median survival 221 days).
Conclusion: Oesophageal stent insertion is confirmed as an effective palliative
option for malignant oesophageal obstruction with a low immediate complication
rate. Stent migration is rare, despite 82% of tumours arising at the gastrooesophageal junction. In our institution, a significant number of stents are inserted at a late
stage in the patient's illness, after recurrence following other forms of therapy.
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Purpose: To present a new CT technique, using air to distend the esophagus,

providing better characterization of the esophageal wall.
Methods and Materials: 24 patients (45y - 67y) were studied with clinical or
radiological suspicion of esophageal cancer. To achieve esophagic distension a
14 F Foley tube was introduced through the nose and settled right below the
cricopharyngeal muscles, previous local spray anesthetic (Lidocaine 2%). Correct location was confirmed by CT scan. We used 0.7-second single-detectorrow spiral CT scanner Philips, Secura, The Netherlands. Acquisition included the
area between C6 and the inferior hepatic contour, scan direction was craniocaudal. Parameters were 3 mm collimation, 1.5 reconstruction index, 120 Kv,
200 mAseg and pich 1. A continuous airflow (20 ml/sec, starting 3 sec before CT
slice acquisition) was supplied. Airflow was sustained during the acquisition for
25 to 30 seconds. Multiplanar, 3D and virtual endoscopy reconstructions were
performed in all patients.
Results: Significant distension of the esophagus (3 cm or more of diameter) including gastro-esophagic transition zone were achieved in all patients. Esophag-
ic lumen was visible in all its extension. 23/24 patients mural thickening (3 mm or
more) was identified and measured. All lesions where characterized in size, shape
and its location. 3/24 lesions were extending to the gastric region. All patients
showed no complications or adverse effects, only one referred chest displeasure
during the study.
Conclusion: PN-CT proved to be a safe, useful and feasible technique for identification of normal and pathological esophageal mural thickening.

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Thoracic aortic invasion of esophageal squamous cell cancer evaluated by
electrocardiogram-gated MDCT comparison with histological findings: A
pilot study
K. Shuto, S. Okazumi, K. Hayano, T. Ochiai, N. Yanagawa; Chiba/JP
(wk8k-sytu@asahi-net.or.jp)
Purpose: To evaluate thoracic aortic invasion of esophageal squamous cell cancer using ECG-gated MDCT to eliminate the influence of aortic pulsation and to
compare with histological results.
Methods and Materials: The study enrolled 25 consecutive patients who were
diagnosed as advanced esophageal cancer of middle or lower thoracic esophagus, and who underwent operation subsequently. 16-low MDCT examination was
performed after intravenous injection of contrast material. Images were reconstructed every 5% of the R-to-R interval, and 4D movies was acquired in the
workstation. We prospectively observed the movement between thoracic aorta
and tumor in 4D movies.
Results: In 20 cases (80%) we could observe a low density band that considered a separate movement between aorta and EC. The band was not detected in
other 5 cases. The deformity of the aortic wall by contiguous cancer was not
recognized in 3 of these 5 cases in the movies. That was considered as a negative finding of direct tumor invasion. 23 of all cases were diagnosed as clinically
T3 with this examination. All 30 patients underwent operation, and all revealed no
aortic tumor invasion histologically (pT3). When a separative movement between
aorta and tumor was observed or the deformity of the aortic wall was not recognized, this was interpreted as a negative finding of direct tumor invasion. The
negative predictive value was 92% (23 of 25 cases) according to this criterion.
Conclusion: This noninvasive and short-time modality can eliminate the influence of aortic pulsation and may become a useful imaging technique.
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Imaging of esophageal disorders in children and adulthood
M. Allona, C. Sanchez Almaraz, M. Lamas, T. Berrocal, F. Guerra, L. de Pablo;
Madrid/ES (mariaallona@yahoo.es)
features of a wide spectrum of congenital and acquired disorders involving the
esophagus in children and adulthood. To evaluate the efficacy of plain radiographs,
barium studies, computed tomography (CT) and magnetic resonance (MR) imaging in the diagnosis and management of these conditions.
Background: We retrospectively reviewed the imaging findings of patients with
disorders involving the esophagus from our database of gastrointestinal pathology. Plain radiographs and barium studies were performed in all patients, while CT
or MR were performed in all tumours and whenever barium studies were not
conclusive. The embryologic and pathological bases of the imaging findings are
discussed in appropriate cases. The key findings at each imaging modality are
shown and compared with the underlying pathologic features when available.
Pitfalls, diagnostic difficulties and differential diagnoses are emphasised.
Imaging Findings: Specific topics addressed include abnormal sucking and
swallowing (cerebral palsy, cricopharyngeal dysfunction, Riley-Day syndrome,
scleroderma, dermatomyositis, achalasia), congenital and developmental anomalies (esophageal atresia and trachoesophageal fistula, congenital stenosis, cysts
and duplications of the foregut, esophageal bronchus, vascular anomalies, esophageal diaphragm or web and esophageal diverticula), esophagitis (gastroesophagic reflux, Barret's esophagus, infectious, caustic, pharmacologic and
postradiation esophagitis), benign tumors, malignant tumors, esophageal trauma (haematoma and perforation), foreign bodies, and postsurgery complications.
Conclusion: Evaluation of patients with esophageal disorders frequently requires
multiple imaging modalities for diagnosis and planning treatment. Because many
of these disorders have characteristic imaging appearances, this exhibit will help
the practicing radiologist to better understand these disorders.
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MR-fluoroscopy of esophageal transit in healthy subjects: Normal patterns
M. Anzidei1, V. Panebianco1, P. Paolantonio2, E. Tomei1, M. Rengo1, V. Vergari1,
R. Passariello1; 1Rome/IT, 2Latina/IT (mikilgenio@hotmail.com)
Purpose: To assess esophageal motility patterns in healthy subjects using MR
with Dynamic TURBO-FLASH sequence and positive oral contrast agent.
Methods and Materials: Twenty healthy volunteers were examined using a 1.5 T
magnet (Magnetom Vision: Siemens, Erlangen, Germany) equipped with phasedarray coil. Imaging protocol was based on the employment of Dynamic TURBOFLASH sequence on sagittal and axial planes to obtain real-time motility evaluation
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(TR 416 mS, TE 1.2 mS, Flip Angle 8, Thickness 20 mm, FoV 350, Matrix 90x128,
N. acquisition 45, TA=25 sec, Position: prone). Lumen distension during functional sequences was achieved by oral administration of positive c.a. boluses (20 ml
semi-fluid yoghurt bolus+1 ml of Gd-DTPA 0.5 M, 1:100). Attention was focused
on both functional and morphological parameters; peristalsis velocity, contraction waves, overall transit time, esophageal length and esophageal calibre were
properly evaluated.
Results: Dynamic TURBO-FLASH sequence offered adequate visualization of
esophageal motility and morphology; average peristalsis velocity was = 2.5 cm/
sec, only primary peristaltic waves were present, average transit time was = 10 sec,
average esophageal length was = 27 cm, average calibre was = 29 mm. The use
of yoghurt as part of contrast agent allowed optimal visualization of esophageal
transit with high signal intensity and good comfort for patients.
Conclusion: MR imaging assessment of normal pattern of esophageal motility
and morphology using Dynamic TFL sequence with oral contrast agent is feasible and represents a promising comparison parameter for the evaluation of esophageal functionality in subjects affected by motility disorders.

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Rectum
Assessment of symptomatic rectocele and rectal intussusception by

dynamic magnetic resonance imaging of pelvic floor
A. Salzano, G. Cavallo, G. Balsamo, R. De Filippo, A. Basilicata, P. De Feo,
G. Pagano, A. Nunziata, V. Nocera; Naples/IT (tonikus@libero.it)
C-360
How accurate can we predict the nodal status in primary rectal cancer with
USPIO MRI?
M.J. Lahaye1, S.M.E. Engelen1, G.L. Beets 1, A.P. de Brune1,
M.F. von Meyenfeldt1, J.M.A. van Engelshoven1, C.J.H. van de Velde2,
R.G.H. Beets-Tan1; 1Maastricht/NL, 2Leiden/NL (rbe@rdia.azm.nl)
Purpose: To determine the accuracy of MR imaging, using a lymph node specific
contrast agent, for the prediction of nodal status in patients with primary rectal
cancer.
Methods and Materials: From February 2003 to June 2005, 40 patients underwent a 1.5 T high-resolution MR imaging after administration of Sinerem contrast agent. Sequences used were 2DT2WFSE in three orthogonal planes and
transverse 3DT1GRE and 3DT2*GRE.
All these patients were treated with TME-surgery, after preoperative radiotherapy
(5x5 Gy). A MR imaging radiologist recorded the amount, localization and signalintensity changes of mesorectal and extramesorectal lymph nodes, depicted by
MR images. Histopathological correlation was performed on a node-to-node basis.
Results: In 40 patients MR imaging depicted 414 lymph nodes, which could be
recovered in the TME specimen. Twenty-two patients were predicted as nodepositive due to MR imaging results. After histopathologic evaluation 14 of these
patients were staged as node-positive. The patient-based sensitivity, specificity,
PPV and NPV were respectively 100%, 69%,64% and 100%. The lesion-by-lesion analysis results in a sensitivity, specificity, PPV and NPV of 95%, 95%, 64%
and 99%, respectively. Striking finding is the high NPV, suggesting that N0- patients can be identified accurately.
False negative findings were due to small micrometastases at the border of lymph
nodes, which are invisible on MR images, but detected at histo-pathology. False
positive findings were seen in lymph nodes where normal lymphocytes had been
replaced by other tissues.
Conclusion: This prospective pilot suggests that USPIO-MR imaging is highly
accurate in identifying N0-patients, stratifying rectal cancer into different risks,
allowing individual tailored treatment according to risks.
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Clarifying terminology in the multidisciplinary management of rectal
cancer: A pictorial study
G. Brown 1, G. Salerno2, I.R. Daniels2, A. Wotherspoon3; 1Sutton/UK,
2
Basingstoke/UK, 3London/UK (gina.brown@rmh.nhs.uk)
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Staging of locally advanced rectal cancer (LARC): Proposal of a "one-stop"
magnetic resonance (MR) imaging-based protocol
A. Petrillo, S. Filice, A. Avallone, P. Delrio, C. Guida, F. Tatangelo, P. Maroni,
A. Nunziata, A. Siani; Naples/IT
Purpose: To illustrate a protocol allowing fulfilled abdomino-pelvic MR assessment of patient with LARC. To discuss the additional value of rectal distension
with contrast medium enema and of liver evaluation with liver-specific contrast
medium.
Methods and Materials: November 2001-February 2005, we evaluated 107 consecutive patients (51M and 56 F, 59 with surgical correlation and 48 who only
had staging MR imaging). MR studies were carried out in two steps. On the first
day, patient underwent liver imaging (T2w-bh sequence) before and after superparamagnetic iron oxide contrast medium injection (Resovist). On the second
day, patient underwent pelvic imaging (T1w-SE and T2w-TSE sequence) with
high-resolution technique (phased-array coil, 3-mm thickness, gap 0), by using
IV gadolinium-DTPA (Magnevist) and per rectum ferumoxil (Lumirem). Coronal
T1w-SE sequences were also obtained to assess lomboaortic and iliac lymph
nodes. In subjects with Resovist detection of unclear lesions, dynamic liver imaging with gadolinium was obtained.
Results: Rectal distension with ferumoxil created high contrast between lumen
and enhanced tumour, without overdistension. Contrast enema allowed optimal
definition of proximal tumour extension, exclusion of obstruction, and assessment of post-radio-chemotherapy residual tumour and complications (fistulas).
Presurgical MR imaging showed a 80% accuracy for T and a 65% accuracy for N.
Presurgical MR imaging was 95% accurate in predicting extension to mesorectal
fascia and 100% accurate in predicting liver metastasis resectability.
Conclusion: State-of-the-art MR equipment and contrast media allow comprehensive TNM staging of LARC. MR imaging can be used as the only staging
technique, in a cost-effective, "one-stop" (two steps!) protocol.
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Diffusion-weight magnetic resonance imaging of rectal cancer
S. Rao, M. Zeng; Shanghai/CN (raoxray@hotmail.com)
Purpose: To determine the feasibility and appropriate b factor of diffusion-weighted
magnetic resonance imaging (DW-MRI) in depicting rectal cancer.
Methods and Materials: Thirty-three patients with primary rectal cancer underwent diffusion-weighted echo-planar imaging and T2 weighted turbo spinecho (T2W-TSE) with phased-array coil. No antispasmodic and no cardiac
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Learning Objectives: 1. Areas of rectum not surrounded by mesorectum are

classified appropriately and the multidisciplinary team use consistent terminology. 2. Radiological, surgical and pathological definition of margins may not always be identical.
Background: With the increasing use of pre-operative therapy in rectal cancer
and the demonstration of the accuracy of MR imaging staging in predicting the
circumferential resection margin (CRM) status, it is important that areas of rectum not surrounded by mesorectum are classified appropriately and the multidisciplinary team use consistent terminology.
Procedure Details: Using digital MRI images and pathological specimen photographs we have demonstrated the pictorial correlation between the following factors:
1. Peritoneal reflection and involvement
2. Circumferential resection margin status and mesorectal fascia - by height
3. Invasion into adjacent structures
4. Mesorectal fascia and surgical resection margin
5. MR imaging nodal involvement and pathological nodes
6. Extra-mural venous invasion on MR imaging and pathological section
7. Invasion of the anal sphincters
Conclusion: Pathological assessment of a rectal cancer represents the 'goldstandard' for staging. Pre-operative identification of these factors allows the selection of patients for pre-operative therapy. Consistency of terminology will enable
meaningful case discussions within the multidisciplinary team meeting.
Learning Objectives: To describe the assessment of dynamic magnetic resonance imaging (MRI) of pelvic floor in selected subjects with rectocele associated to rectal intussusception, previously investigated by defecography (8 rectal
intussusceptions on 21 female rectoceles and 2 intussusceptions on 6 male rectoceles). Both were symptomatic of evacuations difficulties and functional perineal disorders.
Background: 27 subjects (21 females with mean age of 47 years and range of
34-79 years; 6 men with mean age of 57 years and range of 44-73 years) were
studied with dynamic MR imaging in different dynamic phases of pelvic floor: At
rest, squeezing and during evacuation.
We used a high density contrast mixing potato starch (50%) and echo gel substance (50%) simulating the fecal bolus.
Imaging Findings: Dynamic MR imaging showed 9 intussusceptions on 21 female rectoceles and 4 intussusceptions on 6 male rectoceles; besides, 23 cases
of perineal descent syndrome (19 F - 4 M) and 13 cases of cystocele in females.
Dynamic MR imaging provided almost the same results obtained at defecography technique, but it demonstrated better the relationship and the mechanisms of
rectal intussusception in order to rectocele and cystocele and the anatomo-functional dynamics of levator ani muscle.
Conclusion: Dynamic MR imaging of pelvic floor may be actually considered a
new and an alternative method of investigation of pelvic floor among different
diagnostic examinations both radiological and functional studies. It's a non-invasive and well-tolerated imaging modality and may identify in detail the sequence
of rectal intussusception and other perineal pathologies involving pelvic floor and
anorectal area.

triggering was used. All patients held their breath while the diffusion-weighted
images were being acquired. The b factors used were 500, 800, 1000 and 1200 s/
mm2 in each patient. The signal intensities of tumor (SIt) and normal muscle (SIm)
were measured for calculating the CNR (SIt-SIm/SIm). The contrast between the
tumor and normal rectal wall were also assessed in the DW images.
Results: Diffusion-weighted imaging depicted all rectal cancers as hyperintense
areas with various b factors. There had significant difference between the T2WI
and DWI but no significant difference among various b factors in the value of
CNR. The SI of tumors were slightly lower with increasing b factor, but the contrast between the tumor and normal rectal wall became more obvious and the
other hyperintense structures became fewer. The other hyperintense structures
were small intestine, peripheral zone of prostate, seminal vesicles and endometrium. Only the tumors and a few normal structures were hyperintense, when b = 800,
1000 and 1200 s/mm2, but sometimes it was difficult to see the definite outline of
the tumors for the low SI when b = 1000 (2/33) and 1200 s/mm2 (3/33).
Conclusion: DW-MRI has great detectability for rectal cancer and b = 800 s/mm2
may be the appropriate b factor in depicting rectal cancer.
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The variation in mesorectal volume in patients with rectal carcinoma.
Assessment with magnetic resonance imaging
S.D. Allen, V. Gada, D.M. Blunt; London/UK (sdallen@doctors.org.uk)
Purpose: To assess the variability in the mesorectum in patients with rectal carcinoma. Patients with small volume compartments are at increased risk of even
small tumours compromising the circumferential resection margin.
Methods and Materials: Retrospective review was made of pelvic MR imaging
studies in 30 patients (mean age = 64, range 34-88 years, 18M: 12 F) with histologically proven rectal carcinomas that were confined to the mesorectum. The
outer low signal margin of the mesorectum was traced, over at least 10 consecutive 10 mm contiguous slices, till its disappearance. The visceral fascial compartment and total body area were measured, on a solitary slice, at the level of
the L5/S1 disc. Linear regression was calculated for independent determinants
of the mesorectal volume.
Results: Mean mesorectal axial slice area ranged from 3-57.7 cm2, with a mean
of 19.19 cm2 [males = 22.2 cm (95% CI 18.6-25.8), females = 15.4 cm (95% CI
12.6-18.2)]. Mean mesorectal volume in males was 223.8 cm(95%CI 185.4262.2), and in females was 157.5 cm (95%CI 126.1-188.9). The difference in
mesorectal volume between men and women was statistically significant
(P < 0.05). Mean visceral compartment area in males was 18.4 cm (95%CI 16.720.0) and in females was 14.6 cm (95% CI 12.9-16.3). Visceral compartment
area correlated with mesorectal area and volume in both males and females
(P < 0.05). Total body area and age did not correlate with mesorectal area or
volume.
Conclusion: Significant sex variation in mesorectal size and correlation of visceral compartment area with mesorectal size has important prognostic implications in patients with rectal carcinoma.
C-366
How distal is distal rectal carcinoma on MRI?
S.M.E. Engelen, G.L. Beets, M.J. Lahaye, R.F.A. Vliegen, M.F. von Meyenfeldt,
J.M.A. van Engelshoven, R.G.H. Beets-Tan; Maastricht/NL (rbe@rdia.azm.nl)
Distal rectal cancer has high chance of CRM-involvement and thus local recurrence. Endoscopy probably doesn't measure distal tumour margin reliably. MR
imaging might be a useful tool.
Purpose:
a. Comparing MR imaging vs flexible/rigid endoscopy for measuring tumor height
in rectal carcinoma.
b. Studying consistency of MR imaging measurements.
c. Defining level of tumour, at which high chance of CRM involvement is expected.
Methods and Materials: Two retrospective cohorts, 75/23 patients, period 20032004. Preoperative MR and flexible (first cohort)/rigid (second cohort) endoscopy report available.
a. Comparison tumour height MR imaging vs endoscopy.
b. Defining consistency MR imaging (n = 51) by independent reading by two
readers.
c. Evaluation location/height mesorectal tapering on sagittal MR imaging
(n = 75): at what height high chance of CRM-involvement?
Results:
a. Poor correlation MR imaging vs flexible and rigid endoscopy (Pearson = 0.628
and 0.629 resp., p < 0.001)
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b. High interobserver agreement (ICC= 0.83) for defining tumour height.

c. Mesorectal tapering starts at fornix posterior (female, mean = 7.4 cm) and
base seminal vesicles (male, mean = 6.3 cm).
This study shows consistency of MR imaging for defining distal margin, however,
further investigation is needed to determine the best and most accurate modality
to measure height of distal margin of rectal cancer. This study also shows MR
imaging being useful for defining height of mesorectal tapering. Probably, mesorectal tapering is more important than generally accepted '5-6 cm distance from
anal verge' for defining high risk.
Conclusion: MR imaging could be valuable for distinction between 'high-risk'
distal and 'lower-risk' high rectal tumours, by measurement of distal margin and
height of mesorectal tapering.
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External phased-array pelvic MRI of acquired anorectal fistulas: Spectrum
of disease
M.D. Marra, C. Hoeffel, M.D. Crema, L. Azizi, L. Arriv, J.-M. Tubiana; Paris/FR
(monica_dmarra@hotmail.com)
Learning Objectives: To describe the anatomical locations, causes, and clinical
features of acquired anorectal fistulas. To identify the MRI findings in the various
types of anorectal fistulas. To review the current role of MR imaging in the assessment of acquired anorectal fistulas.
Background: The most commonly encountered and known anorectal fistulas are
anorectoperineal fistulas occuring in Crohn's disease. However, there is a variety
of less common fistulas involving the anorectum. Their causes include infection,
inflammatory disease (Behet's disease), neoplasms, trauma and iatrogenic injury. Pelvic MR imaging assessment has proved useful in the evaluation of fistulas and has become an important part of diagnostic work-up before proper case
management. We reviewed the MR examinations of patients with anorectal fistulas involving other pelvic organs performed from July 2002 to July 2005.
Imaging Findings: We illustrate the MR findings in various fistulas involving the
rectum, anal canal, ileal, colonic pouch (in case of previous surgery) and the
vagina, uterus, prostate, urethra, bladder, and ileum. We also present the features of complex anoperineal fistulas. The current role of MR imaging is discussed.
We also illustrate the features of post treated fistulas (myocutaneous flaps, setons, omentoplasty, resections).
Conclusion: External phased-array pelvic MR imaging is an accurate technique
for the identification of acquired anorectal fistulas and their complications. Body
phased-array coil offers both high field of view and spatial resolution, enabling
the demonstration of these fistulas.
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Hydrogen peroxide-enhanced ultrasound in the assessment of perianal
fistulae
J. Cogollos, T. Ripolles, M.J. Martinez, J. Ballestin, P. Calvillo; Valencia/ES
(jocovan@yahoo.com)
Purpose: The aim of this study was to compare prospectively conventional endoanal ultrasound with hydrogen peroxide-enhanced ultrasound in the assessment of perianal fistulae.
Methods and Materials: Endoanal ultrasound was performed in 43 consecutive
patients (36 men; mean age, 40 years) before and after injection of hydrogen
peroxide. Ultrasound was performed using a B&K Diagnostic Ultrasound System
with a 7-MHz rotating endoprobe. Hydrogen peroxide was infused via a small
catheter through the external opening into the fistula. The additive value of hydrogen peroxide-enhanced ultrasound compared with conventional endoanal ultrasound was determined. The results in patients with previous surgical interventions,
in which fibrous tracts made the interpretation of the findings difficult, were also
calculated. The results were compared with surgical features.
Results: The use of hydrogen peroxide provided additional information in 31 of
43 cases (72%). The additive value was superior in cases with previous surgery
(82%) comparing with cases without surgery (65%). It was helpful establishing
the fistulous track in 13 patients (30%) where the non enhanced sonography was
negative. It made possible the visualization of 10 suprasphincteric and 5 extrasphincteric tracts. Unsuspected secondary tracts (complex fistulas) were revealed
in 7 cases. Internal opening was found in 12 patients after the infusion of hydrogen peroxide.
Conclusion: Our results confirm that hydrogen peroxide-enhancing ultrasound
is superior to standard ultrasound in the study of perianal fistulas, specially in
operated cases. It supplies additional information, such as delineating complex
fistulas and detecting internal openings.

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GI Tract
Endoanal ultrasound: Clinical applications

J.R. Varela Romero, J. Castro Perez, I.M. Requejo Isidro, H. Cigarran Sexto,
D. Freire Rodriguez; La Corunna/ES
Small Bowel
Learning Objectives: To present the normal anatomy and pathological conditions of the anal canal, using endoluminal anal sonography and emphasizing the
role of this technique in the diagnostic and therapeutic management of these
disorders.
Background: Endoanal ultrasound has been initially used to study the anal sphincter complex.
Recently the indication of this method has extended to the diagnosis other pathologic conditions of the anal canal and it has been also applied to the pre-treatment assessment and evaluation of surgical results.
Procedure Details: 302 endoanal examinations in 286 patients, were done at
our institution during the last two years.
We describe the endoanal ultrasound technique, including the use of hydrogen
peroxide to depict the fistulous track.
The anatomy of the anal canal is reviewed, describing the normal echographic
appearance of the anal layers and the sphincter complex.
We present the ultrasound findings in perianal fistulas and abscesses (following
Park's criteria to classify the fistula track).
The utility of this method in the diagnosis of other anal disorders (sphincter defects and anal masses) is also evaluated.
Conclusion: Endoanal sonography is a safe, quick and well tolerated exploration. Enables detailed visualization of the anal canal, allowing accurate location
of the fistula track and abscesses. It is a reliable method for sphincter measurements in cases of incontinence and is also helpful in the detection and staging of
anal malignancies.
CT in the follow-up of advanced gastro-intestinal stromal tumors (GIST)

under treatment by Imatinib Mesylate (Gleevec): New criteria of evaluation
M. Mabille1, D. Vanel1, M. Albiter2, A. Le Cesne1, S. Bonvalot1, C. Le Pechoux1,
P. Terrier1, C. Dromain1; 1Villejuif/FR, 2Paris/FR (boulongne@igr.fr)
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Purpose: To define new CT criteria of tumor evaluation during the follow-up of

GIST under Gleevec.
Methods and Materials: This prospective CT study evaluated 107 consecutive
patients with advanced GIST treated with Gleevec.
Results: Seventy patients had total or partial cystic-like transformation of hepatic and/or peritoneal metastases. These pseudo cysts kept the same size on successive CT examinations (stable disease according to RECIST criteria of
response). Forty-six patients underwent secondary changes, with 17 parietal thickening and 29 parietal enhancing nodules. CT changes always announced a local
relapse combined with a Gleevec resistance of the disease. WHO or RECIST
criteria did not allow a reliable evaluation of disease evolution. A new enhancement was the only reliable criterion.
Conclusion: Secondary parietal thickening or enhancing nodules within cystlike metastatic lesions, even without size changes announced the relapse of the
GIST under Gleevec, and should allow to consider an aggressive local treatment before general progression.
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CT appearances of intussusception in adults
C.J. Corr, I. Hagan, R. Hopkins, G. McGann; Cheltenham/UK
(conorcarmelcorr@tiscali.co.uk)
Learning Objectives: To illustrate the range of appearances and causes of intussusception in adults, emphasising the differences between small and large
bowel intussusception.
Background: Intussusception in adults is often thought of as an obstructing condition, usually with an identifiable lead point. However, it often occurs without
obstruction or a lead point, particularly in the small bowel. Whenever there is a
lead point in small bowel intussusception, it is usually benign. Large bowel intussusceptions usually do have a lead point, and are often malignant (50 -80%).
Procedure Details: Multi-detector CT is the ideal method for imaging intussusception, as it normally presents as non-specific abdominal pain or with obstruction. CT diagnoses the intussusception, and often demonstrates the lead point.
With new multi-slice CT and multi-planar imaging, the high quality diagnostic
information gained can help guide management planned. We present several
cases of adult intussusception imaged mainly on a 32 slice CT scanner.
Conclusion: Intussusception in adults is often benign and non-obstructing, and
may not require surgery. Multi-slice CT can give valuable information on the site
and cause of the intussusception, and on the presence or absence of obstruction
associated with it. This information can be invaluable in formulating a management plan.
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Adult celiac disease: Is there a role for MRI?
P. Paolantonio1, F. Iafrate 1, M. Rengo2, M. Anzidei2, R. Ferrari1, E. Tomei2,
A. Laghi1; 1Latina/IT, 2Rome/IT (paolantoniopasquale@hotmail.com)
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Purpose: The aim of our study was to evaluate the role of MR imaging in detection of findings of adult patients with suspected celiac disease.
Methods and Materials: The abdominal MR findings of 45 patients (22 men, 23
women - mean age: 41.3 years) with suspected celiac disease underwent MR
studies were using coronal T2-weighted HASTE and True-FISP sequence in after oral PEG administration.
Results: Final diagnosis was of celiac disease in 31 cases; Crohn's disease in
two patients, one patient was affected by intestinal parasitosis; eleven patients
served as control study group. Images analysis showed alterations of mucosal
pattern of ileal loops with an increased number of folds (5 or more folds per inch)
("ileal jejunalization") in 18 patients; reversal jejuno-ileal fold pattern in 6 patients;
intestinal intussusception was observed in two patients and hyposplenism in one
patient. MR was also able to identify mesenteric lymphadenopaty. No alteration
of small bowel loops was observed in five patients with celiac disease. Crohn
disease and intestinal parasitosis were correctly identified by MR imaging. MR
imaging was negative in subjects of the control study group. Sensitivity and specificity of MR imaging for celiac disease was respectively of 83% and 100%.

Conclusion: PEG-MRI is a feasible and reproducible imaging technique in both
adult and paediatric populations; it may suggest a diagnosis of celiac disease as
well as it is able to identify potential intestinal complications together with extraintestinal findings.
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Usefulness of three dimensional CT enterography with Gastrografin by 16
channel MDCT for the evaluation of small bowel obstruction
M. Hirata, T. Tsuda, T. Kajiwara, S. Kumano, H. Tanaka, T. Mochizuki; Toon/JP
(masaaki@m.ehime-u.ac.jp)
Learning Objectives: To demonstrate the usefulness of three dimensional CT
enterography (3D CT-E) in patients with small bowel obstruction (SBO) using
submillimeter isotropic voxels by multi-detector row CT (MDCT).
Background: Accurate determination of the site, level, and cause of SBO is necessary for treatment planning. Many studies have shown the usefulness of CT in
the diagnosis of patients with SBO. However, the interpretation of axial images
alone is frequently difficult not only for surgeons but also for radiologists. Meanwhile, recent development of MDCT allows us to acquire submillimeter isotropic
voxel data of entire abdomen, which can provide very precise 3D CT-E, such as
multiplanar reformatted (MPR) images and volume rendering (VR) images.
Procedure Details: Patients with suspected SBO were administered 100 mL of
Gastrografin orally or via nasogastric tube. 1-2 hours later, unenhanced CT scan
was performed with the slice thickness of 0.625 mm by a 16 channel MDCT. MPR
images and VR images were reconstructed by an imaging workstation. In this
exhibit, we used Gastrografin as a positive contrast medium to create 3D CT-E.
Nine of ten cases, adequate small bowel distention was obtained because of
hypertonic Gastrografin which would cause water secretion from small intestine.
The sites and causes of obstruction were clearly depicted by 3D CT-E. Most of
the patients could take 100 mL Gastrografin easily. No complication except diarrhea was found in this study.
Conclusion: 3D CT-E with Gastrografin is useful to reveal the details of SBO and
is helpful for treatment planning.
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Multidetector CT of small bowel tumours
P. Rajiah, A.N. Khan; Manchester/UK (rprabhakar73@yahoo.com)
Learning Objectives: 1. To illustrate the spectrum of common and uncommon
tumours involving the duodenum, jejunum, ileum and ileocaecal junction. 2. To
evaluate the efficacy of multidetector CT in the diagnosis of these tumours and
comparing it to ultrasound, barium and MR imaging. 3. To understand the imaging features and differential diagnosis with histopathologic correlation.
Background: The incidence of small and large bowel tumours is progressively
increasing, which might reflect lifestyle and dietary choices. Common tumours
include carcinoid, adenocarcinoma, lymphoma and metastasis.
Imaging Findings: The pictorial review aims to review the imaging spectrum of
common and uncommon tumours involving duodenum, jejunum, ileum and large
bowel. The tumours involved in our study included benign (leiomyoma, lipoma,
polyps, hemangioma, lymphangioma, fibroma, adenoma) and malignant (adenocarcinoma, lymphoma, leiomyoscarcoma, gastrointestinal stromal cell tumour,
carcinoids, metastasis and invasion of adjacent tumours) lesions. The characteristic findings of each tumours are demonstrated with direct histopathological correlation. Emphasis is placed on multidetector CT and MR imaging. Barium,
ultrasound and angiographic appearances are also described. The techniques,
pitfalls and differential diagnosis are discussed. A synopsis of characteristic imaging appearances and a diagnostic algorithm for approaching bowel tumours
are provided.
Conclusion: Imaging is vital in diagnosis and follow-up of small bowel tumours.
Multidetector CT is the most useful imaging procedure.
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40-slice computed tomography enteroclysis after oral hyperhydration with
isotonic solution in comparison with ileocolonoscopy in patients with
Crohn's disease
M. Galia, M. Midiri, G. Lo Re, T. Bartolotta, I. Spoto, G. Runza, I. Cannella,
R. Lagalla; Palermo/IT (mgalia@yahoo.com)
Purpose: To compare the accuracy of 40-slice computed tomography (MSCT)
enteroclysis after oral hyperhydration with isotonic solution to that of endoscopy
in detecting bowel wall alterations of the terminal or neoterminal ileum in Crohn's
disease (CD) patients.
Methods and Materials: A total of 28 patients (15 female; 13 male; mean age
38) referred for CD by ileocolonoscopy and histology were enrolled; 6 patients
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with negative ileocolonoscopy (3 female; 3 male; mean age 35) served as controls. In all cases the MSCT examination was performed after oral administration
of 2000 mL polyethylene glycol electrolyte balanced solution; before the scan, Nbutyl-scopolamine was administered intravenously. All MSCT scans were acquired
at baseline and 50 seconds after the intravenous administration of 110-130 ml
non-ionic iodinated contrast medium. Axial and isotropic multiplanar reconstructions (MPR) were visualized on a dedicated workstation to evaluate; fold distribution, wall thickening, and contrast enhancement, extraparietal involvement and
abnormalities of the abdominal organs.
Results: MSCT enteroclysis detected CD in 26 patients (92.8%) in which it allowed to recognize wall thickening and postcontrast wall high density, which in
fact significantly correlated with the severity of CD. The overall sensitivity and
specificity of CT enteroclysis for ileal CD detection were 92.8% and 100%, respectively (PPV=100%; NPV=75%).
Conclusion: MSCT enteroclysis after oral hyperhydration with isosmotic solution well detected terminal ileal CD involvement. It can be considered a safe and
effective alternative to conventional radiographic studies and to small bowel spiral CT enema in patients that refuse the nasojejunal balloon catheter or the administration of methylcellulose.
C-376
Direct comparison of 1.5 T MR and 16-MDCT enteroclysis in Crohn's
disease evaluation
R. Fiori, M. Sperandio, M. Di Roma, A. Marinetti, F. Laviani, M. Carlani,
G. Simonetti; Rome/IT (mauro.dr@tiscali.it)
Purpose: To directly compare MDCT and MR enteroclysis in the visualization of
small bowel and the detection of intestinal and extra-intestinal pathological findings in Patients with Crohn's disease.
Methods and Materials: 33 Patients with suspected or diagnosed Crohn's disease underwent 1.5 T and 16-MDCT after injection of an iso-osmotic solution
through 8 French nasoduodenal catheter and i.v. injection of scopolaminbutylbromide. After thin slice CT scan before and after double-bolus iodinate contrast
media i.v. injection, MR acquisition were performed, including axial and coronal
T1 TFE, T2 HASTE and SSFP sequences, followed by volumetric T1 fat-suppressed dynamic FFE sequence before and after Gd-DTPA i.v. injection. Raw
data set were elaborated in a dedicated work-station with MPR and MIP algorithms to demonstrate pathological findings.
Results: Image quality, anatomic details and distension degree comparison was
performed by two blinded radiologists and showed statistically significant differences. Two other radiologists independently evaluated the images to detect the
presence of 9 pathological sign. Our series demonstrates significantly higher
accuracy in wall thickness, stenosis, wall enhancement and dilated mesenteric
vessels detection for 16-MDCT; but significant higher accuracy in detection and
characterization of intraperitoneal fluid and fistulas for MR imaging.
Conclusion: MR imaging and 16-MDCT enteroclysis are two techniques with
high specificity and sensitivity value in evaluation of Crohn's disease. Although in
our series MDCT showed better results, we believe that MR imaging can be very
useful in the follow-up of young patients avoiding ionizing radiation exposure.
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An atlas of enteroclysis technique and image findings
F. Sendra, G. Diaz-Cordoba, J. Lpez-Hidalgo; Malaga/ES (sendra@uma.es)
Learning Objectives: To describe the technique of enteroclysis, including some
procedural tricks. To illustrate the different imaging findings of enteroclysis organized by diseases and symptoms.
Background: Enteroclysis is one of the reference methods to detect morphological intraluminal alterations of the small bowel. Compared to per oral barium small
bowel examination enteroclysis allows optimal filling of intestinal loops with higher sensitivity and specificity. CT and MR-enteroclysis have been developed recently to evaluate the small bowel, but enteroclysis remains a useful technique.
Procedure Details: Enteroclysis is performed introducing barium through a nasojejunal tube. The introduction of this tube takes an important part of the whole
procedure time, larger or shorter depending on the gastroduodenal anatomy and
the collaboration of the patient. A continuous infusion of methylcellulose produces lumen distension and helps the passage of the barium through the small intestine. A set of images has been selected from 940 enteroclysis performed in
the section of gastrointestinal radiology of our institution since 2001. Imaging
findings are classified according to diseases (inflammatory -including extensively Crohn subtypes, tumours, or injuries like radiation therapy or surgical complications), and according to symptoms (bleeding, occlusion or subocclusion,
diarrhoea, etc).
Conclusion: Enteroclysis is a useful and efficient method to study small bowel

pathology allowing distinguishing with relative ease some diseases with a characteristic radiological pattern. This atlas exhibits in a detailed and practical way
the basic radiological patterns of those diseases and summarizes their image
findings providing a didactic aid to daily practise.
C-378
Crohn's disease activity: Evaluation with MR time-signal intensity curves
S. Giusti, P. Giusti, L. Marchetti, C. Bartolozzi; Pisa/IT (s.giusti@med.unipi.it)
Purpose: To evaluate the feasibility of MR time signal-intensity curves to differentiate active from chronic Crohn's disease activity.
Methods and Materials: All patients included in our series (22) had diagnosis of
Crohn's disease. Each patient was investigated in a prone position with phasedarray surface coil. Our protocol employed trueFISP, HASTE and Gd-enhanced
3D FLASH fat sat sequences acquired 70-80 seconds after intravenous administration of paramagnetic contrast agent in the axial and coronal plane. Small bowel was previously distended by the administration of PEG (2 l) and drug induced
hypotony. 3D FLASH images were subsequently transferred to a workstation to
analyse typical patterns of Crohn's disease and detect inflamed areas. Regions
of interest were then positioned in most contrast enhancing and thickened tracts
of the bowel. Time-signal intensity curves were obtained in 18/22 cases.
Results: 13/18 patients with active disease showed a rapid initial and a sustained late enhancement, whereas 5/18 patients with non-active disease revealed
a rapid wash-in and a rapid wash-out of the tract evaluated.
Conclusion: Our study suggests that time-signal intensity curves, performed after 3D FLASH sequences, are able to show vascular enhancement and then to
discriminate the active phase from the one non-active of Crohn's disease.
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Collateral findings at 40-slices computed tomography enteroclysis
M. Galia, G. Lo Re, G. Runza, I. Spoto, T. Bartolotta, A. Taibbi, M. Midiri;
Palermo/IT (mgalia@yahoo.com)
Purpose: The aims of this study were to prospectively determine the prevalence
of extra-intestinal findings in patients undergoing 40-slice computed tomography
(MSCT) enteroclysis, as well as to determine the clinical significance and consequences of these findings.
Methods and Materials: From April to August 2005, 58 patients (34 female, 24
male; mean age 55.3 3.4 years) underwent MSCT enteroclysis for different intestinal pathological conditions: Crohn's disease of the small bowel (42 cases),
neoplastic lesion of the colon (5 cases), granulomatous colitis (3 cases), and
malabsorption (8 cases). Filling of the bowel was achieved by means of jejunal
tube (28 patients), via the oral route (22 patients) or via the rectum (8 patients);
before the scan, N-butyl-scopolamine was administered intravenously. All MSCT
scans were acquired at baseline and 50 seconds after the intravenous administration of 130 ml non-ionic iodinated contrast medium. Extra-intestinal findings
were classified as having high, moderate, or low clinical significance.
Results: 47 extra-intestinal findings were detected in 23 patients (39.6%). Of
these 5 (10.6%) were highly significant, 14 (29.7%) moderately significant and
23 (48.9%) of low significance. The highly significant findings were: 1 primary
intrahepatic cholangiocarcinoma, 2 pancreatic cystic tumors, 2 lower lung solitary nodules. All 5 highly significant findings were new findings, leading to additional diagnostic or therapeutic work-up. None of the patients with moderate or
low significant lesions underwent further testing.
Conclusion: MSCT enteroclysis can detect highly significant extra-intestinal findings.
C-380
Spectrum of findings of intestinal non-neoplastic disorders at MRI of the
small bowel with emphasis on Crohn's disease
P. Paolantonio 1, M. Anzidei2, M. Rengo2, F. Iafrate1, F. Vecchietti1,
S. Cucchiara2, A. Laghi1; 1Latina/IT, 2Rome/IT
(paolantoniopasquale@hotmail.com)
C-381
MR imaging of the small intestine in paediatric patients: An overview of
technical features and clinical results
P. Paolantonio1, M. Anzidei2, M. Rengo2, F. Iafrate1, S. Cucchiara2, A. Laghi1;
1
Latina/IT, 2Rome/IT (paolantoniopasquale@hotmail.com)
Learning Objectives: To illustrate major clinical indications for MR imaging study
of the bowel in paediatric patients. To show an overview of some technical issues
of MR imaging of the small bowel with emphasis on bowel distension. To outline
the advantages and limitations of the technique and to illustrate clinical results
based on a series of 215 paediatric patients.
Background: In this exhibit we will describe the MR imaging of the small bowel
performed with a biphasic oral contrast agent with the most suitable indications,
the results, the advantages and the limits of this technique in a paediatric population. 215 paediatric patients with clinical suspicious of small bowel disorders
underwent MR study of the small bowel. The major clinical indication are represented from the work-up of children with suspected IBD. Other clinical indication
are mainly represented by the work-up of patients with Celiac disease or other
intestinal malabsorption.
MR findings of several small bowel disorders with emphasis on Crohn's disease
and Celiac disease will be presented.
Procedure Details: Small bowel distension was obtained by means of oral administration of 10 ml/kg/BW of PEG solution immediately before the examination.
MR examinations were performed using T2W HASTE, True-FISP and T1W FLASH
sequences acquired after iv injection of Gd-DTPA on both axial and coronal planes.
Conclusion: MR studies of the small bowel represent a feasible and valid diagnostic tool for the small intestine evaluation also on a paediatric population.
C-382
VoLumen-enhanced multiplanar isotropic multidetector-row CT
enterography: Technique and clinical applications
F. Vandenbroucke1, M.-R. Oliva2, V. Cantisani3, J. de Mey1, K.J. Mortele2;
1
Brussels/BE, 2Boston, MA/US, 3Rome/IT (spovef@az.vub.ac.be)
Learning Objectives: 1. To describe the optimal technique to perform VoLumenenhanced multiplanar MDCT-enterography. 2. To review the key VoLumen-enhanced MDCT-enterography features of a vast array of small bowel diseases.
Background: Traditionally, the small bowel is studied by fluoroscopic SBFT and
enteroclysis. Oral administration of 0.1% barium sulfate suspension (VoLumen,
E-Z-EM, Westbury, NY), a novel oral contrast agent, increases the osmolarity of
luminal content, and therefore, overcomes absorption and increases bowel distention. Furthermore, when using IV contrast material, this neutral oral contrast
agent facilitates evaluation of abnormal mucosal enhancement and wall thickening.
Procedure Details: Sixty patients with known/suspected small bowel disease
underwent 16-64 channels abdominal MDCT-enterography after oral administration of 1350 cc of VoLumen; all patients ingested 450 ml every 15 minutes. Contrast-enhanced biphasic MDCT images (detector configuration 64X0.625 mm and
16x0.7 mm) were acquired at 40 and 70 s (enteric and parenchymal phase) after
IV administration of 100 ml of non-ionic iodinated contrast material. Axial images
were reconstructed every 3 mm. In every patient, multiplanar (coronal and sagittal) reconstructions were obtained with a reconstruction slice thickness of 3 mm.
Conclusion: MDCT-enterography identifies and depicts clinically significant findings in patients with suspected/established small bowel disease, such as Crohn's
disease, tumors, obstruction, acute ischemia, and other uncommon pathologies.
It is a fast, non-invasive procedure, which provides adequate small bowel distension and small bowel wall demarcation. The combination of high-resolution axial
contrast-enhanced MDCT images with detailed coronal and sagittal reformatations is very promising for accurate evaluation of the small bowel.
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Learning Objectives: To describe findings of several intestinal disorders at MR

imaging of the small bowel with emphasis on Crohn disease. To describe pitfall of
MR of the small bowel miming intestinal disorders.
Background: Moving from the conventional barium studies of the small bowel to
the MR of the small bowel radiologists are called to shift their attention from the
evaluation of mucosal abnormalities and indirect signs of visceral wall pathology
to the direct visualization of the small bowel wall. Using MR of the small bowel the
major findings are represented by changes of small bowel thickness or enhancement pattern of the intestinal wall. Nevertheless, some evaluation on intestinal
mucosal layer are also possible using MR imaging.
Procedure Details: In the past 4 years we analyzed over than 200 patients,
including both pediatric and adult patients. All the MR examination were performed acquiring HASTE and True-FISP sequence and Gd-DTPA-enhancedFLASH T1W sequence after that intestinal distension was obtained by means of
oral administration of a fixed amount of 10 ml/kg of body weight of PEG solution
20 minutes before the MR examination.
We show the typical MR findings of Crohn's disease and Coeliac disease and
also several findings of intestinal infectious like giardia intestinalis, taenia solium
and tuberculosis. Some cases of congenital abnormalities like intestinal malrotation and small bowel involvement drug vasculitis are also described.
Conclusion: PEG-MRI is a valid diagnostic tool in the identification of several
intestinal findings and may help in the diagnostic process of several intestinal
disorders.

GI Tract
Stomach
C-383
Efficacy of three-dimensional, 64 slice multidetector row CT for
preoperative evaluation of gastric cancer
D. Yang, J. Kang, H. Kim, H. Kim; Incheon/KR (dmyang@gilhospital.com)
Purpose: To assess the accuracy of three-dimensional, 64 slice multidetector
low CT (MDCT) in the diagnosis and staging of gastric cancer.
Methods and Materials: Forty four patients (34 male, 10 female; mean age, 57
years) with gastric carcinoma underwent preoperative 64 slice MDCT (slice collimation, 0.6 mm; slice width, 5 mm; feed/rotation, 23 mm; pitch factor, 1.2; and
gantry speed, 0.5 second per rotation). Gastric distension was achieved by ingestion of 8 g of effervescent granules. Scanning was performed during arterial
and portal phases as determined with bolus tracking and automated triggering
technique after intravenous administration of 100 ml of contrast materials (4 ml/
sec). All CT scans were retrospectively reviewed by two radiologists. Each tumor
was staged according to the TNM classification system. All patients underwent
surgery. Results of CT were compared with histologic staging of tumor invasion
depth and regional lymph node metastasis.
Results: The accuracy of MDCT for detection of gastric cancer was 90% (18/20)
and 100% (24/24) in early and advanced gastric cancer, respectively, with overall
detection rate of 95% (42/44). The accuracy of MDCT for determination of depth
of tumor penetration was 80% (16/20) and 88% (21/24) in early and advanced
gastric cancer, respectively, with overall accuracy of 84% (37/44). The accuracy
of MDCT for determination of lymph node metastasis was 90% (18/20) and 71%
(17/24) in early and advanced gastric cancer, respectively, with overall accuracy
of 80% (35/44).
Conclusion: The three-dimensional, MDCT is a promising technique for detection and preoperative staging of gastric cancer.
C-384
Normal anatomy and major complications of Roux-en-Y gastric bypass for
morbid obesity treatment: Imaging findings
M. Andrs Martnez, J. Roldn Ramos, R. Carrera Terrn, M. Prez Nez,
F. de la Cruz Vigo; Madrid/ES (ambar_mir@hotmail.com)
Learning Objectives: To describe normal anatomy of Roux-en-Y gastric bypass
(GBP) surgery. To know the spectrum of major complications, the time of appearance and imaging findings.
Background: Obesity is a chronic disease with an increasing prevalence. Rouxen-Y GBP surgery nowadays represents a successful treatment of morbid obesity. From January 1999 to June 2005, 148 patients with Roux-en-Y GBP surgery
have been reviewed. 24-72 hours after surgery, routine upper GI series were
used in all of them before discharge. The radiographic manifestations of normal
anatomy and follow-up major complications which are those that require surgical
or radiologic intervention, are illustrated in this exhibit. We compare the CT and
other imaging findings with clinical and surgical findings.
Imaging Findings: A total of 14 follow -up major complications occurred in 9 of
148 patients. Only 3 were early complications, the other 11 were late complications and appeared between 1month and 4 years, most of them approximately 1
year after surgery. Imaging findings of anastomotic strictures, stomal stenosis,
gastric staple line dehiscence, fistulas, jejunal and gastric wall necrosis, small
bowel obstruction due to adhesions, loculated fluid collection and celiac trunk
stenosis are illustrated.
Conclusion: It is important for the radiologist to be familiarized with the radiographic manifestations of normal anatomy and major complications after Rouxen-Y GBP. These may be life threatening and usually appear as late complications.
An adequate imaging technique and a prompt evaluation by the radiologist can
help to minimize them.
C-385
The role of 16-channel multidetector-row CT for evaluating early gastric
cancer: Comparison with EUS and histopathologic findings
S. Kumano, T. Tsuda, H. Tanaka, M. Hirata, T. Kajiwara, H. Miki, T. Mochizuki;
Toon/JP (kumano@m.ehime-u.ac.jp)
Purpose: The purpose of this study was to assess the role of 16-channel MDCT
for evaluating early gastric cancer (EGC) by comparison with EUS and histopathological findings.
Methods and Materials: Thirty-five patients with a diagnosis of EGC were enrolled in this study. All patients were preoperatively evaluated with MDCT and
404
EUS within one week. CT examination was performed using a 16-channel MDCT.
Based on the volumetric data obtained by MDCT, multi-planar reformatted images were reconstructed on the workstation. The CT images were evaluated for
depiction, enhancement, and T-staging of the tumors. The results were compared
with EUS findings and pathological analysis after the surgery.
Results: Pathologically, EGCs were classified as M cancer in 21 patients, SM
cancer in 14. On MDCT, 34 of 35 EGCs were correctly staged as T1. The only 2/
21 (10%) M cancers were depicted as focal enhanced lesions, while 9/14 (64%)
SM cancers were depicted. Of the 11 (2 M + 9 SM) depicted cancers, all were
histologically differentiated adenocarcinomas. The 5/14 SM cancers were not
depicted, four of 5 were histologically undiffentiated adnocarcinomas. On the other
hand, on EUS, all cases were correctly staged as T1. The 15/21 M cancers were
correctly diagnosed, while the 6/21 M cancers were overdiagnosed as SM cancer. The 12/14 SM cancers were correctly diagnosed, two cases were underdiagnosed as M cancer.
Conclusion: MDCT may be used for the diagnosis of EGC, differentiating M cancer from SM cancer, which may assist making decision of the therapeutic strategy.
C-386
CT differentiation of benign and malignant ulcers of the stomach
D. Yeh, S. Kim, I. Seo, J. Lee, Y. Jeong, G. Kim, D. Park; Busan/KR
Purpose: Benign ulcer has necrotic fibroid debris in the ulcer crater. In contrast,
malignant one has cancerous crater. Considering this, we evaluate to determine
the CT criteria for differentiating benign from malignant ulcer.
Methods and Materials: 18 clinicopathologically proven benign ulcers that had
been detected by both endoscopy and CT were enrolled in this study. As controls, 26 ulcerative advanced gastric cancers and 26 early gastric cancers with
ulceration, which had been surgically proven, were selected by random sampling
in the pathological database. CT images were assessed by two radiologists and
they reached a consensus about the imaging findings (ulcer size, degree of gastric wall thickening, degree of enhancement of ulcer base, presence of discernible thick-walled ulcer base, transmural enhancement, extension of the ulcer into
or beyond the body of the stomach, perigastric fat infiltration, and perigastric
lymphadenopathy). Statistical analyses were performed with Fisher exact test
followed by Bonferroni's correlation for multiple comparisons.
Results: Indiscernible thin-walled ulcer base (< 1.5 mm) (100% specificity, 89%
sensitivity), suboptimal enhancement of ulcer base (97.9% specificity, 72.2%
sensitivity) and extension of the ulcer into or beyond the body of the stomach
were significantly useful in benign ulcer. The finding of discernible thick-walled
ulcer base (> 2 mm), mild to intense contrast enhancement of ulcer base and
transmural enhancement is highly specific for malignant ulcer. Perigastric infiltration and lymphadenopathy were not significant for differentiation.
Conclusion: Indiscernible thin-walled inner layer with suboptimal enhancement
in ulcer base could be sensitive and specific for diagnosing benign gastric ulcer.
C-387
Gastroduodenal perforation: Role of MDCT
J. Cazejust, B. Castaglioli, B. Bessoud, A.-S. Rangheard, L. Rocher, Y. Menu;
Le Kremlin-Bictre/FR (yves.menu@bct.ap-hop-paris.fr)
Purpose: Early detection of gastro duodenal perforation and identification of the
perforation site may be critical for patient management. The question was to know
if MDCT was able to fulfil these requirements.
Methods and Materials: Over 18 months, 75 consecutive abdominal hollow viscus perforations were recorded in the HIS of a single institution. 20 were gastroduodenal. 5 were treated on the basis of plain film and clinical background. 15
were examined with 16-rows MDCT. Gastroduodenal perforation was strongly
suspected in 5, while 10 patients had atypical symptoms (N=2) or presented with
peritonitis without any aetiological orientation (N=8). MDCT Protocol was: IV iodine 2 ml/kg, 1 mm collimation, Reconstructions were (thickness/interval in mm)
5/5 and 1/0.8. Interpretation was done prospectively by the on-call radiologist at
a workstation. The same radiologist had seen the plain films when performed
previously (N=9). No attempt was made to review the images retrospectively.
MDCT reports were compared to surgery or delayed endoscopy (conservative
management)
Results: MDCT identified pneumoperitoneum in 15/15 as compared with 3/9 for
plain films, including 2 large amount of free peritoneal air on CT, not seen on
plain films. Intraperitoneal fluid was seen in 10/15, peritoneal fat densification in
11/15, wall abnormalities in 8/15. Perforation site was seen in 8/15, of whom two
were seen only on MPR.
Conclusion: MDCT improves detection rate of pneumoperitoneum, and provides
critical data for localization of perforation, due to direct and indirect signs. Multiplanar images seem to improve radiologists' confidence.

C-388
GI Tract
Missed recurrent tumor of the gastric cancer after curative surgery:

Retrospective review of serial CT images
H.-J. Lee, M.-J. Kim, J. Lim, K. Kim; Seoul/KR (iamotwo@yumc.yonsei.ac.kr)
Miscellaneous
Learning Objectives: 1. Enumerate the various recurrent patterns after curatively intended surgery of gastric cancer. 2. Identification of the causes of missed
diagnosis of the early recurrence.
Background: The complete resection of a gastric tumor and adjacent lymph
nodes, is considered the only proven, effective curative treatment modality in
patients with gastric cancer. However, local or systemic recurrent lesions can
develop in various locations of the abdomen and pelvis through several routes.
Early detection of recurrence is important for treatment planning.
Procedure Details: CT is the primary tool of investigation of suspected recurrence. Between January 2002 and December 2004, in our hospital, 67 patients
have shown tumor recurrence after curative surgery. We reviewed serial follow-up
CT images of the patients, and found that 18 patients of them also showed subtle
evidence of early recurrence at the prior CT examinations.
Conclusion: In this exhibit, patterns of local recurrences and distant metastases
will be reviewed and illustrated. The causes of missed lesions will be also discussed.
PET-CT imaging in abdominal oncology

E. Fernandez Canabal, C. Sanchez Almaraz, M. Parron, F. Baudraxler,
L. Martin Curto, N. Gomez Leon; Madrid/ES
(evafernandezcanabal@wanadoo.es)
C-389
Learning Objectives: To illustrate our experience in the evaluation of abdominal

neoplasms with the hybrid technique PET-CT (positron emission tomographycomputerized tomography). To show pitfalls, diagnostic difficulties and differential diagnoses.
Background: Neoplastic disorders affecting the abdominal area are a significant
cause of morbidity and mortality, frequently requiring multiple imaging modalities
to diagnose and plan treatment. In the last decades CT has become an important
diagnostic tool for the management of abdominal neoplasms. Nevertheless, it
has limitations that might be overcome by the use of the hybrid technique PETCT.
Procedure Details: We retrospectively reviewed approximately 2700 PET-CT
studies performed in our hospital in the last two years. 18% of the studies corresponded to patients diagnosed with neoplasms of colon and rectum; 2.9% neoplasms of oesophagus and stomach and less than 1% neoplasms of pancreas,
ovary, testicle and liver. PET-CT images were obtained following a standardised
protocol. Initially a PET and a nonenhanced low-dose CT scans were performed.
Then, a contrast-enhanced whole-body scan (GE Discovery LS) was performed
an hour after intravenous injection of 300 MBq of 18 fluorodeoxyglucose (FDG).
None of the patients had undergone a previous CT study. The key imaging findings are shown and compared with the underlying pathological features when
available. Pitfalls and diagnostic difficulties are emphasized.
Conclusion: PET-CT is a new imaging modality that improves the evaluation of
patients with abdominal neoplasms. This exhibit will help the reader to better
understand the imaging findings and applications of PET-CT in the management
of these patients.
C-390
64-MDCT and low Hounsfield value barium suspension (LHVBS) as an oral
contrast agent: What a great view of mesenteric vessels, small bowel and
upper GI organs!
F. Iafrate1, P. Paolantonio1, M. Rengo 2, R. Ferrari1, M. Anzidei2, A. Laghi1;
1
Latina/IT, 2Rome/IT (francoiafrate@tin.it)
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Learning Objectives: 64-rows MDCT technology allows a faster scanning with

submillimeter collimation. The use of low Hounsfield value barium suspension
maximize MDCT technology enhancing bowel wall and lumen visualization and
providing optimal luminal distention of hollow abdominal organs helping moreover the depiction of mesenteric vessels.
Background: Advent of 64 MDCT scanners has been renewed interest in assessing the small bowel with CT. These studies, often referred as CT enterography (CTE), bring new challenges to oral contrast administration.
Procedure Details: 64-rows MDCT technology allows a faster scanning with
submillimeter collimation. Using a double-headed power injector, a bolus of iodine contrast medium followed by saline flush solution is rapidly injected iv. These
improvements in terms of spatial resolution and temporal resolution are expected to produce high quality images of all abdominal organs and splanchnic vessels. The use of LHVBS maximize MDCT technology enhancing small and large
bowel, gastric and duodenum visualization and allowing a clear differentiation
between vasculature and the GI tract. In this exhibit we will show the diagnostic
capability of 64-rows CT (LightSpeed VCT, GE) and LHVBS (VoLumen -EZEM)
in depicting normal anatomy and variants of splanchnic vessels and spectrum of
findings of neoplastic and inflammatory abdominal diseases.
Conclusion: 64 MDCT enterography with low Hounsfield value barium suspension as contrast to stomach, duodenum and small bowel is a simple, rapid, noninvasive and effective method of evaluating upper GI tract diseases and splanchnic
vessel anatomy.

C-391
Gastrointestinal tract lymphoma: A journey from "top to tail"
J. Maclachlan, A. Gough-Palmer, R. Bryan, S. Howling, J. Kumaradevan,
D. Murray; London/UK (jodymaclachlan@hotmail.com)
Learning Objectives: 1. To appreciate the various imaging appearances of gastrointestinal tract lymphoma. 2. To differentiate gastrointestinal tract lymphoma
from other pathologies.
Background: In forty percent of cases lymphoma arises at extra-nodal sites, of
which gastrointestinal tract involvement is the most common. Gastrointestinal
tract lymphoma may mimic, both clinically and radiologically, many other pathologies. It is important to recognise gastrointestinal tract lymphoma in order to
facilitate prompt staging and treatment.
Imaging Findings: We describe the key features of lymphoma involving each
part of the gastrointestinal tract from top (oropharynx) to tail (rectum) with CT
illustrations for each. Differentiation from other pathologies, both malignant and
benign, is emphasised.
Conclusion: Familiarity with the various radiological appearances of GI tract lymphoma is essential.
C-392
Dynamic magnetic resonance imaging in female patients with pelvic floor
weakness disorders
A. Salzano, G. Cavallo, G. Balsamo, E. Rossi, P. De Feo, G. Pagano,
A. Nunziata, V. Nocera; Naples/IT (tonikus@libero.it)
Learning Objectives: To illustrate the characteristics of dynamic magnetic resonance imaging (MRI) and its ability to study pelvic floor weakness disorders in
order to evaluate the perineum dynamics, the activity of the bladder and levator
ani muscle during evacuation phases.
Background: In our experience 24 females (mean age of 57 years, ranged of 4877 years) with anorectal disturbances combined with urinary incontinence symptoms were investigated with dynamic MR imaging. All patients underwent
uro-proctological evaluation, colonoscopy, defecography; 14 patients had anorectal
manometry. MR imaging was carried out in different functional manoeuvres; at
rest, under squeezing and during evacuation, permitting to catch quickly by T2weighted scans the dynamic excursions of perineum.
Imaging Findings: Dynamic MR imaging showed exactly the entity of perineal
descent in all cases; besides, 17 cases of rectoceles, 15 cases of urinary incontinence, 12 cases of cistoceles, and 6 cases of fecal incontinence combined to
perineal descent syndromes were diagnosed.
In all patients the descent of pelvic floor appeared as a distance > 4 cm below
the bone ischial tuberosities. In 15 cases of combined incontinence the thickness
of levator ani muscle was reduced.
Conclusion: Dynamic MR imaging of pelvic floor can be actually considered a
complementary method to the defecography and other investigations for the management of patients suffering from defecation, urinary and perineal disturbances.
It provides an accurate measure of perineal descent in these subjects, adding
further information of anatomy and function of levator ani muscle and anorectal
area, giving to the clinician useful parameters for the choice of treatment.
C-393
MRI of the ischiorectal fossa: Spectrum of disease
C. Hoeffel, M.D. Crema, P. Forns, M.D. Marra, L. Arriv, J.-M. Tubiana;
Paris/FR (michelcrema@hotmail.com)
Learning Objectives: To review the MR imaging features of diseases involving
the ischiorectal fossa. To review the current role of MR imaging in the evaluation
of the ischiorectal fossa.
Background: Pelvic MR imaging studies are widely used to assess the rectum,
the anal canal and their environment. The ischiorectal fossa or ischioanal space
is an anatomical space that has received little attention lately in the radiological
literature. However, a wide spectrum of diseases are likely to develop in this area,
due to its contents, to its pathways with surrounding spaces, to the proximity of
the anal canal and genitourinary structures. Important landmarks of this fossa
include the levator ani muscle that separates the ischiorectal fossa from the supralevator space of the pelvis, as well as the muscles limiting the anal canal (levator ani muscle and external anal sphincter) that represent its medial boundaries.
We reviewed the patients with ischiorectal fossa disease examined at our institution with external phased-array high resolution 1.5 T pelvic MR.
Imaging Findings: We illustrate the MR imaging features of the disease processes developing in this space including congenital and developmental lesions
(mainly tailgut cysts; cavernous hemangioma) inflammatory and infectious con-
406
ditions; primary tumors (aggressive angiomyxoma, soft-tissue tumors); neighbouring pathologic processes with secondary involvement and miscellaneous. We
also discuss the current role of MR imaging.
Conclusion: MR imaging plays an essential role in the evaluation of some conditions typically located in this space as well as of other conditions that occasionally involve this area or invade the ischioanal space.
C-395
Prediction of the site of bowel obstruction using multislice CT
V. Maniatis, E. Vardaki, A. Roussakis, S. Lachanis, A. Papadopoulos,
J. Andreou; Athens/GR (vmaniatis@hotmail.com)
Purpose: To evaluate the contribution of coronal MPR CT images of predicting
the site of bowel obstruction.
Methods and Materials: Twenty one patients (9 men, 12 women, 28 -88 years
old) are included. They all had a preoperative multislice CT scan (Sensation 16,
Siemens, Germany) diagnostic for small or large bowel obstruction. Due to clinical condition and/or imaging findings, they were operated within 24 hours after
the CT scan. CT evaluation was focused on the prediction of the site of bowel
obstruction. Axial images as well as MPR coronal images were used on this
purpose. Their findings were compared with the surgical findings.
Results: Axial CT images correctly suggested the site of obstruction in 14 cases
while MPR images in 18 cases. The site of obstruction was proved to be in the
small bowel in 18 cases and in the large bowel in 3 cases. Causes of obstruction
proved to be neoplastic infiltration in 10 cases, adhesions in 8 cases, Crohn's
disease in 2 cases and abdominal wall hernia in 1 case. In 3 cases neither axial
nor MPR images were able to propose the site of obstruction.
Conclusion: In cases of small or large bowel obstruction CT is not always able to
predict the site of obstruction. MPR coronal images add to the prediction of the
site of obstruction and assist in surgical planning.
C-396
Abdominal wall hernias: Diagnosis with MDCT, radiological appearance of
prosthetic mesh used in abdominal wall hernia repair and postoperative
complications
J. Parra1, M. Matute1, J. Bueno1, M. Diez1, J. Rodriguez-Cabello1, M. Farias2;
1
Torrelavega/ES, 2Santander/ES (farinasc@unican.es)
Learning Objectives: To illustrate the usefulness of MDCT in the diagnosis of
abdominal wall hernias, to describe the US and CT appearance of the prosthetic
mesh used in abdominal wall hernia repair and to show related postoperative
complications.
Background: The diagnosis of abdominal wall hernia is based primarily on physical exploration. However, more often patients with clinical suspicion of hernia
are referred to the radiological department to confirm hernia and characterize the
size, specific location of the anatomical defect and the contents of the hernia sac.
MDCT at rest and more frequently during Valsalva manoeuvre is used increasingly to characterize and distinguish a hernia from its mimics. As well as in the
diagnosis, the radiologist must also become familiar with the appearance of the
prosthetic mesh used in ventral hernia repair as visualized by various diagnostic
techniques as well as the radiological findings of related postoperative complications.
Procedure Details: At our institution, we have collected a large series of cases
of abdominal wall hernias and related postoperative complications. Images included MDCT and US studies.
Conclusion: The purpose of our exhibit is to provide a pictorial essay and discussion about the usefulness of MDCT performing during Valsalva manoeuvre in
the diagnosis of abdominal wall hernia, as well as to show the radiological appearance of the three most frequent prosthetic mesh used in abdominal hernia
repair and to describe postoperative complications.

C-397
Spiral CT enteroclysis with neutral enteral and IV contrast enhancement in
haemorrhage detection
G. Tth, L. Tth, P. Magyar, E. Turupoli, E.K. Mak; Budapest/HU
(totgez@freemail.hu)
Learning Objective: To show the usefulness of CT enteroclysis in the diagnosis
and assessment of small bowel haemorrhage.
Background: CT enteroclysis gives the advantages of small bowel volume challange using neutral enteral contrast and IV contrast enhancement with the crosssectional and multiplanar capabilities of CT. This technique has proven to be useful
to evaluate bowel wall thickening, and partial small bowel obstruction, and pathological dilatation and identification of small tumors. Our goal was to localise the
focus of gastro-intestinal bleeding if gastroscopy and colonoscopy were negative. We show the typical imaging findings of our experience of CT enteroclysis.
We demonstrate some of our cases.
Procedure Details: From December 2003 to September 2005, 105 CT enteroclysis was performed to investigate unexplained anaemia or GI bleeding. Positive
findings were demonstrated in 32 of 105 patients. 1.4 to 1.8 litres of neutral enteral contrast (0.5% methylcellulose) was administered via a nasojejunal tube at a
rate of 120-140 ml/min. I.m. buscopan (20 mg) was given after infusion of 800 ml
methylcellulose. 120 ml i.v. contrast was infused at a rate of 3 ml/sec. Scans were
performed on a Somatom Plus 4 helical CT with 3 mm coll, 5 mm feed, and 2 mm
reconstruction. We studied normal appearances and pathological changes (wall
thickening, enhancement, stenosis and dilatations, and mesenteric reactions)
Conclusion: CT enteroclysis with neutral enteral and IV contrast is a useful technique to diagnose the cause of gastrointestinal bleeding in small bowel.
C-398
The contribution of abdominal CT in establishing the diagnosis of primary
and secondary aorto-enteric fistula
S. Mylona, A. Kokkinaki, S. Ntai, K. Papavlasopoulos, A. Pagonas, L. Thanos;
Athens/GR (sofimylona@yahoo.com)
Purpose: To assess the diagnostic value of CT in the study of primary and secondary aorto-enteric fistula (AEF) and demonstrate the commonest CT findings.
Methods and Materials: Over a 40-month period, 36 patients with suspected
aortoenteric fistula underwent an abdominal spiral CT (5 mm contiguous slices)
in our department. All patients presented with acute gastrointestinal (GI) bleeding (13/36 with hematemesis, 23/36 with hematochezia), 14/36 with a pulsatile
abdominal mass, 33/36 with abdominal pain and 19/36 reported episodes of minor recurrent self-limiting GI bleeding. Fourteen of them had a history of surgical
and nine of endovascular repair of an abdominal aortic aneurysm. None of them
received gastrografin prior to the examination in order to ensure better demonstration of a probable AEF.
Results: The finding encountered most commonly (36/36) was a mild inflammatory reaction obscuring the margins of the abdominal aorta. Extraluminal gas
was noticed in 16/36 cases, whereas direct visualization of the fistula was accomplished in 5/36 cases. Finally dilated bowel loops containing fluid of increased
density were noticed in 9/36 cases.
Conclusion: CT is a useful diagnostic modality in suspected AEF since it reveals
highly suggestive or pathognomonic findings and thus it renders these patients
subjects to urgent surgical investigation.
C-399
A guide to "hardware and software" on the plain abdominal radiograph
C. Cronin, D. Lohan, S. Walsh, C. Meehan, C. Roche; Galway/IE
my, cecostomy), vascular and gastrointestinal stents, embolization coils, IVC filters and hepato-biliary interventions (TIPPS Stents to double J stents and internal- external drains).
Conclusion: Through our institutional experience we will provide an interesting,
informative and concise guide of both common and uncommon, abdominal radiographic 'hardware and software' foreign materials. Thus, allowing confident radiological diagnosis on imaging grounds.
C-400
Clinically suspected abdominopelvic fistulae: Does an optimal means of
assessment exist?
D. Lohan, C. Cronin, S. Walsh, C. Meehan, C. Roche, P. McCarthy; Galway/IE
Learning Objectives: Considerable debate and variation exists regarding the
optimal method of detection and delineation of abdomino-pelvic fistulae. Undoubtedly, this variation in approach reflects the uncertainty which exists regarding the
benefits and shortcomings of various imaging modalities in the detection of these
intricate entities. We attempt to evaluate and clarify this situation.
Background: Abdomino-pelvic fistulae complication of abdomino-pelvic surgery,
radiotherapy, inflammatory bowel disorder, malignancy to name but a few. They
are usually indolent chronic, extremely difficult cases to treat and manage not to
mind diagnose. Sequelae include distressing discharges, abscess formation to
recurrent surgery.
Procedure Details: Through our experience, a literature review and discussion,
we explore the relative traits of various imaging modalities (barium enema/fistulography/CT/MRI) in the demonstration of abdomino-pelvic fistulae. Furthermore,
we suggest diagnostic algorithms, guided by clinically suspected sites of fistula
origin and termination, with the aim of delineation and demarcation of the fistula
to the satisfaction of the referring surgeon/physician. Finally, we suggest several
novel techniques such as dynamic micturating CT scanning for assessment of
colo-vesical fistula.
Conclusion: We endeavour to provide a thorough diagnostic and management
guide to the growing problem.
C-401
Carcinoid tumors: Spectrum of CT and MRI findings
M.D. Marra, C. Hoeffel, M.D. Crema, A. Oudjit, L. Arriv, J.-M. Tubiana;
Paris/FR (monica_dmarra@hotmail.com)
Learning Objectives: To review CT and MRI findings of primary and secondary
carcinoid tumors. To illustrate the different organs that may be affected by primary or secondary carcinoid tumors and the site-specific characteristics of the tumor.
Background: Carcinoids are tumors of the diffuse endocrine system. Nearly 90%
of carcinoid tumors are found in the gastrointestinal tract. They also occur in the
liver, lung, ovary (as part of a teratoma), and other organs. All carcinoids are
considered to have a potential for metastasis and are considered to be malignant. The radiologic appearance of carcinoids varies depending on their size and
location, and on their variable biological behavior. We reviewed CT and MRI findings of carcinoid tumors developing in a wide variety of organs in patients examined at our institution from January 2003 to August 2005.
Imaging Findings: Primary and secondary carcinoid tumors were found in the
gastrointestinal tract, lung, uterus, breast, pancreas, and other unusual sites. CT
and MRI findings were variable, reflecting the site-specific characteristics. We
discuss and illustrate CT and MRI features of these tumors, highlighting their
location specific characteristics as well as unusual locations of these tumors.
Conclusion: Carcinoid tumors can affect multiple organs. Familiarity with their
appearance on CT and MRI can be helpful for radiologists to avoid misdiagnosis.
GI T
Trract
Learning Objectives: To provide an educational and pictorial review of a diverse

range of hardware and software findings from clips to tips, encountered in abdominal radiograph reporting. To familiarize the radiologist with the radiographic
appearances of drains, stents, coils, clips and miscellaneous structures. To illustrate how the radiologist can decide if the hardware/software is correctly sited
and detect associated migrations/other complications.
Background: Radiologists have unique skills of observation and description. With
many recent advances in surgical and interventional radiologic techniques, comes
a multitude of novel stents, drains, coils and other complex devises. Consequently, it is essential for all radiologists to be familiar with their etiology, location, function, appearance and complications.
Imaging Findings: We illustrate each particular foreign material's radiological
features, its etiology, possible complications, with a pictorial example from our
department. Hardware including: various tubings (nasogastric, gastrojejenosto-
407

C-402
Abdominal emphysematous conditions: A pictorial essay
B. Nieto Baltar, Y. Martinez Alvarez, E. Huelga Zapico, A. Herrasti Gallego,
A. Veron Sanchez, M. Montes Fernandez; Madrid/ES (nietba@yahoo.es)
Learning Objectives: 1. To be aware of the importance of the abdominal emphysematous pathology. 2. To differentiate the benign conditions that resemble lifethreatening emphysematous infectious diseases. 3. To be familiar with the CT
imaging of abdominal emphysematous diseases.
Background: The abdominal emphysematous conditions conform a wide range
of gas-forming infectious pathology, ischemia or local tissue necrosis, as well as
some benign conditions. The differentiation between them are determinant in order to make an early diagnosis and provide surveillance of potential complications.
Although the primary approach to these pathologies can be made through plain
film or ultrasound, CT imaging has proved to be the most sensitive and specific
imaging technique in the detection of the gas, as well as its extension and anatomic localization.
Imaging Findings: We have made a pictorial review showing and describing the
CT imaging features of benign and more aggressive forms of emphysematous
pathology, as infectious or ischemic, involving the following viscera; stomach,
gallbladder, pancreas, small bowel, urinary tract, abdominal wall and perineal
region (Fourier Gangrene).
Conclusion: CT should be considered the imaging modality of choice, due to its
accuracy in gas detection. It is highly important to be familiar with those entities.
Although rare, they associate a higher mortality and complication rate when compared with their non-emphysematous variety. Benign sources of gas must be
identified since the treatment and prognosis vary dramatically.
C-403
Changes in the degree of visualization in CT virtual endoscopy of the
gastrointestinal tract according to the slice thickness
Y. Miyatani1, Y. Hirano2; 1Tokyo/JP, 2Otaru/JP
Learning Objectives: 1. To understand that the degree of visualization of cancers of the gastrointestinal tract varies according to the slice thickness. 2. To
understand that the degree of visualization varies according to the region of interest. 3. To perform CT examination of the gastrointestinal tract with greater accuracy.
Background: Conventional thick-slice scanning shows different degrees of visualization according to the region examined, meaning that lesions may be overlooked in some cases.
Procedure Details: An agar phantom of the gastrointestinal tract with simulated
lesions on the surface with level differences from 0.05 mm to 0.65 mm was
scanned. Images were obtained (1) at different slice thicknesses with the phantom in the same orientation and (2) at a constant slice thickness with the phantom in different orientations. In (1) a, 0.15-mm elevation could be identified when
the slice thickness was 0.5 mm. In (2), when simulated lesions were parallel to
the slice plane, some slice thicknesses showed a lower degree of visualization.
Conclusion: Sub-millimeter scanning is thought to improve the visualization of
lesions such as those in the gastric angle, where lesions occur more frequently
than in other areas, and the sigmoid colon, which follows a complicated threedimensional course.
Conclusion: To understand CT findings of papilla at various pathological conditions can help the radiologists make differential diagnoses.
C-405
Typical and atypical radiological appearances of gastrointestinal tract
lymphoma: A pictorial review
S. Mc Dermott, A. Alhajeri, D. McKenna, P. McCarthy; Galway/IE
(mcdermottshaunagh@gmail.com)
Learning Objectives: The objective of this exhibit is to illustrate the diverse forms
of gastrointestinal tact lymphoma. Knowledge of the multiple radiographic manifestations of the disease is critical for enhanced detection, improved diagnostic
accuracy and treatment planning, and avoidance of imaging pitfalls.
Background: The gastrointestinal tract is the most common site of primary extranodal lymphoma, accounting for up to 10% of extranodal disease at diagnosis.
Primary gastrointestinal lymphoma must be recognised, characterised, and staged
accurately, since, in some areas of the bowel, prognosis and treatment vary substantially when compared with those for other neoplasms, especially carcinoma.
Imaging Findings: Gastrointestinal lymphoma produces a spectrum of radiological appearances. Gastric lymphomas may be infiltrative with thickened folds,
polypoid, ulcerated, nodular or a combination. The typical appearances of small
bowel lymphoma can be classified as aneurismal, constrictive, nodular or ulcerative. Forms of colonic lymphoma include: nodules that can ulcerate and cause
perforation, discrete masses, (usually without obstruction but may cause intussusception), focal or diffuse infiltration of the colonic wall causing fold thickening
and aneurysmal dilatation by destruction of the innervation.
Conclusion: This pictorial review will describe the typical imaging characteristics of gastrointestinal tract lymphoma and highlight findings which can help confirm the diagnosis of lymphoma.
C-406
Acquired gastrointestinal fistulas: Imaging evaluation
M. Navalho 1, J. Incio2, V. Mascarenhas2, A. Fernandes2, I. Tvora2; 1Lisbon/PT,
2
Lisboa/PT (mnavalho@sapo.pt)
Learning Objectives: To review and provide an approach to classifying gastrointestinal (GI) fistulas. To describe and illustrate the individual fistula types and the
relative contribution of the various imaging modalities. The salient clinical features of specific GI fistulas, including management, will also be covered.
Background: GI fistulas can have congenital or acquired causes. Acquired GI
fistulas can be categorized as external or cutaneous if they communicate with
the skin surface or internal if they connect to another internal organ system or
space, including elsewhere along the GI tract itself. The majority of external fistulas represent a complication of recent abdominal surgery. The leading causes of
internal fistulas are Crohn disease, diverticulitis or malignancy.
Imaging Findings: A review of the cases of acquired GI fistulas was performed.
Imaging findings obtained at the time of diagnosis, treatment and follow-up in
different cases are illustrated. Specific topics addressed are intestinal and extraintestinal internal fistulas, high and low-output external fistulas and complex fistulas.
Conclusion: Acquired GI fistulas comprise a spectrum of clinical entities that
remain a serious diagnostic challenge. An understanding of the various types of
GI fistulas and their causes is very important for appropriate patient care.
C-404
C-407
CT evaluation of the bulging papilla: Correlation with endoscopy

D. Yeh, S. Kim, T. Kim, J. Lee, C. Kim, S. Lee, G. Kim; Busan/KR
Bare area of the liver: Physiopathology of the retroperitoneal spreading of

malignancies
F.M. Danza, M. Cirillo, A. D'Amico, A. Magistrelli, E. Bock, L. Bonomo; Rome/IT
(fmdanza@rm.unicatt.it)
Learning Objectives: To understand anatomy of the papilla of Vater. To differentiate normal papilla and abnormal papilla on CT. To understand CT findings of
papillitis.
Background: The diverse pathologic conditions cause abnormality of the papilla
of Vater. With the advent of computed tomography, bulging papilla is frequently
encountered during interpretation of CT images. Although bulging papilla is seen
on CT in normal individuals, various pathologic conditions such as passed stone,
pancreatitis, and malignant pancreaticobiliary disease show bulging papilla on
CT images.
Imaging Findings: Mural thickening and attenuation patterns on contrast-enhanced CT could differentiate pathologic papilla from normal. Target-like or brisk
homogeneous enhancement of the papilla are likely to be benign condition such
as papillitis, whereas prolonged enhancement indicate malignant condition such
as ampullary carcinoma rather than benign condition. Periampullary edema also
causes bulging papilla. Patulous papilla appears as air biliary gram or intrapancreatic gas with deformed papilla on CT.
408
Learning Objectives: To demonstrate the role of bare area of the liver (BA) in
malignancies spreading through the retroperitoneum (RP). Its embryologic origin, crucial anatomical position, particular vascular supply and lymphatic drainage are the key to understand some clinical and radiological of neoplastic
presentations.
Background: Embryological origin of BA from the rotation and adhesion of dorsal mesogastrium explains how it is a door of interconnection between some
hepatic segments (II, III and VII) and a retroperitoneal compartment, right perirenal space (right PRS).
BA a particular anatomic structure that links liver to RP; it plays an important role
for its peculiar vascular and lymphatic supplies.
Procedure Details: We report one case of recurrence (HCC after 14 years after
transplantation) and two cases of neoplastic spread to BA from right PRS (renal

and adrenal neoplasms). CT and MR imaging demonstrate this unusual but not
rare way of diffusion.
The II, III and VII hepatic segments can receive branches from diaphragmatic
arteries or have lymphatic drainage through the BA and the right PRS, instead of
usual way into hepatic hilum. Its lymphatic network can represent an interconnection between BA and RP spaces, particularly with the right PRS.
Conclusion: This anatomical background is the key to understand some apparently atypical, rare recurrences and diffusions of neoplasms like the ones we
report. In particular the colonization through lymphatic network in RP is the key
for understanding such cases, often underestimated.
GI Tract
Peritoneum
C-408
Diseases of peritoneum, mesentery and omentum: Pathologic spectrum
and CT findings
A. Donuru, V.V.R. Kandula, H. Obaid, A. Mcgregor; Leicester/UK
Learning Objectives: 1) To understand a broad spectrum of pathology affecting
the peritoneum, mesentery and omentum. 2) Be familiar with the imaging findings and differential diagnosis of various pathologies in this region.
Background: Peritoneum, mesentery and omentum play important roles as pathways for the spread of various inflammatory conditions and malignancies. The
purpose of this exhibit is to present their numerous features and to assess the
diagnostic value of CT in these diseases.
Procedure Details: We reviewed the CT findings of patients who showed evidence of peritoneal, omental and mesenteric abnormalities on CT and had confirmed histology. They included peritoneal dissemination (adenocarcinoma of
bowel, cholangiocarcinoma, gastrointestinal stromal tumour, ovarian tumours),
pseudomyxoma peritonei, malignant mesothelioma, malignant lymphoma, carcinoid tumour, leiomyosarcoma, liposarcoma and neuroendocrine tumour. The findings included thickening of peritoneum, increased fat attenuation, nodules or
masses and ascitis. Imaging features and histopathologic correlation of disease
processes are demonstrated in this pictorial essay.
Conclusion: CT provides precise information regarding peritoneal, omental and
mesenteric abnormalities and may suggest the diagnosis and biopsy site when
necessary. Knowledge of the spectrum of these abnormalities and their characteristic CT appearances is essential for improving the diagnosis of these conditions.
C-409
CT appearances of sclerosing encapsulating peritonitis
C. George, K. Al-Zwae, M. Puthuran, S. Nair, J. Cast; Hull/UK
Learning Objectives: 1. To illustrate the computerized tomography (CT) appearances of sclerosing encapsulating peritonitis (SEP) in patients undergoing peritoneal dialysis (PD). 2. To describe the clinical and radiological presentations of
SEP along with the treatment options available.
Background: Sclerosing encapsulating peritonitis is a serious complication of
PD characterised by thickened peritoneal membranes which lead to decreased
ultra filtration and intestinal obstruction. Previous reports place the prevalence of
SEP at 0.54%-7.3% and the diagnosis is often established at a late stage of the
disease at laparotomy. This is however changing with increasing radiological diagnosis of SEP. Its presence should be suspected in patients treated by CAPD
who develop small bowel dysfunction with associated abdominal pain and progressive loss of ultra-filtration.
Imaging Findings: We present a pictorial review of the CT appearances in SEP.
CT appearances of SEP in the literature include peritoneal thickening, peritoneal
calcification, loculated fluid collections, and adherent small bowel loops. The clinical course of SEP along with the current treatment options are also discussed.
Conclusion: SEP is a typical, but at the same time, not so frequently observed
complication of PD which is associated with a high mortality. It should be borne in
mind whenever a patient with a history of PD reports episodes of abdominal pain,
nausea and vomiting associated with weight loss. CT of the abdomen should be
performed in such patients and this may help in attaining an early, correct, and
noninvasive diagnosis of SEP for which optimal intervention can be planned.
GI T
Trract
409

Head and Neck
Head
C-410
Magnetic resonance imaging findings of the globe and optic nerves in tilted
disk syndrome
S. Orguc, B. Toprak, S. Tarhan, C. Guler; Izmir/TR
(sebnemorguc@superonline.com)
Purpose: We aimed to assess the anatomical variation of the globe and the optic
nerve in tilted disk (TD) syndrome using the fundoscopic and MR imaging findings, and compared them with the control group.
Methods and Materials: Seven patients who were diagnosed with TD syndrome
during fundoscopic examination were referred for MR imaging of the sella and
chiasm. The shape of the globe, chiasm angle, and insertion angles of the optic
nerves in axial and sagittal planes (determined by lines parallel to the optic nerve
and tangential to the globe) in TD syndrome were compared with the control
group consisting of 9 cases.
Results: Spherical equivalent of refraction defect was -3.8 3.3 D. (mean SD)
for the TD patients and 0.4 0.75 D. (mean SD) for the control group (p < 0.05).
The insertion angle of the optic disk to the globe was wider in the temporal quadrant (p < 0.05), and narrower in the nasal quadrant (p < 0.05) in comparison to
the control group. There was no significant difference in the superior and inferior
insertion angles between groups. The AP diameters of the globe were significantly higher in patients with TD (p < 0.05). There was no difference between the
optic chiasm angles.
Conclusion: The relationship of optic disk and globe were significantly different
in patients with TD syndrome in comparison to the control group. TD syndrome
resulted from the malalignment of optic nerve and globe in the horizontal plane.
C-411
Computed tomography and imaging findings of chronic osteomyelitis of the
jaw
F. Sorrentino, F. Ganguzza, G. La Tona, V. Mastrella, G. Ciotta, A. Lo Casto;
Palermo/IT (drdiving@yahoo.it)
Purpose: To describe CT and dental CT findings of chronic osteomyelitis of the
jaws.
Methods and Materials: 35 patients affected by chronic osteomyelitis of the jaw
were studied by helical CT, using 1 mm section thickness and a bone algorithm.
Transverse axial CT and dental CT reformatted images were evaluated. Panoramic and cross-sectional images done with 2 mm section thickness and 2 mm
intersection gap were reformatted by a dental CT program. According to CT findings, osteomyelitis was classified as sclerotic, suppurative, or with periosteal reaction.
Results: Osteomyelitis involved the mandible in 28/35 patients, maxilla in 4/35
and both jaws in 3/35. Osteomyelitis was sclerotic in 24/35 (68.6%) of cases,
suppurative in 7/35 (20%), and with periosteal reaction in 4/35 (11.4%). 2/7 cases of suppurative osteomyelitis were complicated by fistulation with masticator
space inflammation, requiring further CT or MR imaging with i.v. contrast medium.
Conclusion: CT allows for good definition of different types of chronic osteomyelitis. Dental CT reformatted images allow evaluation of the relationship of the
osteomyelitis with teeth and important anatomic structures such as the mandibular canal and maxillary sinus. Contrast enhanced CT or MR imaging is required
in cases of masticator space inflammation.
C-412
Dental-CT of transplanted teeth: Preoperative imaging technique and
measurement accuracy
A. Gahleitner, W. Zechner, H. Imhof; Vienna/AT
(andre.gahleitner@meduniwien.ac.at)
Purpose: In dentistry tooth transplantations represent a common procedure to
replace missing teeth. For correct preoperative evaluation precise knowledge of
the crown diameter is important. The aim of this study was to determine whether
dental CT is able to accurately determine tooth dimensions and hence to evaluate the potential and optimal size and site for tooth transplantations.
Methods and Materials: In 58 patients, who underwent dental CT of the jaw
prior to an extraction of an impacted tooth, the clinical and CT measurements of
the crown diameter were compared concerning mesio-distal and bucco-lingual
measurements. The transverse images were obtained on a CT scanner (Tomo-
410
scan SR-6000, Philips Medical Systems, Best, the Netherlands). The CT data
were then transferred into a workstation and the diameter of the crown was determined. Using a Zurich sliding gauge the same distances were measured clinically. The results were compared and statistically evaluated.
Results: The mean deviation of CT measurements concerning the bucco-lingual
diameter of the crown was +0.08 mm (SD: 0.38 mm). For the mesio-distal diameter the mean deviation of CT measurements was -0.24 mm (SD: 0.53 mm).
Conclusion: The degree of the deviation between CT measurements and clinical measurements was within the sub-millimeter range which represents a high
reliability of dental CT in answering surgical questions concerning tooth diameters.
C-415
Identification of the ethmoid arteries on thin-slice axial images and coronal
reformatted images of orbits by means of multi-detector row CT
N. Takahashi, T. Higuchi, H. Maeda, M. Ohkubo; Niigata/JP
Purpose: Anterior ethmoid arteries (AEA) are important anatomic structures for
endoscopic sinus surgery. We assessed thin-slice axial images and coronal reformatted images (CRI) of orbits using multi-detector row CT to identify AEA.
Methods and Materials: We performed facial CT in 132 patients with paranasal
or nasal diseases using a 16-row detector CT (n = 59) or a 6-row detector CT
(n = 73) at 1 mm or 1.25 mm slice section, respectively. CRI were reformatted at
section widths of 3 mm and 1 mm. We identified the AEA branched from the ophthalmic arteries on each series. Differences were assessed using chi-square test.
Results: All the scans were of approximately average diagnostic quality. AEA
were identified in 97.5% and 96.6% at slice thicknesses of 1 mm and 1.25 mm on
the axial images, respectively. There was no statistically significant difference in
the detection rate (p = 0.89). On the CRI, AEA were presented tangentially in
75.4% and 90.2% at section widths of 3 mm and 1 mm, respectively. The visibility
of AEA was rated significantly better on CRI at a section width of 1 mm than on
those at section widths of 3 mm (p < 0.0001).
Conclusion: Thin-slice axial images using multi-detector row CT mostly depict
AEA. CRI at a section width of 1 mm are useful to identify AEA for preoperative
evaluation of paranasal sinuses.
C-416
Evaluation of usefulness of computed tomography angiography for
postoperative follow-up of patients after facial microvascular transplants
B. Eksner, M. Boba, B. Bobek-Billewicz, A. Maciejewski, C. Szymczyk,
J. Wierzgon; Gliwice/PL (eksnerx@poczta.onet.pl)
Purpose: Maxillofacial surgery procedures are often connected with extensive
postresective facial defects. Reconstructive surgery allows the excision of tumor
with free tissue transfer in a one stage operation with the intention of restoring
organ function and aesthetic appearance. Success depends on patency of arterial and venous anastomoses. Early detection of thrombosis or detachment of
vascular pedicle enable immediate revision of microvascular anastomoses which
can salvage the flap. Our study aim was to evaluate MDCT angiography (CTA)
capabilities for early detection of free flap failure.
Methods and Materials: 36 consecutive patients who had undergone free flapplasty were referred to CTA within 72 hours of surgery. Conclusions from CT
examination were compared with clinical course. Intermodality agreement between CTA and clinical follow-up was assessed using Fisher exact test.
Results: CTA revealed correct flow in performed anastomoses in 30 patients. In
6 patients CT examination suggested free flap failure due to insufficiency of arterial and/or venous anastomoses. Clinical examination revealed features of flap
necrosis in 7 patients. False positive findings of anastomoses deficiency (which
was inconsistent with physical examination in further follow-up) was obtained in
two patients (5%). In one case (2%) free flap collapse due to venous thrombosis
was misdiagnosed. Sensitivity and specificity of the method were estimated as
SE = 0.96 and SP = 0.71, respectively. Exact probability value for the relationship between both diagnostic methods was p = 0.0003 with kappa value, K of
0.73.
Conclusion: Multidetector computed tomography is a sensitive technique for
postoperative monitoring of patients after facial microvascular transplants.

C-417
Radiological analysis of adipose tissue at the orbital apex and superior
orbital fissure
S. Meng1, M. Prokop2, W.J. Weninger1; 1Vienna/AT, 2Utrecht/NL
(stefan.meng@meduniwien.ac.at)
Purpose: Detailed knowledge of the topography of the orbital apex is crucial for
diagnosing pathologies and a prerequisite for surgical intervention. This presentations aim is to provide data about the normal distribution and radiological appearance of adipose tissue in the orbital apex region and superior orbital fissure.
Methods and Materials: Near isotropic data sets of 30 patients (22-77 yrs) who
underwent a contrast media enhanced examination with a multislice CT scanner
were analyzed with state of the art 3D visualization software.
Results: Two adipose tissue filled compartments could be distinguished in the
orbital apex region. Both extended into the superior orbital fissure and occupied
approximately 25% of its medial part. The first was located in the lower part and
was continuous with, both the tissue space of the pterygopalatine fossa and the
parasellar pterygopalatine compartment. It was detected bilaterally in 83% of our
patients and was separated from the rest of the orbit by a tissue sheet continuous
with the periostium of the orbital floor. The second was part of the orbital adipose
body itself, which protruded in 78% bilaterally into the superior orbital fissure.
Conclusion: Using multislice CT imaging we could distinguish two distinctive
adipose bodies in the orbital apex region. They are separated by strong tissue
sheets and expand into the superior orbital fissure, where they occupy approximately a quarter of its medial part. The topography and extension of these adipose bodies and their compartments is important for the understanding of
pathologies and the planning of surgical procedures.
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Imaging of deep facial spaces: Correlation of anatomy, computed
tomography and magnetic resonance imaging
I. Fauquet, H. Bruge-Grivet, L. Deschildre, F. Bonodeau, L. Ceugnart,
G. Hurtevent-Labrot; Lille/FR (i-fauquet@o-lambret.fr)
Learning Objectives: To illustrate the anatomy of the deep facial spaces and
correlate it with computed tomography (CT) and magnetic resonance imaging
(MRI) in order to provide a baseline for examination of this complex anatomical
area.
Background: The deep facial spaces are in the middle of a complex anatomic
region located between the skull base and the hyoid bone, an area which is clinically difficult to access. Computed tomography and magnetic resonance imaging are useful in providing precise analysis of these areas.
Deep facial spaces are localized around the pharynx. They are divided into two
medial spaces (pharyngeal musosal in front and retropharyngeal space behind)
and three lateral spaces (retrostyloid, prestyloid and infratemporal fossa). Identifying anatomical structures with precision (prestyloid fat, styloid process, internal
carotid artery) is crucial to determine the site of origin of a pathological process.
Knowledge of the contents of every region helps in getting an accurate diagnosis.
Finally, an understanding of routes of communication between these different
spaces and the skull base aids precise definition of disease extent.
Procedure Details: Studies (CT and MRI) performed during the last year were
reviewed, and the most interesting cases to illustrate the deep facial spaces were
selected.
Conclusion: Knowledge of anatomy of the deep facial spaces, their contents
and routes of communication are critical for the radiologist to establish the etiologic diagnosis and assess extension of a pathological process, and thus, optimize the therapeutic management.
Possibilities of 3D ultrasound in the assessment of the orbital part of the

optic nerve
I. Nasnikova, S. Kharlap, E. Kravchuk, A. Markosyan; Moscow/RU
(Niu@cch.pmc.ru)
Purpose: To investigate structural elements, anatomical and topographical characteristics of intraocular and orbital parts of the optic nerve (ON) using real-time
3D US and 3D reconstruction.
Methods and Materials: 40 patients, divided into 3 groups: 1) 20 healthy patients (40 eyes), age range 21-41 years; 2) 10 patients (20 eyes) with unilateral
ON atrophy of different etiology; 3) 10 patients (10 eyes) with elevated intracranial pressure were enrolled in our study. All examinations were performed on Voluson 730 (Kretz), HDI-4000 and HDI-5000 (Philips).3D reconstruction of the ON
was made from the optic nerve head (ONH) up to the apex of the orbit. US data
were compared with MR imaging and laser tomography results.
C-420
Functional MR sialography: A useful diagnostic method of radiationinduced xerostomia
A. Wada, S. Koyama, T. Katsube, N. Uchida, H. Kitagaki; Izumo/JP
(awada-ind@umin.ac.jp)
Learning Objectives: The aim of this study is to exhibit the utility of functional
MR sialography in diagnosis of radiation-induced xerostomia.
Background: Radiation-induced xerostomia is one of the frequent and serious
complications which affect quality of life of patients with head and neck tumors.
Conventional diagnostic procedures in xerostomia involve invasive manoeuvres
such as catheterization and salivary gland scintigraphy. In functional MR sialography, evaluation of the salivation function is based on the ratio of the area of the
main duct and branches of the salivary gland before and after salivation stimulation with tartaric acid.
Imaging Findings: The MR sialography findings of radiation therapy patients
were classified into three types by luminal depiction and response to secretion
stimulation. The patients with serious xerostomia and dysgeusia revealed remarkable atrophy of salivary gland, absence of salivary duct depiction and absence of
response to tartaric acid. The xerostomia patients without dysgeusia showed
improvement of the initial poor visualization of salivary ducts after tartaric acid
administration. The mild xerostomia patients revealed the same findings as in
normal subjects.
Conclusion: Functional MR sialography can objectively evaluate salivary gland
damage. These findings may correlate with a predicted risk of oral cavity complications following radiation therapy of head and neck tumors.
C-421
Congenital conductive hearing loss in children and young adults on high
resolution computed tomography of the temporal bone
P. Tang1, J. Goh1, T. Tan1, W. Smoker2, L.R. Gentry3; 1Singapore/SG, 2Iowa,
IA/US, 3Madison, WI/US (phuahwee@yahoo.com)
Learning Objectives: This poster aims to illustrate the normal anatomy of the
middle ear displayed on high resolution CT (HRCT) of the temporal bone and the
gamut of congenital causes of conductive hearing loss in children and young
adults with no past history of ear discharge or trauma.
Background: Problems with middle ear structures result in conductive hearing
loss and the middle ear structures (ossicles, facial nerve, oval and round windows) are best demonstrated on HRCT of the temporal bone.
Imaging Findings: We performed a retrospective review of patients with congenital conductive hearing loss (CHL) from 4 teaching hospitals in Singapore
and the United States. All patients had undergone HRCT on single or multislice
scanners. Both axial and coronal planes were acquired from the head of the
malleus to the round window when a single-slice CT scanner was utilized. On the
multislice CT scanner, axial images were obtained at 0.5 mm intervals with coronal reformats.
We demonstrate various causes of congenital CHL which include congenitally
abnormal/deformed ossicles, congenital ossicular chain fixation, congenital oval/
round window atresia and a case of a dehiscent facial nerve causing ossicular
impingement.
Conclusion: Most causes of congenital middle ear deafness can be demonstrated on HRCT without requirement for exploratory tympanotomy.
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Results: The method of ON 3D US analysis was developed. The examinations of

the healthy adults and patients with ON pathology showed: ON - is an elastic,
dynamic structure. ON anatomic and hemodynamic characteristics change during globe movements and restore after a period of rest. Using 3D US, the ON and
the optic nerve sheath can be examined along the path to the orbit in cases of
elevated intracranial pressure. In all cases of unilateral atrophy, irrespective of
etiology, the asymmetry of the vascular flows in intraocular and retroocular parts
of ON were revealed using B-mode and 3D Doppler US. The same changes were
detected in the hemodynamic characteristics.
Conclusion: Real-time 3D US of the orbital part of the optic nerve combined with
3D reconstruction can give new information about the hemodynamic conditions
and structural changes of the ON and its sheath.

C-422
Anatomical variants in the sino-nasal region: A pictorial review
C. George, S. Nair, M. Puthuran, S.R. Ell, D.R. Salvage; Hull/UK
Learning Objectives: 1. To illustrate the anatomical variants encountered during
computerized tomography (CT) of the sino-nasal region. 2. To discuss the clinical
importance of these anatomical variations and how these may affect the management of inflammatory diseases of the sino-nasal region.
Background: Radiologists and otorhinolaryngologists rely on cross-sectional
imaging, especially CT, as a roadmap for the pre-operative work up of the patients presenting with inflammatory sino-nasal disease. Knowledge of the anatomy and the variants is paramount in planning surgical treatment. Many potential
operative complications can be avoided by careful interpretation of the pre-operative CT scans.
Imaging Findings: We illustrate and discuss the clinical importance of various
anatomical variants in the sino-nasal region found during CT. Patterns of inflammatory disease are demonstrated and their relevance to the surgical procedure
is explained. Examples include common patterns of inflammatory disease and
isolated disease within pneumatised anatomical variants.
Conclusion: We emphasize the importance of identifying variant anatomy in the
sino-nasal region. A good understanding between the radiologist and the otorhinolaryngologist is essential to provide optimal surgical intervention with minimal
risk.
C-423
Imaging of the intracranial seventh and eighth cranial nerves: Crosssectional anatomy and pathology
J.P.W. Nash, S. Vessal, A. Anbarasu, K. Sherlala; Coventry/UK
(jonathan_nash@hotmail.com)
Learning Objectives: To illustrate the normal course, branches and relevant functions of the intracranial seventh (facial) and eighth (vestibulocochlear) cranial
nerves. To discuss various pathological processes involving these nerves.
Background: A thorough understanding of normal anatomy remains mandatory
in Clinical Radiology. As imaging techniques progress, more detailed information
can be obtained on both variations in normal anatomy and the details of pathological processes. Familiarity with the features of these as seen on current imaging is essential to enable the practising Clinical Radiologist to interpret the obtained
information accurately and with confidence. We feel Clinical Radiologists, particularly those in training, involved in the diagnosis of disorders affecting the seventh and eighth cranial nerves will benefit from this presentation.
Imaging Findings: The CT images were obtained using four-slice multislice CT
scanners. The MR images were obtained using 1.0 T and 1.5 T magnets. Images
were reconstructed on ADW workstations. Contrast was used where appropriate.
All patients were either scanned in our department or referred for second opinion.
Conclusion: The CP angle and IAC sections of the seventh cranial nerve are
best demonstrated by MR. The temporal bone section is better demonstrated by
multiplanar CT and MR with gadolinium in specific situations. The eighth cranial
nerve is best evaluated with high-resolution MR sequences and intravenous contrast enhancement. Example images of the two nerves will include the eighth
cranial nerve's division into vestibular and cochlear branches, congenital variations and features associated with local fractures, vascular ectasia and neoplasms.
C-424
Dose optimization for multislice computed tomography (MSCT) protocols of
the midface
M. Lorenzen, U. Wedegrtner, C. Weber, J. Lorenzen, G. Adam; Hamburg/DE
(mlorenze@uke.uni-hamburg.de)
Purpose: To optimize MSCT protocols of the midface with regard to dose reduction and adequate image quality.
Methods and Materials: MSCT examinations of the midface were performed on
3 corpses with successive reduction of tube current including 150, 100, 70 and
30 mAs at 120 kV as well as 40 and 21 mAs at 80 kV. At 120 kV, a pitch of 0.875
and collimation of 4x1 mm were used. At 80 kV, a pitch of 0.7 and collimation of
2x0.5 mm were used. Images were reconstructed in transverse and coronal orientation. Qualitative image analysis was performed by two radiologists separately using a five-point scale (1= excellent; 5= poor) concerning the following
parameters: Image quality, demarcation and sharpness of lamellar bone as well
as overall image quality and image noise (1= minor; 5= strong). The effective
dose [mSv] and organ dose [mSv] of the eye lens and the interobserver agreement (kappa-coefficient) were calculated.
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Results: Evaluation of the lamellar bone demonstrated adequate sharpness,

demarcation and image quality at 120 kV/30 mAs. For overall image quality and
noise, a dose level of 120 kV/40 mAs was acceptable for evaluation. With regard
to image quality, the effective dose and organ dose of the eye lens could be
reduced from 1.89 mSv to 0.34 mSv and 27.2 mSv to 4.8 mSv. Interobserver
agreement was moderate (kappa= 0.39).
Conclusion: Adequate image quality for MSCT protocols of the midface was
obtained at a dose level of 30 mAs at 120 kV, resulting in a dose reduction of
70 % in comparison to standard protocols.
C-425
A pictorial review of intratemporal causes of facial nerve palsy
J. Goh1, P. Tang1, T. Tan1, H.K. Lee2, W. Smoker2, L. Gentry3; 1Singapore/SG,
2
Iowa, IA/US, 3Madison, WI/US (Julian_Goh@ttsh.com.sg)
Learning Objectives: To demonstrate the gamut of intratemporal causes of facial nerve palsy.
Background: The most common cause of facial nerve palsy is Bell's palsy, a
benign self-limiting inflammatory condition. This has a viral aetiology. Symptoms
may sometimes be unremitting. Other conditions may injure the facial nerve at
any point along its course and produce unremitting facial nerve palsy. The imaging modality of choice (CT versus MR) is dictated by the clinical presentation; on
occasion, both modalities are required to accurately delineate a lesion.
We performed a retrospective review of patients with unremitting facial nerve
palsy in 4 teaching hospitals in Singapore and the United States. All patients
underwent either MR and/or CT. CT was performed with single- or multislice scanners. Coronal and axial planes were acquired with single-slice scanners, while
axial images were obtained at 0.5 mm or 0.75 mm intervals with coronal reformats on multislice scanners. We limit ourselves to the intratemporal causes of
facial nerve palsy, and review the normal anatomy and imaging features of the
facial nerve on CT and MR.
Imaging Findings: We present several conditions which may mimic an unremitting Bell's palsy. These include schwannomas (facial and vestibular), ossifying
and non-ossifying haemangiomas, inflammatory conditions e.g. otitis media, and
tumours including chondrosarcoma of the temporal bone. We also illustrate the
typical imaging features of Bell's palsy, and demonstrate other causes of facial
nerve palsy, including temporal bone trauma involving the geniculate ganglion.
Conclusion: Unremitting facial nerve palsy may be caused by other aetiologies
other than Bell's palsy.
C-426
Fungal sinusitis: Spectrum of CT findings
C.M. Shetty, C.V.S. Badam, A.R. Kambadakone; Manipal/IN
(drcmshetty@yahoo.com)
Purpose: To study the role of CT in the evaluation of fungal sinusitis and to illustrate the spectrum of imaging characteristics of fungal sinusitis on CT.
Methods and Materials: We retrospectively evaluated the CT studies of 40 cases of microbiologically and histopathologically proven fungal sinusitis. Contiguous coronal plain 5 mm sections were obtained in all the patients. Scans were
obtained from the anterior margin of the frontal sinuses to the posterior margin of
the sphenoid sinuses. The imaging studies were reviewed with special attention
to attenuation (HU) density of the soft tissue lesion, presence of air pockets,
sinus expansion, bone remodelling, osseous destruction and adjacent structure
invasion.
Results: Maxillary sinus [90%] was the most commonly involved paranasal sinus
with Aspergillus species [67%] accounting for most of the fungal infections. The
major CT findings included a soft tissue density mass [97%] and scattered air
pockets within the soft tissue density mass [50%]. Sinus expansion [35%], bony
thinning [37%], bony destruction [33%] and increased intrasinus attenuation [20%]
were the other predominant CT findings.
Conclusion: CT plays a major supportive role in the diagnosis of fungal sinusitis
and the important CT signs of fungal sinusitis include intrasinus hyperattenuation, bony destruction and extension of the soft tissue mass into adjacent structures.

C-427
Evaluation of high resolution multislice CT in the characterization of osteoodonto-kerato-prosthesis
R.M. Seidel, K. Hille, P. Fries, G.K. Schneider; Homburg a.d. Saar/DE
(rarsei@uniklinik-saarland.de)
Purpose: To investigate the diagnostic feasibility of high resolution multislice CT
(HRMSCT) in patients with osteo-odonto-kerato prosthesis (OOKP) for optic lens
replacement in severe corneal diseases, to assess evolving biological changes.
Methods and Materials: I: 20 patients with OOKP were investigated by nonenhanced HRMSCT using a helical scan with 100 mAs, 0.5 mm collimation and
an ultra-high-resolution reconstruction algorithm. Three plane reconstructions and
3D volume calculations based on density measurements were performed to characterize implant morphology as well as the volume. In 10 patients follow-up investigations could be performed.
II: In a phantom model 8 cortical pieces of bovine tibia measuring between 1 and
4 mm in thickness (standard length 7.5x13 mm), without (group 1) and with (group
2) bores (3 and 4 mm) positioned in oil solution were scanned analogously and
compared to calibrate measurements and volume calculations according to the
principle of Archimedes.
Results: I: Mean peak density of the implants was 2070 HU. The calculated mean
volume was 95 mm3. One patient presented with critical pericylindrical resorption
of the OOKP- material leading to malpositioning. 5 of 10 patients showed significant increase of implant volume by bone apposition within 2 years.
II: Phantom measurements revealed no significant difference regarding metric
parameters compared to calibrated measurements (p < 0.05). CT based volume
calculation for the phantoms differed in an underestimation of < 5% compared to
the Archimedic principle.
Conclusion: HRMSCT with adjusted windowing levels provides an accurate diagnostic tool for the evaluation of OOKP to detect critical morphological changes
with the risk of paraprothetic infection.
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Orbital tumors and pseudotumors
V. Gutierrez, M. Caraballo, I. Cogollos, J. Sastre, S. Nieto, R. Manzanares;
Madrid/ES
Learning Objectives: To establish the importance of image findings in orbital
tumors and pseudotumors. To demonstrate computed tomography (CT) and magnetic resonance (MR) imaging appearance of various orbital tumors. To compare
CT and MR in diagnosis of orbital lesions.
Background: Computerized techniques (CT and MR) allow precise delineation
of orbital anatomy and abnormalities. Orbital tumors are well depicted by these
methods; various examples are illustrated in our exhibit.
Magnetic resonance (MR) is an excellent choice for displaying high soft tissue
contrast and multiplanar capability.
Imaging Findings: We have reviewed radiological orbit studies performed in our
hospital during the last five years. We show the most typical images of different
orbital tumors detected on CT and MR. Orbital tumors include both benign and
malignant neoplasms, including hemangiomas, lacrimal gland tumors, lymphomas, carcinomas, metastases and optic nerve tumors.
Orbital pseudotumors include cellulitis, abscess, granulomatous disease and
inflammatory pseudotumors. Histologic examination after tumoral biopsy or surgery were performed in all the cases.
Conclusion: CT and MR imaging are excellent, non-invasive modalities for detection and diagnosis of orbital pathologies, and MR is far superior to CT examination of the orbit.
Imaging of mandibular lesions: Odontogenic and nonodontogenic cysts

and tumors of the jaws
M. Martin, A.-G. Alcal, F. Ballenilla, L. Herraiz, A. Bermejo, I. Arribas;
Madrid/ES (mamartin@seram.org)
Learning Objectives: Illustrate the pathological conditions affecting the mandible. Review imaging findings of mandibular lesions and their histopathological
correlation. Approach the differential diagnosis of lesions of the jaw.
Background: The mandible is a unique bone considering its location and relationship with several structures of the oral cavity, and because it holds the dental
structures, thereby exhibiting a wide variety of pathology. We retrospectively examined 308 mandibular lesions, studied with panoramic radiographs in all cases,
and CT or MR in other cases. These entities were classified into odontogenic
(202; 66%) and nonodontogenic lesions (106; 34%).
C-430
Interactive volume rendering of the paranasal sinuses: Correlations with
endoscopic sinus surgery
E. Neri, L. Muscatello, V. Seccia, S. Sellari Franceschini, C. Bartolozzi; Pisa/IT
(neri@med.unipi.it)
Purpose: Endoscopic sinus surgery is a established surgical technique that is
curative in polyps or tumor, as well as in sinusitis and other pathological conditions of the paranasal sinuses. The surgical approach requires accurate knowledge of the patient's anatomy and the surgeon uses coronal CT images to
"navigate" through the sinuses during the intervention. An alternative to this approach is interactive volume rendering (VR) with CT datasets. The aim of this
study was to correlate VR with endoscopy.
Methods and Materials: Twenty-five patients with chronic sinusitis (n = 13), polyps (n = 9), tumor of the maxillary sinus (n = 2), and angiofibroma (n = 1) underwent multirow CT for diagnosis and planning surgery. In each case CT datasets
were processed with a VR system based on stereoscopic display (Volume Interactions/Bracco; Singapore). Expansive lesions (e.g. polyps and tumors) were
segmented and highlighted in the 3D model. The surgeon worked on the 3D with
hand-tracking devices reproducing the surgical perspectives he needed during
the intervention.
Results: At intervention the endoscopic views were correlated with VR perspective. The time efficiency of the surgical procedure in the case of chronic sinusitis,
was significantly better for cases in which endoscopic surgery was pre-planned
by VR compared to a control group of interventions (8 cases of chronic sinusitis)
where the surgeon correlated endoscopic images with coronal views alone.
Conclusion: Planning sinus surgery with VR improved time efficiency of the surgical procedure.
C-431
CT virtual endoscopy of the middle ear: When is it really useful?
E. Neri, S. Berrettini, F. Forli, C. Bartolozzi; Pisa/IT (neri@med.unipi.it)
Purpose: CT virtual endoscopy (CT-VE) in the study of the middle ear has been
proven to increase the visualization of subtle changes in the tiny structures of the
tympanic cavity. We aimed to identify the applications where CT-VE is useful and
address its clinical use.
Methods and Materials: Two-hundred and thirty-three CT studies of the petrous
bone were reviewed on a dedicated workstation for 3D imaging, as follows: 100
normal cases, 53 otosclerosis, 32 cholesteatoma, 8 ossicular chain malformations, 25 postoperative (mastoidectomy 18, stapedectomy 7), 20 otitis media.
The cases were randomly presented to the reviewer, and the evaluation included
a primary axial and coronal viewing followed by VE of the tympanic cavity. Time
for reviewing was recorded for each visualization method.
Results: Axial and coronal viewing were conclusive for diagnosis in all normal
cases, otosclerosis, cholesteatoma, post-operative and otitis media. In such cases the addition of VE did not contribute to the specific clinical request. In cases
with tympanic cavity filling with soft tissue or fluid, VE was not feasible. In cases
of malformations, axial and coronal viewing were able to detect an alteration of
the chain development, but VE was superior to describe the type of malformation.
Conclusion: In clinical practice, VE is useful in evaluating the conspicuity of
ossicular chain malformations. It did not add value to CT in the remaining pathologic conditions evaluated in this study.
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Imaging Findings: W e have found two radiological patterns: Radiolucent lesions group (90%) mainly include odontogenic cysts and tumors such as ameloblastoma. Radio-opaque lesions (10%) mainly comprise fibro-osseous lesions,
inflammatory diseases and tumors such as cementoma, odontoma or osteosarcoma. Most odontogenic cysts and tumors are round lytic lesions with a thin
sclerotic rim. In clinical practice, most odontogenic lesions are benign, although
it may be difficult to differentiate benign odontogenic tumors from epithelial cysts.
The most frequent malignant tumors of the mandible are squamous cell carcinomas of the oral cavity, particularly carcinomas of the floor of the mouth and gingiva which secondarily invade the mandible.
Conclusion: Initially, panoramic radiographs allow us to recognize the lesions
and their radiological pattern. CT is useful in demonstrating shape and margins
of the lesion and its relationship with adjacent teeth. Sometimes MR is necessary
to evaluate the contents of some cysts and tumors and to define the infiltration of
soft tissues.

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Head and Neck
Ultrasound of the thyroid and parathyroid glands: Technique and imaging

findings with clinical correlation
F. Takis1, A. Papatheodorou2, P. Ellinas2, N. Batakis2; 1Keratea - Attica/GR,
2
Athens/GR (ftakis@otenet.gr)
Neck
Learning Objectives: To be able to perform a comprehensive ultrasound examination of the thyroid/parathyroid glands region, to recognize the different patterns of disease, correlate them with clinical and laboratory findings, and to
propose further workup.
Background: Ultrasound is the first imaging modality for thyroid and parathyroid
pathology. It is fast, feasible, and reproducible. Best results can be obtained if the
examinee has recent hormone and antibody levels available. The examiner should
not limit himself in lesion description, but should suggest a possible further diagnostic workup, based on a comprehensive assessment.
Procedure Details: Thyroid pathology can show no findings at all, or can show
diffuse or focal findings. These findings, together with other clinical and laboratory findings will allow the radiologist to present a proper differential diagnosis. The
parathyroid glands normally are not seen, but if they increase in size, and are not
ectopic, will be easily identified. Also any superficial neck lymph node enlargement can be identified.
This exhibit will present a step by step examination protocol, and a gallery of
common and uncommon pathology. Also basic flowcharts will be presented to
suggest probable diagnostic workup based on previous findings.
Conclusion: Ultrasound is the first imaging modality for performing examinations of the thyroid gland, parathyroid glands and of the superficial neck lymph
nodes. Proper description of the findings, as well as correlation with other clinical
and laboratory findings should be done in order to reach a reasonable differential
diagnosis, and to suggest further diagnostic workup.
C-433
Pitfalls in cross sectional imaging of the larynx
A. Pallan, L. Senthil, J.F. Olliff; Birmingham/UK (arvindpallan@doctors.org.uk)
Learning Objectives: To demonstrate potential difficulties in the cross sectional
imaging of the larynx. To highlight the causes of common errors in image interpretation and provide instruction in their avoidance.
Background: Laryngeal cancer has an incidence of 3.3 per 100,000 population
in the United Kingdom with a mortality of 1.1 per 100,000 population. Effective
surgical or non surgical management is dependent on accurate tumour staging.
Whilst the clinician may inspect the mucosal surfaces, accurate staging requires
cross-sectional imaging of the larynx. This imaging is often not straightforward
and care must be taken to appreciate and avoid several potential pitfalls of interpretation.
Imaging Findings: The imaging of laryngeal carcinoma within our institution over
the past five years was reviewed. During this review cases were identified where
there had been diagnostic difficulty or error due to potentially preventable misinterpretation of the computed tomography (CT) or magnetic resonance imaging
(MRI) studies. Potential strategies in error avoidance and optimisation of studies
are presented. The review demonstrates examples of suboptimal imaging technique causing interpretation difficulty. Appearances of the larynx following radiotherapy and a range of surgical interventions are provided. Current imaging
strategies in the assessment of the laryngeal framework are illustrated with relevant histological correlation.
Conclusion: An imaging review is presented to illustrate potential pitfalls in imaging of the larynx which might result in important misinterpretations.
C-434
CT and MR appearances of cystic lesions in the suprahyoid neck: A
pictorial review
E. Woo, S. Connor; London/UK (e.woo@doctors.org.uk)
Learning Objectives: To describe and illustrate the CT and MR appearances of
cystic lesions in the suprahyoid neck.
Background: Cystic lesions in the head and neck are important entities that are
increasingly investigated by cross sectional imaging. The patient usually presents
with a neck swelling and after initial clinical examination, an ultrasound scan may
demonstrate the cystic nature of the lesion. Further imaging with CT and MR are
often necessary to elucidate the aetiology of the lesion.
Imaging Findings: In this poster we describe the typical CT and MR appearances and the locations of a range of cystic lesions in the suprahyoid neck. Thyroglossal duct cysts, branchial cleft cysts and their subtypes, epidermoids/
dermoids, ranulas, laryngocoeles, neoplastic cystic lymphadenopathy (from squamous cell carcinoma, lymphoma and papillary carcinoma), lymphangiomas,
vallecula and other mucosal retention cysts, cysts of the facial skeleton and cystic lesions in the salivary glands will be discussed and illustrated. Pathological
correlation will be provided.
Conclusion: The purpose of this exhibit is to familiarise the reader with cystic
lesions in the suprahyoid neck and their characteristic CT and MR appearances.
C-435
Multispatial and transpatial diseases of the neck: A pictorial review of CT
findings
A.R. Kambadakone, C.M. Shetty, R.V. Kadavigere, B.N. Lakhkar; Manipal/IN
(avinashkr77@yahoo.co.in)
Learning Objectives: To review the spectrum of multispatial and transpatial diseases of the neck. To illustrate the CT features of these conditions with emphasis
on key findings to establish an accurate diagnosis.
Background: The disease processes which involve more than one space in the
neck could be either transpatial or multispatial. The term transpatial is used to
describe a mass lesion which involves multiple contiguous spaces at presentation and multispatial is used when multiple lesions are present in noncontiguous
spaces. A unique spectrum of disease processes account for these lesions and
hence the method of image analysis and interpretation has to be different to
come to a diagnosis. Accurate analysis also requires a knowledge of the spatial
anatomy of the neck to understand the transpatial spread of lesions.
Imaging Findings: A retrospective review of the neck CT examinations of 60
patients was done. The pathological processes which show transpatial spread
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include infectious lesions, benign tumours and malignant tumours predominantly
squamous cell carcinoma and lymphoma. Cystic lesions like lymphangioma and
cystic hygroma show a transpatial nature which gives a clue to their developmental aetiology. A major group of multispatial lesions include inflammatory and malignant nodal adenopathy followed by rarer conditions like neurofibromatosis.
Conclusion: We present a pictorial review of the CT findings of multispatial and
transpatial lesions of the neck. Knowledge of the CT features and the pattern of
spatial distribution allows an organized approach to the evaluation of the neck
pathologies involving more than one space.
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Invasion of carotid artery by malignant tumors: Sonographic detection
A.H.M. Caiado, M. Chammas, M. Pinho, C. Simes, E. Gebrim, A. Marcelino,
R. Blasbalg, G. Cerri; So Paulo/BR (angelacaiado@gmail.com)
Purpose: Establish the value of sonographic criteria in detecting invasion of the
carotid artery by malignant neoplasms.
Methods and Materials: During a 3-year period, we examined 32 patients (27
men and four women, aged 21-71 years) with proven cancer of head and neck:
squamous cell carcinoma in 29, paraganglioma in one case and salivary gland
carcinoma in one. All patients were clinically suspected of invasion, with inconclusive computed tomography scanning. Six patients had received radiation therapy previously. Sonography was performed with a 7-11 MHz transducer. The
criteria for carotid invasion were loss of the hyperechoic band of the carotid artery wall; tumor fixation (mobility was used to exclude infiltration by dynamic
manoeuvres such as sonopalpation or swallowing), encasement (contact area
between tumor and vessel more than 180 degrees) and narrowing and deformity
of the lumen.
Results: Twenty patients underwent surgery, with pathologic correlation. Fourteen examinations were true-negative, 3 were true-positive, none were falsely
negative and 3 were falsely positive. Sensitivity was 100%, specificity was 82.4%.
Positive predictive value was 50%. Negative predictive value was 100%. Accuracy was 85%.
Conclusion: High resolution ultrasound showed good accuracy in detecting
malignant invasion of the carotid artery. Loss of hyperechoic interface of the carotid wall, tumor fixation in the vessel wall, and narrowing and deformity of the
lumen were the best criteria, when used together. All falsely positive studies were
associated with loss of hyperechoic interface of the carotid wall, used as a single
criterion. Dynamic manoeuvres were very helpful to exclude infiltration.
C-438
Superficial lymph nodes: Ultrasound evaluation
E.J. Bialek, W. Jakubowski, A.B. Szczepanik, R.K. Maryniak,
M. Prochorec-Sobieszek, R. Bilski; Warsaw/PL (ebialek@amwaw.edu.pl)
Learning Objectives: To demonstrate the spectrum of ultrasound imaging features of normal or reactive superficial lymph nodes and wide range of possible
lymph nodes pathologies, with application of power Doppler, three-dimensional
(3D), tissue harmonic (THI) and panoramic imaging. To present diagnostic pitfalls and overlapping images in different lymph nodes diseases.
Background: In evaluation of superficial lymph nodes, ultrasound is the first
method of imaging applied. Based on images acquired between January 2000
and August 2004 a pictorial essay with schemes and examples of ultrasound
appearance of normal, inflammatory, metastatic and lymphomatous lymph nodes
in gray scale (with use of 3D, THI and panoramic mode) and flow imaging techniques (power Doppler) will be presented.
Imaging Findings: Ultrasound anatomy of normal or reactive superficial lymph
nodes will be presented, including possible variations with respect to location. A
typical spectrum of the ultrasound features of metastatic and lymphomatous lymph
nodes will be demonstrated. Images showing reactive lymph nodes with ultrasound features of metastases will be included, as well as examples of lymphomatous lymph nodes looking like reactive ones. Possible pitfalls caused by other
neck pathologies, and ultrasound of metastases and solitary lymphomatous nodes
with pseudo-cystic appearance will be discussed.
The work was partially financially supported by grant from State Committee for
Scientific Research nr3P05B01125.
Conclusion: Ultrasound is the initial diagnostic method in assessment of the
superficial soft tissues and lymph nodes and may significantly support differential diagnosis. However, knowledge of limitations and possible pitfalls in this method
is important.
C-437
Imaging of nasopharyngeal tumours and spread patterns
L. Oleaga, M. Isusi, M. Campo, A. Legorburu, J. Grande, D. Grande; Bilbao/ES
(lauraoleaga@wanadoo.es)
k
Head and Nec
Neck
Learning Objectives: 1. To identify the normal anatomy of the nasopharynx, 2.

To illustrate the CT and MR imaging appearance and spread patterns of
nasopharyngeal tumours, 3. To determine the anatomical sites to be studied when
staging nasopharyngeal tumours.
Background: Nasopharyngeal carcinoma (NPC) is by far the most commonly
diagnosed malignancy involving the nasopharynx. NPC has different spread patterns. It often infiltrates the pterygopalatine fossa (PPF) through the sphenopalatine foramen. Once the tumor is in the PPF perineural spread can occur along
cranial nerve V2 through the foramen rotundum into the intracranial cavity. Tumors can spread further superiorly to the inferior orbital fissure and the orbital
apex and intracranially via the superior orbital fissure. They can also invade the
masticator space. Once the tumor is within the masticator space, there is a risk of
perineural infiltration along cranial nerves with intracranial tumor extension and
denervation atrophy of the mastication muscles.
Procedure Details: The nasopharynx has a complex anatomy, understanding of
which is a prerequisite for the correct diagnosis and accurate delineation of nasopharyngeal tumors. Surgeons, oncologist and radiation therapists depend on
accurate radiologic assessment to optimize treatment plans. Imaging plays a
central role in the management of nasopharyngeal tumors, because this region
is inaccessible to clinical evaluation. CT is ideal for outlining the bony architecture whereas MR imaging provides soft tissue details.
Conclusion: We present the CT and MR imaging findings in patients with nasopharyngeal tumors showing the different ways of extension of nasopharyngeal
tumors.
415

Head and Neck
Miscellaneous
C-439
Superselective intraarterial infusion chemotherapy using high dose
cisplatin for advanced head and neck carcinomas
H. Hirota, K. Nagasawa, K. Takahashi, M. Mineta, T. Yamada, T. Yamaki,
H. Sato, T. Aburano; Asahikawa/JP (hatsune@asahikawa-med.ac.jp)
Purpose: Patients with head and neck cancers of stage III and IV have a poor
outcome despite our best efforts, and surgical cures often decrease quality of life
owing to loss of important functions such as swallowing and speech. We performed superselective high-dose intraarterial infusion of cisplatin (CDDP) and
intravenous infusion of its antidote thiosulfate, with concomitant radiotherapy for
advanced head and neck cancer, over the past few years. We evaluated the usefulness, side effects and problems of this therapy.
Methods and Materials: Fourteen patients with stage III and IV head and neck
cancer received 4-6 weekly simultaneous infusions of 100 mg/m2 systemic CDDP
and neutralization with intravenous bolus sodium thiosulfate, and concomitant
radiotherapy (200 mGy x20-35 fractions).
Results: The complete response rate for primary tumor was 11/14 (79%), and
the partial response rate was 3/14 (21%). The overall response rate was 100%.
The rate of grade III, IV chemotoxicity was 7/15 (47%). Central nervous system
complications related to the infusion technique occurred with 1/72 infusion, which
was reversible. The median length of follow-up was 20 months. There have been
2 recurrences, and overall disease free survival rate was 80%.
Conclusion: We conclude that the combination of superselective intraarterial
infusion of CDDP, thiosulfate neutralization and concomitant radiotherapy can be
effectively applied to patients with advanced head and neck cancer and may
improve the prognosis for patients with this disease.
C-441
Optimized contrast-enhanced protocols for multidetector CT of the brain,
head and neck
R. Bruening1, M. Lev2, S.R. Pomerantz 2; 1Hamburg/DE, 2Boston, MA/US
Learning Objectives: 1. To review the principles of contrast media (CM) optimization for multidetector (MDCT) scanners. 2. To compare differences in acquisition and reconstruction parameters among MDCT scanner manufacturers. 3. To
learn protocols that take maximum advantage of the speed afforded by MDCT
scanners, illustrated with relevant patient cases.
Background: Faster MDCT scanners require an optimization of scanning protocols to obtain the best results from iodinated CM. Parameters for scan delay,
bolus tracking and other acquisition and reconstruction parameters vary according to scanner manufacturer. In general, CM injection parameters remain constant across scanners, and an understanding of the interplay of CM parameters
(e.g., volume, iodine concentration, flow rate) will help you implement the most
efficient protocols for your scanner.
Procedure Details: This exhibit will identify essential differences among MDCT
scanners and will present protocols for contrast-enhanced 16- and 64-slice MDCT
of the brain, head and neck.
Conclusion: Optimizing duration of enhancement, and the intensity of parenchymal/arterial enhancement enables the clinician to get better diagnostic results
and potentially reduce total CM dose injected. These protocols will help you make
the most safe and effective use of iodinated contrast media for MDCT in neuroradiologic imaging.
C-442
The diagnostic role of dynamic contrast-enhanced MR imaging (DCE-MRI)
in various head and neck masses, and differentiation of benign versus
malignant tumors
E. Unlu1, S. Albayram2, O. Temizoz 1, M. Caloglu1, Y. Tamer1; 1Edirne/TR,
2
Istanbul/TR (drercument@yahoo.com)
Purpose: Our purpose of this study was to investigate dynamic contrast-enhanced
magnetic resonance imaging (DCE-MRI) in the differentiation of benign versus
malignant lesions and to evaluate DCE-MRI parameters that are most predictive
for malignancy.
Methods and Materials: 41 head & neck tumors in 41 patients were examined at
gadolinium-enhanced dynamic MR imaging. There were 26 malignant and 15
benign tumors. Time-signal intensity curves (TICs) of the tumors on dynamic MR
images were plotted, and then time of peak enhancement (Tpeak), and enhance-
416
ment ratios (ER) with different times (such as ER30, ER60, ER90, ER120, ERmax)
were also calculated. Data of the benign and malignant group with head & neck
masses were compared by the Mann-Whitney U-test.
Results: The mean values of time to peak (T peak) were found to be significantly
shorter for the malignant group than benign one (P < 0.05). The mean enhancement rate of malignant lesions were ER30: 60.62 52.62, ER60: 105.65 56.26,
ER90: 113.17 45.83, ER120: 116.59 46.75 and ERmax: 128.56 56.51 whereas
the mean enhancement rate of benign lesions were ER30: 67.35 60.78, ER60:
79.79 63.33, ER 90 : 84.53 64.92, ER 120 : 88.41 67.07 and ER max :
112.06 66.48. The mean signal intensity values at the 60 th second (ER60) and
the 90th second (ER90) were significantly different between benign and malignant
groups, facilitating differentiation (P < 0.05).
Conclusion: The parameters obtained from the time-signal intensity curve are
important in differentiating benign and malignant enhancing lesions in dynamic
head-neck MR imaging. DCE-MRI, if added by appropriate criterion to the routine
MRI, improves differentiation between benign and malignant lesions.

Interventional Radiology
Vascular
C-443
Pulmonary artery aneurysms in Behet's disease: Mid- and long-term
experience with endovascular treatment
L. Hendaoui, A. Miaoui, L. Dridi, L. Charrada Ben Farhat, A. Askri, L. Rezgui;
La Marsa/TN (lotfi.hendaoui@rns.tn)
tics such as vessel tortuosity or anatomy preclude safe deployment of the embolic protection device or stent. In this exhibit, we delineate the indications, techniques, and complications of CAS. We will review recently conducted clinical trials
which compare the efficacy of CAS and CEA. Based on a review of the literature,
we will summarize current concepts addressing the role of CAS in the management of patients with carotid stenosis.
Conclusion: Carotid artery stenting with embolic protection is a safe and effective treatment that compares favorably to CEA in the treatment of high-risk patients with carotid stenosis.
Purpose: Behet's disease is a chronic multisystem vasculitis. Pulmonary arterial aneurysms (PAA) have a poor prognosis. Embolization of PAA is useful as the
first line treatment for massive haemoptysis. In this study, we report our experience with percutaneous transcatheter occlusion of 14 PAA in 10 patients with
Behet's disease.
Methods and Materials: Between July 1990 and September 2005 ten patients
(9 male and 1 female), aged 17-43 years old, with a history of haemoptysis were
seen. Chest X-ray, computed tomography with vascular opacification and bronchoscopy were performed in all patients. Only one patient had an angio MR imaging. Initial investigation included global and hyperselective pulmonary
angiography to localize the aneurysm. The aneurysms were embolized by insertion of several large steel coils.
Results: The course of Behet's disease ranged from 1 to 13 years. The diameter of the aneurysms ranged from 2 to 7 cm and between 1 and 5 saccular aneurysms have been detected in the same patient. Insertion of MR imaging compatible
steel coils was successfully achieved in 13 of 14 PAA. Embolization was performed in 14 PAA in 10 patients, 7 of them were occluded completely and 4 were
moderately occluded. No major complication were observed. The rate of recurrence in the first year after endovascular treatment therapy was 30%.
Conclusion: PAA have a poor prognosis and their fatal rupture remains the major cause of death in Behet's disease. Embolization can be performed in most
cases and any recurrence may be re-embolised.
C-446
C-444
C-447
How to place a chestport device under echographic and fluoroscopic

guidance in an angiographic suite
J.J.M.L. Rommens1, M. Laureys1, J. Golzarian2; 1Brussels/BE, 2Iowa, IA/US
(jrommens@ulb.ac.be)
Endovascular therapy for management of oral hemorrhage in malignant

head and neck tumors
H. Kakizawa, N. Toyota, A. Naito, Y. Fujimura, M. Hieda, N. Hirai, T. Tachikake,
K. Ito; Hiroshima/JP (kakizawa@hiroshima-u.ac.jp)
Learning Objectives: 1. How to implant a chestport device. 2. Discuss the results and complication rates when performed in interventional radiology.
Background: Between January 2001 and July 2005 we performed 941 chestport implantations in a positive pressure angiographic suite. Most procedures
took place under local anesthesia. Results and complication rates are discussed.
Procedure Details: The different steps of the implantation are explained and
illustrated by photos and video sequences. The importance of systematic placement under echographic and fluoroscopic guidance, which results in more patient comfort and less complications, will be emphasized. Special attention is
given to the esthetic aspect of the scar.
Conclusion: The main objective of this interactive presentation is to encourage
interventional radiologists to implant chestport devices.
Purpose: To evaluate the efficacy and safety of endovascular therapy in oral

hemorrhage from malignant head and neck tumors.
Methods and Materials: Ten patients (mean age 56 years) with oral hemorrhage
caused by malignant head and neck tumors underwent a total of 13 emergency
embolization procedures using gelatin sponge particles, steel and/or platinum
coils, or a combination of these embolic materials. Angiographic abnormalities,
technical success rate, clinical success rate, recurrence rate, complications, hemostatic period, hospital days, survival days, and patient outcome were all analyzed.
Results: Angiographic abnormalities were identified during 85% of procedures
(11/13). The technical success rate was 100% (13/13 procedures). The primary
and secondary clinical success rates were 77% (10/13 procedures) and 67% (2/
3 procedures) respectively. The overall clinical success rate was 92%, and the
recurrence rate was 22% (2/9 procedures) in patients whom we were able to
observe during the 1-month period after embolization. No major complications
occurred. Several patients in whom gelatin sponge particles had been used complained of transient local pain after the procedure. The median hemostatic period
was 71 days (range 0-518 days). Median hospital and survival days were 59 days
(range 3-209 days) and 141 days (range 4-518 days), respectively. Three patients survived and 7 patients died during the observation period. Only 1 of these
7 patients died from hemorrhage.
Conclusion: Our findings suggest that endovascular therapy is an effective, safe,
and repeatable treatment for oral hemorrhage caused by malignant head and
neck tumors.
Carotid stenting: Indications, technical considerations, complications, and

evidence-based outcomes with comparison to carotid endarterectomy
R.T. Gandhi, T.O. McNamara, G. Duckwiler; Los Angeles, CA/US
(ripgandhi@hotmail.com)
Learning Objectives: 1. To discuss patient selection criteria for carotid artery
stenting. 2. To describe the techniques and complications of carotid stenting. 3.
To review the current status of carotid stenting, including recent and ongoing
clinical trials, with comparison to carotid endartectomy.
Background: Carotid endarterectomy (CEA) has been the traditional standard
for treatment of patients with significant carotid stenosis. Although CEA has been
proven to be superior to medical management, it is not without risk. Carotid artery stenting (CAS) offers a less invasive alternative to surgical therapy for the
prevention of stroke in patients with carotid stenosis.
Procedure Details: Several cerebral protection devices have been developed to
minimize the risk of plaque embolization. There are several available embolization protection devices, each with its own advantages and disadvantages. Carotid stenting may be favored when perioperative morbidity is increased secondary
to comorbidities such as prior CEA, radical neck dissection, radiation, and contralateral laryngeal nerve palsy. CEA may be better tolerated when characteris-
Purpose: The purpose of this study was to categorize the anatomic variants of
the uterine arteries.
Methods and Materials: Between January 2000 and December 2004, 432 female pelvic angiograms were performed at Department of Interventional Radiology, Clinical Center Nis. We analyzed and categorized the angiographic anatomic
variants of the origins of the uterine arteries. We chose Abdominal DYNA option
on Siemens Axiom Artist dFT, for better visualization in different angles.
Results: The branching of the internal iliac artery was studied on the bought
siedes of the pelvis. Of the 864 uterine arteries that were evaluated, 81% were
classifiable types and 19% of them were inconclusive. Classification was as follows: type I 25.4%; type II 14.6%; type III 42.8%; and type IV 17.2%. We also
analyzed different aspects of anatomical, angiographic and surgical classification of the internal iliac artery and its branches.
Conclusion: Since uterine artery emobilization has become a feasible alternative to hysterectomy or myomectomy in the treatment of symptomatic fibroids, the
uterine artery anatomy and its variations become important for performing this
procedure safely and expediently, while minimizing radiation and avoiding manipulating catheters and wires into the adjacent arteries.
C-448
Endovascular treatment of carotid-cavernous fistulas
J. Villalba, C. Castao, L. San Romn, E. Guardia, M. De Juan, J. Ruscalleda;
Barcelona/ES (jvillalbaa@hsp.santpau.es)
Learning Objectives: 1. To review the normal anatomy of the cavernous sinus.
2. To discuss the indications for therapy based on the clinical symptoms and the
radiologic findings. 3. To review the current therapeutic endovascular strategies
for these vascular anomalies.
417
ventional R
adiology
Inter
Radiology
Interv
C-445
Anatomic variants of the uterine artery: Angiographic classification

D.S. Ilic, A. Bojanovic, S. Ristic, M. Ilic, D. Stojanov, P. Bosnjakovic; Nis/YU

Background: Direct and indirect carotid cavernous sinus fistulas (CCF) are uncommon vascular anomalies that result in increased pressure in the cavernous
sinus. The changes in blood flow may lead to orbital venous congestion, cranial
neuropathies, and glaucoma. Therapy depends mainly on the presenting clinical
symptoms and the angiographic findings. Options include observation, manual
compression and arterial or venous embolization. Surgical obliteration or stereotactic radiosurgery are rarely indicated. We retrospectively evaluated 14 patients
with CCF who were treated at our institution from October 2002 to April 2004; 3
patients with direct CCF and 11 with indirect CCF. We review the clinical features,
natural history, radiologic findings and the management of CCF. Therapeutic strategies will be focused on endovascular techniques.
Procedure Details: The procedure is performed preferably with conscious sedation or general anesthesia when patient tolerance is suboptimal. Previous complete cerebral angiogram and selective ECA injections determine the preferable
approach (arterial or venous). Direct fistulas are predominantly treated transarterially with detachable balloons and/or coils, intracranial stents or transvenous
n-butyl cyanoacrylate infusion. The indirect fistulas can be treated using transvenous access with coils and n-butyl cyanoacrylate.
Conclusion: The endovascular occlusion of carotid cavernous fistulas is a very
effective treatment, with a high cure rate and low incidence of complications.
C-449
Perioperative balloon placement for placenta accreta/percreta: An
endovascular approach
K. Sheah, P.L. Kei, K.H. Tay, B.S. Tan; Singapore/SG (radioround@yahoo.com)
Learning Objectives: Understand the indications and technique for prophylactic
endovascular placement of balloons to prevent obstetric haemorrhage in cases
of placenta accreta/percreta.
Background: Pregnancy-related haemorrhage (PPH) can be managed by local
measures, uterotonic drugs or uterine massage. If these fail, surgery is performed,
but surgical ligation of the iliac or hypogastric vessels has a success rate of < 50%.
Hysterectomy does not stop bleeding from collateral vessels, and sacrifices fertility. Prophylactic placement of internal iliac artery balloons is a useful technique
to prevent catastrophic blood loss in cases of pregnancy with placenta accreta/
percreta.
Procedure Details: Under fluoroscopic guidance, both common femoral arteries
are accessed with the Seldinger technique. Guidewires are then placed into both
internal iliac arteries in a cross-over fashion, over which balloon mounted catheters are advanced. At the time of anticipated delivery, the balloons are temporarily inflated to reduce or stop blood flow into the internal iliac arteries and
subsequently the uterine arteries. The balloons are then slowly deflated after
successful delivery and haemostasis. Using images and data from 5 consecutive
cases at our institution, we outline the procedure and review the available literature on this technique.
Conclusion: The use of prophylactic placement of internal iliac artery balloons is
a useful technique to prevent catastrophic blood loss in pregnancies with placenta accreta/percreta.
C-450
Peri-diaphragmatic venous anatomy associated with gastric varices for
successful endovascular treatment: Demonstration by multidetector row CT
H. Kiyosue, S. Matsumoto, S. Ueda, Y. Kubota, M. Maruno, H. Mori; Oita/JP
(hkiyosue@med.oita-u.ac.jp)
Learning Objectives: 1. To know the importance of the knowledge of the anatomy of peri-diaphragmatic veins. 2. To comprehensively understand the anatomy
of the peridiaphragmic veins, gastric varices, and gastric veins. 3. To demonstrate that these peri-diaphragmatic veins associated with gastric varices can
easily be detected on the multidetector row CT (MDCT). 4. To understand that the
therapeutic difficulty for endovascular treatment of gastric varices can be predicted.
Background: Gastric varices associated with a gastrorenal shunt can be treated
by balloon-occluded retrograde transvenous obliteration. However, half of cases
have additional high-flow peri-diaphragmatic collateral veins or have another shunt
which often requires complicated techniques. It is important to know the anatomy
of the potential communications between gastric varices and peri-diaphragmatic
veins, including the inferior phrenic vein and its tributaries, pericardiophrenic vein,
vertebral plexus, (hemi) azygous vein, and other veins. We will describe the imaging anatomy of peri-diaphragmatic veins associated with gastric varices.
Imaging Findings: We review MDCT images, portography, balloon-occluded
venography of the gastrosystemic shunt, and gastroendoscopy in 121 cases with
gastric varices. Gastric varices mostly drained through the left inferior phrenic
418
vein and formed gastrorenal shunts (75%) or gastrocaval shunts (20%), or drained
other peri-diaphragmatic veins (5%). There were many communications between
these veins.
Conclusion: MDCT can detect the peri-diaphragmatic veins associated with
gastric varices, which is useful for predicting the therapeutic difficulty for endovascular treatment.
C-451
Management of complications of percutaneous implantable arterial
catheter-port systems
F. Pedrazzini, G. Lingua, G. Gallarato, R. Priotto, F. Testa, F. Groppo Marchisio,
F. Melchiorre, M. Grosso; Cuneo/IT (grosso.m@ospedale.cuneo.it)
Purpose: To present our experience in the treatment of 42 complications after
percutaneous arterial port implantation in our series of over 400 patients treated
by percutaneous indwelling intrahepatic arterial catheter.
Methods and Materials: We treated 42 complications. In 33 displacements the
tip of the catheters were repositioned. There were 4 occlusions; 3 treated by
fibrinolytic agent, 1 by recanalization and catheter replacement. Three hepatic
artery occlusions were treated by fibrinolytic agents. Three pseudoaneurysms of
the left axillary artery were treated by covered stents, only two with port replacement with femoral access. Two cases of gastritis were treated by additional embolization.
Results: No complications occurred during procedures. In 33 cases the repositioning of catheters into the hepatic artery was possible, but two new displacements occurred in the follow-up. In 2 cases of fibrinolytic treatment patency of the
artery was restored; in one cases the treatment failed and the catheter was removed. Exclusion of axillary pseudoaneurysm was possible in all cases. After
embolization of the gastroduodenal artery no new gastritis occurred.
Conclusion: Percutaneous implantation of arterial ports has become a widely
adopted technique in locoregional treatment of hepatic and extrahepatic tumours.
The complication rate is similar to surgical series, but most of them can be resolved percutaneously and the patients were able to continue the intraarterial
chemotherapy.
C-452
Percutaneous embolization of visceral pseudoaneurysm: Medium and long
results
G. Luppi, F. Fanelli, A. Bruni, M. Corona, A. Pucci, V. Dominelli, E. Boatta,
R. Passariello; Rome/IT (tonino.b@libero.it)
Purpose: To evaluate the efficacy and the results of percutaneous treatment of
visceral pseudoaneurysms.
Methods and Materials: Fifty-five patients with visceral pseudoaneurysms were
treated with percutaneous embolization. Pseudoaneurysms were located in the
extrahepatic region (n = 11), intrahepatic region (n = 8), hepatic vein (n = 2),
splenic artery (n = 9), superior mesenteric artery (n = 3), celiac trunk (n = 1), left
gastric artery (n = 1), subclavian artery (n = 3), carotid artery (n = 1) and renal
artery (n = 17). Embolization was performed using different materials: coils, gelfoam plugs, alcohol, thrombin glue, alone or in combination.
Results: Embolization was successfully performed in 52/55 patients (94.5%).In
2 cases reintervention was necessary to obtain complete resolution of the pseudoaneurysm. In 3 cases (5.5%) the treatment result remained incomplete, while
in 2 cases (3.6%) a surgical intervention was necessary to obtain complete resolution of the pseudoaneurysm. One patient (1.8%) died due to rupture of the
pseudoaneurysm after an incomplete embolization and before surgical intervention.
Conclusion: Embolization of visceral pseudoaneurysms represents a safe and
effective procedure to obtain complete exclusion of the pseudoaneurysm, avoiding the high mortality rate of surgical intervention.
C-453
Salvage of non-developed vascular accesses for hemodialysis
H. Rikimaru, M. Arakawa, K. Abe; Ishinomaki/JP
Learning Objectives: 1. To describe percutaneous transluminal angioplasty for
non-developed vascular access for hemodialysis. 2. To discuss it's indications. 3.
To illustrate and describe the technique and pre-procedural evaluation. 4. To describe the risks and complications, and their prevention and treatment. 5. To assess its use and efficiency.
Background: Percutaneous transluminal angioplasty (PTA) for steno-occlusive
disease involving hemodialysis access is performed widely. However, it has long
been thought that immature fistulas contraindicate an endovascular approach.

Compared with surgery, interventional techniques preserve the vein for its entire
length and can be repeated as often as necessary during the life of the fistula.
Therefore, percutaneous repair should be attempted as the first choice for nondeveloped vascular access.
Between January 1998 and August 2005, 57 non-developed vascular accesses
for hemodialysis were treated using PTA techniques. The technique, its indications, and results are described and illustrated.
Procedure Details: Ultrasound was performed in the patients with insufficient
hemodialysis access 7 to 10 days after creation. Steno-occlusive disease was
evaluated and located. The approach (transvenous or transarterial) was also determined. Angiography was performed followed by the therapy, which consisted
of : PTA, PTA + mechanical thrombectomy, or PTA + fibrinolysis.
Conclusion: Initial technical success was obtained in 88% of the cases. Hemodialysis access developed between 3 and 33 (mean 14.4) days after PTA. Percutaneous repair is the technique of choice for non-developed access, with surgical
treatment being reserved for fistulas that cannot be recovered percutaneously.
C-454
Percutaneous placement of central venous catheters: Comparison of
anatomical landmark method and radiological guided technique for central
venous catheterization through internal jugular vein in emergent
hemodialysis patients
M. Koroglu1, O. Akhan1, B. Kale Koroglu2, H. Yildiz2, B. Baykal2, A. Yesildag2,
O. Oyar2; 1Ankara/TR, 2Isparta/TR (akhano@tr.net)
Purpose: To compare the success and immediate complication rates of anatomical landmark method (group 1) and radiological (combined real-time ultrasound
and fluoroscopy) guided technique (group 2), for the placement of central venous
catheters in emergent hemodialysis patients.
Methods and Materials: This study was performed prospectively in a randomized
manner. The success and immediate complication rates of radiological guided
placement of central venous access catheters through the internal jugular vein
(n = 40) were compared with those of the anatomical landmark method (n = 40).
The success of placement, the complications, the number of passes required
and whether a single or double-wall puncture occurred were also noted and compared.
Results: The groups were comparable in age and sex. Indication for catheter
placement was hemodialysis access in all patients. Catheter placement was successful in all patients in group 2 and unsuccessful in one (2.5%) patient in group
1. All catheters functioned adequately and immediately after the placement (0%
initial failure rate) in group 2, but 3 catheters (7.5 % initial failure rate) were nonfunctional just after the placement in group 1. The total number of needle passes,
double venous wall punctures and the complication rate were significantly lower
in group 2.
Conclusion: Percutaneous central venous catheterization via the internal jugular vein can be performed by interventional radiologists with better technical success rates and lower immediate complications. In conclusion, central venous
catheterization for emergent dialysis should be performed under both real-time
ultrasound and fluoroscopic guidance.
C-455
Purpose: To assess the role of arterial closure devices in femoral arterial punctures compared to manual compression, and reasons for their failure.
Methods and Materials: Prospective analysis of all femoral arterial punctures in
our unit. Angioseal or Starclose devices; or manual compression were compared.
Exclusions from closure device use, complications in device deployment, immediate and delayed complications were documented. Type of procedure, puncture
type, sheath size and patient characteristics were recorded.
Results: A total of 205 punctures were carried out in 183 patients. Angioseal was
used in 91 patients, Starclose in 55 and manual compression in 59. Deployment
difficulties occurred in 6 Angioseal and 4 Starclose cases, resulting in 1 haematoma in the former and 1 pseudoaneurysm requiring thrombin injection in the
latter. There was immediate failure to achieve hemostasis in 3.3% Angioseal and
9.1% Starclose cases causing hematomas. Delayed complications presented in
3.3% Angioseal (1 pseudoaneurysm delaying discharge, 1 asymptomatic common femoral artery occlusion, 1 common femoral vein thrombosis a week later),
1.8% Starclose (1 with delayed bleeding) and 5.1% manual compression patients (2 pseudoaneurysms not requiring treatment, 1 hematoma).
Conclusion: Although device failure occurs, the complication rate was compara-
C-456
Paclitaxel-eluting versus bare metal stents in the renal artery of a pig model
D. Karnabatidis, T. Voudoukis, G.C. Kagadis, K. Katsanos, N. Christeas,
E.N. Liatsikos, D. Siablis; Patras/GR (karnaby@med.upatras.gr)
Purpose: To compare the paclitaxel-eluting stents with bare metal stents and
evaluate the visualization of neointimal hyperplasia with three-dimensional CTA
and virtual angioscopy in the renal artery of a pig model.
Methods and Materials: We report on an experimental study with 10 female
pigs, weighing between 25-30 kgs. The metal stents were randomly placed in
either the right or the left renal artery in each of the 10 study animals, for a total
of 20 stented arteries. 10 arteries were stented with a bare metal stent (Group A)
and 10 with a paclitaxel-eluting coronary stent (group B). Conventional DSA and
multislice CTA were performed 24 hours and 1 month later prior to animal sacrifice. Virtual endoscopy images were reconstructed and compared to postmortem
angioscopy. Histomorphometric analysis was performed on autopsy specimens.
Results: Positioning of the stents was successful in all cases via percutaneous
femoral access and no major complications occurred. The one-month patency
rate was 70% (7 arteries) in group A and 90% (9 arteries) in group B. In addition,
the in-stent minimum lumen diameter was significantly higher in the paclitaxeleluting stents when compared to the conventional bare endoprostheses (p < 0.05).
Three-dimensional CTA images enabled virtual endoscopic navigation within the
stents.
Conclusion: Paclitaxel-eluting metal stents, when compared to conventional bare
metal stents, are more efficient in inhibiting vascular restenosis in the renal artery of the pig model. Virtual angioscopy may enable accurate exploration of the
stented arterial segments.
C-457
Transcatheter arterial embolization of liver tumors: Evaluation of posttreatment response with contrast enhanced ultrasound
K. Chatzimichail, G. Economou, K. Malagari, S. Kampanarou,
G. Dimitrakopoulou, D. Letsou, D.A. Kelekis; Athens/GR (lkmk@panafonet.gr)
Purpose: To assess by contrast enhanced ultrasound (CEUS) the immediate
and late changes in liver tumors treated with transcatheter arterial chemoembolization (TACE) using a newly available drug delivery embolization system.
Methods and Materials: From January to March 2005, 16 patients (15 with hepatocellular carcinoma and one with metastasis from colon adenocarcinoma) have
been studied. The protocol includes pre-, immediate post-TACE and monthly CEUS
in addition to 3-phase spiral CT. Superselective TACE was performed using the
new embolization material DC beads. The beads are slow releasing, doxorubicin
loaded, non-resorbable hydrogel microspheres. CEUS was performed using a
Sequoia 512 employing the CPS technology with a 2nd- generation echo-enhancer.
Results: Comparison of CEUS pre- and immediate post-TACE showed reduction of the enhancing tumor component during the arterial phase in 11 patients.
Unexpectedly, during the first 24-hours after TACE, clustered echogenic speckles are demonstrated within the tumor, always surrounded by a thick non-enhancing rim. This may represent echoes from aggregated beads in the intratumoral
vessels and mark embolised tissue. The CEUS at one and two months showed
slight further decrease in the extent of tumor enhancement in six patients and
stability in four. Non-enhancing areas in CEUS corresponded to "liquefaction" in
CT.
Conclusion: CEUS seems essential after TACE; it assists in depiction of infarcted areas and shows distribution of the clustered speckles which is important with
this new embolic material. CEUS may assess the need for further embolization.
C-458
Experience of transradial and transulnar abdominal angiography and
intervention
T. Sato, M. Kajikawa; Hiroshima/JP (tomoyasu_satou@yahoo.co.jp)
Purpose: In coronary angiography and angioplasty, transradial approach has
currently been accepted as an alternative catheterization method to transfemoral
or transbrachial approach. We started transradial abdominal angiography in 1999
and transulnar abdominal angiography in 2003. The purpose of this study was to
419
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The use of arterial closure devices in femoral arterial punctures

L.A. Ratnam, G. Munneke, J. Raja, A.M. Belli; London/UK
(lakshmi@doctors.org.uk)
ble to the manual compression group. Patients with heavily calcified vessels, very
thin and obese patients showed a higher incidence of failure. Highlighting these
patients for exclusion or careful monitoring will aid the continued use of arterial
closure devices as a safe, effective alternative to manual compression in achieving hemostasis which enables more rapid patient mobilisation.

report the practical and clinical applicability of these methods to abdominal angiography and intervention.
Methods and Materials: Between February 1999 and August 2005, 350 abdominal examinations were tried transradially or transulnarly in 205 cases. 280 examinations were with intervention. 25 cases were examined twice, 19 cases were
examined 3 times, 9 cases were examined 4 times, 5 cases were examined 5
times, 1 case was examined 6 times, 5 cases were examined 7 times and 1 case
was examined 9 times during this period transradially.
Results: Radial puncture failed in 10 examinations (2.8%) and was changed to
brachial puncture. In cases of hepatocellular carcinoma, superselective catheterization was available and transarterial chemoembolization was done. In cases of
abdominal branch aneurysm, successful coil embolization was done in 3 cases.
Femoral approach was needed for superselective catheterization another day in
2 cases. Patients were free from bed rest just after the examination. No puncture
site hematoma was seen. Weak radial pulsation was found in 6 cases at next
examination and changed to ulnar or brachial puncture. No cerebrovascular trouble was noted.
Conclusion: Transradial approach is an alternative catheterization method even
in abdominal angiography and intervention.
C-459
Interventional radiology treatment of complications after liver
transplantation
R.Y. Zhai, J.F. Wang, D.K. Dai; Beijing/CN (jianfeng_wang@126.com)
Purpose: This study evaluated the application of interventional radiology for the
complication after liver transplantation.
Methods and Materials: Eighty-two patients with various degrees of complications after liver transplantation underwent interventional procedures from July
1999 to June 2005. The bile duct complications were mainly treated with percutaneous transhepatic biliary drainage (PTBD) and/or balloon dilatation. Percutaneous transluminal angioplasty (PTA) and/or metallic stents were applied for vascular
stenosis.
Results: Of the 62 patients with biliary strictures, 41 underwent extra drainage
through T tube, 34 PTBD and 9 underwent balloon dilation. Three cases with
hepatic artery stenosis were treated with PTA and stents; one case with thrombosis received transcatheter thrombolysis with good effect. Nine patients with
inferior vena cava strictures were successfully treated with stents and one received a single balloon dilatation with satisfactory result. Five hepatic vein stenoses were effectively treated by balloon dilatation and expandable stent
deployment. In nine portal vein cases, six cases with stenosis received stents
after balloon dilatation. The total success rate of the interventional procedures
was 93% with no procedure related complications.
Conclusion: Interventional radiology techniques are very useful for managing
biliary and vascular complications after liver transplantation.
C-460
Endovascular treatment of varicocele by sclerotherapy: Six year experience
with over 900 patients
M. Manenti1, F. Pedrazzini2, G. Lingua2, F. Groppo Marchisio2, F. Testa2,
M. Gerratana2, F. Melchiorre2, G. Gallarato2, M. Grosso2; 1Torino/IT, 2Cuneo/IT
(grosso.m@ospedale.cuneo.it)
Purpose: To report 6-years experience in treatment of varicocele (affecting 1015% in the 15-25 y/o male population) by retrograde transcatheter sclerotherapy
of the internal spermatic vein.
Methods and Materials: From 1999 to August 2005, 909 treatments were performed in 890 patients, between 9.6 and 65.5 y/o (mean = 29.3, median = 30.4).
Catheterization of spermatic vein under local anaesthesia, assessed incontinence
and/or collateral vessels and embolizations were obtained by polidocanol (hydroxy-polyethoxy-docanol) injection.
Results: Catheterization and sclerosis were performed in 890/909 cases (97.9%);
failures were due to abnormal vessel anatomy not allowing performance of the
procedure (3/21), the impossibility of catheterization (12/21) and perforation of
the vein (2/21) which never required surgery. In 4/21 patients incontinence was
not demonstrated, so they were not treated. Nineteen patients were treated twice
because of relapse or to complete a previous procedure; 17/19 (89.5%) obtained
good results, in 1/19 (5.3%) further catheterization was not possible and 1/19 did
not present incontinence. Patients were followed by US and Doppler to survey
recurrences, and sperm analysis to estimate the clinical results of percutaneous
therapy. Compared to preprocedural assessments, spermiograms showed constant improvement in sperm count, motility and morphology. Radiation dose was
negligible.
420
Conclusion: Percutaneous treatment of varicocele, also in recurrences, is a rapid and minimally traumatic method, that avoids hospitalization. Compared to surgery, reflux mechanisms are shown by phlebography, allowing the procedure to
be adapted to venous anatomy. Liquid embolus diffuses and scleroses collateral
veins, with a lower rate of recurrences.
C-461
Comparison of 4 different embolic materials for pre-operative portal vein
embolization: Animal experiment
T. de Baere 1, A. Denys2, V. Paradis3, A. Laurent4; 1Villejuif/FR, 2Lausanne/SZ,
3
Clichy/FR, 4Jouy en Josas/FR (debaere@igr.fr)
Purpose: To evaluate the efficacy of different embolic materials for pre-operative
portal vein embolization (PPVE).
Methods and Materials: Twenty pigs received left and median lobe portal vein
branch embolization under US and fluoroscopic guidance through a percutaneous approach. Five pigs received each of the following products: N-butyl cyanoacrylate, Hydrophilic phosphorylcholine gel, Ivalon 50-150 microns and Ivalon
700-900 microns. Portal vein pressure was measured. Blood samples were obtained before embolization, at day 2 and before sacrifice. Direct portography and
portal vein pressure measurements were performed before embolization, immediately after embolization and before sacrifice. Tissue wedges from peripheral
embolized, central embolized, peripheral non-embolized and central non-embolized liver were analyzed at histopathology.
Results: Blood tests revealed a significant increase of serum ASAT levels after
cyanoacrylate when compared to other products. Complete embolization of the
left portal branches could be obtained in all pigs, but this embolization was incomplete on the 7 day portogram in 1 animal embolized with gel, and 1 animal
embolized with 700-900 Ivalon. Significant increases in portal vein pressure were
found after NBCA and 50-150 micron embolization. The ratio of the portal lobule
surface of the embolized to the non-embolized liver was significantly different for
NCBA when compared to other embolic material. There was no difference between tissue wedges from central or peripheral liver.
Conclusion: Small size embolic material and NCBA seems to provide better
embolization and more differences between embolized and non embolized liver.
C-462
Therapeutic transcatheter arterial embolization in the management of
intractable bladder haemorrhage from malignant pelvic tumors and bladder
irradiation therapy
A. Martin, J. Perendreu, J. Falco, J. Fortuo, P. Bermudez, J. Branera;
Sabadell/ES (amartino@cspt.es)
Learning Objectives: To illustrate our experience with arterial embolization as a
measure in the control of intractable bladder haemorrhage from malignant pelvic
tumors and bladder irradiation therapy. To describe the results of the procedure
based on a series of sixteen patients.
Background: Bladder hemorrhage following radiation therapy or caused by malignant pelvic tumors is a serious and potentially life-threatening complication.
Bladder hemorrhage following radiation therapy can occur immediately or even
after several months. Several methods have been proposed to control this situation, however results have been far from satisfactory, except drastic measures
such as hypogastric artery ligation and radical cystectomy. Embolization has been
successfully used for managing intractable bleeding in advanced pelvic malignancies. We have treated sixteen patients with bladder haemorrhage in our department, from June 2000 to July 2005. In this exhibit we will describe the use,
the indications, the results and the advantages of this technique.
Procedure Details: The major indication is intractable bladder haemorrhage secondary to severe vesicoprostatic pathology (neoplastic disease and radiation
cystitis). The internal iliac artery bilaterally or cystic arteries when possible, are
selectively catheterized through femoral artery access, using the Simmons I (Terumo, Europe, Leuven, Belgium) catheters and embolized using Espongostan
(Ferrogan A/S, Soeborg, DK) and coils (Coon Europe, Bajaeverskov, DK)
Conclusion: Transcatheter arterial embolization was effective in fourteen of sixteen patients with few major complications and a low recurrence rate concerning
bleeding. For these reasons we consider this technique as the treatment of choice
in intractable bladder hemorrhage.

C-463
Piercing of middle cerebral artery by deflated balloon catheter combined
with thrombolytic therapy, for acute middle cerebral artery embolism
I. Ikushima, H. Ohta, D. Miyahara, K. Yokogami, N. Maeda; Miyakonojo/JP
(iku-i@fk.enjoy.ne.jp)
Purpose: We assessed feasibility, safety and efficacy of piercing of the middle
cerebral artery (MCA) using a deflated balloon catheter combined with intraarterial thrombolysis for acute ischemic stroke.
Methods and Materials: Seven consecutive patients who had acute occlusion of
MCA underwent piercing of the MCA by deflated balloon catheter. Piercing was
performed with a low-profile microballoon catheter. The microballoon was inflated once in the carotid siphon and immediately deflated, then advanced to just
distal to the occlusion site in the MCA. Thereafter, intraarterial thrombolysis of
the MCA was applied. Maximum times from onset of symptoms to start of treatment and maximum dosage of urokinase were 3 hours and 360,000 units. Outcome was classified as good for Rankin Scale (RS) scores of 0-1, fair for RS
scores of 2-3, and poor for RS scores of 4-5 and death.
Results: Complete recanalization was achieved in 4 patients and partial recanalization was achieved in 3 patients. Two patients recovered to RS scores 0 or 1,
4 to scores of 2 or 3, and 1 to scores of 4 or 5. No patients died. There was no
major intracerebral hemorrhage.
Conclusion: Piercing of the MCA using a deflated balloon catheter combined
with intraarterial thrombolysis may be a safe and effective treatment for acute
ischemic stroke.
C-464
Endovascular therapy for abdominal pseudoaneurysms: Analysis of
technical and clinical aspects
H. Kakizawa1, N. Toyota 1, A. Naito 2, M. Hieda1, N. Hirai1, T. Tachikake1,
Y. Fujimura1, K. Ito1; 1Hiroshima/JP, 2Kure/JP (kakizawa@hiroshima-u.ac.jp)
Purpose: To clarify the factors that determine outcomes of endovascular therapy
for abdominal pseudoaneurysm (PSA) from both technical and clinical aspects.
Methods and Materials: Sixteen patients with PSAs underwent embolization.
Embolic methods were classified into 2 groups; proximal and distal embolization
(PDE), and only proximal embolization (PE). The patients were classified into 4
groups by shock index. Pre-embolization hemoglobin (Hb) level and decrease in
Hb level were valued. Outcomes were classified into 2 groups: successful recovery and failure in spite of successful PSA embolization.
Results: There were no statistical differences in success, recurrence, complication rate, and outcomes between the two embolic methods. There was a statistically significant correlation between the grades of shock indices and outcomes
(P < 0.05). There was no statistical difference between the Hb levels and outcomes.
Conclusion: Outcomes were not dependent on the embolic method. Shock index, that reflects clinical status, may be a simple predictor of outcomes. Therefore PSA should be treated before it ruptures, as soon as possible, by optimal
embolic methods.
C-465
Purpose: To evaluate the usefulness of a newly developed biodegradable stent

for benign stenosis of the gastrointestinal tract.
Methods and Materials: We developed a biodegradable stent constructed of
knitting polylactic acid monofilament in a zig-zag shape. The device system used
was composed of four stents with six bends each. The diameter and length were
15 mm and 12 mm respectively. Strength of the stent was evaluated by measuring the force required to change the diameter; defined as pressure to change the
diameter of the stent by 5 mm divided by length of the pressed segment along
the stent axis (g/mm/cm). The expansive forces were compared between the biodegradable stent, metallic Z stent and metallic spiral Z stent. In addition, the
influence on the expansive force by the different pH conditions was also evaluated.
Results: The expansive force of the biodegradable stents was 21 g/mm/cm and
larger than those of the metallic Z stent (14 g/mm/cm) and metallic spiral Z stent
(7 g/mm/cm). The expansive force was not significantly influenced by immersing
into various pH solutions with one month observation. However, a slight loss of
the force was noted at alkalic state with three months observation. On six months
observation, the stents in all kinds of solution showed loss of the expansive force.
C-466
Locoregional treatment of adrenal metastasis: Transcatheter arterial
embolization/chemoembolization (TAE/TACE) alone or followed by
radiofrequency ablation (RFA)
F. Fiore, R. D'Angelo, M. Cascella, O. Catalano, R.V. Iaffaioli, A. Siani;
Naples/IT
Purpose: Isolated adrenal metastases or those in combination with a controlled
intrahepatic recurrence, are preferably treated with surgery. RFA has been proposed when resection is unfeasible. Nevertheless, RFA alone has shown unsatisfactory response in patients with large lesions. We report our experience using
TAE/TACE for adrenal metastases > 5 cm.
Methods and Materials: Between January 2002 to April 2005 we treated twelve
patients with good performance status. These subjects were not responding to
systemic chemotherapy or progressing after chemotherapy and were not eligible
for surgery. There were 14 adrenal metastases: 8 from HCC (1 bilateral involvement), 1 from lung cancer, 1 from prostate gland sarcoma, and 1 from colon
cancer (bilateral adrenal involvement). Superselective catheterisation was done
with a 3 F microcatheter after selective catheterisation of the main adrenal branches. We then embolized the most evident vessels tributary to the adrenal mass
with PVA powder (45-150 m diameter). TACE (50 mg of epirubicin plus 5 mL of
Lipiodol) was carried out in 4 patients while 8 only had TAE therapy. RFA was
subsequently performed in 4 patients with large residual tumour after TAE/TACE.
Results: We performed helical CT evaluation one month later, to assess response
rate. After TAE/TACE, we observed a partial response of the target lesion in 3
patients and stable disease, with a reduction of CT attenuation values in 9 patients.
Conclusion: Locoregional treatment of adrenal metastasis is safe and technically feasible, allowing effective devascularization and positive short-to-medium term
clinical effects.
C-467
Anatomic classification of gastric varices: Predicting technical difficulties
of retrograde transvenous obliteration
H. Kiyosue, M. Maruno, S. Matsumoto, S. Tanoue, J. Kashiwagi, H. Mori;
Oita/JP (MARUM@med.oita-u.ac.jp)
Purpose: To investigate relationships between anatomical features of gastric
varices, and techniques and results of balloon-occluded retrograde transvenous
obliteration (B-RTO).
Methods and Materials: Eighty-two patients with gastric varices treated by BRTO were retrospectively investigated. Cases were classified into three groups
according to the degree of collateral draining veins, based on balloon occluded
venography of the shunt: low-flow collateral type, moderate-flow collateral type,
and high-flow collateral type. Cases were also classified into two types based on
CT findings of afferent veins/varices components: simple and complex. Additional techniques used in B-RTO procedure included microcatheter technique, coil
embolization of collaterals, advancing balloon technique, and double balloon technique. Use of additional techniques, treatment results, and thrombosis of the varices were reviewed and were compared in each type.
Results: According to the classification of drainage venous components,
there were 29 cases of minimum-flow type, 24 cases of moderate-flow type, and
29 cases of high-flow type. With regards to afferent veins/varices components,
there were 51 cases of the simple type and 31 cases of the complex type. Additional techniques were more frequently used in moderate-flow and high-flow types
(100%) than low-flow type (72%). Success rate of B-RTO procedure was 91% in
all cases, and was higher in low-flow (100%) and moderate-flow type (96%) than
high-flow type (79%). Partial thrombosis of gastric varices was more frequently
observed in complex type (26.1%) than simple type (13.7%).
Conclusion: Anatomic features of gastric varices can affect degree of difficulties
and results of B-RTO, and should be critically evaluated.
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Development of biodegradable stents

T. Tanaka, N. Nitta, A. Furukawa, M. Yamasaki, M. Takahashi, K. Murata;
Otsu/JP
In addition, we report some clinical cases with benign stenosis treated with the
biodegradable stent.
Conclusion: Newly developed biodegradable stents proved to have sufficient
expansive force to dilate gastrointestinal stenosis.

C-468
Trans-arterial chemo-embolization (TACE) of neuroendocrine hepatic
metastases using drug eluting beads
C. Teriitehau, T. de Baere, F. Deschamps, M. Abdel Rehim; Villejuif/FR
(cterii@caramail.com)
Purpose: To examine the feasibility, tolerance and efficacy of drug eluting beads
for TACE in neuroendocrine hepatic metastases.
Methods and Materials: Sixteen patients underwent 28 courses of TACE with 24 mls of beads (GelSphere) loaded with 40-100 mg of doxorubicin. Clinical and
biological tolerance were assessed with blood samples. Morphologic response
was evaluated with CT and CT perfusion studies evaluated for blood flow (BF)
and mean transit time (MTT).
Results: Minor post-embolization symptoms were found after 24/28 courses. Mean
SGOT/SGPT increased respectively from 30/27 IU/l before treatment, to 139/135
IU/l within 3 days of treatment and were 51/84 UI at day 5. Mean total bilirubin
was respectively 13 and 21 mmol/l before, and within 3 days of treatment and
return to baseline value at day 5. Within one month of TACE, all 4 patients with
neuroendocrine-related symptoms experienced a decrease in symptoms. One to
2 months after the first TACE, no patient showed progressive disease, 6 patients
showed a partial response according to RECIST criteria, 9 showed a minor response and 1 patient had stable disease. On follow-up CT three patients demonstrated some degree of hepatic necrosis. Elongation of MTT and decrease of
mean BF were demonstrated 4 days after TACE and persisted at 2 months.
Conclusion: TACE with doxorubicin eluting beads is well tolerated and seems to
be efficient. Perfusion CT seems promising in detecting early changes in tumor
vascularisation whereas mere morphological/RECIST criteria may fail to detect
early treatment effects.
C-469
Embolization procedures in aneurysms and false aneurysms of the splenic
artery (14 patients)
R. Loffroy, D. Ben Salem, B. Guiu, J. Mazaud, M. Dranssart, F. Ricolfi,
J.-P. Cercueil, D. Krause; Dijon/FR (denis.krause@chu-dijon.fr)
Purpose: To assess and to demonstrate the long-term efficacy and viability of
selective embolization and exclusion of true and false aneurysms of the splenic
artery (SP).
Methods and Materials: Between 1998 and 2004.14 patients were investigated
by US, CT and angiography for a localized arterial ectasia of the SP, with a mean
size of 25 mm, distributed as follows: 5 proximal, 7 the intermediate part of the
SP and 2 the distal SP near the hilum. Seven of the vascular lesions were symptomatic: abdominal pain (3), pancreatitis (2) and gastrointestinal bleeding (2).
Seven were incidental findings. The 2 first patients were treated with occlusion of
the proximal part of the SP with the "sandwich" technique. For the remaining 12
patients, selective embolization was performed directly into the aneurysm with a
microcatheter. Microcoil packing technique (8) or GDC system (4) were used,
especially for distal hilar lesions. In these 12 patients, the SP was completely
preserved. Imaging follow-up was based on US, MRA and CT examinations.
Results: The endovascular treatment of true and false splenic artery aneurysms
was quite possible in splenic ectasias (12/14), using controlled leading coils. In
the symptomatic patients, the clinical signs have rapidly resolved post procedure. Early (8 months) and late (24 months) follow-up with US and MRA have
confirmed definitive aneurysm exclusion and the absence of eventual partial neck
recanalization (12/14). Splenic parenchyma integrity was better analysed with
CT.
Conclusion: More frequent diagnosis of a SP aneurysm (US, CT) allows selective endovascular treatment, which spares the spleen, excluding the possibility of
a high risk of rupture. On long term follow-up, the lesion exclusion is definitive.
C-470
Preoperative embolization of the common hepatic artery in preparation for
radical pancreatectomy for pancreas body cancer
D. Abo, Y. Sakuhara, T. Shimizu, Y. Hasegawa, A. Sawada, K. Miyasaka;
Sapporo/JP (abo@radi.med.hokudai.ac.jp)
Purpose: To evaluate results of preoperative embolization of the common hepatic artery, in preparation for distal pancreatectomy with en-bloc resection of the
celiac and common hepatic arteries, for pancreas body cancer involving these
arteries.
Methods and Materials: Eighteen patients underwent the embolization with coils
1-15 (median: 4) days before surgery. Coil anchors and/or a 0.035 inch or micro
detachable coil were used to obtain the appropriate position of embolization in 14
422
patients. For additional and complete embolization 0.035 inch or micro pushable
coils were used. A balloon catheter was also used during procedures to control
arterial flow of the common hepatic artery in 12 patients.
Results: Immediately after embolization, collateral pathways developed from the
superior mesenteric artery via the pancreatoduodenal arcades to the proper hepatic and gastroduodenal arteries in 17of 18 patients. There were two complications during the embolization procedure, including coil migration to the splenic
artery and the renal artery. The pulsation of the proper hepatic and gastroduodenal arteries was well palpable during surgery in 15 of 18 patients. There were four
ischemia-related complications in the four patients who underwent radical surgery. But finally all patients improved.
Conclusion: Preoperative embolization of the common hepatic artery is a relatively safe technique, and has the potential to enlarge the collateral pathways by
the time of distal pancreatectomy with en bloc resection of the celiac artery, and
prevent postoperative fatal ischemia-related complications.
C-471
Percutaneous endovascular treatment of venous graft thrombosis after
pancreas transplantation
A. Lpez Soriano, M.I. Real, R. Gilabert, M. Burrel, . Garca Criado,
A. Radosevic, X. Monta, M.J. Ricart, L. Fernandez-Cruz; Barcelona/ES
(37644als@comb.es)
Purpose: Pancreas venous graft thrombosis accounts for the majority of non
immunologic graft loss in the early post-operative period. We evaluate the efficacy of percutaneous endovascular treatment of partial venous graft thrombosis
after pancreas transplantation.
Methods and Materials: From March 1997 to July 2005, 10 pancreas transplant
recipients (9 simultaneous pancreas-kidney (SPK) transplantation and 1 pancreas after kidney (PAK) transplantation) that developed partial venous thrombosis
underwent percutaneous rescue treatment of the graft. The interventions were
performed when partial thrombi filling 2/3 or more of the splenic and/or mesenteric
graft veins were identified during routine Doppler ultrasonography. Partial thrombosis of the splenic vein (PTSV) was documented in 6 patients, 3 showed partial
thrombosis of the superior mesenteric vein (PTSMV) and 1 patient had PTSV
and PTSMV. Percutaneous procedures were as follows: 6 patients underwent
percutaneous thrombectomy, 2 patients were treated with infusional local thrombolysis and both thrombectomy and fibrinolysis were performed in the remaining
2 patients. All interventions were followed by heparinization and oral anticoagulation.
Results: All recipients were successfully treated with no complications related to
the interventional procedure. Normal graft function (insulin free) has been documented in the 2 month-8 years observational period (median 27 months).
Conclusion: Percutaneous endovascular procedures are minimally invasive, safe
and effective in the rescue treatment of PVGT after pancreas transplantation.
Early detection of these thrombi in the post-operative period is of paramount
importance for the appropriate management of this complication and successful
organ outcome.
C-472
The outcome of intra-arterial thrombolysis using urokinase in patients with
carotid T occlusion
S. Park, S. Suh, D. Kim, J. Kim, D. Kim; Seoul/KR (iamtaz@nate.com)
Purpose: To evaluate the clinical outcome of intra-arterial thrombolysis using
urokinase in patients with acute carotid T occlusion.
Methods and Materials: Twelve patients (M:F = 6:6, mean age = 56.8 years)
with acute carotid T occlusion were enrolled. All T occlusions were diagnosed
with CT angiography after admission. Intra-arterial thrombolysis was performed
with urokinase (mean dose: 744,000 IU) in all patients. Final infarction size was
evaluated on follow-up MR or CT, 1 to 3 days after thrombolysis, and recanalization was evaluated on follow-up transcranial Doppler sonography 24-48 hours
after treatment.
Results: NIH Stroke Scale (NIHSS) score on admission was 17 (9 to 23). Final
infarct size was less than or equal to one-third of the MCA territory in 4 patients
(33%) and greater than two-thirds in 8 patients (67%). Complete or partial MCA
recanalization within 24 hours after symptom onset was observed in 2 patients
(17%). Three patients (25%) had a favorable outcome (modified Rankin Scale
score 2) after 3 months and 6 patients (50%) a poor outcome. Three patients
(25%) died.
Conclusion: Acute stroke with carotid T occlusion still has a poor prognosis even
when intra-arterial thrombolysis is performed, and it should be necessary to apply these patients with another aggressive treatment.

C-473
The clinical efficacy of adjunctive aspiration thrombectomy in the treatment
of iliofemoral deep vein thrombosis
S. Park, S. Suh, J. Won, D. Lee; Seoul/KR (iamtaz@nate.com)
Purpose: To evaluate the safety and efficacy of adjunctive aspiration thrombectomy in the treatment of iliofemoral deep vein thrombosis.
Materials and Methods: Twenty-four patients (9 males and 15 females, mean
age 53.8 years) treated with aspiration thrombectomy were enrolled over 4 years.
The day after urokinase thrombolysis, aspiration thrombectomy using a 12-F
sheath was performed in any long segment residual thrombus (> 8 cm). Residual
short segmental (< 8 cm) thrombus and/or focal stenosis were treated with stent
placement. Oral administration of warfarin continued for 6 months, and color Doppler ultrasonography, venography and/or computed tomography was performed
for the evaluation of venous patency.
Results: The technical and clinical success rate was 100% and 92%. Twentythree patients were treated with urokinase thrombolysis and iliac stent. Six patients had re-intervention with stent and angioplasty 24-48 hours after the initial
procedure. The total dose of infused urokinase was 600,000 - 4,000,000 IU (mean
1,810,000 IU) and the total procedural time was 16-43 hours (mean 23.3 hours).
The median follow-up period was 13.2 months. The overall patency rate at 1, 2
and 3 years was 85%, 82% and 81%. There were no severe complications except
pulmonary embolism in only one patient.
Conclusion: In the treatment of iliofemoral deep vein thrombosis, adjunctive aspiration thrombectomy combined with conventional thrombolysis and stent placement can be an effective and safe method, which markedly reduces infusion dose
and time of urokinase.
Results: All the embolization procedures were technically successful. The hemoptysis was controlled in all patients within 3 days. During the follow-up period
(2-747 days, mean 250 days), hemoptysis recurred in 19 patients (21.4%), of
which eight patients (9.5%) required repetitive embolization (n = 11). Hemoptysis free survival rates were 87.8% at 60 days, 79.0% at 180 days, 70.0% at 360
days, and 61.3% at 540 days following the procedure. Ischemic procedure related complications were not observed on follow-up bronchoscopy (n = 43) and CT
(n = 24). Seven patients died of unrelated causes: myocardial infarction (n = 2),
pneumonia (n = 2), peritonitis (n = 1), and unknown cause (n = 2).
Conclusion: In contrast to previous concerns regarding ischemic complications,
we have found NCBA to be a safe and effective agent in bronchial and nonbronchial systemic artery embolization in hemoptysis patients.
C-474
Placement of filters in the superior vena cava and azygos system:
Preliminary experience
J. Tisnado, M.K. Sydnor, U.R. Prasad; Richmond, VA/US (jtisnado@vcu.edu)
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Purpose: Filter placement in the IVC is an established procedure to prevent PE

from DVT of lower extremities and pelvis. The incidence of PE from DVT of the
upper extremities is increasing in this era of aggressive medical therapy and
widespread use of central catheters. Some patients with IVC occlusion may develop large collaterals draining into the azygos veins. Therefore, in some of these
patients, the placement of a filter in the SVC and/or azygos is necessary to prevent PE from the SVC and upper extremity DVT. We understand that this topic is
controversial and has not received adequate attention in the literature. We therefore present our experience with 20 patients.
Methods and Materials: We have placed filters in these very unusual locations
in 20 patients. Filters were placed in the SVC in 17 patients and in the azygos
vein in 3 patients. Some of these patients also required placement of filters in the
IVC. Filters used were the "old" stainless steel Greenfield, the Titanium Greenfield, the "new" stainless steel Greenfield, the Simon nitinol, the Gnther tulip,
and the TrapEase filters.
Results: All procedures were successful. No complications related to the procedures were recorded. No SVC or azygos occlusions were found. No migration or
misplacement occurred.
Conclusion: Placement of filters in the SVC and/or azygos system is a safe,
easy and effective, albeit controversial method to prevent PE in certain patients
under specific circumstances.
C-475
Bronchial and non-bronchial systemic artery embolization using N-Butyl
cyanoacrylate
C. Yoon, S. Kang, N. Paik, K. Lee, Y. Kim; Seongnam/KR
(yooncj@radiol.snu.ac.kr)
Purpose: N-butyl cyanoacrylate (NBCA) has rarely been used for bronchial artery embolization to avoid potential ischemic complications. This study was performed to evaluate the efficacy and safety of NBCA in bronchial and non-bronchial
artery embolization for hemoptysis.
Methods and Materials: Eighty-four patients with massive (n = 38) or recurrent
hemoptysis (n = 46) underwent bronchial (n = 137) and non-bronchial systemic
artery (n = 254) embolization using NBCA and lipiodol mixture. The hemoptysis
was caused by tuberculous (n = 48) or non-tuberculous (n = 19) bronchiectasis,
mycetoma (n = 8), malignancy (n = 4), sequestration (n = 1), and unknown etiology (n = 4). We retrospectively evaluated the clinical outcomes including technical and clinical success of the procedures, recurrence of hemoptysis, symptom
free survival rate, and complications.
423

Interventional Radiology
Non-Vascular
C-476
Combination of radiofrequency ablation and percutaneous cementoplasty
in painful bone metastasis: Experience in 90 patients
X. Buy, G. Bierry, J. Garnon, R.M.C. Freitas, A. Gangi; Strasbourg/FR
(xavier.buy@chru-strasbourg.fr)
Purpose: To evaluate the feasibility and the efficiency of the combination of radiofrequency ablation and percutaneous cementoplasty in the purpose of pain
management and consolidation of painful bone metastasis.
Methods and Materials: 90 patients suffering from painful bone metastases (54
male and 36 female, mean age 68.5 years) underwent percutaneous radiofrequency ablation combined with percutaneous cementoplasty with PMMA under
CT and fluoroscopy guidance. The lesions were located in the iliac bone, acetabulum, ischium, and spine. The lesions were all painful with soft tissue invasion.
The mean diameter of the tumor was 4.3 cm. The primary tumors were: lung,
breast, myeloma, kidney, melanoma, and thyroid. The interventions were performed under general anesthesia or spinal anesthesia. Pain was evaluated using
a visual analogic scale.
Results: 93% of the patients reported a notable reduction of pain with improvement of mobility within 24 to 72 hours. The pain remission lasted for 5 to 24
months. Four cement leakages occurred: one in the hip and three in soft tissue.
All cases were asymptomatic. Post procedural pain was systematic during the
first 8 to 12 hours after radiofrequency ablation and was controlled by analgesics
and non steroidal anti-inflammatory drugs.
Conclusion: The combination of these techniques appears very promising for
the management of painful osteolytic metastases. Radiofrequency ablation allows local tumor destruction specially in large lesions with surrounding tissue
invasion, and cementoplasty ensures consolidation of load-bearing bone.
C-477
Percutaneous biopsy under CT guidance in cases of mediastinal
abnormalities: Methodology, indications and possible complications
S. Mylona, L. Thanos, N. Fragiskou, E. Karachaliou, O. Tserga, N. Batakis;
Athens/GR (sofimylona@yahoo.com)
Learning Objectives: To demonstrate various lesions of the mediastinal compartments that are amenable to percutaneous CT -guided biopsy and establish
the differential diagnosis.
Background: To demonstrate step by step the methodology of percutaneous CTguided biopsy in cases of mediastinal masses and familiarize the viewer with the
access routes, the analgesia and the equipment to be used. Understanding the
indications, the limitations, and the possible complications of this interventional
procedure. We point out the advantages and evaluate the accuracy of the method
in the diagnosis of mediastinal abnormalities.
Imaging Findings: It is known that the true nature of mediastinal lesions is very
difficult to identify, if reliance is placed solely upon clinical symptoms, signs, and
findings of diagnostic imaging procedures. In this presentation we discuss the
diagnostic impact of percutaneous CT-guided biopsy in the clinical management
of 210 patients with mediastinal masses who underwent biopsy in our department between January 2000 and July 2005.
Conclusion: According to our experience percutaneous biopsy under CT is a
secure, low cost, minimally invasive method for the diagnosis of mediastinal abnormalities.
C-478
Relieving malignant obstructions and symptomatology, infarcting malignant
masses and their blood supply, and preventing life threatening hemorrhage:
A review of the growing field of onco-radiology
C. Cronin, D. Lohan, N. Gough, C. Meehan, R. Mc Loughlin, G. O'Sullivan;
Galway/IE (carmelcronin2000@hotmail.com)
Learning Objectives: To provide an educational and pictorial review of interventional radiology's contribution to oncology, with the novel, diverse spectrum of
stents, drainage systems and embolization procedures available to palliate terminally ill patients or alleviate their symptoms. Subsequently, to discuss the intricate anatomy and technique, indications, contraindications, complications and
results (radiological and clinical) of these procedures (described below).
Background: Minimally-invasive low-morbidity interventional radiological procedures have been a major advance, and are consequently playing a significant
424
role in alleviating distressing obstructive symptoms (not amenable to open surgery, especially in compromised clinical states) and assisting palliative care. The
treatment of patients with malignant obstruction as the sole palliative treatment
or as an adjunct to other treatment modalities is possible due to the introduction
of expandable metal stents and embolization therapy.
Imaging Findings: Through our institutional experience and a literature review,
in this pictorial exhibit, we will perform an in-depth analysis of these procedures.
We will review options for relieving central airway malignant stenosis, embolising
malignant erosions of pulmonary arteries, stenting almost any part on the gastrointestinal tract (usually obstructed by tumor in-growth or stricturing lesions),
stenting or using bypassing drainage systems in the hepato-biliary system and
pre-operative and palliative renal tumor embolization. We explore the use of stents
throughout the vascular tree (in particular the venous side) re-opening obstructed venous systems.
Conclusion: In this educational exhibit we have provided a thorough, informative
and concise guide to the numerous options and indeed complications in this expanding field.
C-479
Self-expandable metal stents (SEMS) for the treatment of malignant
obstruction of the gastrointestinal tract
M. Certo1, L. Lopes2, J. Ramada2, A.M. Ribeiro1; 1Porto/PT,
2
Viana do Castelo/PT (manuelacerto@sapo.pt)
Learning Objectives: 1. Review the indications for SEMS in the gastrointestinal
(GI) tract. 2. Illustrate the procedure with a combination of fluoroscopy and endoscopy technique in the esophagus, cardia, gastric outlet and in the colon. 3.
Discuss the advantages and disadvantages of GI stenting.
Background: SEMS are designed to treat malignant luminal obstruction of the
GI tract. They can be employed in the oesophagus (E), stomach (S), small bowel
(B) and colon (C). Although their use is primarily for palliation of malignant obstruction, they also can be used within the colon as a preoperative modality. Between September 2004 and September 2005, 30 patients were treated in our
department (E=8, S+B=10, C=12).
Procedure Details: GI SEMS may be placed under endoscopic guidance with
the aid of fluoroscopy by interventional gastroenterologists or with fluoroscopy
only by interventional radiologists. The main principals of SEMS placement apply
to both endoscopic and radiologic insertion. We usually use 2 different types of
stents: Ultraflex (Microvasive) and the Wallstent (Microvasive). The stent chosen should be at least 3 to 4 cm longer than the obstruction. Most lesions that
produce colonic obstruction will be within the left colon. Contraindications are
free perforation and multiple sites of obstruction not within the area that can be
covered by stents.
Conclusion: SEMS within the upper and lower gastrointestinal tracts will provide
appropriate patients palliation of their obstructive symptoms. The minimally invasive nature of these procedures will further benefit patients by allowing them to
avoid more extensive and invasive surgical procedures.
C-480
Optimal needle path for CT-guided biopsy of small subpleural nodules
J. Tanaka1, N. Nishi1, M. Yuasa1, T. Ushimi2; 1Iruma-gun/JP, 2Tokyo/JP
(jtanaka@saitama-med.ac.jp)
Learning Objectives: To identify the best needle path for CT-guided biopsy of
small subpleural lesions based on a prospective study of 720 procedures.
Background: CT-guided biopsies of pulmonary lesions frequently involve small
lesions beneath the pleura, which are hardly visible fluoroscopically and for which
initial transbronchial procedures are nondiagnostic. CT-guided biopsy of such
lesions can also be difficult due to the presence of ribs in front of the lesion. Since
1993 we have noted the anatomical shape of the ribs, which are slanted like the
scales of a fish, and have tried an oblique path in which the needle is sharply
inclined toward the chest wall, which may provide an easy way to cross the chest
wall with less interference from the ribs.
Procedure Details: Up to July 2005, biopsies of 720 subpleural nodules less
than 2.5 cm were performed under CT guidance. One of two methods was selected at random: (1) piercing the chest wall at a right angle as usual (n = 332),
and (2) an oblique path in which the needle is inclined sharply to the chest wall
within a slice according to the shape of the ribs and the intercostal spaces, creeping
in and below the chest wall over a longer distance (n = 388). The procedures
were considered successful when diagnostic samples were obtained. The success rate of procedure (2) (92.4%) was significantly superior to that of procedure
(1) (51.8%).
Conclusion: For percutaneous biopsy of small subpleural lesions under CT guidance, an oblique path offers a significant advantage over a perpendicular path.

C-481
C-arm flat-panel detector cone beam computed tomography: Volumetric
imaging during interventional procedures
J.C. Hellinger1, M. Kuo2; 1Stanford, CA/US, 2San Diego, CA/US
(jchellinger@stanford.edu)
Learning Objectives: 1. To discuss the technical principles of C-arm flat-panel
detector cone beam computed tomography (C-arm CT). 2. To review alternative
visualization techniques for 3D workstation interpretation. 3. To illustrate clinical
applications of interventional C-arm CT.
Background: Conventional fluoroscopic systems used for interventional procedures yield two dimensional projections. Computed rotational angiography (CRA)
combines 2D projectional and 3D volume imaging during a single injection of
contrast medium. This technology affords greater understanding of complex vascular anatomy. However, clinical use of CRA has been limited to high contrast
applications. The recent development of flat-panel detector cone-beam computed tomography, with the flat panel detectors mounted on a C-arm, offers both low
(i.e. soft tissue) and high contrast applications. This new technology affords the
interventional radiologist three simultaneous complimentary datasets for image
guided procedures.
Imaging Findings: C-arm CT technology has promising potential for cardiac,
vascular, and non-cardiovascular interventional procedures. The 2D fluoroscopic
images provide real time information, such as hemodynamic flow. The 3D images
provide valuable anatomic displays which can assist in pre-procedural planning;
intra-procedural 3D-guidance and trouble-shooting; and post-procedural assessment. The CT data can be viewed in cross-section or from multiple projections
using MPR, MIP, and/or VR visualization techniques. This exhibit will highlight the
technical principles of C-arm CT and then illustrate the clinical advantages of
using C-arm CT for interventional procedures.
Conclusion: C-arm CT is promising technology for interventional procedures.
Catheter manipulations, contrast medium volume, and exam time could all be
reduced, potentially lowering patient risk and increasing patient through-put.
C-482
MR predictors of bone cement leakage in percutaneous vertebroplasty
Y. Koh 1, D. Han1, J. Cha1, W. Jin2; 1Seoul/KR, 2Incheon/KR
(mrikyh@yahoo.co.kr)
C-483
Clinical use of the self-expanding metallic stent in the management of acute
malignant colorectal obstruction
Y.S. Cheng, Y.B. Fan, N.W. Chen; Shanghai/CN (chengys@sh163.net)
C-484
Nephrostomy: When it is complicated
J. Raja, G. Munneke, L. Ratnam, N. Ramachandran, U. Patel; London/UK
(jowadraja@gmail.com)
Learning Objectives: 1. Understand the technique of percutaneous nephrostomy using ultrasound and fluoroscopy. 2. Be aware of strategies for dealing with
difficult nephrostomies in a variety of scenarios. 3. Learn how the interventional
radiologist deals with complications which may arise.
Background: Percutaneous nephrostomy is a common interventional radiology
procedure which many general radiologists perform. There are however patients
in whom specialist skills are required. These include patients with undilated obstructed systems, non obstructed systems, transplant kidneys, children and pregnant women.
Procedure Details: Our presentation illustrates the alterations in technique that
are required in the aforementioned situations. We will demonstrate each of the
above with images from our experience. The complications which may arise are
outlined, together with practical advice on how to deal with them.
Conclusion: Percutaneous nephrostomy insertion is the most common procedure performed on the kidney by a radiologist. Out-of-hours nephrostomy insertion is commonly performed by general radiologists.
The aim of our article is to arm the general radiologist with key information in
dealing with the difficult nephrostomy insertion.
C-485
Diagnostic efficacy of CT fluoroscopy-guided percutaneous biopsy of focal
pulmonary lesions: Should combined fine-needle aspiration and core
biopsy be the routine practice?
A.S.C. Low, S.P.J. Tan, K.H. Tay, T.N. Lau, R.H.G. Lo, F.K. Cheah, M.M. Htoo,
B.S. Tan; Singapore/SG (judytsp@hotmail.com)
Purpose: To evaluate the diagnostic efficacy of CT fluoroscopy-guided biopsy of
focal pulmonary lesions by the combined use of fine-needle aspiration (FNA) and
core biopsy.
Methods and Materials: A prospective non-randomised study of 147 consecutive CT-guided lung biopsies performed over 1 year was carried out. Combined
FNA and core biopsy were performed in 124 procedures while FNA alone and
core biopsy alone were performed in 20 and 3 procedures respectively. The FNA
and core biopsy samples were sent for cytological and histological examination
respectively. The final diagnosis was confirmed following 142 procedures.
Results: The rates of diagnostic specimens obtained by FNA and core biopsy
were 85.4% (123/144) and 90.6% (115/127) respectively, whereas that obtained
by combined biopsies was 95.2% (118/124). The sensitivities, specificities and
diagnostic accuracies of FNA alone and core biopsy alone were 93.3%, 100%
and 94.2%, and 93.8%, 100% and 94.6% respectively while those by combined
biopsies were 97.0%, 100% and 97.4%. The rates of cell-specific pathologic diagnosis of malignant lesions made by FNA alone, core biopsy alone and combined biopsies were 87.8% (86/98), 95.6% (87/91) and 95.9% (93/97) respectively
while those for benign lesions were 53.3% (8/15), 73.3% (11/15) and 75.0% (12/
15) respectively.
Conclusion: The combined use of FNA and core biopsy improves the diagnostic
efficacy of CT fluoroscopy-guided percutaneous lung biopsy, compared with either technique alone, and should be the routine practice.
Purpose: To summarize our experience with the use of self-expanding metallic

stents (SEMS) in the management of acute malignant colorectal obstruction.
Methods and Materials: A retrospective chart review of all patients undergoing
placement of SEMS between Apr 2000 and Sep 2005 was performed.
Results: Insertion of SEMS was attempted in 45 patients under fluoroscopic
425
ventional R
adiology
Inter
Radiology
Interv
Purpose: To find MR findings related with bone cement leakage after percutaneous vertebroplasty.
Methods and Materials: Percutaneous vertebroplasty was done in 45 osteoporotic
compression fractures of 35 patients. All procedures were done by bipedicular
approach. Shortly after the procedure, all patients underwent a non contrast CT
covering the vertebroplasty sites. A retrospective study was performed to find if
cement leakage is related to any of following MR findings: presence of cortical
disruption of the vertebral body, severity of vertebral body compression, amount
of bone cement, amount of bone cement/severity of body compression ratio, presence of either vacuum or a cystic portion below a linear dark signal in a fractured
vertebra. Logistic discrimination model stepwise method was used in the statistical analysis.
Results: At post-vertebroplasty CT scan, bone cement leakage was detected in
or around 29 vertebrae (64%). There were no neurologic symptoms or signs in
any patients. The most frequent site of bone cement leakage was the anterior
external vertebral venous plexus (49%). Endplate cortical bone disruption was
related to increased risk of intervertebral bone cement leakage (P < 0.05). Bone
cement leakage tended to occur less frequently when there is a vacuum or cystic
change below the dark linear signal intensity in a fractured vertebra (P < 0.05).
Other MR findings had no significant statistical correlation with bone cement leakage.
Conclusion: At pre-vertebroplasty MR, vertebral endplate cortical bone disruption and vacuum or cystic change below dark linear signal intensity in fractured
vertebra showed significant correlation with bone cement leakage.
guidance with occasional endoscopic assistance. Successful stent placement

was achieved in 41 of the 45 patients. The locations of lesions were: splenic
flexure (2), left colon (7), sigmoid colon (17) and Rectum (15). The intended uses
of SEMS were: for palliation in 7 patients and as a bridge to elective surgery in
34. In the latter group, SEMS placement allowed for preoperative systemic and
bowel preparation one-stage anastomosis. Obstruction did not resolve in one
patient after successful placement of SEMS. Minor SEMS-related complications
occurred in 5: 4 stent migration and 2 anal pain.
Conclusion: SEMS represent a useful tool in the management of obstructing
colorectal neoplasms. As a bridge to surgery, SEMS provide time for a mechanical bowel preparation and systematic support and may obviate the need for fecal
diversion or on-table lavage. As a palliative measure, SEMS can eliminate the
need for a colostomy.

C-486
Early ERCP complications: Prospective study from a radiologist led single
centre
S. Puppala1, D. Joy1, S. Agarwal2, E. Hicks1; 1Pontypridd/UK, 2Cardiff/UK
(puppalasapna@hotmail.com)
Purpose: The aim of this study was to prospectively analyse the early ERCP
morbidity and mortality at a radiologist led single centre against published data.
Methods and Materials: A prospective study of ERCPs undertaken from Sept
2002 to March 2005 in a district general hospital. These were evaluated with
regards the nature of procedure, indications, findings and early complication rates.
Results: In total 475 procedures were performed on 373 patients. Of these 466
ERCPs were included in the study. Nine patients were lost to follow-up. There
was 87% success at cannulation of the CBD. ERCP was undertaken for biliary
stone disease (279) and for cancer (78). There were 17 recorded complications
(5.7%): pancreatitis in 10 (2.1 %), significant bleeding in 1 (0.2%), sepsis in 4
(0.8%), other complications in 1 (0.2%) and mortality in 1 (0.2%) patient respectively.
Conclusion: Our study revealed results that are comparable and superior to most
published data suggesting the higher performance standards of radiologists. In
the era of increasing turf wars between clinicians and radiologist for radiologically guided interventional procedures, our paper clearly defines the role of a radiologist.
C-487
Technical difficulties and efficacy of radiofrequency ablation in poorly
accessible liver tumours
A. Nikita, L. Thanos, D. Danassi-Afentaki, S. Kampanarou, A. Kelekis,
D. Kelekis; Athens/GR (loggitsi@med.uoa.gr)
Purpose: To evaluate the efficacy and complications of radiofrequency ablation
(RF) in liver tumours located in difficult to access sites.
Methods and Materials: During a 3-year period, 57 patients with 57 liver tumours (HCC or metastatic lesions) were treated with RF ablation. The location of
the treated lesions was: 21 subdiaphragmatic, 9 adjacent to the gallbladder, 10
subcapsular, 3 adjacent to the bowel loops and 14 near large blood vessels.
Electrode needles with 7-9 tips were used and inserted under CT guidance. The
duration of the procedure was 15-20 minutes, with a target temperature of 90115 C. Contrast enhanced CT scan was performed after the completion of the
RF ablation, in order to evaluate the immediate imaging result.
Results: Complete necrosis was observed in 50 out of 57 lesions (87.7%). The
immediate CT scan revealed a residual tumour in the remaining 7 cases (12.3%),
which was treated with a second RF ablation session within a period of 2-3 weeks.
Complications included: 2 subcapsular hematomas, 2 small right pleural effusions, and 4 patients experienced severe pain during and for a short time after
the procedure.
Conclusion: RF ablation is an efficient and minimally invasive therapeutic technique without major complications, even when applied to liver tumours which are
difficult to access.
C-488
Oxygen-ozone (O2-O3) chemodiscolysis versus steroids and anaesthetic
injections in the treatment of acute sciatica
N. Limbucci, F. Salvati, G. Gismondi, A. Catalucci, M. Gallucci, C. Masciocchi;
L'Aquila/IT (alessiacat@tiscali.it)
Purpose: To assess the clinical efficiency of intraforaminal and intradiscal injection of a combination of steroids, local anaesthetic and oxygen-ozone (O2-O3)
mixture (chemodiscolysis) versus intraforaminal and intradiscal injection of steroids and anaesthetic in the management of radicular pain related to acute lumbar disc herniations.
Methods and Materials: Ninety-six consecutive patients entered the study, and
were randomly assigned to two groups. All patients had radicular pain congruous
with acute lumbar disc herniation and were resistant to conservative therapy.
Group A (66 patients) underwent intradiscal and intraforaminal injection of steroids and anaesthetic. Group B (73 patients) underwent the same treatment with
the addition of O2-O3 mixture injection. Procedures were performed under computed tomography (CT) guidance using a spinal needle (22G). We administered
the Oswestry pain questionnaire before treatment and during 6 months follow-up.
Patients and clinicians who tested them were blinded as to which treatment patients underwent.
Results: In Group A, treatment was successful in 32 patients (48.5%) after six
months, while in Group B treatment was successful in 54 patients (74.0%) after
426
six months. The difference between Group A and Group B was significant
(P < 0.01). No complications were reported.
Conclusion: Intraforaminal and intradiscal injection of steroids, anaesthetics and
O2-O3 is more effective than the injection of only steroids and anaesthetics in the
same sites. O -O chemodiscolysis is useful for treatment of pain and sciatica
2
3
caused by acute lumbar disc herniation.
C-489
Colonic self-expandable stent for management of acute left-sided
obstruction
A. Talens, A. Batista, S. Ferrer, E. Alonso, M. Flores, M. Alegre, A. Alonso;
Valencia/ES (adelabat@hotmail.com)
Learning Objectives: To evaluate the usefulness of the self-expandable metallic
stents (SEMS) in the treatment of the acute left-sided colonic obstruction either
to palliate the condition or to prepare for an elective surgical resection.
Background: From June 2000 to July 2005, 53 patients (23M/30 F, mean age
70.2 years) presenting with acute colonic obstruction, were initially treated by
SEMS placement. Criteria for the stent placement were: presence at the hospital
of the interventionist radiologist; patient with serious clinical picture and high risk
for urgent surgery; obstruction for inoperable malignancy.
Imaging Findings: Causes of obstruction were: 35 colorectal neoplasms, 13
peritoneal carcinomatosis, 1 post-chirurgic and 3 post-radiotherapy stenosis, and
1 diverticulitis. SEMS insertion was technically successful in 40 (75.4%) of 53
cases. Signs and symptoms of intestinal obstruction resolved within 24 hours of
stent placement in 95.5%. Stent placement failed in 13 patients: in 10 of them
passage through the obstruction was not technically possible, the stent was not
opened in 2 and 1 case of perforation was reported. Two overlapping stents were
required in 2 patients due to immediate migration during the stent insertion. The
other 2 stents were ejected. Twenty-eight patients underwent elective surgical
therapy, and in 12 patients with non curable neoplasm, the stent placement was
considered the primary palliative treatment.
Conclusion: Self-expanding metallic stents placement in left sided colonic obstruction allows resolution of the obstructive syndrome and secondary planned
radical surgery under better conditions. In patients who are not surgical candidates it is an adequate palliative option.
C-490
Radiological insertion of oesophageal self expanding stents
T. Sabharwal, J.P. Morales, R. Salter, R. Dourado, A. Adam; London/UK
(Tarun.Sabharwal@gstt.nhs.uk)
Learning Objectives: To describe the technique, indications, contraindications,
safety and efficacy of self-expandable metallic stents (SEMS) placed under fluoroscopy guidance, in patients with oesophageal cancer.
Background: Cancer of the oesophagus is the sixth leading cause of death from
cancer worldwide. Fewer than 50 per cent of patients are suitable for resection at
presentation. As a result palliation is the best option in this group of patients.
SEMS are a very good option for palliation maintaining oral intake, minimizing
hospital stay, relieving pain, eliminating reflux and regurgitation, and preventing
aspiration.
Procedure Details: Stents are inserted using radiological guidance with light
sedation in the interventional suite. In this study we aim to describe the whole
process for radiological insertion of oesophageal stents - the initial oesophagogram, anaesthetic used, guidewire and catheter manipulation, balloon dilatation,
stent deployment and post stent care. The choice of stents available will also be
discussed. We also aim to share tricks and pitfalls involved in this procedure and
list complications with examples and references.
Conclusion: SEMS insertion under fluoroscopy guidance is technically feasible
and should be considered a realistic option for palliation in patients with oesophageal carcinoma. Interventional radiologists are best suited to carry out this procedure.
C-491
Clinical efficacy of percutaneous vertebroplasty in multiple myeloma
patients
S. Ristic, P. Bosnjakovic, M. Mrvic, A. Bojanovic, D. Ilic, D. Stojanov, M. Ilic;
Nis/YU (s.ristic@eunet.yu)
Purpose: This study was undertaken to report the clinical efficacy of percutaneous vertebroplasty for the treatment of back pain associated with multiple myeloma vertebral body lesions.
Methods and Materials: Over the period of the last 3 years, 19 patients were

treated at 35 vertebral levels (26 lumbar, 9 thoracic) to relieve pain related to
vertebral body involvement by multiple myeloma. There were 14 female and 5
male patients in our group. Mean age was 58 years, ranging from 38-79. All patients suffered intractable spinal pain refractory to conservative therapy. Vertebroplasty was performed under local anesthesia, in prone position, with imaging
control using fluoroscopic guidance. Percutaneous puncture of the involved vertebral bodies was performed via transpedicular or intercostovertebral approach.
The mean amount of PMMA was 3.2 ml at each level.
Results: All cases showed good technical success and resulted in pain relief
and clinical improvement in all patients 48 hours after the procedure. Preoperative VAS score ranged 6, 6-9, 4 (mean 7.8) decreased to 0-3, 8 (mean 2.3) postoperative. No major complications were noted. Six paraspinal soft tissue leakages,
eight epidural and five intradiscal leaks of PMMA had no clinical importance.
Beneficial effects persisted in all cases at follow-up, with mean duration 18.6
months (range 2-30 months).
Conclusion: Percutaneous vertebroplasty is a highly effective, minimally-invasive technique for treating pain in pathologic vertebral fractures due to myeloma
bone disease. Under adequate imaging guidance, the risks of complications are
minimal, while the potential benefit to patients is significant.
Molecular Imaging
C-492
In vivo imaging of integrin alpha (v)beta (3)-expression using planar and
tomographic methods
A. von Wallbrunn, C. Hltke, M. Zhlsdorf, W. Heindel, M. Schfers, C. Bremer;
Mnster/DE (geli@uni-muenster.de)
Purpose: In vitro and in vivo NIR fluorescence imaging of integrin av3 using a
cyclic RGD-Cy 5.5 conjugate.
Methods and Materials: A 3-targeted peptide cyclo-[Cys-Arg-Gly-Asp-Cys]Gly-Lys was labelled with the cyanine dye Cy 5.5. Binding of the optical tracer
was tested on human melanoma (M21), HT-1080 fibrosarcoma and MCF-7 adenocarcinoma cells. M21 tumor bearing mice were i.v. injected with either 2 nmol
of unmodified Cy 5.5 or RGD-Cy 5.5, respectively. For blocking studies 250 nmol
of the non-labelled RGD-peptide were administered prior to the injection of RGDCy 5.5.
Results: In vitro, the peptide-dye conjugate showed a distinct binding affinity to
av3-positive M21 melanoma cells. Binding of RGD-Cy 5.5 could specifically be
blocked by incubation with the unlabelled RGD-peptide. In vivo, M21 xenografts
were clearly visualized up to 24 h revealing an up to 40% higher target-to-background ratio as compared to the non-modified dye (p < 0.05). The signal could
partially be blocked by incubating with the free peptide. Fluorescence mediated
tomography (FMT) allowed quantification of fluorochrome-distribution in deeper
tissue sections. An average fluorochrome concentration of approximately 100nM
was measured in the tumor tissue. Competition with the free peptide resulted in a
significant reduction of fluorochrome concentration (appr. 40 nM).
Conclusion: RGD-Cy 5.5 in combination with novel tomographic optical imaging
methods allows non-invasive imaging and quantification of alpha (v)beta (3)-expression in vivo and may thus facilitate tumor detection.
C-493
Identifying molecular targets for near infrared fluorescence imaging of
angiogenesis
T. Vag, T. Schramm, I. Hilger, W.A. Kaiser; Jena/DE
(Tibor.Vag@med.uni-jena.de)
C-494
Synthesis and evaluation of specific silane-coated ultra small
superparamagnetic iron oxide particles (USPIO) specifically binding to
alpha-v-beta3-integrin
C. Zhang, B. Waengler, H. Zentgraf, M. Eisenhut, M. Mueller, W. Semmler,
F.M.A. Kiessling; Heidelberg/DE (F.Kiessling@dkfz.de)
Purpose: To synthesize specific silane coated and RGD-peptide coupled USPIOs and to evaluate their specificity and potential to visualize vascular cells.
Methods and Materials: The magnetic core of USPIO was synthesized by coprecipitation of ferric and ferrous salts in sodium hydroxide solution. Then particles were coated with organic 3-aminopropyltrimethoxysilane (APS) through a
dehydration process at high temperature. RGD was bound to the surface of acti-
427
ging
Molecular Ima
Imaging
Purpose: Imaging of tumor-angiogenesis is increasingly becoming an important

modality for evaluation of antiangiogenic drugs in anticancer-therapy. Our objective was to identify targets other than the commonly used alphavbeta3 for near
infrared fluorescence imaging (NIRF) of tumor vessels using an in vitro model for
angiogenesis (human umbilical vein endothelial cells - HUVECs).
Methods and Materials: Expression rate of the tumor-endothelial markers,
CD105, VEGFR2 and TEM-7 were determined on HUVECs by FACS-analysis
using phycoerythrin (PE) as fluorescent dye. NIRF was performed with Dy676
(Dyomics, exc:674nm em:699nm) in the small animal imaging system bonSAI from Siemens, using different exposure times (0.2 to 18 seconds) and cell
numbers (0.5 x 106 to 1.5 x 107 cells).
Results: FACS analysis of CD105 expression showed a 200-fold higher intensity
than the isotype controls, VEGFR2 only 2-3 fold. In the case of TEM7, no difference compared to the isotype controls was found. NIRF imaging revealed a linear increase of fluorescence intensity (100 to 4000 arbitrary units, a.U) with
increasing exposure times reaching its maximum at 18 s, as well as increasing
cell numbers, yet not reaching a threshold in the investigated interval. Fluorescence intensity was again significantly higher for CD105 (4000 a.U at 15 s exposure time and a cell number of 8 x 106) compared to VEGFR2. Regarding TEM7,
no fluorescence could be observed.
Conclusion: Our investigations show, that for NIRF imaging CD105 might be a
better marker than the commonly used alphavbeta3.

vated particles. Human umbilical vein endothelial cells (HUVEC) were incubated
with the RGD-USPIOs, and as controls with RGD-USPIOs in the presence of
free RGD (competition) and with USPIOs without RGD. The time-dependent
(10 min, 20 min, 1h, and 3h) uptake of the particles (0.03 mol/L iron concentration) and its effect on cell viability were studied using histological staining, massspectrometry and MR imaging at 1.5 T.
Total diameter of the silane coated USPIOs was less than 10 nm.
Results: T2-relaxivity of the particles was about 130 mmol-1s-1. At 10 min, 20 min
and 1h in line with the histology T2-relaxation time determinations on HUVECs in
gelatin successfully indicated reduced binding and uptake of RGD-USPIOs after
addition of RGD. Even lower cellular uptake was found for the unspecific USPIOs. After 3 h, however, the results became less significant most probably due to
increased non-specific phagocytosis of all particles. At USPIO concentrations of
0.03 mol/L no significant cell toxicity was observed.
Conclusion: Silane-coated RGD-coupled USPIOs show high T2-relaxivity and
specifically bind to alpha-v-beta-three-receptors on endothelial cells. Ongoing
study will show whether these particles are also able to visualize angiogenic
vessels in vivo.
C-495
Implication of tumor-induced angiogenesis in functional CT imaging:
Pathophysiological nature of tumor-induced neovascularization and
technical overview of functional CT imaging
T. Ueda1, H. Suito2, M. Minami1; 1Tsukuba/JP, 2Okayama/JP
(takueda-rad@umin.ac.jp)
Learning Objectives: The purpose of this exhibit is to review current status of
functional CT imaging toward the assessment of tumor-induced neovascularization: 1. To outline tumor-induced angiogenesis, especially focused on the pathophysiological nature relevant to hemodynamic environments. 2. To describe basics
of functional CT imaging reviewing the various models of tracer kinetic analyses
and mathematical solutions. 3. To discuss current status, limitations, and future
directions of functional CT imaging for oncologic imaging.
Background: Clinical interest in oncologic imaging has been focusing on in-vivo
assessment of tumor-induced angiogenesis, which is a fundamental process in
tumor development.
Procedure Details: Functional CT imaging is a strategy to evaluate tissue perfusion by tracer kinetic analysis of contrast medium. The pathophysiological nature of tumor-induced neovascularization affects the pharmacokinetic parameters
in functional CT imaging.
Conclusion: Functional CT imaging may be a useful tool toward the assessment
of tumor-induced angiogenesis.
C-496
Medical imaging for cancer drug development
S. Chica; Innsbruck/AT (sandra.chica@parexel.com)
Learning Objectives: 1. Leverage imaging for response assessment to cancer
treatments. 2. Challenges for implementation of imaging in multicenter trials and
ways to standardize the analysis. 3. Perspective of regulatory authorities on the
use of imaging in cancer drug development.
Background: Reliance on imaging as a surrogate endpoint for early decisionmaking and to support licensing claims of cancer drugs, is increasing. Regulators focus on how imaging is managed and they require that strict quality standards
are met.
Procedure Details: Imaging is increasingly being used to demonstrate the efficacy and safety of cancer drugs in an expedited and cost-efficient manner. Drug
developers rely on imaging to make internal decisions and regulators demand
that they present sufficient scientific proof for efficacy and safety claims, having
demonstrated increased willingness to accept imaging as a surrogate endpoint.
Imaging for cancer drug development encompasses functional/molecular imaging in early phases and structural imaging in late phases. Early stages benefit
from methodologies that enable an early assessment of tumor changes at a molecular level, likely predictors of efficacy and safety. Late stages rely on objective
endpoints that are highly likely to demonstrate clinical benefit. Imaging of macroscopic tumor changes is being supported by regulators as an adequate method
to substantiate licensing claims. Applicable imaging methodologies will be described, including challenges for implementation, ways to standardize the analysis, reproducibility considerations and perspective of regulators on their use.
Conclusion: Implementation of imaging for cancer drug development requires
consideration of defined requirements to ensure objectivity and adherence to
regulatory standards.
428
C-497
Influence of local environment and differentiation of experimental prostate
cancers on tumor metabolism and vascularisation
C.M. Zechmann1, E.C. Wnne1, G. Brix2, N. Radzwill3, M. Ilg3, S. Kirsch1,
P. Bachert1, P. Peschke1, F. Kiessling1; 1Heidelberg/DE, 2Neuherberg/DE,
3
Ettlingen/DE (c.zechmann@dkfz.de)
Purpose: Due to the low mortality of prostate cancer the determination of those
patients who need treatment is uncertain. Thus, the purpose was to phenotype
experimental prostate cancers with different malignancy. Another aim was to study
the influence of local environment on tumor development as a model of primary
tumor and metastasis.
Methods and Materials: Tumors were induced by implanting H- (hormone-sensitive), HI- (hormone-insensitive) and AT1- (anaplastic) Dunning fragments subcutaneously or in the prostates of rats. Tumor growth was investigated by MR
imaging (1.5 T) over a time period of up to 256 days. 1H-MR-spectroscopy was
performed for subcutaneous tumors at 9.4 T. Histological evaluation of tumors
included HE, immunofluorescence (CD31, smooth muscle actin, KI67) and
TUNEL-staining.
Results: Tumor growth depended on tumor subtype and location. H-tumors grew
significantly slower than HI- and AT1-tumors. In H- and HI-tumors growth of orthotopically grown ones was significantly delayed, while no significant influence
of tumor location on growth was found for AT1-tumors. All three tumor types showed
a different composition of lipids. There was a clear increase of free unsaturated
lipid components from H to HI and to AT1-tumors. The highest vessel density was
found in orthotopic H-tumors. Also the ratio of mature vessels was clearly higher
in H-tumors as compared with more malignant ones.
Conclusion: Local tumor environment drastically influences vascularisation and
growth of tumors but becomes less important for higher malignant tumor types.
Free lipid components increase with rising tumor dedifferentiation and may be
suitable for tumor classification.
C-498
Calcified lymph nodes as a cause of PET/CT artifacts
S. Thomas, B.M. McCook, T.M. Blodgett; Pittsburgh, PA/US
(sthomas@hotmail.com)
Learning Objectives: Unlike dedicated PET scanners, which use point sourcebased transmission scans to perform attenuation correction, combined PET/CT
uses CT for attenuation correction. There are several artifacts unique to PET/CT
imaging with many due to limitations in the current CT-based attenuation correction algorithm.
Background: We noted several CT-based attenuation correction artifacts due to
inanimate objects, including those from intravenous, oral contrast, and metallic
devices; however, we are not aware of any reported causes of an attenuation
correction artifact secondary to a biological structure, such as a calcified lymph
node. We report three cases of calcified lymph nodes causing an attenuation
correction artifact.
Procedure Details: Images were gathered from patients who were scanned using a typical PET/CT scanning algorithm with 10-15 mCi of FDG injected, a 4560 minute uptake period, and 4-5 minutes per bed position PET scanning. The
CT scans were done with both oral and intravenous contrast. Increased uptake,
corresponding to calcified lymph nodes on CT was present only on attenuation
corrected images. These artifacts would have had a change in the staging and
likely management if they would have been misinterpreted as true FDG uptake.
These attenuation correction artifacts are not seen on PET cameras using other
methods of attenuation correction.
Conclusion: In PET/CT imaging, attenuation correction artifacts need to be considered as a potential cause of FDG activity when calcified lymph nodes are
present on the CT portion of a PET/CT study in order to avoid misinterpretation.
C-499
PET-CT angiography: Technique and clinical application
J.C. Hellinger, A. Quon, G.D. Rubin, D. Fleischmann, R. Herfkens; Stanford,
CA/US (jchellinger@stanford.edu)
Learning Objectives: 1. To discuss the technique for performing PET-CT angiography. 2. To illustrate clinical applications of PET-CT angiography.
Background: PET-CT has become an effective modality for fusing physiology
and anatomy. It is now often the study of choice for staging and re-staging tumors. Many protocols do not utilize contrast medium. However, depicting tumors
and extension into adjacent soft tissues and identifying lymphadenopathy with
CT is more reliable with contrast medium. In addition, when a contrast enhanced

CT is acquired with an angiographic technique, tumor vascularity and vessel
encasement can also be assessed and the tumor can be displayed with greater
resolution and detail on a 3D workstation.
Procedure Details: Currently in our practice, we acquire PET-CT angiograms
when clinical services request a standard PET-CT and a contrast enhanced CT.
In our experience to date (N=10), all CT angiograms (CTA) have been performed
on an 8-channel MDCT PET-CT scanner, utilizing a collimation of 1.25 mm, pitch
of 1.35, and a gantry rotation time of 0.5 seconds. Contrast medium administration has occurred with a volume of 150 cc and rate of 4 cc/sec, following timing to
the aortic arch. Studies have been reconstructed into datasets of 1.25 mm and
5.0 mm nominal section thickness and interpreted with post-processed fused PETCTA images on a 3D workstation. This exhibit will highlight our early clinical work,
demonstrating clinical application, image findings, and pitfalls.
Conclusion: Combined PET-CTA imaging is technically feasible. Further work is
necessary to evaluate optimum scanning technique and clinical utility.
Musculoskeletal
Bone
C-500
Bone marrow changes in beta-thalassemia major: Quantitative MR findings
and correlation with iron stores and treatment protocols
E.E. Drakonaki, T.G. Maris, A.H. Karantanas, A. Papadakis,
O. Papakonstantinou, N. Gourtsoyiannis; Iraklion/GR (drakonaki@yahoo.gr)
Purpose: To describe the MR imaging features of bone marrow in beta-thalassemia major (BTm) and investigate their relation with liver iron siderosis and chelation protocols.
Methods and Materials: Bone marrow was prospectively assessed on abdominal MR studies of 25 transfusion patients with BTm (mean age 31 years) undergoing quantification of hepatic siderosis and 5 healthy controls, using T1 (120/4/
90), PD (120/4/20) and T2* (120/9/20)-w GRE sequences. Bone Marrow was
assessed by measuring the signal intensity (SI) of the trabecula in the body of
the first lumbar vertebra. SI ratios of liver and bone marrow to paraspinal muscles
(L/M and B/M respectively) were calculated on each MR sequence. Serum ferritin levels and chelation protocols were recorded.
Results: All patients presented with bone marrow hypointensity in at least one
sequence. No correlation between B/M and L/M was found, whereas B/M correlated with mean ferritin values in all sequences (Pearsons correlation, r=-0.610,
p = 0.001 in T1, r=-0.579, p = 0.002 in PD and r=-0.496, p = 0.01 in T2* respectively). Ferritin values correlated with L/M only in T1 sequence (r=-0.463, p = 0.02).
None of the patients presented with focal areas of SI abnormality indicative of
focal lesions in the lumbar vertebrae. B/M ratio was higher in patients receiving
oral chelation therapy in comparison to those on intravenous protocols (ANOVA,
p < 0.04).
Conclusion: Bone marrow hypointensity, expressing iron deposition, is a common MR finding of BTm patients. The degree of marrow siderosis, expressed as
B/M ratio, correlates with serum ferritin levels and chelation protocols but not with
liver siderosis.
C-501
Paper laminated life-sized 3D solid model created using volume data
obtained from MDCT: Experimental study for a new simulation technique of
a scaphoid fracture repair
H. Kakizawa, Y. Akiyama, N. Toyota, K. Ito; Hiroshima/JP
(kakizawa@hiroshima-u.ac.jp)
C-502
Imaging the calcaneum: A pictorial review
P. Rajiah; Manchester/UK (rprabhakar73@yahoo.com)
Learning Objectives: 1. To understand the anatomy of the calcaneum and its
relationship to other tarsal bones. 2. The describe the traumatic and stress injuries of the calcaneum. 3. To illustrate the spectrum of diseases affecting the calcaneum including congenital, neoplastic, infective and inflammatory conditions.
Background: The calcaneum, largest bone in the hindfoot, is vital for maintain-
429
Musculosk
eletal
Musculoskeletal
Purpose: We have developed a new technique for producing a life-size 3D solid

model by laminating thin paper, using MDCT. The purpose of this study was to
evaluate the accuracy of the model.
Methods and Materials: The volume data of fourteen dry cadaver hands obtained from a 16-detector row scanner was reconstructed on a workstation, and
the data was transferred to 3D imaging, rendering, modelling and measurement
software. Using the software, the boundaries of the scaphoid bone were traced
and a simple 3D surface rendering image was created. The model was produced
by cutting a solid laminated sheet material based on the 3D image data. First, the
length, height, width, height-to-length ratio, and the dorsal cortical angle were
compared between the models (= Group 1) and the scaphoid bones that had
been removed (= Group 2). Then identification of the six landmarks between the
two groups was valued.
Results: In Group1, the mean length, height, width, height-to-length ratio, and
dorsal cortical angle were 29.3 2.2 mm, 17.7 1.9 mm, 14.1 1.4 mm,
0.59 0.04, and 110 8 respectively. In Group 2, these were 29.6 1.9 mm,
18.1 1.8 mm, 14.3 1.5 mm, 0.61 0.03, and 110 8respectively. None of
these data were statistically significantly different between the two groups. The
identification of the landmarks completely corresponded.
Conclusion: The model was almost perfectly produced in size and shape. This
technique proves useful in operating simulation of a scaphoid bone fracture.

ing the balance of the foot. It is affected by a wide variety of pathological processes which have debilitating effects on mobility of the patient.
Imaging Findings: In this pictorial review the anatomy of the calcaneum, its ligaments, muscular attachments and surrounding joints are illustrated with schematic diagrams, X-rays, 3D CT and MR imaging. The various projections for
imaging the calcaneum are described. Normal anatomical variants and accessory ossicles are discussed. The classification system for calcaneal fractures and
vital points to be identified in multidetector CT are discussed. The entire spectrum of calcaneal lesions such as stress fractures, infections (acute osteomyelitis, tuberculosis), inflammatory (RA, gout, ankylosing spondylitis, psoriasis),
developmental (coalition) and neoplastic disorders (cyst, lipoma, osteoma, ganglion, osteosarcoma, metastasis etc) are discussed. Characteristic features of
these lesions are presented. Calcaneal ultrasound for osteoporosis is described.
Conclusion: X-ray, CT and MR imaging are essential for the diagnosis and characterisation of calcaneal lesions.
C-503
Scaphoid non-union pre- and post-treatment strategies: A radiological point
of view
E. LLopis1, L. Aguilella1, P. Ferrer1, V. Higueras 1, L. Cerezal2; 1Valencia/ES,
2
Santander/ES (ellopis@hospital-ribera.com)
Learning Objectives: To review multimodality approach to scaphoid non-union
(plain films, multidetector-CT and GD-MRI). To understand how radiological imaging features are useful in the management of scaphoid non-union in order to
plan palliative or reconstructive surgical procedures. To discuss the radiological
features of postoperative scaphoid non-union.
Background: Scaphoid fracture is the most common in the carpus. Inadequate
treatment and some vascular conditions may lead to non-union. Scaphoid nonunion shows progression to osteoarthritis. Radiological techniques have become
important, not only to provide the diagnosis, but also to give guidance for the best
surgical procedure. Palliative techniques are indicated if arthrosis has developed,
and reconstruction techniques when the midcarpal joint is preserved.
Imaging Findings: Plain films permit diagnosis and staging of non-union when
no evidence of healing is seen at 6 months. Avascular necrosis of the proximal
pole is a poor prognosis factor. Therefore the role of imaging is to assess proximal fragment vascular status for which GD-MRI is an excellent tool, that has
good correlation with Green groups. Wedge bone grafting is a good surgical option when a good vascular state is present, whereas when the proximal fragment
does not enhance vascular grafts are recommended. Evaluation of post-surgical
patients can be difficult. Multidetector-CT provides reformatted images in any
plane, demonstrating bone bridges within the nonunion. GD-MRI can assess the
revascularisation process.
Conclusion: Imaging findings do influence the choice of surgical procedure. Plain
films and GD-MRI are used as pre-surgical evaluation. Multidetector-CT and MRI
can be used for post-surgical follow-up, however bone bridges are more easily
seen with CT.
C-504
Secondary chondrosarcomas: Spectrum of imaging findings with
pathologic correlation
N. Caete, J. Llauger, D. Martins-Romo, J. Palmer, R. Guerrero, S. Valverde;
Barcelona/ES (ncanete@santpau.es)
Learning Objectives: To describe the characteristic radiologic findings of secondary chondrosarcomas as seen on bone radiographs, CT, and MR imaging. To
learn the most useful findings in differentiating secondary chondrosarcomas from
benign chondral tumors. To correlate radiologic findings of secondary chondrosarcomas with their pathologic features.
Background: Chondrosarcoma is the most common bone sarcoma, accounting
for 11-22% of all primary malignant bone neoplasms. Most chondrosarcomas
arise de novo in previously normal bone. In contradistinction with primary tumors, secondary chondrosarcoma develops in a previously benign chondral tumor, such as enchondroma, osteochondroma, hereditary osteochondromatosis,
and enchondromatosis (Ollier's disease and Maffucci's syndrome). Even more
rarely, some tumors may develop in patients with primary synovial chondromatosis, or in a non-chondral lesion, such as Paget's disease, fibrous dysplasia, irradiated bone, and relapsing polychondritis. Secondary forms are usually low-grade
tumors and are diagnosed in younger patients than primary chondrosarcoma.
The purpose of this exhibit is to describe the radiologic manifestations of secondary chondrosarcomas. Emphasis is placed on findings that allow differential diagnosis.
Procedure Details: Retrospective review of imaging and pathologic studies of
430
patients with secondary chondrosarcoma, including radiographs, CT, and MR

examinations.
Conclusion: Risk of malignant transformation of solitary osteochondroma to
chondrosarcoma is very low, and rises significantly in patients with hereditary
disease and multiple lesions. Radiology plays a major role in the diagnosis of
these lesions. Secondary chondrosarcoma should be suspected in cases of margin
irregularity, expansion, cortical destruction and soft tissue mass with chondral
calcifications in a pre-existing benign chondral lesion.
C-505
Imaging of musculoskeletal infections in pediatric patients: State-of-the-art
C. Sanchez Almaraz, E. Fernandez Canabal, T. Berrocal, F. Baudraxler,
M. Tapia, R.R. Lemos; Madrid/ES (csalmaraz@hotmail.com)
Learning Objectives: To illustrate a wide spectrum of infections involving the
musculoskeletal system (soft tissues, bones and joints) in pediatric patients. To
evaluate the efficacy of plain radiographs, US, CT, and MR imaging in the diagnosis and management of these infections. To discuss the key findings of each
imaging modality and the differential diagnosis.
Background: Symptoms of musculoskeletal infections are often non-specific in
children. Imaging is often able to confirm the clinical diagnosis, evaluate the site
and extent of disease, and determine the best therapy. Selection of the appropriate imaging modality is still essential for a rapid and accurate diagnosis. The
imaging findings of patients with infections involving the musculoskeletal system
were reviewed. Plain radiographs and ultrasound were performed in all cases,
while CT and MR imaging were performed whenever conventional radiographic
findings were not conclusive.
Imaging Findings: Reviewed conditions include: soft tissue infections (cellulitis,
parasitic infestation, pyomyositis), osteomyelitis (sclerosing, chronic recurrent
multifocal, and neonatal osteomyelitis), septic arthritis, tuberculosis (TB spine,
TB arthritis, TB osteomyelitis), brucellosis, hydatid disease of the bone, syphilis,
viral infections, and fungal infections. The efficacy of plain radiographs, US, CT,
and MR imaging in the diagnosis and management of these conditions is discussed. The key findings at each imaging modality are shown. Pitfalls and differential diagnoses are emphasized.
Conclusion: Evaluation of patients with infections involving the musculoskeletal
system frequently requires multiple imaging modalities for diagnosis and planning treatment.
C-506
Extraspinal musculoskeletal tuberculosis: MR imaging features
L.B. Jans1, A.I. de Backer 1, K.L. Verstraete1, K.J. Mortel2, F.M. Vanhoenacker 3,
P.M. Parizel3; 1Gent/BE, 2Boston, MA/US, 3Edegem/BE
(lennartjans@hotmail.com)
Learning Objectives: To present a comprehensive overview of the MR imaging
features in extraspinal musculoskeletal tuberculosis (TB) illustrated with multiple
cases.
Background: Extraspinal musculoskeletal TB is among the least common manifestations of TB. Hematogenous spread of the tubercle bacillus is the cornerstone of the pathogenesis. Three patterns of extraspinal musculoskeletal TB may
be seen: arthritis, osteomyelitis and soft tissue involvement. Early diagnosis and
prompt treatment is mandatory in preventing severe joint deformity, bone destruction, abscess and fistula formation.
Imaging Findings: MR imaging findings in tuberculous arthritis consist of focal
areas of cartilaginous destruction interspersed with areas of relatively normalappearing chondral elements, subchondral bone erosions, hypertrophied synovial lining and joint effusion. Bone marrow changes may reflect osteomyelitis or
bone marrow edema. With disease progression, joint destruction and ankylosis
may occur. Extra-axial tuberculous osteomyelitis shows bone marrow changes
with or without areas of necrosis. Soft tissue tuberculosis may result from local
extension however isolated tenosynovitis, bursitis and muscular involvement may
rarely be seen. Soft tissue fistula, sinus tract and abscess are better delineated
on gadolinium enhanced images.
Conclusion: Extraspinal musculoskeletal TB may affect the joints, skeleton,
muscles, tendon sheaths or synovial bursae and may show local extension into
neighbouring tissues. MR imaging is the modality of choice for early diagnosis
and evaluation of disease extent. Final diagnosis is based upon microbiological
and/or histological examination.

C-507
Value of CT-guided biopsy in the diagnosis of cervical spine chordomas
O. Lazoura, C. Kokkinis, L. Fragopoulou, A. Peteinelli, S. Stathopoulou,
N. Makris, C. Tsilikas, P.J. Papadaki, G.M. Zavras; Athens/GR (rstathop@in.gr)
Purpose: Cervical spine chordomas are rare locally aggressive tumors. Their
early diagnosis is difficult due to slow growth and insidious initial symptoms. We
report the value of CT-guided biopsy in the preoperative diagnosis of cervical
spine chordomas.
Methods and Materials: We reviewed 7 cases of patients with cervical spinal
chordomas during the past 5 years. The patients presented with neck pain and
neurological deficits of the upper and lower extremities. X-rays, CT and MR imaging investigation followed as well as CT-guided biopsy, before surgical management.
Results: X-rays depicted destructive cervical vertebral lesions. CT and MR imaging examinations revealed soft tissue masses destroying part or all of one or
more vertebral bodies and their posterior elements and prevertebral and intraspinal extension. The appearance of cervical chordomas at diagnostic imaging was
suggestive but not pathognomonic. In all 7 patients histological and cytological
specimens obtained during CT-guided biopsy as well as immunohistochemistry
results were compatible with chordomas. The diagnosis was confirmed postoperatively in all cases.
Conclusion: CT and MR imaging may suggest the diagnosis of cervical spine
chordomas but CT-guided biopsy is useful in confirming this diagnosis and planning the therapeutic approach.
C-508
Pictorial review of craniosynostosis
P. Rajiah, A. Shabani; Manchester/UK (rprabhakar73@yahoo.com)
Learning Objectives: A. To learn the various types of craniostenosis and associated syndromes. B. To understand the CT scanning parameters used for evaluation of abnormal head shape, including 3D reconstruction techniques. C. Pictorial
review of the various types of craniostenosis and syndromes.
Background: Craniostenosis is a complex association of syndromes and isolated diseases characterized by premature closure of cranial sutures. An irregular
shape of head is the most common clinical presentation. Three-dimensional (3D)
computed tomography (CT) reconstructions have been widely used in the preoperative assessment and postoperative follow-up of craniostenosis, because of
their effectiveness and diagnostic accuracy.
Imaging Findings: This review discusses the technical parameters used for evaluation of suspected craniostenosis. Acquisition parameters and 3D reconstruction techniques are discussed. The pictorial review illustrates the different skull
shapes including scaphocephaly, plagiocephaly, trigonocephaly and turricephaly. Important parameters to be assessed in 3D CT are discussed. Features of
syndrome such as Crouzon's syndrome, Carpenter's syndrome and Apert's syndrome are illustrated.
Conclusion: CT scanning with 3D reconstruction is the most important imaging
modality for complete evaluation of abnormal head shape and craniostenosis.
C-509
Fractures of the talus: A pictorial review
S. Kar, E.E. Rutherford, G.W. Bowyer, L.J. King; Southampton, Hampshire/UK
(skar@doctors.org.uk)
C-510
Bone mineralization measured by DXA in children affected by chronic
intestinal diseases
C. Albanese, M. Paganelli, F. Marchetti, K. Lanciotti, S. Cucchiara,
R. Passariello; Rome/IT
Purpose: To evaluate BMD and its determinants in pediatric patients with chronic intestinal diseases.
Methods and Materials: Twenty-seven patients, 17 with Crohn's disease (CD)
and 10 with ulcerative colitis (UC), with a median age of 13.1 years (range 4.519.3 years) were evaluated. Lumbar spine (L1-L4) BMD was measured by dualenergy X-ray absorptiometry (DXA). Z-scores were obtained by comparison with
age- and sex- matched normal values. Multiple regression analysis was used to
evaluate association between BMD and potential risk factors, allowing for possible confounding variables.
Results: Low BMD was found in 84% of patients, while a very low BMD (z-score
2 SD) was found in 36%. The prevalence of low and very low BMD matched on
bone age were 55% (53.9% for CD, 62.5% for UC) and 5% (0% for CD, 12.5% for
UC) respectively. There was a significant correlation between low BMD, body
mass index, body weight, calcium intake, short stature and longer disease duration. Higher lifetime cumulative dose of corticosteroids from diagnosis to enrolment also correlated with low BMD.
Conclusion: The major determinants of BMD in IBD patients are nutritional status, disease duration and cumulative steroid use. Low BMD has a high prevalence in pediatric patients with IBD, but it has to be assessed using bone age
instead of chronological age to avoid overestimation. Subjects with IBD should
be evaluated for BMD, and correct interpretation of DXA results is important for
identifying children at a real risk for osteoporosis.
C-511
Radiological imaging of primary bone lymphoma
K. Potocki, M. Prutki, M. Kralik, R. Stern Padovan; Zagreb/HR
(kristina.potocki@zg.htnet.hr)
Learning Objectives: To describe the imaging appearances of primary bone
lymphoma based on a series of 30 patients. To compare radiological imaging
with histopathological findings.
Background: Primary bone lymphoma is one of the rarest primary bone malignancies, accounting for less than 5% of the malignant bone tumours. Primary
bone lymphoma is a malignant haematological tumour arising in the medullary
cavity of a single bone without concurrent regional lymph node or visceral involvement. Establishment of early and correct diagnosis is of particular importance in terms of prognosis and treatment of disease.
Imaging Findings: Primary bone lymphoma on plain radiography and computed
tomography (CT) presents as mixed lytic-sclerotic lesions that might cause softtissue mass and bone marrow changes associated with a little cortical destruction. On magnetic resonance imaging (MRI), lesions are homogeneous and
hypointense on T1-weighted images, and heterogeneous and hypointense, isointense or hyperintense with respect to fat on T2-weighted images. Increased
uptake of radiotracer is noticed on bone scintigraphy. The most common location
of primary bone lymphoma is the pelvis. Almost all cases are caused by nonHodgkin's lymphoma.
Conclusion: Plain radiography underestimates the extent of the disease, but
lesions usually present with lytic-sclerotic pattern. CT and MR imaging are standard imaging procedures for diagnosing primary bone lymphoma. MR imaging is
more sensitive for detecting the extent of bone marrow abnormality and soft tissue invasion, but it is inferior to CT in predicting the histology of bone tumours at
initial assessment. Meticulous skeletal survey of a suspected lesion may help
establish early, correct, and definitive diagnosis.
C-512
Radiographs in multiple myeloma: Five years audit
S.K. Agarwal1, H.A. Euinton2, S. Puppala3; 1Sheffield/UK, 2Chesterfield/UK,
3
Cardiff/UK (sanaga28@hotmail.com)
Purpose: Skeletal survey is still the most commonly used imaging method for
multiple myeloma in the UK. In Chesterfield Royal Hospital it has been standard
practice to do 10 films in the survey: whole spine (3), skull (1), chest (1), pelvis
(1), femur (2) and humerus (2). In general, what are the trends of positivity in the
axial and peripheral skeleton? Can the number of films performed for multiple
myeloma be reduced without compromising the diagnostic needs?
431
Musculosk
eletal
Musculoskeletal
Learning Objectives: To review the anatomy and blood supply of the talus, with
reference to trauma. To recognize the types of fracture encountered, with emphasis on the mechanism of injury. To demonstrate imaging features of different types
of talar fracture and recognize the patterns of associated injury.
Background: Talar integrity is critical for normal function of the ankle, subtalar
and transverse tarsal joints. Although they are uncommon, talar fractures can
interfere with normal coupled motion of these joints and can result in long-term
disability due to pain, loss of mobility and deformity. These fractures may be difficult to detect by standard radiographs, because of the complex anatomy of this
region. As a result, cross-sectional imaging has become invaluable in the demonstration of talar injuries.
Imaging Findings: We present a pictorial review of the salient features of talar
anatomy, with particular reference to trauma, the mechanism of injury and the
types of fractures that are encountered, illustrated with examples including gunshot injuries and avascular necrosis.
Conclusion: Knowledge of talar anatomy and a high index of suspicion, combined with an awareness of the typical injury patterns encountered, are necessary to accurately diagnose talar fractures. Cross-sectional imaging is an essential
adjunct to plain radiographs in demonstrating the morphology and extent of these

injuries.

Methods and Materials: A list of all the patients diagnosed with multiple myeloma between January 2000 and January 2005 (5 years) was obtained. Demographic data, survival time, serum monoclonal protein positivity and staging were
obtained from the haematology database. The reports of the skeletal survey were
then evaluated for all patients and recorded simultaneously in an Excel spreadsheet.
Results: Total number of patients with a definite diagnosis was 95 (males = 50,
females = 45). Age range was 40 to 90 years. Mean age at diagnosis was 73
years. None of the cervical spine radiographs were positive. Three patients had
positive peripheral skeleton radiographs with no lesions identified in the axial
skeleton. Peripheral skeleton radiographs are positive in a significant number of
patients: femur (21%) and humerus (17%).
Conclusion: Cervical spine radiographs can be excluded from the routine skeletal survey series. The peripheral skeleton is involved as often as the axial skeleton and the peripheral skeleton can be positive without involvement of the axial
skeleton. Multiple myeloma is not an uncommon malignancy and plain radiography continues to make a difference in diagnosis and staging of the disease.
C-514
Maffucci's syndrome: Spectrum of imaging manifestations
A. Manzella, P. Borba Filho, H. Rojas, T. Correia, A. Albuquerque,
A. Rodrigues, K. Macedo, M. Dourado; Recife/BR
(adonismanzella@yahoo.com.br)
Learning Objectives: 1. To illustrate the broad spectrum of manifestations of this
syndrome using a multimodality approach (conventional radiography, ultrasound,
scintigraphy, computed tomography, magnetic resonance imaging, magnetic resonance angiography). 2. To become familiar with a variety of typical and atypical
associated features. 3. To differentiate this condition from other similar diseases.
Background: Maffucci's syndrome is a rare congenital disease due to neuroectodermal dysplasia and is characterized by multiple enchondromas and subcutaneous hemangiomas. It was first described in 1881 by Angelo Maffucci and
since then fewer than 200 cases have been published in the English literature.
The purpose of this pictorial exhibit is to demonstrate the spectrum of imaging
findings of such a rare condition including some unusual associations and to
illustrate these features using different imaging modalities, some of them only
recently reported. A review of the literature concerning Maffucci's syndrome is
presented.
Imaging Findings: The authors demonstrate the bone lesions as well as the
appearance of the soft tissue hemangiomas with conventional radiographs, computed tomography, magnetic resonance, scintigraphy and ultrasound including
Doppler. Some of the associated manifestations found in this syndrome are also
illustrated such as: breast fibroadenomas, skull base lesions and thyroid nodules. Follow-up of the development of the most important features of Maffucci's
syndrome is shown in this review.
Conclusion: We recommend the careful evaluation of any patient diagnosed with
Maffucci's syndrome with various imaging modalities in order to diagnose associated conditions that will alter the prognosis and future follow-up.
C-515
Extracranial Langerhans cell histiocytosis: Plain radiographic and MR
features according to evolutional phases
J.-M. Son, W.-H. Jee, S.-J. Hong, J.-Y. Kim, M.-S. Sung, K.-N. Ryu, K.-A. Chun,
Y.-S. Lee, J.-H. Cho; Seoul/KR (whjee@catholic.ac.kr)
Purpose: To describe the MR findings of Langerhans cell histiocytosis according
to radiologic evolutional phases.
Methods and Materials: MR images of 22 proven cases of Langerhans cell histiocytosis were analyzed for signal intensity, internal hypointense band, fluid-fluid
levels, periosteal reaction, adjacent bone marrow and soft tissue abnormality,
and patterns of contrast enhancement.
Results: There were three radiologic evolutional phases: early (n = 4), mid (n = 16)
and late (n = 2) phases. All cases of histiocytosis showed hypointense to intermediate signal intensity on T1-weighted MR images. On T2-weighted images, 12
of the 22 lesions (55%) were hyperintense and ten (45%) were intermediate signal. All lesions showed diffusely heterogeneous signal on T2-weighted images.
Internal low signal bands were observed in 9 cases (41%). There was one case
with fluid-fluid levels. Periosteal reaction was observed in 13 (59%) cases. Adjacent bone marrow or soft tissue abnormal signal was observed in 20 cases (91%).
Ten (46%) lesions showed cortical destruction including one patient with a pathologic fracture. Soft tissue mass was seen in 8 cases (36%). On contrast-enhanced images (21 patients), diffuse enhancement was observed in 90% (19/21)
and marginal and septal enhancement in 10% (9/21). According to early, mid,
432
and late phases, bone marrow and soft tissue abnormal signal in 100%, 100%,
and 0%, respectively.
Conclusion: MR imaging was helpful in the diagnosis of Langerhans cell histiocytosis, particularly in early and mid phases.
C-516
Imaging features of primary bone lymphoma: A review
C. Cronin, D. Lohan, C. Meehan, E. Kelliher, P. McCarthy, D. O'Keeffe,
C. Roche; Galway/IE (carmelcronin2000@hotmail.com)
Learning Objectives: To provide an educational and pictorial review of the radiological imaging features (plain radiography/bone scintigraphy/CT/MRI), distribution and classification of primary lymphoma of the bone. To illustrate the clinical
features and peculiar radiological appearances with pathological correlation. To
discuss differentials, in particular in differentiating bone lymphoma from other
primary bone tumours, metastases or osteomyelitis.
Background: Primary bone lymphoma, a rare malignant neoplastic disorder of
the skeleton, is most commonly Non-Hodgkin's in origin. It is essential to separate primary lymphoma of the bone from skeletal involvement by systemic lymphoma which is much more common. The former is stage 1E (extranodal) disease
and the latter, stage IV disease. The radiographic appearances of primary bone
lymphoma are variable. As lesion's can appear near normal on plain radiographs,
a second modality such as bone scintigraphy or magnetic resonance (MR) imaging should be used. MR imaging not only permits early identification but also
depicts the extent of soft-tissue involvement and can be used to assess the outcome of treatment. Although radionuclide scans are useful for surveying the entire skeleton, MR images help assess the exact extent of local involvement. CT is
helpful for detecting cortical erosion and biopsy guidance.
Imaging Findings: Through an institutional experience and a review of literature
we provide a diverse review of presentations and appearances (plain film/bone
scintigraphy/CT/MRI/PET) of primary bone lymphoma.
Conclusion: As it has a better prognosis than many other malignant bone tumors, awareness and early identification of primary bone lymphoma allows appropriate treatment. We have provided an interesting, informative and concise
radiological guide.
C-517
Ewing's sarcoma revisited
Learning Objectives: 1) To learn the imaging features of typical Ewing's sarcoma. 2) To understand the variety of presentations of Ewing's sarcoma. 3) Pictorial
review of the common and uncommon presentations of Ewing's sarcoma. 4) To
learn the role of various imaging modalities in assessment of Ewing's sarcoma.
Background and Imaging Findings: Ewing's sarcoma is a malignant tumour
seen in children, which arises from primitive neuroectodermal tissue with varying
levels of differentiation. It is common in the first two decades, in males and in the
diaphysis. The characteristic location is around the knee joint and it shows permeative bone destruction with onion skin periosteal reaction, spiculation, Codman's triangle and extensive soft tissue mass. However, it can arise from any
bone and imaging features are variable depending on the location and grade.
The pictorial review illustrates the imaging features of Ewing's sarcoma in different locations including atypical cases. X-ray is the initial modality. CT is useful for
finding the extent of the lesion and soft tissue involvement. MR imaging is more
accurate in assessing extent, soft tissue involvement and response to therapy.
Bone scan is used for finding skeletal metastasis and 201 thallium scanning is
useful in monitoring response to treatment.
Conclusion: Although the imaging features of typical Ewing's sarcoma are well
known, there is a wide spectrum of imaging appearances. Knowledge of this
variation is essential in diagnosing this malignant condition.
C-518
Imaging findings of sacral tumors
S. Gerber1, L. Ollivier1, J.G. Leclre2, D. Vanel2, H. Brisse1,
S. Neuenschwander1; 1Paris/FR, 2Villejuif/FR (sophie.gerber@curie.net)
Learning Objectives: To study the different types of sacral tumors, to describe
the specific aspects of different histological types of tumor and to set out the
principles of available treatments.
Background: All of the constitutive components of the sacral bone may induce
local tumors. Bone metastasis and bone involvement of hemopathies are the
more frequent etiologies. Primitive bone tumors, meningeal or nervous tumors
are more unusual. Some particular histologic forms such as chordoma or giant

cell tumor have a specific tropism for the sacral bone. Clinical signs are usually
poor and lesions are currently diagnosed when compression of pelvic or nervous
structures occurs.
Procedure Details: A PC power point presentation of cases coming from two
Cancer Centers and one Orthopaedic Surgical Department, reviewed and analysed in the light of the literature. Images are presented in a didactic form. The
role of conventional radiology, CT and MR imaging is discussed, and radiologic
features are compared with the histological data. The impact of imaging features
on therapeutic decisions, especially surgery and at follow-up, is also reviewed.
Conclusion: Analysis of radio-clinical cases of sacral tumors compared with data
from the literature completes the knowledge of the radiologist and improves their
diagnostic performance.
C-519
MR differentiation of low-grade chondrosarcoma from enchondroma
H.-J. Sunwoo1, W.-H. Jee1, J.-H. Cho2, J.-Y. Kim1, K.-A. Chun1, S.-J. Hong1,
H. Chung1, M.-S. Sung1, Y.-S. Lee1; 1Seoul/KR, 2Suwon/KR
(whjee@catholic.ac.kr)
Purpose: To evaluate the MR imaging for discrimination between low grade chondrosarcoma versus enchondroma.
Methods and Materials: MR images of 34 patients who were confirmed as low
grade chondrosarcoma or enchondroma were retrospectively reviewed. After review of medical records, MR findings in 18 patients with low grade chondrosarcoma and 16 patients with enchondroma were compared.
Results: The patients with low grade chondrosarcoma had a significantly higher
incidence of MR findings as follows (p < 0.05): predominantly intermediate signal
on T1-weighted images in comparison with that of muscle [72% (13/18) in low
grade chondrosarcoma vs 25% (4/16) in enchondroma], multilocular appearance
on contrast enhanced T1-weighted images [83% (15/18) vs 44% (7/16)], cortical
destruction [33% (6/18) vs 0% (0/16)], a soft tissue mass [28% (5/18) vs 0% (0/
16)], adjacent bone marrow and soft tissue abnormal signal [22% (4/18) vs 0%
(0/16)], and an involvement of epiphysis or flat bone [56% (10/18) vs 19% (3/16)].
There was no significant difference in high signal area from residual normal fatty
marrow on T1-weighted images [89% (16/18)] in low grade chondrosarcoma vs
69% (11/16) in enchodroma], low to intermediate signal on T2-weighted images
in comparison with that of fat [22% (4/18) vs 19% (3/16)], heterogeneous signal
on T2-weighted images [100% (18/18) vs 81% (13/16)], or multiseptation on T2weighted images [83% (15/18) vs 75% (12/16)] (p > 0.05).
Conclusion: MR imaging shows helpful features for differentiation of low grade
chondrosarcoma from enchondroma, however no single finding or combination
of findings allows definitive differentiation of low grade chondrosarcoma from
enchondroma.
C-520
MR features of tumorous lesions of the hand and foot: A pictorial review
K. Taguchi, O. Tokuda, Y. Harada, N. Matsunaga; Ube/JP
(koutarou0724@yahoo.co.jp)
C-521
MDCT of non-united scaphoid fractures: Information for surgical planning
S.L.J. Williams, P.T. Brooks, F.B. Schreuder; Stevenage/UK
(sarahlwilliams@doctors.org.uk)
Learning Objectives: 1. To understand the anatomy and pathophysiology of the
scaphoid in trauma. 2. To review the MDCT findings with non-united scaphoid
fractures. 3. To describe the features that are salient to subsequent surgical management. 4. To understand post surgical assessment.
Background: Scaphoid fractures are the commonest fracture of the carpal bones.
Two thirds of scaphoid fractures occur at the waist, which can be impinged upon
by the radial styloid process during radial deviation. The initial diagnosis and
subsequent management of these injuries can be difficult. Of the complications
following scaphoid fractures, non-union and delayed union is well documented.
Imaging Findings: Once suspected, MDCT can confirm delayed union and demonstrate features that predict whether union is likely to occur. Non-union is confirmed on MDCT using the following criteria: bone cysts, sclerosis or distraction
of the fragment ends, or shortening of the proximal pole. All of these features
have a bearing on the subsequent management and surgical planning (including
the type of bone graft). Post surgical MDCT in the patient with continuing problems can demonstrate the positioning of internal fixation, bones grafts and the
native fractured bone.
Conclusion: MDCT of the scaphoid allows for more precise evaluation of scaphoid
injury enabling the appropriate management plan and operative planning if applicable.
C-522
Limb defects induced by sodium fluoride: A multigenerational drinking
water study
M. Koroglu1, B. Kale Koroglu 2, H. Yildiz2, B. Baykal2, A. Yesildag2, O. Oyar2,
U.K. Gulsoy2, E.F. Mumcu 2; 1Ankara/TR, 2Isparta/TR
Purpose: This study examined the teratogenic effect of sodium fluoride (NaF).
Because of the lack of reliable studies on the long-term multigeneration effects of
NaF, it was given to rats continuously over three generations.
Methods and Materials: One hundred 4 weeks old Wistar-Albino rats (50 males,
50 females) received 175 ppm sodium fluoride (79 ppm fluoride) for 10 weeks.
The same number of control group rats (50 males, 50 females) received deionized drinking water. Then they were mated 1:1 within each group. Parental generation was named F0, offspring generation was named F1 and their litters were
named F2. One hundred F1 (50 F1 males and 50 F1 females) fluoride-treated
Wistar-Albino rats were randomly selected for mating. 100 F1 (50 F1 males and
50 F1 females) control group rats were also randomly selected for mating. The
F1 rats in the fluoride treated group were given fluoridated water, and the F1 rats
in the control group were given distilled water for 10 weeks. All of the F2 generation rats (404 fluoride treated versus 410 control group) were examined.
Results: Two (% 0.49) of the 404 rats in the fluoride treated F2 generation had
significant limb defects. In 410 F2 generation control group rats no limb defects
were detected.
Conclusion: Taking this important teratogenic effect of fluoride into consideration, we suggest that the fluoridation of drinking water must be avoided in the
regions with high fluoride content of freshwaters.
C-523
Our experience and literature review in musculoskeletal tuberculosis
J.G.R. Jesus, R.D.P. Rafael; Madrid/ES (jguzman@seram.org)
Learning Objectives: To review imaging findings of musculoskeletal tuberculosis (TB). To illustrate the key points and top differential diagnoses of this disease.
To suggest a diagnostic decision tree for musculoskeletal TB investigation.
Background: Spain is the country with the second highest incidence and mortality rates attributed to TB in the Europe Union. Immunodeficiency syndrome (AIDS)
are the patient group at greatest risk for developing musculoskeletal TB, but immigration in Madrid. Musculoskeletal TB develops in less than 3% of the patients
infected. Radiological manifestations may mimic other diseases.
Imaging Findings: We demonstrate imaging findings (with plain radiograph, CT,
MR imaging, and ultrasound) in 85 patients with a microbiologically confirmed
diagnosis of musculoskeletal TB. The patients were identified by retrospective
review of a 15-year period at our institution. The illustrations were classified as
spinal and extraspinal (arthritis, osteomyelitis and soft tissue lesions) and in some
cases, the evolution of abnormalities are also detailed.
433
Musculosk
eletal
Musculoskeletal
Learning Objectives: To show the magnetic resonance (MR) imaging findings in

the evaluation of tumorous lesions of the hand and foot and their correlation with
pathologic specimens.
Background: Almost all of the tumors of the hand and foot are benign however,
surgical treatment is often performed because of severe pain. Consequently, correct diagnosis before surgical treatment is needed.
Imaging Findings: Twenty-four histologically confirmed tumorous lesions were
included in the present study. We found glomus tumor, hemangioma, extraskeletal myxoid chondrosarcoma, bizarre parosteal osteochondromatous proliferation
(BPOP), palmar fibromatosis, Morton's neuroma, giant cell tumor of the tendon
sheath (GCTTS), fibroma, osteochondroma, enchondroma, extra-skeletal myxoid chondrosarcoma, epidermal inclusion cyst, periosteal chondroma, osteoid osteoma, ganglion and gout. Glomus tumor and Morton's neuroma were small lesions
that showed very high signal intensity on STIR image and strong contrast enhancement. Soft tissue hemangioma was characteristically of very high signal
intensity, and high signal intensity component on T1-weighted images corresponded to fatty degeneration. Palmar fibromatosis showed a large mass with inhomogeneous high signal intensity on STIR images. Cancellous low signal intensity in
the tumor was characteristic of palmar fibromatosis. Epidermal inclusion cysts
showed high signal intensity on T2-weighted images without contrast enhancement, however the soft tissues surrounding the tumor demonstrated contrast
enhancement. Preservation of cortical bone under the osteocartilaginous mass
on T1-weighted MR imaging, and homogeneous intramedullary enhancement
could be helpful for distinguishing BPOP from other tumors.
Conclusion: MR imaging is a useful technique to speculate pathologic diagnosis

of the tumorous lesions of the hand and foot.

Conclusion: Our findings were consistent with the literature: spondylitis (n = 40)
located in the lower thoracic and upper lumbar spine; peripheral arthritis (n = 28)
distributed in the hip (n = 8), knee (n = 8), ankle (n = 3), shoulder (n = 3), wrist
(n = 3), elbow (n = 2) and sacroiliac joint (n = 1); osteomyelitis (n = 17) with cases of quistic TB, and BCGitis. We also encompass soft tissue abscesses, bursitis
and tenosynovitis. It is important to maintain a high degree of suspicion to allow
early diagnosis and treatment of this re-emerging disease.
C-524
Imaging features of extraosseous myeloma
O. Mathieu, C. de Bazelaire, Y. Uzunhan, A.-M. Zagdanski, V. Nahon,
E. de Kerviler, J. Frija; Paris/FR (oliviermat2002@yahoo.fr)
Learning Objectives: To illustrate the spectrum of imaging findings in extraosseous myeloma. To compare our results with other reports published in the literature.
Background: Extraosseous myeloma is very uncommon (less than 5 % of patients) and few references are available in the literature. However, it is probably
underestimated as suggested by autopsy series. Extra-skeletal involvement has
been described in many organ systems (mainly lymph nodes, liver, pleura and
soft tissues) but the radiological features remain unrecognized.
Imaging Findings: We review 13 patients with myeloma, in whom extraosseous
lesions have been diagnosed. Extra-skeletal myelomatosis has been proved by
histology, cytology or by response to specific treatment. Overall, 20 extraosseous
lesions were identified in the 13 patients. The radiological characteristics are
described and illustrated. Imaging techniques include sonography, CT and/or MR
imaging, and are compared with the other published reports.
Conclusion: The imaging features of extraosseous myeloma are non-specific
and may mimic metastatic disease. Although such lesions are uncommon, the
radiologist should be aware about the potentiality of extra-skeletal spread of myeloma, which is a sign of aggressive disease with poor prognosis.
C-525
Tumor response to molecular-targeted therapy: Comparison of GIST and
chordoma MR-CT imaging patterns
A. Messina, C. Spreafico, P. Casali, D. Vergnaghi, A. Gronchi, C. Costa,
S. Stacchiotti, R. Musumeci; Milan/IT (messanto@tin.it)
Purpose: To compare CT and MR patterns of tumor response to imatinib mesylate in patients affected by GIST and chordoma.
Methods and Materials: Retrospective review of 84 patients with advanced abdominal GIST and 14 patients with PDGFB/PDGFRB-expressing chordoma (12
with chordoma of the sacrum, one with chordoma of the clivus and one with
vertebral chordoma), undergoing therapy with imatinib mesylate, was performed.
In all patients CT and MR examinations were performed at baseline and then at
2, 4, 6, 8, 10 and 12 months during treatment.
Results: CT and MR patterns in responsive patients (54/84 for GIST and 8/14 for
chordomas) were: (A) tumor decrease in size in all cases (with an increase in
tumor volume in 8% of the cases of GIST and in 60% of chordoma at the first 2
months due to necrosis or bleeding). Reduction in size was slower in patients
affected by chordomas; (B) hypovascularization of the lesions in all cases (due to
necrosis); (C) peritoneal fluid at the first month (15% of cases), reabsorbed in the
following months (only in patients affected by GIST); (D) hypointensity of the lesions on T1-w and ce-T1-w MR images, hyperintensity of the lesions on MR T2w images and hypodensity of the lesions on ce-CT images in all cases (correlating
with the presence of degenerative tissue or necrosis).
Conclusion: In GIST and chordoma, we saw similarities in radiological changes
induced by imatinib mesylate. Similar tissue alterations manifested early in both
diseases, but evolved slowly in chordoma. Peritoneal fluid was only evident in
GIST patients.
C-526
Musculoskeletal lymphoma: A pictorial review
E. de Luis, J.J. Noguera, L. Daz, I. Vivas, B. Zudaire, J.D. Aquerreta;
Learning Objectives: To review the radiological aspects of primary musculoskeletal lymphoma. To learn the common differential diagnosis of primary bone lymphoma (PBL). To realise about the possibility of a multifocal variant (primary
multi-focal osseous lymphoma - PMOL).
Background: Primary musculoskeletal lymphoma is an uncommon malignancy
that accounts for less than 5 % of primary bone and soft tissue tumours. We
performed a retrospective study (1984-2004) searching for musculoskeletal lym-
434
phomas. Radiological (plain films, CT, MR, US) and nuclear medicine (scintigraphy, PET, PET-CT) studies were evaluated. Twenty-one cases of PBL and two of
primary muscular lymphoma were found. PBL may be associated with haematological diseases or HIV.
Imaging Findings: In our series, primary muscular lymphoma appears as welldefined soft tissue masses located in leg muscles, which show profuse vascularization on US and hyperintense signal on T2-weighted MR images. PBL appears
as lytic (permeative pattern on plain films) lesions associated with soft tissue
masses but with little cortical destruction on CT images. The most frequent locations of PBL were long bones and vertebral bodies. When PMOL needs to be
ruled out, nuclear medicine techniques are recommended. Differential diagnoses
should include other round cells tumours (sarcoma and myeloma) and osteomyelitis.
Conclusion: When a solitary lytic lesion with little cortical destruction, associated with a soft tissue mass, is found in a patient older than 30 years, PBL has to
be included in the differential diagnosis. However PBL may not be detected on
conventional plain films and other imaging techniques are required.
C-527
The role of MRI and plain film radiography in the assessment of metatarsal
osteomyelitis in diabetes patients
A. Cremona, G. Argento, M. Cavallini, F. Fallucca, V. David; Rome/IT
(gargento@sirm.org)
Learning Objectives: Osteomyelitis affects bone marrow. It may occur because
of haematogenous spreading, or through penetrating skin and superficial lesions
such as plantar ulcerations. It is important to correctly determine bone marrow
extent and soft tissue involvement, to distinguish chronic lesions from acute and
to carefully examine the sites of previous surgical resections.
Background: Thirty-five patients with diabetes and clinical suspicion of osteomyelitis (26 males, 9 women, age range 39-2, average 55) underwent plain film
and MR imaging of the foot (MRT 1.5 T Siemens Sonata), using multiplanar TSE
T1-w and T2-w sequences followed by enhanced fat-sat SE T1-w images.
Imaging Findings: Even though X-ray films differentiate chronic from acute conditions, they have low sensitivity (61%) and specificity (72%) remaining negative
in the first 2 weeks. MR imaging demonstrated high sensitivity due to excellent
contrast resolution and multiplanar imaging. In our experience the 1st and 5th
metatarsal bone and distal phalanx of the toe were more frequently involved in
osteomyelitis, characterized by enhancement on fat-sat SE T1-w images. Magnetic resonance images also permit detection of related abnormalities such as
ulcerations, abscesses, sinus tract, septic arthritis and fat tissue cellulitis.
Conclusion: X-ray remains the cheapest and easiest to obtain method in forefoot studies, but the higher sensitivity and contrast resolution of MR imaging make
it the best choice for assessing and staging osteomyelitis and its associated soft
tissue abnormalities. These factors have great value in monitoring pharmacological treatment response and evaluating surgery outcome.
C-528
The ultrasound scan in monitoring in regenerated bone
A. Bulzacchi 1, C. Iacobellis1, A. Rioda2; 1Padova/IT, 2Dolo/IT (anbulza@tin.it)
Purpose: The aim of this work was to delimit the diagnostic possibilities of the
ultrasound scan in the evaluation of regenerated bone produced in bone lengthening and transports.
Methods and Materials: The study is based on 56 ultrasound scans of regenerated bone regarding 4 lengthenings and 18 bone transports. X-ray examinations
were taken in 13 patients contemporarily with the ultrasound scans and a comparative and qualitative evaluation between the radiographic gap and the ultrasound one was made.
Results: The ultrasound scans allowed us to distinguish 3 kinds of regenerated
bone: normal, cystic and hypertrophic. In 7 cases, at the proximal third of the
tibia, a cyst in the regenerated bone was noticed on ultrasonography. The evaluation of these cysts after slowing down the distraction speed was satisfactory in
the sense that they disappeared in the following examinations, their volume did
not change and they did not interact with the following maturation and corticalization of the regenerated bone. In one case, at the proximal third of the tibia, we
noticed two cysts that disappeared after regenerated bone compression while,
after a new distraction made at lower speed, a cyst appeared again maintaining
its unchanged volume. The presence of one or more cysts indicates an initial
crisis of the regenerated bone which could develop into a dangerous hypotrophy
if the distraction speed remained unchanged.
Conclusion: The ultrasound examination can offer a precise monitoring of distractional osteogenesis.

C-529
Musculoskeletal
Assessment of pain in the metatarsal region with MRI

R. Domnguez-Oronoz, O. Persiva, X. Merino-Casabiel, V. Pineda, S. Gispert;
Barcelona/ES (gisppy@yahoo.es)
Joints
Purpose: 1. To evaluate with MR the underlying conditions in our series of patients with pain in the metatarsal region. 2. To correlate several biomechanic parameters of the forefoot bone structures with the appearance of bone and soft
tissue disorders leading to forefoot pain.
Methods and Materials: Thirty patients with pain involving the metatarsal region
were studied with MR. These parameters were considered: plantar arch deformities,; luxation, coronal rotation and axial deviation of the metatarsal heads; proximal interphalangeal joint luxation; hallux valgus deformity; plantar fascia and
plantar plate injuries; extensor and flexor tendon complex injuries; presence of
intermetatarsal bursitis; Morton neuromas and bone disorders including sesamoid bones abnormalities. These figures are posteriorly correlated with the clinical
setting of the patient.
Results: Up to two thirds of the patients in our series presented with disturbances of the relationship among the bone structures of the forefoot such as presence
of hallux valgus deformity (67%), plantar arch collapse (63%), several degrees of
metatarsal rotational deviation in the coronal plane and metatarsal head luxation.
These abnormalities lead to a biomechanical impairment causing pain in the
metatarsal region. Flexor tenosynovitis (57%), Morton neuroma (47%), bone disorders (25%), and intermetatarsal bursitis (23%) are among the leading causes
of forefoot pain in our series.
Conclusion: A metatarsophalangeal joint biomechanical approach with MR is
proposed for a better understanding of the underlying conditions leading to pain
in the forefoot region.
Radial tears of the medial meniscus: MRI correlated with arthroscopy

Y.-M. Sohn, S.-J. Hong, K.-U. Nha, S.-K. Joo, D.-W. Kim, C.-M. Park; Seoul/KR
(sonyumee@naver.com)
C-530
Influence of a new stemless femoral prosthesis on bone remodelling
evaluated by DXA
C. Albanese, K. Lanciotti, M. Rendine, F. Marchetti, F. Santori, R. Passariello;
Rome/IT
Purpose: In this study, DXA scan was employed to evaluate and compare the
behaviour of different femoral components including a recently developed stemless implant which features complete stress transfer over the proximal femur.
Methods and Materials: A total of 20 patients, operated with six different femoral implants, were included in the present study. Five of these stems are widely
commercially available (ABG, CFP, IPS, Mayo, Zweymueller) and present different patterns of stress distribution. The sixth, with a stemless design, was recently
introduced. Average interval between the operation and the DXA exam was 3
years, each group included 20 patients. Periprosthetic bone mineral density was
measured by DXA according to the seven Gruen femoral regions (ROI), using
the software metal removal.
Results: Differences in bone density were found in each group as well as between different groups. Significant differences (p < 0.001) were found between
the stemless implant and the other five groups in zone I, IV, and VII. CFP, IPS and
ABG groups showed decreased bone density in ROI I, while Mayo, IPS, ABG and
Zweymueller were osteopenic in ROI VII. An increased bone density in ROI IV
was found in Zweymueller, Mayo, ABG and IPS groups.
Conclusion: Our data suggest that DXA device in a conservative stemless implant with complete load transfer, was able to detect the redistribution of bone
density in the single ROI and the proximal periprosthetic bone stock.
C-531
Purpose: Radial tears of the meniscus can lead to early degenerative changes
due to loss of hoop tension, and they have been reported to be very difficult to
visualize on MR images. The purpose of this study is to assess 1) the characteristics and the ability of MR imaging to detect, 2) the incidence and 3) the lesions
associated with radial tears of the medial meniscus.
Methods and Materials: Two hundred and sixty consecutive arthroscopic meniscectomy, excluding ligament injuries, were performed from January 2003 to
July 2004 by one orthopaedic surgeon. Of the 260 cases, MR images of the knee
were obtained preoperatively in 226 cases. One orthopaedic surgeon and one
musculoskeletal radiologist analyzed MR imaging findings of the cases with radial tear of the medial meniscus prospectively. Two radiologic signs were used to
detect a radial tear: 1) the cleft sign and 2) increased signal or absence of the
posterior meniscus (ghost meniscus).
Results: Forty-seven cases with radial tears of the medial meniscus were identified (18.0 %, age range 48-85 years, mean 60.5 years) by arthroscopy. All of
them were located in the posterior root of medial meniscus and were full thickness tears except 3 cases. Thirty-four patients had pre-existing cartilage degeneration and osteonecrosis. The sensitivity and specificity of the cleft sign and
ghost sign were 72.9% and 98.8%, and 93.7% and 98.8% respectively, at preoperative MR imaging. When these two criteria are combined, the sensitivity, specificity, and accuracy were 97.9%, 97.7%, and 97.7% respectively.
Conclusion: We can accurately diagnose radial tear of the medial meniscus in
preoperative MR imaging with combined use of cleft sign and ghost meniscus
sign.
C-532
Arthro-MRI follow-up of osteochondral lesions of the knee after
arthroscopic repair
A. Barile, N. Limbucci, L. Zugaro, V. Calvisi, C. Masciocchi; L'Aquila/IT
(antonio.barile@cc.univaq.it)
435
Musculosk
eletal
Musculoskeletal
Purpose: To assess the role of MR imaging and arthro-MR imaging in the evaluation of the post-operative knee after arthroscopic interventions for osteochondral lesions.
Methods and Materials: Thirty-nine patients entered the study. All patients presented osteochondral lesions diagnosed by pre-operative MR imaging (dedicated 0.2 T or whole-body 1.5 T units). All patients underwent operative arthroscopy.
Seventeen patients (Group A) had chondral defects with no bone involvement; 8
of them underwent microfracture chondroplasty, 7 osteochondral autograft, and
2 autologous chondrocyte transplantation. Twenty-two patients (Group B) had
osteochondral defects (in 10 cases dissecans osteochondritis); 8 patients underwent osteochondral autograft, 2 osteochondral allograft, 5 microfracture and 7
drilling technique. All patients underwent MR imaging and arthro-MR imaging
(1.5 T unit) follow-up two months and one year after surgery.
Results: After one year, MR imaging and arthro-MR imaging showed success of
chondroplasty in 13 Group A patients. Failure of 2 autografts (after 2 months) and
2 microfracture attempts (after 1 year) were reported. In Group B at one year,
surgery had been successful in 10 cases. Failure was evident in 5 grafts (4 after
2 months, 1 after one year), 2 microfracture attempts (after one year), and 5
drilling attempts (after two months). After one year, 8 of 20 patients submitted to
microfracture or drilling showed MR imaging signs of fibrosis. In all cases of graft,
arthro-MR imaging provided additional information about cartilage and fragment
stability.
Conclusion: MR imaging and arthro-MR imaging are very useful to study the
post-operative knee after osteochondral lesion repair. We emphasize the role of
arthro-MR imaging in cartilage and stability evaluation.

C-533
Magnetic resonance imaging of the temporomandibular joint: An illustrative
review of anatomy, biomechanics, and selected pathology with clinical
correlation
J.S. Weaver, M.A. Hughes, M. Kalume Brigido, Y. Morag, D.A. Jamadar,
P.C. Maly Sundgren, M. De Maeseneer, J.A. Jacobson; Ann Arbor, MI/US
(jennweav@umich.edu)
Learning Objectives: To review MR anatomy of the temporomandibular joint,
the biomechanics of the temporomandibular joint and selected pathology of the
temporomandibular joint.
Background: Temporomandibular joint syndrome is the most common cause of
facial pain second only to dental pain. Temporomandibular joint pain and dysfunction can be incapacitating, with important social and economic ramifications
for the patient. One must be familiar with the MR imaging appearances of such
pathology to provide an accurate diagnosis.
Procedure Details: We used a computerized database search to retrieve all temporomandibular joint MR examinations performed from June 1995 to May 2005
at our institution. Images from 160 MR examinations were retrospectively reviewed.
Imaging findings were compared to available clinical data. A total of 156 patients
(30 male, 126 female; mean age 38.6 years) with symptoms attributable to the
temporomandibular joint were identified. Meniscal abnormalities were the most
common abnormality encountered. Other disorders include osteoarthritis, synovial cysts, synovial osteochondromatosis, and rheumatoid arthritis. This exhibit
will review the normal anatomy, including normal findings in both open mouth
and closed mouth positioning. Each pathologic example will also be demonstrated, and correlated with clinical findings when available. Pitfalls will be discussed.
Familiarity with normal anatomy and common pathology of temporomandibular
joint MR imaging is important in formulating an accurate diagnosis.
Conclusion: Teaching points are as follows: (1) MR imaging is an accurate method to identify the extent and location of temporomandibular joint abnormalities;
(2) MR imaging provides information about meniscal biomechanics and pathology; (3) MR imaging provides help in the diagnosis of a wide spectrum of temporomandibular joint disorders.
C-534
Posterior cruciate ligament injuries: What the surgeon needs to know
E. LLopis1, P. Ferrer1, V. Higueras1, M. Padron 2; 1Valencia/ES, 2Madrid/ES
(ellopis@hospital-ribera.com)
Learning Objectives: To review the spectrum of imaging features of posterior
cruciate ligament (PCL) injuries, isolated or combined with associated soft tissue
and bone injuries, and to emphasize each imaging modality role. To describe the
MR imaging appearance of PCL in the follow-up of conservative treatment and
after surgical graft techniques.
Background: PCL injuries are more frequent and less benign than previously
thought. Proper diagnosis and management of concurrent associated lesions can
avoid treatment failure.
Imaging Findings: Acute isolated injuries are well classified on MR imaging as
intrasubstance, partial or complete tears. Bone bruises permit identification of
the mechanism of injury and provide a valuable clue to depict other internal derangement. Posterolateral corner soft tissue injuries are usually associated with
PCL injury in high-speed accidents. If knee dislocation is suspected MR imaging
is essential to plan early surgery and neurovascular injuries must be ruled out by
angio-CT. Multidetector-CT helps in type II and III avulsion fractures to delineate
the shape and degree of comminution as a prelude to surgical fixation. MR imaging is an efficient tool to follow-up conservative and surgical treatments. PCL
frequently develop a low intensity ligament-like tissue. The postoperative appearance of the PCL graft shows mild to moderate signal intensity during the 1st postoperative year, that decreases with time. Knowledge of correct graft tunnel
placement is essential for postsurgical evaluation.
Conclusion: Radiologists must be aware of the specific imaging features, associated injuries and new surgical treatments in order to improve diagnostic accuracy and aid to patient management.
C-535
Ultrasound demonstrated neovascularity in the patella tendons of elite
athletes
H.R. Galloway1, C. Purdham2, A. Harvey1; 1Woden/AU, 2Bruce/AU
(howardrg@netspeed.com.au)
Purpose: To determine the prevalence and relationship of the grey scale changes of patella tendinosis and power Doppler ultrasound changes of neovascularity
436
and their relationship to current symptoms, previous symptoms and clinical tendon score.
Methods and Materials: Forty-three international level athletes in volleyball,
netball and basketball were screened clinically and by ultrasound on induction
into the Australian Institute of Sport. Subjects were assessed clinically for symptoms of previous or current patella tendinosis, other causes of knee pain and
given a recognised (VISA) functional score. Ultrasound of the patella tendon was
assessed for the presence of an hypoechoic area, the presence of neovascularity and the total neo-vessel length.
Results: The prevalence of grey scale changes alone was 20%, the presence of
neovascularity alone was 5% and the prevalence of combined grey scale changes and neovascularity was 6%. The prevalence of symptomatic patella tendinosis
was 8%. US abnormalities of all types were more common in the symptomatic
group than in the asymptomatic group (72% vs 12%). The combination of grey
scale and Doppler changes was more common in symptomatic tendons than in
asymptomatic tendons (44% vs 1.6%). The mean neovascularity score was 3x
higher in the symptomatic tendons but there was wide variation (3-15.5 mm).
Conclusion: The results suggest that the finding of neovessels in addition to
grey scale findings is significant in the symptomatic tendon.
C-536
Interobserver reliability in ultrasound examinations of the shoulder
B. Laoutliev1, L. Morcel1, S. Karstrup2; 1Kge/DK, 2Roskilde/DK
(hanlao@dadlnet.dk)
Purpose: To determine the interobserver reliability in ultrasound (US) examination of the rotator cuff between two radiologists. All patients presented with traumatic history.
Methods and Materials: Twenty consecutive patients underwent US examinations of the shoulder due to clinically suspected rotator-cuff abnormality. Two radiologists with a special interest in musculoskeletal US performed the examinations
independently on the same day. Both radiologists used different settings of the
ultrasound unit - spatial compounding, photopic and speckle reduction imaging.
Both observers registered abnormalities of the shoulder by using a standardized
predesigned schema. The study was done prospectively and the results were
blinded to each observer.
Results: Satisfactory agreement was obtained when the observers suspected
calcium deposits with positive findings in 15 and 19 patients respectively and
overall agreement 0.7. When rupture of the surpraspinatus tendon was suspected, the two observers agreed on a positive finding in 10 and 14 patients respectively (overall agreement 0.7). In cases of impingement the results showed lower
reliability, as the observers found impingement in 6 cases and 9 cases (overall
agreement 0.6). The overall agreement for biceps tendon abnormality was 0.65.
Conclusion: The results indicate that ultrasonography of the shoulder is a complex examination with variation in the interobserver agreement. This should be
kept in mind, especially in cases where no final results can be obtained, and
underlines the importance of supervision and continuous quality control.
C-537
Diagnostic performance of MR arthrography after rotator cuff repair
S.R. Duc, B. Mengiardi, C.W.A. Pfirrmann, B. Jost, J. Hodler, M. Zanetti;
Zrich/CH (csduc@dplanet.ch)
Purpose: The objective of this study was to investigate the diagnostic performance of MR arthrography after rotator cuff repair.
Methods and Materials: MR arthrographic examinations of the shoulder performed after rotator cuff repair and before revision surgery were retrospectively
analyzed in 48 patients (17 women, 31 men, mean age 50.3 years). Full-thickness and partial thickness defects of the supraspinatus, infraspinatus and subscapularis tendons were diagnosed independently by two radiologists. Revision
surgery served as the standard of reference.
Results: Observer 1 correctly recognized 5/8 intact supraspinatus tendons, 10/
19 partial defects and 19/21 full-thickness defects. For observer 2 the results
were 3/8, 8/19 and 18/21. The corresponding numbers for the infraspinatus for
observer 1 were 28/31, 0/3 and 14/14. For observer 2 they were 28/31, 2/3, 11/
14. For subscapularis, observer 1 made the correct diagnosis in 18/31, 5/6 and 9/
11 tendons. The results for observer 2 were 26/31, 1/6 and 10/11. Interobserver
agreement (weighted ) was 0.47 for the supraspinatus, 0.64 for the infraspinatus and 0.20 for the subscapularis tendons respectively.
Conclusion: Postoperative full-thickness defects of the RC are reliably diagnosed
with MR arthrography. The diagnostic performance for partial thickness defects is
only moderate.

C-538
MR of ankle sprain: Clinical and anatomical considerations to tailor the
most adequate examination protocol
F.M. Martina, P. Simoni, C. Di Capua, C. Malafarina, M. Sammarra,
R.F. Grasso, P. Pavone, B. Beomonte Zobel; Rome/IT (f.martina@unicampus.it)
Learning Objectives: To illustrate the most appropriate MR imaging sequences,
planes and patient positions to provide correct evaluation of the ankle structures
involved in each different mechanism of injury. To describe the relevant anatomical structures not well visualized on conventional protocols. To provide an overview of anatomical details improving depiction of subtle pathological findings.
Background: Due to the anatomical complexity of the ankle, standard MR protocols routinely performed in the evaluation of acute ankle sprains, are often ineffective in demonstrating all involved structures. The mechanism of injury must be
considered in tailoring the MR protocol, thus improving diagnostic accuracy, reducing examination time and patient discomfort.
Procedure Details: We performed a series of 60 ankle MR examinations on 30
asymptomatic volunteers without history of trauma or ankle sprain, using a Siemens Symphony 1.5 T unit. Images were acquired in neutral position, with the
ankle taped into full plantar flexion and into 10 of dorsiflexion. Since the traumatic involvement of structures follows a characteristic "kinetic chain", we propose a
clinical-anatomical approach suggesting a different MR protocol for each mechanism of injury. In our exhibit the normal anatomy will be discussed in detail using
high quality MR images, while each "kinetic chain" of injury will be represented
by drawings and selected clinical cases.
Conclusion: A tailored MR examination based on a clinical-anatomical approach
is mandatory to reduce examination time and to improve diagnostic accuracy
and patient compliance.
C-539
Location-specific intra- and inter-reader reproducibility of MRI cartilage
scoring in the knee joint
H. Yoshioka, K.H. Zou, J.G. Bhagwat, G. Neumann, D.S. Meredith, P. Lang;
Boston, MA/US
Purpose: To assess the reproducibility of MR imaging scoring of cartilage lesions in osteoarthritis (OA) for various regions in the knee joint.
Methods and Materials: MR images were obtained in 28 patients with moderate
knee OA at 1.5 T (sagittal fat-suppressed FSE, TR ms/TE ms 4000/13 and 39;
sagittal fat-suppressed 3D SPGR 60/5, 40?). Three readers independently scored
12 cartilage regions (anterior, central, posterior medial and lateral femoral condyle or tibial plateau: AMFC, CMFC, PMFC, ALFC, CLFC, PLFC, AMTP, CMTP,
PMTP, ALTP, CLTP, PLTP) using a scale of loss of cartilage loss from 0-7 and a
scale of loss of cartilage size from 0-5. MR imaging's were reviewed twice by
each of the three observers independently. Intra-reader and inter-reader agreement among 3 readers were assessed by binarized kappa statistics.
Results: For loss of cartilage depth, intra-reader kappa was very good in CMFC
and PLTP (0.81-1.00), but fair to moderate in ALTP (0.38-0.60). Inter-reader kappa was again moderate to very good with PLTP (0.43-0.82) and poor to fair with
CLFC, PLFC, and ALTP (-0.05-0.36). For loss of cartilage size, intra-reader kappa was good to very good with AMTP (0.76 -1.00), but poor with ALTP. Interreader kappa of loss of cartilage depth tended to be higher than that of loss of
cartilage size.
Conclusion: The intra- and inter-reader reproducibility of measurements of loss
of cartilage depth and size depended on the region measured on the articular
surface of the knee. The diagnosis of a knee cartilage lesion may be influenced
by the site where the cartilage lesion develops.
High-resolution MRI of the ulnar side of the wrist: Morphological analysis in

various positions
H. Yoshioka1, T. Ueno2, T. Tanaka3, P. Lang1; 1Boston, MA/US, 2Morioka/JP,
3
Rochester, MN/US
Learning Objectives: To learn detailed anatomical variations of ulnar side structures of the wrist dependent on it's positioning.
Background: Wrist motion is three dimensionally complicated including pronation/supination, ulnar/radial deviation, and extension/flexion. At the ulnar side of
the wrist, there are many small ligamentous and tendinous structures including
the triangular fibrocartilage complex (TFCC), and they play important roles in
wrist motion and stability even though each structure is small. However, there are
few in vivo MR imaging studies of these structural changes in various positions.
Imaging Findings: High-resolution MR imaging of the wrist was obtained using
C-541
A support vector machine based classification scheme for automatic
discrimination among hip osteoarthritis severity categories
I. Boniatis1, L. Costaridou1, D. Cavouras2, I. Kalatzis2, E. Panagiotopoulos1,
G. Panayiotakis1; 1Patras/GR, 2Athens/GR (panayiot@upatras.gr)
Purpose: The radiographic assessment of osteoarthritis (OA) severity relies on
qualitative criteria, based on OA radiographic features. The aim of this study is
the design of a classification approach for the automatic assessment of hip OAseverity.
Methods and Materials: Thirty six hips (18 normal, 18 osteoarthritic) of 18 patients, with verified unilateral-OA were studied by digitizing corresponding pelvic
radiographs. Radiographic severity of OA was assessed by an expert orthopaedist employing the Kellgren and Lawrence (KL) scale. Based on the KL scale,
hips were grouped in three OA-severity categories labelled as: "Normal", "Mild/
Moderate", and "Severe". Radiographs were first processed applying a custom
developed adaptive wavelet algorithm for enhancing the Hip Joint Space (HJS)
articular margins. On each processed radiograph, 2 ROIs corresponding to osteoarthritic and contralateral-normal radiographic HJSs, were determined. A number
of regional descriptors, related to the shape and size of the selected HJS-ROIs,
were computed and used as inputs to a Support Vector Machine (SVM) classifier.
The latter was used for the classification of hips into the following categories: (i)
Normal-Pathological, (ii) Mild/Moderate-Severe.
Results: The SVM-based classification scheme assigned correctly 35 out of 36
hips to the Normal-Pathological categories (overall accuracy 97.2%, specificity
94.4%, sensitivity 100%). Regarding the discrimination between hips of "Mild/
Moderate" and "Severe" OA, 17 out of 18 osteoarthritic hips were classified properly (overall accuracy 94.4%, specificity 100%, sensitivity 88.9%).
Conclusion: The relatively high classification scores achieved demonstrate the
potential positive contribution of shape classification in the assessment of hipOA severity.
C-542
Imaging findings of sesamoid abnormalities of the 1st metatarsophalangeal
joint
Y.-M. Jeong, W. Jin, D.M. Yang; Incheon/KR (delicate79@nate.com)
Learning Objectives: To know the imaging findings of sesamoid abnormalities
and other lesions, which are similar to sesamoid abnormality on clinical examination, near the 1st MTP joint.
Background: There are several abnormalities of sesamoid bones of the 1st toe.
In addition, lesions in flexor hallucis longus tendon or surrounding soft tissue
have similar clinical finding to sesamoid bone abnormality. In this exhibit we will
describe the imaging findings of 1st sesamoid bone abnormalities and surrounding lesions in 15 pathologically proven or clinically confirmed cases.
Imaging Findings: There were 5 cases of fractures, 2 cases of sesamoiditis, 3
cases of avascular necrosis, one case of bone marrow edema, one case of Nora's lesion, 2 cases of FHL tenosynovitis, and one case of keratinous cyst. In
fractures, fragmentations with bone marrow change were noted. In sesamoiditis,
bone marrow changes and prominent soft tissue change were detected. In avascular necrosis, decreased size of the sesamoid bone with marrow sclerotic change
was seen. In bone marrow edema from stress, only bone marrow change without
significant surrounding soft tissue change or bony fragmentation was noted. Other lesions showed ossified lesion from MTP joint, cystic lesion below MTP joint,
or fluid collection along the tendon sheath with enhancement.
Conclusion: There are some overlapping findings in fracture, sesamoiditis and
avascular necrosis of the 1st MTP sesamoid bones. However, the presence of
bony fragmentation, size change of the sesamoid bone and surrounding soft tissue change will give us helpful points to diagnose these lesions differentially.
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Musculosk
eletal
Musculoskeletal
C-540
a 47-mm microscopy coil at 1.5 T. The shape of the disc proper and triangular
ligament rarely changes for various wrist motions such as ulnar/radial deviation
and supination/pronation. However, the ulnotriquetral ligament and lunotriquetral
intercarpal ligament are tensioned in radial deviation. From pronation to supination, the ulnar head rotates in the counter clockwise direction in relation to the
radius about 150-160 degrees. Extensor carpi ulnaris tendon and its tendon sheath
normally sit in the groove of the ulnar in pronation, while they show sublaxation,
and extensor digitorum quinti is pushed radially, in supination. The distal radioulnar joint capsule of the dorsal side is well demonstrated in the supination. There
is an inverse relationship between ulnar variance and TFCC thickness. Each TFCC
thickness is not uniform, even in normal volunteers.
Conclusion: It is important to recognize morphological changes to ulnar side
structures of the wrist in various positions.

C-543
C-546
MR imaging of autologous chondrocyte implantation of the knee: A pictorial

review
S.L.J. James, D.A. Connell, A. Saifuddin; Stanmore/UK (jamesslj@email.com)
Imaging findings in the swollen toe: Pictorial review

N. Griffin, Y. Griffin, J. Healy; London/UK (nyreegriffin@hotmail.com)
Learning Objectives: To illustrate the MR imaging findings identified in patients

who have undergone autologous chondrocyte implantation of the knee and to
illustrate complications identified in patients who have undergone this procedure.
Background: Autologous chondrocyte implantation (ACI) is a surgical technique
that is increasingly being used in the treatment of full thickness defects of articular cartilage in the knee. It involves the arthroscopic harvesting and in vitro culture of chondrocytes that are subsequently implanted into a previously identified
chondral defect. The aim is to produce a repair tissue that closely resembles
hyaline articular cartilage that gradually becomes incorporated, restoring joint
congruity. Over the long-term, it is hoped that this will prevent the progression of
full thickness articular cartilage defects to osteoarthritis. This educational exhibit
reviews the normal appearances of ACI on MR imaging. Common complications
that are encountered with this technique are illustrated including periosteal flap
hypertrophy, arthrofibrosis, delamination, graft fissuring and subchondral marrow oedema.
Conclusion: It is important for radiologists to be aware of the MR imaging appearances of autologous chondrocyte implantation. The normal findings in the
post operative period, and complications are presented to allow accurate reporting of this increasingly used surgical procedure.
C-544
The diabetic foot: A review of MR findings
S.G. Davies, S. Puppala; Cardiff/UK (Stephen.davies@pr-tr.wales.nhs.uk)
Learning Objectives: 1. To demonstrate the role of magnetic resonance imaging
(MRI) in evaluation of the diabetic foot. 2. To develop effective MR imaging protocols for evaluating the diabetic foot. 3. To recognise osteomyelitis, cellulitis and
abscess. 4. To recognise Charcot arthropathy and differentiate from osteomyelitis. 5. To identify other pathological features of the diabetic foot.
Background: MR imaging is a key imaging modality for evaluation of the diabetic
foot. The commonest indication for imaging is sepsis. Care must be taken with
protocol and interpretation for accurate diagnosis.
Imaging Findings: This educational exhibit will develop the learning objectives
with images drawn from a series of cases.
Conclusion: This exhibit aims to give the reader an enhanced knowledge of the
role of MR imaging in the evaluation of the diabetic foot.
C-545
Partial-thickness tears of the rotator cuff: Diagnosis with MR arthrography
including ABER views
B.-B. Choi, W.-H. Jee, J.-Y. Jung, H.-J. Chun, Y.-S. Kim, J.-M. Kim; Seoul/KR
(whjee@catholic.ac.kr)
Purpose: To determine the reliability and accuracy of MR arthrography with and
without ABER views for the diagnosis of partial-thickness tears of the supraspinatus tendon.
Methods and Materials: Thirty-two patients who had arthroscopy and MR arthrography including ABER views were included. Ten patients who had full-thickness tear of supraspinatus tendon arthroscopically were excluded. MR images
were independently scored by two observers for partial-thickness tears of the
supraspinatus tendon. Interobserver agreement for detection of partial-thickness
tears of supraspinatus tendon was calculated by using coefficients. The differences in areas under the receiver operating characteristic (ROC) curves were
assessed with a univariate z score test.
Results: Sensitivity, specificity, and accuracy of each reader on MR imaging without ABER views were 83% (10/12), 90% (9/10), and 86% (19/22); and 83% (10/
12), 80% (8/10), and 82% (18/22) respectively. Sensitivity, specificity, and accuracy of each reader on overall interpretation with ABER views were 92% (11/12),
70% (7/10), and 82% (18/22); and 92% (11/12), 80% (8/10) and 86% (19/22)
respectively. Interobserver agreement for partial-thickness tears was substantial
( = 0.68). The areas under the ROC curves for each reader were 0.96 and 0.90,
which were not significantly different.
Conclusion: MR arthrography of the shoulder is reliable and accurate for detection of partial-thickness tears of the rotator cuff and the diagnostic sensitivity can
increase with ABER view.
438
Learning Objectives: To provide a pictorial review of conditions resulting in a

swollen toe. To recognise the typical radiological features of seronegative arthritides and to formulate a differential diagnosis for these appearances. To recognise less common, but important pathologies affecting the toe.
Background: There is a multifactorial aetiology to the causes of a swollen toe. A
diagnosis or limited differential can be derived from a knowledge of the possible
conditions affecting the foot and their typical imaging appearances.
Imaging Findings: In this pictorial review, classic appearances of seronegative
arthritides (i.e. psoriasis, Reiter's, ankylosing spondylitis and arthropathy related
to inflammatory bowel disease) affecting the foot are first described with an explanation of the underlying pathology. The differential for an erosive arthropathy
is given (e.g. rheumatoid arthritis, gout, septic arthritis) with typical radiological
features demonstrated for each. An algorithm is provided in order to help determine the aetiology. Other common conditions causing a swollen toe are presented including neuropathic arthropathy, osteomyelitis, hallux valgus, hallux rigidus,
turf toe, sesamoiditis, osteochondral defect and stress fractures. The radiological
features associated with neoplasms affecting the foot are also presented including osteochondroma, enchondroma, aneurysmal bone cyst, osteoid osteoma,
chondrosarcoma, metastases and giant cell tumour of the nerve sheath. Finally,
more unusual pathologies are described such as tumoral calcinosis and bizarre
parosteal osteochondromatous proliferation.
Conclusion: This review will enable a systematic radiological approach to the
different causes of a swollen toe in order to reach an appropriate diagnosis or
C-547
MR imaging of the reconstructed anterior cruciate ligament: Normal
appearance and complications
I.Y.Y. Tsou1, L.-F. Foo2, H.G. Potter2; 1Singapore/SG, 2New York, NY/US
(ian_tsou@ttsh.com.sg)
Learning Objectives: To review the normal appearance of the reconstructed
anterior cruciate ligament (ACL) in the knee with magnetic resonance (MR) imaging, as well as the possible complications.
Background: The anterior cruciate ligament is an important stabilizer of the knee
joint, and is frequently damaged in trauma and sports injuries. ACL reconstruction allows patients to return to their pre-injury levels of activity, as well as prevent instability. Re-injury to the reconstructed ligament or complications may
require imaging to assess the integrity of the graft.
Imaging Findings: The normal ACL graft shows increased signal intensity for a
variable period after surgery, and the positions of the femoral and tibial tunnels
need to be accurately placed to prevent graft dysfunction. Potential complications include: (i) graft failure which manifests as discontinuity of the low signal
graft fibres, (ii) graft impingement due to abnormal position of the graft or a "cyclops" lesion, (iii) arthrofibrosis seen as diffuse low signal fibrosis spreading anteriorly from the graft to the infrapatellar region, (iv) ganglion formation where
fluid accumulates within the graft, surrounded by intact fibres, and (v) infection.
Conclusion: ACL reconstruction is an established procedure in orthopaedic surgery. In post-reconstruction patients with persistent symptoms or a repeat injury,
MR imaging allows identification of a ruptured graft or post-operative complications. We have described the MR appearances of the normal reconstructed ACL
graft, as well as graft injuries and surgical complications.
C-548
Paediatric foot lesions
Learning Objectives: (1) To learn the common and uncommon congenital and
acquired anomalies of the foot in children. (2) To illustrate the imaging spectrum
of paediatric foot lesions. (3) To learn the imaging techniques used for evaluation
of foot lesions.
Background: Congenital deformities of the foot are common in children. They
can be classified into flexible or rigid. Early diagnosis of these deformities is critical for management. Acquired lesions range from trauma to tumours.
Imaging Findings: The pictorial review illustrates the various foot deformities
such as flat foot, club foot, vertical talus, arthrogryposis congenital multiplex,
hallux valgus, hallus varus, metatarsus adductus, hammer toe, skewfoot, polydactyly, syndactyly, venous malformations, tarsal coalition and adductor digiti
minimi quinti. The characteristic findings, various angles and imaging techniques

used to evaluate these deformities are discussed. Acquired paediatric foot lesions such as fractures, dislocations, infections (osteomyelitis, leprosy, fungal
and mycobacterial), arthritis, diabetic foot and tumours (benign and malignant)
are also illustrated. A simple algorithm is provided for approaching these deformities.
Conclusion: X-ray, nuclear medicine, CT and MR imaging are the most useful
investigations in evaluation of paediatric foot lesions.
C-549
Non-arthrographic magnetic resonance imaging of glenoid labral injuries
C.H. Tan, I.Y.Y. Tsou, C.W. Eng, M. Yegappan; Singapore/SG
(tchers1977@yahoo.com.sg)
Purpose: Magnetic resonance (MR) arthrography has been shown to be able to
evaluate glenoid labral tears in the shoulder accurately. However, it requires injection of contrast into the joint space. We sought to evaluate the sensitivity and
specificity of non-arthrographic MR imaging in the detection of glenoid labral injuries, in correlation with arthroscopic findings.
Methods and Materials: We reviewed 212 non-arthrographic shoulder MR examinations over an 18-month period. A total of 32 patients subsequently underwent shoulder arthroscopy by a single orthopaedic surgeon. The mean patient
age was 30 years (range15 to 66), with a male preponderance (M:F=29:3). The
labrum was divided into four quadrants, with the biceps anchor taken to be 12
o'clock. The integrity of the labrum in all quadrants was evaluated, and findings
were correlated with the arthroscopic findings anatomically.
Results: The overall sensitivity and specificity of non-arthrographic MR in detection of labral tears was 91% and 64% respectively, when compared to arthroscopy as the gold standard. In particular, labral tears in the anteroinferior quadrant
were detected with a sensitivity of 89% and specificity of 93%. This is important
as this quadrant represents the site of Bankart's injury, which is a common site
for labral tears.
Conclusion: Non-arthrographic shoulder MR imaging is both sensitive and specific in detecting labral tears associated with glenohumeral instability, comparable to direct arthrographic MR studies. This retains the advantage of MR imaging
being a non-invasive study. Further experience and awareness of normal variants may help to increase the overall specificity of this examination.
C-551
Shoulder MR arthrography: A radiological guide
D. Lohan, C. Cronin, S. Walsh, C. Meehan, P. Mc Carthy, D. O'Keeffe;
Galway/IE (carmelcronin2000@hotmail.com)
C-552
MR imaging of anterior cruciate ligament tears: Evaluation of standard
orthogonal and tailored paracoronal images
S.R. Duc1, M. Zanetti1, J. Kramer 2, K.P. Kch3, C.L. Zollikofer3, K.U. Wentz3;
1
Zrich/CH, 2Linz/AT, 3Winterthur/CH (csduc@dplanet.ch)
C-553
Magnetic resonance imaging of anterior cruciate ligament (ACL)
autografting
S.P. Morozov, E.S. Belysheva, V.E. Synitsyn, A.V. Korolev; Moscow/RU
(spmoroz@mail.ru)
Learning Objectives: To demonstrate the application of MR imaging in postoperative ACL autograft assessment. To illustrate major findings and diagnostic pitfalls of the technique.
Background: Arthroscopic reconstruction of ACL by patellar tendon autograft
represents the "gold standard" treatment for ACL ruptures. The fixation of graft
bone plugs in femoral and tibial bones is usually achieved by interference screws
with bioabsorbable ones being the optimal choice. Conventional X-ray techniques
do not allow visualization of the autograft and bioabsorbable screws. MR imaging
has been shown to be highly effective for the postoperative assessment of graft
harvesting sites, bone tunnels, surrounding bone marrow, and the graft itself.
Imaging Findings: The study sample included 27 patients with symptoms suspicious for postoperative complications or autograft injury. Patients from several
surgical centers were referred for knee MR imaging (1.5 T) for ACL graft control.
Visualization of ACL graft was ideally achieved in double-oblique plane or by 3D
gradient-echo sequences. Positioning of the tibial tunnel and bone plug anterior
to Blumensaat's line resulted in compression of the graft by the tibial roof and
predisposition to rupture. Autograft rupture characteristics were similar to that of
ACL rupture. Normal ligamentization of the autograft should be differentiated from
spraining and edema. MR imaging signs of osteolysis around bone tunnels indicated probable dislocation of screw and fixation failure.
Conclusion: MR imaging became a "one-stop-shop" method for ACL autotransplant assessment, providing indications for timely re-operation. Recognition of
MR imaging features of normal and complicated reconstruction of the ACL is
ideally pursued by the close cooperation of radiologists with orthopaedic surgeons.
C-554
Extrinsic carpal ligaments: Normal high resolution US (HR-US) appearance
F. Lacelli, M. Giglio, L.M. Sconfienza, A. Muda, E. Silvestri; Genova/IT
(enzo.silvestri@infinito.it)
Purpose: Carpal ligaments are divided into two main groups: intrinsic and extrinsic. Extrinsic ligaments are often involved in carpal instability. The aim of this
study is to describe the normal ultrasound appearance of extrinsic carpal ligaments and their bone insertions using HR-US.
Methods and Materials: We have studied both wrists in 18 patients with a Philips
iU22 HR-US and a high resolution linear broadband array (5-17 MHz). We have
scanned along the major axis of extrinsic palmar and dorsal ligaments to assess
the inner structure and the bone insertions. We have also measured the normal
thickness of those ligaments.
Results: In all patients we were able to appreciate the ligament as a fine fibrillar
hyperechoic structure and also its insertions on the bone. We have been able to
assess the course of the ligament and all the connections it takes with the surrounding joint structures, using sagittal and transverse scan plans, oriented along
the anatomic axis of the ligament.
Conclusion: HR-US allows assessment of the extrinsic carpal ligaments with a
very good anatomic detail and it is a suitable tool to study carpal instability.
Purpose: To evaluate the three standard orthogonal imaging planes and a paracoronal imaging plane for anterior cruciate ligament (ACL) tears.
Methods and Materials: Ninety patients (91 knees, 29 females and 61 males)
aged between 15 and 84 years (mean 36.9 16.4 years) underwent an MR imaging of the knee prior to arthroscopy. At surgery 32 knees had an intact ACL, 4
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Learning Objectives: To illustrate the optimal technique for performance of MR

shoulder arthrography, including patient selection (versus non-contrast), preparation and positioning, fluoroscopic intra-articular injection of gadolinium preparation and selection of diagnostic MR imaging sequences. To consider the range
of acute and chronic pathologies that may be detected by this imaging modality.
Background: Radiological investigation of shoulder joint traumatic pathology has
been revolutionised by the advent of gadolinium-enhanced shoulder MR arthrography in assessment of acute and chronic shoulder pathology. The soft tissue
resolution of this technique, coupled with our ability to produce multiplanar reformats has almost entirely condemned diagnostic conventional arthrography, with
its associated radiation exposure, to the historical arcades.
Imaging Findings: Each of the rotator cuff muscles will be considered in turn
with images in their longitudinal and transverse axes in a variety of dedicated
sequences, allowing assessment of a variety of pathologies. We will review presentations and radiological features ranging from muscle to labral tears, and from
effusions to haemorrhages, concomitantly outlining associated bony pathology.
Conclusion: We provide a thorough overview of the wide range of information
obtainable with this imaging technique and, by way of a pictorial review, explain
how this information is optimally acquired.
a partial tear, and 55 a complete ACL tear. In all patients axial, sagittal, coronal
and paracoronal T2-weighted turbo-SE images were acquired. The ACL was classified as intact, partially or completely torn. Partial and complete tears were combined for statistical evaluation.
Results: Partial ACL tears (four cases) were not correctly diagnosed at MR imaging except in one knee by one observer on coronal images. The sensitivity in
detecting ACL tears was 95% (reader 1) and 63% (reader 2) in the axial, 93%
and 95% in the sagittal, 93% and 86% in the coronal, and 100% and 93% in the
paracoronal plane, respectively. The specificity was 75% and 81% in the axial,
72% and 81% in the sagittal, 78% and 94% in the coronal, and 78% and 88% in
the paracoronal plane, respectively.
Conclusion: ACL tears can be diagnosed accurately with each of the standard
orthogonal planes. Based on reader confidence and interobserver agreement
paracoronal images may be useful in equivocal cases.

C-555
Direct MR-arthrography (MRA) of the wrist, ankle, and elbow: Technical
approach
F.M. Martina, P. Simoni, V. Valentini, E. Faiella, A. Ruggiero, P. Pavone,
R.F. Grasso, B. Beomonte Zobel; Rome/IT (f.martina@unicampus.it)
Learning Objectives: To illustrate how to safely and easily approach the wrist,
ankle and elbow joint capsule to perform a successful intraarticular injection. To
discuss advantages and disadvantages of fluoroscopic and US guidance of procedures and to suggest the adequate preparation and amount of contrast media
for each joint.
Background: Direct MRA has been increasingly used to evaluate pathology in
several articulations, but it is the glenohumeral joint and knee that have been
most frequently interrogated by MRA. MRA has also proved to be useful when
considering treatment planning in other joints such as the wrist, ankle and elbow
but is currently considered difficult for an inexperienced operator to perform, dangerous and time consuming.
Procedure Details: During our clinical activity we selected two injection procedures (one fluoroscopic-guided, one US guide) for each joint to realize a short
video-clip. In each clip we summarize the "critical-points" of the procedure. In this
exhibit we also focus on other technical aspects such as the choice of needle,
contrast media preparation, respect of asepsis, potential complications, practical
tips and how to improve patient compliance.
Conclusion: Direct MRA of the wrist, the ankle, the elbow and the hip is easy,
safe and fast to perform. Both US and fluoroscopic guidance can be adopted,
depending on the operator's preference. In our experience injection under fluoroscopic guidance is preferred by both the patient and operator and provides better
asepsis, with a low radiation burden.
C-556
MR arthrography of the shoulder: A proposal for classification of rotator
cuff tears
A. Aliprandi, P. Randelli, A. Fausto, M. Monteleone, S. Modestino, F. Sardanelli;
Milan/IT (a_aliprandi@yahoo.it)
Learning Objectives: The aim of this exhibit is to propose a classification of
rotator cuff tears obtained from the modification of arthroscopic 14 levels classification according to S.J. Snyder (SJS).
Background: MR arthrography of the shoulder is a sensitive imaging modality to
detect rotator cuff tears. Arthroscopic classification according to SJS is used by
orthopaedists to diagnose and plan surgery of the shoulder. A standardized communication between Radiologists and Orthopaedists could increase the effectiveness of shoulder MR arthrography for presurgical evaluation. We retrospectively
evaluate MR arthrography after arthroscopy surgical description, comparing results and modifying it in ten radiological levels of severity.
Procedure Details: We divided the pathologic findings as follows: 1. reduced
subacromial space and synovitis/subacromial bursitis (SJS=0); 2. supraspinatus
tendon (SST) articular surface fibrillation or flap (SJS=A1-2); 3. SST freying of
the bursal surface (SJS=B1-2); 4. SST tendinosis-flap and chronic subacromial
bursitis (SJS=A3-4 or B3-4); 5. SST partial erosion of both surfaces (SJS=C0); 6.
SST full tear of 1 cm (SJS=C1); 6. SST full tear of > 1 cm (SJS=C2); 7. SST
and infraspinatus tendon (IST) full tear (SJS=C3); and 8. full involvement of two
tendons with retraction and muscle degeneration (SJS=C4).
Conclusion: The radiologic-arthrography classifications proposed could be easily used in rotator cuff tears. The similar language of the two classifications could
increase the cooperation with orthopaedics for surgical treatment planning.
C-557
Radiologic overview of pathological findings in small joint arthroplasties
P. Melloni, R. Valls, A. Lttich, M. Prefaneta, A. Martin, M. Prieto; Sabadell/ES
Learning Objectives: To evaluate the spectrum of findings for different radiologic imaging techniques in patients with complications of prostheses of the small
joints. To describe the usefulness of each imaging technique in follow-up and
evaluate different imaging strategies.
Background: We have compiled plain film, US, CT and MR images of pathologic
findings of arthroplasty failure in small joints such as the shoulder, elbow, metacarpophalangeal and interphalangeal knuckles of the hand, scaphoid silicone
prostheses, ankle or metatarsophalangeal joints and silastic or metallic endosinotarsal prostheses.
Imaging Details: We analyzed radiological features of the normal and pathological evolution of small-joint prostheses. Complications (11.8%) include infection,
aseptic loosening, osteolytic lesions, fractures, heterotopic calcifications, migrations, dislocations and others.
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Conclusion: Plain films are essential for evaluation of and detection of complications related to small joint arthroplasties. Other complementary imaging techniques (US, CT and MR) are also useful in certain cases.
C-558
MR arthrography of rotator interval complex: Pictorial review
Y. Shin, K.-A. Chun, K. Kim, O. Kwon; Gyeong Gi Province/KR
(crystal57@hanmail.net)
Purpose: To illustrate MR anatomy and biomechanics of the rotator interval related to glenohumeral joint stability and rotator cuff tendon tear. To demonstrate
the spectrum of abnormalities involving the rotator interval complex.
Methods and Materials: A review of MR arthrography performance at our hospital was completed to identify patients with rotator cuff interval abnormality that
was confirmed arthroscopically.
Results: The rotator interval complex injuries includes tear of the rotator interval
capsule and ligaments, bicipital sling injury, biceps tendon abnormality and associated instability.
Conclusion: MR arthrography appears to be an important modality for evaluation of the rotator interval through distension of the capsule and depiction of the
associated ligaments.
C-559
Bankart revisited: The surgeon, the injury and the procedure
J.M. Mellado1, J. Calmet 2; 1Tudela (Navarra)/ES, 2Tarragona/ES
(jmellado@comz.org)
Learning Objectives: (1) To discuss the historical significance of Bankart's contributions. (2) To summarize the intraoperative and imaging appearance of Bankart
lesions. (3) To review the imaging features of the operated shoulder after conventional and modified Bankart techniques.
Background: Arthur Sydney Blundell Bankart is one of the great British orthopaedists from the period between the wars. He identified the cause of anterior
shoulder instability as the tearing of the fibrocartilaginous origin of the capsule
from the glenoid. He also suggested reconstructing the labrum by passing sutures through holes drilled in the osseous glenoid rim.
Imaging Findings: We summarize the imaging appearance of the bony and softtissue injuries traditionally known as "Bankart lesions". We review the original
and modified Bankart procedures, and describe the imaging features of the shoulder after conventional and modified Bankart techniques.
Conclusion: A comprehensive review of the historical significance of Bankart's
contributions is presented.
C-560
MRI in state value of TMJ and soft tissues after mandibular condylar
fractures
T.V. Bulanova, A.Y. Vasilyev, S.B. Butsan; Moscow/RU (tbulanova@rambler.ru)
Purpose: To determine the abilities of MR-examinations in evaluating soft tissues and temporomandibular joint (TMJ) changes in patients with condylar fractures.
Methods and Materials: The results of MR imaging of 47 patients with 52 condylar fractures (5 two-sided injuries) are presented. All patients (16-55 years) were
divided in to 3 groups: 30 patients with subcondylar fractures, 15 patients with
condylar neck fractures and 7 patients with condylar head fractures. MR imaging
protocol (1.0 T system using 10 sm-FOV coil) included: first, T1 and T2 weighted
images (WI) in oblique-sagittal projection and T1 WI in oblique-coronal projection
with occlusion; second, T1 WI in oblique-sagittal projection with an open-mouth.
All the patients underwent MR examinations at 5-7 days post trauma, 23 patients
underwent dynamic examinations on day 5-14 postoperation and 7 patients had
follow-up examinations at 6-30 months post trauma.
Results: Changes in TMJ with hemarthrosis of different degrees were determined in 47 patients. In patients with subcondylar and condylar neck fractures
soft tissues interposition was found in 38 cases (73.1%), in 2 cases (3.8%) a
bone contusion out of the fracture zone was noticed. Articular disc dislocation
combined with rupture of this bilaminar structure was determined. Air bubble from
the acoustic duct was observed in 2 cases of posterior joint wall fractures. Dynamic MR imaging shows the hemarthrosis resorption in all 23 cases after correct condyle repositioning within 10 days of surgery without punctures. In 30.1%
of the patients, in spite of correct bone repositioning, the disk displacement remained.
Conclusion: MR imaging has prior role in value of all TMJ elements and periarticular tissues.

C-561
Musculoskeletal
Symptomatic rotator cuff calcifications: Short term results of US guided

needle puncture, trituration and lavage
R. Giuliani, I.G. Burrelli, P. Vagli, L. Salvatori, E. Camerini; Lido di Camaiore/IT
(paolavagli@yahoo.it)
Soft Tissue
Purpose: Short term efficacy of US guided needle puncture, trituration and lavage of symptomatic rotator cuff calcifications (RCC).
Methods and Materials: Twenty patients with symptomatic RCC confirmed by
X-ray and US, refractory to conservative therapy were included. The procedure
was performed percutaneously with US guidance, puncturing calcification with
two 16G needles for saline injection and fluid aspiration. Clinical follow-up was
performed by questionnaire (pain score maximum 4, 6 for disfunction) at 3 weeks
and 6-12 months. Statistical variation with respect to preprocedural score was
calculated. Imaging follow-up (X-ray, US) was obtained at 6-12 months to assess
calcification changes (number and size).
Results: We treated 20 shoulders with calcifications of supraspinatous (17), subscapularis (2) and supra/infraspinatous (1). A single calcification was seen in 17
cases while 3 had multiple. Calcification size was: 10-20 mm (15), > 20 mm (1),
< 10 mm (4). US always displayed calcifications whereas X-ray missed 4. Technical success was achieved in 17 while 3 patients required re-treatment. No complications occurred. Clinical (3 weeks) and clinical/imaging follow-up (6 months
and in 7 at 12 months) was obtained in all cases. Clinical results showed statistically significant improvement of the 3 week disability score and of total score at
6-12 months (p < 0.01) with 13 patients cured and 6 improved. One patient had
no significant improvement, with unchanged calcification. At 6 months US revealed absence of calcification (4), residual hyperechoic spots (7), calcification
fragments (9); X-ray showed absence of calcifications (14) and calcification fragments (6). Clinical/imaging results at 12 months replaced those at 6 months.
Conclusion: Our experience show this procedure to be effective for RCC treatment, leading to significant clinical improvement in most cases with low risks.
C-562
Ultrasound findings in sports related peripheral nerve injuries
P. Govind1, G. Bodner2; 1Bangor, Gwynedd/UK, 2Innsbruck/AT
(praveengovind@hotmail.com)
Learning Objectives: Ultrasound of peripheral nerves is under-utilised as a diagnostic tool. We have imaged a series of patients with sport related peripheral
nerve injuries where it's useful role is documented. The advantages of this modality are outlined along with it's limitations.
Background: Sport related nerve injuries occur in up to 5% of athletes. The diagnosis and management of these patients is currently based on electro-myographic/
nerve conduction studies. Accurate management is critical due to the risk of irreversible muscle atrophy. Ultrasound can be useful as a primary imaging tool or as
an adjunct in the management of these patients. The development of new software, coupled with the availability of high frequency (15-17 megahertz) probes
has made adequate visualisation of the peripheral nerves possible.
Procedure: A series of patients with peripheral nerve injuries were examined.
Some of the peripheral nerves imaged included the brachial plexus, radial and
median nerve. High frequency (15-17 megahertz) probes were used. Excellent
correlation with pathological specimens was obtained in most cases.
Conclusion: Ultrasound is an effective way of diagnosing peripheral nerve abnormalities. The importance of early diagnosis and prevention of irreversible
muscle change is vital for recovery. Education and awareness of its useful role in
the management of these injuries is important.
C-563
High-resolution magnetic resonance imaging in study of the skin: Normal
patterns
O. Loustau, N. Sans, M.-L. Despeyroux-Ewers, H. Chiavassa-Gandois,
C. Lalande, J. Giron, J.-J. Railhac; Toulouse/FR (sans.n@chu-toulouse.fr)
Purpose: To validate the quantitative and qualitative criteria of normal healthy
skin using high resolution MR imaging.
Methods and Materials: Gradient echo (FIESTA) and spin echo sequences of
the skin of the heel, back and calf were obtained in 31 healthy volunteers. A
dedicated 3-inch antenna for study of the skin was used to optimize reception
sensitivity. Quantitative analysis was performed to measure skin thickness in these
three sites and qualitative analysis aimed to differentiate the various skin layers.
Results: With both sequences, the stratum corneum appeared as a hyperintense layer. The epidermis was visualized and appeared as a fine, homogeneous, hyperintense line. The dermoepidermal junction was clearer particularly in
the calf. The dermis was identified in each sequence and in each anatomic site.
The signal was hypointense on both sequences, homogeneous with spin echo
and more heterogeneous with FIESTA. The interface between the papillary and
the reticular dermis could be distinguished. The hypodermis was visualized in
both sequences and in all sites and hypodermal inclusions in the dermis were
seen, particularly in the back and calf. Lastly, the pilosebaceous follicles and the
deep vascular network of the reticular dermis were more clearly seen with the
FIESTA sequence. Measures of overall skin thickness and for each layer according to site and MR imaging sequence were performed. Statistical analysis was
then performed to seek significant differences between the results according to
these parameters.
Conclusion: MR imaging provides global analysis with high resolution of the
various skin layers down to the hypodermis and the muscular fascia.
Soft tissue tumors: MR imaging and pathologic features according to the

new WHO classification
J.C. Vilanova1, K. Woertler2, J.A. Narvez3, J. Barcel1, S.J. Martnez4,
M. Villaln1; 1Girona/ES, 2Munich/DE, 3Barcelona/ES, 4Durham, NC/US
(kvilanova@comg.es)
Learning Objectives: 1. To review the new WHO classification of soft tissue
tumors. 2. To show the MR findings with pathologic correlation of soft tissue tumors according to the new WHO classification.
Background: Soft tissue tumors are a large and heterogeneous group of neoplasms hence classification is often difficult. The most effective management
decisions are made when a working group applies the same diagnostic standard
criteria in the evaluation of soft tissue tumors. A new WHO classification of soft
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C-564

tissue tumors had been up-to-dated and established in 2002. The new classification includes the following groups: 1) adipocytic tumors, 2) fibroblastic/myofibroblastic tumors, 3) so-called fibrohistiocytic tumors, 4) smooth muscle tumors, 5)
pericytic (perivascular) tumors, 6) skeletal muscle tumors, 7) vascular tumors, 8)
chondro-osseous tumors, 9) neurogenic tumors and 10) tumors of uncertain differentiation.
Imaging Findings: The poster will depict the MR findings with pathologic correlation of soft tissue tumors according to the new WHO classification and the most
outstanding changes.
Conclusion: The new WHO classification of soft tissue tumors, with MR-pathologic correlation, might serve as a guide for radiologists working in a multidisciplinary committee with clinicians, surgeons and pathologists for the purpose of
uniformity, better patient management and improved outcome.
C-565
MR characterization of post-irradiation soft tissue changes
E. lvarez, E. Sanz, P. Manjn, C. Lopez, L. Glaria, A. Bartolom; Madrid/ES
(elenalvmor@seram.org)
Learning Objectives: To describe the changes in soft tissue post-irradiation.
Background: Radiation therapy is often used to treat musculoskeletal neoplasms,
and results in soft tissue changes in the radiation field. Tumor recurrence typically manifests as an area of high signal intensity on T2-W and STIR sequences.
Unfortunately, all methods of tumor treatment commonly result in local edema,
necrosis, haemorrhage, and fibrosis, that can also cause increased signal intensity, making it difficult or impossible to rule out subsequent tumor recurrence.
Procedure Details: We have reviewed all patients that received radiotherapy for
musculoskeletal sarcomas between 1996 and 2005. We have chosen 20 patients
who had adequate MR follow-up that allowed sequential assessment of soft tissue changes following irradiation; in 2 of them there were tumoral recurrences.
On each of the serial MR imaging studies, we have studied subcutaneous fat,
muscle, and intramuscular septa, grading subjectively the size and signal intensity.
Conclusion: In general, soft tissue signal intensity in the radiation field initially
increased over time. After an average of 6 months, signal intensity decreased
slowly over time. However, at the end of the follow-up period, signal intensity
remained elevated in most patients. Signal intensity increase in the intramuscular septa persisted for much longer than for fat or muscle. A mild increase in size
was noted in the subcutaneous fat and intramuscular septa. Muscle, showed a
decrease in size following treatment. In the two cases with tumoral recurrence a
hyperintense mass with gadolinium enhancement was observed in addition to
the postradiation changes.
C-566
Detection of intra-myocellular lipids (IMCL) in human lumbar muscle by
means of NMR spectroscopy
N. Theumann, J. Pictet, R.A. Meuli; Lausanne/CH
(Nicolas.Theumann@chuv.ch)
Purpose: Muscles show two kinds of fat: extra-myocellular (EMCL) and intramyocellular lipids (IMCL). In the last years, measurement of IMCL in muscles by
MRS has been of interest. For the first time we present spectra acquired at 3 T in
the low back muscles.
Methods and Materials: Spectra were acquired on healthy volunteers. MR spectroscopy was performed on 3 T units. Bodycoil was used for RF-excitation and
surface coil for detection. The shimming was Fastestmap. PRESS sequences
with water presaturation and outer volume suppression were performed. Echo
time varied between 40 and 200 ms, acquisition was 128 and volume of interest
(VOI) varied around 13x13x17 mm3.
Results: Several parameters can influence the separation of the EMCL and IMCL
peaks. First, the muscle fibre orientation changes the chemical shift of the EMCL
peak and consequently the separation. Second, the magnetic field Bo homogeneity changes the peak's linewidth and consequently the overlap of the two peaks.
Finally the VOI position and size also influence the overlap as follows: a high
EMCL/IMCL ratio can makes the IMCL quantification more difficult and this ratio
depends on both the volunteer and particularly the VOI size and exact position.
Conclusion: These first well resolved spectra acquired in the low back muscle
are promising. These measurements could be very useful to determine if the ratio
of IMCL/EMCL could be used as a prognostic indicator of muscular recovery in
chronic low back pain patients.
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Exercise-enhanced MR imaging of skeletal muscle in normal volunteers:
Time-dependent changes of T2 relaxation time and ADC values
O. Tokuda, K. Taguchi, Y. Harada, N. Matsunaga; Ube/JP (chinupapa@goo.jp)
Purpose: To analyze time-dependent changes of T2 and apparent diffusion coefficient (ADC) values in skeletal muscle after calf exercise.
Methods and Materials: T2 and ADC values of the gastrocnemius (fast-twitch)
and soleus (slow-twitch) muscles were measured in 10 healthy volunteers by
using magnetic resonance (MR) imaging. Axial T2 weighted spin-echo and diffusion weighted images were collected after exercise at mid-calf level. The protocol
of exercise was as follows; the volunteers stood on a box, then extension and
flexion of the ankle joint was performed against their own body weight, with an
ankle joint range of motion between full plantar and dorsal flexion. After exercise,
MR images of the calf muscle were obtained at 5-min intervals from 4 to 64 min.
The relationship between T2 and ADC values of each muscle after exercise was
statistically analyzed.
Results: Both T2 and ADC values of the skeletal muscle gradually decreased
after exercise. There were significant differences in T2 values of the lateral
(p < 0.001) and medial gastrocnemius (p < 0.0001) and soleus muscles (p < 0.05),
and ADC values of the lateral gastrocnemius (p < 0.05) and soleus muscles
(p < 0.001) between the various imaging times. T2 values were significantly correlated with ADC variations in soleus muscle (r = 0.6154, p < 0.0001).
Conclusion: Exercise-enhanced MR imaging of skeletal muscle demonstrates
recovery of the water content and diffusion of the skeletal muscle after exercise,
and is useful for sports medicine.
C-568
Tropical pyomyositis: Imaging of tropical pyomyositis with clinical and
surgical correlation
A.J. Stanley, Y.Y. Ho, S.-C. Wang; Singapore/SG (dnrwsc@nus.edu.sg)
Learning Objectives: To demonstrate the spectrum of radiological appearances
of tropical pyomyositis in the context of clinical and surgical findings.
Background: Tropical pyomyositis is a primary infection of the deep skeletal
muscles resulting in intramuscular abscess formation. Although mostly seen in
tropical and sub-tropical regions, with increasing frequency of travel, cases in
temperate regions have been reported. The exact pathophysiology is not fully
understood, but predisposing factors such as an immunocompromised state,
chronic illnesses such as diabetes, and previous muscle trauma are known associations. Staphylococcus aureus is the organism responsible for most cases.
Imaging Findings: Over a 4 year period, between September 2001 and May
2005, 12 cases (10 of which were surgically proven) of tropical pyomyositis were
identified at our institution. The patient group consisted of 8 male and 4 female
patients with an age range from 10 to 70 years. Predisposing factors included
diabetes mellitus, acute lymphoblastic leukemia (ALL), beta-thalassemia and
previous muscle trauma. The lower limb muscles were most commonly involved.
Other sites included the chest wall and forearm. Preoperative imaging with MR
imaging (n = 9), ultrasound (n = 2) and CT (n = 1) confirmed the site, size and
number of intramuscular abscesses and other associated features such as myositis and cellulitis.
Conclusion: Although relatively rare, tropical pyomyositis should be considered
in the differential diagnosis of patients presenting with muscle pain and fever,
especially with certain underlying conditions. Rapid and accurate diagnosis can
be achieved with MR imaging or ultrasound examination.
C-569
Extraperitoneal desmoid tumors: Usefulness of MRI for diagnosis,
treatment planning and follow-up
J.A. Narvaez1, E. Merino1, S. Martinez2, A. Sanchez1, M. De Albert1, X. Mallol1;
1
Barcelona/ES, 2Durham, NC/US (salem2000es@yahoo.es)
Learning Objectives: To describe the MR imaging findings of extraperitoneal
desmoid tumors, with special emphasis on those features which suggest a specific diagnosis. To review the differential diagnosis of extraperitoneal desmoids
tumors, considering different anatomic locations. To correlate changes in MR
imaging signal features of the tumor with clinical outcome in patients treated with
tamoxifen or radiotherapy.
Background: Extraperitoneal desmoid tumors (also called aggressive fibromatosis) are a rare connective tissue neo-formation, originated in the connective
tissue of muscle, the overlying fascia or the aponeurosis. Although histologically
benign, they show an infiltrative growth and frequent local recurrences. Our purpose is to review the usefulness of MR imaging in the management of extraperitoneal desmoid tumors.

Imaging Findings: We retrospectively reviewed the medical charts, and MR imaging studies of all patients with histologically proven extraperitoneal desmoid
tumors seen in a tertiary hospital over a 10-year period. Morphology, lesional
borders, signal intensity on T1-w, T2-w, and STIR sequences, Gd-enhancement
pattern, and signal homogeneity/heterogeneity on MR imaging were assessed in
all cases. Tumor location and infiltration of the surrounding structures, vessels or
nerves were evaluated on MR imaging studies in order to plan surgical treatment.
Differential diagnosis was discussed, considering each specific anatomic location. In non-surgical tumors treated with radiation therapy or tamoxifen, signal
intensity changes on MR imaging were correlated with clinical outcome.
Conclusion: MR imaging is the modality of choice in the diagnosis, treatment
planning and follow-up of extraperitoneal desmoid tumors.
C-570
Whole body MRI in patients with polymyositis and muscular dystrophy
C.M. Born, S. Schnberg, S. Wagner, P. Reilich, M.F. Reiser; Munich/DE
(christine.born@med.uni-muenchen.de)
Learning Objectives: To illustrate the spectrum of whole body MR imaging in
patients with myopathy. To outline the advantages and limits of the technique.
Background: Primary myopathies are rare conditions in patients with weakness.
The diagnosis is based on clinical examination and blood tests results. MR imaging reveals edema and fatty infiltration of muscles as well as localizing the best
place for muscle biopsy.
Procedure Details: A recently introduced 1.5 T scanner (Magnetom Avanto, Siemens) combines 76 coil elements and 32 receiver channels. It allows PAT in all
three-dimensions with free table movement at a total field of view of 205 cm. The
protocol consisted of T1-w SE and STIR sequences. After one single positioning
the patient was examined at five body levels with a coronal STIR sequence, followed by coronal whole-body T1-w SE sequences (fat suppressed) before and
after administration of Gd-DTPA, combined with axial fs-T1-w sequences of the
lower extremities. The total scanning time was 43 minutes. We examined 5 patients with rare kinds of myopathy: 3 patients suffering from primary polymyositis
e.g. Jo1-syndrome and inclusion body myositis, and 2 patients with congenital
limb girdle muscular dystrophy. In all patients we could evaluate typical signs of
fatty infiltration and/or edema as well as CM-enhancement during the active phase
of the disease. The distribution is characteristic for the relevant muscle disease.
Conclusion: Whole body MR imaging allows the performance of a practicable
"single-shot" examination to detect the distribution and grade of involvement of
the muscles as well as to guide diagnostic biopsy.
C-571
Classification and MR imaging of synovial tumors and tumor-like lesions
M. Rodrguez Alvarez, J. Maas Uxo, E. Fontoira Moyer, A. Iglesias Castaon,
M. Arias Gonzalez; Vigo/ES (marta.rodriguez.alvarez@sergas.es)
The role of MRI in diagnosing pseudohypertrophy of the calf muscles

J. Pantazis, G. Michailidis, V. Sotiropoulos, I. Biliara, N. Bontozoglou;
Athens/GR (jpan1968@otenet.gr)
Purpose: Chronic denervation usually results in atrophy of muscular tissue. Nevertheless, it may rarely result in muscle pseudohypertrophy, an entity which has
been reported in patients with chronic radiculopathy, peripheral nerve injury, poliomyelitis, neurinoma, anterior horn-cell diseases and tethered cord syndrome.
The aim of our study is to evaluate the ability of MR imaging in diagnosing calf
pseudohypertophy.
Methods and Materials: Five patients (6-58 years) with unilateral painless calf
enlargement underwent MR imaging in order to rule out tumor. Two patients had
a history of remote trauma, one patient had a history of poliomyelitis, and two
patients had a history of chronic radiculopathy. None of them had a history of
primary muscle disease. MRI images of the affected muscles were obtained before and after intravenous administration of gadolinium. In all patients diagnosis
was confirmed by biopsy.
Results: MR imaging studies revealed unilateral enlargement of the calf muscles
with lipomatous replacement of muscular tissue in three of the patients and the
presence of fat interspersed among muscle fibers in the other two. There was no
disturbance of the architecture of the affected muscles and in all patients except
one there was no pathologic enhancement. The histopathologic results of all patients were negative for malignancy and disclosed atrophy of muscular fibers
with variable amounts of fat.
Conclusion: In cases of painless calf enlargement the demonstration on MR
imaging of fat deposition without disturbance of the muscles architecture is highly suggestive of neurogenic pseudohypertrophy.
C-573
Soft tissue and bone changes in leprosy patients from an outpatient clinic
in Manaus Amazon, Brazil
D.T. Amaral, H.L. Pereira, S.L. Ribeiro, R. Ciconelli, A.C.R. Fernandes;
Sao Paulo/BR (lazden@terra.com.br)
Learning Objectives: Review radiologic findings related to this chronic infectious disease which, in its various clinical forms of presentation, primarily involves the skin and nerves. Underscore the wide spectrum of bone lesions ranging
from those due to direct bone involvement by the micro organism to several abnormalities secondary to denervation of the extremities.
Background: 20 leprosy patients (14 men, 28-75 years old) attended an outpatient clinic in the Amazon. All patients had radiographs of the hands, feet or both,
and had already received a full course of antiloprosy treatment.
Imaging Findings: The lepromatous type was more prevalent (40%) and the
mean duration of disease was 11.1 years. Bone alterations in the hands (n = 8)
were: distal phalangeal absorption (37.5%), claw hands (50%), osteolysis and
osteomyelitis (12.5%). Abnormalities in the feet (n = 18) included: distal absorption of the phalanges (25%), combined distal and concentric absorption (16%),
concentric absorption of the metatarsus and phalanges (10%), osteomyelitis
(22%), osteolysis, periostitis, pathological fracture and neurophatic changes (27%).
The most frequent findings were distal absorption (40%) and secondary osteomyelitis (25%).
Conclusion: Bone changes were secondary to denervation of the extremities.
Feet were most frequently involved.
C-574
Muscle injuries in athletes during the olympic games of Athens 2004:
Imaging with US and MR
A. Balanika, O. Papakonstantinou, E. Chatzimichael, C. Tsompanliotou,
S. Kampanarou, A. Kelekis, E. Brountzos, D. Kelekis, N. Kelekis; Athens/GR
(mpaltas@hotmail.com)
Purpose: To correlate the role of ultrasonography (US) and magnetic resonance
imaging (MRI) in the assessment of muscles injuries in athletes during the Olympic Games of Athens 2004.
Methods and Materials: Thirty-six athletes were identified with muscle injuries
sustained during sports events (mainly judo, tennis, runners). The clinical injuries
included skeletal muscles of the elbow, upper arm, hip, thigh, calf, ankle and
abdomen. All patients were examined by dynamic ultrasonography and MR imaging. Sonograms were obtained using high resolution (7-12 MHz, 12-15 MHz)
linear transducers. In 29 athletes MR imaging was additionally performed.
Results: The echogenity, the alteration in muscle function and any movement of
disrupted fibres (helping differentiate grades of tear) were found by dynamic ul-
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Musculoskeletal
Learning Objectives: To classify synovial tumors and tumor-like lesions. To describe MR imaging (MRI) features, emphasizing those findings that suggest a
specific diagnosis.
Background: Synovial masses can be classified as non-infectious proliferative
diseases (synovial osteochondromatosis, arborescens lipoma, pigmented villonodular synovitis, rheumatoid arthritis), deposition disease (gout, amyloidosis),
infectious granulomatous disease (tuberculosis), vascular malformations, benign
tumors of mesenchymal origin (lipoma, fibroma, hemangioma) and malignancies
(synovial sarcoma). Knowledge of MR imaging features of these synovial conditions aids the radiologist to suggest a confident diagnosis and to asses exact
location and extent. We have selected the most representative cases from patients studied at our institution between 1997 and 2005.
Imaging Findings: Arborescence lipoma is a villous synovial proliferation with a
signal intensity similar to fat or mass-like subsynovial fat deposit. PVNS shows
diffuse or localized synovial masses with paramagnetic effect due to hemosiderin deposition. Giant cell tumor of tendon sheath is the tenosynovial counterpart.
Synovial osteochondromatosis shows lobulated masses with intermediate signal
on T1 and high signal on T2. Calcified free bodies have low signal, ossified nodules display signal similar to bone. Amyloidomas are hypointense masses without paramagnetic effect. Synovial lipoma, fibroma, hemangioma and vascular
malformations have similar findings to their counterparts in other locations. The
remaining conditions do not display pathognomonic features but MR imaging allowed for correct classification and treatment planning nevertheless.
Conclusion: MR imaging has become the modality of choice to evaluate synovial lesions, allowing for a specific diagnosis in most cases and correct treatment
planning in all cases.
C-572

trasonography. US findings in the 36 patients include: complete muscle rupture
(4/36 patients), partial rupture (11/36 patients), oedema (8/36 patients) and elongation (9/36 patients). In 19 patients the US findings correlated with MR imaging
findings in regard to staging. Ultrasound revealed subtle muscles injuries in 2
patients that were not recognized in MR imaging. In 8 patients US seemed to
underscore the stage of injury, while MR imaging was more accurate in defining
the extent of injury.
Conclusion: US proved to be very useful for the initial assessment of muscle
injuries in athletes, while MR imaging was more accurate in detecting the extent
of muscles injury. Very subtle muscles injuries maybe occasionally be revealed
only on US.
C-575
Soft tissue tumors: Imaging features
E. Alymlahi, I. Chami, N. Boujida; Rabat/MA (elkha2003@yahoo.fr)
Learning Objectives: 1) To review the new WHO classification of soft tissue
tumors. 2) To show the MR findings with pathologic correlation of soft tissue tumors. 3) To illustrate the MR-pathologic appearance of soft tissue tumors according to the new WHO classification.
Background: Soft tissue tumors are a large and heterogeneous group of neoplasms hence classification is often difficult. The most effective management
decisions are made when a working group participates in the same standard
diagnostic criteria in the evaluation of soft tissue tumors.
Imaging Findings: The purpose of this pictorial review is to show the new WHO
classification of soft tissue tumors updated and established in 2002. The new
classification includes the following groups: 1) adipocytic tumors, 2) fibroblastic/
myofibroblastic tumors, 3) so-called fibrohistiocytic tumors, 4) smooth muscle
tumors, 5) pericytic (perivascular) tumors, 6) skeletal muscle tumors, 7) vascular
tumors, 8) chondro-osseous tumors, 9) neurogenic tumors and 10) tumors of
uncertain differentiation.
Conclusion: The exhibit will depict the MR findings with pathologic correlation of
soft tissue tumors. The classification might serve as a guide for radiologists working in a multidisciplinary committee with clinicians, surgeons and pathologists.
C-576
MR imaging of giant-cell tumors of the tendon sheath of the hand
A. Garca Bolado1, R. Garca-Barredo Prez2, T. Piedra Velasco1,
M. Fernndez Echevarra1, R. Landeras Alvaro1, E. Gallardo Agromayor1,
P. Martnez Zubieta1; 1Santander/ES, 2Liencres/ES (tatianapiedra@yahoo.es)
Learning Objectives: Describe the spectrum of MR findings in giant-cell tumors
of the tendon sheath of the hand. Establish the correlation between ultrasound
and MR findings and the gross pathological specimen.
Background: Giant-cell tumors of the tendon sheath (GCTTS) usually present
as a firm lobulated painless soft tissue mass, frequently on the volar aspect of
the fingers.
Imaging Findings: At ultrasound, GCTTS of the hand typically appear as solid,
homogeneous hypoechoic masses with detectable internal vascularity that are
associated with the flexor tendons of the fingers. At MR imaging they usually
have predominantly low signal intensity on both T1- and T2-weighted images,
and usually enhance when Gd-DTPA is administered. In some cases they have
atypical features, like absence of enhancement after gadolinium administration
or bone erosion. MR imaging is specially useful in staging GCTTS, particularly in
delineating soft-tissue extension.
Conclusion: Recognition of the spectrum of radiologic appearances of GCTTS
is important in guiding surgery and facilitating early detection of recurrence.
C-577
Ultrasound guided steroid injection in the treatment of painful amputation
stump neuromas
N. Crundwell, D. Elias; London/UK (neilcrundwell@hotmail.com)
Purpose: Post amputation neuromas may be painful. Ultrasound is used to guide
phenol or steroid injection. The outcome of steroid injection is not widely reported.
Methods and Materials: Seven lower limb amputees had clinical symptoms referable to a neuroma [age 23-80 yrs; transfemoral (4), transtibial (3); amputation
due to trauma (2), osteomyelitis (3), atherosclerotic disease (2); time since amputation 2-18 yrs; symptom duration 5-30 months]. Sonography revealed discrete
neuromas (6) or diffuse hypoechogenicity (1). Ultrasound guided injection of depomedrone (deeper lesions) or hydrocortisone (superficial) with 0.25% bupivicaine was performed in each case following local anaesthetic. Patients were later
contacted for telephone interview.
444
Results: One patient was lost to follow-up. Four patients reported moderate/minimal discomfort on injection, 2 severe/extreme pain. Three had complete symptom resolution without recurrence (follow-up 5-23 months), one six months
resolution with recurrence at diminished intensity and frequency, and one 80%
diminution in symptom severity maintained to 1 year. One had 4 days pain relief
before recurrence of original symptoms. Those patients who had been amputees
for the longest time period had lesser responses regardless of symptom duration. The 2 patients who described the injections as extremely or severely painful
both had recurrent pain at 6 months albeit diminished compared with presentation. No long-term complications were reported.
Conclusion: We achieved good to excellent results in 5 of 6 patients (83%). This
compares favourably to published studies of phenol injection and surgical treatment. We favour steroid injection over phenol as the local toxicity risks are reduced.
C-578
Anatomy, pathology, imaging and intervention of the iliopsoas muscle
C. Cronin, D. Lohan, E. Delappe, J. Reynolds, G. O'Sullivan, C. Roche,
P. McCarthy; Galway/IE (carmelcronin2000@hotmail.com)
Learning Objectives: Review the anatomy including musculature, fascial planes,
localised organs and routes of entrance and spread of disease. Outline the clinical presentation, pathologies and differentials. Provide a pictorial review of the
imaging features of a diverse number of iliopsoas pathologies.
Background: Classically, ruptured appendix and severe pyelonephritis were the
associated common aetiologies. With more immuno-compromised patients, the
incidence of iliopsoas pathology is increasing. Iliopsoas muscle pathology, due
to its retroperitoneal location, often presents in an indolent manor with a wide
variety of non-specific signs and symptoms. Due to its proximity to the spinal
canal, prompt diagnosis and treatment is required to prevent devastating outcomes. CT outlines the extent of disease; it may also identify the primary source
of pathology. CT guides biopsy/drain insertion and aids follow-up. Non-contrast
enhanced CT visualises acute haemorrhage and calcification, whereas contrast
enhanced CT optimises imaging of infection and tumour. MR imaging is a helpful
adjunct to CT, especially where spinal canal or vertebral involvement is suspected.
Imaging Findings: Through our institutional experience and a review of literature we will provide a pictorial review of CT and MR imaging features of the iliopsoas compartment and a vast array of its pathology; in particular, inflammatory,
infective, metastatic and haemorrhagic causation of presentation. We provide an
algorithm for investigation, intervention and follow-up.
Conclusion: An understanding of its anatomy, proximity to surrounding structures, pathway of disease spread and detailed presenting clinical history, in association with imaging features, can lead to an accurate and timely diagnosis. We
provide an informative and concise guide.
C-579
Soft tissue tumors of fibrous tissue origin: MR appearance with histological
correlation
M. Pilavaki, D. Chourmouzi, R. Thomaidis, K. Koutroumanidis, A. Fotiadou,
P. Palladas, A. Drevelegas, L. Sakkas; Thessaloniki/GR
Learning Objectives: To illustrate the spectrum of MR imaging findings for each
type of soft tissue tumor of fibrous tissue origin and correlate with histologic features.
Background: From a group of 124 histologically proven soft tissue tumors (77
benign, 47 malignant) we had only 7 tumors of fibrous tissue origin. We retrospectively studied the MR examinations of these tumors (1 nodular fasciitis, 1
elastofibroma, 4 fibromatosis, 1 fibrosarcoma) and correlated the findings with
the histological examination.
Imaging Findings: All tumors showed special imaging findings which reflected
the histological pattern. Nodular fasciitis showed an infiltrative pattern spreading
along the internal septa of subcutaneous fat and the superficial fascial planes.
Elastofibroma reflected the histologic composition of entrapped fat within a fibrous mass. On both T1- and T2-weighted images the tumor had intermediate
signal intensity with linear areas of high signal intensity, similar to that of fat.
Fibromatosis contained hypointense foci on both spin echo sequences which
reflected collagen. Fibrosarcoma showed high signal intensity T2-weighted images with areas of low signal. Also the tumor showed peripheral enhancement
with a spoke-wheel appearance.
Conclusion: Soft tissue tumors of fibrous tissue are rare tumors with varying MR
signal characteristics. The diagnosis can be suggested from the recognition of
special imaging findings, which reflect the histological pattern of the tumors.

C-580
Musculoskeletal
Ultrasound of sports-related nerve injuries

A. Tagliafico1, L. Bacigalupo1, E. Capaccio1, G. Bodner2, S. Bianchi3,
C. Martinoli1; 1Genova/IT, 2Innsbruck/AT, 3Geneva/CH (agtag@libero.it)
Spine
Learning Objectives: To provide an overview of the US findings in the most

common sports-related neuropathies.
Background: In the upper limb, sports-related neuropathies include the burner/
stinger syndrome which involves the upper brachial plexus (contact sports), axillary and suprascapular neuropathies (athletes exposed to overhead repetitive
trauma), the cubital tunnel (pitchers, elite power athletes with hypertrophied triceps) and Guyon tunnel (cyclist's palsy) syndromes, and carpal tunnel syndrome
(weightlifters, rock climbers, cyclists). In the lower limb, specific nerve entrapment syndromes related to sports activities that are amenable to US examination
are: the involvement of the sciatic nerve at the proximal thigh in patients with
hamstring injuries (basketball, soccer, water-skiing), superficial peroneal neuropathy of the lower leg (dancers, athletes with previous ankle sprains) and deep
peroneal neuropathy at the dorsal foot (runners, soccer players, dancers).
Imaging Findings: This computer presentation will use schematic drawings, static
US images and real-time video clips to illustrate the US appearance of sportsrelated neuropathies for which US examination is indicated. Correlation of US
findings with the results from MR imaging and a detailed explanation of the pathogenesis of these lesions will be provided.
Conclusion: With continued experience, it is likely that the use of US will increase with regards to evaluation of pathologic conditions affecting nerves in
athletes.
Imaging the craniocervical junction

P. Rajiah, A.N. Khan; Manchester/UK (rprabhakar73@yahoo.com)
C-581
Benign versus malignant peripheral nerve sheath tumors: MR imaging
evaluation
E. De Lama Salvador1, J.A. Narvaez1, S. Martinez2, M. De Albert1, Y. Roca3;
1
Barcelona/ES, 2Durham, NC/US, 3Badalona/ES (kenadelama@hotmail.com)
Purpose: A number of MR imaging features suggesting extracranial peripheral
nerve sheath tumors have been described, but differentiation between benign
and malignant PNST has received less attention. Our aim is to evaluate the usefulness of MR imaging in the differential diagnosis of benign and malignant PNST.
Methods and Materials: A retrospective review of the clinical charts and MR
studies of 34 consecutive pathologically confirmed cases of extracranial PNST
(9 malignant, 25 benign) was performed. Our patient group comprised 18 males
and 17 females, mean age 47 8 years, 4 presenting with type 1 neurofibromatosis. Clinical presentation (palpable mass, growing mass, pain at rest, neurologic deficit, muscle atrophy) was noted in each case. Two radiologists reviewed, by
consensus, the nerve root-tumor relationship, size, shape, borders, signal intensity on T1-, T2- and Gd-enhanced T1-WI, presence of cysts/necrosis, target sign
on T2-WI and fat-split sign on MR studies. The Chi-square test was used for
statistical analysis.
Results: There were no statistically significant differences in clinical presentation between benign and malignant PNST. Size less than 5 cm, well-defined borders, fusiform shape and presence of the target sign on T2-WI were significantly
more common (p < 0.05) in benign PNST. Absence of the fat split sign and necrosis were more common in malignant PNST but did not reach statistical significance.
Conclusion: Our findings suggest that some MR imaging findings (size less than
5 cm, well-defined borders, fusiform shape and presence of the target sign on
T2-WI) may be useful in differentiating benign from malignant PNST.
C-582
Learning Objectives: 1) To learn the development and anatomy of the craniocervical junction. 2) To understand the role of imaging in assessing the craniocervical junction, especially multidetector CT and MR imaging. 3) To illustrate
X-ray, CT and MR imaging appearances of various pathologies affecting the craniocervical junction.
Background: The craniocervical junction is involved in a variety of conditions
which include congenital, developmental, traumatic, infective, inflammatory and
neoplastic lesions. Pathology in this region can result in compression of the brainstem, spinal cord, cranial nerves, cervical roots and vascular structures. Multidetector CT and MR imaging scans have revolutionised the imaging of this critical
region.
Imaging Findings: X-rays were the first investigation used in craniocervical junction lesions. Multidetector CT with multiplanar reconstruction and MR imaging
were obtained for further information. The pathologies illustrated include congenital (Chiari malformation, syringomyelia, achondroplasia, mucopolysaccharidosis, pyknodysostosis, Downs syndrome, Klippel Feil malformation), traumatic
(fractures, dislocations), bony abnormalities (atlantoaxial subluxation, basilar invagination, platybasia, assimilation of atlas), infections (TB, pyogenic, Grisel's
syndrome), inflammatory (rheumatoid, gout, pseudogout, ankylosing spondylitis,
Paget's disease) and tumours (Ewing's sarcoma, metastasis, lymphoma, etc).
Conclusion: MR imaging is the ideal modality for evaluating the craniocervical
junction, with its excellent soft tissue contrast and multiplanar imaging capabilities.
C-583
MR imaging characteristics of tuberculous spondylitis versus pyogenic
spondylitis
Y. Harada, O. Tokuda, K. Taguchi, N. Matsunaga; Ube/JP
(yuuko-ygc@umin.ac.jp)
C-584
Radiological assessment of lumbar intervertebral instability
A. Leone, N. Magarelli, A.M. Costantini, M. Cirillo, A. Ierardi, L. Bonomo;
Rome/IT (a.leonemd@tiscali.it)
Learning Objectives: 1) Summarize the current concepts of lumbar intervertebral instability. 2) Pay attention to the radiological analysis of vertebral displacement which is of pathophysiologic and therapeutic concern. 3) Review the different
imaging modalities used to make the diagnosis as evident as possible.
Background: Because no well-established clinical criteria are available, the diagnosis of vertebral instability is based on the radiological finding of abnormal
vertebral motion. We reviewed the spine imaging of 180 patients admitted for
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Musculoskeletal
Purpose: To assess magnetic resonance (MR) imaging features in differentiating tuberculous spondylitis from pyogenic spondylitis.
Methods and Materials: MR imaging findings in 14 patients with tuberculous
spondylitis were compared with those of 10 patients with pyogenic spondylitis.
Well-defined paraspinal abnormal signal, presence of paraspinal or intraspinal
abscess, thin and smooth abscess wall, subligamentous spread three or more
vertebra, involvement of multiple vertebral bodies and presence of thoracic spine
involvement were analyzed. MR imaging findings in tuberculous spondylitis and
pyogenic spondylitis were tabulated and then examined statistically with use of
the Fisher exact test. Significance was accepted with a p value of less than 0.05.
Results: Well-defined paraspinal abnormal signal (100% vs. 57.1%, p = 0.0156),
thin and smooth abscess wall (90% vs. 21.4%, p = 0.0003), and thoracic spine
involvement (60% vs. 14.3%, p = 0.0181) was more common in tuberculous spondylitis than in those with pyogenic spondylitis. There were no significant differences in presence of paraspinal or intraspinal abscess (100% tuberculous spondylitis
vs. 71.4% pyogenic spondylitis, p = 0.0686), subligamentous spread three or more
vertebra (60% tuberculous spondylitis vs. 28.6% pyogenic spondylitis, p = 0.1347),
and involvement of multiple vertebral bodies (90% tuberculous spondylitis vs.
71.4% pyogenic spondylitis, p = 0.2894).
Conclusion: MR imaging features of well-defined paraspinal abnormal signal,
thin and smooth abscess wall, and thoracic spine involvement is very helpful in
the differentiation of tuberculous spondylitis versus pyogenic spondylitis.

functional lumbar spine radiography for clinically suspected instability from our
scientific files. Eighty-one patients, following radiography results, underwent a
CT scan (twist-test in 27). MR imaging was performed in 74 patients.
Imaging Findings: Functional radiographs demonstrated intervertebral instability in 42 patients (Posner's radiographic criteria). In nine of these patients (22%),
annular tears were the most relevant MR finding. CT scan provided a detailed
view of spine degenerative changes and facet joint orientation. The twist-test
functional CT technique demonstrated a gap of the facet joint space during rotation of the trunk in three patients.
Conclusion: Functional radiographs are the only imaging technique that can
demonstrate intervertebral instability or at least what is considered to be an abnormal motion between two vertebrae. CT scan can demonstrate underlying predisposing anatomic factors such as facet joint asymmetry that may lead to
abnormal axial rotation of a vertebra on the subjacent one. Identifying patients
with an increased chance of instability on MR images can be clinically relevant
and can influence indications for flexion-extension radiography.
C-585
Correlative evolution of anterior chest wall blood supply and right-convex
thoracic idiopathic scoliosis in female adolescents being treated with
thoraco-lumbo-sacral orthosis (TLSO): A color Doppler ultrasonography
study
P. Iliopoulos, I. Tsamis, P. Stergiou, E. Ikonomi, G. Koureas, P. Korovessis;
Patra/GR (eliopan@otenet.gr)
Purpose: To investigate the possible link between evolution of idiopathic thoracic
scoliosis and anterior chest wall blood supply in female adolescents being treated with TLSO.
Methods and Materials: Twenty female adolescents with radiologically documented progressive right-convex idiopathic thoracic scoliosis (scoliotics) treated
with TLSO (skeletal maturity Risser I-II) and 20 age-matched girls without spine
deformity (controls), were studied with CDU twice within a two-year period. CDU
measured IMA anatomical parameters (lumen diameter (D), cross sectional area
(AR)) and haemodynamic flow parameters ([time average mean flow velocity (TAM)
and flow volume per minute (FV)).
Results: TLSO prevented scoliosis progression and reduced it from
(average SD) 30 9, to 24 10 (average reduction 20%, p = 0.004), while in
the same period, IMA-AR decreased bilaterally significantly both in scoliotics
(right p < 0.01, left p < 0.03) and in controls (right p < 0.001, left p < 0.02). On the
last observation, R-IMA FV decreased significantly in the scoliotics (p < 0.04),
while in controls IMA FV decreased bilaterally (right p < 0.03, left p < 0.02). In
addition, on the final observation, L-IMA FV was significantly higher in scoliotics
(p < 0.05) than in controls and thoracic scoliosis correlated significantly with IMAFV bilaterally (right, p = 0.05 and left, p = 0.05).
Conclusion: This study showed that the evolution of the successfully conservatively treated right-convex female adolescent idiopathic scoliosis was related to
the evolution of the anterior chest wall blood supply derived from the IMA. This
may be of clinical significance in monitoring the conservative treatment of adolescent idiopathic scoliosis. Further comparative studies are needed to augment
the conclusions of this study.
C-586
The role of MRI in ankylosing spondylitis
G. Delimpasis, A. Gyftopoulos, E. Protopapa, E. Ampatziadis, M. Malamas;
Athens/GR (tassosg@hotmail.com)
Learning Objectives: To evaluate the role of MR imaging in ankylosing spondylitis.
Background: Ankylosing spondylitis is a disease characterized by inflammation
of multiple articular and para-articular structures, frequently resulting in bony
ankylosis. It has a predilection for the axial skeleton, particularly affecting the
sacroiliac and spinal facet joints as well as the paravertebral soft tissues. Extraspinal manifestations are also present including peripheral arthritis, iritis, pulmonary involvement, and systemic upset. Young males typically are affected.
Radiographs are an important imaging technique for detection, diagnosis, and
follow-up monitoring of patients. MR imaging has an important role in ankylosing
spondylitis. Advantages of MR imaging include direct visualization of cartilage
abnormalities, detection of bone marrow edema, improved detection of erosions,
and lack of ionizing radiation. Detection of synovial enhancement at MR imaging
has been found to correlate with disease activity. MR imaging detects pseudoarthrosis, diverticula associated with cauda equina syndrome, and spinal canal
stenosis. MR imaging is considered to be mandatory in patients with neurologic
symptoms. However, it has a relatively poor ability to detect calcification, ossification, and cortical bony changes.
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Procedure Details: Magnetic resonance imaging was performed on a 1.5 Tesla

scanner. The MR imaging sequences that were used were T2-weighted fat-suppressed, T1-weighted pre- and post-gadolinium and STIR.
Conclusion: MR imaging is more sensitive than either radiography or CT in detecting early cartilage changes and bone marrow edema of the sacroiliac joints,
although it is not specific for diagnosing ankylosing spondylitis as the cause of
sacroiliitis. It also has an important role in monitoring treatment and complications.
C-587
Imaging of complications in the postoperative lumbar spine
N. Gomez Ruiz, M. Jorquera Moya, C. Polidura Arruga, M. Yus Fuertes, E.
Vano-Galvan; Madrid/ES (eliseovano@yahoo.es)
Learning Objectives: To describe the findings in imaging of the varied complications encountered after lumbar spine surgery.
Background: There are characteristic findings in imaging that permit us to differentiate between recurrent disc herniation and postoperative epidural scar formation, the most frequent surgical complications in the postoperative lumbar spine.
There are also findings that allow an adequate diagnosis of some less frequent
complications such as arachnoiditis, epidural hematoma, discitis, osteomyelitis,
abscess, pseudomeningocele or arteriovenous fistula. We show some examples
of all these pathologies. At this moment the diagnostic procedure recommended
for an adequate diagnosis in postoperative patients with persistent or recurrent
lumbar spine symptoms is magnetic resonance imaging (MR), specially Gadolinium-DTPA-enhanced MR. This allows an adequate differential diagnosis between
the most frequent causes of those symptoms in most cases and permits us to
initiate appropriate treatment for the patient.
Procedure Details: A retrospective review of imaging in patients with previous
lumbar spine surgery was performed, specially in those who had persistent or
recent symptoms referred to it. Most of the included cases had previous surgery
for disc herniation, although there were some cases with previous orthopaedic
surgery or diagnostic procedures (such as lumbar puncture) instead.
Conclusion: Imaging techniques, specially MR, are the most important diagnostic procedures in symptomatic patients after lumbar spine surgery.
C-588
Osteoid osteomas and osteoblastomas of the axial skeleton in children
M. Chasiotou, E. Manoli, K. Miliakou, D. Papadimitriou, N. Mparmpaliou,
I. Deligiannis; Ag. Paraskevi/GR (manolieleni@in.gr)
Purpose: Osteoid osteomas and osteoblastomas are highly vascular, benign
osteoblastic lesions. In more than 50% of cases osteoblastomas are located in
the axial skeleton (spine 40%, skull 15%), whereas only 10% of osteoid osteomas are in the axial skeleton. The purpose of this study is to present the imaging
features of osteoid osteoma and osteoblastoma, located in the axial skeleton in
22 children.
Methods and Materials: We retrospectively evaluated the imaging features in 22
children (14 girls and 8 boys) aged between 4.5 and 16 years, with osteoid osteoma or osteoblastoma of the axial skeleton. The imaging modalities used were Xray studies, bone scintigraphy, computed tomography and magnetic resonance
imaging.
Results: The study included 13 cases of osteoid osteoma and 9 cases of osteoblastoma. Concerning localization, the spine was involved in 17 cases (9 osteoid
osteomas, 8 osteoblastomas), the acetabulum in 3 (2 osteoid osteomas and 1
osteoblastoma) and the clavicle in 1 case (osteoid osteoma). The rib was involved in one case of osteoid osteoma. Apart from localization, size and more
specific imaging features (such as marginal sclerosis, extension in to a neighboring joint, synovial thickening, regional osteopenia, scoliosis, bone edema, contrast uptake and muscular atrophy) were evaluated.
Conclusion: Imaging investigation is of great importance not only for the diagnosis of either osteoid osteoma or osteoblastoma of the axial skeleton, but also for
pre-operative planning and for evaluation of treatment efficacy.
C-589
Bone mineral density in ankylosing spondylitis
K. Potocki, M. Prutki, I. Kos, R. Stern Padovan, N. Laktasic, D. Babic Naglic;
Zagreb/HR (maja.prutki@zg.htnet.hr)
Purpose: Analysis of bone mineral density (BMD) was used to establish the
prevalence of osteoporosis in ankylosing spondylitis and to determine the risk
factors for fractures in patients with ankylosing spondylitis.
Methods and Materials: Our study included 48 patients with ankylosing spond-

ylitis. Bone mineral density was analyzed at the lumbar spine and total hip by
dual energy X-ray absorptiometry (DXA). The World Health Organisation classification recommended for quantifying the lost bone mass (normal, osteopenia, or
osteoporosis) was used. One radiologist interpreted plain radiographs of the lumbar spine and pelvis. We only covered fractures that occurred after the onset of
ankylosing spondylitis, unrelated to trauma.
Results: The mean BMD in lumbar spine and hip of patients with ankylosing
spondylitis was similar (p > 0.05). While 25.0% of patients with ankylosing spondylitis had osteoporosis, 20.8% of patients had osteopenia in the lumbar spine.
The osteoporosis of total hip was found in 33.3% patients and osteopenia in
29.2% of patients with ankylosing spondylitis. There were four patients (8.3%)
with vertebral fractures since the diagnosis of ankylosing spondylitis.
Conclusion: Patients with ankylosing spondylitis have reduced BMD. Osteoporosis occurs more often in men with longer disease duration, and in older age. For
assessing the extent of osteoporosis in ankylosing spondylitis it is more convenient to measure BMD in the hip since it provides more accurate results due to the
existence of syndesmophytes and ligament calcification of lumbar spine. Diffuse
osteoporosis causes bone fragility that can cause vertebral fractures.
Musculoskeletal
Miscellaneous
C-590
The arcade of Frohse: Dynamic US normal anatomy
M. Giglio, E. Silvestri, C. Martinoli, L. Saitta, A. Muda; Genova/IT
(enzo.silvestri@infinito.it)
Purpose: The arcade of Frohse is a fibrous arch at the proximal edge of the
supinator muscle; it is the most common location of nerve compression in radial
tunnel syndrome. The deep branch of the radial nerve (posterior interosseous
nerve, PIN) courses right beneath the arcade. The purpose of this electronic
poster is to present the normal anatomy and the US appearance of the arcade of
Frohse and its relationship to the posterior interosseus nerve.
Methods and Materials: The normal US appearance of the arcade of Frohse
was assessed in 20 healthy subjects using high-frequency linear broadband array transducers. The US dynamic examination was performed with both long and
short axis views, during pronation and supination of the forearm. All US images
were analyzed and matched to schematic drawings to illustrate the normal US
morphology of the arcade of Frohse, its location, extent and relation to adjacent
structures.
Results: Our poster shows, with didactic and interactive slides, how we technically identified the arcade of Frohse by following the radial nerve all the way
through its bifurcation into the two terminal branches. Common variations of the
normal anatomy of the arcade of Frohse and the surrounding structures are also
presented.
Conclusion: Dynamic US imaging is a suitable technique for a musculoskeletal
sonographer to easily identify the arcade of Frohse and its close anatomical relationship with the PIN. It is a valuable tool in the differentiating between PIN syndrome and resistant lateral epicondylitis.
C-591
Ultrasonography of peripheral nerves in extremities
J.J. Lee, Y. Lee, S. Lee, K. Cho; Daegu/KR (jonglee@knu.ac.kr)
C-592
Pictorial review of the radiology of bomb blast injury
S.S. Hare, E.A. Dick; London/UK (samanjit@btinternet.com)
Learning Objectives: Bombs and their resultant explosions can cause unique
and wide-ranging patterns of injury. A need for understanding the nature and
patterns of explosion related injury, particularly in confined spaces, has come to
the fore with the current worldwide threat from terrorist activity.
Background: Patients may be affected by one or more types of blast injury. Pri-
447
Musculosk
eletal
Musculoskeletal
Learning Objectives: To understand the ultrasonographic technique, normal features, and abnormal findings during the examination of peripheral nerves in the
extremity.
Background: Due to the development of ultrasonographic technology, higher
resolution imaging of nerves becomes popular. Ultrasonographic imaging of nerve
pathology is regarded as the diagnostic modality of choice.
Imaging Findings: To demonstrate the ultrasonographic technique and normal
features of peripheral nerves, a 39-year old female volunteer was used. The pathologic findings of peripheral nerves were acquired from 83 patients with mean
age of 42 years. A 7~15 MHz linear transducer was used for ultrasonographic
examination. The ultrasonographic techniques were decided by proper positions
and scanning directions of probes according to each destination nerve. Adjacent
landmarks for convincing identification of the destination nerves were also decided. In addition, pathologic features of nerves were described. In the upper extremity, scanning for normal features covered from the brachial plexus to the proper
digital nerve and in the lower extremity, from sciatic and femoral nerves to the
proper digital nerve was evaluated. The pathologic findings identified in this study
were: tumor (47), entrapment (15), scar (6), laceration (6), neuritis (4), extrinsic
compression (3), and atrophy (2). The nerves showing abnormal findings were:
median (19), ulnar (15), tibial (12), common peroneal (8), radial (8), common
palmar digital (4), sural (4), axillary (3), common plantar digital (3), proper palmar
digital (3), sciatic (2) and posterior interosseous (1) nerves, and the brachial plexus (1).
Conclusion: In this presentation ultrasonographic techniques, normal findings,
and pathologic features of peripheral nerves in the extremities were described.
Based on familiarity with these facts, the ultrasonographic evaluation of peripheral nerves will become more accurate and feasible.

mary blast injuries are due to the initial high pressure blast wave impacting on
both solid and air filled structures (barotrauma) e.g. lungs, middle ear or gastrointestinal tract. Secondary blast injuries are caused by flying debris and bomb fragments. Tertiary injuries occur when individuals are thrown by the 'blast wind'.
Quaternary injuries include all other injuries and illnesses, including the exacerbation of existing conditions.
Imaging Findings: This pictorial review presents the radiological sequelae which
arise from an explosion in a confined space. It covers 38 patients managed at St
Mary's Hospital after the Edgware Road tube bomb blast of the 7th July 2005.
Using plain film radiography and CT imaging we demonstrate a diverse range of
injury patterns that are typically seen in victims of a bomb blast. These include
traumatic limb amputation, comminuted limb fractures, orbital blow-out fractures,
cervical spine injury, pneumothoraces, vascular and solid organ tears, and multiple embedded shrapnel fragments (frequently soft tissue and bone originating
from other casualties).
Conclusion: Not only are such injuries very different from those seen in standard trauma cases but, in an individual with one serious injury, further injuries at
multiple distant anatomical sites must be strongly suspected and investigated.
C-593
Pointing out the finger: Pathologic spectrum and multimodality imaging
S.-Y. Kim, K.-B. Joo, S.-J. Kim; Seoul/KR (soo9403@yahoo.co.kr)
Learning Objectives: To review the anatomy of ligaments, tendons and bones of
the finger with MR imaging and US. To describe the features of conventional
radiography, US and MR imaging of finger abnormalities. To understand the full
spectrum of finger abnormalities and associated radiologic findings.
Background: The finger is a functionally complex structure that is little understood compared to larger parts of the body. The components of the finger including the tendons, vessels and nerves are extremely fine and entangled together.
In order to understand the variable pathologies involving the finger, familiarity
with the fine anatomy of the normal finger is crucial. MR imaging is a useful
method for evaluating anatomy. A wide variety of disease processes can involve
the finger either focally or as part of a systemic process.
Imaging Findings: Variable pathologies involving the finger include soft tissue
and bone tumors, inflammatory lesions, trauma, congenital anomaly, vascular
disease and metabolic diseases. Arthritis (including rheumatoid arthritis, osteoarthritis, systemic sclerosis and psoriatic arthritis) represents the most common pathology due to systemic conditions. Tenosynovitis is the most common
lesion resulting from an inflammatory process. Soft tissue tumor of the finger
includes ganglion cyst, glomus tumor, giant cell tumor and rarely hemangioma
and malignant tumor. Metabolic diseases include hyperparathyroidism and thyroid acropathy.
Conclusion: Knowledge of these abnormalities and familiarity with the imaging
of these processes will allow radiologists to contribute to the diagnosis and management of finger disorders.
C-594
Musculoskeletal system involvement in hydatid disease
R. Arkun, S. Biceroglu, M. Argin, D. Sabah; Izmir/TR (rarkun@yahoo.com)
Learning Objectives: To review and present imaging findings of musculoskeletal system hydatid disease.
Background: Hydatid disease is a parasitic disease most commonly caused by
echinococcus granulosus that shows rare involvement of the bone and soft tissues. Seventeen patients with confirmed primary histological hydatid disease
were evaluated with routine radiographs (n = 7), US (n = 5), MR imaging (n = 16)
and CT (n = 4). Age and sex of the patient, location of involvement and radiological characteristics for each imaging technique were recorded.
Imaging Findings: Of the 17 patients with hydatid disease, 10 had disease in
soft tissues and 7 in bones ( soft tissues). The average age was 43. On plain
radiography, bone lesions showed variable radiological patterns: a cystic expansile lytic lesion with regular or irregular margins, cortical destruction or an osteolytic lesion which mimics inflammatory changes. CT examination also showed
similar changes to plain radiography with additional hypodense soft tissue components. In soft tissue hydatidosis, MR imaging showed cystic masses within the
intermuscular compartments. Six of ten soft tissue hydatidosis had a multicystic
appearance. In MR imaging examination, daughter vesicles were detected in 8 of
10 soft tissue hydatid disease patients either on T1-W or T2-W images. The other
findings were: the waterlily sign (3), hydatid sand sign and fluid-fluid level (3), and
peritumoral edema (2). Using I.V. Gd-DTPA, 11 patients had peripheral enhancement representing the rim sign in the wall of the lesions.
Conclusion: MR imaging provides valuable information in the diagnosis of hy-
448
datid disease by demonstrating multiseptated, multicystic mass lesions. MR imaging should be the modality of choice in evaluation, preoperative planning and
for correct diagnosis of these lesions.
C-595
A proposed method to perform length and angle measurements of the
lower leg using composed digital radiographic images
G. Tsimitselis, E. Lavdas, I. Fezoulidis; Larissa/GR (tsimitselis@yahoo.com)
Learning Objectives: 1. To illustrate an ideal method for obtaining high quality
images of the lower extremity, suitable for length and angle measurements. 2. To
highlight the clinical utility of such measurements. 3. To highlight the possible
pitfalls of the performance of such measurements.
Background: Length differences or angle variations between the lower extremities may be due to a variety of reasons: congenital or acquired (e.g. trauma,
inflammation, surgery, radiation). Neurological conditions, mainly manifested by
paralytic symptoms or difficulty moving, may also cause length leg discrepancies.
Procedure Details: The procedure can be performed unilaterally or bilaterally. A
series of overlapping digital X-ray images (Multidiagnost 94 DSI, Philips Medical
Systems) of each leg from the hip to the ankle are taken. The images are produced with the patient in the upright position whilst weight bearing at a frame rate
of 4 per second. At a work station (Easy Vision, Philips Medical Systems), a
digital composite-overview image was produced. After reconstruction, calibration was performed, and measurements were taken. A complete illustration of
anatomical points used in these measurements will be depicted in our exhibit.
The length measurements are recorded in millimeters, and the angle measurements in degrees.
Conclusion: The performance of length and angle measurements of the lower
extremities using composed digital radiographic images, is an easy and accurate
technique, valuable for the presurgical evaluation of such cases. We hope that
our exhibit will augment the participants' experience in the performance of such
measurements.
C-596
Viewing back to past. The testing and validation of radiological investigation
on paleopathological material and its potentiality in forensic medicine
P. Charlier1, I. Huynh2, D. Morillon1, A. Cotten1, P.L. Thillaud2, D. Gourevitch2;
1
Lille/FR, 2Paris/FR (ph_charlier@yahoo.fr)
Learning Objectives: Radiology has been used since the origins of paleopathology i.e. the medical analysis of old human remains coming from archaeological excavations. New radiological methods have been tested on some historical
remains (sometimes famous) permitting testing and development of new forensic
techniques.
Background: One of the biggest interests of paleopathology is to test and develop techniques that could be used in anthropology, osteology, rheumatology and
forensic medicine.
Procedure Details: Conventional radiographs and tomodensitometry were performed on different human skulls: Santa Afra from Augsburg (Germany), and
King Louis the XIth and his wife Charlotte de Savoie (France). For the first time in
archaeology, a TDM was performed on a full-bone funeral vase before archaeological investigations (the urn of Agns Sorel: 1422-1450).
Conclusion: Radiology allowed diagnosis without destruction of old human bone
samples. With 3D imaging technology, we were able to compare skull surfaces
with original sculptures from the supposed corresponding personages, then to
confirm the identity of some of the dead. Foreign bodies were found in some
cases (for example a reliquary vase in Santa Afra's skull). Fine quality tomodensitometry differentiated between cremation and beheading (two death versions
followed by historical sources about Santa Afra). Such examples may show the
interest of these techniques, not only for paleopathologists and historians of
medicine but also for forensics.

Neuro
Brain
C-597
Diffusion tensor imaging in ALS using a new mixture model for fiber
integrity quantification
S.K. Schimrigk1, B. Bellenberg1, C. Lukas1, M. Schlter2, J. Rexilius2,
H.K. Hahn2, B. Stieltjes3, R. Drescher1, O. Kster1; 1Bochum/DE, 2Bremen/DE,
3
Heidelberg/DE (carsten.lukas@ruhr-uni-bochum.de)
Purpose: Fiber degeneration within the corticospinal tract (CST) in amyotrophic
lateral sclerosis (ALS) can be quantified by diffusion tensor imaging (DTI). A new
method to quantify axonal diffusion characteristics using a probabilistic mixture
model for fiber tissue and background is evaluated.
Methods and Materials: Axial EPI DTI datasets of 9 patients and 9 controls (6
gradient directions, 10 repetitions, 1.5 T MR imaging scanner) were acquired
and processed using the MeVisLab image analysis platform. Local fiber orientation was visualized by DTI color maps in a 3D orthogonal viewer with a unique
planar color coding method which allows precise definition of evaluation planes
at different levels cross-secting the CST. The model classifies voxels inside a ROI
as pure fiber, background or mixture. This allows a reduction of partial volume
effects and measurement variability.
Results: FA was measured within the CST at levels ranging from capsula interna
to pons. Coefficients of variation of intra-rater, scan-rescan and inter-rater reproducibility were determined as 2.4%, 3.0% and 5.7% respectively. The optimal
measurement position along the CST with respect to minimum FA variability and
maximum FA difference between patients and healthy subjects was assessed.
FA in the patient group (0.61 0.02) was significantly decreased compared to
the control group (0.68 0.06). A negative correlation between FA and the disease status was shown.
Conclusion: The new method for fiber integrity quantification is suited to assess
FA in ALS patients with good reproducibility. This tool can be useful in future
studies to monitor disease status and progression.
C-598
Combination of functional MRI and diffusion tensor fiber tractography
H. Chen, J. Dai, J. Ma, F. Sun, L. Ai, S.W. Li; Beijing/CN
(hyc221@yahoo.com.cn)
Purpose: To combine motor functional MR imaging (fMRI) and diffusion tensor
fiber tractography (DT-FT), and to investigate the therapeutic value of image combination in intracranial glioma patients.
Methods and Materials: 9 cases of histologically proven intracranial gliomas (5
male, 4 female, mean age 48.5) were studied. Preoperative diffusion tensor imaging (DTI) and motor fMRI were performed in all cases using a GE Signa 3.0 T
MR imaging Scanner, while postoperative DTI and fMRI were performed in 2
patients. DT-FT were performed using diffusion TENSOR Visualizer (dTV) software. We used the stream line algorithm to deduce the bilateral corticospinal
tract (CST) from seed points selected in the bilateral posterior limb of the internal
capsule and U fiber from seed points selected in the white matter adjacent to the
location of the maximum fMRI activation. The fMRI data were analyzed by SPM2
and the activation points were extracted by t test (corrected p value < 0.001 and
the extent threshold > 20 voxels). The image combination of fMRI and DT-FT
were performed using fMRI Merge (FM), a plug-in unit of dTV.
Results: Activation of motor fMRI and the white matter fibers (including CST and
U fibers) were manifest on one image. The relationship of tumor, activation points
and fibers could be observed directly and three-dimensionally on the combined
image.
Conclusion: The image combination between fMRI and DT-FT has advantages
in displaying the relationship between activation points, the relative fiber tracts
and tumors, which will help to make a preoperative plan.
C-599
Learning Objectives: 1. To describe different fMRI paradigms used to evaluate

working memory. 2. To demonstrate differences in fMRI activation for several paradigms. 3. To describe easy implementation of working memory fMRI paradigms
C-600
Characterization of subthalamic nucleus (STN) by 3 T MRI in Parkinson's
electrical stimulation therapy: Direct targeting to avoid uncertain
localization with indirect atlas-based methods
P. Browaeys, C. Pollo, P.P. Maeder, S. Binaghi, P. Schnyder, J.-G. Villemure,
R.A. Meuli; Lausanne/CH (patrick.browaeys@skynet.be)
Learning Objectives: 1. Show capacities of 3 T MR imaging for reliable and
reproducible visualization of STN. 2. Describe the imaging technique and its integration with stereotactic requirements.
Background: Bilateral high frequency electrical stimulation of the subthalamic
nucleus (STN) is an ongoing therapy for advanced Parkinson's disease. While
STN localization based on stereotactic atlas correlation remains the standard in
most institutions, direct targeting avoids critical discrepancies which may occur
with indirect methods between actual and predicted STN position.
Procedure Details: Before frame implantation over the patient's head, we perform a 3 T T2w coronal acquisition which can trace iron deposits and reproducibly show the STN, using maximal 3 T resolution and avoiding frame artefacts.
For operative stereotactic requirements, we then acquire a 1.5 T T1w sequence
after stereotactic frame placement over the head of the patient.
Fusion of the two acquisitions is done in post-processing, with direct 3 T targeting of STN combined with stereotactic information. The result is transferred onto
the operative room stereotactic localizer to determine electrode positioning.
Conclusion: 3 T imaging of STN combined with 1.5 T classic frame based acquisition provides reliable direct targeting of STN, in addition to stereotactic information. The technique could contribute to optimum electrode positioning in
advanced Parkinson disease.
C-601
Whole brain perfused blood volume: New perspective in CT imaging of
acute stroke
S.P. Kloska1, T. Fischer1, R. Dittrich1, E. Klotz2, H. Ditt2, D. Nabavi1,
R. Fischbach1, W. Heindel1; 1Mnster/DE, 2Forchheim/DE
(kloska@uni-muenster.de)
Purpose: To evaluate a prototype software for the calculation of whole brain perfused blood volume (pBV) images in patients with suspected acute stroke.
Methods and Materials: 15 patients received multidetector row CT imaging for
suspected stroke including CT, CTA of the whole brain and PCT at the level of the
basal ganglia. Whole brain pBV reconstructions were calculated from the existing CT data. The pBV CT was displayed on a workstation using a color coded
scale. The size of perfusion abnormalities in the pBV CT and the different PCT
maps was correlated. The volume of perfusion abnormality in the pBV CT was
correlated with the final infarction on follow-up scan (CT or MRI). The SpearmanRho test was used for statistic evaluation.
Results: The whole brain pBV CT was true positive in 13/15, true negative in 1/
15 and false negative in 1/15. The size of pBV abnormality correlated best with
the perfusion abnormality of the CBV map (Spearman-Rho=0.869, p < 0.01).
Moreover, the final size of infarction at the PCT section level was closer correlated to the size of perfusion abnormality of the pBV CT than of any PCT map
449
o
Neur
Neuro
Evaluation of working memory with functional magnetic resonance imaging

(fMRI): An overview of several paradigms and research and clinical
applications
M. Smits, C. Tam, J. van der Geest, P. Koudstaal, A. van der Lugt;
Rotterdam/NL (marion.smits@erasmusmc.nl)
for clinical and research applications. 4. To review the neuroanatomical background of working memory.
Background: FMRI of working memory is currently under investigation for use in
patients with memory difficulties, resulting from e.g. (traumatic) brain injury, multiple sclerosis and whiplash syndrome. Especially when the patients' complaints
cannot be objectified by means of neuropsychological testing, fMRI has been
proposed as a new method of diagnosing and objectifying cognitive abnormalities. While currently mainly used for research purposes, fMRI of working memory
may in future be used clinically for evaluation and active support (biofeedback) of
memory therapy.
Procedure Details: We describe three different paradigms for working memory
developed in our department (1.5 T MR-scanner; General Electric), that can be
easily implemented for research or clinical purposes without the need for sophisticated equipment. Pooled results from 10 healthy volunteers show subtle differences in activation patterns between the paradigms, with common areas of
activation in the dorsolateral prefrontal cortex (Brodmann area (BA) 45, 46, 47),
supplementary motor area (BA 6) and parietal cortex (7, 9, 40). We explain these
differences in view of functional anatomical background and current literature of
working memory.
Conclusion: FMRI of working memory is a promising tool for the evaluation of
cognitive abnormalities, both for clinical and research purposes. Use of the proper paradigm is essential for correct evaluation and interpretation.

(Spearman-Rho=0.713, p < 0.01). The pBV CT demonstrated a good correlation
of the volume of perfusion abnormality with the final volume of infarction (Spearman-Rho=0.838, p < 0.01).
Conclusion: The pBV CT technique was superior to PCT for the prediction of the
size of final infarction and showed evidence of visualizing the infarct core with
close correlation of the perfusion abnormality in the pBV CT and the CBV map.
C-602
Four-dimensional multi-slice CT (4D-MSCT) in intracranial aneurysm
evaluation: How can a 64-row MSCT provide a new insight in aneurysm
characterization?
P. Browaeys, R.A. Meuli, P.P. Maeder, P. Schnyder, S. Binaghi; Lausanne/CH
(patrick.browaeys@skynet.be)
Learning Objectives: 1. Show how to image cerebral aneurysm behaviour relating to cardiac cycle with latest generation 64 row MSCT. 2. To demonstrate and
reproducibly measure "aneurysm pulsation", based on volumetric variation.
Background: Age and aneurysm diameter are the main predictors of future bleeding when an unruptured aneurysm is discovered. However, management is variable due to poor correlation between these factors and natural aneurysm history.
64 row MSCT now allows us to study the eventual deformation of the aneurysm
wall during the cardiac cycle, in order to perhaps improve prognostic evaluation.
Procedure Details: We first obtain a cardiac cycle synchronized acquisition, focused on aneurysm localization, which consists of twenty acquisitions during
one cardiac cycle. We then create a movie of the aneurysm, using the same tools
as cardiac imaging. The method establishes the temporal relationship between
aneurysm morphology and cardiac cycle. To determine an objective parameter of
pulsation, we study aneurysmal volume variation, related to cardiac cycle. This
parameter allows separation of the aneurysm population into two different groups,
which could each have different outcomes.
Conclusion: The latest MSCT technical improvements gave us the capacity to
study cerebral aneurysms from a new insight: The relationship between aneurysm and cardiac cycle. We attempt to define a new parameter, aneurysmal pulsation, in an objective way.
C-603
Abnormal frontal functional connectivity in schizophrenia revealed by fMRI
combined with DTI
Q. Zhang, Y. Zhang; Tianjin/CN (zhangquan0912@163.com)
Purpose: To assess the practical value of functional MR imaging combined with
diffusion tensor imaging (DTI) in studying abnormal frontal functional connectivity in schizophrenia.
Methods and Materials: Ten medication free schizophrenic patients and 10
matched healthy comparison subjects were studied with fMRI and DTI using a
GE Twin-speed 1.5 T MR scanner. fMRI data was collected while performing a
block designed working memory (n-back) task. DTI data was acquired with b
value 0 and 1000 s/mm2, and with thirteen diffusion directions. The fMRI and DTI
data were analyzed using SPM99 and FUNCTION 2 respectively. Functional regions were identified, and then fractional anisotropy (FA) measured in regions of
interest (the junction between activated cortex and adjacent white matter) in both
groups. Two sample t-test for the FA was performed between the two groups.
Results: Compared with healthy subjects, the extent of activation in the bilateral
dorsolateral part of prefrontal cortex (dPFC), left premotor area (PMA) and the
posterior part of the left inferior frontal gyrus (plIFG) decreased significantly; the
left inferior parietal lobule (IPL) had no activation in schizophrenic patients. The
FA values of the ROI in bilateral dPFC, left PMA and plIFG were significantly
lower in the patient group than in the subject group (p < 0.05), but the FA value in
the left IPL had no significant difference between the two groups (p > 0.05).
Conclusion: Abnormal function of frontal cortex and abnormal transmittability of
the adjacent white matter may be responsible for the working memory impairment in schizophrenic patients. fMRI combined with DTI has potential value in
studying the pathogenesis of schizophrenia.
C-604
Magnetic resonance diffusion tensor imaging in a rat model of acute
cerebral ischemia and reperfusion
Z. Sun, X. Zhang, Y. Zhang; Tianjin/CN (zhihuasun@eyou.com)
Purpose: To study the application of diffusion tensor imaging (DTI) in a rat model
of acute cerebral ischemia and reperfusion.
Methods and Materials: Modified Zea-Longea operations were performed for
middle cerebral artery occlusion in a model of 200 male Wistar rats, divided into
450
permanent ischemia group and four reperfusion groups after 0.5 h, 1.5 h, 2.5 h
and 3.5 h respectively. After 0.5-48 h, diffusion weighted imaging (DWI) and DTI
were performed. Average diffusion coefficient (DCavg) and fractional anisotropy
(FA) of different areas within the ischemic focus (points 1, 2 and 3 from center to
periphery), the peri-ischemia region with normal signal intensity on DWI (point
4), and within normal tissue were measured.
Results: The ischemic lesion had a characteristic disciplinarian on DTI. DCavg
would reduce, elevate and reduce again. FA would elevate before 9h and decline
irreversibly. The difference between the 2.5 h and 3.5 h reperfusion groups and
the permanent ischemia group were not statistically significant (P > 0.05). In different groups, there were statistically significant differences in DCavg (P < 0.05)
between point 1 and 2 before 3 h, between point 1 and 3 before 12 h, and between point 2 and 3 during 3-12 h. Differences of FA had statistical significance
(P < 0.05) between point 1 and 2 or 3 before 3h, and between point 2 and 3
before 6 h. In point 4, DCavg was slightly lower and FA was slightly higher than
normal.
Conclusion: DTI can be helpful for diagnosis of acute cerebral ischemia and
penumbra. DCavg is more sensitive than FA. The time window of effective reperfusion should be lower than 2.5 h. The present time window of ischemic penumbra may be 12 h.
C-605
The activation of the human affective system during passive music
listening: A preliminary fMRI study
Q. Zhang, Y. Zhang; Tianjin/CN (zhangquan0912@163.com)
Purpose: To localize the functional areas related to music processing with fMRI,
and to discuss the possible neural mechanism underlying emotion experience
and music therapy.
Methods and Materials: Thirty healthy non-musicians underwent fMRI study using
a GE 1.5 T Twin-speed MR scanner. Experimental tasks included listening passively to instrumental pieces of scale, pleasant classic music and scary music (3
pieces each), which were given in block design. Conjunction analysis contrast
analysis among tasks were performed using SPM99 to render the mean functional images.
Results: Both the pleasant music and the scary music activated the neural substrates underlying affective processing, the former mainly included bilateral lateral prefrontal cortex (left advantage), the left orbitofrontal cortex, the anterior
cingulate cortex, the left anterior part of insula, the right thalamus and the left
lenticula; the latter mainly included bilateral lateral prefrontal cortex (right advantage), bilateral orbitofrontal cortex, bilateral medial frontal gyrus, bilateral anterior cingulate cortex and bilateral amygdaloid complex. Activated areas during scary
music contrasting to pleasant music mainly included the bilateral amygdaloid
complex; while pleasant music contrasting to scary music, dorsal lateral part of
bilateral prefrontal cortex and bilateral orbitofrontal cortex were activated.
Conclusion: Passively listening to pleasant and scary music could strongly activate distinct emotion processing substrates, and the positive emotion processing
system activation during pleasant music listening may be one of the neural mechanisms of music therapy.
C-606
Age-related changes in conventional magnetic resonance, perfusion and
diffusion weighted imaging findings: Study with whole brain tissue
histogram analysis
S. Kara, . Yazgan, S. Bagcier, B. Yilmaz, O. Koak; Ankara/TR
(simaykara@yahoo.com)
Purpose: Magnetic resonance perfusion (MRP) provides information that complements the anatomical information available with conventional MR imaging
(CMRI). Analysis of data from perfusion (MRP) imaging yields quantitative estimates underlying microvasculature. Diffusion-weighted imaging (DWI) can provide data, in terms of restricted water diffusion, that's not apparent on CMRI. We
conduct a study to investigate the influence of aging on CMRI, MRP, DWI.
Methods and Materials: CMRI, DWI, and MRP sequences were obtained from
159 patients who had only millimetric ischemic changes. Their ages were between 19-72 (42.4 15.7). Measurements were performed from brainstem, pons,
mesencephalon, cerebellum, temporal, occipital, parietal, frontal white matter,
centrum semiovale, basal ganglia, thalamus, genu and splenium of corpus callosum, and perirolandic region. Apparent diffusion coefficient (ADC) values, cerebral blood volume (CBV), cerebral blood flow (CBF), time of arrive (TO), time to
peak (TTP) and mean transit time (MTT) were measured from all regions. DWI
was performed with the diffusion gradient in three axis direction: b factor, 0 and
1000 s/mm2. MRP parameters were T2* weighted sequence (TR/TE/NEX 619/

30/1, flip angle 45) with 16 axial sections. Bivariate correlations were assessed
by using the Spearman rank correlation coefficient.
Results: Significant correlations were found between subject age and the following variables: Number of hyperintense areas in the brain T2-weighted MR imaging (p < 0.001), mean ADC (p < 0.001), CBV (p < 0.005), CBF (p < 0.005), TO
(p < 0.005), TTP (p < 0.005).
Conclusion: In addition to the extent of CMRI, DWI and especially MRP imaging
measurements (CBV, CBF, TO, TTP) provide additional information about microstructural and microvascular age-related brain tissue changes.
C-607
Visualization of perforating arteries by cerebral 3D-CTA and its clinical
utility
S. Kayano, M. Saito, A. Takahashi; Sunagawa City, HOKKAIDO/JP
(s_kayano@med.sunagawa.hokkaido.jp)
Learning Objectives: Up to now, the intracranial perforating arteries could not
be visualized on cerebral 3D-CTA. However, the recent development of multislice CT allowed us to visualize the perforating arteries. The objective of our exhibit is to evaluate visualization of the perforating arteries by cerebral 3D-CTA,
and assess its clinical utility.
Background: We evaluated visualization of the perforating arteries by cerebral
3D-CTA on a group of unruptured aneurysms (n = 114) and a ruptured group
(n = 22). 3D-CTA images were acquired on a 16-multi-slice CT, with 0.5 mm thickness. We evaluated 4 kinds of perforating arteries; namely, the hypothalamic artery (HTA), anterior choroidal artery (AChA), lenticulostriate artery (LSA), and
thalamo-perforating artery (TPA). These were evaluated by visual scoring (1 point:
Not-visualized, 2 points: Visualized, 3 points: Clearly visualized).
Imaging Findings: The averages were HTA: 1.95, AChA: 2.71, LSA: 2.89, TPA:
2.33 in the unruptured group, and HTA: 1.29, AChA: 2.86, LSA: 2.57, TPA: 2.14 in
the ruptured group.
Conclusion: The variations of the perforating arteries were abundant, but those
adjacent to the common sites of cerebral aneurysms could frequently be observed. The visualized perforating arteries matched those observed during surgery. We think that 3D-CTA is a useful less-invasive method of visualizing
perforating arteries, which could help to avoid perforating artery injury during
aneurysm surgery.
C-608
Brain tumour diagnosis and prognosis by in vivo 1H MRS and ex vivo
metabolomic and genomic data. A prospective study as part of eTUMOUR
(FP6-2002-LSH503094)
D. Monleon1, C. Martinez-Bisbal1, B. Martinez-Granados1, V. Esteve1,
R. Ferrer-Luna1, M. Mata2, J. Piquer3, L. Marti-Bonmati2, B. Celda1;
1
Burjassot/ES, 2Valencia/ES, 3Alzira/ES (daniel.monleon@uv.es)
Diffusion tensor MR imaging of cerebral glioma grading at 3 T

H. Chen, J. Dai, J. Ma, F. Sun, L. Ai, S.W. Li; Beijing/CN
(hyc221@yahoo.com.cn)
Purpose: To evaluate the usage of diffusion tensor MR imaging (DTI) in grading
of cerebral gliomas.
Methods and Materials: 30 cases with histologically proven cerebral gliomas
(16 male, 14 female, mean age 42.8) were studied. The patients were divided
into low-grade glioma groups (WHO I-II, 16), and high-grade gliomas (WHO IIIIV, 14). Routine exam and DTI were performed in all the cases using a GE Signa
3.0 T MR imaging Scanner. Four different types of tissue were identified by routine images: Parenchyma of tumors, cystic tissue and necrosis, abnormal peritumoral region on T2WI and contralateral normal brain tissue. Fractional anisotropy
(FA), relative anisotropy (RA), apparent diffusion coefficient (ADC) and exponential ADC (EADC) were calculated with Functool software based on the four types
of tissue. Statistical differences in these values among the tissue types were
assessed with an independent sample t test.
Results: Mean RA in parenchymal regions were 0.183 0.065 for high-grade
gliomas and 0.143 0.042 for low-grade gliomas, while mean EADC were
0.185 0.064 for high-grade gliomas and 0.138 0.057 for low-grade gliomas,
respectively. Significant differences in RA and EADC were observed between
the two groups (p < 0.05). The FA and ADC measurements, on the other hand,
showed no discrepancy. The four values in cystic tissue and necrosis, peritumoral abnormal region on T2WI and contralateral normal brain tissue types showed
no difference.
Conclusion: The difference in RA and EADC values in parenchymal tissues between high-grade and low-grade gliomas were significant. This findings may indicate a role for DTI in the detection of grade of cerebral gliomas.
C-610
Hippocampal age-dependent ADC changes measured with low and high bvalue DWI
J.M. Garca Santos, C. Ordez Gonzlez, F. Lloret Esta, S. Torres del Ro;
Murcia/ES (crisog24@yahoo.es)
Purpose: To investigate normal gender and age-dependent apparent diffusion
coefficient (ADC) changes on brain diffusion weighted imaging (DWI) in areas
normally affected in Alzheimer's disease.
Methods and Materials: A cross-sectional prospective study was carried out in
a group of 50 randomly selected normal patients (26 men, 24 women), ranging
from 8 to 76 years-old. Two different b-value DWI sequences (1000 and 3000 s/
mm2) were added to our conventional MR imaging protocol. ADC was calculated
by means of ROIs carefully located on hippocampus (gray matter), precuneus
and posterior cingular gyrus (subcortical white matter) in both sides. Inter and
intra-hemispheric ADC values, as a whole first, and sorted by gender and age
(< 31y - 31-60y - > 60y) afterwards, were compared and statistically analyzed by
ANOVA test.
Results: No statistical inter-hemispheric ADC differences were found between
equivalent places. The three evaluated anatomical areas showed significant intra-hemispheric differences. There was neither significant sex effect on diffusion,
nor age-dependent changes on the precuneus and cingulum. But there were statistical age-dependent differences in hippocampal ADC. It lessened from group 1
to group 2, and went up again in the older group. Diffusion variations also proved
to be different depending on the b-value applied. While, with a low b-value, they
were stronger in the older subjects (p < 0.004), with a high b-value DWI they
were much more significant in the younger (p < 0.001).
Conclusion: Hippocampal ADC shows an age-dependent evolution which should
be taken into account when measurements are obtained in Alzheimer's disease.
Different b-values could measure different diffusion components.
C-611
Albumin and magnesium sulfate combination with thrombolysis extend
thrombolytic time window in rat
J.-G. Zhao; Shanghai/CN (zhaojungongmd@sohu.com)
Purpose: To identify whether albumin and magnesium sulfate combination with
thrombolysis could extend the thrombolytic time window.
Methods and Materials: The intraluminal middle cerebral artery filament model
was used to produce focal middle cerebral artery occlusion (MCAO). Separate
animal groups were treated intravenously either with 20% human albumin (1.25 g/
kg), magnesium sulfate injection (500 mg/kg), combination with urokinase
(25000 IU/kg) or with urokinase (25000 IU/kg) at 3 or 6 hours after MCAO. All
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Purpose: There is a great need to improve our understanding of brain tumour

biology to improve diagnosis and to develop new treatments. The purpose of this
communication is to check the complementarity between in vivo 1H MRS and ex
vivo metabolomic and transcriptomic data for a better diagnosis and prognosis of
brain tumour, using the multi-center protocols provided in the LSH-FP6 European project eTUMOUR.
Methods and Materials: The MR study was performed in a 1.5 T superconductive unit (Philips Gyroscan Intera). MRS protocol included SV (TE 31 and 136 ms)
in the lesion. The voxel volume was fitted to the high cellularity region of the
lesional mass using TSE-CSI (272 ms TE) Cho images. Signals coming from
outer volume were suppressed with saturation slabs. Mass of tumoral tissue analyzed for each patient ranged from 16 to 35 mg.
Results: Spectroscopy and genetic microarray studies were done in 20 patients
with histopathological diagnoses of GBM, astrocytoma, meningiomas, oligodendrogliomas, oligoastrocytomas and metastases.
Conclusion: Our results demonstrate the viability of an extensive characterization of brain tumour biopsies by spectroscopic and genomic tools. In addition,
comparative analysis of in vivo 1H-MRS and HRMAS data have been useful for a
better identification of in vivo spectra and, therefore, for an improved brain tumour classification. This analysis provided brain tumour classifiers for in vivo and
ex vivo MR data. Particular attention has been focused in the metabolomic and
phenotypic differences between glioblastomas with different survival times; short
as primary and longer as secondary glioblastoma.
C-609

rats underwent MR imaging before treatment, and 3 hours, 2 days and 9 days
after the treatment respectively, through which infarct volumes were determined.
Damage to the blood-brain barrier was assessed at 9 days after the last MR
imaging examination by fluorometric measurement of FITC-albumin extravasation in ischemic brain regions, and matrix metalloproteinase -2 (MMP-2) was also
evaluated. Semi-quantitative morphological analysis of neurons as well as astrocytes was performed by transmission electron microscopy at the same time.
Results: Infarct volumes decreased significantly (P < 0.05) only in animals treated with combined therapy in the 3 hours group, the morphological improvement
of neuron and astrocyte as well as MMP-2 decrease appeared both in the 3
hours and 6 hours ischemic rats with combined therapy. Fluorometric measurement revealed remarkably diminished FITC-albumin extravasation in ischemic
brain regions with combined therapy as well. No hemorrhagic transformation occurred even in the 6 hours ischemic rats with combined therapy.
Conclusion: Albumin and magnesium sulfate combining with thrombolysis could
extend the thrombolytic time window through inhibition MMP degradation of the
extracellular matrix as well as increasing the survival of neurons and astrocytes.
C-612
Brain activation by functional MRI in response to isovaleric acid: Informed
and naive condition
Y. Murata, I. Yokoe, F. Okutani, M. Nakahira, K. Morio, T. Sasaki, T. Ushida,
Y. Ogawa; Nankoku/JP (village@ps.inforyoma.or.jp)
Purpose: The purpose of this study was to investigate the differences in regions
of brain activation by functional MR imaging in response to olfactory stimulation
with isovaleric acid, with and without prior warning.
Methods and Materials: Participants were 17 healthy right-handed volunteers
(4 men and 13 women) who were assessed to have normal olfactory function by
T&T olfactometry test. Odor stimulation was performed under the following two
conditions: with immediate prior warning for 8 "informed" subjects and without
prior warning for the remaining 9 "naive" subjects. Odorant used was 13.5% of
isovaleric acid. Subjects reported the valence of a series of olfactory stimulations
with isovaleric acid, rating each stimulation as either pleasant, unpleasant or
neither unpleasant nor pleasant.
Data was obtained with a 1.5 T MR imaging system. Imaging data were analyzed
using FEAT (part of FMRIB'S software library) (p < 0.01, corrected).
Results: In the informed group, significant activations were observed in the insula, entorhinal cortex and lateral orbitofrontal cortex. All subjects reported the odor
to be unpleasant. In the naive group, significant activations were observed in the
anterior cingulate cortex, entorhinal cortex, lateral orbitofrontal cortex. Only 2
subjects reported the odor as unpleasant, though the remaining 7 reported it as
neither nor unpleasant.
Conclusion: These results suggest that prior conditions affect odor recognition
and the brain activation in response to olfactory stimulation.
C-613
Investigation of white matter changes in Parkinson's disease (PD) and
Alzheimer's disease (AD) by diffusion tensor MRI and 2-[18 F]F-A-85380
positron emission tomography (2-FA-PET)
D. Lobsien1, P. Meyer1, K. Kendziorra1, S. Hesse1, H.-J. Gertz1, J. Schwarz1,
J.-P. Schneider1, O. Sabri1, C. Zimmer2; 1Leipzig/DE, 2Munich/DE
(donald.lobsien@medizin.uni-leipzig.de)
Purpose: Diffusion tensor MR imaging (DTI) can assess alterations of the brain
structure via changes in diffusional anisotropy of water molecules. In PET the
tracer 2-FA selectively binds to alpha4beta2 nicotinic acetylcholine receptors
(nAChR). We correlatively investigated white mater changes in AD and PD patients to test whether: (1) nAChR availability is altered in the WM, (2) there are
WM changes detectable with DTI, (3) there is a correlation between 2-FA-PET
and DTI results.
Methods and Materials: Eight healthy controls, 12 patients with PD and 5 with
AD all non-smoking were included in the study. Subjects were studied by dynamic 2-FA-PET and by Diffusion Tensor MR imaging (Magnetom Symphony, 1.5 T,
Siemens). After co-registration, binding potential (BP[2-FA]) and fractional anisotropy (rFA[DTI]) were assessed bilaterally in medial and lateral periventricular
WM (PVWM), ventral capsula interna (CIV), genu corporis callosi (GCC) by ROIanalysis and normalisation to GCC.
Results: BP (2-FA) (vs controls): medial PVWM: PD -27.9, AD -19.1%; lateral
PVWM: PD -18.6, AD +1.5%; CIV: PD -26.5, AD +7.7% [p < 0.05]. rFA (DTI):
medial PVWM: PD +5.0, AD +7.4%; lateral PVWM: PD -5.4, AD -18.8% [p0.68,
p < 0.02). MMSE vs BP (2-FA) in medial PVWM in PD (R=0.59, p = 0.05), MMSE
vs rFA (DTI) in CIV in AD (R=-0.87, p = 0.03).
452
Conclusion: FA[DTI] and BP[2-FA] show a differential regional pattern of alterations. Correlations found between MMSE, FA[DTI] and BP[2-FA] in the WM indicate the potential that this combined imaging bears for assessment of the white
matter integrity and cholinergic function.
C-614
Three-dimensionally displayed MR imaging of the normal cranial nerves
H. Sherif, A.E. Mahfouz; Doha/QA (sherifhanan@yahoo.com)
Learning Objectives: To learn the anatomical appearance of the cranial nerves
on three-dimensionally displayed MR imaging.
Background: Three-dimensionally displayed MR images are now feasible owing
to advances in three-dimensional acquisition pulse sequences of the brain and
advances in three dimensional image reconstruction. The present exhibit illustrates the normal cranial nerves in three dimensions.
Procedure Details: Three-dimensionally acquired images of the brain have been
performed by 3D fat-saturated T1-weighted turbo-FLASH (fast-low-angle shot)
sequence covering the whole brain. Images have been reconstructed by volume
rendered technique (VRT-INSPACE, Siemens, Erlangen, Germany). Volume cropping has been performed to demonstrate the individual cranial nerves and illustrate their course and their important anatomical relations.
Conclusion: Three-dimensionally acquired and displayed images of the cranial
nerves offer better understanding of their anatomical course and relations.
C-615
Diffusion tensor imaging in systemic lupus erythematosus: A prospective
study of ADC and FA values in different regions of the brain
M.A. Hughes, X. Fan, S. Gebarski, J. McCune, P.C. Sundgren; Ann Arbor,
MI/US (marionh@umich.edu)
Purpose: To determine if significant differences in apparent diffusion coefficient
(ADC) and fractional anisotropy (FA) values in different gray and white matter
regions of the brain in patients with systemic lupus erythematosus (SLE) exist
when compared to healthy individuals.
Methods and Materials: 10 patients (aged 23-59, mean 44.6) with symptomatic
SLE and 25 normal controls (aged 22-59, mean 44.4) were evaluated. All subjects had a routine brain MR imaging. Diffusion tensor imaging was also obtained
using a single shot spin-echo EPI technique along nine different directions with a
b-value of 1000 s/mm2. 50 mm3 volumes of interest were placed in standardized
normal appearing grey and white matter regions within both hemispheres. ADC
and FA maps were generated and ADC and FA values and standard deviations
were calculated. A two-sample t-test was used for statistical analysis.
Results: Statistically significant differences (p < 0.005) were found in both ADC
and FA values when comparing the SLE patients to the normal controls in the
thalamus, parietal white matter, and frontal white matter. Significant differences
in FA values in the corpus callosum and significant differences in ADC values in
the insular cortex and internal capsule were also noted when comparing the two
populations.
Conclusion: DTI can distinguish significant differences in FA and ADC values in
several normal appearing regions of the brain in SLE patients when compared to
healthy individuals. DTI can play a role in the detection of occult parenchymal
abnormalities, the assessment of disease burden and progression, and possibly
help explain specific symptoms in SLE patients.
C-616
Quantitative multislice CT perfusion in diagnosis and evaluation of acute
cerebral ischemia
M. Dziubinska-Basiak, M. Hartel, M. Basiak, M. Konopka; Katowice/PL
(maria.dziubinska@helimed.pl)
Purpose: CT perfusion is a relatively new technique enabling assessment of
tissue hemodynamics. The aim of our study is to show the usefulness of CT
perfusion in evaluation of acute cerebral ischemia.
Methods and Materials: CT perfusion examination was performed in 16 patients
(9 male, 7 female, mean age 68 7.28) with symptoms of acute stroke. We evaluated acute ischemia using the following parameters: Cerebral blood flow (CBF),
cerebral blood volume (CBV), mean transit time (MTT) and permeability surface
(PS). Also areas of infarct and penumbra were measured. Our patients had control CT examination in which we assessed the area of post-ischemic lacuna and
compared it with the area of infarct from CT perfusion examination.
Results: In 13 patients CT perfusion showed infarct of extent confirmed in control CT examination and area of penumbra without abnormalities in control CT. In
3 patients with neurological symptoms of cerebral ischemia CT perfusion did not

show abnormalities, control was also normal - it was transient ischemic attack
(TIA) confirmed by neurologist.
Conclusion: CT perfusion is an easy, fast and accurate technique in evaluation
of acute ischemia. It shows morphological and functional abnormalities, enables
differentiation of infarct from penumbra which is fundamental to qualify a patient
for thrombolytic treatment. CT perfusion with control examination also makes
possible the confirmation of transient ischemic attack.
C-617
MTT as a prognostic value in evaluation of acute cerebral ischemia
M. Dziubinska-Basiak, M. Hartel, M. Konopka, M. Basiak; Katowice/PL
(maria.dziubinska@helimed.pl)
Purpose: Mean transit time (MTT) is one of the parameters illustrating tissue
hemodynamics in CT perfusion examination. It appears to be very accurate in
assessment of acute cerebral ischemia.
Methods and Materials: In 37 patients with suspected cerebral stroke CT perfusion was performed using multi-row CT. The first stage of the examination was
CT without contrast enhancement. In the second stage we applied 40-50 ml of
contrast medium iv. with a constant speed of 4 ml/sec using an automatic syringe, and in the 5th second of application we started scanning with 1 scan/sec,
slice thickness 10 mm, 80kv and 190 mAs. Then we studied color maps of brain
perfusion, measuring MTT in regions of interest, taking great care to exclude
areas of vessels.
Results: In 12 patients MTT was significantly increased showing the area of
infarction, 5 of them also had an area of slightly increased MTT showing the
penumbra. In another 16 patients we found an area of penumbra with a slender
increase of MTT value. In 4 patients CT perfusion did not show an ischemic focus
but we found post-infarct lacuna on control CT examination at a different level the reason for this was that the stroke was at a different level than the basal
ganglia, which is standard level of CT perfusion examination. In 5 patients we
found no abnormalities in CT perfusion and control.
Conclusion: MTT appears to be accurate, useful and the most sensitive parameter of CT perfusion in the diagnosis of cerebral ischemia. It is necessary to carry
out further studies on this ground.
C-618
MR imaging in the detection of diffuse axonal injury with mild head trauma
N. Bolca Topal, C. Erdogan, M. Bulut, . Kksal, B. Hakyemez, M. Parlak;
Bursa/TR (nailebolca@yahoo.com)
Purpose: To evaluate the occurrence and distribution of diffuse axonal injury
(DAI) caused by mild head trauma using MR imaging.
Methods and Materials: Twenty seven patients with mild head trauma who had
normal cranial CT findings were examined with a standard MR protocol including
T1 weighted, T2 weighted, fluid attenuated inversion -recovery (FLAIR), gradient
-echo (GRE) and diffusion-weighted (DW) sequences. MR imaging was performed
within 24 hours of injury. Lesions were characterized as DAI on the basis of their
location and morphological appearance.
Results: MR imaging showed DAI lesions in 4 patients (14.81% of all patients).
In 3 of these, lesions were depicted on FLAIR, GRE and DW sequences. In one
patient DAI was detected only on DW sequences.
Conclusion: MR imaging can be helpful to reveal the DAI lesions in patients with
normal CT scan findings after mild head trauma. FLAIR, GRE, DW sequences
are superior to conventional spin-echo images to detect DAI lesions.
C-620
Hypointense line along the posterior rim of the precentral gyrus on FLAIR
images in patients with ALS
M. Michelassi, M. Cosottini, G. Siciliano, L. Faggioni, S. De Cori, G. Lazzarotti,
F. Di Salle, C. Bartolozzi; Pisa/IT (chiaramichelassi@tin.it)
C-621
Functional mean diffusion map: A non-invasive MR imaging biomarker for
evaluating brain glioma cell proliferation
Z.X. Li, J.P. Dai, T. Jiang, S.W. Li, Y.L. Sun, P.Y. Gao, J. Ma; Beijing/CN
(tshirtjean@163.com)
Purpose: To investigate the correlation between the mean diffusivity (MD) measured using diffusion tensor imaging (DTI) and the Ki-67 labelling index in gliomas.
Methods and Materials: DTI was performed using a Siemens Trio MR scanner
in fifty-six consecutive patients with histologically proven gliomas. The regions of
interest (ROIs) were positioned on the solid portion of the lesion. The MD values
were calculated. Ki-67 staining of paraffin embedded sections with monoclonal
antibody MIB-1 was performed. In the area with the highest number of labelled
cells, the percentage of Ki-67 positive nuclei (labeling index: LI) was determined.
Then, the results of Ki-67 LI were divided into three groups: High (LI > 40 %),
median (15 % LI 40 %) and low (LI < 15 %). Then, the Ki-67 LI were compared with MD values.
Results: The MD values of the high Ki-67 LI group (0.863 0.197 10-3 mm2/s)
were significantly lower than those of the median Ki-67 LI group (1.130 0.275
10-3 mm2/s) (p = 0.015) or low Ki-67 LI group (1.278 0.298 10-3 mm2/s) (p < 0.001).
Negative correlation existed between MD values and Ki-67 LI (r s =-0.570,
p < 0.001).
Conclusion: In brain gliomas, Ki-67 LI bears a significant relationship to MD
values. Its molecular pathological base is that Ki-67 can precipitate the tumor cell
proliferation. The MD value of DTI is regarded as a non-invasive MR imaging
biomarker for evaluating cell proliferation in gliomas.
C-622
Diffusion tensor imaging for preoperative evaluation of tumor grade in
gliomas
Z.X. Li, J.P. Dai, S.W. Li, T. Jiang, Y.L. Sun, P.Y. Gao, J. Ma; Beijing/CN
Purpose: The relationship between water diffusion parameters measured using
diffusion tensor imaging (DTI) and histological malignancy of gliomas was investigated.
Methods and Materials: DTI was performed using a Siemens Trio MR scanner
in 61 consecutive patients with histologically proven gliomas. The region of interest (ROI) was determined on DWI and T1-weighted MR images with contrast
medium and positioned on the solid portion of the lesion. The ROI was automatically transferred to the co-registered fractional anisotropy (FA), mean diffusivity
(MD) and exponential apparent diffusion coefficient (exp. ADC) maps. Then, the
FA, MD and exp. ADC values were calculated and compared with the WHO classification of the gliomas.
Results: The FA values of low grade gliomas (0.121 0.035) were significantly
lower than those of high grade gliomas (0.155 0.057)(p = 0.006). The MD values of low grade gliomas (1.255 0.322 10-3 mm2/s) were significantly higher
than those of high grade gliomas (0.928 0.240 10-3 mm2/s) (p < 0.001). The exp.
ADC values of low grade gliomas (0.170 0.080) were significantly lower than
those of high grade gliomas (0.263 0.084) (p < 0.001).
Conclusion: FA, MD and exp. ADC values can distinguish between high grade
and low grade gliomas. This is useful in deciding the surgical strategy or selecting the site of stereotactic biopsy.
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Purpose: To assess the overall diagnostic accuracy of magnetic resonance using FLAIR sequences for clinically definite amyotrophic lateral sclerosis (ALS).
Methods and Materials: We evaluate 24 patients and 32 age-matched controls
for the presence of high signal intensity along the corticospinal tracts (CST) and
the dark line along the posterior rim of the precentral gyri on FLAIR images.
Results: The high signal intensity along the CST was found more frequently
(p = 0.003) in ALS patients (8/24) with respect to the control group (1/32); sensitivity, specificity and diagnostic accuracy were 33%, 96% and 69% respectively.
The dark line along the posterior rim of the precentral gyri was found more frequently (p = 0.01) in patients (14/24) with respect to controls (7/32); sensitivity,
specificity and diagnostic accuracy were 58%, 78% and 69% respectively. Dis-
ease duration and severity measured with ALSFRS were not significantly different in patients with high signal intensity along CST (p = 0.75 and p = 0.82 respectively), or dark line along the posterior rim of the precentral gyri (p = 0.07
and p = 0.83 respectively), with respect to the patients without FLAIR abnormalities.
Conclusion: The signal intensity along the CST and the dark line along the posterior rim of the precentral gyri appeared more frequently in ALS patients. On
FLAIR images high signal intensity of CST has a better specificity in detecting
definite ALS, while the dark line along the precentral gyrus has a better sensitivity. The diagnostic accuracy of both signs on FLAIR images is low, confirming
that conventional MR imaging has a limited rule in the ALS diagnostic workup.

C-623
Functional MR imaging and diffusion tensor tractography in patients with
brain gliomas involving motor areas: Clinical application and outcome
Z.X. Li, J.P. Dai, T. Jiang, S.W. Li, Y.L. Sun, P.Y. Gao, J. Ma; Beijing/CN
Purpose: To explore the role of preoperative BOLD functional MR imaging (fMRI)
and diffusion tensor tractography (DTT) in neurosurgical treatment with intraoperative electrical stimulation of gliomas involving motor areas, to identify the relationship between motor cortical area, pyramidal tracts and brain gliomas.
Methods and Materials: BOLD-fMRI with a bilateral hand movement paradigm
and DTI were performed using a Siemens Trio MR scanner in 28 consecutive
glioma patients with involvement of motor areas. Activation mapping of hand
movement on three dimensional pyramidal tracts was performed. The relationship between motor cortical area, pyramidal tracts and brain gliomas was demonstrated, which was used to optimize pre-surgical planning. All patients received
microsurgical intraoperative electrical stimulation. The brain lesions were removed
as far as possible with regard to eloquent areas and pyramidal tract preservation.
The preoperative and postoperative KPS were performed to evaluate the state of
patients.
Results: The relationships between the motor cortex area, pyramidal tracts and
brain gliomas were localized by preoperative fMRI and DTI. The primary motor
area was monitored by the method of direct electrical stimulations. There was a
good correlation between preoperative fMRI and intraoperative cortical stimulation. Furthermore, the preoperative fMRI and DTT could make up for the unmonitored motor areas and pyramidal tracts during operative cortical stimulation.
Comparing the preoperative KPS, the postoperative KPS was advanced.
Conclusion: BOLD-fMRI and DTT could non-invasively localize the relationship
between brain motor cortex, pyramidal tracts and brain gliomas in vivo to optimize surgical planning and guide the microsurgery of intraoperative electrical
stimulation.
C-624
Prognostic value of cranial MR imaging in moderate and severe traumatic
brain injury
A. Ramos, F. Ballenilla, A. Lagares, M. Martin, P. Martin, L. Escudero;
Madrid/ES (fballenilla@seram.org)
Purpose: To predict long-term neurological outcome in patients with acute and
moderate traumatic brain injury, and to determine if MR data alone or in combination with classical CT and clinical data provided better prediction.
Methods and Materials: We conducted a prospective MR study of 103 patients
with moderate and severe traumatic head injury in the subacute period (average
10 days after injury). All clinical variables that could be related to the prognosis
as well as the initial CT findings according to Marshall classification were recorded. Our MR imaging protocol for traumatic brain injury included T1 sagittal images, T2 and FLAIR axial and coronal images and T2 gradient echo sagittal and
axial views. The location, size and appearance of MR imaging lesions were assessed by two neuroradiologists who were blinded to CT findings and clinical
status of the patients. Gentry's classification was used to classify patients with
diffuse axonal injury (DAI) in MR imaging. Global outcome was scored according
to the Glasgow Outcome Scale (GOS), the Barthel index and Folstein Mini-Mental State Examination at six months after injury.
Results: Using a multivariable study with logistic regression we found only two
variables with statistical significance that influence prognosis: initial motor GCS
and MR imaging findings according to Gentry classification. In patients with DAI,
MR imaging findings were superior to initial motor GCS to determine prognosis.
Conclusion: Depth of traumatic lesions in MR imaging is the best predicting
outcome in patients with traumatic brain injury.
C-625
Establishing platform criteria for trauma related follow-up CT head:
Experience from a UK university hospital
H. Obaid, K. Damodharan, V. Kandula, N. Messios; Leicester/UK
(vinay.kandula@uhl-tr.nhs.uk)
Purpose: Over the past few years there has been a dramatic increase in the
number of repeat CT head examinations following head injury, especially after
the implementation of NICE guidelines in the UK. Currently, repeat CT head can
be requested at the clinicians' discretion. So far, there are no established solid
criteria to control such referrals. We propose platform criteria for this purpose
where repeat CT head might be considered vital for patient management.
Methods and Materials: A retrospective review of the reports of head scans for
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those patients who had repeat scans within a week of the initial scan following
head injury, was done using CRIS, over a one year period, in a University Teaching Hospital. The reports were assessed for any significant change compared to
the initial scan findings.
Results: We identified 42 patients who satisfied the above criteria. 33 patients
showed no significant change on the repeat scan within a week. Amongst the 9
patients who had a significant change, seven had a positive initial study.
Conclusion: Our study suggests that if the initial scan following trauma was normal it is unlikely that the repeat scan will show any significant change.
C-626
Hypertrophic olivary degeneration: Causes and consequences
A. E, D. Cheong, B. Ching, C. Lim; Singapore/SG (tchoyoson_lim@nni.com.sg)
Learning Objectives: 1. To understand the white matter fibers and brainstem
nuclei involved in the Guillian-Mollaret triangle and how disruption of this neural
pathway can lead to hypertrophic olivary degeneration (HOD). 2. To learn the
causes of damage to the Guillian-Mollaret triangle. 3. To appreciate the clinical
differential diagnosis of hypertrophic olivary degeneration.
Background: Hypertrophic olivary degeneration is a rare but characteristic phenomenon of swelling and signal change of the medullary olives best visualized
on MR imaging. It is a form of transsynaptic degeneration that results from disruption of various nuclei in the brainstem, or their white matter connections. These
form the Guillian-Mollaret triangle, and a variety of lesions can lead to HOD. We
present MR imaging studies in patients with HOD.
Imaging Findings: Characteristic findings of HOD include swelling and non-enhancing hyperintensity of the medullary olives on T2-weighted and FLAIR images. The causative lesion affecting the Guillian-Mollaret triangle (dentate nucleus,
red nucleus and medulla and their white matter connections) are usually well
visualized. These include posterior fossa tumor such as medulloblastoma and
pilocytic astrocytoma, cavernous angioma, and hypertensive hemorrhage. In
particular, HOD swelling in post-treatment follow-up imaging in neoplasms must
be distinguished from tumor recurrence.
Conclusion: Hypertrophic olivary degeneration is caused by disruption of the
Guillian-Mollaret triangle. This characteristic condition should be recognized by
neuroradiologists to avoid pitfalls in diagnosis.
C-627
Diffusion tensor based white matter tractography of the corpus callosum in
patients with bipolar disorder
N. Papanikolaou1, S. Karampekios1, P. Bitsios1, T.G. Maris1, E. Papadaki1,
S. Frangou2, N. Gourtsoyiannis1; 1Iraklion/GR, 2London/UK
(npapan@med.uoc.gr)
Purpose: This study was conducted to assess any potential abnormalities in the
corpus callosum of subjects with bipolar disorder.
Methods and Materials: Eight right-handed bipolar I patients and 8 right-handed aged matched healthy control subjects were studied. A diffusion tensor imaging sequence with 6 directions, b value of 1000, 12 acquisitions and 60 slices of
2 mm thickness was applied. White matter tractograms of the corpus callosum
were generated by means of dedicated software in all patients and normal subjects. Qualitative, visual assessment of the three-dimensional tractograms was
performed.
Results: In all patients various degrees of abnormality located in the corpus
callosum were found. These ranged from minor reduction in the density of the
fibers to significant pruning of distal and proximal bundles of corpus callosum,
located in genu (85.7%), anterior body (57.1%), posterior body (14.3%), isthmus
(42.8%) and splenium (28.5%).
Conclusion: Abnormal density and fiber loss in callosal areas may affect interhemispheric communication and be involved in the pathophysiology and cognitive impairment found in bipolar disorder.
C-628
Diffusion tensor imaging findings in fibromyalgia patients: ADC and FA
values in different brain regions
B.R. Foerster, X. Fan, M. Petrou, S.A. McLean, D.J. Clauw, P.C. Sundgren;
Ann Arbor, MI/US (compfun@umich.edu)
Purpose: To evaluate if there are significant differences in apparent diffusion
coefficient (ADC) and fractional anisotropy (FA) values in different regions of the
brain in fibromyalgia patients, compared to normal healthy individuals, that may
provide insight into the pathogenesis of this condition.
Methods and Materials: 20 patients diagnosed with fibromyalgia and 25 aged-

matched normal healthy controls were evaluated. Self-report questionnaires,
standard labs, and pain pressure testing were performed on all patients. All subjects had a pre- and post-contrast conventional brain MR imaging. In addition, a
diffusion tensor image was obtained using a single shot spin-echo EPI technique
along nine different directions with a b-value of 1000 s/mm2 to generate ADC
and FA maps. Standardized regions of interests with a size of 50 mm2 were placed
bilaterally in regions of the brain known to be important in pain processing to
obtain ADC and FA values. Student's T-test was used for statistical analysis.
Results: The mean FA value of right thalamus in fibromyalgia patients was
0.257 0.021 compared to the normal healthy control mean of 0.274 0.028,
which was statistically significant (p = 0.03). There were no significant differences in the ADC and FA values between the fibromyalgia patients and the controls
in the other brain regions examined.
Conclusion: This study identified significant differences in the right thalamus by
diffusion tensor imaging in fibromyalgia patients compared to the normal controls, which is consistent with findings of decreased thalamic blood flow in previous SPECT studies. Diffusion tensor imaging may be of clinical utility in further
understanding and monitoring this disease.
C-629
Benefit of 3 Tesla in pituitary gland studies
R. Agati1, F. Girard2, P. Ghedin3, M. Leonardi1; 1Bologna/IT, 2Buc/FR, 3Milan/IT
(franck.girard@med.ge.com)
Introduction: Adenomas of the pituitary gland are a severe disease that must be
treated in the earliest possible stage. The study of the pituitary gland with MR
requires a very high temporal resolution, a very high spatial resolution, and high
sensitivity. It is our aim to show in this study we achieve these goals on a 3 T MR
system, increasing diagnostic accuracy.
Methods and Materials: A GE whole-body 3 T MR system (GE Healthcare, USA),
using an 8ch head coil (Invivo Corp., USA) was used for the whole study. A dynamic T1-weighted 3D gradient-echo sequence, with a resolution of
0.36x0.36x2 mm, and a 20 second temporal resolution was achieved. 5 patients
with suspected micro-adenoma were studied. Informed written consent was obtained prior to the study. The post-processing was done with the Functool software provided by GE, to compute the positive enhancement integral of the image.
2 regions of interest were drawn, one in a normal region, the other one in the
suspected adenoma, and contrast uptake curves were computed.
Results: Uptake curves depicted the adenoma even on very small lesions. No
noticeable susceptibility artefact was present, ensuring reliable measurements.
Conclusion: 1.5 T pituitary studies often lack either temporal or spatial resolution. The higher 3 T signal-to-noise ratio, combined with a high number of channels, makes these studies more accurate, ensuring earlier detection of the lesions.
C-630
Enlargement of the uncal sulcus angle: A simple and convenient index to
distinguish Alzheimer's disease from the normal aging brain
S. Koyama, A. Wada, T. Katsube, H. Kanda, N. Okada, T. Yoshizako,
K. Yoshikawa, N. Uchida, H. Kitagaki; Izumo/JP (gokun@iris.ocn.ne.jp)
Abnormal perfusion in active plaques in comparison to the contralateral

normal-appearing white matter in patients with clinically isolated syndrome
(CIS)
A.M. Lancharro, C. Tirado, J. Guzman de Villoria, L. Muoz, C. de Andres,
T. Cuesta; Madrid/ES (ainvar06@hotmail.com)
Purpose: The pathogenesis of multiple sclerosis (MS) has not been established
yet. Therefore, there is a significant vascular component that suggests a potential
focus for angiogenesis, which plays a vital role in both the development of lesions
and the progression of the disease. Changes in vascular permeability precede
the onset of demyelinating lesions, whereas thickening of the wall vessel with
vascular proliferation is evident in autopsies of patients with MS. Our aim is to
use the perfusional abnormalities to detect local inflammatory and metabolic
changes within active plaques.
Methods and Materials: We have studied a total of 21 patients during one year.
They were classified into CIS. All patients were studied during an attack, in the
absence of treatment. The MR imaging protocol included T2WI, T1WI before and
after Gadolinium administration, DWI and Perfusion T2* EPI. The parameters
used to measure perfusion were the relative cerebral blood flow (rCBF), and
relative mean transit time (rMTT).
Results: There is an increased rCBV in enhancing lesions after Gadolinium administration when compared to contralateral normal-appearing white matter. We
compared MR perfusion metrics between those patients with CIS (13) with those
included in the control group (8) resulting in a prolonged time to peak and rMTT
in the normal-appearing white matter of frontal lobes in the first group.
Conclusion: The increased rCBV in active plaques is probably related to microangiopathy, angiogenesis and immuno-modulated phenomena.
The improvement in resolution offered by this technique allows for the pathophysiological and treatment effects to be measured more accurately.
C-632
Perfusion MR imaging characterization of post-recanalization
hyperperfusion and its microvessel changes in rats
J.-G. Zhao; Shanghai/CN (zhaojungongmd@sohu.com)
Purpose: Although animal and human studies have demonstrated that post
ischemic hyperperfusion may occur both early and late time points following acute
cerebral ischemia, there is a lack of evidence with microvessel control data. We
use perfusion MR imaging to characterize hyperperfusion in rats following intravenous thrombolysis and compare to microvascular study by laser-scanning confocal microscopy (LSCM).
Methods and Materials: Rats received 3 or 6 hours of middle cerebral artery
occlusion (MCAO) by an intraluminal suture, and were treated with urokinase
(25000 IU/kg) intravenously after suture withdrawn. Perfusion MR imaging was
performed before treatment and 2 to 3 hours following vessel recanalization. Laser-scanning confocal microscopy was employed to examine the rat microvascular architecture, which was labelled by fluoro isothiocyanate-albumin after the
last MR imaging examination.
Results: Hyperperfusion was visualized in all rats within 3 to 5 hours after recanalization. Within the core region of hyperperfusion in the 6 hours group, the
mean relative cerebral blood volume (mean 247%) was greater than those (mean
153%) in 3 hours group (P < 0.05); severe FITC-albumin extravasation occurred
in ischemic brain regions in the 6 hours group, while no or mild leakage of FITCalbumin in the 3 hours group.
Conclusion: Perfusion MR imaging could characterize post-ischemic hyperperfusion with good correlation to microvascular damage.
C-633
Venous networks through middle and posterior cranial base; anatomical
variations demonstrated on contrast enhanced MR imaging and
multidetector row CT
S. Tanoue 1, H. Kiyosue1, Y. Hori1, M. Okahara2, Y. Sagara1, J. Kashiwagi1,
H. Mori1; 1Oita/JP, 2Beppu/JP (tanoue@med.oita-u.ac.jp)
Learning Objectives: To know the anatomical variations of venous system drainage through middle and posterior cranial base. To describe the usefulness of
contrast-enhanced fat-suppressed 3D fast-gradient-echo MR imaging and multidetector row CT in evaluating venous structures of the cranial base.
Background: Intracranial venous blood flow drains to extracranial veins converging into major venous sinuses, such as cavernous sinus and trans-sigmoid
sinus. There are many venous structures flowing into the sinuses, and the veins
form networks with each other by means of draining into the sinuses and the
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Learning Objectives: The aim of this study is to propose a simple, convenient

index by which to distinguish between a brain with Alzheimer's disease and a
normally aging brain having dilatation of the inferior horn of the lateral ventricle.
Background: Atrophy of the medial temporal lobe structures is one of the most
accurate and characteristic findings of Alzheimer's disease. This morphologic
change is recognized as a dilatation of the inferior horn of the lateral ventricle on
clinical brain imaging. However, similar dilatation of the inferior horn is often depicted in the normal aging brain.
Imaging Findings: We acquired whole brain thin-slice coronal MR images of 24
patients with Alzheimer's disease and of 24 control patients without dementia, all
of whom were matched in age, sex and volume of whole brain. We defined the
angle between the superior margin of the uncal sulcus and the horizon on coronal images as "uncal sulcus angle" and evaluated the relation of the degree of
this angle and temporal lobe atrophy (volume of the inferior horn of the lateral
ventricle). In the Alzheimer's disease group, a significant positive correlation was
shown between the degree of uncal sulcus angle and temporal lobe atrophy
(P < 0.01, Spearman two-tail method); no significant correlation was shown in
the control group.
Conclusion: Enlargement of the uncal sulcus angle reflects atrophy of the enthorial cortex which is a characteristic change in the early stage of Alzheimer's
disease. This finding helps to distinguish Alzheimer's disease from the normal
aging brain.
C-631

jugular vein. The anatomy is complicated and the classification of variations is
incompletely characterized in previous reports.
Procedure Details: Two neuroradiologists retrospectively evaluated the images
of cases which had undergone contrast-enhanced fat-suppressed 3D fast-gradient-echo MR imaging or contrast-enhanced CT by using multidetector row CT
from the database of our institution. The obtained images were evaluated on a
viewer with transverse section or multiplaner reformat images, regarding normal
anatomy and variations.
Conclusion: Contrast-enhanced fat-suppressed 3D fast-gradient-echo MR imaging and contrast-enhanced CT by using multidetector row CT depicted the
skull base venous structures and venous networks through the cranial base well.
Knowledge of accurate anatomy and variations is important for diagnosis and
consideration of strategies of endovascular treatment for some pathological conditions involving the veins.
C-634
Central nervous system complications during pregnancy and the
postpartum period
Y.O. Tanaka, H. Hamada, I. Anno, Y. Okamoto, H. Yoshikawa, M. Minami;
Tsukuba/JP (ytanaka@md.tsukuba.ac.jp)
Learning Objectives: To know imaging findings of CNS complications during
pregnancy and the postpartum period with incidence, causes and clinical importance.
Background: Most complications during pregnancy which affect the central nervous system have a close relationship to pregnancy-induced hypertension. However, imaging findings of cerebrovascular accidents during pregnancy are slightly
different from those in elderly people. In addition, available imaging tools during
pregnancy are limited. Therefore, it is important for radiologists to know the specific imaging findings and indications of examinations for CNS complications during pregnancy.
Imaging Findings: Eclampsia is defined as newly developed convulsions occuring at 20 weeks gestation or later, and is closely related to hypertension. Recently, imaging findings of eclampsia have been recognized as one of the causes of
reversible posterior edema. Stroke is one of the most critical complications during pregnancy. Intracerebral hemorrhage due to ruptured aneurysm or arteriovenous malformation also occurs during pregnancy, especially at 16 weeks
gestation or later. Ischemic stroke is also caused by both arterial and venous
occlusion during pregnancy. Dural sinus thrombosis is known for its tendency to
develop hemorrhagic infarction, which often affects pregnant women. Compared
to stroke, it is not a life-threatening problem, but lymphocytic hypophysitis is well
known for almost always affecting pregnant women.
Conclusion: We will present typical imaging finding of these disorders with incidence and clinical information.
C-635
Seed method: A method to carry out semiautomatic quantitative analysis of
cerebrospinal fluid flow through the aqueduct of sylvius using phase
contrast magnetic resonance imaging
N. Flrez-Ordoez, D. Moratal-Prez, J. Forner-Giner, E. Arana,
L. Mart-Bonmat, J. Millet-Roig; Valencia/ES (marti_lui@gva.es)
Purpose: To develop a method that allows the user to mark a seed point within
the aqueduct of Sylvius to semiautomatically define the region of interest (ROI)
providing, at the same time, reproducibility in the measurements and reducing
the interobservers' variability. This method corrects errors that may lead to inaccuracies in the calculus of the different parameters that characterize the motion
of CSF (mean flow, mean velocity and stroke volume) as well as errors introduced by background offset and aliased pixels.
Methods and Materials: Our method was evaluated by two observers analyzing
21 healthy subjects. MR examinations were performed using a 1.5 T scanner
with a phase contrast sequence (Venc of 20 cm/s, FOV = 160 mm, 3 mm slice
thickness, matrix size = 256 x 256, TR = 53 ms, TE = 11 ms, NSA = 2 and 23
frames per cardiac cycle with peripheral retrospective pulse gating). It was developed using MATLAB R7. To correct possible residual systematic errors an average value of offset per frame is measured in background baseline regions where
brain motion is minimal or absent during the cardiac cycle, as in midbrain and
regions surrounding the ROI.
Results: Differences in outcomes between the two observers are expressed in
terms of mean flow, stroke volume, standard deviation, ICC, and systematic difference. The method was highly reproducible, our results can be observed in
(table 1).
Conclusion: Our semiautomatic method is significantly reproducible, allowing a
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generalization of the calculus of flow parameters with great consistency and independency of the operator.
C-636
Diffusion-tensor-imaging: How to get exemplary protocols
H. Rumpel, L.L. Chan; Singapore/SG (helmut.rumpel@pacific.net.sg)
Learning Objectives: To demonstrate the concepts of diffusion-tensor-imaging
to investigate the brain white matter structures regarding location, orientation,
and fractional anisotropy (FA). Strategies for reproducible definition of regionsof-interest will be illustrated and artifacts related to partial volume effects with
large white-matter tracts and crossed-fiber anisotropic diffusion will be discussed.
Background: Recently, diffusion-tensor-imaging has been used to characterize
brain development and aging, as well as structural changes induced by infectious, neurological, and neuropsychiatric disorders.
Procedure Details: To illustrate these strategies, diffusion-tensor-imaging results of early pathological changes of the motor connectivity circuit underlying
Parkinsonism are presented. There were 18 patients (stage 2, mean age 65y)
and 25 controls (mean age 60y) in the study based on a 2D EPI diffusion tensor
imaging acquisition. The results showed significantly decreased FA along the
nigrostriatal projection fibers and in other relay-stations of this motor circuit.
Conclusion: Subtle changes in FA might be hidden by fiber orientation heterogeneity in a region-of-interest.
C-637
MRI of intracranial hypotension syndrome: The role of the "internal auditory
canal" sign
A. Catalucci, V. Pupillo, L. Zugaro, R. De Amicis, M. Gallucci, C. Masciocchi;
L'Aquila/IT (alessiacat@tiscali.it)
Purpose: Spontaneous intracranial hypotension (SIH) is a rare condition mainly
consisting on postural headache. It could be spontaneous (spinal CSF leakage)
or secondary. We retrospectively reviewed and reported the main MR imaging
features in cases of intracranial hypotension, pointing our attention to the "internal auditory canal sign" (IAC sign), up to today never described in literature.
Methods and Materials: MR imaging of 30 patients affected by SIH were evaluated to identify the main MR imaging features of this pathological condition (diffuse pachymeningeal thickening and enhancement, brain "sagging", pituitary and
cavernous sinus enlargement) and the "internal auditory canal" sign: Gd enhancement close to the IAC wall. The presence of this sign was evaluated in 10 cases
with meningeal changes by different causes (3 meningitis in otomastoiditis, 3
pachymeningeal carcinomatosis, 3 bilateral subdural haematomas, 1 sarcoidosis). Axial images before and after Gd were always available; sagittal images in
19 cases, coronal ones after Gd in 24 cases; 3 patients underwent to myelo-MR
imaging, 3 patients to both myelography and myelo-CT.
Results: Dural thickening/enhancement were observed in all cases; brain sagging in 18/19, pituitary and cavernous sinus enlargement in 23/24; the IAC sign in
26/27. In the 10 cases examined as control it was never observed. In 2/3 cases in
which myelo-MR imaging showed the CSF leak, it was confirmed by myelo-CT.
Conclusion: Our experience confirms the diagnostic role of MR imaging in cases of SIH. We believe the IAC sign to have a diagnostic accuracy equal or superior to the other MR imaging features; it could be useful in cases of atypical
presentation.
C-638
Clinical indications of low dose (LD) head computer tomography (CT) scans
S. Tripathi, K. Das, S. Niven, S. Chakraborty; Liverpool/UK
(sankalptripathi@hotmail.com)
Purpose: CT is an invaluable diagnostic tool but its growing use has led to increasing radiation exposure to the patient. Efforts have been made to minimize
radiation dose. Although a number of studies have shown the images produced
by LD CT to be of acceptable diagnostic quality, none have addressed the issue
of their clinical indication. We aimed to formulate a list of clinical indications for
LD CT of the head.
Methods and Materials: Patients included in the study had serial scans within 2
weeks of each other, where one was a LD CT and other a normal dose (ND) CT.
Indications for CT included: Shunt position, hydrocephalus; post-biopsy. The study
was double blinded where two neuroradiologists independently reported 46 LD
scans and the corresponding ND scans two weeks later. Abnormalities, and whether the neuroradiologist felt that the examinations adequately answered the clinical question, were tabulated. A list of possible clinical indications for LD CT was
then formulated.

Results: In 45 out of 46 cases the findings were concordant between ND and LD
CT. One case was erroneously done as LD.
Conclusion: Our results indicate that LD scans can be interpreted with similar
accuracy to ND CT, for certain indications. A list of clinical indications for LD CT
was successfully formulated and LD CT is now routinely used for follow-up examination at our centre. LD CT reduces radiation dose to the patient and should be
considered where multiple follow-up examinations would ordinarily lead to a very
high cumulative radiation dose.
C-639
All about CT perfusion's surface permeability map
J. Jord, T. Piedra, E. Marco de Lucas, E. Ruiz Prez, M. Torres,
P. Ruiz Hernndez, J. Arniz, A. Gonzlez Mandly, A. Gutirrez; Santander/ES
(emarco@seram.org)
Learning Objectives: 1) To describe the technical definition and physical and
physiological theory of surface permeability map calculation. 2) To analyze the
main clinical information it can provide and its main imaging applications.
Background: Surface permeability map is one of the maps obtained in a CT
perfusion study. It provides information about blood-brain barrier (BBB) alteration, because it analyzes persistence of contrast agent in brain tissue. This map
is usually used in brain neoplasms studies that alter BBB, or other neoplasms
like meningiomas without BBB which show intense high values in the map.
Procedure Details: We reviewed 212 CT perfusion studies performed in 197
patients. 'CT Perfusion 2' software from GE was used to analyze the results obtained. Permeability surface maps provide very important information in stroke
patients showing BBB dysfunction in peri-ischaemic areas, improving delineation of the mismatch area (CBV-MTT). We also analyze PS map encountered in
other pathologies such as cerebral trauma or infection.
Conclusion: Permeability surface map of CT perfusion studies provides very
useful information in brain neoplasm studies and stroke patients. Some pitfalls
must be detected to avoid erroneous interpretations.
C-640
Diffusion-MR imaging usefulness in the differential diagnosis of acute
leukoencephalopathy in children during treatment of haematological
malignancies
E. Marco de Lucas, A. Gonzlez Mandly, E. Snchez, A. Gutirrez, C. Dez,
M. Pelaz, G. Blanco, R. Pelln, J. Jord; Santander/ES (emarco@seram.org)
Learning Objectives: 1) To show the MR imaging including DWI findings in patients with acute methotrexate neurotoxicity. 2) To analyze the differential diagnosis based on DWI and ADC findings of patients with acute neurological
treatment-related complications during treatment of haematologic malignancies.
Background: Several causes are included in the differential diagnosis of white
matter changes on MR imaging in children during therapy for acute haematologic
malignancies. Acute methotrexate neurotoxicity causes a strokelike event with
bilateral hyperintensities in the centrum semiovale in both FLAIR and DWI indicating cytotoxic oedema. Clinical symptoms usually resolve rapidly and should
not necessarily prompt modification of potentially curative chemotherapeutic regimens. On the other hand, posterior reversible encephalopathy syndrome (PRES)
related to tacrolimus, cyclosporin-A shows hyperintensity on T2-weighted and
FLAIR images. DWI showed isointensity and increased signal intensity on ADC
values, indicating vasogenic edema. DWI is also of major help in the differential
diagnosis of infection or vascular injury.
Imaging Findings: We reviewed the clinical and neuroimaging findings of seven
patients presenting at our institution with white matter hyperintensities and neurologic complications during treatment of hematologic malignancies.
Conclusion: We therefore believe that DWI and ADC should be performed in
patients with suspected acute methotrexate neurotoxicity to allow a more confident recognition and differential diagnosis.
C-641
Purpose: Precise target delineation of the arterial supply of the nidus of arteriovenous malformations (AVM) is mandatory for successful stereotactic irradiation
(i.e. gamma knife). For this purpose an imaging modality with high spatial and
sufficient time resolution is required. Currently routine stereotactic neuroimaging
C-642
What is the minimum required temporal sampling rate in perfusion
computed tomography in patients with acute ischemic stroke?
A. Ringelstein; Dsseldorf/DE (ar75@gmx.de)
Purpose: Assessment of the necessary temporal sampling rate (TSR) in dynamic perfusion CT to safely diagnose acute cerebral ischemia.
Methods and Materials: Ninety-three patients (mean age: 79.4 years; range: 39
to 91 years) with clinically acute neurological deficit underwent a PCT study at a
64-detector-row CT (Somatom Sensation Cardiac 64, Siemens Medical Solutions, Germany). Scanning was performed with a collimation of 20 x 1.2 mm at
80 kV and 270 mAs with acquisitions every second for a time period of 40 seconds. 40 cc of non-ionic contrast material (300 mg iodine/ml, Accupaque, Amersham Buchler, Germany) was injected at 5 ml/sec. Central blood flow (CBF),
cerebral blood volume (CBV), mean transit time (MTT), and the maximum of the
residue function (Tmax), respectively, were calculated by deconvolution analysis
using singular value decomposition. These parameters were calculated with varying TSR of 1, 2, and 3 seconds, respectively.
Results: Using a TSR of 1 second, the ischemic area could be clearly diagnosed
in all cases. At a TSR of 2 seconds this difference in MTT and Tmax diminished
leading to a less distinct definition of infarct size. However, CBF and CBV showed
visually constant results. At a TSR of 3 seconds, none of the parameters revealed diagnostically relevant information.
Conclusion: An increase of TSR leads to incorrect results for Tmax and MTT in
PCT of patients with ischemic stroke. CBV and CBF can reliably be determined
at a TSR of 2 seconds. A further increase in order to reduce patient radiation
exposure cannot be recommended.
C-644
Cerebral vasospasm in patients with intracerebral hemorrhage: Preliminary
study
J. Kochanowicz, K. Kordecki, A. Lewszuk, J. Janica, J. Walecki, J. Lewko;
Bialystok/PL (alewszuk@o2.pl)
Purpose: Delayed cerebral vasospasm of the intracranial arteries is a frequent
and dangerous complication of aneurysmal subarachnoid hemorrhage (SAH).
However, only a few cases of cerebral vasospasm in intracerebral hemorrhage
(ICH) accompanied by intraventricular bleeding have been reported. Therefore,
we retrospectively analyzed cerebral arteriograms in ICH patients to evaluate the
development of vasospasm.
Methods and Materials: 46 patients with ICH, aged 20-72 (mean 49.6 13.9
SD, median 47 age; 15 women and 31 men), who had cerebral arteriography
were included in this study. Cerebral vasospasm was assessed by a 2 neuroradiologist and graded as mild (up to 25% of vessel narrowing), moderate (26-50% of
vessel narrowing) and severe (more than 50% of vessel narrowing).
Results: We observed vasospasm of the ipsilateral middle cerebral artery (MCA)
in 11 (23.9%) patients and the anterior cerebral artery (ACA) in 3 patients. Also,
one patient had spasm of the contralateral MCA to the side of ICH. MCA spasm
was graded as severe in 2, moderate in 5, and mild in 5 patients. ACA spasm was
mild.
Conclusion: Initial results indicate that cerebral vasospasm may be a frequent
complication in ICH patients. Further studies are warranted to determine the clin-
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Cerebral arterio-venous-malformations: Introduction of multi-detector

computed tomographic angiography (MD-CTA) as a non-invasive imaging
method for radiosurgical dose planning
S. Gentzsch1, K. Friedrich1, R. Wechsberg1, V. Vasilevska2, K. Kitz1,
A. Herneth1; 1Vienna/AT, 2Skopje/MK (stephan.gentzsch@meduniwien.ac.at)
procedures such as DSA, MR imaging and MD-CT are used for this purpose.
However, these imaging techniques lack either spatial resolution due to image
distortion or parallax error, or they lack time resolution. Dynamic multi-detectorcomputed tomographic angiography (MD-CTA) is introduced as a non-invasive
tool, which fulfils these requirements.
Methods and Materials: Dynamic MD-CTA (40 ml contrast material; flow: 7.0 ml/
sec; rotation time: 0.5 sec; slice thickness: 16x1.5 mm; scanning time: 30 sec;
table feed: 0.0) was performed in 60 consecutive patients with cerebral AVMs
prior to radiosurgery. The imaging data was transferred to a digital dose planning
system for target delineation. The dose planning results were compared to those
obtained from the routine stereotactic neuroimaging procedures.
Results: MD-CTA provides reliable morphological information to characterize
cerebral AVMs. Based on the time density curves the arterial supply of the nidus
could be accurately delineated in all patients, except in high flow AVMs (n = 8).
The planning results did not differ substantially to those obtained from conventional stereotactic neuroimaging.
Conclusion: MD-CTA provides images with high spatial and sufficient time resolution for accurate target delineation. MD-CTA is a non-invasive technique, which
can be rapidly performed and its usefulness is not reduced by image distortion or
parallax error.

ical importance, prevalence, and time course of vasospasm; however, they should
be based on continuous use of noninvasive techniques (e.g. transcranial Doppler).
Neuro
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C-646
Brain response to language tasks in progeny of epileptic mothers

A. Salagierska-Barwinska, B. Goraj, J. Wendorff, B. Wisniewska; Lodz/PL
(anna.salagierska-barwinska@wp.pl)
MR imaging in the differential diagnosis of postoperative infectious discitis

from postoperative aseptic inflammatory disk degeneration
M. Arias Gonzlez, A. Iglesias Castan, J. Brasa Fernndez,
M. Rodrguez lvarez, J. Maas Uxo; Vigo/ES (aiglesias64@hotmail.com)
Purpose: Our previous studies demonstrated that in 40% of children of epileptic

mothers there are specific difficulties in learning to read and write, which constitutes a significantly higher percentage than in our comparative group of progeny
of non-epileptic mothers (p = 0.046) as well as the general population. The aim of
this project is to deepen the knowledge on developmental dyslexia concerning a
special progeny population of epileptic mothers.
Methods and Materials: fMRI was carried out in 10 participants - the progeny of
epileptic mothers (5 with and 5 without developmental dyslexia).
Three different cognitive language tasks were used: The verb generation language task, the semantic language activation task and the phonological language
task. Statistical analysis of the evoked blood oxygenation level-dependent responses, measured with echoplanar imaging (1.5 T), employed statistical parametric mapping (SPM).
Results: The brain activation in 5 children with specific difficulties in reading and
writing was different from activation in 5 children without dyslexia, but not specific. Moreover, anatomical location of cortical activation in all participants was unusual compared to our preceding research in control dyslexic and normal
participants. During the tasks in children of epileptic mothers no significant activation in Broca's center (44.45 BA) in the left lobe was observed.
Conclusion: The obtained fMRI results bring new data on dyslexia pathogenesis
in children and its connection with epilepsy in mothers, and encourage further
investigation.
Spine
Learning Objectives: 1) To describe MR imaging findings in postoperative infectious discitis. 2) To describe MR imaging findings in postoperative aseptic inflammatory disk degeneration. 3) To show the most helpful findings in MR imaging to
discriminate postoperative infectious discitis from postoperative aseptic inflammatory disk degeneration.
Background: Postoperative aseptic inflammatory disk degeneration is a quite
unknown cause of pain after lumbar surgery. It is crucial to "think about it" when
reading a MR study, but also mainly to differentiate it from postoperative infectious discitis.
Imaging Findings: This is a retrospective study of 11 patients with postoperative
aseptic inflammatory disk degeneration (2.2%) and 9 patients with postoperative
infectious discitis (1.8%), out of 500 postoperative lumbar MR examinations. Basic differential diagnosis findings are explained and discussed: Time after surgery, disc signal on T2 weighted images, disc enhancement, listhesis, soft tissue
mass. Diagnosis was confirmed after biopsy in 13 patients (65%) and with follow-up
for at least a two year period in the other 7 (35%).
Conclusion: Postoperative aseptic inflammatory disk degeneration is a rare cause
of recurrent pain after lumbar surgery that must be distinguished from postoperative infectious discitis. MR imaging findings may help to differentiate both processes. Most helpful findings to diagnose postoperative aseptic inflammatory disc
degeneration were vertebral body spondylolisthesis, and rim enhancement of
disc on gadolinium-enhanced MR images. Most helpful findings for diagnosis of
postoperative infectious discitis were paraspinal soft-tissue mass and diffuse
enhancement of discs on gadolinium-enhanced MR images.
C-647
MR-based measurement of spinal cord atrophy in multiple sclerosis:
Reproducibility and sensitivity of a new semi-automated procedure
C. Lukas1, B. Bellenberg1, J. Rexilius 2, H.K. Hahn2, M. Kahle1, O. Kster1,
S.K. Schimrigk1; 1Bochum/DE, 2Bremen/DE
(Carsten.Lukas@ruhr-uni-bochum.de)
Purpose: Spinal cord atrophy in multiple sclerosis (MS) occurs early and pathology in this area is an important cause of disability in this disease. A new fast and
reliable semi-automated approach for quantitative assessment of spinal cord atrophy in MS is introduced.
Methods and Materials: Thin-sliced T1 weighted images (MPRAGE) were acquired from 35 MS patients (13 relapsing remitting (RR) MS, 16 secondary progressive (SP) MS, 6 primary progressive (PP) MS) and 18 control subjects. A
semi-automated volumetry method combining a marker based segmentation and
an automatic histogram analysis was used in this study. Cross-sectional spinal
cord area was measured within a section of 50 mm thickness starting at upper
border of C2 rostrally. To evaluate the intra-rater reproducibility, the same observer repeated the volume measurement twice on the 35 MS subjects. For assessing the inter-rater reproducibility the same subjects were measured by a second
observer. Four subjects underwent serial imaging on the same scanner at least
one week apart to estimate scan-rescan reproducibility.
Results: The intra-rater coefficient of variation (COV) of the method was 0.49%.
Inter-rater COV was 1.24% and scan-rescan COV was 1.33%. Mean cross-sectional spinal cord area in MS patients was 74.7 mm2, in control subjects 79.7 mm2
respectively. Examination of subgroups showed significant atrophy in the SP and
PP group in contrast to healthy control subjects.
Conclusion: This new fast technique is reproducible and sensitive to changes in
the spinal cord area and highly suitable for quantitative studies of spinal cord
atrophy in MS.
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Abdominal
C-649
Radiologic findings of hepatic hamartoma in children
W.-S. Kim, B. Youn, J.-E. Cheon, I.-O. Kim, K. Yeon, S.-E. Jung; Seoul/KR
(kimws@radcom.snu.ac.kr)
Purpose: Hepatic hamartoma is a rare benign liver tumor. Many of the previous
reports on this tumor have described cystic mesenchymal hamartoma in infants.
We summarize the variable radiologic findings of hepatic hamartoma in children.
Methods and Materials: The subjects were nine patients with pathologically
confirmed tumors (five boys and four girls, mean age 3.5 years). One of them had
previously undergone Kasai operation for biliary atresia. Pathologically, six patients had mesenchymal hamartoma and three had mixed hamartoma. Alphafetoprotein was within the normal range in all patients. Both ultrasonography and
CT were performed in each patient.
Results: Each patient had a single mass and the longest diameter of the mass
ranged from 1.8 to 15 cm (longer than 10 cm in seven patients). Five patients had
"mixed solid and cystic masses" and four had "solid masses". In four of five patients with "mixed solid and cystic masses", multiseptated cystic portions were
seen within the masses. On CT scans after contrast-enhancement, the solid component of the tumors showed homogeneous (n = 2) or heterogeneous
enhancement (n = 7). Tumor capsule was not seen in any of the patients. No
calcification was seen within the masses.
Conclusion: Hamartoma of the liver can show variable radiologic features, from
a multiseptated cystic mass to a solid mass. It should be included in the differential diagnosis of a large hepatic mass in children. Typically it shows no tumor
capsule and no calcification within it.
C-650
Magnetic resonance cholangiopancreatography in children
A. Pallan, H.J. Williams; Birmingham/UK (arvindpallan@doctors.org.uk)
Learning Objectives: To describe the techniques of magnetic resonance cholangiopancreatography (MRCP) as used in the paediatric population. To demonstrate the pathologies identified on MRCP studies in children.
Background: MRCP is a well established non-invasive technique for the investigation of adults with pancreaticobiliary disease where it is comparable with endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of biliary
and pancreatic ductal diseases. The technique is still evolving and ERCP remains an important procedure because of frequent need for interventional procedures in this population. In children, congenital abnormalities of the biliary system
are more frequent, and these are often treated surgically. Stone disease and
tumours requiring interventional procedures are uncommon. Furthermore, ERCP
is technically more difficult in children and often requires general anaesthesia.
ERCP is not possible in patients following liver transplantation when the biliary
system drains into a Roux-loop. MRCP is therefore an increasingly performed
investigation in children with some modifications of technique and different range
of findings when compared to an adult population.
Imaging Findings: Retrospective review of cases investigated at a tertiary referral children's hospital over a 6 year period is presented. A variety of pathology
can be demonstrated using this technique, including choledochal cysts, Caroli's
disease, pancreatic ductal disease, variations in pancreatic duct anatomy, and
biliary complications of liver transplantation.
Conclusion: MRCP is ideal for the non-invasive investigation of biliary and pancreatic disease in children but may require adaptation of the technique in order to
obtain diagnostic images.
patients (pts) with a median age of 2.7 years (range 7 months to 16.7 years)
affected by AS were studied. There were 10 females and 8 males. All patients
underwent MR, abdominal and cardiac ultrasound. Eight pts had diagnostic and
interventional cardiac catheterization, which led to 3 angioplasties of the pulmonary artery, and 2 surgical procedures (closure of interventricular defect and correction of aortic coartation). All patients received OLTx.
Conclusion: Ultrasound and MR are the pre-operative diagnostic modalities of
choice for patients with Alagille syndrome. Despite the associated anomalies of
the cardiovascular system, these patients can be successfully treated by interventional radiologists, cardiothoracic and liver transplant surgeons.
C-653
New method of first choice for kids and teens: Navigator gated MRCP
G. Hahn, K. Glutig; Dresden/DE (gabriele.hahn@uniklinikum-dresden.de)
Purpose: New navigator gated MRCP sequences provide a non-invasive and
direct technique for the visualisation of bile ducts of babies and children with
good quality images.
Methods and Materials: 26 patients underwent MRCP from 2002 to 2005. 37
MRCP examinations were reviewed retrospectively. Respiratory triggered MIP of
3 D TSE and breath hold single shot TSE were compared. Applying a five point
scale, two radiologists assessed the image quality blind.
Results: 10 children had normal biliary trees, 9 cases of various types of choledochal cyst were seen, 4 children had sclerosing cholangitis, 4 had wide bile ducts
after CCE and one child had a pancreatitis. The mean age was 14 years (newborn-17 years).
From 13 examinations with breath hold single shot technique, only 2 (15%) were
classified as good. In contrast, 7 (54%) respiratory triggered MRCP could be
classified as good.
Conclusion: In newborns and children, respiratory triggered MRCP with a diaphragm navigator is a very good and highly sensitive method for accurate diagnosis of the biliary tree disorders.
C-654
Primary liver tumors in children: Radiologic-pathologic correlation
J.P. Penedo, J.P. Conceio e Silva; Lisbon/PT (jpfpenedo@gmail.com)
Learning Objectives: To illustrate several cases of primary liver tumors in children diagnosed in an oncologic institution and to review imaging and pathologic
findings.
Background: Pediatric hepatic tumors are rare entities. During 15 years, 22 cases were identified in our institution. Mean age was 2.2 years (0-13). There was a
male preponderance (M:F = 13:9). The most common presenting sign was an
abdominal mass felt by the parents, except in 8 cases (36%) detected by routine
examination or US due to other symptoms. Imaging techniques (US, CT and MR)
play a decisive role in the differential diagnosis and staging of these lesions including evaluation of vascular or secondary involvement.
Procedure Details: US was the first imaging test in all cases. The diagnosis was
established by imaging (US, CT and MR), histologic and laboratory (alpha-fetoprotein) correlation. Chest X-ray or CT were used for staging in suspected malignant cases. Chemotherapy of malignant lesions followed SIOPEL guidelines. All
malignant lesions and some benign doubtful cases were histologically confirmed.
Follow-up tests included imaging and in some cases, alpha-fetoprotein (AFP)
levels.
Conclusion: There were 10 (45%) malignant tumors: 6 hepatoblastomas, 2 hepatocellular carcinomas, one in a HbsAg positive child and one in a patient with
tyrosinemia, 1 transitional cell liver tumor (TCLT), a very unusual and recently
described entity and 1 sarcoma. 12 cases (55%) were benign: 6 hemangioendotheliomas, 2 hemangiomas, 2 hamartomas and 2 focal nodular hyperplasias
(one in Down syndrome).
C-651
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Alagille syndrome: Imaging, clinical findings and treatment

A.A. Lemos, L. Marchetti, V. Burghignoli, A. Bacila, P.R. Biondetti; Milan/IT
(alessandrolemos@hotmail.com)
Learning Objectives: To be confident with imaging findings in children with Alagille
syndrome. To know medical conditions related to the syndrome.
Background: Alagille syndrome (AS) is a multisystem disorder involving the liver, heart, eyes, face and skeleton. Atresia of the biliary system represents the
most common clinical manifestation. Orthotopic liver transplantation (OLTx) is
considered the treatment of choice of this syndrome's associated end-stage liver
disease.
Procedure Details: From November 1996 through to February 2005. 18
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C-655
Pediatric
What is the difference in the sonographic features of the appendix in

asymptomatic children with cystic fibrosis?
M. Vakaki, G. Pitsoulakis, S. Doudounakis, C. Koumanidou; Athens/GR
(geop@hol.gr)
Lung
Purpose: To present the sonographic features of the appendix in children with

cystic fibrosis without clinical symptoms of acute appendicitis.
Methods and Materials: 15 children (age range 3-14 years) with cystic fibrosis
were sonographically studied. The sonographic evaluation of the appendix and
the periappendiceal region was part of their routine follow-up sonographic abdominal examinations. There was no clinical suspicion of an inflamed appendix.
High frequency (5-12 MHz) linear transducers were used. The overall transverse
appendiceal diameter was measured and the wall and contents of the appendix
were evaluated.
Results: The appendix was sonographically identified in all children. Its diameter
ranged from 4 to 10 mm. In 12 cases, the transverse diameter measured more
than 6 mm, the threshold between a normal and enlarged appendix. Hyperechoic (mucoid) material was demonstrated in its lumen in 13 children. Wall thickening
was not noted in any of the patients. The sonographic appearance of the periappendiceal region was normal.
Conclusion: Despite the small number of patients included in this study, the
transverse appendiceal diameter seems to be increased in the vast majority of
children with cystic fibrosis, while its lumen contains mucoid material. Consequently, enlargement of the appendiceal transverse diameter (> 6 mm), which
represents the main, but not sole sonographic criterion for the diagnosis of acute
appendicitis, cannot be accurately used in children with cystic fibrosis. This knowledge is quite important in the diagnostic investigation of this specific group of
young patients when acute appendicitis is clinically suspected.
C-656
Imaging features of post transplant lymphoproliferative disorder (PTLD) in
pediatric patients: Correlation of PET (/CT), CT and MRI findings
C. von Falck, B. Maecker, E. Schirg, A. Boerner, C. Klein, M. Galanski;
Hannover/DE (c.v.falck@gmx.de)
Learning Objectives: To illustrate the spectrum of imaging features of pediatric
PTLD with PET (/CT), CT and MR imaging correlation. To demonstrate the change
of imaging features during the course of therapy and to outline the advantages of
functional imaging with [18F]-FDG-PET/CT over morphologic imaging in the evaluation of response.
Background: Post transplant lymphoproliferative disorder (PTLD) is a disease
associated with chronic immunosuppression in patients that have undergone solid
organ transplantation. It represents a broad spectrum of lymphoid expansion,
ranging from polyclonal lymphoid hyperplasia to highly malignant monoclonal
lymphoma. In this exhibit we demonstrate the imaging features of PTLD with
PET (/CT), CT and MR imaging correlation in pediatric patients in the initial staging and during the course of therapy with a chimeric anti-CD20 antibody (Rituximab). The advantages and disadvantages of the different modalities are described
and illustrated.
Imaging Findings: PTLD can affect almost every organ system, including the
allograft, resulting in a broad variety of morphological and functional imaging
findings. Organ involvement can be either focal or diffuse. Typically, FDG-PET
demonstrates areas of markedly increased tracer uptake. In CT and MR imaging,
enlargement of lymphatic nodes, focal lesions in parenchymal organs and pulmonary nodules are most common. Early response to therapy is characterized
by normalisation of tracer uptake in FDG-PET, whereas CT and MR imaging
show only delayed changes of lesions size.
Conclusion: [18F]-FDG-PET/CT is helpful in the initial staging of PTLD in pediatric patients. It can demonstrate response to therapy earlier than morphologic
imaging modalities like CT and MR imaging.
C-657
Tuberculosis in children: A pictorial review
M.F.R. Pires, A. Duarte, L. Lobo, J. Fonseca-Santos; Lisbon/PT
(mf.pires@netcabo.pt)
Learning Objectives: To describe imaging features of pediatric tuberculosis (TB)
primary and post-primary. To outline the main differential diagnostic pitfalls. To
emphasise the role of imaging evaluation in treatment and follow-up.
Background: TB is one of the most common infectious diseases worldwide. Epidemiology of TB in childhood is closely related to TB in adults. Immunological
immaturity and social dependence facilitate the spread of infection and the development of the disease process. Primary TB is difficult to diagnose. The diagnosis
is usually established by indirect signs including social contacts, symptoms and
the tuberculin skin test. A precise diagnosis is essential for adequate treatment.
Imaging, particularly the chest X-ray, play an important role.
We describe imaging features and problems with the differential diagnosis of
pediatric TB from selected cases studied in our department.
Imaging Findings: An overview of the imaging findings of pulmonary and extrapulmonary TB in children- primary and post-primary- are presented. Chest X-ray
plays a major role in pulmonary TB, with chest computed tomography (CT) usually indicated for equivocal or complicated cases. In extra-pulmonary TB, imaging modalities such as ultrasound, CT and magnetic resonance are needed for
diagnostic evaluation and follow-up.
Conclusion: TB is a worldwide infection, with high impact on individual and community health.
TB has a wide spectrum of clinical and imaging features. Although seldom specific, there are some imaging clues that point to possible TB that radiologists
should be aware of, in order to help pediatricians with prompt diagnosis. Imaging
evaluation is also essential to assess therapeutic response and follow-up.
C-658
Pulmonary emphysema in cystic fibrosis: Visual grading versus thinsection, low-dose MDCT densitometry
K.M. Unsinn, M.C. Freund, H. Ellemunter, J. Eder, W.R. Jaschke; Innsbruck/AT
(karin.unsinn@uibk.ac.at)
Purpose: To evaluate two different grading systems for emphysema in patients
460

with cystic fibrosis. To compare the reliability of visual versus semiquantitative
grading by densitometry of lung parenchyma involved by emphysema.
Methods and Materials: All patients had proven cystic fibrosis (CF).
Low-dose 4-slice CT (MDCT; GE Qx/i) of the chest was performed in 17 patients
(7 - 38 years) without contrast administration in a supine position at end-inspiration during single breath-hold with the following scan parameters: 1.25 mm slice
thickness/interval, 120 kV, 10 mA, 0.8 sec rotation time/360, standard and lung
reconstruction algorithm. Dose-length product (mGy cm) was recorded in all patients.
Visual grading was performed utilizing a scoring system proposed by Bhalla (score
0, 1, 2 indicating emphysema of 0, 1-5, or > lung 5 segments) or by Bankier
(score 0, 1, 2, 3, 4 indicating 0%, < 25%, 25-50%, 50-75%, > 75% of lung parenchyma involved by emphysema). All images were evaluated by 2 radiologists.
Densitometry was performed with Pulmo CT software (Siemens Medical Systems); percentage of relative lung area of less than -950 HU attenuation values
for both lungs (RA950) was calculated.
Results: Range of recorded dose-length product: 08.50 - 22.52 mGy cm.
The mean correlation coefficients of 2 readers for relationship between the visual
grading system and densitometric measurements (RA950) was 0.590 (r value).
The intraobserver resp. interobserver agreement for visual scores was 0.56 resp.
0.83.
Conclusion: Subjective visual grading of emphysema should be supplemented
with more reliable objective methods i.e. densitometric measurements of lung
parenchyma in patients with cystic fibrosis.
C-659
Optimising the use of computed radiography in paediatric chest imaging
E. Vano-Galvan, R. Sanchez-Jacob, E. Vano, N. Gomez Ruiz, J.M. Fernandez,
C. Prieto, D. Martinez; Madrid/ES (eliseovano@yahoo.es)
Purpose: To analyze image quality of chest examinations in paediatric patients
using computed radiography (CR) obtained with a wide range of doses to suggest the appropriate value for sufficient image quality.
Methods and Materials: A sample of 240 chest images in four age bands (< 1, 1
to < 5, 5 to < 10 and 10 to < 16 years) was randomly selected from the examinations routinely performed during the last year. Images were obtained using the
Agfa CR system and evaluated independently by 3 radiologists. Each image was
scored using the criteria proposed by the European Guidelines on Quality Criteria in Paediatrics. Mean global scoring and scoring of the criteria more related to
noise (reproduction of vascular pattern, trachea, proximal bronchi, diaphragm,
spine and paraspinal structures and retrocardiac lung) were used to evaluate
image quality. Dose level (DL) measured as the median of the logarithmic pixel
values in the main histogram of the image, was in the range 1.20 to 2.85.
Results: It was found that there was no significant improvement (R2 < 0.21) in
image quality when increasing DL for any of the age bands either for global score
or for criteria more related to noise. The median value of DL was in the range 1.92.1 for the four age bands.
Conclusion: From the present study a DL value of 1.6 (including a safety margin
of 0.4) is proposed for paediatric CR chest imaging, meaning roughly a reduction
of a factor of 2.5 in the present median value of patient entrance doses.
C-660
HRCT findings of permanent pulmonary sequelae after adenoviral
pneumonia
B. Youn, W. Kim, J. Cheon, I.-O. Kim; Seoul/KR (younbj@radiol.snu.ac.kr)
C-661
Orbital CT and MR imaging in children: A pictorial review
V.V.R. Kandula, A. Donuru, H. Obaid, A. Mcgregor; Leicester/UK
Purpose: To demonstrate CT and MR imaging appearances of various orbital
pathologies in children.
Methods and Materials: We retrospectively reviewed the CT and MR findings in
paediatric patients with lesions in the orbit over a 10year period. We evaluated
the lesions according to the location, gross appearance, signal intensity, contrast
enhancement patterns and associated bony change.
Results: Congenital conditions included anophthalmos, microphthalmos, coloboma and persistent hyperplastic primary vitreous. Tumoral conditions included
metastasis (ALL recurrence), retinoblastoma and rhabdomyosarcoma. Benign
conditions include haemangioma, lymphangioma, lacrimal mucocele, lipoma,
demoid cyst and epidermoid cyst. Inflammatory conditions included orbital cellulitis and subperiosteal abscess. Traumatic conditions were orbital blow out fractures and dislocation of lens. Other miscellaneous conditions included optic
atrophy, optic neuritis and benign intracranial hypertension. These lesions could
be differentiated by clinical history, signal intensity, enhancement pattern and
location.
Conclusion: Adequate knowledge of the anatomy of the eye and orbit is needed
to correctly limit the differential diagnosis. Awareness and knowledge of lesions
of the orbit in children is very important. Familiarity with imaging findings of lesions of the orbit will facilitate accurate diagnosis and can help to avoid unnecessary surgery.
C-662
Imaging characteristics of atypical teratoid/rhabdoid tumor (ATRT) in
children
T. Chung1, J. Seo2, J. Hunter3; 1Gwangju/KR, 2Jeonnam/KR, 3Houston, TX/US
(twchung@jnu.ac.kr)
Learning Objectives: To describe the imaging characteristics of atypical teratoid/rhabdoid tumors (ATRT) in a large series of pediatric patients with ATRT.
Background: ATRTs are rare malignant embryonal central nervous system tumors composed of rhabdoid cells which occur most commonly in children. Even
after surgery and chemotherapy treatment, the survival rate for children younger
than 3 at diagnosis is less than 10 percent.
Imaging Findings: We retrospectively studied preoperative CT and MR imaging
of thirteen male and four female patients, median age 3.5 years, range 2 months
- 15 years, with pathologically proven ATRT.
Tumor location was varied, with lesions present infratentorially in nine patients,
supratentorially in eight. CT showed iso or hyper-attenuation in all patients. MR
signal intensity was heterogeneous in all patients, predominantly low or isointense on T1- and variable on T2-weighted images, low or isointense in eleven
and hyperintense in six. In all eight patients examined, on diffusion weighted
images, diffusion restriction was noted. Prominent MR imaging features were
multiple cystic and necrotic areas associated with an inhomogeneous contrastenhancing solid component. Calcification (n = 7), hemorrhage (n = 3) and leptomeningeal seeding (n = 2) were identified.
Conclusion: Although ATRTs share indistinguishable imaging features with medulloblastomas, the most suggestive imaging features of ATRTs are an infratentorial
location in a child less than 5 years of age, multiple cystic and necrotic areas,
hyperdensity on CT, low or isointensity on T1-weighted MR imaging, and diffusion restriction on diffusion-weighted images.
C-663
Diffusion-weighted imaging patterns in 30 patients with x-linked
adrenoleukodystrophy: A follow-up study
D. Touitou, P. Aubourg, C. Andre, G. Kalifa, C. Adamsbaum; Paris/FR
Purpose: The aim of the study was to investigate whether diffusion-weighted MR
imaging patterns could aid prediction of progression in X-linked adrenoleukodystrophy (ALD) in patients who received hematopoietic cell transplantation (HCT)
and in ungrafted patients.
Methods and Materials: The study included 30 patients with cerebral ALD, who
all had diffusion-weighted MR imaging between 2001 and 2005 in a reference
center. During follow-up, 8 patients received HCT. The X-ALD MR imaging sever-
461
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ediatric
Purpose: Adenoviruses are a worldwide cause of respiratory infection, particularly in infants or young children. Some strains of adenovirus, predominantly types
7 and 3, can cause fatal pneumonia with respiratory failure and survivors are
reported to develop permanent pulmonary sequelae. The aim of this study is to
describe the HRCT findings of adenoviral pneumonia sequelae.
Methods and Materials: We retrospectively reviewed follow-up HRCT findings
of ten patients with adenoviral pneumonia. Follow-up period between initial diagnosis and follow-up HRCT was 2 months to 116 months (mean 35 months). Adenovirus was confirmed by immunofluorescence positivity in nasal aspirates.
Results: HRCT scans showed variable abnormalities with mosaic attenuation
(100%), atelectasis (80%), bronchiectatic change (60%), fibrosis (20%), and tiny
centrilobular opacities (10%). Plain radiographs only showed mosaic attenuation
(70%), atelectasis (40%), and bronchiectatic change (30%).
Conclusion: Long term follow-up in children with adenoviral pneumonia should
be undertaken with HRCT rather than plain radiography, to detect sequelae.
Pediatric
Neuro

ity scale score (MRISS), contrast enhancement, and the apparent diffusion coefficient (ADC) in regions of interest and in normal structures were assessed in all
patients.
Results: 71 MR imaging's of 22 ungrafted patients were analysed. All patients
had increased ADC values in the center of lesions. During follow-up, MR imaging
progression was observed in 12/22 (54%) of ungrafted patients and in 2/8 patients who received HCT. In 11 ungrafted patients, a concentric arrangement of
alternating high and low signal intensity was observed on diffusion-weighted images. In these patients, ADC values significantly decreased from the center of
lesions, through the thin rim surrounding the center, to the peripheral zone. ADC
values were significantly higher in pathological regions than in normal-appearing
white matter (NAWM). In all patients, ADC values of NAWM were normal. In ungrafted patients, ADC values in the center of lesions significantly correlated with
disease progression and MRISS. Conversely, after HCT, these central ADC values did not correlate with MRISS any more.
Conclusion: Diffusion-weighted imaging patterns might be helpful to predict disease progression in ALD. This should now be confirmed in larger series.
C-664
Imaging findings of pilomatricomas in children
J. Oh, S. Im, H. Lim, G.-Y. Lim, Y. Ku, B. Kang; Seoul/KR (saim@catholic.ac.kr)
Purpose: To characterize the imaging findings of pilomatricoma on CT, MR, and
ultrasonography (US) in children.
Methods and Materials: We retrospectively evaluated the imaging findings of 38
pilomatricomas in 37 patients (M:F=14:23, mean 7 years) on CT (n = 24), MR
(n = 5), and US (n = 14). These images were evaluated based on variable characteristics including size, location, shape, margin, US patterns (echogenicity,
calcification, peripheral halo, hypoechoic rim, and acoustic shadowing), attenuation and calcification on CT, signal intensity on MR.
Results: All lesions were located in subcutaneous fat, attaching to the overlying
skin (0.5-2.8 cm, mean 1.6 cm). The involved sites included head & neck (n = 28),
upper extremity (n = 9), and lower extremity (n = 1). The shape was ovoid in 35
(92%) lesions, round in two (5%), and lobular in one (3%). The margin was welldefined in all cases. US showed hyperechoic/isoechoic/complex pattern (72/21/
7%), heterogeneous/homogeneous calcification (93/7%), acoustic shadowing
(71%), hypoechoic rim (71%), and peripheral halo (50%). CT showed soft tissue
attenuation with heterogeneous/homogeneous calcification (58/21%) and peritumoral streaky densities (33%). All lesions were hypointense with hyperintense
reticulations on T2-weighted MR images. Internal reticular and rim enhancement,
peritumoral enhancing streaky signals were seen on contrast enhanced T1-weighted images.
Conclusion: In children with well-defined subcutaneous masses, pilomatricoma
should be included in the differential diagnosis when the mass attaches to skin
and contains variable calcification on radiologic examinations. In addition, characteristic signal intensity and enhancement pattern on MR images may be also
helpful in diagnosis of this tumor, in spite of its insensitivity to calcification.
C-665
Facial pathology in children: Sonographic findings with CT and MRI
correlation
M. Martin, F. Ballenilla, C. Gallego, A. Muoz, M. Miralles, D. Delgado;
Madrid/ES (mamartin@seram.org)
Learning Objectives: Review the differential diagnosis of the congenital malformations and tumors of the maxillofacial area in the paediatric age group.
Illustrate the pathologic conditions of the salivary glands in children.
Describe the sonographic technique, initial and follow-up findings in craniofacial
osteogenesis distraction.
Background: Due to the superficial location of salivary glands, mandible and
muscular structures in the face, ultrasound is the initial imaging study to perform
in children with pathology in this region.
We have reviewed the sonographic, CT and MR imaging findings in 105 patients
that were admitted with a mass, inflammation or pain between March 2001 and
May 2005.
We have also analyzed the image changes in children suffering from plagiocephaly, mandibular hypoplasia and/or other facial dysostosis after osteogenesis distraction.
Procedure Details: All patients were evaluated by ultrasound with high frequency transducers (10 MHz) and correlated with sialography, CT or MR as needed.
Destructive lesions of the mandible such as histiocytosis and cherubism, were
studied with US that also guided fine needle aspiration and biopsy.
US evaluation of osseous distraction has proved to be useful to analyze the chang-
462
es in the immediate postoperative period, at mid-stabilization and at the end of

the stabilization.
Conclusion: 60% of the patients presented with salivary gland lesions, most of
them were located in the parotid (85%), chronic parotiditis and hemangioma being the most common entities. US is the first imaging modality in the evaluation of
facial pathology in children despite non-specific findings, and is an accurate weapon in the follow-up of craniofacial distractions.
C-666
Longitudinal MR imaging follow-up of medulloblastoma
B. Ching, A. E, H. Teo, W. Seow, C. Lim; Singapore/SG
(tchoyoson_lim@nni.com.sg)
Purpose: Radiological assessment of medulloblastoma includes pre-surgical
assessment of the brain and spinal canal and follow-up imaging for tumor recurrence, both in the brain and spine. Post-treatment surveillance is important for
decision making and initiation of salvage therapy. We describe follow-up MR imaging of medulloblastoma and mimics of tumor recurrence.
Methods and Materials: We retrospectively reviewed MR imaging studies of 12
patients with medulloblastoma. Pre-surgical and post-treatment MR studies of
the brain and spine were reviewed for the presence of enhancing masses, spinal
canal metastasis and other radiological findings.
Results: All 12 patients underwent surgical resection and had follow-up MR imaging of the brain and spine. Three patients had recurrences in the post-operative bed and two had residual tumors that were controlled by adjuvant radiotherapy
and/or chemotherapy. At initial presentation, four patients had spinal drop metastases and in three patients there was improvement after treatment. One patient
suffered spinal tumor relapse during follow-up. Three patients had complications
of decreased intracranial pressure as a result of ventricular shunt, including subdural haematoma and diffuse dural enhancement in the brain or spinal canal.
These resolved without surgical treatment. Two patients had swelling and nonenhancing hyperintensity of the medullary olives which resolved spontaneously
on follow-up.
Conclusion: Medulloblastoma recurrences may occur in the post-operative bed
and in the spinal canal and must be distinguished from non-tumor mimics such
as dural thickening and enhancement (caused by intracranial hypotension) and
hypertrophic olivary degeneration (caused by disruption of the Guillian-Mollaret
triangle).
C-667
Incidence of occult spinal dysraphism in patients with isolated sacral pits,
sinuses, hairy tufts and skin tags
T. Szyszko, N. Wakeham, M. Watson; London/UK (nickwdoc@hotmail.com)
Purpose: The purpose of this study was to look at the outcomes of lumbar spine
ultrasound in infants with cutaneous markers for occult spinal dysraphism. The
new RCR guidelines suggest that isolated sacral pits/dimples are safe but other
stigmata of occult spinal dysraphism require imaging.
Methods and Materials: We looked at the outcome of all lumbar spine ultrasound examinations performed on infants from 2000-2004 at West Middlesex
Hospital, London. The indications for the scan were divided into sacral skin pits/
dimples; skin sinuses; hairy tufts and skin tags. We then checked if the scans
were normal or abnormal and what further follow-up was required.
Results: Of the 88 ultrasound scans, 85 were completely normal, including all
infants with sinuses, hairy tufts and skin tags. There were 3 minor abnormalities
found in patients with skin dimples. All these patients were reviewed by the paediatricians and discharged from follow-up. Approximately 10% had a hypoechoic
line running from the sacrum to the dimple, which did not change in any way in
infants followed up for 3 months and was assumed to be a normal variant.
Conclusion: As an isolated abnormality, sacral sinuses, hairy tufts and skin tags
as well as pits/dimples are not useful markers of occult spinal dysraphism.

Pediatric
Urogenital
C-668
Isolated preauricular skin tags and renal anomalies in the UK population: A
multicentre study
T. Szyszko, N. Wakeham, C. Ward, Z. Stetina, M. Owen, D. Lindo; London/UK
(nickwdoc@hotmail.com)
Purpose: To look at the incidence of renal anomalies detected on postnatal ultrasound scans carried out on infants with preauricular skin tags in the UK. A study
from Israel on 70 infants with isolated preauricular skin tags showed an incidence of renal anomalies in 8.7%. A pilot study carried out at Kingston Hospital
in 2004 showed no such association and hence a multicentre study was undertaken.
Methods and Materials: We looked at the outcomes of renal ultrasounds carried
out on 115 infants with isolated preauricular skin tags at 3 separate hospitals in
London from 2000-2004. 56 were done at Kingston Hospital, 50 at Hammersmith
Hospital and 9 at West Middlesex Hospital.
Results: 100% of the 115 infants with isolated preauricular skin tags had completely normal renal ultrasound scans. One infant at Hammersmith Hospital who
had skin tags as part of a syndrome had bilateral hydronephosis, but this had
been detected on the antenatal ultrasound scan.
Conclusion: There is no need to routinely refer infants with isolated preauricular
skin tags for postnatal renal ultrasound.
C-669
Ovarian imaging in pediatric patients
A. De Cima, E. Sanz, R. Carrera, G. Del Pozo, C. Serrano, M. Miralles;
Madrid/ES (andrea96910@hotmail.com)
Learning Objectives: To illustrate the wide spectrum of disorders affecting the
ovary in girls. To show the utility of each technique in their diagnosis. To know the
key findings and differential diagnosis of these entities.
Background: A wide spectrum of disorders may involve the ovary in girls with
imaging playing a central role in their evaluation and management. We describe
the imaging findings of these conditions, emphasizing the utility of each imaging
modality. Differential diagnosis and key findings are evaluated.
Imaging Findings: We reviewed 151 patients from our database of pediatric
genito-urinary pathology. Topics include 77 cysts (60 simple, 17 hemorrhagic),
33 torsions (including 9 cystic ovaries and 2 ovaries containing a mature teratoma), 3 inguinal hernias, 2 endometriosis, 33 germ cell tumors (28 mature and 3
immature teratomas, 1 dysgerminoma, 1 endodermal sinus tumor), 2 sex cordstromal tumors (granulosa cell tumor and Sertoli-Leydig cell tumor) and 1 ovarian metastasis. Ultrasonography was performed in all patients and was conclusive
in all patients with hernias or endometriosis, in 29 torsions and 72 cysts. Complementary techniques were performed in 45 cases. The main use of plain film was
to confirm the presence of calcium. CT or MR were required for better characterisation of the lesion or staging.
Conclusion: This exhibit provides an overview of the disorders affecting the ovary in girls as well as the utility of each imaging technique. Because many of these
disorders have a characteristic appearance, this exhibit helps the radiologist to
better recognize these entities.
C-670
Paediatric renal tumours: A pictorial review
P. Rajiah, R. Natarajan, A. Shabani; Manchester/UK
(rprabhakar73@yahoo.com)
C-671
Diagnostic imaging findings in pediatric scrotal masses
J.-E. Kim, M.-H. Kim, D. Yang; Incheon/KR (boram107@gilhospital.com)
Learning Objectives: To illustrate the imaging findings and the proper differential diagnosis of scrotal masses in children, based on USG and MR imaging examinations of 20 children. To know the benefits and limitations of USG and MR
imaging for evaluating scrotal masses.
Background: Scrotal masses are not uncommon manifestations of pediatric scrotal disorders. The pathology and frequency of scrotal masses that occur in children are different from those in adults. USG is an ideal tool for assessment of
scrotal masses, although MR imaging can be a useful adjunctive modality. The
role of imaging is to confirm the presence of a mass, define if it is intratesticular
or extratesticular and to characterize it. Many overlapping characteristics were
shown to exist among the scrotal masses; these overlapping characteristics led
to a long list of differential diagnoses. However in some cases, familiarity with the
radiologic key features in combination with clinical information provides enough
information for adequate lesion characterization.
Imaging Findings: The disease entities are divided into intratesticular tumors
including teratoma, epidermoid cyst, yolk sac tumor, embryonal carcinoma, neuroblastoma metastasis and extratesticular tumors, including rhabdomyosarcoma
of spermatic cord and mimics of paratesticular tumors including torsion of appendix testis. Teratomas are well circumscribed heterogeneous mixed echogenic lesions (cystic component, calcifications and fat). Epidermoid cysts are
sonographically well circumscribed and hypoechoic with an onion-skin appearance. If the imaging characteristics are sufficiently suggestive of these two entities in children, tissue sparing surgery may be possible.
Conclusion: Familiarity with the imaging findings of pediatric scrotal masses
facilitates accurate diagnosis and accurate patient treatment.
C-672
Processus vaginalis related disorders: High-resolution sonographic review
A. Marn, V. Garriga, N. Roson, S. Medrano, L. Berrocal, S. Carb,
M. Cuadrado, S. Vizcaya, X. Pruna; Granollers/ES (annamarinaz@yahoo.es)
Learning Objectives: To review the high-resolution sonography (HRUS) of processus vaginalis related disorders in childhood. To highlight the ability of HRUS in
the differential diagnosis of groin masses.
Background: The processus vaginalis is an embryological outpouching of parietal peritoneum through which the testis descends to the scrotum during fetal life.
Abnormal closure of the processus vaginalis results in an increased risk for the
following conditions: cryptorchidism, inguinoscrotal hernia, hydrocele, spermatic
cord cyst, and less commonly, inguinal hernia which may contain other intraabdominal structures.
HRUS enables a correct differential diagnosis of these entities and can help to
determine a correct management.
Imaging Findings: The study includes 14 pediatric cases with processus vaginalis disorders. Patients were 0-2 years old (12 boys, 1 girl and 1 intersex patient). All of them were studied by high-multifrequency linear-array transducer
using color Doppler to identify vascular anatomy. Our results showed 1 ovarian
hernia, 4 spermatic cord cysts (one with proximal omentum and distal scrotal
hydrocele), 3 cryptorchidism (one with associated inguinal hernia), 3 simple hydrocele (one containing an abnormal atrophic testis), 2 isolated inguinal hernia
(one containing bowel) and 2 ovotestis hernia in an intersex patient.
Conclusion: Inguinal hernias are the most common cause of a pediatric groin
mass which requires surgical management. Even though routine sonographic
evaluation is not necessary, it represents an easy, safe and fast technique in
cases suspicious for other related conditions. All these other disorders are subsidiary of conservative management and HRUS represents a good tool to follow
them up.
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ediatric
Learning Objectives: A. To learn the renal tumours in the paediatric population.

B. To understand the role of ultrasound, Doppler, CT and MR imaging in evaluation of paediatric renal tumours. C. To present a pictorial review of the entire
spectrum of common and uncommon paediatric renal tumours. D. To describe
salient and differentiating features of the various lesions.
Background and Imaging Findings: Wilms tumour is the most common renal
tumour in children. Other less common tumours are also seen. These include
mesoblastic nephroma, malignant rhabdoid tumour, renal cell carcinoma, clear
cell sarcoma, metastasis, synovial cell sarcoma and lymphoma. These lesions
differ in their age of presentation, imaging and pathological features. The pictorial
review illustrates the imaging features of these common and uncommon renal
tumours with histological and clinical correlation. Ultrasound, CT and MR imaging features are discussed. Salient features of each tumour are discussed. The
role of imaging in diagnosis, biopsy, treatment and follow-up are considered.
Conclusion: Although Wilms tumour is the most common paediatric renal tumour, there are a wide variety of other renal tumours. Knowledge of the imaging
features of these tumours is essential in making an accurate diagnosis. Imaging
is essential in characterization and providing guidance for biopsy.

Pediatric
C-678
Vascular
Central venous cannulation in critically ill children: Is a postprocedure

chest radiograph necessary after B-mode and color Doppler sonography
check?
C. Lanza, V. Bolli, G. Pieroni, M. Russo, G. Fabrizzi; Ancona/IT
(lanzacecilia@hotmail.com)
C-676
Transcranial Doppler ultrasound in premature neonates: Definition of
normal Doppler values of main intracranial arteries
G. Tsimitselis, V. Tsikrika, E. Gaitana, I. Fezoulidis; Larissa/GR
(tsimitselis@yahoo.com)
Purpose: The main aim of this study is the definition of normal Doppler values of
main intracranial arteries in premature neonates.
Methods and Materials: 88 premature (33-38 weeks gestation) neonates (42
males and 46 females) aged 4-23 days old (mean12.25) have been examined
using transcranial Doppler. All neonates were clinically normal. Any health problem apparent after delivery was successfully treated. 5 main intracranial arteries
were sampled in the supine position via the anterior fontanelle: intracranial segment of ICA, anterior (ACA), middle (MCA) and posterior (PCA) cerebral arteries, and basilar artery. A convex Doppler ultrasound probe was used with 7 MHz
frequency in the B-mode and 4 MHz Doppler frequency. Registered values were
peak systolic velocity (PSV), end diastolic velocity (EDV), resistance and pulsatility indices (RI and PI).
Results: ICA: PSV: 10-135 (50.3 17.64) EDV: 3.8-37.6 (11.3 5.07) RI: 0.610.88 (0.78 0.1) PI: 1-2.42 (1.49 0.3).
ACA: PSV: 11-103 (52.8 25.23) EDV: minus15-30.3 (11.7 8.36) RI: 0.62-1.41
(0.81 0.17) PI: 0.94-2.82 (1.61 0.51).
MCA: PSV: 12.2-150 (56.2 29.67) EDV: minus12.5-30.1 (12.9 8.11) RI: 0.51.27 (0.77 0.16) PI: 0.75-2.77 (1.54 0.63).
PCA: PSV: 11.3-158 (47.21 24.24) EDV: minus16.5-22.6 (10.48 8.21) RI: 0.51.56 (0.82 0.24) PI: 0.41-2.67 (1.46 1.09).
Bas.Art: PSV: 21-70.2 (45.6 13.6) EDV: 3-22 (10.97 4.37) RI: 0.46-1.14
(0.77 0.11) PI: 0.64-2.82 (1.52 0.47).
(velocity in cm/sec, (mean velocity SD))
Conclusion: In relation to full term neonates: a) a slight reduction of PSV and
EDV is apparent, b) a slight end diastolic flow inversion is sometimes seen, c) RI
values are slightly increased, d) mean values of different vessels are approximating each other.
C-677
Sonographic imaging of umbilical disorders in childhood
M. Vakaki, M. Papadaki, G. Pitsoulakis, P. Antonopoulou, E. Karamanoli,
C. Koumanidou; Athens/GR (geop@hol.gr)
Learning Objectives: To present the embryology, pathology and imaging features of a wide spectrum of congenital and acquired disorders involving the umbilicus and periumbilical region in children. To highlight the role of sonography in
the imaging investigation of these disorders in childhood. To familiarize pediatric
radiologists with the differential diagnosis of these entities.
Background: Umbilical disorders can be classified according to embryonic remnants contained in the umbilicus (urachus, omphalomesenteric duct, round ligament of the liver), the umbilical ring and the umbilicus itself. Clinical presentation
is usually nonspecific. Sonography is the first and sometimes the only preoperative imaging method in children with umbilical disorders.
Procedure Details: In this exhibit, the embryology and anatomy as well as the
sonographic features of the various umbilical disorders, supplemented by other
imaging methods when necessary, are described and illustrated. These entities
include all types of congenital urachal and omphalomesenteric duct abnormalities, recanalization of the omphalic vein, omphalocele, various hernias, inflammatory processes etc. The differential diagnosis is discussed.
Conclusion: Knowledge of the anatomy, the differential diagnosis and sonographic
features of the various umbilical disorders in children is of utmost importance to
achieve a prompt diagnosis and for proper treatment. The further imaging investigation is decided on occasion. Sonography as the only preoperative work-up in
children with umbilical disorders is often sufficient to demonstrate the existing
abnormality, because of their typical locations relative to the urinary bladder and
umbilicus.
464
Purpose: The aim of this study was to determine in a pediatric population whether color Doppler with a few mls of saline solution injected through the catheter
after central venous access is useful to evaluate catheter position and possible
procedural complications. Specifically, we wished to determine the concordance
between color Doppler and chest radiography and the diagnostic accuracy of
color Doppler.
Methods and Materials: 20 consecutive central venous access procedures placed
surgically, were performed in a pediatric intensive care unit. Catheters were placed
in the right internal jugular vein (8), left femoral vein (2), right femoral vein (4) and
right subclavian vein (6). At the end of the procedure B-mode sonography and
color Doppler sonography with a few mls of saline solution injected through the
catheter were used to assess catheter position. A postprocedural chest radiograph was obtained in all patients.
Results: Postprocedural B-mode in nineteen cases showed the catheter tip position in vena cava and color Doppler sonography demonstrated color Doppler signals within the right atrium. In one case there was no color Doppler signal and the
postprocedure chest radiograph confirmed an inappropriate catheter tip position
The correlation between color Doppler and chest radiography was 100% in the
detection of catheter position.
Conclusion: Color Doppler sonography is a useful, noninvasive tool for the evaluation of catheter position after central venous access. Postprocedure chest radiographs may be performed only in cases of suspected inappropriate catheter
tip position following ultrasound examination.
C-679
Congenital anomalous pulmonary venous connections: CT and MR
angiographic demonstration
S. Fitoz, E. Tutar, T. Ucar, S. Atalay, A. Uysalel; Ankara/TR (sfitoz@yahoo.com)
Learning Objectives: To evaluate the utility of MR and CT angiography in the
evaluation of pulmonary venous abnormalities in pediatric patients and to outline
the advantages of these techniques.
Background: Pulmonary venous abnormalities, including congenital partial or
total anomalous connections, are very rare and may occur in isolation or in combination with heterotaxy syndromes. Although partial venous connections can be
asymptomatic or present with nonspecific clinical manifestations, patients with
TAPVC present early and often require urgent cardiac surgery. Cross-sectional
imaging has an important role in diagnosis and may obviate the need for cardiac
catheterization. In this exhibit we will present the examples of venous return abnormalities demonstrated by MRA and/or CTA.
Imaging Findings: We evaluated the imaging findings of seven patients. Diagnoses included TAPVC in five patients (infracardiac in 2, supracardiac in one,
cardiac in one and mixed in one) and partial venous return in two (scimitar syndrome in one and right total abnormal venous return in another). Operation results were available in five patients. In all patients the course of the common or
anomalous pulmonary vein and its opening could be demonstrated. A stenosis of
the common pulmonary vein at its junction shown by MRA was confirmed by
Doppler US and surgery in a patient with an infracardiac type. In one patient, the
right upper pulmonary vein could not be visualized properly by MRA because of
motion artifacts.
Conclusion: MRA and CTA are fast, accurate and noninvasive techniques that
allow detailed and comprehensive evaluation of the pulmonary veins.

Pediatric
Miscellaneous
C-680
Preliminary results in whole-body MRI in children: A prospective study
S. Krohmer, R. Kluge, A. Krausse, I. Sorge, T. Kahn, W. Hirsch; Leipzig/DE
(swetlana.krohmer@tiscali.de)
Purpose: Our prospective study was intended to find out the possibilities, accuracy and limitations of whole-body MR imaging for investigation of malignant pediatric diseases.
Methods and Materials: 23 children with different malignant diseases underwent whole-body FDG-PET screening for tumor search and staging and wholebody MR imaging (INTERA, Phillips) with coronal T1w, T2-STIR and axial STIR.
Our gold standard was a positive finding both in dedicated cross-sectional imaging (MRI/CT) as well as in PET in the same anatomical position.
Results: All 21 regions with positive PET and a positive finding in dedicated
cross sectional imaging had a positive finding in WB-MRI (100% positive concordance with gold standard).
Additionally we found 18 suspect lesions in dedicated MRI/CT without positive
PET findings. Seven of these lesions were missed on WB-MRI (2 small pulmonary lesions, 4 lymph nodes) in restaging after chemotherapy (e.g. fibrotic lesions). We did not miss any of the MRI/CT lesions on initial staging.
Conclusion: WB-MRI seems to be a very sensitive method for tumor search and
initial staging in malignant pediatric diseases.
A problem up to now has been the missing reference for isolated positive PET
findings without any correlation with dedicated imaging (MRI/CT). However, the
evaluation of isolated positive PET findings was not the aim of this study.
Whole-body MR imaging is a promising technique in the detection of tumors in
metastatic diseases. The value of WB-MRI in the assessment of small lymph
node involvement and in restaging after chemotherapy could be limited.
C-681
Entertaining children in the radiology department: Ideas and techniques.
A review
N. Ramesh1, H. Khosa1, F. Khosa2; 1Portlaoise/IE, 2Cavan/IE
(drnramesh@hotmail.com)
Learning Objectives: The purpose of this poster is to present the various ideas
and techniques presently used to make the visit to the radiology department a
pleasant experience for the paediatric age group.
Background: A visit to the radiology department can be a daunting experience
for children. Hospitals and radiology departments around the world come up with
different and exciting ideas to keep children comfortable and have a pleasant
experience. The waiting rooms, general rooms, screening, ultrasound, CT scanner all need to be in a bright, colourful environment to relax the children. From
teddy bears, high-tech fish tanks, colouring papers, books, play things, photos
and paintings of famous sportpersons, ceiling projecting slides {in ultrasound
rooms}, visits by famous personalities and artists or even a simple lollipop - the
ideas and techniques are varied and effective. The equipment is given a fancy
name e.g. CT scanner is called a 'space ship,' the ultrasound monitor is a 'telly.' In
some departments, models of popular toys {Winnie, Barbie, Shrek} are shown
getting investigations or photo albums of the same; in other departments a 'lucky'
box of gifts is distributed to children. Showing the organs on the 'telly' after the
ultrasound examination, especially the heart never fails to entertain some of the
older kids.
Procedure Details: The poster aims to review the various ideas and present
some helpful tips.
Conclusion: Entertaining children in the radiology department plays a major role
in making the visit to the department a pleasant experience.
Magnetic resonance imaging of the neonate

E. Whitby; Sheffield/UK (e.whitby@sheffield.ac.uk)
Learning Objectives: 1. To understand the problems and possible solutions to
imaging the neonate by MR. 2. To gain a practical approach to imaging the neonate that is possible in the delegates own clinical environment.
Background: There is increasing interest in imaging the neonate by MR. Pressures are put on general radiologists to perform specialist examinations with minimal experience and support.
Procedure Details: Safety of the neonate is of paramount importance both dur-
C-683
Extrapulmonary tuberculosis in Norway. Diagnostic methods and findings
L. Borgen, M.O. Haakonsen, T. Gudmundsen, D. Solheim; Drammen/NO
(lars.borgen@sb-hf.no)
Learning Objectives: To describe the current diagnostic imaging methods in
detection of extrapulmonary tuberculosis.
Background: During the last three decades the number of tuberculosis cases
has declined among native Norwegians, but increased among immigrants.
The total number of tuberculosis cases declined until the mid-1990s, but increased
thereafter. The number of immigrants among Norwegian tuberculosis patients
increased from 5% in the 1970s, to almost 80% today. The largest increase has
been among Asian and African immigrants, Somalians being the largest group.
Even though pulmonary tuberculosis is the most common form, extrapulmonary
tuberculosis is also relatively common and often without concurrent lung manifestations. Extrapulmonary tuberculosis is rarely contagious, but can cause serious illness and the diagnosis can prove difficult.
A standard chest X-ray to reveal tuberculosis is performed on all new immigrants
when arriving to Norway. Extrapulmonary tuberculosis however, is not necessarily detected by this routine. Basic diagnostic imaging techniques are often insufficient, and special examinations such as MR imaging, CT, ultrasound or
scintigraphy may be necessary. This is illustrated in the case of a Somalian family
of six.
Findings: Of the six family members, one had pulmonary tuberculosis, one had
both pulmonary tuberculosis and extrapulmonary tuberculosis and four had extrapulmonary tuberculosis, some with multiple foci. In only 1 of the 5 cases of
skeletal tuberculosis could this be detected on a standard skeletal X-ray.
Conclusion: Tuberculosis is increasing in Norway, mainly due to immigration.
MR imaging and skeletal scintigraphy appear to be the most reliable methods of
diagnosing skeletal tuberculosis.
C-684
Birth trauma: Imaging findings
M. Montes, A. Veron, R. Sanchez, B. Nieto, Y. Martinez; Madrid/ES
(anaveron@hotmail.com)
Learning Objectives: To describe the most common birth trauma imaging findings in conventional radiography, ultrasound, CT and MR and to show rare injuries that may also occur.
Background: Most cases of birth trauma are self-limiting and have a favorable
outcome. Significant birth injury accounts for fewer than 2% of neonatal deaths
and stillbirths in our country. In this exhibit we will describe the most common
birth trauma imaging findings we have found. We also include other rare but illustrative birth injuries that may occur.
Imaging Findings: We describe the conventional radiography and ultrasound
imaging findings of cephalhematoma, subgaleal hematoma, caput succedaneum,
clavicular fractures and sternocleidomastoid injury as common birth injuries.
We also present unusual birth trauma cases of skull fracture, subdural hematoma, intraparenchymal hematoma, subarachnoid hemorrhage, carotid dissection
and associated cerebral stroke, brachial plexus injury, fractures of long bones,
hepatic laceration and adrenal hemorrhage and describe the conventional radiography, ultrasound, CT and/or MR imaging findings.
Conclusion: Imaging is needed to recognize birth trauma injuries. Although infrequent, serious birth injuries should be considered in order to be diagnosed in
time.
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ediatric
C-682
ing transfer and scanning. Specialist centres have built in MR compatible equipment specific to the neonate, other centres do not. Two means of ensuring safety
are to purchase a MR compatible incubator that doubles as a transport incubator
reducing the amount of handling and maintaining the environment of the neonate,
or to purchase a dedicated scanner. Neonates may need sedation or general
anaesthesia but these carry a finite risk and it is possible to image post feed
without either. Fast sequences reduce the time needed to image the neonates
and provide diagnostic information. These include ultra fast T2 (single shot fast
spin echo) weighted sequences, RF fast T1, fast inversion recovery allowing time
for diffusion weighted imaging and spectroscopy if required.
If required manual restriction of movement is possible by experienced personnel.
Mechanical ventilation is possible with standard equipment if this is modified to
extend the tubing required.
Conclusion: Novel approaches to imaging the neonate allow it to be a safe procedure in non specialist centres.

C-685
Pediatric
Magnetic resonance imaging of the fetus

E. Whitby; Sheffield/UK (e.whitby@sheffield.ac.uk)
Musculoskeletal
Learning Objectives: To develop a technique that is safe and reliable. To gain

tips on imaging. To gain tips on sequences that are useful in certain pathologies.
To become familiar with normal at different gestational ages.
Background: Fetal MR is increasing and non specialists are being asked to provide a service with little or no experience. Most MR scanners are now capable of
doing ultrafast imaging.
Procedure Details: The mainstay of fetal MR is the ultrafast T2 weighted single
shot fast spin echo sequence. The exact parameters vary with the different manufacturers. RF fast T1 weighted sequences provide useful information in cases
with cortical abnormalities, any case with a suspect haemorrhage, to view the
liver and bowel in cases with abdominal pathology and cases with a diaphragmatic hernia. Diffusion weighted imaging is useful in most CNS cases but especially if ischemic injury is considered.
Tips to imaging include:
Image the patient in a decubitus position, a comfy mum reduces fetal movement.
Image all sequences of the same parameters first as the fetal movement
increases at each change of audible noise.
Rapid planning from the previous image reduces chances of fetal movement
between scans and improves with experience.
Breath hold techniques are useful in cases with a breech presentation.
Conclusion: Fetal MR is possible, experience helps with interpretation, tips and
tricks help reduce the time taken and increase the quality of the images.
C-687
C-686
PET/CT: Imaging in pediatric oncology
B. Marin, E. Fernandez Canabal, M. Martinez Schmickrath, D. Marin,
N. Gomez Leon, L. Martin Curto; Madrid/ES (begona_marin@yahoo.es)
Learning Objectives: To illustrate the utility of the hybrid technique positron
emission tomography and computed tomography (PET/CT) in the diagnosis and
management of several pediatric neoplasms. To show our experience in the use
of this new diagnostic tool.
Background: CT has become the main imaging modality to confirm the clinical
diagnosis, evaluate the site and extension of the disease and monitoring treatment in pediatric oncology. PET appears to be a useful technique for the evaluation of the oncologic disease, demonstrating high diagnosis accuracy and
supplying functional more than anatomical information. PET/CT is much more
reliable than CT and PET alone, due to its capacity of combining both techniques.
Procedure Details: PET/CT studies of 22 oncologic pediatric patients (under 18
years of age) from a total of 2700 oncologic studies performed in our hospital in
the last two years were retrospectively reviewed. None of the patients had previously undergone a CT study or received treatment. Most patients were diagnosed with Hodgkin and non-Hodgkin disease while others were diagnosed with
different tumours such as neuroblastoma, rhadbomyosarcoma, etc. A multidisciplinary approach was necessary in order to achieve a consensus of validation,
due to the lack of articles published in medical literature and the scarce experience in this new field regarding pediatric patients. Parent cooperation was always required.
Conclusion: Although it seems like there is quite strong evidence that the PET/
CT study is highly accurate in diagnosing malignant diseases, further studies are
necessary to determinate its true impact in pediatric oncology.
466
Imaging in bone transplantation in children: A pictorial review

P. Rajiah, A. Shabani; Manchester/UK (rprabhakar73@yahoo.com)
Learning Objectives: A. To understand the complications of bone marrow transplantation in children. B. To learn the role of imaging in diagnosing the various
complications of bone marrow transplantation. C. To present a pictorial review of
various pathologies secondary to bone marrow transplantation.
Background: In children, bone marrow transplantation is used in conditions such
as leukaemia, lymphoma, aplastic anemia, immunodeficiencies and tumours. The
transplant can be autologous or allogenic.
Imaging Findings: Imaging is essential for diagnosing the complications of the
procedure, complications of high dose therapy, proliferative disorders and infections occurring due to immunosuppression. The primary complication is graft
versus host disease, which predominantly affects the bowel. Complications of
high dose therapy include hepatic venoocclusive disease, encephalopathy, pulmonary fibrosis and hemorrhagic cystitis. Infections due to immunosuppresion
include viral (cytomegalovirus, herpes, varicella), fungal (candida, aspergillus),
bacterial (pneumonias, colitis) and mycobacterial infections. Post transplant lymphoproliferative disorder (B cell proliferation) is another complication due to immunosuppression. X-rays, ultrasound, CT, HRCT and MR imaging are used in
diagnosis of complications in different organ systems.
Conclusion: Imaging plays a vital role in the diagnosis of the wide spectrum of
complications arising consequent to bone marrow transplantation in children.
C-688
Does dark signal intensity of the femoral head on gadolinium-enhanced MR
imaging always mean the early stage of Legg-Calve-Perthes disease?
J.-E. Kim, D. Yang; Incheon/KR (boram107@ghil.com)
Purpose: To evaluate the nature of dark signal intensity of the femoral head on
gadolinium enhanced fat suppressed MR imaging.
Methods and Materials: We retrospectively evaluated 16 MR examinations which
demonstrated dark signal intensity (absence of enhancement) of the femoral head
compared to the opposite site. 15 hips of 13 children (11 boys, two girls, mean
age 6.1years, range 3-13 years) with hip pain or a limp were included in the
study. The final diagnosis was based on pertinent radiologic findings, clinical and
laboratory findings and results of joint aspiration.
Results: The final diagnoses of dark signal intensity (15 hips of 13 children) of
the femoral head on gadolinium-enhanced fat suppressed MR image were LCP
disease in 9 hips of 7 children (bilateral in two children) and transient synovitis in
6 hips of 6 children.
Conclusion: Our cases show that dark signal intensity of the femoral head on
gadolinium-enhanced MR imaging is not a finding specific to the early stage of
Legg-Calve-Perthes disease but can also be observed in transient synovitis.
C-689
Primary bone tumours in children with imaging/pathologic correlation
V.V.R. Kandula, A. Donuru, H. Obaid, A. Mcgregor; Leicester/UK
Purpose: The purpose of this poster is to give a pictorial review of primary bone
tumours with proven histology.
Methods and Materials: All the paediatric primary bone tumours resected or
biopsied in the last 15 years in our institution are included.
Results: They include bone forming tumours (osteoma, osteoid osteoma, osteoblastoma and osteosarcoma), cartilage forming tumours (chondroblastoma,
chondromyxoid fibroma and osteochondroma), fibrous tumours (fibroma, fibrous
dysplasia), bone tumours containing giant cells (aneurysmal bone cyst) and other tumours (solitary bone cyst, benign teratoma, hamartoma, Ewing's sarcoma,
rhabdomyosarcoma and eosinophilic granuloma).
Conclusion: Understanding the classification and imaging appearances of bone
tumours is vital for the radiologist to propose an appropriate differential diagnosis
and for the consideration of further treatment.

C-690
Radiologic evaluation of complications in pediatric bone marrow transplant
recipients: From head to toe
Y.-J. Lee, G.-Y. Lim, S.-A. Im, D.-Y. Lee, S.-T. Hahn; Seoul/KR
(shlgy@catholic.ac.kr)
Learning Objectives: Illustrate typical radiologic manifestations of specific organs from head to toe and describe the time course and risk factors.
Background: Bone marrow transplantation has been used in the treatment of
lymphoma, leukemia, severe aplastic anuemia and some solid tumors in children. A wide variety of complications may occur in BMT recipients and are a
major cause of morbidity and death.
Imaging Findings: Complications may be seen acutely in severely immunocompromised patients or may develop as chronic problems. Thus, different complications occur either by time elapsed after BMT or by organ system affected. We
present a pictorial review of these pulmonary, abdominal, neurological and musculoskeletal complications depending on the elapsed time following BMT in children.
Conclusion: Awareness of radiologic manifestations is essential for timely, accurate diagnosis of complications following BMT and to reduce patient mortality
and morbidity.
C-691
PedBone (www.tnt-radiology.de/pedbone): The reference database in
pediatric plain film radiography
M. Grunewald1, M. Wagner1, H. Greess1, W. Bautz1, M. Uhl2, R. Talanow3;
1
Erlangen/DE, 2Freiburg/DE, 3Cleveland, OH/US
Learning Objectives: To develop a reference database in plain film radiography
for pediatric radiology.
Background: In pediatric skeletal diagnostics it is difficult especially for the beginner to decide what is a physiological variation and what should be deemed as
pathological due to age-specific variations of the child's bone. It is substantially
more difficult for the beginner in pediatric radiology and the radiologist on-call to
internalize the "physiological reference image." The suitable book is often unavailable or there is a lack of time to find the reference image one is looking for.
Procedure Details: Over a course of one year approximately 450 images in pediatric skeletal radiography were collected in standard settings and after specialized medical peer review regarding body regions, age and sex, this data was
entered into a database. The database can be queried on one hand through selection of all three criteria, or additionally offers the possibility to selectively choose
each criterion separately. The latter offers itself mostly for determination of bone
age using the left hand. Under WWW.TNT-RADIOLOGY.DE/PEDBONE the chosen selection mode offers the user at least one reference image according to
each body region, age and sex that is entered.
Conclusion: PEDBONE is a free reference database for almost all standard images in plain film radiography, from infancy to adulthood. The database serves
the radiologist on-call and the inexperienced pediatric radiologist. PEDBONE has
received positive feedback by its first users, in particular younger colleagues in
the field and less experienced pediatric radiologists.
C-692
Neurofibromatosis type 1 in the pediatric skeleton
R.G. Schumacher, R. Brzezinska; Mainz/DE
C-693
Ankle sprain in children: MRI compared to clinical signs and X-ray
K. Stock, S.-O. Hhne, R. Spielmann, R. Finke, C. Kunze; Halle a.d. Saale/DE
(karsten.stock@medizin.uni-halle.de)
Purpose: The aim of the study was to compare the results of MR imaging, X-ray
and clinical examination of ankle sprain in childhood. Implications for treatment
related to the results of MR imaging were of special interest.
Methods and Materials: MR imaging, X-ray, and clinical results in 50 children
with supination trauma of the ankle were prospectively analysed. Changes in
treatment were of special interest.
Results: 12 of 13 fractures could be shown on MR imaging (96%), 9 fractures
were seen on X-ray (69%). 25 ruptured ligaments were exclusively diagnosed on
MR imaging. One avulsion was seen on X-ray. Fibulotalar and fibulocalcaneal
ligaments were ruptured most often. Bone bruise diagnosed on MR imaging had
no influence on therapy. MR imaging had a strong impact on therapy; in 34% of
the 50 children the therapy could be minimized and in 12 % it had to be increased.
Diagnosis of joint effusion and bone bruise on MR imaging had no effect on the
treatment.
Conclusion: MR imaging is the most sensitive method in the verification of fractures, ligamentous injury and epiphyseal plate lesions compared to X-ray and
clinical examination. MR imaging is able to replace plain films in ankle trauma.
Currently however, regular use of MR imaging in trauma diagnostics of children
is not yet feasible.
C-694
Paediatric lateral discoid meniscus diagnosed by magnetic resonance
imaging in Manchester, UK
N.W.H. Townsend, A.G.S. Shabani; Manchester/UK
(nealtownsend@hotmail.com)
Learning Objectives: To demonstrate the application of the adult three slice rule
for diagnosing discoid lateral meniscus (DLM) in a paediatric UK population.
Background: DLM is the most common abnormal meniscal variant in children. A
discoid meniscus is more prone to tear because of increased shearing forces
placed on it by its unusual shape. However, DLM is often asymptomatic and incidentally found at arthroscopy. Magnetic resonance imaging (MRI) using the three
slice rule has been shown to be useful for diagnosing DLM in the adult population. There is limited evidence to support the use of this rule in a paediatric setting. The imaging findings using the three slice rule in our paediatric population
are described.
Procedure Details: 600 knee MR imaging scans were performed between 7th
September 1995 to 31st July 2003 in children attending our hospitals. Discoid
meniscus was diagnosed when there was continuity between the anterior and
posterior horns on three or more sagittal images. Imaging identified 31 knees (29
children) with DLM. 10 Knees (9 children) had arthroscopic confirmation, 10 knees
(9 children) had clinical acceptance of the imaging findings, 8 knees (8 children)
were followed up at an outside hospital and 3 knees (3 children) were lost to
follow-up. In cases where there was surgical or clinical follow-up, MR imaging
was regarded as correctly identifying all positive cases (20 knees).
Conclusion: The three slice rule using MR imaging is a promising tool to diagnose DLM in children.
C-695
Pediatric ilium: The spectrum of osteolytic lesions
C. Hadjigeorgi, M. Zarifi, G. Pitsoulakis, J. Nikas, K. Stefanaki; Athens/GR
(marza@mailbox.gr)
Purpose: To demonstrate the broad differential diagnosis for osteolytic lesions
that may occur in the ilium of children and demonstrate the imaging findings of
plain radiographs, CT and MR imaging.
Methods and Materials: Plain radiographs, CT and MR scans of 33 children (27
boys and 6 girls, aged 4 months to14 years), that were examined in our department for osteolytic lesions of the ilium during the last 15 years, were reviewed.
The imaging findings were correlated with the histopathological findings.
Results: The 33 children with osteolytic lesions of the ilium were diagnosed with
Ewing's sarcoma of the ilium (5), PNET (2), Langerhans' cell histiocytosis (3),
simple bone cyst (2), aneurysmal bone cyst (1), osteomyelitis (5) and metastatic
disease (15), from neuroblastoma (6), leukemia (2), lymphoma (2), rhabdomyosarcoma (2), Ewing's sarcoma (2), Wilms tumor (1). The major imaging findings
467
tric
Pedia
ediatric
Learning Objectives: Recognize the spectrum of skeletal manifestations of NF1.

Background: NF1 is not a rare genetically transmitted disorder with sometimes
confusing findings. By thorough image analysis, specific findings and skeletal
changes can strongly hint at the underlying disease.
Imaging Findings: Plain X-ray images are still the most effective diagnostic tool
in neurofibromatosis 1. In depicting characteristic skeletal changes such as aplasia of the greater sphenoid wing or congenital tibial pseudarthrosis, in conjunction with the family history, an early diagnosis can be made. Common to all patients
is the striking asymmetry of findings. Though the X-ray delivers a good survey of
skeletal changes and is suitable for follow-up, it does not show the fundamental
soft tissue disease.
This pictorial essay covers the findings in the skull (aplasia of the greater sphenoid wing, dilatation of the optic canal), the vertebral column, (scoliosis, deformation by expanding lesions (neurofibroma and ectasia of the dural sac) of the
vertebral bodies and vertebral arcs, dysplasia of vertebral bodies)
the pelvis, (focal hypertrophy - hemi hypertrophy, cortical erosions)
the thorax, (notching of the ribs, deformation and erosion of ribs, scoliosis, soft
tissue tumors) and the extremities (congenital bowing and pseudarthrosis of the
tibia, cortical erosions by pressure.
Conclusion: NF1 can be diagnosed or at least suspected on the basis of specific

radiographic findings in the skeleton.

were osteolytic lesions with periosteal reaction, bone cortex destruction with or
without a soft tissue mass that enhanced variably.
Conclusion: A wide range of osteolytic lesions may be encountered in the pediatric ilium. CT and MR imaging show characteristic but not specific imaging findings in most of the cases. The final diagnosis is based on the histopathological
findings. Metastatic disease, infection, Ewing's sarcoma and Langerhans' cell
histiocytosis are the most frequent entities to be included in the differential diagnosis.
Physics in Radiology
Computed Tomography
C-696
Assessment of low contrast sensitivity for computed tomography (CT)
systems
W.J.H. Veldkamp, R. Wijntjes, J. Geleijns; Leiden/NL (w.j.h.veldkamp@lumc.nl)
Purpose: Low contrast sensitivity of CT scanners is regularly assessed by (subjective) scoring of low contrast detectability within CT images of a phantom. Subjective rating of low contrast visibility might be biased since low contrast objects
are arranged in known fixed patterns. The purpose of this study was to develop a
software tool for objective low contrast measurements, both in a semi-automated
(four alternative forced choice) and automated approach (measurement of contrast-to-noise ratio). Results between observer performance for the traditional
(subjective) and semi-automated methods were compared.
Methods and Materials: Images of the low contrast module of the Catphan 500
phantom were used for the evaluations. The phantom contains three series of low
contrast patterns (size 2 -15 mm; contrast 0.3% - 1.0%). Software was developed
(MatLab) for designing a four-alternative-forced-choice detectability experiment
using the low contrast patterns. The low contrast objects were extracted from the
original slices and put in one of the four quadrants of a template image. The
template image was constructed from a original image containing only background
signal. The observers task was to select the corner containing the low contrast
object. The software package additionally offered automated determination of
contrast-to-noise ratio.
Results: Results from 5 observers show clearly worse low contrast performance
in the four-alternative-forced-choice detectability experiment compared to the traditional method.
Conclusion: Results suggest that low contrast performance is overestimated by
observers when visually inspecting low contrast patterns in phantom images.
Technical specifications of low contrast sensitivity of CT scanners might therefore be inadequate.
C-697
Abdominal multi-detector computed tomography imaging: Clinical
applications of multi-planar and three-dimensional reformation techniques
Learning Objectives: To describe the principles of three-dimensional (3D) and
multi-planar reformation techniques. To recognize advantages, limitations and
potential pitfalls of each technique on abdominal multi-detector computerized
tomography (MDCT) imaging. To list the main clinical applications on abdominal
imaging.
Background: Multi-detector technology has had an important impact on CT
abdominal imaging. Thanks to the rapid volume coverage speed and the reduced
section width, near isotropic data can be obtained providing excellent multi-planar and 3D displays of the data volume.
Imaging Findings: The authors review the principles of the main visualization
techniques currently used on clinical 3D workstations, namely multi-planar reformation (MPR), maximum intensity projection (MIP), shaded surface display (SSD)
and volume rendering (VR). Advantages, limitations and clinical applications of
each method are described and illustrated thoroughly.
Conclusion: 3D and multi-planar imaging techniques represent a new insight in
MDCT abdominal imaging, expanding its role in multiple clinical settings, namely
in the characterization of renal and pancreatic neoplasms, in the evaluation of
the aortic and mesenteric vasculature, in the workup of liver transplantation and
pre-surgical hepatic vascular mapping.
C-698
Design and development of a pulsating cardiac flow phantom for cardiac
MR and cardiac MDCT/VCT
Y. Shen1, M. Sato2, F. Kimura3, J. Qi4; 1Beijing/CN, 2Tokyo/JP, 3Saitama/JP,
4
Tianjing/CN (yun.shen@med.ge.com)
Purpose: The comparison of cardiac MR and cardiac MDCT is very important for
cardiac coronary artery diagnosis. The purpose of this exhibit is to show design
and fabrication of pulsating cardiac flow phantom for comparison of diagnosis
ability for MR and MDCT.
Methods and Materials: The developed phantom has following six key advantages: 1) separate structure for driver component and phantom component; 2)
the pulsating phantom component constituted of chambers to simulate LV and
468

RV and one direction flow structure; 3) the cardiac coronary component constituted of acryl/silicon tube (2-5 mm inner diameter) with stent/in-stent restenosis/
stenosis/soft plaque/calcification parts and one direction flow structure; 4) the
only one servomotor to move the phantom in 3D dimensions (X-Y-Z direction)
and to get one direction flow of phantom and coronary; 5) 16 presets of different
heart type is easy for multipurpose experiments; and 6) the all cardiac phantom
and coronary phantom was submerged in tank to simulate clinical state.
Results: The comparison of cardiac MR and cardiac MDCT was demonstrated
by using a developed pulsating cardiac flow phantom. For evaluation of cardiac
image we: 1) show cardiac image quality of MR and MDCT; and 2) show coronary image quality of MR and MDCT.
Conclusion: We have designed and constructed a new pulsating heart phantom,
and it is very useful for comparison between cardiac MR and cardiac MDCT.
C-699
Initial study of a CT QA-method to determine spatial variation in X-ray focus
position (flying focus and collimation) and CT gantry vibrations
L. Herrnsdorf; Mlndal/SE (lars.herrnsdorf@rti.se)
Purpose: Investigate the impact of variation in X-ray focus position and gantry
vibrations.
Methods and Materials: A rotation-independent detector is used to measure the
spatial dose distribution on the falling slope of a dose profile free from scatter.
Since the detector is very thin (approximately 300 m) the spatial modulation of
the X-ray beam can be seen when the beam moves in and out on the detector.
The source for this modulation could be a flying focus or/and vibration of the
gantry in z-direction. The frequency and spatial movement can be determined by
a detail study of an enlarged part of the slope. Since the spatial movement is
determined in isocentrum and the distance to the focus point is known, the effective movement in z-direction can be determined at the detector plane. A Barracuda equipped with the MPD and the SEM module was used together with the
CT-SD16 dose profile detector (RTI Electronics AB). The RTW analyzer program
0-10-56 was used to collect high speed/high resolution dose profile data points
for further zoom and FFT analyze.
Results: Practical measurements were made and a vibration frequency and
movement were observed. A similar method has been used to determine the
effect of "flying focus" on Siemens sensation 64. If the movement is a too large
part of the detector resolution, the image could be affected.
Conclusion: A QA method have been described that gives the indication of resolution in the z-directions that can possibly affect the image resolution.
C-700
A new method for quantitative evaluation of artifacts on CT images using
statistics of extremes
K. Imai1, M. Ikeda1, Y. Enchi2, T. Niimi1, S. Wada3; 1Nagoya/JP, 2Osaka/JP,
3
Niigata/JP (imai@met.nagoya-u.ac.jp)
Analysis of time sampling and its interpolative effect on singular value

decomposition for quantification of cerebral blood flow using dynamic
contrast-enhanced CT
S. Lee, J. Kim, J. Lee, J. Seo, S. Park, J. Shin; Seoul/KR (lsho76@snu.ac.kr)
Purpose: To investigate sampling and its interpolative effect of the time-signal
intensity curve (TIC) from dynamic CT on cerebral blood flow (CBF), in order to
prove the possibility of low radiation dose examination.
Methods and Materials: After non-enhanced transverse scanning of a patient's
brain, contrast material-enhanced scanning was performed every 1 second for
40 seconds at a single-slice level. Uniform time sampling was executed from 1/2
to 1/6 rate of total time series. 30 tissue TIC data were collected and arterial input
function (AIF) was fitted by gamma-variate function. The sinc function and the
cubic spline method were introduced for interpolation. Interpolation method was
classified as sinc-sinc, cubic-cubic, sinc-cubic and cubic-sinc in order of AIF and
tissue TIC. Deconvolution analysis based on singular value decomposition was
performed for quantification of CBF. The lower singular value corresponding to
the minimum difference between residue and its exponential curve-fitted function
was regarded as the optimal threshold value. The CBF values were acquired
from the maximum of the residue function. The effect of each interpolation method on CBF was compared by independent samples t-test.
Results: The CBF values calculated after interpolation fluctuated around the original CBF values with decrease in sampling rate. The CBF values were statistically similar to the original CBF values up to 1/5 sampling rate regardless of
interpolation method.
Conclusion: Acceptable CBF values can be obtained by interpolation up to some
less sampling rate. This study will help in selecting a reasonable image acquisition time interval for low radiation dose examination.
C-702
High-frequency data sampling technique in MDCT for improvement of
image quality
N. Yasuda, Y. Ishikawa, Y. Kodera; Nagoya/JP (narumi@neko.chan.ne.jp)
Purpose: Multidetector-row computed tomography (MDCT) has dramatically increased speed of scanning, and allows high-resolution imaging compared with
conventional single detector-row CT (SDCT). However, the increasing use of the
MDCT has made both the frequency of use of volume scanning and radiation
dose to patients increase simultaneously. In this work a new technique for reduction of radiation dose MDCT is proposed, and its addition benefit in improving
image quality or denoising effects.
Methods and Materials: In this proposed method, volume data of patient are
obtained by high-frequency sampling (over-sampling) of x-, y- and z-direction
and processed image is obtained by averaging these data. Each pixel value of
the processed image is obtained from nx,y2*nz voxels by nx,y-times sampling for xand y-direction, and nz-times sampling for z-direction. In other words, signal-tonoise ratio (SNR) of the processed image increases root nx,y2*nz-times. This proposed method was applied to chest MDCT image and discussed about reduction
of radiation dose and improvement of image quality.
Results: In this proposed method, noise in flat areas (e.g. heart region) is reduced obviously without decreasing amplitude of signal, and high-frequency signal areas (e.g. lung region) were not affected as in frequency filtering processing.
Conclusion: Noise reduction is possible without degradation of image quality by
this new method. By applying this to noisy images obtained with low-dose scanning, reduction of radiation dose accompanying this processing is possible.
469
sics in R
Phy
adiology
Radiology
Physics
Purpose: Several methods of quantifying spatial resolution power and image

noise of CT exist. However, the method for quantitative assessment of artifacts
on CT images has not yet been clarified. In this study, we have devised the new
evaluation method for artifacts on CT images using "statistics of extremes".
Methods and Materials: A chest phantom was prepared. Four polymer tubes
filled with water were placed on the chest wall of the phantom to evaluate artifacts in homogeneous backgrounds. CT scans were performed using a 16-multidetector row CT scanner with 0.5-second gantry rotation period, 10 mA, and
120 kVp. A CT value profile of a tube image for each slice was measured at onepixel intervals in the perpendicular direction to the artifacts. The largest variation
in a profile curve was employed as a feature index of the artifact, and was calculated from each profile. The feature indices for a tube image were analyzed with
statistics of extremes, and the artifacts were evaluated based on this analysis.
Results: The generation-probability density function of artifacts f (x) were expressed as f (x)=(1/a)exp ((-x)/a-exp ((-x)/a)) (x: feature index, a: scale parameter, : location parameter). Therefore, generation-probabilities of artifacts were
found to be governed by Gumbel distribution. A feature index yielding the highest
generation-probability and a scale parameter describing the variation in feature
indices were calculated from this function. These two parameters showed high
values on CT image including shoulders and a liver.
Conclusion: Our devised method would make it possible to evaluate artifacts on
CT images quantitatively.
C-701

Dose
C-703
Guidance levels for the management of patient doses in interventional
cardiology: An IAEA coordinated research action
P. Ortiz-Lopez1, E. Vano2, R. Padovani3, S. Balter4, K. Faulkner5, G. Bernardi3,
E. Cotelo6, A. Ramirez7, R. Nowotny1; 1Vienna/AT, 2Madrid/ES, 3Udine/IT,
4
New York, NY/US, 5Wallsend/UK, 6Uruguay/UY, 7Santiago/CL
(eliseov@med.ucm.es)
Purpose: To report the results obtained during an IAEA coordinated research
programme to explore the possibility of establishing guidance levels for interventional cardiology procedures.
Methods and Materials: A working group evaluated patient doses from fluoroscopically guided cardiology procedures. A sample of 6,000 cases of coronary
angiography (CA), coronary angioplasty (PTCA) or combined CA and PTCA from
10 interventional cardiology laboratories in five different countries was used for
the analysis. Intercalibration of dose area product (DAP) meters and common
quality control tests have been carried out. Skin dose distribution was also measured. Image quality criteria have been tested in a small sample of patients. Procedure complexity was evaluated in a sub-sample of 1,000 cases. The influence
of X-ray systems technique settings was also evaluated.
Results: For the same procedures, median values of DAP between centers varied over a range of three. The suggested guidance levels for simple procedures
are 40, 100, 140 Gycm2 for CA, PTCA, and combined procedures. The complexity of the procedures was grouped in three levels, and was found to have an
influence in patient exposure up to a factor of 2 in dose. Skin doses > 1.5 Gy
occur in 2% of procedures. No skin radiation injuries have been reported.
Conclusion: Median patient doses vary among laboratories. This exposure variation can be reduced by correcting for procedure complexity. Guidance (reference) levels for interventional cardiology procedures are feasible, allowing
sub-optimal practices or inappropriate techniques to be identified and stimulate
corrective actions.
C-704
Patient dose and complexity index in interventional cardiology
P. Ortiz-Lopez1, R. Padovani2, G. Bernardi2, E. Vano3, S. Balter4, A. Ramirez5,
D. Miller6; 1Vienna/AT, 2Udine/IT, 3Madrid/ES, 4New York, NY/US, 5Santiago/CL,
6
Bethesda, MD/US (padovani.renato@aoud.sanita.fvg.it)
Purpose: To quantify the effect of complexity of percutaneous transluminal coronary angiography (PTCA) procedures on patient doses during an IAEA coordinated research programme.
Methods and Materials: We collected patient doses in 1000 PTCAs performed
in five countries and analysed the relationships between procedure complexity
determinants and dose factors (fluoroscopy time [FT], number of cine frames
[NCF] and kerma-area product [KAP]). A complexity index (CI) predicting the
increase in FT, NCF and KAP was generated, as well as reference (guidance)
levels (RL) based on procedure complexity and derived as the 3rd quartile of the
dose distribution.
Results: Weighting factors (WF) for the CI, derived from a multivariate analysis,
were: number of vessels treated (WF=1.0), lesion type (0.5), occlusion > 3 months
(0.7), severe tortuosity (0.7) and bifurcation stenting (0.6). The CI derived for
PTCA ranges from 1.0 to 4.2. PTCAs were divided in 3 groups, based on their CI.
The RLs for these 3 groups were: (i) Simple PTCA (FT: 15 min, NCF: 1500, KAP:
100 Gycm2), (ii) Medium complex PTCA (20, 1650, 130) and (iii) Complex PTCA
(32, 2230, 200).
Conclusion: Determinants of procedure complexity can be identified, and their
effect quantitated, for interventional fluoroscopy procedures. Derived RL, expressed as a function of CI, demonstrate that patient dose is related to the procedure complexity.
C-705
Paediatric patient doses with computed radiography
E. Vano, D. Martinez, J.M. Fernandez, C. Prieto, J.I. Ten, R. Sanchez-Jacob,
E. Vano-Galvan; Madrid/ES (eliseov@med.ucm.es)
Purpose: To report paediatric patient doses in projection radiography during the
last 2 years in a large university hospital using computed radiography (CR).
Methods and Materials: Entrance surface air kerma (ESAK) for 12,000 paediatric examinations have been calculated from the dose level (DL) related with the
470
light emitted by the phosphor plate, and archived in the DICOM header of the
images for the used AGFA system, and automatically transferred to a data base
using a dedicated software. Experimental curves obtained for different kV and
patient thicknesses (with and without bucky) allow to correlate DL with ESAK.
Results: Median values of ESAK for chest, abdomen and pelvis (total of 3,596
examinations) for the age groups of: < 1 year, 1-5; 5-10; > 10 years, are reported.
DLs range between 1.6-2.8 for the images with diagnostic image quality. Median
values of calculated ESAK are roughly 50% of the proposed European Diagnostic Reference Levels for paediatrics. Wide distributions in doses are found with
ratios between maximum and minimum values for the different each groups and
kind of examinations, between 10 and 300.
Conclusion: Audit of patient doses in computed radiography is a critical task
especially in paediatric patients. Estimation of ESAK from DL archived in the
DICOM header can be a pragmatic approach to get patient doses and to transfer
these data to the personal patient record. The wide dose distributions in paediatric digital radiology suggest the need of optimisation programmes.
C-706
Thyroid dose and associated cancer risk from head examinations during
childhood: A Monte Carlo study
M. Mazonakis, A. Tzedakis, J. Damilakis, N. Gourtsoyiannis; Iraklion/GR
(mazonak@med.uoc.gr)
Purpose: The thyroid gland of children is extremely sensitive to the carcinogenic
action of ionizing radiation. The aim of this study was to estimate the thyroid dose
and the associated cancer risk in pediatric patients undergoing head X-ray examinations.
Methods and Materials: The Monte Carlo N-particle transport code and mathematical phantoms simulating the average individual of 1, 3, 5, 10 and 15 years
old were employed to estimate the mean thyroid dose resulting from: (a) anteroposterior, posteroanterior and lateral skull radiography and (b) CT examinations
of the brain, orbits and paranasal sinuses performed on a 16-slice scanner. The
Monte Carlo models were validated by measuring thyroid dose using humanoid
phantoms and thermoluminescence dosimetry.
Results: Skull radiography resulted in a thyroid dose of 14-60 microGy depending upon the patient age and skull projection. The scattered dose to thyroid from
multislice CT of the brain, orbits and paranasal sinuses was 1.7-3.5, 0.9-2.2 and
1.9-4.1 mGy, respectively. The mean difference between Monte Carlo results and
experimental measurements was 6.2 %. The excess risk for thyroid cancer induction attributable to skull radiography and head CT scanning was up to 0.5106
and 3110-6, respectively.
Conclusion: Multislice CT head examinations in pediatric patients can result in
an increased risk for thyroid cancer induction. The current study provides the
required data to estimate thyroid dose and the subsequent cancer risk accounting for the effects of patient age and scanned region.
C-707
Development of phantoms for evaluating CT automatic exposure control
(CT-AEC)
Y. Muramatsu 1, N. Keat 2, S. Ikeda3, R. Sekine4, N. Niwa5, M. Terada4,
S. Miyazaki4, K. Ohsawa6; 1Chiba/JP, 2London/UK, 3Kanagawa/JP, 4Tokyo/JP,
5
Kyoto/JP, 6Nara/JP (ysmurama@east.ncc.go.jp)
Purpose: We developed 4 truncated conical CT-AEC test phantoms (circular cone,
elliptical cone with a constant x:y ratio, elliptical cone with a variable x:y ratio to
obtain a constant slice area, and two-stepped cylinder) to evaluate the x-y-z
modulation.
Methods and Materials: Specific phantom requirements were set: the area to
vary continuously along the z-axis, the shape matching the modulation response,
and with a shape and size similar to the body. Phantom size and shape were
based on the water equivalent diameter at each slice position in scanograms of
291 adults. Phantoms were scanned with and without AEC. Image noise was
calculated. Scan parameters were 120 kV, 0.5 s/rot., pitch 0.9375, 1 mm x 16
DAS.
Results: The circular cone is 30 mmf at the foot, and 350 mmf at the other end.
The constant x:y cone has a fixed diameter ratio of 1:1.5, with the cross-sectional
area of each slice equal to that of the circular cone. The foot and all other slices
of the constant slice area cone ranging from 2.5 to 1 are 200 mmf. The stepped
phantom is 2 cylinders 200 and 250 mmf. For the circular and elliptical cones,
image noise in each slice increased exponentially without AEC. But with AEC,
image noise was nearly constant. For the constant slice area cone, image noise
increased quadratically with or without AEC. For the stepped phantom, image
noise varied before and after the diameter changed.

Conclusion: These phantoms are useful for evaluating the performance of various CT-AEC methods.
C-708
Actual maximum skin radiation dose in patients who underwent
intravascular neurointervention: Dosimetry performed without the
knowledge of the operator
J. Tanaka, N. Nishi, M. Yuasa; Iruma-gun/JP (jtanaka@saitama-med.ac.jp)
Monitors
C-711
"Aperture modulation": A new technology for pixel structure for
monochrome LCD monitors
T. Yoneda, N. Hashimoto; Hakusan, Ishikawa/JP (yoneda@nanao.co.jp)
Learning Objectives: To improve understanding of following points concerning:
1. The LCD panel used on established monochrome LCD monitors has limitations in improvement of image quality. 2. We can expect implement of 12-bit simultaneous grayscale display and improvement of modulation transfer function
(MTF) by using the LCD panel which has the new technology "Aperture Modulation".
Background: Monochrome LCD monitors are being more frequently used for
soft-copy diagnosis. The image quality of monochrome LCD monitors for medical
diagnostic imaging has various parameters, but improving most of parameters is
restricted by the structure of LCD panel, for example, numbers of simultaneous
grayscale display and MTF. We have adopted the LCD panel with the structure
called "Aperture Modulation" in order to overcome this limitation and improve the
image quality. We will explain its panel structure and the image quality improvements.
Procedure Details: Regarding monochrome LCD panels, every pixel is consisted of three sub-pixels which have the same aperture ratio. Whereas, each of
three sub-pixels of the LCD panels with "Aperture Modulation" structure has all
different aperture ratio. This difference has two benefits: (1) capability of 12-bit
simultaneous grayscale display and; (2) improvement of MTF. We will present
theoretical proof of (1), and will show the data we have measured to prove (2).
Conclusion: We introduced the new technology "Aperture Modulation". Since
you need to distinguish subtle difference of gray tones and shade of image in
detail for medical diagnostic imaging, this technology will become more and more
significant.
C-709
C-712
Effective dose evaluation in coronary CT

L. Pierotti, M. Di Donna, S. Magi, M. Benati, C. Bergamini; Bologna/IT
(pierotti@aosp.bo.it)
"Digital uniformity equalizer": New technology to compensate luminance

non-uniformity of monochrome LCD monitors
T. Yoneda, N. Hashimoto; Hakusan, Ishikawa/JP (yoneda@nanao.co.jp)
Purpose: The purpose of this work was to evaluate the effective doses of 16MDCT during CT coronary angiography by using direct dosimetry and computer
simulations.
Methods and Materials: Direct dose measurements were performed using an
anthropomorphic physical phantom equipped with 150 LiF TLD dosimeters. Organ doses were measured and the effective dose for male and female patients
were calculated according to guidelines published in ICRP 60. Computer simulations were performed using Monte Carlo (MC) computer technique combined
with free in air values of CTDI: "ImPACT" spreadsheet, WinDose, CT dose.
Results: CTDI measurements in air and in QA phantom agree with the reference
value from data sheet. The effective dose measurement values were 18.4 mSv
for direct dosimetry and 16 mSv for MC techniques. These dose values are in
accordance with the estimation of effective dose from DLP as indicated in the
European guidelines on quality criteria for CT (EUR 16262).
Conclusion: Our work confirms that coronary CT is a high dose CT procedure.
Dose values from TLD dosimetry are 15% higher than those from computer simulated methods. The underestimation by the MC techniques can be attributed to
difference between the Rando Alderson and the mathematical phantoms.
Learning Objectives: To improve understanding of the below points about monochrome LCD monitors, which have been getting more frequently used for softcopy diagnosis:1. Luminance of a monitor's entire display area is uneven. This is
caused by the characteristics of LCD panel. 2. QC standards/guidelines of monitors for medical diagnostic imaging have standard values for this luminance nonuniformity. 3. The new technology "Digital Uniformity Equalizer" enables to
compensate luminance non-uniformity.
Background: The image quality of monochrome LCD monitors for medical diagnostic imaging have various parameters including luminance uniformity of display area. Each QC standard/guideline of monitors such as AAPM TG18,
DIN6868-57 and EUREF has its own measurement method and standard value.
Luminance non-uniformity is caused by the characteristics of LCD panel, and
LCD panel itself cannot improve this with current technology. In order to resolve
this issue, we have developed new technology called the "Digital Uniformity Equalizer".
Procedure Details: We will firstly explain the reasons why luminance non-uniformity occurs, as well as the standard value on each standard/guideline in this
exhibit. Then we will show the data, we have measured with our new technology.
With this data, we will explain how luminance uniformity at the initial installation
improves, and that there is an advantage in holding deterioration over time of
use.
Conclusion: We have introduced this new technology the "Digital Uniformity
Equalizer". This new technology enables monochrome LCD monitors to meet
standard values on various QC standards/guidelines over a long period of time.
471
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Radiology
Physics
Purpose: To measure actual maximum skin radiation dose of patients unbeknown

to the operator by faithfully reproducing procedures during intravascular neurointervention on a phantom.
Methods and Materials: Eighteen patients who underwent intravascular neurointervention between April 2002 and July 2005 were studied. Dose-area products during surgical procedures were recorded in all patients using a transmission
ionization chamber attached to the collimator of the X-ray tube. The surgical procedures were then reproduced on the angiographic equipment using an acrylic
phantom based on the detailed records, and the skin radiation dose at the site
where the strength of the X-ray beam was highest was measured by a standard
dosimeter. Dose-area products of the actual examinations and the reproduced
examinations, respectively measured by a transmission ionization chamber, were
compared and used as an index for the accuracy of the reproducibility.
Results: The maximum skin radiation dose at the site where the radiation dosage was highest was 0.33 to 2.39 Gy (average, 1.19 Gy). The discrepancy of the
measured values, obtained by a transmission ionization chamber, between the
actual examination and the reproduced examination was 6 to 29% (average,
13.9%).
Conclusion: No patients reached a skin radiation dose at which a deterministic
effect could develop. It was suggested that multidirectional fluoroscopy and angiography prevented the concentration of radiation into a small area in spite of the
fact that the gross radiation doses might be higher. Development of deterministic
effects needs to be observed carefully if unidirectional fluoroscopy and angiography are performed sequentially.

C-713
Introduction to tracer kinetic modelling with dynamic contrast-enhanced
MR imaging (DCE MRI) for angiogenesis imaging: Basis and derivation of
modelling equations
C.H. Thng, K.C. Tan, T.S. Koh; Singapore/SG (tankokchye@yahoo.com)
Learning Objectives: To explain the basis of tracer kinetic modelling and to explain the derivation of modelling equation in simple terms understandable to the
general radiologist.
Background: Tracer kinetic modelling with dynamic contrast-enhanced MR imaging (DCE MRI) has recently become popular as a method of evaluating the
effects of anti-angiogenic chemotherapeutic agents. The scan acquisition is technically easy and can potentially be done in any center with a power injector. However, the modelling expertise is still limited to certain academic centers and
commercial companies. Participation of the radiologist requires understanding of
the basis of the models to avoid being a blind follower.
Procedure Details: Of the 3 commonly used two-compartment models, the Brix
model is explained and derived. Intracapillary tracer concentration is modelled
according to known equations of fluid mechanics. The tracer then exchanges
with the interstitium based on the law of diffusion. Assumptions are made to simplify the unknown variables. The solution of the differential equation by de-convolution is explained qualitatively to facilitate understanding by the general radiologist.
The dual flip angle method of T1 calculation is explained. The need for power
injector, fixed injection protocol, high temporal resolution, arterial input function,
T1 calculation and avoidance of phase artifacts is explained and emphasized
such that the radiologist can play a useful role.
Conclusion: DCE MRI has the potential to become an important modality for the
assessment of anti-angiogenic effects. Understanding the basis of DCE MRI would
enable the radiologist to assume a more active role.
C-714
Fast imaging techniques in magnetic resonance: Principles and clinical
applications
Learning Objectives: To describe the basic concepts and current advances in
fast magnetic resonance (MR) imaging. To discuss advantages, disadvantages,
tradeoffs and clinical applications of fast imaging techniques.
Background: Fast MR imaging techniques are evolving thanks to recent advances
in software, gradient technology, coil design and magnet strength. They are useful to reduce examination times, resulting in improved tolerance by patients and
more efficient utilization of MR equipment. In addition, they decrease motion related artefacts providing excellent image quality, namely in cardiovascular and
body imaging.
Procedure Details: The authors present a review of the most widely available
strategies of fast MR imaging, that include partial filling of K-space, segmentation, interleaved image acquisition, low angle gradient-echo imaging, single pulse
imaging, spiral imaging, fast spin-echo imaging, parallel imaging, among others.
Advantages, disadvantages, tradeoffs and clinical applications of the different
methods are discussed and illustrated.
Conclusion: Fast imaging techniques have expanded the role of MR imaging in
many clinical settings. High quality images can be obtained rapidly, allowing excellent morphological detail and functional real-time evaluation. Understanding
the physical principles of each method provides insight into a better employment
of the available hardware and software of the MR equipment.
C-715
7T) brain MRI
Contrast relations in ultrahigh field (
P. Schmalbrock1, J.T. Heverhagen 1, D.W. Chakeres1, M.R. Thompson2,
M.V. Knopp1; 1Columbus, OH/US, 2Cleveland, OH/US
(schmalbrock.1@osu.edu)
Learning Objectives: To elucidate altered image appearance at ultrahigh field
MR imaging, contrast was computed and compared with image examples. Optimization allows to make best use of ultrahigh field MR imaging.
Background: Routine diagnosis is based on familiarity with T1, T2, and proton
density MR imaging contrast patterns for normal and pathologic conditions. Because of longer T1, shorter T2, and RF inhomogeneity, contrast patterns shift
substantially at ultrahigh field.
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Procedure Details: Contrast was computed from measured T1, T2 and T2* for
gradient echo (GE), spin echo (SE), and inversion recovery (IR) sequences and
various TR, TE, TI and flip angles, and compared to brain images. For 2D-GE
with TR 500-800 ms and short TE < 3 ms, weak proton density (PD) contrast
results for flip angles near 20 o, and marginal T1 contrast at 70-90o. For longer TE
> 8 ms, conventional T1-weighting is no longer achieved. Low signal for veins
due to deoxyhemoglobin is the hallmark of these images. For short TR 3D-GE,
overall signal is decreased due to long T1. Spin echo images with short TE, do
not exhibit conventional T1 contrast; i.e. WM and GM are near isointense and
CSF is bright. Moderately long TR > 2000 ms and TE > 50 ms produce T2 weighted
images, however, overall signal for brain is low compared to CSF and GM/WM
contrast is variable in different regions. True T1-weighting is achieved only with IR
sequences.
Conclusion: Ultrahigh field contrast is overall lower and patterns are significantly altered compared to conventional MR imaging. Acquisition parameters thus
have to be carefully optimized.
C-716
Regional fat fraction analysis using multislice fourfold gradient-echo MRI
S. Matsunaga1, T. Miyati1, N. Arai1, Y. Motono1, M. Suzuki1, H. Kasai2, M. Hara2,
Y. Shibamoto2, T. Matsuda3; 1Kanazawa/JP, 2Nagoya/JP, 3Tokyo/JP
(matusayoko@hotmail.com)
Purpose: We devised a method for analyzing regional fat content using a multislice fourfold gradient-echo (4GRE) sequence.
Methods and Materials: The regional fat fraction was calculated with theoretically fitted signal intensity curve for 4GRE images at each echo time (2.3, 4.6,
6.9, 9.2 ms) on a 1.5 T MR imaging to correct T2* decay and phase cycling. Then
the complex images of the first echo were also used to differentiate between
below and above 50 percent fat content. To eliminate the T1 effect, the flip angle
was set at 12 degrees. In the phantom studies, fat fractions with 4GRE were
compared with those using conventional double GRE, and other MR imaging
techniques. Moreover, fat fractions of liver and spinal bone marrow in healthy
volunteers were determined during a breath-hold.
Results: The 4GRE-derived fat fraction of the phantom agreed best with the actual fat content. On the other hand, in both phantom and healthy volunteers, the
double GRE was underestimated at low fat content, and overestimated at high fat
content due to T2* decay.
Conclusion: The 4GRE method makes it possible to analyze of the regional fat
fraction non-invasively, simply and accurately.
C-717
T1-selective imaging for best visualization of pathological changes of brain
N.V. Anisimov, L.V. Gubskiy, Y.A. Pirogov, P.V. Babich; Moscow/RU
(gubskii@mail.ru)
Purpose: The purpose of research is to obtain the MR-images "cleared" of normal tissues. It is useful for the best visualization and 3D-reconstruction of the
pathological formations having T1, distinct from what have normal tissues.
Methods and Materials: For simultaneous suppression of signals from two normal tissues, we used double inversion-recovery (DIR) pulse sequence (1800-TIW1800-TIF-900-acquisition). If it was required to suppress one more normal tissue it
was spent additional scan for the same FOV, but with other parameters TIF,W. After
that two images were multiplied to obtain the new image emulating simultaneous
suppression up to 4 components. For suppression of signals from fat, free water
and mucous values TIF=80 ms, TIW=1300 ms and TIW=550 ms were set. If the
investigated tissue had T1 distinct from TIF,W/ln2 its MR-signal remained enough
greater. The method was realized on MR-scanner Tomikon-S50 (Bruker).
Results: By means of pulse sequences DIR and the subsequent multiplication of
images we obtained the images emulating simultaneous suppression of signals
from many tissues. Owing to suppression of strong background signals the receiver well adapted for receive of signals from tissues with some selected values
T1. Simplification of contrast improves visualization of pathological formationstumors, hemorrhages, etc. Graphic 3D-processing- MIP-reconstruction and volume rendering also becomes simpler. We use 3D-processing for evolution monitoring of pathological changes.
Conclusion: Offered version of T1-selective imaging is based on T1-selective
suppression of many tissues unwanted for visualization. It leads to simplification
of contrast at MR image and to the best visualization of researched pathological
tissue.

C-718
High b-value diffusion weighted MR imaging findings: Normal anatomy and
disease
Y. Murakami1, A. Furukawa2, K. Imoto1, M. Yamasaki2, T. Sakamoto1,
K. Murata2; 1Kohka/JP, 2Otsu/JP (yokomurakamikoka@yahoo.co.jp)
raised with the jelly phantom of low density by vibration. This resulted from the
jelly phantom trembling with vibration.
Conclusion: The ADCs in the trembled region such as mammo DWI maybe have
errors. A countermeasure is to support region adequately.
Learning Objectives: To describe high b-value diffusion weighted MR imaging

(DWI) findings of visceral disease. To show normal diffusion-weighted MR imaging and to determine the role, the clinical usefulness, and pitfalls of DWI combined with MR imaging for the detection of visceral disease and compared the
findings on DWI.
Background: Recent advances in MR gradient technology allow acquisition of
diffusion weighted MR images with high b factor even in the body.
Imaging Findings: 450 patients with visceral disease outside of central neural
system detected or suspected by computed tomography or clinical condition were
referred to our hospital for the examination with MR imaging between February
2003 and March 2005. It is useful for finding liver metastasis and bone metastasis, lymph node metastasis with malignant tumor showing high signal. DWI was
highly sensitive in detecting most malignant tumors, for example urethral cancer,
cervical cancer and breast cancer. Abscesses and active inflammatory lesions
demonstrated high signal on DWI. Anal fistula could also be demonstrated by
virtue of their high signal. It is useful that a normal spermary shows a high signal
to find a stoppage spermary.
Conclusion: DWI is quite less invasive and easy to perform and should be applied in addition to conventional MR imaging when lesion detection is the main
purpose of the study. Distinction between malignant tumors and inflammatory
lesions by DWI alone was not always possible.
C-719
Comparison of body diffusion weighted imaging using diffusion weighted
whole body imaging with background body signal suppression and 18FDGPET in malignant tumors
R. Ochiai, T. Yoshida, H. Kobayashi, M. Kitagawa, K. Ono; Kurume/JP
Purpose: To compare a new way of body diffusion weighted imaging (DWI) using
the short TI inversion recovery-echo planar imaging sequence and free breathing
scanning (DWIBS: Diffusion weighted whole body imaging with background body
signal suppression) with 18FDG-PET for the detection of malignant tumors.
Methods and Materials: Fifty patients with malignant tumors underwent both
MR and 18FDG-PET at our institution from September 2004 to July 2005. We
evaluated the detection rate of 52 primary cancers (18 breast, 18 lung, 9 colon, 2
thyroid, 2 gastric, 1 pancreatic, 1 ovarian, 1 endometrial) le and accurate regional lymph node metastases in operative cases. MR examinations with body DWI
using DWIBS were performed with a 1.5-Tesla system. The FDG-PET scans were
performed in conjunction with a conventional examination including an inquiry
medical check and CT. The average injection dose of FDG was 180 MBq (3.7 MBq/
kg weight). Whole body PET scans were started at one-hour post injection to
collect the transmission and emission data with a PET camera.
Results: The detection rate of primary lesions on MR imaging examinations with
body DWI using DWIBS and 18FDG-PET were 47/52 and 43/52, respectively.
Accuracy rates of regional lymph node metastases were 37/52 and 35/52, respectively.
Conclusion: Within our limited number of cases, a close correlation was observed between the body DWI using DWIBS and 18FDG-PET.
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Radiology
Physics
C-720
Effect of vibration due to time-varying magnetic fields for diffusion
weighted body MRI
A. Ogura, F. Maeda, A. Miyai, T. Hongoh; Kyoto/JP
(a-ogura@mbox.kyoto-inet.or.jp)
Purpose: High b-factor diffusion weighted MR imaging of the body increasingly
being used to detect and diagnosis the cancer. Echo planar imaging sequence
and high motion probing pulse at diffusion weighted images results in high table
vibration. This study will assess if vibration due to time-varying magnetic fields
influence the diffusion signal and the apparent diffusion coefficient (ADC) values.
Methods and Materials: Two different DW images were compared. In the first
phantoms were fixed on MR imaging unit's table- transmitted vibration. In the
second phantoms were supported in air- not transmitted vibration. Two phantoms
were employed "solution phantom" was made from the agarose of differing densities; "jelly phantoms" were made from agarose which was heated. The diffusion
signal and ADC value of each image were compared.
Results: The signal of DWI was not affected by vibration. However, ADC was
473

Ultrasound
Miscellaneous
C-721
C-722
Development of phantoms for fine resolution testing in ultrasonography

H. Natori1, M. Inaba1, K. Takahashi1, M. Mitani 1, K. Narai2, J. Kato2;
1
Sapporo/JP, 2Kyoto/JP
The population radiation exposure from diagnostic X-rays procedures in

Luxembourg
F. Shannoun, C. Back; Luxembourg/LU (shannoun@santel.lu)
Purpose: Calibration and adjustment of the ultrasonograph is necessary in daily

practice. In those procedures, ultrasonographic phantom is required to test overall function of the diagnostic ultrasound system. According to recent advances in
ultrasonograph, development of fine resolution phantom is necessary to test higher
resolution power for those equipments. Targets of ordinary phantom usually have
1 mm lateral resolution by string targets, and 2 mm in diameter for cyst targets
because of technical limitation. Authors tried to develop more fine phantoms for
the ultrasonograph.
Methods and Materials: Three types of custom made phantoms, as multi-purpose phantom, string targets phantom, and cysts phantom are developed with
synthetic materials. Ultrasonograph type SDU-2200, Shimadzu, with 2-5.5 MHz
convex probe and 5-10 MHz linear probe were used for the basic test in the developmental phase of this study. In the assessment phase, 5 different ultrasonographs were tested by developed phantoms.
Results: Stable propagation speeds in various temperatures were obtained. Echo
positive string target images in fine granular background echoes were obtained
by multi-purpose phantom. Various sizes of echo negative cyst patterns in granular background were obtained in the images of the phantom. In this study, 0.5 mm
lateral resolution targets, and 1 mm cyst target were successfully made. Precision of the phantom was practically acceptable for calibration of accuracy of registration of the ultrasonograph for clinical practice.
Conclusion: Newly developed phantoms were suitable for fine resolution tests
of recent high-end ultrasonograph and also daily calibration and adjustment for
clinical diagnostic ultrasound system.
Purpose: A nation-wide evaluation on radiation doses from diagnostic procedures was conducted in Luxembourg for the period 1994-2002 aiming an estimation of the annual collective dose and the practical implementation of the European
Directive 97/43, which obliges the Member States to determinate the population
dose from medical exposure.
Methods and Materials: The study consisted of the health insurance data acquired for more than 425000 radiology patients. Concerning the dosimetric aspects, information regarding the effective dose per examination was taken in
account. The results were compared with recent studies from Germany, Switzerland, Belgium and Austria.
Results: The annual effective collective dose per caput has increased from
1.59 mSv in 1994 to 1.98 mSv in 2002. The impact of computed tomography (CT)
has risen from 0.48 mSv to 0.99 mSv for the same period. CT contributed 50% to
the collective dose in 2002. Luxembourg has today with 135/1000 habitants, the
highest CT examinations rate compared to other European countries with similar
health care systems like Belgium with (118), Austria (101), Germany (91) and
Switzerland (46).
Conclusion: Radiation diagnostic procedures are an accepted and essential part
of modern medicine; it appears that both the total number of CT examinations
and the collective dose from CT has drastically increased since 1994 in Luxembourg. An effort should be made to reduce the patient dose from CT through the
optimisation of the technical parameters and the involvement of medical physicists in routine patient dosimetry.
C-723
The best sensitivity of a flat-panel detector for chest radiography in a dualenergy subtracted system: Measurement of radiation dose and visual
evaluation by the normalized-rank approach
N. Bandai1, H. Tagashira1, K. Arakawa1, T. Mochizuki1, K. Murase 2; 1Toon/JP,
2
Osaka/JP (bandainatsuko@mail.goo.ne.jp)
Purpose: The new dual-energy subtraction system allows the fast acquisition of
two, high and low voltage images using CsI:Tl amorphous silicon flat-panel technology. However, radiation dose in this system tends to increase more than one
shot or screen-film method. The purpose of study was to demonstrate the optimal
sensitivity of a flat-panel detector (FPD) for dual-energy chest radiography to
reduce further radiation dose and maintain quality of diagnostic imaging.
Methods and Materials: The combination of high and low voltage for dual-energy chest images was 140 kV and 60 kV. The sensitivity of an acceptance surface
of the FPD we used was 100, 125, 160, 200, 250, 320 and 400. The surface dose
of the FPD with each sensitivity and conventional computed radiography (CR) for
a chest phantom were measured by a fluoroglass dosimeter. These images were
evaluated with the normalized-rank approach by six radiologists. All rank orders
were transformed to distance scale by statistical methods.
Results: The surface dose with a FPD had 1.94, 1.58, 1.30, 1.05, 0.88 and 0.74
times, respectively, compared to CR in the order of increasing sensitivity of the
acceptance surface. There were no significant differences between FPD images
with the sensitivity below 160 and a CR image (p > 0.05).
Conclusion: On the basis of the radiation dose and visual evaluation, we consider that the appropriate sensitivity of the acceptance surface of the FPD for dualenergy chest radiography is 160 or 200.
C-724
Internet-based multilingual dictionary in medical physics
M. Stoeva1, S. Tabakov2, A. Cvetkov1; 1Plovdiv/BG, 2London/UK
(ms_stoeva@yahoo.com)
Learning Objectives: The globalization of medical science and particularly medical radiation physics and the increasing demand for improving the communication between professionals throughout the world are the main objectives for the
development of an internet-based multilingual medical physics dictionary. The
main objective of this paper is to present the second stage of the development of
the internet-based multilingual medical physics dictionary as a part of the EU
Leonardo Da Vinci EMIT project.
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Background: During its first stage of development the multilingual medical physics dictionary was awarded the first ever Leonardo Da Vinci award which EU
launches to acknowledge achievements in education and training. The strong
interest to the dictionary resulted in increasing the number of languages and
transferring the application to an universal on-line based engine.
Procedure Details: The internet-base dictionary is a server based application
incorporating the functionality of MS SQL database and .NET platform. It incorporates western and central European and Asian languages and covers the main
topics of diagnostic radiology, nuclear medicine, radiotherapy, MR imaging and
ultrasound imaging. The collection of terms is translated by selected specialists
and updated by the whole EMIT and EMERALD consortia.
Conclusion: This interdisciplinary on-line application is a result of the common
efforts of an international team of experts and it is widely used in more than 50
countries around the world.
C-725
The application of information theory to contrast-detail analysis
T. Niimi1, K. Imai1, M. Ikeda1, H. Maeda1, A. Mano1, Y. Enchi2; 1Nagoya/JP,
2
Osaka/JP (nim@nagoya2.jrc.or.jp)
Purpose: Contrast-detail (C-D) analysis has been employed for assessments of
image qualities in medical images, and has been accepted as a useful method
for maintenance of the image qualities of radiologic modalities. However, it is
difficult for this analysis to assess exactly to what extent image information is lost
by the degradation of the image qualities. The purpose of this study is to adopt
information theory to quantify information losses in C-D diagrams.
Methods and Materials: A commercially available CDMAM phantom was employed as a test object, which consisted of discs of 16 rows and 16 columns with
different diameters and thickness. To provide degradation of image qualities of
the phantom images, they were acquired with a computed radiography system
by changing entrance radiation doses. Three radiologists and twelve radiographers agreed to participate in the image reading examination. The thinnest visible disc thickness was defined as contrast detectability, and was recorded for
each disc diameter. An information loss for each disc diameter was devised from
the entropy Spilog (1/pi) with detection probability of observers pi.
Results: In C-D diagrams, the contrast detectability for each disc diameter decreased with the reduction in radiation doses. In contrast, information losses decreased with the increase in disc diameters and with the increase in radiation
dose.
Conclusion: Our devised evaluation method would make it possible to assess
the degradation of image qualities as information losses, and the information
loss would make a good approach to controlling image quality through visual
inspection.
C-726
Synchrotron X-ray mammography: Clinical experimentation.
Characterization of a mammographic screen-film system
D. Dreossi, F. Arfelli, P. Bregant, R. Longo, R. Perabo', E. Quai, T. Rokvic,
G. Tromba, E. Castelli; Trieste/IT (Diego.Dreossi@ts.infn.it)
A new contrast-detail test object using tungsten thin films for digital
mammography: Preliminary results
J. Bermudez1, V. Palmieri1, P. Favaron1, G. Gennaro2, C. di Maggio2;
1
Legnaro/IT, 2Padua/IT (judilka@hotmail.com)
Purpose: To study uniformity and reproducibility constraints as a first step in the
manufacturing of a contrast-detail test object tungsten-based using physical vapor deposition techniques (PVD), for employment in digital mammography.
Methods and Materials: A 6x6 matrix of disks with nominal diameters from 5 mm
down to 0.1 mm was obtained by tungsten deposition over quartz substrate
5x5 cm2. A first uniform layer for all diameters was released to evaluate thickness
deposition uniformity. Moreover, three thickness values in the range 1-4um were
deposited for larger diameter to study metal thickness control. The thickness range
was computed to cover the whole range of nominal contrast values for the final
test object. Reproducibility errors among three test objects were also estimated.
Thickness measurements were performed by a surface profiler with nanometer
sensitivity. Contrast measurements were carried out from X-ray images acquired
by a full-field digital mammography system, to correlate thickness to contrast
variability.
Results: Despite thickness variability of the three thickness values for each test
object of around 10%, resulting contrast variability was lower than 3%. Contrast
reproducibility error among three different depositions of the same thickness was
within 5%.
Conclusion: Tungsten thin film deposition by PVD technique proposed for contrast-detail test object manufacturing seems to be adequate for the contrast range
required by digital mammography. Control over metal deposition is sufficient to
provide good uniformity for each thickness value as well as object reproducibility.
Due to its slightly lower X-ray absorption, tungsten shows some advantages over
other more common materials.
C-728
An experimental comparison of flat-panel detector performance for direct
and indirect systems
T. Gomi, J. Miyagawa, H. Hirano; Matsumoto/JP (gomi@on.rim.or.jp)
Purpose: The purpose of work was to compare direct and indirect detectors in
terms of their system linearity, presampled modulation transfer function (MTF),
Wiener spectrum (WS), noise equivalent quanta (NEQ), and power spectrum.
Methods and Materials: Measurements were made on two flat-panel detectors,
GE Revolution XR/d (indirect), and Shimadzu Safire (direct) radiographic techniques. The system linearity of each systems was measured using a time-scale
method. The MTF of the systems were measured using an edge method. The WS
calculated the different image that changed exposure dose using two-dimensional Fourier analysis. The NEQ were assessed from the measured MTF, WS, and
estimated ideal signal-to-noise ratios. The power spectrum of the systems was
determined for clinical images (head origin).
Results: System linearity was excellent for the direct systems (direct; R2=0.9995,
indirect; R2=0.9968). For the direct systems, the MTF was found to be significantly higher than that for the indirect systems (2% MTF value [cycles/mm], direct; 5.6, indirect; 2.6) and very close to an ideal function associated with the
detector pixel size. For the direct systems, the WS was relatively uniform across
all frequencies. In comparison, the indirect systems exhibited a drop in the WS at
high frequencies. At lower frequencies (~0.5 cycles/mm), the NEQ and power
spectrum for the indirect systems was noticeably higher than the direct systems.
For the direct systems, the NEQ and power spectrum at mid to high spatial frequencies were higher linearity.
Conclusion: In general, the direct systems exhibit improved image quality over
indirect systems at comparable exposure dose.
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Radiology
Physics
Purpose: For the starting phase of the "Synchrotron X-ray mammography: Clinical experimentation" project, carried out at the SYRMEP (SYnchrotron Radiation for MEdical Physics) beam line of Elettra (Trieste, Italy), a commercial
screen-film system is foreseen as image receptor. The overall characteristics of
this screen-film system play an important role in selecting exposure parameters
for the mammographic examination. In particular we studied the dependence of
screen-film system response with X-ray energy and reciprocity law failure.
Methods and Materials: The synchrotron radiation machine provides a stationary laminar beam; therefore the radiographic image is obtained scanning the
object in front of the beam together with the image receptor. In this experiment a
monochromator allows the selection of energy in the range 16-22 keV, with a
resolution of less than 2%. A mammographic screen film system, produced by
Kodak, is used. Different characteristic curves are obtained as a function of the
energy. For a fixed energy the reciprocity law failure, versus the exposition time,
has been also investigated.
Results: The response of the screen film system depends on beam energy. For a
given energy, the inflection point of the characteristic curve changes: this change
can be described in analytic form as a function of the exposure time.
Conclusion: Thanks to the results of this study, it is possible to take properly into
account the monochromatic energy beam and the exposure time during a mammographic examination, in order to obtain the requested optical density.
C-727

Radiographers
C-731
Physics
Performance evaluation of CT automatic exposure control using new

phantoms scanning technique for balancing dose reduction and image
quality
K. Oosawa1, Y. Muramatsu 2, N. Keat 3, S. Ikeda4, R. Sekine5, N. Niwa6,
M. Terada5, S. Miyazaki5; 1Nara/JP, 2Chiba/JP, 3London/UK, 4Kanagawa/JP,
5
Tokyo/JP, 6Kyoto/JP (alfa-k155@t-kadomatsu.net)
C-729
MR-cholangiopancreatography: Techniques and clinical applications
A. Buzzi, M. Hjelt, P. Buzzi, V. Alarcon, P. Nazr, S. Merola, C. Gotta;
Buenos Aires/AR (aebuzzi@fibertel.com.ar)
Learning Objectives: To describe the technical characteristics of 2D and 3D
MR-cholangiopancreatography (MRCP). To illustrate the broad spectrum of entities that can be diagnosed and studied with MRCP. To describe MRCP indications.
Background: In the past, improvements in T2 weighted-imaging and fat-suppression techniques have made possible the visualization of the biliary and pancreatic ducts with MRCP. MRCP has shown a high accuracy in the diagnosis of
biliary diseases, depicting normal and dilated ducts, showing distal biliary obstruction (both benign and malignant), and choledocholithiasis, and pancreatic
diseases (anatomic variants, acute and chronic pancreatitis and pancreatic carcinoma). MRCP has provided a non-invasive tool to obtain images comparable to
those obtained with other invasive techniques.
Procedure Details: MRCP uses the inherent tissue contrast between fluid filled
structures and the surrounding solid organs to generate images of the fluid containing structures (gallbladder, bile ducts, and pancreatic ducts). No exogenous
contrast is necessary, and the technique is completely non-invasive. MRCP can
be achieve both with 2D and 3D techniques. We describe and illustrate the pros
and cons of each of them. The combination with parenchymal imaging made
MRCP and excellent technique for abdominal imaging.
Conclusion: MRCP has become a competitive replacement for invasive imaging
techniques (such as ERCP) in many clinical settings thanks to its lower cost,
absence of ionizing radiation, high accuracy, and safety.
Invasive techniques should be reserved for patients for whom a therapeutic procedure is necessary.
C-732
C-730
Dose reduction in CT examinations by an attenuation based online
modulation of tube current and its association with body anthropometry in
a large population based study: The age, gene/environment susceptibility
Reykjavik study
S. Sigurdsson1, T. Aspelund1, T.B. Harris2, G. Einarsson3, G.S. Karlsdottir1,
A. Gudmundsdottir1, G.F. Johannsdottir1, G. Eiriksdottir1, V. Gudnason1;
1
Kopavogur/IS, 2Bethesda, MD/US, 3Reykjavik/IS (sigurdur@hjarta.is)
Purpose: This study was designed to quantify the total radiation dose reduction
by the use of automatic tube current modulation (ATCM) in multi detector computed tomography (MDCT) examinations of multiple anatomical areas as a function of gender, age, and measurements for body anthropometry.
Methods and Materials: Thirteen hundred and sixty subjects (603 males and
757 females) aged 68 to 96 years (mean 77) underwent a MDCT examination of
the thorax, lumbar spine, abdomen, hips and thigh in a large population-based
study. All were scanned with identical acquisition parameter presets. ATCM was
applied on all hip and lumbar spine scans. The total modulated milliampere-seconds (mAs) for each study as displayed on the MDCT scanner was recorded. The
percent difference between total mAs presets and total modulated mAs was calculated and compared by gender, age, height, body mass index (BMI) and abdominal waist circumference.
Results: The mean mAs reduction for males and females was significantly different (p < 0.0001), 18.7 3.7% and 20.2 3.8% respectively. For males and females there was a weak but significant relationship between mAs reduction and
height (r = 0.22, p < 0.0001) and (r = 0.19, p < 0.0001) respectively and BMI (r=0.09, p = 0.027) and (r = 0.22, p < 0.0001) respectively. For females there was
also a weak but significant relationship with age (r=-0.13, p = 0.0005) and abdominal waist circumference (r = 0.28, p < 0.0001) but not for males.
Conclusion: The radiation reduction with ATCM associates subject anthropometry differently for males and females indicating different body attenuation characteristics. Patient height show stronger correlation to radiation reduction than BMI
and may therefore be of better use when selecting optimal mAs presets.
476
Purpose: CT auto exposure control (CT-AEC) functions are effective, but their
characteristics have not been fully evaluated. Newly developed phantoms (#06E-1134-ECR) were scanned to evaluate the CT-AEC functions of various CT systems.
Methods: Using CT-AEC, various phantoms were scanned using standard scan
conditions for the chest and abdomen to calculate the image noise (SD, based on
the IEC standard). The phantoms used were cone, elliptical, variable XY, and
stepped phantoms (Kyoto Kagaku, Tokyo, Japan). The CT systems used were
Aquilion 16: Real-EC with SD (Toshiba, Nasu, Japan), Sensation Cardiac16: CARE
Dose 4D (Siemens, Germany), etc.
Results: When Real-EC (with an image quality setting function) was used, the
specified SD values were obtained irrespective of changes in diameter for the
cone phantom, while the SD value increased as the vertical/horizontal ratio increased for the elliptical phantom. This indicates that image quality must be adjusted to the optimal level or image processing (RASP) must be performed taking
the target region or patient size into consideration. On the other hand, with CARE
Dose 4D, the SD varied when the phantom diameter changed, but the change in
SD was small when the vertical/horizontal ratio of the elliptical phantom changed.
In addition, the SD curves obtained differed depending on the scan direction of
the stepped phantom.
Conclusion: Image characteristics differ markedly depending on the CT-AEC
function of the CT system. Therefore, both a lower dose and better image quality
can be achieved by selecting the optimal scan parameters according to the CTAEC characteristics.
A short study on exclusion of the lens of the eye in CT scan of the brain in a
UK university hospital
S. Kolpattil, S.B. Rai, K. Sherlala, T. Dew; Macclesfield,CHESHIRE/UK
(ajshyamkumar@hotmail.co.uk)
Purpose: To emphasise the importance of lens exclusion while doing CT scan of
the brain. To compare institutional practice of lens exclusion with the national
guidelines in the United Kingdom.
Methods and Materials: 100 cases of brain CT scans were studied prospectively at University hospital Coventry &Warwickshire NHS trust during the period 25/
01/04 to 04/02/04. Indication for CT examination was also noted. The scans were
performed on two scanners (Scanner A which had a maximum gantry tilt of 30
degrees and scanner B which had a maximum tilt of 22 degrees).
Results: Although the National and local guidelines insist on 100% lens exclusion, our study showed only 76% exclusion. In our series Scanner A which has a
maximum gantry tilt of 30 degrees showed only one case of lens inclusion out of
the nine cases whereas, scanner B with a tilt of twenty two degrees showed
twenty three cases out of ninety one.
Conclusion: The authors feel that all radiologists and radiographers all over the
world should be emphasised the need to achieve 100% lens exclusion. CT scanners with the maximum gantry tilt may be of benefit in achieving this aim. Recommendations have been put in place in our institution to achieve 100% lens exclusion
while doing CT of the brain.
C-733
The contribution of spiral CT and 3D reconstruction in the assessment of
craniofacial deformities
A.A. Manolitsas, C. Papagiannakis, C. Papastergiou, I. Tsitouridis;
Thessaloniki/GR (iapetus@otenet.gr)
Purpose: To demonstrate the contribution of 2D-3D reconstruction in assessment of craniofacial deformities.
Methods and Materials: We studied 33 cases (15 cases with complex scull fractures, 9 cases with craniosynostosis, 6 cases with lagostoma and 3 cases with
congenital dysplasia of scull bones. The examinations were performed using a
Picker PQ5000 Spiral CT scanner and a Picker Voxel Q visualization workstation.
The original CT scans were reconstructed in MPR, SSD and VR models.
Results: We describe the advantage and disadvantage of each method. MPRs
proved valuable in studying the pathology in several perspectives, giving images

of same diagnostic value with the original CT scans. SSD were helpful in the
evaluation of complex fractures in determine of the position and extension of the
fractures. On the other hand SSD was unable to define intra-articular fragments
and soft tissue trauma. VR proved valuable in demonstrating the complications of
bony fractures such as soft tissue trauma. Segmentation techniques helped in
the separation of the bones. In this way we would study the articular surfaces in
cases with intra-articular pathology.
Conclusion: It should be noted that the quality of 2D-3D reconstruction depends
on the quality of the original CT scans and should be regarded as a complement
of them. We consider that they offer an overall evaluation of the area that we
examined and they assist in presurgical planning. However all techniques were
useful in the quantification of information with regard to the morphology, the architecture, and the functionality of each examined region.
C-734
Procedures to optimise the imaging practice of the chest X-ray
examinations to newborns treated in PICU
A. Kettunen, A. Servomaa, H. Tanner, A. Honkanen; Oulu/FI
(antti@servomaa.net)
Learning Objectives: To understand the importance of optimisation of radiation
doses to children. To find methods for optimisation.
Background: Many studies have shown wide variations in imaging techniques,
radiation doses and practices in chest X-ray examinations of newborn. Special
radiation protection requirements are needed in childhood (MedDir/97/43/
Euratom). This paper describes the procedures purposed to create a good practice for chest X-ray examinations produced in pediatric intensive care unit (PICU).
Imaging Findings: Radiation doses of newborns' chest examinations in PICU
were measured by DAP. ESD and effective doses were estimated separately for
each newborn. The variation in field size and doses with in the same size group
of newborns was noticeable. To unify the practice a guide book for chest examination in PICU was made. Demonstration of the dose indicator of the current
imaging plate system was produced and a flow chart of the imaging practice in
PICU was made.
Conclusion: Radiographer students planned as their Bachelor thesis a guide
book including pictures of positioning of the newborn for chest and chest and
abdomen, imaging technique and advice for hygiene in PICU. The staff were
trained to the use of current imaging plate system. A flow chart including the
whole imaging procedure in PICU form the referral to the PACS was applied by
students. Follow-up research of the changes in practice will go on regularly.
C-735
Higher Education Network for Radiographers in Europe (HENRE):
investigating current programmes for radiographer education, learning and
teaching methods and CPD opportunities in Europe
M. Dow, V. Challen; Lancaster/UK (val@henre.co.uk)
Reflective radiochromic dosimetry films for evaluation of exposure on CT

and IVR by directional dependences
S. Takewa, T. Katsuda, R. Gotanda, M. Eguchi, A. Tabuchi, A. Matsushita;
Okayama/JP (saori19830706@yahoo.co.jp)
Purpose: Reflective radiochromic dosimetry film (RRDF) is constructed by a trilaminar process, with the front and back layers of this film being constructed of
different materials. Using computed tomography (CT), multidirectional incidence
X-rays were obtained on RRDF. During interventional radiology (IVR), the incidence of X-rays from one side was obtained. RRDF also has self-absorption and
generates scattered radiation. This study investigated the benefits and demerits
of using RRDF for CT and IVR based on directional dependence.
Methods and Materials: RRDF was given a total exposure dose of 13cGy with
at 10-degree angle intervals. The scattered radiations were measured when the
X-ray incidence was from the front to back layer or vice versa. These RRDFs
were scanned using a flat bed scanner and data were analyzed on by image
analysis software.
Results: Directional dependence of RRDF was small on each side. When the
film density at right angle was considered 100%, the maximal change rates of the
front and back layers were 12.7% and 18.5% including nonuniformity of RRDF
(5%), respectively. Exposure doses showed that incident X-rays from the front
were larger than those from the back (18.1%). Whereas the scattered X-ray from
the back layer was larger than that of front layer (11.9%).
Conclusion: On CT and IVR, front layer should be in contact with the patient
surface to measure surface dose and reduce scattered X-rays. Additionally, the
incidence of X-rays for generating dose-pixel value calibration should be from the
back to front layer.
C-737
Radiographer "stand-alone" reporting of double contrast barium enemas:
An audit of accuracy rates
N. Crundwell, S. Ryan; London/UK (neilcrundwell@hotmail.com)
Purpose: Radiographer performance of double contrast barium enemas (DCBE)
is well established, radiographer stand-alone reporting a more recent development. At Maidstone Hospital, five radiographers perform and report barium enemas. The department wished to audit reporting accuracy of "stand-alone"
radiographer reporting.
Methods and Materials: At Maidstone the performing radiographer and a second senior radiographer create separate reports, and if concordant a final report
is issued. A consultant radiologist arbitrates if discordant. A 'Gold Standard' report was created by two radiologists (from King's) separately re-reporting 100
studies, and then conferring. The radiographer report was compared to this report. Discord was record as major: - non or over reporting of a significant lesion
(e.g. polyp or stenosis) or minor: - suspicious lesions that were inadequately
demonstrated, or inadequate demonstration of the bowel not referenced in the
report.
Results: The overall discordance rate was 15%. This comprised a 5% major and
a 10% minor discordance rate. 4 major discords were false negatives. 80% of the
minor discords were due to sub-optimal visualisation mostly of the right colon, an
acknowledged difficulty of DCBE.
Conclusion: The major discordance rate is in line with published data and the
reporting accuracy is acceptable. Whilst 'virtual colonography' makes the future
of DCBE uncertain, this study supports the inevitable increase in radiographer
led reporting. In our practice we regularly comment on study adequacy in reports
believing this does not undermine performer or report. We suggest an increased
commentary on study technical adequacy with regular review of captured images.
C-738
The evaluation of the exposure dose in X-ray fluoroscopy
E. Yoshida, H. Ohtani, M. Yachi, M. Okuyama; Tokyo/JP
Purpose: It is important to protect an important organ of a lung and a spinal cord
by radiation exposure dose by a X-ray fluoroscopy in an upper gastrointestinal
examination. It is necessary to manage fluoroscopy time of the esophagus, the
field size and body position statistically. The purpose of this study is to do dosimetry using Phantom and estimate the exposure dose of an important organ.
Methods and Materials: The outside of chest Phantom which became the double structure was filled with water and the acrylic tray which supposed the inner
air stratum in a esophagus was put inside. A glass dosimeter was installed under
the acrylic tray and chest Phantom. The incident dose of the spinal cord and the
477
Radiog
s
adiogrrapher
phers
Purpose: To identify the nature of radiographic education across Europe within

and outside the Higher Education sector and the learning outcomes of radiographic programmes of study. To explore the learning and teaching methods used
within radiographic education and identify continuing professional development
opportunities.
Methods and Materials: The activities of 3 working groups included the use of
survey methods to identify 1. Programme content delivered within different European countries for first post radiographers 2. E-learning opportunities for student
radiographers 3. Differing CPD requirements for qualified radiographers.
Results: There are wide differences in the initial radiography education, including learning and teaching methods, between European countries with the consequence that mutual academic and professional recognition is not yet applicable
across Europe. The HENRE thematic network project, in the light of the Bolgna
declaration and other educational pronouncements including Tuning, have begun to address these issues by bringing together radiography practioners, educators and professional bodies.
Conclusion: A directory of first post radiography and CPD programmes will enable easy cross referencing. The production of learning and teaching materials
will provide some common frames of reference. The forthcoming launch of HENRE 2 will continue the work already developed.
C-736

exit dose were measured. The absorbed dose of the spinal cord was calculated
from the incident and the exit dose.
Results and Conclusion: The absorbed dose which is about right anterior oblique position (RAO45) more than the fundamental position was small in body
position of fluoroscopy of a esophagus. This is because a spinal cord is contrary
to an X-ray incidence from the physical relationship with esophagus. Absorbed
dose in RAO45decreased 20~30% more than absorbed dose in the fundamental position. Fluoroscopy which assumed the width of esophagus 3 cm decreased
30~40% in field of 6 cm. When 3 mm put barium of 200 w/v% in esophagus,
absorbed dose decreased 40~50%. By making body position in fluoroscopy of
esophagus oblique position and narrowing a field down, and it suggested that the
exposure dose decrease.
C-739
Method of duplicating a film using the CR system: Evaluation of
detectability in a simulated nodule
A. Fukuyama1, S. Ando 2, K. Fukuyama1; 1Sapporo/JP, 2Suzuka/JP
Purpose: Since film processors used for screen-film systems have been decreasing recently, it is becoming difficult to develop duplicating film (Dup film) used
conventionally. The purpose of this study was to evaluate the usefulness of the
method of duplicating film using a computed radiography (CR) system.
Methods and Materials: The process of duplicating film using CR is 1) to eliminate energy accumulated on the imaging plate (IP) using white light, 2) to accumulate energy on the whole surface, and 3) to place the original film in piles. 4)
After an exposure of white light, duplicated films can be obtained by CR system.
In order to evaluate the reproducibility of our system, duplicated films were read
by experienced observers and ROC analysis was carried out. Observers read 50
images with a simulated nodule and 50 images without a simulated nodule.
Results: The average Az values were 0.9439 for the original films, 0.9101 for
films duplicated using Dup film, and 0.9045 for films duplicated using the CR
system. When the two-tailed paired-T test was performed for each result, there
were no statistically significant differences at p < 0.05.
Conclusion: The detectability of a simulated nodule for films duplicated using
the CR system did not differ from the detectability of films duplicated using Dup
film. This method may be a reasonable substitute for the conventional duplication
system.
C-740
From conventional to digital archive: The education process of the clinical
staff
A. Kettunen1, J. Reponen2, E. Tapanainen2, J. Joensuu1, J. Ervasti2; 1Oulu/FI,
2
Raahe/FI (jarmo.reponen@oulu.fi)
Purpose: Raahe hospital started as a filmless hospital in 2002. The staff were
educated to new models of work before the filmless radiology started and supported later when using the system. This study was focused on finding out the
changing process and satisfaction of the users in policlinics after one years' experience.
Methods and Materials: A questionnaire was sent to medical doctors, nurses
and assistant staff in Raahe hospital and health centres nearby.
Results: There were 129 returned questionnaires. 62.8 % were nursing staff,
32.2 % medical doctors and 5 % assistant staff. Mostly the respondents were
satisfied with the X-ray department's arrangements and training. The respondents were quite satisfied concerning the possibility to order the examinations
quickly. The delay between examination and getting the image to monitor was
shorter than with films. The systems seem to be to easy to use according to the
respondents' opinions. The reports and old images were easy to find from the
archive, although they were needed very rarely.
Conclusion: According this study both the medical doctors and nursing staff
were very satisfied with the filmless radiology and the whole process of change.
The quality of images was good enough on the monitors and the staff were quite
satisfied to the education they had received concerning filmless radiology. Radiographers' role has changed: they are now more responsible for the quality but
the radiologists reports in same way as earlier. Radiological meetings are now
more meaningful because the teaching archive is always present.
C-741
The BI-RADS importance for the mammographer
A.N. Chalazonitis1, G. Tsimitselis2, D. Koumarianos1, V. Nikolaou1, N. Ptohis1,
J. Tzovara1, A.A. Ghiatas1; 1Athens/GR, 2Larissa/GR (red-rad@ath.forthnet.gr)
Learning Objectives: To demonstrate Breast Imaging Reporting and Data System (BI-RADS) in a simple way, presented with many clinical examples, of
478
each mammographic feature described. To help the participant understand the

importance and the many benefits of a standardized breast imaging report. To
identify BI-RADS limitations.
Background: Breast Imaging Reporting and Data System (BI-RADS) of the
American College of Radiology includes the Breast Imaging Lexicon of standardized terminology, and the Reporting System which suggests a standardized approach to the organization and wording of the breast imaging report. With the
introduction and widespread use of BI-RADS mammographers have begun to
realize its benefits.
Imaging Findings: In our exhibit we present the standardized BI-RADS Reporting System and the Breast Imaging Lexicon report with a rich collection of
mammographic examples.
Conclusion: Because the specialized to mammography X-ray technologist works
closely with the radiologist, the effective Breast Imaging Reporting and Data System can become a sophisticated and effective diagnostic tool, for every day
clinical practice.
C-742
Subtraction image for dynamic liver MRI using free breath-hold at
functional residual capacity: A clinical trial
A. Tabuchi, T. Katsuda, M. Eguchi, S. Takewa, R. Gotanda; Okayama/JP
Purpose: Dynamic liver MRI images have been obtained under expiration breath
holding (BH). However, problems with obtaining reproducible liver positions often
observed. This study investigated ways to improve the reproducibility of liver position on dynamic liver MRI.
Methods and Materials: After giving informed consent, 60 patients (32 males,
28 females, ages 33-85, median age 69) were examined by liver dynamic MRI
under two types of BH. The BH phases were voluntary expiration phase (VE)
without any explanations and functional residual capacity phase (FRC) after careful
explanation was provided.
Plain images, arterial phase images, portal phase images and parenchymal phase
images were obtained. For statistical evaluation of reproducibility, the area of the
2nd or 3rd images from top of the liver was measured in each phase using a threshold
value of half maximum. Misregistration areas were calculated by finding the remainder of the liver area in the plain-arterial (Pl-A) phase, arterial-portal (A-Po)
phase, plain-parenchymal (Pl-Pa) phase. Contingency table analysis was done
due to the misregistration was occurred of not.
Results: Misregistration of liver image on the VE and the FRC of three phase
types were statistical significant on the Pl-A (p < 0.01), on the A-Po (p < 0.01)
and on the Pl-Pa (p < 0.05), respectively.
Conclusion: The FRC phase following careful explanation of the BH provided
significantly improved reproducibility of liver position on dynamic liver MRI. Therefore, precise subtraction images could be obtained for routine clinical examinations without slice matching.
C-743
Improvement of diaphragmatic reproducibility for dynamic liver MRI using
free breath-hold at functional residual capacity
M. Eguchi, T. Katsuda, A. Tabuchi, S. Takewa, R. Gotanda; Okayama/JP
(croix1218@yahoo.co.jp)
Purpose: Dynamic liver MRI images have been obtained under expiration breath
holding (BH). However, problems with the reproducibility of diaphragmatic positions are often observed. This study investigated to improve the reproducibility of
diaphragmatic position for dynamic Liver MR imaging.
Methods and Materials: After informed consent, 26 volunteers (12 males and
14 females, ages 20-34, median age 22) were examined by MRI of the diaphragmatic area using a time lag that was the same as dynamic liver sequence without
contrast agents, under three types of BH. The BHs were voluntary expiration
(VE), maximum expiration (ME) without any explanations and functional residual
capacity (FRC) after careful explanation.
Four phase images were obtained under each BH. The first images were nonenhanced. Second images (arterial) were obtained after 60 seconds from the
first images. Third images (portal) were obtained after two normal breathing cycles following from the second images. Fourth images (parenchymal) were obtained 90 seconds after the third images. For statistical evaluation of diaphragmatic
position, sagittal images were reconstructed in each phase. Distances from the
upper edge of image to the near apex of the diaphragm were measured using a
profile set to at half maximum.
Results: Mean diaphragmatic moving distances of the three BHs were 5.385 mm
under VE, 3.115 mm under ME and 2.077 mm under FRC. (p < 0.01, ANOVA and
p < 0.05, Tukey-Kramer HSD).

Conclusion: FRC following a careful explanation of BH significantly improved
the reproducibility of diaphragmatic position on dynamic liver MRI.
C-744
Low SAR fat suppression technique using spectral-spatial RF pulses
K. Uchida1, T. Katsube1, A. Wada1, N. Uchida1, H. Kitagaki1, T. Matsuda2;
1
Izumo/JP, 2Asahigaoka Hino-shi Tokyo/JP
Purpose: Chemical fat suppression techniques (FS) have the disadvantage of
inducing higher specific absorbance ratio (SAR), resulting in restriction of multislice number per sequence. To solve the problem, we applied spectral-spatial RF
pulses (SSRF) to spin echo images, the latter of which is now used only for MR
spectroscopy. The purpose of this study was to experimentally compare FS combined with SSRF to conventional FS.
Methods and Materials: MR system was a 1.5 T clinical imager (Signa CV/i; GE
Medical Systems, U.S.A). First, we obtained the neck image of a healthy volunteer obtaining informed consent. Spin echo FS images obtained by SSRF (with
12 partitions) and those obtained by chemical shift-selective pulse method
(CHESS) were compared. We evaluated peak-SAR and the derived number of
the multi-slice. MR phantom model 90-401 (NIKKO FINES Co., Japan), saline
solution and vegetable oil were used as materials. In phantom study, SSRF and
CHESS were compared by evaluating signal-to-noise ratio (SNR), water-to-oil
signal intensity ratio (w/o ratio), T1 contrast ratio and magnetization transfer (MT)
effect.
Results: Peak-SAR and multi-slice number per sequence by SSRF were 0.83fold and 1.33-fold compared to those by CHESS. In phantom study, SNR, w/o
ratio, T1 contrast ratio and MT effect by SSRF were 1.25, 1.11, 1.27, 0.56 fold
respectively, against those by CHESS.
Conclusion: FS technique using SSRF reduced SAR, and improved the image
quality.
C-745
The detection of intracerebral microbleeds with susceptibility weighted MRI
sequences: The age, gene/environment susceptibility Reykjavik study
S. Sigurdsson, A. Sigmarsdottir, O. Kjartansson, B. Oskarsdottir, T. Aspelund,
L. Lenore, S. Sveinbjornsdottir, G. Eiriksdottir, V. Gudnason; Kopavogur/IS
(sigurdur@hjarta.is)
C-746
Incomplete magnetic resonance imaging (MRI) examinations due to
claustrophobia; is cognitive impairment a contributing factor? The age,
gene/environment susceptibility Reykjavik study
S. Sigurdsson1, L. Launer2, M. Chang1, T. Aspelund1, M. Jonsdottir 1,
G.F. Johannsdottir1, B. Valtysdottir1, G. Eiriksdottir1, V. Gudnason 1;
1
Kopavogur/IS, 2Bethesda, MD/US (sigurdur@hjarta.is)
Purpose: To examine the relationship between claustrophobia (CLA) while undergoing MR imaging and cognitive impairment among older adults in a large
population-based study.
Methods and Materials: A total of 801 men and 1101 women aged 68 to 96
C-747
Missing data in epidemiologic magnetic resonance imaging study
L. Gudmundsdottir1, B. Jonsdottir1, S. Sigurdsson2, T. Aspelund2, L. Launer3,
V. Gudnason2; 1Reykjavik/IS, 2Kopavogur/IS, 3Bethesda, MD/US
(lovisa@hjarta.is)
Purpose: Missing data in epidemiologic studies present several problems to the
analyst including difficulties in variable selection, reduced power, and potential
for bias in the resulting estimates. The purpose of this study was to investigate
the missing image data rate, the causes of missing image data and to examine
the difference between participants with and without missing data.
Methods and Materials: Participants in this study where those who had enrolled
in the AGES (Age, Gene/Environment Susceptibility) Reykjavik Study, where 8000
of the surviving 11,000 members of the Reykjavik Study cohort, (subjects born
1907 to 1935) will eventually be phenotyped. The imaging part of the study includes MR imaging of the brain. All the image data was stored in PACS and all
variable information data was stored in an Oracle database.
Results: Data was collected from 1606 participants (942 women, 664 men) with
an age range of 66-95 years (mean 76.7). A total 13% of the participants could
not have MR imaging. The two most common reasons were: claustrophobia (2.8%)
and pacemaker (2.3%). These individuals were statistically significantly older and
with higher BMI. Of the participants 3.40% had missing data as not all imaging
sequences could be completed (1.9%) and because images could not be retrieved from PACS due to technical problems (0.5%). There was no difference in
BMI, age or gender between those with missing data and not.
Conclusion: Our study emphasizes the importance of performing specific missing data analyses in any imaging study to account for potential bias.
C-748
Magnetic resonance angiography: A technical, anatomical and clinical
review
A. Buzzi, M. Hjelt, P. Buzzi, C. Garca Pellegrino, M. Canedo, S. Merola,
E. Eyheremendy; Buenos Aires/AR (aebuzzi@fibertel.com.ar)
Learning Objectives: To review the basic principles of MRA techniques and flow
phenomena. To picture the normal anatomy of major vascular territories. To illustrate the main pathological entities that affect these territories. To illustrate the
common artefacts that can hide or mimic those diseases.
Background: Hardware and software improvements of MR imaging systems have
made MRA the first choice in many clinical settings, and a useful technique for
initial screening in patients with suspected vascular disease. There is a variety of
MRA techniques with different capabilities. Selecting one can be guided by the
information expected and specific characteristics of each of them.
Imaging Findings: MRA includes TOF based techniques, phase-sensitive techniques and contrast enhanced breath-hold techniques (body/cervical), each one
providing images with particular characteristics: 3D TOF for the brain arteries, 2D
TOF for the vessels of the neck and the lower limb, phase-sensitive techniques
for brain venography and renal arteries, contrast enhanced breath-hold techniques
for cervical and body MRA, etc).
Conclusion: MRA has become a widely used method in the study of vascular
disease, based on its capability to provide images with exquisite detail without
iodinated contrast injection or use of X-rays. An understanding of its principles
479
Radiog
s
adiogrrapher
phers
Purpose: To evaluate the accuracy of b0 dual-spin echo type echo planar images (SE-EPI) and gradient echo type echo planar images (GRE-EPI) with short
echo time (TE) and long TE in the detection of intracerebral microbleeds (CMBs)
associated with susceptibility dephasing.
Methods and Materials: Fifty two subjects (mean age 79.4 5.7 years) including 29 suspected of having CMBs and 25 randomly selected were included in the
study which is a part of another larger cross-sectional study of an elderly population. Images were acquired with 1.5 T MR imaging system. Contrast-to-noise ratio (CNR), sensitivity and specificity to detection of CMBs were evaluated for the
sequences above. To assess sensitivity and specificity, CMB findings for each
sequence were compared to a gold standard, consisting of images generated
with a GRE-EPI sequence with a long TE together with Fast SE T2-weighted
sequence. Findings were based on a consensus of two experienced observers.
Results: A total of 163 CMBs were found in 30 subjects with the gold standard.
The mean CNR in CMBs of the GRE-EPI with long TE, GRE-EPI with short TE
and b0 SE-EPI was 12.5 6.0, 10.2 6.3 and -2.4 7.6 respectively and significantly different between each sequence (p < 0.05); the sensitivity was 91%, 92%
and 51% respectively; and specificity 96%, 97% and 96% respectively.
Conclusion: The overall accuracy of the GRE-EPI with long TE was highest in
detecting CMBs when taking into account highest mean CNR and comparable
sensitivity and specificity to GRE-EPI with short TE. Dual-SE-EPI b0 images should
not be used in screening for CMBs.
years (mean 76 5.5) participated in the study and were scheduled for brain MR
imaging. CLA was defined if subjects cancelled the appointment or had premature termination of the MR imaging examination due to anxiety or related symptoms. Cognitive impairment (CI) was defined by a Mini Mental State Examination
score (MMSE) 23 or Digit Symbol Substitution Test score (DSST) 17. Multivariate logistic regression was used to estimate the association of CLA to CI,
adjusting for age, gender, level of education (4 levels: elementary, secondary,
college, and university), abdominal waist circumference, and physical function
measured with the Timed-Up and Go test.
Results: In the total sample of 1902, 4.7% (n = 90) had failed MR imaging due to
claustrophobia and 18% (n = 340) had cognitive impairment. Out of the 90 who
failed MR imaging, 24.4% (n = 22) were cognitively impaired. After adjusting age,
gender, level of education, physical function, and abdominal waist circumference,
subjects with CLA had significantly higher cognitive impairment compared to those
without CLA (odd ratios = 2.1; 95% confidence interval, 1.2-3.8; p = 0.008).
Conclusion: Among those who have an incomplete scan due to claustrophobia,
a significantly higher percent had cognitive impairment. Management strategies
for these individuals should be considered to increase their comfort, reduce motion artefacts and reduce the number of cancelled or prematurely terminated
studies.

and common artefacts, as well as of normal and usual pathological processes
affecting the vascular system is mandatory for proper image generation and interpretation.
Vascular
C-749
C-751
Inversion-recovery sequences: Technical features, variants and clinical

applications
A. Buzzi, M. Hjelt, P. Buzzi, R. Lpez Quintero, V. Nieto, S. Merola,
R. Rostagno; Buenos Aires/AR (aebuzzi@fibertel.com.ar)
MDCT in thoracic aortic stent-grafts

C. Sebastia, S. Quiroga, A. Alvarez, R. Boy, H. Cuellar, A. Miranda;
Barcelona/ES (mcsebastia@vhebron.net)
Learning Objectives: To show inversion-recovery (IR) sequences properties,

technical features and most frequently used variants.
Background: Because of the initial 180-degree radiofrequency pulse, IR sequences have higher contrast level than spin-echo. Also, IR sequences are very versatile when varying the inversion time (TI). According to this, we illustrate the
application of IR sequences in daily practice using clinical cases with short TI
(STIR), medium TI (silicone suppression) and long TI (FLAIR).
Procedure Details: MR inversion-recovery imaging was performed with a 1.5 T
scanner (Visart; Toshiba) in the axial, sagittal and coronal planes with a fast SE
sequence. We use an inversion time of 140 msec for the STIR sequence, an
inversion time of 440 for the silicone-suppression sequence, and an inversion
time of 2200 msec for the FLAIR sequence.
Conclusion: To achieve suppression of the signal from gray matter, white matter,
fat, or cerebrospinal fluid, the proper TI should be chosen so that the signal of the
tissue is absent when the longitudinal magnetization is zero. At the selected TI, a
series of radiofrequency pulses are applied to obtain signal from the other tissues.
C-750
Radiographic approach to the pulmonary hilum
W.L. Koh, J.W. Kwek, E.H. Tan, J.S.J. Gan, H.S. Teh; Singapore/SG
(cyber_xray@yahoo.com)
Learning Objectives: To illustrate the normal hilar anatomy and pathology on
plain chest radiographs with correlation with multiplanar reconstructions (MPR)
from multi-detector CT (MDCT) thorax studies.
Background: Evaluation of the pulmonary hilum on plain radiographs can be
difficult and increasing number of CT thorax studies are performed for evaluation
of suspected hilar pathology and the discordant findings are not uncommon. MDCT
thorax with MPR is an extremely valuable tool to correlate normal anatomy and
pathology on frontal and lateral chest radiograph.
Imaging Findings: Normal MDCT thorax studies are correlated with frontal and
lateral chest radiographs of the same patient to illustrate the normal left and right
hilar structures in the hilum. Important regions on the lateral chest radiograph
helpful for diagnosis such as posterior wall of bronchus intermedius, inferior hilar
window and right upper lobe bronchus are illustrated and correlated with MPRs
from MDCT thorax. Lateral radiographs of patients with pneumonectomy, hilar
mass or lymphadenopathy, pulmonary vascular abnormalities are also illustrated
with MPRs from MDCT for better understandings of classic radiological signs.
Conclusion: This exhibit will allow the reader to achieve a better understanding
of hilar anatomy and pathology through direct correlation of plain frontal and lateral radiographs with MPRs from MDCT thorax.
480
Computed Tomography
Learning Objectives: To review important points for assessing the thoracoabdominal aorta with MDCT before endoprosthesis placement. To describe our MDCT
protocol for evaluating thoracic aortic stents. To show MDCT images of stent
complications. To depict special points in MDCT studies of aortic dissection before and after stent placement.
Imaging Findings: Thirty-five patients with descending thoracic aortic disease
have been treated with commercially available endoprostheses in our hospital
over the last 4 years. The conditions included 10 atherosclerotic aneurysms, 12
traumatic aneurysms, 9 chronic type B aortic dissections, 1 penetrating aortic
ulcer and 1 chronic intramural hematoma. All patients were assessed before and
after stent-graft placement by means of MDCT (Philips 4-detector MX-8000 and
Siemens 16-detector Sensation).
This exhibit reviews the pre- and post-stenting MDCT protocol and the most useful reconstructions (multiplanar and volume rendered), with emphasis on specific
points for aortic dissection studies.
We present follow-up images of properly located stent-grafts with no associated
complications as well as images of complications, including
- Endoleaks:
Type I (5 patients, 2 proximal and 3 distal; one spontaneously sealed)
Type II (1 patient with persistent intercostal artery)
Type III (1 patient)
- Aortic perforation (1 patient)
- Iliac artery trauma (1 patient)
- Stent-graft misplacement (2 patients)
- Insufficient stent-graft expansion (1 patient)
- Accidental coverage of a branch vessel with the stent-graft (2 patients with left
subclavian thrombosis)
- Superior mesenteric artery embolus (1 patient)
- Persistence of distal false lumen in aortic dissection (7 patients).
C-752
MDCT imaging of peripheral arterial bypass complications
P. Rinaldi, M.A. Politi, A. Cina, F. Citterio, L. Bonomo; Rome/IT
(pierluigi.rinaldi@rm.unicatt.it)
Learning Objectives: 1. To briefly describe the various surgical techniques employed for revascularization of peripheral arteries. 2. To illustrate technique, tips
and pitfalls of MDCT in follow-up of peripheral arterial bypass. 3. To describe
major radiological findings of bypass graft failures. 4. To assess the role of MDCT
angiography in the diagnostic work-up of bypass related complications.
Background: Peripheral arterial bypass graft surgery is the only conservative
treatment for symptomatic arterial occlusive disease of the lower extremities, when
endovascular treatment is ineffective. Bypass grafts are classified into two groups:
distal, below the knee, and proximal, above the knee. Grafts may be synthetic or
autologous using the saphenous vein. A large percentage of bypass grafts are
unsuccessful (up to 30%) due to early (technical procedure and poor run-off) and
late complications (intimal proliferation, atherosclerosis), poor patient compliance,
infections. Routine surveillance of peripheral bypass patency is usually carried
out with echo color Doppler and angiography (DSA). MDCT has proven to be
suitable for morphologic assessment of bypass grafts and for detection of graft
related complications.
Imaging Findings: A comprehensive review of bypass graft complications, with
a careful analysis of typical CT findings and pitfalls will be provided. Topics covered will include: MDCT technique; early complications (residual valve cusps,
anastomotic stenosis, arteriovenous fistulas, thrombosis); late complications
(pseudoaneurysm, intimal hyperplasia, progression of atherosclerosis); bypass
infection. All these causes resulted in graft failure.
Conclusion: MDCT angiography is a noninvasive technique which is an alternative to DSA as standard panoramic examination for graft related complications.

C-754
CT angiography of the abdomen with a 64-slice scanner: Pictorial review
A.J.B.S. Madureira, I.M. Ramos; Porto/PT (ajbmadureira@clix.pt)
Learning Objectives: To discuss the proper technique of performing CT angiography with a 64-slice scanner. To review the postprocessing tools and techniques
available. To review the imaging findings of the most important and frequent vascular pathologies of the abdomen. To discuss the impact of 64-slice CT angiography in the current evaluation of patients suspected of having pathology of the
abdominal vessels.
Background: The development of multislice CT (MSCT) and the improved imaging processing techniques have revolutionized CT angiography (CTA). The whole
visceral arterial vasculature and the aorta and iliac arteries can now be evaluated with a single acquisition.
Procedure Details: The scan protocol and timing of the contrast agent injection
are crucial in order to obtain a high quality data set. The optimization of scan
protocols adapted to the new 64-slice scanners will be discussed. The key imaging findings of the major disorders affecting the abdominal vasculature will be
presented, including the abdominal aorta, iliac arteries, hepatic artery, mesenteric
vessels and renal vasculature, based on our experience with a 64-slice CT scanner (Siemens Sensation 64 Cardiac, Germany). The limitations and pitfalls of the
technique will also be discussed.
Conclusion: The introduction of 64-slice CT scanners has had a major impact in
the assessment of the abdominal vasculature. CTA is now the modality of choice
in the evaluation of the abdominal vessels as it is able to depict small distal visceral branches as well as the aorta and iliac arteries in a short acquisition time.
C-755
Eigenshape based estimation of missing data from 3D curves: Application
to vascular centerline restoration in CT angiography of femoropopliteal
artery occlusions
T. Rakshe1, J. Roos1, M. Straka2, S. Napel1, D. Fleischmann1; 1Stanford,
CA/US, 2Vienna/AU (rakshe@stanford.edu)
Purpose: Automatic tracking of arterial centerlines through occluded and severely diseased arterial segments remains an unsolved problem in CT angiography. We developed a novel knowledge based algorithm for estimating missing
portions of 3D curves and demonstrated its use in tracking centerlines through
simulated occlusions in the femoropopliteal artery.
Methods and Materials: Thirty patients without peripheral arterial occlusive disease underwent lower extremity CT-angiography. Femoropopliteal centerlines,
extracted by expert radiologists using a semi-automated algorithm, were parameterized with respect to adaptive reference frames to compensate for the movements in hip and knee joints for each patient. This database underwent principal
component analysis to produce eigenshapes of the centerlines. The eigenshapes
were used to find the best fit to a partially known centerline and estimate the
missing segment. For validation, we simulated 20 occlusions of different lengths
at random locations in each patient dataset, and used the remaining 29 as a
database to bridge the occlusions. Since the true centerline was known, we computed the maximum deviation between true and estimated centerline as an error
metric.
Results: Mean and SD of maximum deviation in all patients for different occlusion lengths were (mean SD (Occlusion length) in mm): 0.94 0.56 (50 mm),
1.5 0.93 (75 mm), 2.14 1.32 (100 mm), 2.68 1.6 (125 mm), 3.14 1.8
(150 mm), 3.8 2.0 (175 mm), 4.3 2.3 (200 mm).
Conclusion: Femoropopliteal artery occlusions up to 100 mm can be effectively
bridged using a knowledge base of similar arterial shapes, substantially reducing
the user-interaction time to generate CPRs through diseased arterial segments.
C-756
Learning Objectives: 1. To describe clinical utilities of partial splenic embolization for patients with splenomegaly (hypersplenism) caused by liver cirrhosis. 2.
To illustrate technical aspects of a synchrotron radiation (SR) ultra-high resolution CT. 3. To quantitatively demonstrate three-dimensional (3-D) microvascular
architecture of the spleen.
Background: Partial splenic embolization is a minimally invasive technique for
splenomegaly (hypersplenism) caused by liver cirrhosis. To quantitatively demonstrate and explore 3-D microvascular architecture of the spleen is clinically
important for proper choice of embolization agents.
C-757
Multidetector CT angiography of the hypothenar hammer syndrome: A
retrospective comparison with intraarterial digital subtraction angiography
J.-P. Zabel1, S. Faivre2, M. Brandao da Costa1, F. Dap2, A. Blum1; 1Nancy/FR,
2
Toul/FR (jp.zabel@wanadoo.fr)
Purpose: To determine the accuracy of CT Angiography (CTA) using a multidetector scanner in the evaluation of patients with hypothenar hammer syndrome.
Methods and Materials: Sixteen patients with hypothenar hammer syndrome
underwent, both Digital Subtraction Angiography (DSA) and CTA of the forearm
and the hand.
Two radiologists reviewed all examinations. The pattern of the ulnar artery were
divided into 5 categories: normal, stenosis, thrombosis, aneurysm and corkscrew
pattern. Intertechnique agreement was measured for each radiologist. The arterial supply of the hand was divided into 19 segments. Findings were graded according to 3 categories: patent, occluded and nondiagnostic. The sensitivity and
the specificity in showing arterial occlusions of CTA was calculated.
Two surgeons reviewed DSA and CTA separately. They could choose three therapeutic options. CT-angiography findings were compared with DSA findings for
each patient.
Results: Intertechnique agreement for depicting ulnar artery abnormalities was
0.78.
The sensitivity and specificity of CTA for depicting occlusions of the radial and
ulnar arteries and of the palmar arches was 100 %. For the common and the
proper digital arteries they were 100 and 99 %, and 53% and 96 % respectively.
In 82 % of cases, the same treatment was decided with CTA or DSA. CTA often
changed the length of the graft, because it highlighted abnormalities of the vessel wall.
Conclusion: Multislice CT-scan is an efficient technique for evaluating the arterial network of the hand, except proper digital arteries, which are still difficult to
assess. It provides sufficient information for surgeons.
C-758
One-stop-shopping of living renal donors using 64-detector-row CT: Initial
results
D. Blondin, M. Cohnen, P. Krpil, A. Saleh, A. Ringelstein, U. Mdder, G. Jung;
Dsseldorf/DE (blondin@med.uni-duesseldorf.de)
Purpose: The assessment of renal vascular and ureteric anatomy is necessary
for planning of explantation. To avoid invasive angiographic investigation of potential living renal donors (LRD), computed tomographic angiography (CTA) and
low dose computed tomographic urography have been carried out using 64-Detector-Row-CT.
Methods and Materials: 26 potential LRD have been investigated with a Somatom-Sensation Cardiac 64 scanner (Siemens Medical Solutions, Germany).
The examinations consisted of an arterial CTA (started by bolus triggering) a
venous phase scan and a late low-dose urography scan. Scan parameters were
100 KV and 150 mAs; collimation/slice thickness: 64 x 0.6 mm/0.75 mm (CTA);
venous-phase (120 KV and 125 mAs): 20 x 1.2 mm/5 mm and low-dose urography-scan (80 KV and 30 mAs): 20 x 1.2 mm/1.5 mm; pitch was 1.2 or 1.4, respectively. 100 ml non-ionic contrast-agent (300 mg/ml iodine, Accupaque) was
automatically injected at 3 ml/sec followed by a saline chaser. CT results were
compared to the operative report.
Results: In 11 of 26 LRD, 12 accessory arteries, two of a diameter below 1.5 mm,
were found, 11 arose from the abdominal aorta, one originated from the right iliac
artery. Two retroaortic renal veins and three duplicated renal veins could be de-
481
Vascular
Three-dimensional microvascular architecture of the spleen with a

synchrotron radiation ultra-high resolution CT
K. Shimizu1, J. Koizumi2, M. Ootaki1, Y. Imai2, H. Ikura3, K. Umetani4;
1
Hachioji/JP, 2Isehara/JP, 3Imabari/JP, 4Sayo/JP (simi@is.icc.u-tokai.ac.jp)
Procedure Details: We used pig spleens and a human spleen obtained at splenectomy. The samples were prepared as follows: First, barium and starch mixture
was infused into the splenic arteries. Then, contact radiography was obtained to
confirm proper filling into the periphery. Subsequently, they were fixed by formalin for two weeks. Finally, they were cut down to the sample specimens that could
be filled into a cylindrical tube (20 mm in diameter).
We have previously reported an SR microtomography system constructed at the
bending magnet beamline at the SPring-8 (Hyogo, Japan). Serial SR microtomographic images of the sample specimens were obtained. Then they were stacked
to yield the isotropic volumetric data with ultra-high resolution (12 m3 in voxel
size). Finally, volume rendering technique was applied to quantitatively demonstrate 3-D microvascular architecture of the spleen.
Conclusion: To quantitatively demonstrate and explore 3-D microvascular architecture of the spleen using an SR microtomography with ultra-high resolution
would offer a new approach to establish the theoretical basis of partial splenic
embolization.

tected. In contrast, no ureter variation was documented. Besides some renal cysts,
one renal tumor was detected. Vascular calcifications could easily be demonstrated in the venous phase scan. Up to now, 11 renal transplantations have
been carried out and no discrepancy in vessel anatomy was found.
Conclusion: The preliminary results demonstrate that modern integrative imaging of potential LRD can be reliably performed using 64-Detector-Row-CT. Radiologic results lead to relevant decisions concerning if and which organ should be
transplanted.
C-759
Age related changes of human aortic distensibility: Evaluation with ECGgated CT
M.-K. Ganten, H. von Tengg-Kobligk, U. Weidemann, H.-U. Kauczor, M. Bock;
Heidelberg/DE (mkhahmann@yahoo.com)
Purpose: Aortic distensibility is a parameter for the grading of vascular diseases
and age-related changes of vascular distensibility which depends on the mechanical properties of the vessel wall. Aortic cross-sectional area changes have
been determined using ECG-gated CT to analyse the age-dependency of aortic
distensibility.
Methods and Materials: Distensibility measurements were performed in the aorta
of thirty-one volunteers (28 y to 85 y). The CT images were acquired with a 4 and
16 detector row CT. Time-resolved CT images were calculated either off-line using a dedicated image reconstruction software package or using the standard
image reconstruction software environment. Aortic cross-sectional area changes
were obtained by semiautomatic segmentation.
Results: In all volunteers the aorta could be segmented successfully. A decrease
of aortic distensibility with age (r = 0.54) from Dinfrarenal = 2.7 10-6 Pa-1 at 28y to
Dinfrarenal = 3.76 10-6 Pa-1 at 80y was found.
Conclusion: Distensibility measurements to obtain functional information of the
vessel wall can easily be integrated into a modified routine CT-angiography study.
C-760
Vascular imaging on MDCT: Tricks and tips
K. Ogura, H. Hyodoh, T. Hirano, A. Kumagai, N. Sakai, J. Satoh, M. Hareyama;
Sapporo/JP (ogura@sapmed.ac.jp)
Learning Objectives: To learn the optimal scan and injection protocols for various vascular conditions. To learn the optimal reformat techniques and their pitfalls.
Background: Multi-detector row CT (MDCT) is the main imaging tool to evaluate
vascular disease (especially in aortic aneurysms/dissections) and the physician
must know its advantages and pitfalls. In this presentation, the established scan
parameters and image-reformat techniques will be discussed.
Procedure Details: We will present the established optimal scan protocol (field
of view, phase, delay time and injection techniques) in each clinical condition
(aneurysms, dissection, Takayasu's aortitis, artery of Adamkiewicz, and developmental anomalies), and setting (screening, preoperative and postoperative). We
also present the various image reformat techniques (e.g. movie (paging), multiplanar reconstruction, maximum intensity projection, minimum intensity projection, volume rendering, and virtual endoscopy). The tricks and tips of the imaging
process will be discussed in each case.
Conclusion: We present the optimal scan/image reconstruction techniques in
evaluating vascular conditions with MDCT. The ideal scan and image reconstruction would be necessary for correct diagnosis and decision to select the optimal
operation strategy.
C-761
Role of craniocaudal scanning and saline flush in the study of epiaortic
vessels (and vertebral arteries) origin with MDCT angiography
F. Marchisio, P. Sacchetto, I. Tosetti, A.F. Genovesio, G. Gandini; Turin/IT
(afgenovesio@libero.it)
Purpose: To evaluate the advantages of craniocaudal versus caudocranial scanning with saline flush in the analysis of epiaortic vessels origin and in the study of
carotid arteries with MDCT angiography.
Methods and Materials: Between January and August 2005, forty patients underwent a CT study of the epiaortic vessels. Scanning was performed on a 16channel multi-detector row CT system (GE Lightspeed) with 120 kV and automatic
mAs, 0.625-mm collimation, 0.9-cm/rot table feed and 0.5-second gantry rotation
time. The iodinated nonionic contrast agent (Iomeron 400 Bracco) volume was
80-90 ml with a 50-ml saline chaser bolus and a flow rate of 4-5 ml/s. A bolustracking method was used, placing the tracker on the prepetrous tract of the inter-
482
nal carotid artery in the twenty scans with craniocaudal direction (protocol B) and
on the aortic arch in the twenty scans with caudocranial direction (protocol A).
Two expert radiologists performed a double-blind evaluation of the epiaortic vessels origin, with a quality score of 1=severe artefacts, 2=moderate artefacts, 3=optimal imaging of the epiaortic vessels at the thoracic inlet level.
Results: The average quality score result was higher in protocol B; this difference was statistically significant (p < 0.05).
Conclusion: Protocol B allows an improved visualization of epiaortic vessels
and vertebral arteries and can reduce beam hardening artefacts originating from
concentrated contrast medium in the subclavian vein.
Raw data sets with less artefacts can be processed in a better way by automatic
software for vessel analysis and they are also more suitable for the growing acquisition speed of MDCT scanners.
C-762
Predictors of the incidence of deep venous thrombosis and pulmonary
arterial thrombosis in 50 subjects after total knee replacement using
multislice computed tomography in logistic regression models
N. Funabashi, J. Miyagi, M. Suzuki, M. Asano, H. Moriya, I. Komuro; Chiba/JP
(jinmiyagi@graduate.chiba-u.jp)
Purpose: To determine the predictors of the incidence of deep venous thrombus
(DVT) in lower extremities and pulmonary arterial thrombus (PAT) after total knee
replacement (TKR), we evaluated the incidence of these events using MSCT in
logistic regression models.
Methods and Materials: 50 subjects (41 females, 53-81 years old) underwent
enhanced CT before and 1 week after TKR to evaluate PAT and DVT. Logistic
models for predicting the incidence of DVT or PAT were constructed using age,
sex, body mass index, presence of anticoagulant therapy, total amount of bleeding during the operation, levels of fibrinogen degradation products (FDP), hemoglobin and PaO2.
Results: DVT and PAT were detected in eleven (22%) and twelve (24%) subjects
respectively, after TKR. Hemoglobin levels the day after TKR, and FDP levels
three days after TKR were significantly higher, and PaO2 the day after TKR was
lower in the subjects with DVT than in those without. Only the levels of Pa02 the
day after TKR were significantly lower in the subjects with PAT than in those
without PAT. In a logistic regression model for predicting the incidence of PAT, the
relative risk of Pa02 levels the day after TKR was 0.90, but it was not significant
(P=0.11). In the DVT model, hemoglobin and PaO2 levels the day after TKR were
associated with an increased incidence of DVT. (Relative risks 2.4 (p < 0.05),
and 0.89 (p < 0.05), respectively)
Conclusion: High levels of hemoglobin and low levels of PaO2 the day after TKR
may predict the occurrence of DVT.
C-763
Embryology and anatomic variations of the inferior vena cava on multislice
CT
J.J. Noguera, I. Vivas, E. De Luis, P.D. Domnguez, G. Bastarrika, D. Cano;
Pamplona/ES (jnoguera@unav.es)
Learning Objectives: 1. To give a brief and schematic overview of the embryogenesis of the venous system. 2. To describe the more frequent anomalies of the
development of the inferior vena cava and expose their possible clinical manifestations.
Background: Most inferior vena cava (IVC) anomalies remain asymptomatic until
found in surgical or angiographic procedures, but some of these anomalies may
have significant clinical implications. These anatomic variants must be known
and accurately identified by radiologists in order to inform preoperatively the interventional radiologists or surgeons of potential complicating factors.
Imaging Findings: This exhibit reviews the complex embryogenesis of the IVC
and presents various examples of congenital anomalies identified by cross-sectional and reformatted CT images. We report cases of IVC duplication, transposition of IVC, retroaortic left renal vein (LRV), circumaortic LRV or azygous
continuation of an interrupted IVC.
Conclusion: Familiarity with anatomic variants of IVC and these appearances in
axial and reformatted CT images can avoid misinterpretation of imaging findings
and allow correct planning of surgical and interventional treatments.

C-764
Image quality improvement of pulmonary vessels around the heart by
reducing cardiac motion on ECG-gated 16-row and 64-row multidetector
helical CT
X. Deng, L. Zhang, Y. Shen, H. Zhang, R. Zhai; Beijing/CN
(cindydeng2005@yahoo.com.cn)
Purpose: This study was carried out to investigate the feasibility of the ECGgated MDCT to improve image quality of pulmonary vessels around the heart
and to determine the best cardiac algorithm.
Methods and Materials: 90 patients underwent non-ECG-gated and ECG-gated
computed tomography pulmonary angiography on MDCT. Each patient's images
were displayed by helical algorithm and three ECG-gated cardiac algorithms.
The scoring value for pulmonary vessels around the heart was estimated in 3
grades, and the best algorithm was also subjectively evaluated. Statistical tests
were used to compare the mean scoring value (MSV) of helical with that of each
cardiac algorithm and to calculate the ratio of the best algorithm.
Results: The MSVs for pulmonary vessels were Helical: 2.27 0.44, CHR:
2.68 0.29, MSR-2: 2.29 0.51, MSR-4: 2.19 0.50. The MSVs were significantly different between helical and CHR (p < 0.001), but not significantly different between helical and the other cardiac algorithms. The ratios of best algorithm
for pulmonary vessels were Helical: 27.6%, CHR: 56.9%, MSR-2: 11.6%, MSR4: 4.0%. The ratio of CHR was higher than the other algorithms.
Conclusion: The ECG-gated and CHR algorithm of 16 & 64-row MDCT is a feasible technique to improve image quality of pulmonary vessels around the heart by
reducing cardiac motion. This study established a basis of improving the diagnostic level of small pulmonary embolism around the heart.
C-765
4-, 16-, and 64-detector row CT angiography of peripheral arterial disease:
An overview
M.C.J.M. Kock, M. Dijkshoorn, R. Ouwendijk, P.M.T. Pattynama, M. Hunink;
Rotterdam/NL (m.kock@erasmusmc.nl)
Learning Objectives: Discuss technical factors involved in acquiring and reconstructing contrast-enhanced CT images of the peripheral arteries using 4-, 16-,
and 64-detector row CT scanner. Discuss management of large datasets involving storage, evaluation and presentation. Discuss clinical role of multi-detector
CT angiography of peripheral arteries involving costs, reproducibility and validity.
Background: Multi-detector row CT angiography (MDCTA) is a minimally invasive technique which can depict the entire peripheral arterial run-off. It is challenging to obtain the best image quality and to achieve reliable enhancement of
the entire arterial run-off using MDCTA. Therefore, optimization of acquisition
parameters, contrast delivery method and postprocessing is important.
Procedure Details: In this review, different scan protocols are described for imaging of peripheral arteries using 4-, 16-, and 64-detector CT angiography and
their effect on image quality. Different approaches to 3D postprocessing techniques and image evaluation are provided to enable optimal implementation into
clinical practice. The clinical role of MDCTA of peripheral arteries is discussed
and reviewed using up to date literature on this topic.
Conclusion: MDCTA of the peripheral arteries can be performed on a 4-, 16-, or
64-detector row CT scanner. 16-detector CT allows a scan protocol optimized for
obese patients or allows a fast scan protocol. 64-detector CT allows both a high
scan speed permitting a higher tube load for obese patients at submillimeter
collimation.
C-766
Multi-detector CT angiography with perfusion analysis in the follow-up after
renal artery stenting
R.A. Bucek, S. Puchner, M. Reiter, E. Minar, J. Lammer; Vienna/AT
(robert.bucek@meduniwien.ac.at)
C-767
Planning of carotid artery stenting with 16-slice multidetector CT
angiography
U. Rozzanigo, R. Pacchioni, R. Caudana; Mantova/IT (urozzanigo@sirm.org)
Learning Objectives: To define the role of 16-slice multidetector CT (MDCT)
angiography in the pre-operative selection of patients with carotid artery stenosis. To describe the scanning protocol and the post-processing technique. To define the anatomical factors that are important to plan procedures of carotid artery
stenting.
Background: The majority of patients with clinical indications for endarterectomy are treated surgically on the basis of colour Doppler ultrasound findings. A
second-level examination is required in case of uncertain colour Doppler ultrasound or for planning carotid artery stenting: MDCT angiography is nowadays
considered a non-invasive alternative to DSA.
Procedure Details: Between June and September 2005, 35 patients with carotid
artery stenosis were examined with MDCT angiography in our department. The
examination was acquired from the circle of Willis to the aortic arch; the post
processing included curved MPR, MIP and VRT reconstructions of the supraaortic vessels. An interdisciplinary team, composed by radiologists and vascular
surgeons, discussed the indications for surgical or endovascular treatment in
every case. 10 patients were considered eligible for endovascular treatment and
successfully underwent carotid artery stenting.
Conclusion: 16-slice multidetector CT angiography with 2D and 3D reconstructions is a valuable tool for decision making of carotid artery stenting or endarterectomy. It can replace DSA in the pre-interventional diagnostic imaging and allows
accurate planning of endovascular procedures.
C-768
MDCT of the thoracic aorta: Post-surgical and post-interventional follow-up
M.A. Politi, P. Rinaldi, R. Marano, C. Di Stasi, N. Luciani, L. Bonomo; Rome/IT
(mpoliti@sirm.org)
Learning Objectives: 1) To illustrate MDCT study protocol for the follow-up of
surgical or endovascular treatment of the thoracic aorta. 2) To describe major
radiological findings. 3) To focus the role of 2D and 3D reformatted images.
Background: While surgical treatment is mandatory in the diseases involving
the ascending thoracic aorta, the development of interventional procedures (covered stent-graft) represents an alternative choice to conventional surgery in the
diseases involving the descending thoracic aorta because of their reduced invasiveness and lower rate of peri- and post-surgical complications. MDCT angiography is the fastest, most accurate and easily accessible noninvasive method to
evaluate both aortic diseases and follow-up of surgical or endovascular treatment, with high spatial resolution, speed and 2D and 3D high image quality.
Imaging Findings: A comprehensive review of post-surgical and post-interventional follow-up of the thoracic aorta with careful analysis of typical CT findings
and pitfalls will be provided. Topics covered will include MDCT technique, aortic
dissection, degenerative aortic aneurysm, aortic coarctation, and penetrating
atherosclerotic ulcer.
Conclusion: MDCT angiography is a reliable noninvasive technique in the
follow-up of surgical or endovascular treatment of the thoracic aorta.
C-769
Atlas of normal and variant vascular 3D anatomy in the abdomen with 64
channel multidetector-CT
P. Sedati, P. Nardis, G. Orgera, M. Anzidei, C. Catalano, R. Passariello;
Rome/IT (psedati@hotmail.com)
Learning Objectives: 1. To illustrate basic splanchnic vascular anatomy and its
variation with multiplanar and 3D imaging using 64 detector row CT. 2. To provide
an atlas of normal and variant vascular 3D anatomy. 3. To illustrate the basic
principle of multiplanar and 3D imaging using 3D workstation and to explain how
to optimize image quality.
Background: Multi-detector CT (MDCT) is now a standard type of clinical CT
483
Vascular
Purpose: Renal artery stenosis may cause secondary arterial hypertension and
end-stage renal disease. Percutaneous transluminal stent angioplasty (PTRAS)
allows effective treatment with high primary technical success rates. This study
focuses on the additional value of perfusion analyses as assessed with multidetector computed tomography angiography (CTA) in the follow-up after renal
artery stenting.
Materials and Methods: 33 consecutive patients after primary successful PTRAS
of a main renal artery underwent CTA. The initial contrast medium bolus series
for bolus tracking was used for perfusion imaging by placing one additional region of interest in the cortex of each kidney. We then calculated 4 perfusion parameters. The morphological assessment was based on the analysis of source
images as well as standard reconstructions (MIP, CPR)
Results: The morphological analysis revealed in 5/33 stented arteries (15.2%) a

stenosis of 0-50%, in 1 (3%) 51-75%, in 2 (6.1%) 76-99% and 1 occlusion (3%).
Mean relative HU-max was 63.7 29.7, the mean HU-ratio 0.37 0.12, the mean
time-to-peak (TTP) was 32.9 s 7.4 s and the mean TTP-ratio 0.76 0.10. None
of these parameters was significantly different between patients with and those
without hemodynamically significant restenoses.
Conclusion: None of the evaluated perfusion parameters adds any useful information in the follow-up after renal artery stenting.

scanner. Appropriate post-processing of MDCT images enables the efficient gathering of much more information than by just evaluating thin source images. Postprocessing techniques are useful in clinical, pre-surgical situations and for
educational purposes. However, incorrect use of these techniques may hide important information.
Imaging Findings: Recognition of abdominal vascular anomalies on imaging is
important because several such variants may be associated with specific clinical
symptoms, syndromes and other pathologic processes.
Conclusion: Major vascular anomalies that involve the systemic arterial and venous systems of the abdomen are reviewed with emphasis on key imaging findings and differential diagnostic features that allow for differentiation from other
abnormalities.
C-770
Multi-detector row computed tomography and three-dimensional
reformation techniques in the evaluation of the cava system
Learning Objectives: To describe the normal anatomy and embryonic origins of
the superior vena cava, inferior vena cava and their main tributaries. To illustrate
comprehensively the multi-detector computed tomography (MDCT) spectrum of
findings in multiple congenital and acquired anomalies of the caval system. To
outline three-dimensional image reformation methods as powerful adjuncts in
the depiction of the complex anatomy of these vessels.
Background: MDCT and 3D reformation techniques are evolving as powerful
non-invasive tools in the assessment of the systemic venous system. Shorter
acquisition times, greater coverage and reduced scan width provide superior image
resolution of the tortuous anatomy of the superior vena cava, inferior vena cava
and their main tributaries.
Imaging Findings: The authors review comprehensively the spectrum of findings of multiple congenital anomalies and acquired diseases of these vessels,
based on the experience of our tertiary care hospital. Advantages and limitations
of MDCT in the evaluation of the caval system are discussed and illustrated.
Conclusion: MDCT and 3D reformation techniques can depict accurately the
caval system anatomy and related diseases. Familiarity with image findings is
fundamental to avoid potential diagnostic pitfalls and eventual complications during therapeutic procedures.
C-771
Whole body angiography using 64-slice computed tomography in patients
with atherosclerosis
S. Kanao, E. Tadamura, M. Yamamuro, K. Togashi; Kyoto/JP
(kanaos@kuhp.kyoto-u.ac.jp)
Purpose: To evaluate the feasibility of whole body angiography using 64-slice
computed tomography.
Methods and Materials: Forty patients with atherosclerotic disease (carotid artery stenosis, aortic aneurysm or dissection, renovascular stenosis and artherosclerosis obliterans) underwent whole body CT angiography with a 64-slice
scanner. A total of 100 ml intravenous contrast agent (350 mgI/ml) was injected
(30 ml at 3.5 ml/s, then 70 ml at 2.8 ml/s) followed by a 20 ml chaser bolus. The
scan delay was determined using an automatic bolus tracking system. A helical
scan was performed from head to toe. CT attenuation values of twelve arterial
segments were measured. We evaluated the whole artery by dividing them into
three regions; supraaortic vessels, aorta or renal arteries, and infraaortic vessels.
Results: The mean values of internal carotid arteries, aortic arch, abdominal
aorta, renal arteries, common iliac arteries, superficial femoral arteries and popliteal arteries were 383, 380, 349, 318, 374, 299, and 337 HU, respectively. 469
of 478 arterial segments (98.1%) were over 200 HU. Six segments of superficial
femoral artery, three of popliteal artery were under 200 HU, but minimum CT
value was 169 HU. Twenty one of 40 patients (52.5%) had atherosclerotic lesions
in more than two regions.
Conclusion: Whole body angiography is feasible using a 64-slice CT. Whole body
angiography will contribute to the understanding of distribution and progression
of atherosclerotic lesions.
Vascular
C-772
MR venography in the chest and abdomen
E. de Kerviler, O. Mathieu, C. de Bazelaire, M. Albiter, V. Nahon, P. Bourrier,
A.-M. Zagdanski, J. Frija; Paris/FR (eric.de-kerviler@sls.ap-hop-paris.fr)
Learning Objectives: To illustrate the different techniques to visualise thoracic
and abdominal veins with MR imaging. To overview various pitfalls in MR venography. To describe the best indications and results of each MR venography technique.
Background: Contrast-enhanced CT is the method of choice for analysing deep
vessels in the chest or abdomen. However, iodine contrast media may be contraindicated and MR imaging represents a useful alternative tool for examining deep
veins. Because of flow phenomenon, non-linear relationship linking MR signal
with gadolinium concentration, and the need for an optimal acquisition window,
the success of the examination requires careful sequence planning and a good
knowledge of the questions to answer.
Procedure Details: MR venography relies on black blood, white blood, or contrast-enhanced techniques. The first two techniques only allow assessment of
venous patency and provide anatomical landmarks, whereas contrast-enhanced
techniques provide venograms. At first pass or at second pass of a gadolinium
bolus, the concentration of the contrast agent, the injection rate and the sequences
are different. Sequences may be pure MRA sequences sensitive to high concentration of gadolinium or parenchymal sequences compatible with lower concentration. Therefore, they must be carefully selected to match contrast concentration
and acquisition window.
Conclusion: The aim of this exhibit is to show an overview of the various MR
venography techniques, to provide the reader with some important take-home
points from comprehensive clinical cases, and to describe common pitfalls easy
to avoid.
C-773
Magnetic resonance imaging for the lower extremity venous abnormalities
J. Koizumi, T. Horie, I. Muro, M. Orii, K. Shimizu, N. Yanagimachi, J. Endo,
T. Ichikawa, Y. Imai; Isehara-city/JP (jkoizumi@is.icc.u-tokai.ac.jp)
Learning Objectives: To learn the appropriate magnetic resonance sequences
and postprocess techniques for the demonstration of the anatomical and pathological details of the lower extremity veins.
Background: Prior to surgery or endovascular therapy for lower extremity varicose veins or deep venous thrombosis (DVT), ultrasonography provides useful
information. But it depends on the operator's technique and each image is limited
to the small area and is subjective. Thus magnetic resonance imaging is now
available for the gross and objective demonstration of these lesions.
Procedure Details: Using a 1.5 Tesla machine, fat suppressed 3D coronal balanced turbo field echo (bTFE) is mainly applied in the semisupine position. For
DVTs, direct thrombus imaging (DTI) using fat suppressed 3D coronal inversion
recovery-prepared blood suppressed gradient echo sequence is added. Gadolinium enhancement on DTI or fluid attenuated inversion recovery (FLAIR)- bTFE
sometimes follows. The original images are transferred to a workstation and 3D
images are reconstructed using maximum intensity projection (MIP) including
the soap bubble (SB), multiplanar reconstruction (MPR), and volume rendering
(VR) techniques.
Conclusion: Varicose veins on the muscle fascia are easily recognized on VR
and the perforating veins can be identified on MIP and axial MPR. The signal
intensity of DVT depends on the clot's age on DTI and is sometimes confusing on
bTFE. After gadolinium administration, blood shows higher signal intensity than
clots regardless of the age and DVT can be easily depicted as filling defects on
the axial DTI and summarized on SB-MIP.
C-774
The role of MR angiography for the diagnosis and follow-up of Takayasu
arteritis
M. Malamas, A. Gyftopoulos, E. Protopapa, K. Georganas, G. Delimpasis;
Athens/GR (tassosg@hotmail.com)
Learning Objectives: 1. To evaluate the role of MR imaging in Takayasu arteritis.
2. To describe the best indications and approval criteria for MR imaging. 3. To
review the basic concepts of Takayasu arteritis and the technique of three dimensional (3D) MR angiography. 4. To demonstrate the important advantages of MR
imaging over CT and conventional angiography in Takayasu arteritis.
484

Background: Takayasu arteritis is a rare disease; it is a form of large vessel
vasculitis (chronic granulomatous) with a possible autoimmune origin that may
cause stenosis of the aorta and its major branches. Six types of Takayasu arteritis are recognized, the type depending on the affected aortic branch. Clinical
features of the disease include diminished pulses, claudication, hypertension,
and mesenteric angina. Conventional angiography has been the gold standard
for diagnosis and evaluation of Takayasu arteritis. Magnetic resonance (MR) angiography can effectively demonstrate thickening of the vessel wall, which may
be the earliest manifestation of the disease, occurring before stenosis and dilatation. On the other hand conventional angiography demonstrates only the lumen
of the vessel.
Procedure Details: Magnetic resonance imaging was performed on a 1.5 Tesla
scanner. The MR imaging technique included T2-weighted fat-suppressed multiplanar sequences, pre- and postcontrast T1-weighted fast spoiled gradient-echo
(FSPGR) and MR angiography to evaluate luminal narrowing and dilatations.
Image interpretation was done with the aid of a computer workstation. Postprocessing techniques were performed, such as multiplanar volume reformation, MIP
reformation, and volume rendering.
Conclusion: MR angiography is a reliable tool for the diagnosis and follow-up of
Takayasu arteritis.
C-775
Hemodialysis access fistulas: MR angiography evaluation
L. Zugaro, A. Catalucci, A. Giordano, N. Limbucci, E. Di Cesare, C. Masciocchi;
L'Aquila/IT
Learning Objectives: 1) To provide MRA technique for evaluating permanent
hemodialysis access fistulas of the forearm. 2) To explore the possibilities of MRA
in the diagnosis and grading of hemodialysis fistula stenosis.
Background: The patency of permanent hemodialysis access fistulas of the forearm is limited; with time, stenotic complications often compromise access function. Recognizing these complications is important to preserve the access.
Evaluation of the vascular anatomy is fundamental for surgical or interventional
treatment planning. Color Doppler ultrasound is usually the first step for diagnosis and treatment planning. It provides both morphological and functional information but DSA is still the gold standard. MRA has been proposed as a
non-invasive alternative to DSA to evaluate the arterial and venous structures.
We performed MRA in 23 patients with suspected haemodialysis forearm access
dysfunction. The degree of stenosis was evaluated with a 3 point scale (1=mild;
3=severe); we compared MRA and ultrasound results.
Procedure Details: We used a 1.5 T unit (Philips Intera) and performed the examinations with the knee coil. We propose a protocol based on both 3D-PC technique (VENC 30 cm/sec) before and after iv GD injection, and 3D-FFE-T1
sequence during iv GD injection (CE-MRA). MIP reconstructions were always
obtained. We observed a good correlation between MRA and ultrasound findings. MRA always showed the entire fistula with an excellent evaluation of the
stenosis. In 2 cases MRA showed stenoses missed by ultrasound. CE-MRA proved
more useful than PC-MRA.
Conclusion: MRA is an effective tool to evaluate hemodialysis fistula complications, being a valid alternative to diagnostic DSA.
C-776
Evaluation of pulmonary vessels by MR imaging
G.K. Schneider, P. Fries, B. Kramann, R.M. Seidel; Homburg a.d. Saar/DE
(ragsne@uniklinikum-saarland.de)
C-777
Efficacy of three-dimensional contrast-enhanced magnetic resonance
angiography (3D CE-MRA) in the diagnosis of thoracic outlet syndrome
E. Unlu, D. Demirbag-Kabayel, F. Ozdemir; Edirne/TR
(drercument@yahoo.com)
Purpose: We evaluated a group of patients with suspected thoracic outlet syndrome (TOS) by using three-dimensional contrast-enhanced magnetic resonance
angiography (3D CE-MRA) during arm abduction and adduction.
Methods and Materials: Twenty-two consecutive patients with clinical symptoms
of neurovascular TOS were examined in the 1.0 T MR unit (Siemens, Erlangen,
Germany). Of those, 17 (77.2%) were female, and 5 (22.8%) were male. Their
average age was 38.8 years. Examinations were obtained by using 3D CE-MRA
technique with the arms abducted (n = 22) and adducted (n = 22). After acquisition, MIPs images were produced for each phase. In this way, 44 arms were
evaluated for possible subclavian artery and/or vein pathologies.
Results: Image quality was optimal in the majority of cases. Venous overlapping
was seen in the first phase of the study in 3 patients, but there was no diagnostic
difficulty. Fifteen of 44 subclavian arteries (39%) were found to have impingement or stenosis of different degrees. Majority of lesions were localized at the
costoclavicular region. Venous phase sequences of 3D CE-MRA showed compression of the subclavian vein in 17 areas. Three patients, however, had normal
MRA examinations.
Conclusion: TOS remains a controversial diagnosis, particularly in patients with
no muscle atrophy, hand ischemia findings or venous stasis symptoms. 3D CEMRA is noninvasive and the technique does not require ionizing radiation or administration of iodinated contrast material. Compression and stenosis of the
subclavian vessels may be diagnosed early without the need for any invasive
procedures.
C-778
Evaluation of dialysis access shunts: Comparison of three non-contrast
enhanced techniques of MR angiography
H. Takahashi1, T. Aoki1, Y. Korogi 1, M. Yokoyama1, T. Inenaga1, M. Miyazaki2;
1
Kitakyushu-shi/JP, 2Otawara-shi/JP (hiroyuki@med.uoeh-u.ac.jp)
Purpose: To determine the clinical feasibility and utility of non-contrast enhanced
MR angiography (MRA) for evaluation of dialysis shunts.
Methods and Materials: Both MRA and digital subtraction angiography (DSA)
was performed in 22 patients with dialysis shunts using a 1.5-T MR system. Three
MRA methods, a 2D time-of flight (TOF), arterial spin labelling (ASL) and fresh
blood imaging (FBI), were compared and evaluated in terms of focusing on the
visualization of feeding arteries, anastomoses and stenosis of draining veins.
The MR visibility of the three methods was rated using a four-point grading scale
(excellent = 3, good=2, fair = 1, poor = 0) and compared to DSA as the gold standard.
Results: Of 22 draining veins 14 were stenosed and 8 were normal. The average
scores in all patients for visualization of feeding arteries and anastomoses were
2.7 and 1.0 with TOF, 1.9 and 0.7 with FBI, 0 and 0 with ASL, respectively. In 14
patients with stenosis of draining veins, the average scores were 2.7 with TOF,
0.9 with FBI, and 0.1 with ASL. Ten of 14 stenoses of draining veins were delineated most clearly by TOF. Two stenoses were equally visualized by using TOF
and FBI. In the remaining 2 cases with severe stenosis and resulting in slow
blood flow, only FBI allowed delineation of stenosis.
Conclusion: The 2D TOF MRA seems feasible and sensitive for the examination
of dialysis shunts; whereas FBI may be valuable in cases with severe draining
vein stenosis.
485
Vascular
Learning Objectives: This exhibit demonstrates the potential of MR imaging for

the evaluation of arterial and venous pulmonary vessels in the context of a large
variety of cardiovascular or pulmonary disease.
Background: Within the last few years, MR imaging has gained more and more
importance in the field of vascular imaging. Unenhanced and contrast enhanced
MR angiography can provide important morphological as well as functional information of vascular structures on the basis of a non-invasive approach.
Imaging Findings: Multiplanar imaging techniques as well as 3D contrast enhanced MR angiography will be demonstrated for the characterisation of the pulmonary vasculature in a large spectrum of underlying pathologies.
MR imaging for the characterisation of congenital vascular abnormalities has
become a basic diagnostic tool. Intra- and extralobar sequestration, anomalous
venous return, pulmonary sling abnormalities, arterio-venous fistulae and malformations, veno-lobar syndrome and others are demonstrated. Secondary vascular changes due to acute or chronic embolic disease or pulmonary vein
thrombosis leading to pulmonary hypertension will be illustrated. Pathologies such
as tumors of the pulmonary arteries or secondary infiltrating tumors will be pre-
sented. Moreover, the work up of patients post surgery with congenital diseases
or tumors will be included.
Conclusion: MR imaging as a non-invasive procedure is an excellent diagnostic
procedure for the characterisation of complex vascular structures such as in congenital cardiovascular disease. Furthermore, morphologic as well as functional
aspects in acquired disease can be depicted in a large variety of pathologies
without the disadvantages of invasive procedures and the use of ionizing radiation.

C-779
Vascular
The role of time-resolved magnetic resonance angiography in

hemodynamic evaluation of vascular pathologies
E. Maj, A. Cieszanowski, W. Szeszkowski, O. Rowinski, R. Tworus, M. Szostek;
Warsaw/PL (em26@wp.pl)
Peripheral
Purpose: To assess the quality of images obtained with the use of time-resolved
MRA and to evaluate the haemodynamic information provided by this technique.
Methods and Materials: The study group included 120 patients (75 men, 45
women) suspected of having different vascular diseases, excluding intracranial
and peripheral vessels. All patients underwent time-resolved MRA. Two radiologists evaluated MRA studies, assessing the quality of the images on a 3 point
scale (3-good, 1-poor), as well as the presence or absence of haemodynamic
information (3-dynamic information important for the diagnosis, 2-unimportant
dynamic information, 1-lack of dynamic information) for different vascular pathologies. Results were correlated with other imaging techniques: DSA (n = 44), CTA
(n = 26), Doppler ultrasound (n = 73) and intraoperative findings (n = 4). Studies
were performed on 1.5 T-unit with the use of 3D MRA technique.
Results: There was concordance between time-resolved MRA results and the
standard of reference in 116 cases (97%). Four false negative results were noted. Mean quality of MRA examinations was 2.96 (reader A and B) and was similar for different pathologies. The mean grading (reader A and B) for the presence
of dynamic information was more than 2 for the following pathologies: Pseudoaneurysm of abdominal artery (3), subclavian steal syndrome (3), vascular malformation (3), Leriche syndrome (2.5), renal artery stenosis (2.06), aortic dissection
(2.05); and it was less than 2 for: Pelvic arterial occlusive disease (1.6), abdominal aortic aneurysm (1.25) and carotid artery stenosis (1.24).
Conclusion: Time-resolved MRA provides images of good quality, enabling reliable diagnosis of vascular pathologies and providing often important haemodynamic information.
C-780
Vascular compression syndromes: A pictorial review
R.A. Lavis, N.E. Manghat, P. Suresh, C.A. Roobottom; Plymouth/UK
(robert.lavis@nhs.net)
Learning Objectives: To identify the role of radiology in imaging both common
and rare vascular compression syndromes and to recognise their imaging characteristics.
Background: Vascular compression syndromes are rare. The vessel in question
can be the subject or the cause of compression. They are often unexpected findings in the search for the cause of common symptoms. As such, the radiologist
must bear them in mind when interpreting image datasets.
Imaging Findings: We present a series of patients and their imaging findings,
predominantly in the form of contrast enhanced multi slice computed tomography
(CEMSCT), but also utilising ultrasound, conventional angiography and video
clips from MSCT angiography. The diagnoses include, among others: 'Nutcracker' compression of the renal vein, superior vena cava compression, bronchial
compression, medial arcuate ligament syndrome, dysphagia lusoria, myocardial
bridge and vascular dissection.
Conclusion: Vascular compression syndromes can be rare but important causes of some common symptoms and are readily recognised, especially in CEMSCT, if the radiologist is aware.
C-781
Imaging of aortic dissection: Atypical features and potential pitfalls
M.D. Crema, L. Monnier-Cholley, S. Ederhy, A. Cohen, J.-M. Tubiana, L. Arriv;
Learning Objectives: To describe the atypical features of aortic dissection. To
discuss the potential pitfalls with CT and MR imaging.
Background: Aortic dissection is a cardiovascular emergency that requires prompt
diagnosis and treatment. CT and MR imaging assessments allow diagnosis of
aortic dissection with a sensitivity and specificity of nearly 100%. Diagnosis of
aortic dissection with CT and MR imaging is easy in typical cases, when true and
false channels are clearly separated by the intimal flap. Imaging usually enables
differentiation between proximal (Stanford type A) and distal aortic dissection
(Stanford type B). However, diagnosis can be more difficult to confirm or rule out
in atypical cases or when potential pitfalls are present, simulating or hiding aortic
dissection. We reviewed the CT and MR imaging examinations of patients with
suspected or known aortic dissection examined at our institution, from February
2002 to August 2005.
Imaging Findings: A variety of pitfalls were encountered that mimicked or hid
aortic dissection. These pitfalls were attributable to streak artifacts generated by
high-attenuation material, high-contrast interfaces, or cardiac motion in CT examinations; periaortic structures (e.g., mediastinal veins, pericardial recess); aortic
wall motion; aortic variations such as congenital ductus diverticulum; when calcifications did not follow the intimal flap; and when the false channel was thrombosed. We also discuss atypical cases of aortic dissection.
Conclusion: We illustrate the atypical cases and potential pitfalls in the diagnosis of aortic dissection imaged with CT and/or MR imaging that may lead to incorrect interpretation. Familiarity with these pitfalls will help to avoid misdiagnosis.
C-782
Automatic vessel analysis of carotid artery stenosis by three dimensional
rotational angiography (3DRA): Comparison with selective angiography
(SA)
F. Pozzi-Mucelli, M. Doddi, A. Calgaro, F. Degobbis, M. Cova; Trieste/IT
(pozzi-mucelli@libero.it)
Purpose: To verify if the "automatic vessel analysis" (AVA) tool of 3DRA workstation is able to reduce interobserver and intraobserver variability in the evaluation
of carotid artery stenosis in comparison to standard evaluation done on AP/LL
SA.
Methods and Materials: 40 patients underwent DSA for evaluation of carotid
artery stenosis preliminarily detected on CDUS. In all cases rotational angiography with 3D reconstructions on a separate workstation was done and SA in AP/
LL projections was obtained as gold standard. Three readers evaluated the stenosis degree using ECST, NASCET and common carotid (CC) criteria on 3D images (on monitor) using AVA tool and SA (on film) independently and after two
486

weeks. The results were statistically evaluated with T Student and Bland-Altman
Test.
Results: Average degree of stenosis evaluated by three readers in two separate
evaluations for 3DRA was: ECST: 34/36%, 35/36%, 37/39%; NASCET: 23/25%,23/
23%,24/26%; CC: 48/51%, 46/53%,51/57%, while for SA was: ECST: 45/52%,41/
44%,48/53%; NASCET: 35/36%, 33/34%, 43/45%; CC: 51/59%,55/55%,59/61%.
A statistically significant difference was observed between 3DRA and selective
angiography (p < 0.05). The interobserver Bland-Altman evaluations showed a
bias of 0.40 with a standard deviation bias of 5.11 for 3DRA, while bias for SA
was -3.04 9.44. The intraobserver Bland-Altman evaluation showed a bias of
1.5 5.04 in 3DRA and a bias of -11.67 19.97 in SA.
Conclusion: ECST, NASCET and CC evaluations done with 3DRA tend to underestimate the degree of stenosis in respect to SA. However interobserver and
intraobserver variability in grading of carotid artery stenosis was significantly reduced by the automatic evaluation tool.
C-783
Cost benefit analysis of magnetic resonance arteriography compared with
digital subtraction angiography in the diagnosis of peripheral arterial
disease
A.E. Haworth1, S. Powell1, S. Clayton 1, A.E. Healey2, A. Camenzuli1,
G. Flintham1, J. Hannah 1; 1Liverpool/UK, 2Toronto, ON/CA
(ae_haworth@yahoo.co.uk)
Learning Objectives: Digital subtraction angiography (DSA) is the gold standard for diagnosis of peripheral arterial disease. However, with the development of
magnetic resonance angiography (MRA) it may now be possible to achieve similar standards of imaging, without requiring ionising radiation and an interventional procedure.
Background: Peripheral arterial disease accounts for many hours of interventional theatre time and is a major cause of morbidity and mortality in Europe. With
many departments moving towards non invasive imaging we will consider the
advantages and limitations of an MRA based system compared to the current
gold standard and allude to other factors relating to patient well-being. Our cost
benefit analysis derived from data pertaining to 2004 and 2005.
Procedure Details: From 1 st April 2004 - 31st March 2005 the department performed 512 angiograms. These included 484 transfemoral angiograms and 28
MRA's of the lower limbs. Using current standings and costs we calculated the
yearly total (inc. angioplasties) for these procedures as 348,722.15. If MRA was
used in the first instance this figure would fall to an estimated 182,425.60 without and 313903.96 with angioplasty. This is a saving of 34,818.19 per annum.
The qualitative data is also described in our exhibit.
Conclusion: MRA reduces expenditure by 34,818.19 per year. Our data does
not reflect any impact on the increased workload of the MR Dept, and this would
need to be assessed in the future.
C-784
Three-dimensional anatomy of the maxillofacial arteries on flat-detector
angiographic CT (FACT)
H. Takano, H. Funatsu; Chiba/JP (hfunatsu@chiba-cc.jp)
Vertebral artery waveform patterns and the subclavian steal phenomenon:

Study of 33 cases
J.P. Penedo, J. Ferreira; Lisbon/PT (jpfpenedo@gmail.com)
Purpose: Our goal was to classify and analyse changes in the Doppler vertebral
artery waveform tracing suggesting subclavian steal phenomenon, considering
the high prevalence of atherosclerotic disease in our country and the rarity of this
entity.
Methods and Materials: During 7 years, 33 patients (23 men and 10 women)
referred to vertebral artery Doppler examination due to vertebrobasilar or arm
symptoms were found to have changes indicating subclavian steal physiology.
According to Doppler findings, they were divided into 3 groups: Reduced antegrade vertebral flow (group 1), bidirectional vertebral flow (group 2) and predominantly retrograde vertebral flow (group 3). The hemodynamic significance of these
changes depending on the side affected and the importance of manoeuvres like
the blood pressure cuff test are also analysed.
Results: 14 (43%) patients were classified into group 1, 12 (36%) in group 2 and
7 (21%) in group 3. Left vertebral artery was involved in 27 (82%) cases and in all
groups 3 patients, which should be evaluated considering the normal anatomy of
the aortic arch and great vessels.
Conclusion: Doppler ultrasound is a valuable and non-invasive technique for
vertebral artery examination in the scope of atherosclerotic disease. In our study
we found an important group of waveform patterns already considered to indicate a more serious stenotic involvement (group 2 or 3) stressing the importance
of evaluating asymptomatic Portuguese patients with risk factors for atherosclerotic
disease.
C-786
Acute aortic pathology: Spectrum of imaging findings
J. Incio, T. Almeida, J. Gallego, S. Mendes, A. Silva, P. Campos; Lisbon/PT
(joao.r.inacio@gmail.com)
Learning Objectives: To illustrate the imaging spectrum of aortic pathology that
can present in the acute emergency setting, with particular emphasis on the acute
aortic syndromes. To outline the value of the various imaging techniques in the
assessment of this group of patients, emphasizing the rationale of a dedicated
computer tomography (CT) protocol, the complementary role of trans-oesophageal echocardiography (TOE) and the place for magnetic resonance (MR) in the
follow-up.
Background: Acute aortic syndromes comprise a group of distinct pathological
conditions that usually manifest with similar clinical symptoms. The development
of various imaging technologies (CT, MR and TOE) has allowed the identification
of classic aortic dissection, intramural haematoma and penetrating atherosclerotic ulcer as a group of different pathological entities that can present with chest
"aortic" pain. Imaging methods can reliably differentiate these entities with important implications in the management and prognosis. Acute complications of chronic
aortic disease can also present as vascular emergencies where imaging plays a
crucial role on the diagnosis and management.
Procedure Details: Review of the literature and pathological, surgical and imaging correlation of selected typical and atypical cases which presented in the emergency department of our institution, from January 2003 to December 2005 with
the clinical suspicion of acute aortic pathology.
Conclusion: Imaging diagnosis of acute aortic pathology depends on the complementary role of various imaging techniques based on the identification of particular signs. Current imaging technologies allow for good correlation between
imaging and anatomopathological findings, allowing a confident early diagnosis.
C-787
Classification and treatment of malperfusion syndromes in aortic
dissections
F. Thony, M. Rodiere, V. Monnin, T. Martinelli, R. Hacini, D. Blin, G.R. Ferretti;
Grenoble/FR (fthony@chu-grenoble.fr)
Learning Objectives: To understand the mechanisms of malperfusion syndromes
(MS) in aortic dissection (AD). To know the CT scan features of MS and their
evolving risks. To understand the different endovascular techniques used to treat
these MS.
Background: A MS occurs in 10-30% of AD and it increases the mortality rate to
50%, compared to 30% without MS. Surgical treatment has been considered to
relieve these MS but the mortality rate is high: 50-88%. Endovascular treatment
has been proposed but the techniques used are somewhat difficult and need a
good understanding of the mechanisms of MS.
487
Vascular
Learning Objectives: To describe the three dimensional anatomy of the maxillofacial arteries and relationships between the arteries and bony structures based
on a series of 11 flat-detector angiographic CT's (FACT). To outline the advantage and limits of the FACT.
Background: Recently, flat-detector angiographic CT (FACT) has been developed. This can show finer vascular structures than MSCTs. The better performance has increased the ability of radiologists to accurately assess the anatomy
of the maxillofacial arteries in their evaluation for intra-arterial injection therapy
and embolization therapy of maxillofacial tumors.
Procedure Details: We performed FACT of 3 craniofacial subtraction angiography studies and of 8 cerebral subtraction angiography studies covering the maxilla, using DynaCT (Siemens, Germany). We studied three-dimensional
reconstructions of ACT. Three-dimensional volume rendering, maximum intensity projection (MIP) and multiplanar reformats were performed. Dual volume method
was also used for evaluation of small arteries. The middle meningeal artery, accessory meningeal artery, middle deep temporal artery, infraorbital artery and
sphenopalatine artery were recognized on all reconstructions of FACT. On three
FACT's, pterygovaginal artery was visible within the pterygovaginal canal, which
was seen upon superimposing cropped bony reconstructions.
Conclusion: All FACT showed the major maxillofacial arteries. Good subtraction
FACT gives more information than two-dimensional digital subtraction angiography. Three-dimensional reconstruction was very helpful for recognizing small arteries and for intervention.
C-785

Imaging Findings: This work exposes the dynamic and static mechanisms of
MS with different illustrations and cases. The different CT scan features with their
evolving risks are presented. For each hemodynamic configuration, the different
endovascular techniques that can be performed are detailed and demonstrated
with different clinical cases.
Conclusion: CT scan allows for complete and precise investigation of MS in AD.
This precise evaluation is the basis for endovascular treatment that is to date, the
first line treatment in MS.
C-788
Multislice CT (MSCT) and MRI venographic findings of Klippel-Trnaunay
syndrome: Correlation with conventional venography
G. Bastarrika, A. Martnez-Cuesta, J.J. Noguera, D. Cano, A. Sierra, O. Cosn,
P. Redondo; Pamplona/ES (bastarrika@unav.es)
Learning Objectives: To describe MSCT and MR imaging venographic findings
in patients with Klippel-Trnaunay syndrome (KTS). To demonstrate the correlation of these findings with conventional venography. To present the most common
venous abnormalities of KTS such as deep venous absence or hypoplasia, venous dilatations, duplications and varicosities. To emphasize the usefulness of
MSCT and MR imaging venography for the pretherapeutic planning.
Background: KTS is a constellation of signs which manifests as cutaneous vascular nevus of the affected extremity, venous malformations and soft tissue and
bony enlargement. In this syndrome, vascular malformations are typically combined with persistence of abnormal superficial veins associated with deep venous hypoplasia and duplications and cutaneous capillary malformations.
Traditionally, plain films, ultrasonography, MR images and conventional angiographic techniques have been employed for the evaluation of KTS. New diagnostic techniques have added new perspectives for the pretherapeutic planning.
Imaging Findings: Development of MSCT and MR imaging angiography have
allowed non-invasive global evaluation of patients suffering KTS. In this exhibit
MSCT and MR imaging venographic anatomy of patients with KTS is presented.
Examples of most common venous abnormalities by MSCT and MR imaging
venography and their correlation with conventional venography is shown, emphasizing the role of non-invasive techniques for the pretherapeutic planning.
Conclusion: MSCT and MR imaging venography allow the non-invasive assessment of venous anatomy in patients suffering KTS, being useful angiographic
techniques for complete pretherapeutic evaluation of these patients.
C-789
3D computer model of the sapheno-femoral junction: Anatomy, patterns of
incompetence and surgical consequences
M. Alvarez Perez, J.M. Abadal Villayandre, S. Gonzalez Cabestreros,
L. Jimenez Juan, A. Hernandez Lezana, I. Rodriguez Jimenez; Leganes,
Madrid/ES (mariajesusalvarez@yahoo.es)
Learning Objectives: Illustrate a 3D computer reconstructed model of the sapheno-femoral junction (SFJ).
Learn the anatomy and common anatomical variants of the SFJ.
Understand the patterns of reflux of the SFJ in order to define the most appropriate treatment.
Background: The SFJ is a complex venous confluence in the groin and an important connection between the deep and the superficial venous systems.
A 3D-computer model helps to understand the anatomy and common anatomical
variants that are found when color Doppler ultrasound is performed.
Pathophysiology of venous insufficiency secondary to valvular reflux and within
tributary veins of the SFJ is shown. These findings are essential before planning
surgery or endovascular treatment.
Varicose vein recurrence after surgery of the SFJ is also reviewed.
Procedure Details: Normal SFJ and varicose vein recurrence at this site have
been reviewed in 490 patients.
After clinical examination a color Doppler ultrasound has been performed. Examinations have been carried out in decubitus and supine positions, with Valsalva
and pressure manoeuvres. A team of vascular radiologists, vascular surgeons
and informatics have designed a 3D computer model, based on the imaging and
hemodynamic recorded data, for teaching purposes.
Conclusion: A 3D computer model of the SFJ has proved useful for sonographers to understand the complex anatomy of the SFJ and the pathophysiology of
venous insufficiency.
488
C-790
Doppler ultrasonography mapping of varicose veins in the lower extremity:
Comparison study with three-dimensional CT venography
W. Lee, J. Chung, Y. Yin, J. Park, H. Jae; Seoul/KR (leew@radiol.snu.ac.kr)
Purpose: To reveal the accuracy of Doppler ultrasonography mapping of varicose veins by comparison with three-dimensional CT venography.
Methods and Materials: In 50 consecutive patients with varicose veins in their
lower extremities, Doppler ultrasonography mapping and CT venography were
performed. One experienced radiologist performed all Doppler ultrasonography
examination. All pathways of varicose veins and all significant perforators were
mapped and. CT venography was performed with multi-detector-row spiral CT
with 3 minutes scan delay. Three-dimensional volume rendering images were
reconstructed. We analyzed the detection rate of perforators and varicose pathways of Doppler ultrasound compared with CT venography as a gold standard.
Results: There were 74 affected limbs in 50 patients. One mild deep-seated varicosity was missed by ultrasonography. In CT venography, there was a total of
242 perforators larger than 2 mm. The overall Doppler ultrasonography detection
rate of perforators larger than 2 mm is 92.6%. Doppler ultrasonography missed
more than one perforator in 20.2% limbs with varicosities. There were 62 insufficient perforators found in 62% patients. There were 150 varicose pathways in 74
affected limbs and Doppler ultrasonography detected 138 channels. The Doppler
ultrasonography detection rate for varicosity pathway is 92 %. Doppler ultrasonography missed 12 channels in 10 limbs.
Conclusion: The detection rate of Doppler ultrasonography is 92.6% for perforators and 92% for varicosity channels.
C-791
Early detection of cardiovascular disease: Carotid intima-media thickness
by high resolution B-mode ultrasonography
I. Diez, C. Alvarez, A. Marco, M. Gamo, F. Aguilera, C. Izquierdo;
Alcala de Henares/ES (cherry-septiembre@hotmail.com)
Learning Objectives: Description of the protocol. Value of carotid intima-media
thickness (IMT) findings by high resolution B-mode ultrasonography. To determine its importance in early detection of cardiovascular disease. To discuss and
illustrate the spectrum of appearances and extension on grey-scale ultrasound
of the atheromatous plaques. Pitfalls and artifacts.
Background: Studies show a close relationship between the progression of coronary disease and the carotid intima-media thickness (IMT). Carotid B-mode ultrasonography permits the evaluation of lumen diameter, intima-media thickness,
and presence and extent of plaques, which are clearly connected with an increase in the risk of angina, stroke and myocardial infarction, aneurysms and
peripheral vascular disease.
Procedure Details: To describe US technique and how to measure the IMT. To
review the range of morphological stages of the vascular wall obtained by high
resolution US. Description of spectral analysis and IMT categories. This helps to
quantify the severity and development of atherosclerosis disease. High resolution ultrasonography informs about the plaque composition and its susceptibility
to break and embolize. To discuss the results, artefacts and limitations of this
method. To describe the potential pitfalls of the findings of US in the diagnosis of
cardiovascular disease.
Conclusion: High-resolution B-mode ultrasonography for carotid intima-media
thickness (IMT) is an easy non-invasive technique for evaluation of risk of cardiovascular disease.
C-792
CT findings in inflammatory deep vein thrombosis
M.D. Crema, L. Monnier-Cholley, L. Azizi, M. Lewin, J.-M. Tubiana, L. Arriv;
Learning Objectives: To describe the CT findings in inflammatory deep vein
thrombosis. To allow recognition of this entity in order to avoid pitfalls and misdiagnosis.
Background: Deep vein thrombosis (DVT) and inflammation are closely related.
DVT is a common finding in CT examinations. Rarely, DVT can present as a
marked inflammatory reaction around the thrombus. Such inflammatory changes
related to DVT can mimic neoplastic conditions. In this exhibit we illustrate the CT
features of chronic DVT associated with marked inflammatory reaction.
Imaging Findings: We searched, in the records of our university hospital, for
patients with chronic deep vein thrombosis initially misdiagnosed. We observed
inflammatory aspects of DVT in several locations including inferior vena cava,
jugular, innominate, ovarian, portal, and mesenteric veins. Definite diagnosis was

obtained by long term follow-up and/or pathological examination. We describe
two patterns of inflammatory DVT, a massive form presenting as a tissue-density
mass with mass effect on surrounding structures and an infiltrating form. Thrombosed vein is usually non visible in the massive form but is always visible in the
infiltrating form, responsible for an infiltration of surrounding tissue.
Conclusion: DVT with marked inflammatory reaction may create a confusing
appearance and occasionally mimic neoplastic conditions. This entity needs to
be known to radiologists in order to avoid misdiagnosis.
C-793
64-slice CT angiography of the supra-aortic vessels: Spectrum of findings
A.J.B.S. Madureira, I.M. Ramos; Porto/PT (ajbmadureira@clix.pt)
Learning Objectives: To discuss the proper technique of performing CT angiography of the supra-aortic vessels with a 64-slice scanner. To review the postprocessing tools and techniques available. To review the imaging findings of the
most important and frequent vascular pathologies encountered. To discuss the
impact of 64-slice CT-angiography in the current evaluation of patients suspected
of having pathology of the supra-aortic vessels.
Background: The recent developments in multislice CT and post-processing techniques are making CT angiography (CTA) of the supra-aortic and intra-cranial
vessels an excellent imaging modality in the assessment of pathology in these
areas.
Procedure Details: In order to obtain high quality examinations it is mandatory
to optimize the imaging parameters and protocols. Multislice CTA protocols used
in the evaluation of the supra-aortic vessels are discussed. Key imaging findings
are reviewed and illustrated based on our experience with a 64-slice CT scanner
(Siemens Sensation 64 Cardiac, Germany). In this presentation, we summarize
our current approach to the imaging evaluation of the supra-aortic vessels, review the pertinent imaging findings and discuss the limitations of CT imaging as
well as pitfalls in diagnosis.
Conclusion: CTA of the supra-aortic vessels is a valuable imaging modality and
is replacing digital subtraction angiography as the modality of choice in the evaluation of the supra-aortic vessels.
C-794
Functional tests performed under color Doppler ultrasound monitoring in
the evaluation of arterial vessels reactivity
L. Stefanczyk, B. Wozniakowski, A. Antosik, A. Majos, M. Olszycki, P. Grzelak;
Lodz/PL
Background: Evaluation of the arterial vessel function is conducted in order to
determine early the individual predisposition to arteriosclerosis. It is hypothesized that one of the predisposing causes of arteriosclerosis is a defect in NO
secretion by the endothelium. This endothelial dysfunction can be observed during functional tests monitored during an US-CD. Aim of the study was to investigate arterial reaction in different age groups during the most commonly used
tests: ischemic test and nitrate stimulation.
Procedure Details: 94 healthy volunteers were examined (male 18-70 age), with
a low risk of a cardiac event (according to the SCORE scale). We analyzed the
diameter of the brachial artery and the spectrum flow on this level. Next, an ischemic test (controlled ischemia for a duration of 4.5 min performed using sphygmomanometer cuff) and nitrate stimulation (one sub-lingual dose of glycerol trinitrate)
was performed. We found significant increases in both arterial diameter and in
flow during tests, especially maximum systolic velocity and early diastolic velocity (statistically significant difference). We determined a significant difference in
the arterial reaction in different age categories (gradual increase of initial vessel
diameter and decrease of their elasticity).
Conclusion: Functional tests can show the gradual decrease of the arteries functional reserve, with advancing age. There is variability in time of onset of the
reaction among different age groups; a reading taken 120 seconds after the NTG
administration most reliably differentiates between the age groups. The most useful
and reliable estimation parameter is early diastolic velocity.
Background: We observed five patients with a lusorian artery, mostly asymptomatic, but one suffered dysphagia and one had subclavian steal syndrome. We
also scanned the literature. We found only one full description of steal syndrome
caused by lusorian artery in the recent literature. It however referred to two older
references. Nevertheless, "dysphagia lusoria" was a frequently described complication.
Imaging Findings: Lusorian artery is the right subclavian artery with the origin
distal to the left subclavian artery and a retroesophageal course. The diagnosis
is usually confirmed by angiography, but CT also shows an abnormal vascular
structure posterior to the esophagus. They sometimes also reveal a retroesphageal stenosis of the artery. The most common symptom is dysphagia, due to the
compression on the esophagus, usually confirmed as a posterior notch on an
esophagogram or during endoscopy. Duplex ultrasound detects subclavian steal
syndrome, if present.
Conclusion: Lusorian artery is a variation of aortic arch, which, according to
autopsy findings, affects some 1% of the population. However, most patients are
asymptomatic. Some patients suffer dysphagia, due to the posterior indentation
of the esophagus. Very rarely, subclavian steal syndrome may also occur, accompanied by difference in blood pressure between both arms. The treatment is
either conservative or surgical (usually extrathoracic carotid - subclavian anastomosis). Endovascular treatment is sometimes also considered.
C-796
Prediction of the occurrence of subclavian arterial and brachiocephalic
arterial stenosis in logistic regression models for use in the preoperative
evaluation of coronary arterial bypass procedure
N. Funabashi, M. Asano, I. Komuro; Chiba/JP (funanobu2005@yahoo.co.jp)
Purpose: Internal thoracic arteries (ITA) are often used in coronary artery bypass grafts (CABG). But pre-CABG evaluation of subclavian (SCA) and brachiocephalic (BA) arteries is not standard. We evaluated predictors of occurrence of
stenosis of BA or proximal SCA in logistic regression models.
Methods and Materials: 76 subjects (39 males, 36-83 years-old) underwent
MSCT for the presence of luminal stenosis (> 50%) of BA and SCA. A logistic
model for predicting occurrence of stenosis of BA or SCA was constructed using
age, sex, CRFs (hypertension [HT], diabetes mellitus [DM], hyperlipidemia [HL],
smoking habits, obesity) and presence of anginal symptoms or calcified and noncalcified plaque (CP, NCP) in coronary arteries.
Results: Stenoses of BA (n = 0) or proximal right (n = 2) or left (n = 11) SCA
were detected in 11 subjects (4 males, mean 71 years. Mean number of CRFs
2.4: 64% with HT, 55% DM, 45% HL, 55% smoking habit, 18% obese; 18% had
anginal symptoms, 82% had CPs, 18% NCPs). The numbers of CRFs, the incidence of DM, HL, smoking, anginal symptoms, and CPs were significantly higher
in subjects with stenosis of these arteries than those without. In a logistic regression model, female gender and presence of smoking were associated with increased occurrence of stenosis of BA or SCA (relative risks 108.7 and 79.7,
P < 0.05 respectively).
Conclusion: The occurrence of stenosis of BA or SCA was significantly influenced by female gender and the presence of smoking. Therefore before planning
the use of ITA in CABG, it would be wise to evaluate these arteries.
Vascular
C-795
Lusorian artery: Anatomy, clinical repercussions, imaging findings and
treatment
A. Krnic, Z. Sucic, F. Jelavic-Kojic, T. Krpan, T. Sucic; Zagreb/HR
(anton.krnic@zg.t-com.hr)
Learning Objectives: To remind the reader of the lusorian artery as an anatomical variation. To describe dysphagia lusoria and subclavian steal syndrome as
possible clinical repercussions. To demonstrate radiological methods of examinations and findings. To review the methods of treatment.
489

Vascular
Visceral
C-797
CT and MRI of acquired and congenital portal venous system disorders
I. Lupescu, R. Capsa, N. Masala, M. Grasu, N. Campeanu, S.A. Georgescu;
Bucarest/RO (ilupescu@hotmail.com)
Learning Objectives: To present CT and MR imaging aspects of normal anatomy, variants and different pathologies involving the portal venous system. To describe the imaging appearances of intrahepatic vascular communications. To
recognize liver perfusion disorders associated with changes in portal vein hemodynamics.
Background: For liver surgery and interventional procedures it is necessary to
have correct mapping of normal anatomy and variants and to recognize congenital and acquired disorders of the portal venous system.
Imaging Findings: Over a period of 5 years, we have reviewed 725 cases of
portal venous system abnormalities explored by helical CT and 160 cases explored by MR imaging. 40 cases were explored by both methods. MPR and MIP
reconstructions were used to evaluate portal venous disorders. Anatomical variants: Trifurcation-5 cases, right anterior portal vein from left portal vein-1 case
and right posterior portal branch from the main portal vein-2 cases. Congenital
anomalies: Agenesis of portal vein-3 cases. Acquired abnormalities: Portosystemic collateral vessels in portal hypertension-75% cases, cavernous transformation of the portal vein after thrombosis-10% cases or in cases of congenital
agenesis of the portal vein-3 cases. Intrahepatic vascular communications: Portosystemic shunts-2 cases, arterioportal shunts-10 cases, arteriosystemic shunts3 cases. Aneurysms of the portal venous system -3 cases. Portal vein
thrombosis-25% cases. Presence of gas in the portal venous system-1 case.
Conclusion: Biphasic helical CT is useful to evaluate perfusion disorders of the
liver associated with portal venous system pathologies. MR imaging can aid in
diagnosis of these conditions and in particular cases is complementary to helical
CT evaluation.
C-798
The spectrum of tumoral vein invasion and thrombosis in patients with
neoplastic disease
E. Testempassi, G. Katsou, M. Kalomenopoulou, V. Vantali, D. Chondros;
Athens/GR
Learning Objectives: To illustrate the radiological signs of major venous obstruction either by invasion, compression by neighboring neoplasms or thrombosis. To review the US, CT and MR imaging findings of major venous invasion and
thrombosis by common and uncommon neoplasms. To evaluate possible side
effects and imaging consequences of obstruction of major veins.
Background: Thromboembolism or vein invasion are commonly recognized in
patients with neoplastic disease. Vein obstruction may be due either to invasion
of a vein from a neighboring tumor or to systemic thromboembolic disease which
is seen in most cancer types.
Imaging Findings: We classified the veins in five areas: Head and neck, thorax,
abdomen, pelvis and extremities. The most common cancer types seen in patients with vein involvement are breast, colorectal, lung, pancreas, ovary and
brain. The side effects of venous obstruction and their imaging consequences
are shown. Pulmonary thromboembolism and systemic thromboembolic disease
are also discussed. US, CT and MR images are shown and morphologic criteria
for venous thrombosis and invasion are depicted. Obstruction of the internal jugular
vein, cavernous sinus and cerebral sinuses is depicted. In the region of the thorax, abdomen and pelvis, obstruction of the superior vena cava, internal mammary veins, azygos, inferior vena cava and right atrium, portal and hepatic veins,
superior mesenteric vein, renal, iliac and gonadal veins is considered. In the extremities, obstruction of the axillary, femoral and popliteal veins is presented.
Conclusion: The Radiologist must be familiar with imaging features of venous
obstruction and thrombosis.
C-799
Helical CT and conventional chest radiography findings in mediastinal
vascular anomalies
J. Quintero, I. Guasch, C. Pozuelo, A. Olazabal, D. Mulattieri, M. Romero;
Badalona/ES (jquintero@bsa.gs)
Learning Objectives: To describe the normal vascular anatomy of the mediastinum and to describe the mediastinal vascular anomalies. To present the correla-
490
tion between the conventional chest radiography and helical CT of the mediastinal vascular anomalies. To review the literature of the mediastinal vascular (arterial and venous) anomalies.
Background: We reviewed all the reports over the last three years of thoracic
CTs done at our institution. We selected the cases in which mediastinal vascular
anomalies were present and these were retrospectively reviewed by two radiologists who were unaware of conventional chest radiography and helical CT findings.
Generally, studies had been carried out with: 7-mm collimation, pitch: 1.5, 100 mL
of contrast medium, rate: 2.5 mL/sec, delay: 25-30 sec. From July 2002 to July
2005 we found 4210 consecutive thoracic CTs. We encountered 98 cases (2.32%
of the studies) of mediastinal vascular anomalies.
Imaging Findings: 1. Venous anomalies: of the SVC - azygos lobe (25), left SVC
persistent (16), right brachiocephalic vein vertical (2), left brachiocephalic vein
retroaortic (1), isolated pulmonary venous anomalous drainage (3) and absence
of the hepatic segment of the IVC with azygos/hemiazygos continuation (8) 2.
Arterial anomalies: Aberrant right subclavian artery (30), right aortic arch (8),
double aortic arch (5).
Conclusion: Mediastinal vascular anomalies are very common. Knowledge of
these is essential to avoid diagnostic pitfalls.
However, conventional radiographic appearances of normal and abnormal vascular structures can be misinterpreted as representing neoplasms and this can
lead to inappropriate diagnostic procedures. Helical CT is the technique of choice
if an abnormal mediastinal contour is present.
C-800
Imaging of porto-systemic venous shunts in patients with portal
hypertension: Spectrum of findings using a 64 MDCT scanner
P. Sedati, G. Pelle, L. Paciucci, F. Macri', M. Anzidei, C. Catalano,
R. Passariello; Rome/IT (psedati@hotmail.com)
Learning Objectives: 1) To illustrate multidetector CT reconstructions of collateral venous channels. 2) To review the anatomy of porto-systemic shunts. 3) To
have a better understanding of the pathophysiology of portal hypertension and
its implications.
Background: Portal hypertension may be defined as a portal pressure gradient
of 12 mm Hg or greater and is often associated with varices and ascites.
The portal vein drains blood from the small and large intestines, stomach, spleen,
pancreas and gallbladder. The superior mesenteric vein and the splenic vein unite
behind the neck of the pancreas to form the portal vein. The portal trunk divides
into 2 lobar veins. The right branch drains the cystic vein, and the left branch
receives the umbilical and paraumbilical veins that enlarge to form umbilical varices
in portal hypertension. The coronary vein, which runs along the lesser curvature
of the stomach, receives distal esophageal veins which also enlarge in portal
hypertension.
Procedure Details: To assess the capability of 64-channel MDCT to demonstrate porto-systemic shunts in patients with portal hypertension. 20 patients with
liver cirrhosis and portal hypertension underwent 64-channel MDCT to evaluate
suspected liver nodules using thin collimation. Scan parameters were: 0.6 mm
collimation, 1 mm slice thickness, 0.4 mm recon increment. We administrated
oral contrast medium and pre-contrast, arterial, portal and delayed phases were
obtained on each patient. Images were reconstructed with VR, MPR and MIP
algorithm.
Conclusion: The accuracy of the reformatting process was compared to anatomical planes.
C-801
Demonstration of the right adrenal vein at multi-detector row helical CT
M. Tsuboi; Furukawa/JP
Purpose: Adrenal venous sampling is a very useful examination for diagnosing
primary aldosteronism. To understand the accurate location of the right adrenal
vein before sampling is helpful to catheterize to it. We assessed the ability of
multi-detector row helical computed tomography in depicting the right adrenal
vein.
Methods and Materials: CT images of fifty-six patients with hypertension examined were retrospectively reviewed. CT images were with the following parameters: 0.5 seconds per rotation, 1-mm collimation, pitch factor 0.68. Adrenal venous
phase and hepatic venous phase were acquired and obtained after intravenous
bolus administration of 100 ml and 3 ml/sec. The transverse sections were reconstructed with following 2 patterns: 1) 1-mm slice thickness at 0.5-mm interval,
2) 5-mm slice thickness at 5-mm interval. The visualization of the right adrenal
vein was investigated.

Results: In 48 (86%) of the 56 patients, at least a single right adrenal vein was
clearly visualized arising from the inferior vena cava or hepatic vein in the 0.5 mm
interval group. And in 17 (30%) patients, single right adrenal vein was clearly
visualized in the 5 mm interval group.
Conclusion: Thin slice images using multi-detector row helical CT with intravenous contrast material depicts the right adrenal vein in a high percentage of patients.
Vascular
Miscellaneous
C-803
Should patients with atherosclerotic diseases be screened for lung cancer?
P. Nardis, A. Napoli, F. Calabrese, G. De Filippis, C. Catalano, R. Passariello;
Rome/IT (p.nardis@libero.it)
Purpose: To retrospectively evaluate the incidence of primary lung cancer in
patients with symptomatic atherosclerotic vascular disease undergoing multidetector-row computed tomography angiography (MDCTA).
Methods and Materials: From January 2001 until September 2004, 894 MDCTA-examinations were evaluated. 771 patients presented significant atherosclerotic disease (172 women and 599 men; age 41-96). CTA was required for carotid
artery stenosis (n = 299), thoraco-abdominal aortic aneurysm (n = 44), thoracic
aortic aneurysm (n = 36), abdominal aortic aneurysm (n = 207) and lower extremity arterial disease (n = 185). Scan volume always included the lung apices
in the examination of carotid arteries, the lung bases when examining the abdominal aorta and run off vessels, and the entire lung in cases of thoracic aortic
disease. Lung nodules or masses suspected to be malignant were evaluated by
the observers and biopsy was performed. Study population incidence was compared to the data obtained in healthy subjects aged > 40 y living in the same
metropolitan area (incidence 118.3/100.000 - 0.12%).
Results: Lung cancer was found in 18 patients, 12 men and 6 women; the incidence was 2.3% with an increased relative risk with respect to healthy subjects,
as much as 20-fold for primary lung cancer. When considering each sex separately, we found 2% incidence in males and 3.5% in females, where the relative
risk was as high as 9-fold and 124-fold respectively.
Conclusion: Our study showed a higher incidence of lung cancer in patients with
symptomatic atherosclerotic disease. This study suggests extending the CT scan
for vascular patients, to include the entire lung parenchyma using a very low
dose.
C-804
Normal findings at spectral and color Doppler ultrasound (US) imaging:
What the beginner needs to know
M. Certo, M. Frana, R. Themudo, M. Gomes, F. Reis, R. Machado,
A.M. Ribeiro; Porto/PT (manuelacerto@sapo.pt)
491
Vascular
Learning Objectives: To review basic spectral and color Doppler principles. To

illustrate and explain the normal findings at spectral and color Doppler US examinations of the abdominal, pelvic, peripheral and cervical vessels.
Background: Doppler US includes detection, quantification and medical evaluation of tissue motion and blood flow using the Doppler effect.
The instrumentation has evolved to provide more information about hemodynamics. The algorithms and the instrumentation used are complex. We will try to simplify these concepts and explain the normal blood flow patterns in different blood
vessels.
Imaging Findings: The most common form of Doppler US is color Doppler imaging. Pulsed-wave US spectrum displays the maximum, minimum and average
calculated blood flow velocities. The pulsatility index, resistive index and systolicto-diastolic ratio are calculated from these values.
The internal carotid artery supplies the low resistance circulation of the brain and
demonstrates flow similar to that in vessels supplying other organs (liver and
kidneys). The common feature in all low resistance arterial waveforms is that a
large quantity of forward flow continues throughout diastole.
The normal findings in the upper extremity veins mirror those seen in the lower
extremity veins. The normal portal vein demonstrates an undulating hepatopetal
flow. The normal blood flow in the inferior vena cava and hepatic veins is phasic
in response to the cardiac and respiratory cycles. In women, uterine perfusion
shows a high-velocity, high-resistance pattern.
Conclusion: Doppler US is a challenging technique. It is crucial to understand
the normal blood flow dynamics.

C-805
Angle of origin of the internal carotid artery as determinant of carotid
atherosclerosis: Age gene/environment susceptibility (AGES) study
L.P. Asgeirsdottir 1, M.L. Bots2, H.D. Birgisdottir1, R. Meijer2, M. Chang1,
A.T. Gudmundsdottir1, G. Eiriksdottir1, T. Harris3, V. Gudnason1; 1Kopavogur/IS,
2
Utrecht/NL, 3Bethesda, MD/US (liljapetra@hjarta.is)
Purpose: We studied whether the origin of internal carotid artery (ICA) relates to
atherosclerotic plaque formation in the internal carotid artery.
Methods and Materials: The angle of the origin of ICA was routinely collected
during the ultrasound examination with the Meijers carotid arc. Plaque information was coded into none, minimal, moderate and severe. Common carotid intima-media thickness (CIMT) was assessed as well as established cardiovascular
risk factors. Right carotid artery measurements only were considered.
Results: Data were available on 1151 participants, aged 66-93 years (mean 76
years), 423 men and 728 women. Mean CIMT was 0.96 mm. Mean ICA plaque
score was 2.14 (SD 1.1) A dorsal/dorsomedial origin of the ICA was significantly
related to severity of plaques in the ICA: mean plaque score was 0.16 higher
[95% CI 0.02-0.32] compared to other angles of origins (adjusted for age and
sex). Further adjustment for smoking, blood pressure, height, weight, cholesterol, previous CVD, diabetes did not affect the relation: mean difference was 0.20
[95% CI 0.05-0.35]. ICA origin showed an inverse relation with the far wall CIMT,
and a positive relation with the near wall.
Conclusion: Our study shows that the origin of the ICA is a major determinant of
atherosclerosis in an elderly population. This finding was independent of established risk factors.
C-806
The brain focal impairment and hemodynamic parameters in relation to the
type of collateral supply
F. Todua, D. Gachechiladze, M. Beraia; Tbilisi/GE
Purpose: To study the relationship between collateral flow via different pathways
and cerebral hemodynamic parameters in patients with unilateral high-grade internal carotid artery (ICA) changes.
Methods and Materials: 41 patients with severe stenosis and 30 patients with
occlusion of ICA underwent brain MRT, 3D-TOF-MRA, color Doppler of extra and
intracranial vessels was performed to investigate collateral flow via the circle of
Willis (anterior communicating (AComA) and posterior communicating (PComA)
arteries) and via the ophthalmic artery (OphA). Blood flow velocities (V) in the
middle, anterior, posterior cerebral arteries (MCA, ACA, PCA) and pulsatile indexes (PI) were measured.
Results: Investigation revealed collateral flow via the AComA in 56 cases, and
only via the PComA in 15 cases. Whether patients without collateral flow via the
circle of Willis or flow via the PComA only have a high incidence of brain infarction (13 (85%)) and impaired hemodynamic parameters in the MCA (V mean38 sm/s, PI-0.69), than patients with collateral flow via the AComA (2 infarctions,
Vmean-44 sm/s, PI-0.77).
Patients with reversed OphA flow could prove an additional risk for infarction. In
patients with antegrade ACA flow, VACA was normal or slightly low, hemispheric
VACA/VMCA=0.76; but where ACA flow was reversed, the VACA increased and
VACA/VMCA=1.35.
Conclusion: Patients with collateral flow via the PComA and reversed OphA
flow have more impaired hemodynamic parameters and higher risk of brain infarction than patients with collateral flow via the AComA. Complex use of TCCD
and 3D-TOF-MRA gives all the necessary information about type and hemodynamic parameters of collateral supply in high-grade ICA changes.
C-807
Clarify vascular enhancement technology in vascular 2D ultrasound
E. de Luis, J.J. Noguera, A. Villanueva, M. Elorz, M.J. Pons, A. Benito;
Learning Objectives: To teach and familiarise radiologists with the Clarify
vascular enhancement (VE) technology imaging in US. To show how Clarify
VE improves ultrasound image quality of macro and microvasculature in any organ accessible with ultrasound.
Background: Clarify VE is a new technology (Siemens Medical Solutions) based
on a sophisticated algorithm that provides advancements in vascular B-mode
imaging. Clarify VE technology uses power Doppler information to enhance Bmode tissue resolution and reduce partial volume artefacts in two-dimensional
ultrasound imaging throughout the region of interest.
Imaging Findings: This exhibit compares regular ultrasound images and Clari-
492
fy VE findings of neck and abdominal lesions. A pictorial description of neck

and abdominal lesions, including thyroid, liver, biliary tract, pancreas, kidney,
spleen, pelvis and vascular lesions in a prospective study using vascular B-mode
and Clarify VE techniques is provided. Images were obtained using an US
scanner (Antares Siemens, Germany).
Conclusion: Clarify VE technology helps to depict tissue and vasculature
including vessels of all structures. Clarify VE provides better visualisation of
abdominal vessels when compared with vascular B-mode, especially renal arteries. A big advantage of this application is the better resolution of vessel wall
pathology.
C-808
Doppler assessment of hemodynamic changes after radial optic neurotomy
in non-ischemic central retinal vein occlusion
B. Kaderli, N. Bolca Topal, . Gelisken, R. Avci; Bursa/TR
(nailebolca@yahoo.com)
Purpose: To assess the blood flow changes after radial optic neurotomy (RON)
in non-ischemic central retinal vein occlusion (NICRVO).
Methods and Materials: The maximum systolic and end-diastolic blood flow velocities (BFVs) and resistance index in the ophthalmic, central retinal and posterior ciliary arteries and the maximum and minimum BFVs in the central retinal
vein (CRV) were measured in 13 eyes undergoing RON and in 13 contralateral
unaffected eyes before and 1 week, 1, 3 and 6 months after RON.
Results: Three and 6 months after surgery, maximum BFVs of the CRV in affected eyes were significantly higher than the preoperative values (p < 0.05). The
preoperative, 1 week and 1 month values of maximum BFV of the CRV were
significantly lower in affected eyes when compared to the unaffected eyes
(p < 0.01, p < 0.01 and p < 0.05 respectively).
Conclusion: The BFVs of the CRV improved after RON in eyes with NICRVO.
C-809
Three dimensional road mapping (3DRM) for deployment of intravascular
stents: Technical note
F. Pozzi-Mucelli, M. Belgrano, M. Coss, E. Makuc, M. Cova; Trieste/IT
(pozzi-mucelli@libero.it)
Learning Objectives: To describe the technical aspects of a new modality of
road mapping which enables deployment of stents in a three-dimensional environment.
Background: Three dimensional roadmapping is an evolution of common roadmapping and it is a new function available in 3D elaborations starting from rotational angiography acquisition. Fundamental operations to perform 3DRM are:
- rotational angiography of the artery to be stented with the guide-wire already
inserted across the lesion;
- elaboration of the 3D image in the colour gradient rendering mode with evidence of only lumen wall;
- activation of the 2D-3D display mode (contemporary visualization of the fluoroscopy over the 3D image).
Procedure Details: We evaluated 3DRM in ten cases of iliac artery stenting
done either with ipsilateral or contralateral approach. Stenting was successful in
all cases. However, problems were observed in the first cases done without insertion of the guide wire through the lesion because of significant modification in
the vessel position which was noted in the phase of stent deployment when a stiff
guide wire was in place (especially in cases done with a contralateral approach).
Another important requirement is patient cooperation.
Conclusion: 3DRM is a valid tool which needs a learning curve for the operator
who wants to use it. It could be useful in selected cases where correct positioning
of a stent is crucial.
Scientific Exhibits - ECR Research Grant Winners

ECR Research Grant Winners
C-812
C-810
Non invasive quantitative assessment of tumor angiogenesis with contrast

enhanced functional ultrasound imaging (fUSI)
O. Lucidarme, Y. Badachi, E. Jouannot, A. De Oliveira, S. Mule, P. Grenier,
S. Bridal; Paris/FR
Multislice spiral computed tomography for assessment of myocardial

viability in myocardial infarction
A.H. Mahnken, J.E. Wildberger; Aachen/DE
Purpose: Multislice spiral computed tomography (MSCT) allows for the detection of acute myocardial infarction (MI). Early perfusion deficits as well as delayed-enhancement on MSCT have been reported to correlate to the presence of
acute MI. The aim of our study was to evaluate the MSCT appearance of subacute and chronic MI applying different examination protocols.
Material and Methods: In 14 pigs reperfused acute MI was created by balloon
occlusion and reperfusion of the LAD. Contrast-enhanced ECG-gated 16-slice
CT of the heart was performed 0, 7, 28 and 120 days after the procedure. Images
were acquired in the arterial phase and 5, 10, 15 and 30 minutes after administration of contrast material. All animals underwent late enhancement MRI after
administration of 0.2 mmol Gd-DTPA/kg/bodyweight. The size of MI was compared between the different imaging techniques using the Bland-Altman method.
Contrast between infarcted and normal myocardium was compared with multivariate analysis.
Results: All pigs underwent MSCT 2h after MI. 7 pigs died within one week after
the procedure. 7/14 pigs underwent all MSCT and MRI examinations. Mean infarct size on delayed-enhanced MSCT images at 0, 7, 28 and 120 days was
47.2 17.1mm3, 49.8 14.9mm3, 68.8 22.2mm3 and 69.6 34.1mm3, respectively. Bland-Altman plots showed a good agreement between MRI versus MSCT
late-enhancement. Average contrast between infarcted and normal myocardium
on delayed-enhanced MSCT images acquired at 5, 10, 15 and 30 minutes after
contrast injection was 22 12 Hounsfield Units (HU), 39 21 HU, 34 17 HU
and 11 10 HU, respectively. Multivariate analysis revealed significant differences between the different points of image acquisition (p < 0.0001).
Conclusion: Contrast-enhanced MSCT allows for the reliable assessment of subacute and chronic MI. The amount of contrast material and the selection of the
scan delay have a substantial impact on the image quality.
C-811
Proton MR spectroscopy of breast tumors: in vivo 1.5-T and ex vivo 9.4-T
study
A. Fausto1, G. Carpinelli2, P. Baccini3, E. Iorio2, F. Podo2, F. Sardanelli1;
1
Milan/IT, 2Rome/IT, 3Genoa/IT
C-813
Fluorinated gases for measurement of lung ventilation in 19F-MRI
U. Wolf, A. Scholz, K. Markstaller, W.G. Schreiber, C.P. Heussel; Mainz/DE
Purpose: The aim was to improve the gas application procedure and SNR in
dynamic breathhold imaging. Delayed wash-in of the contrast gas as well as long
TA were major drawbacks. Emphasis was put on both removal of residual gases
from the tubing as well as shortening of the TA.
Material and Methods: A number of pilot studies were performed in anesthetised healthy pigs, which were ventilated with 30% O2 and 70% C2F6 or SF6
mixtures. The tubing system was completely filled with the gas mixture prior to
connection to the endotracheal tube. FLASH projection imaging was done on a
1.5 T MRI during and after gas wash-in at inspiratory hold (TA=2 s). Furthermore, images were acquired after wash-in at several medium receiver bandwidths
with NEX down to 1.
Results: After modification of the application procedure, no more delay was observed for the wash-in of the gas mixtures. Furthermore, TA could be shortened
to 2s leading to a measuring cycle of 5 s for performing a single-breath and an
inspiratory hold during acquisition. First comparing studies suggest that C2F6 is
more suitable for medium receiver bandwidths than SF6. After wash-in, for scan
times less than a second, images of appreciable SNR could be obtained.
Conclusion: We report considerable improvements in 19F-MRI with breathhold
imaging: gas application procedure was simplified and image quality has attained
a good level. These improvements push the 19F-imaging-technology a significant step forward towards a low budget-easy-to-use research tool in pulmonary
imaging.
C-814
In vivo investigation of fetal lung maturation with magnetic resonance
imaging
C. Balassy, G. Kasprian, P.C. Brugger, M. Weber, B. Csapo, C. Mittermayer,
D. Prayer; Vienna/AT
Purpose: To determine the signal intensity behaviour of the normal fetal lung on
different MR imaging sequences and to analyze the predictive value of the data
in the assessment of lung maturation.
Materials and Methods: T2wTFE, three different T2wTSE, T1wFFE and FLAIR
sequences were acquired in 126 singleton pregnancies (20th-37th gestational
weeks). Signal intensity ratios (SIR) of lung/liver (LLSIR) and lung/gastric fluid
(LGSIR) were correlated to gestational age (GA) using Pearsons correlation.
Mean differences between the SIRs of five age groups were assessed by the
Kruskal-Wallis test. Differences between the SIRs of fetuses with mature and
immature lungs were analyzed using the Mann-Whitney U-test. Logistic regressions of LLSIRs and LGSIRs were performed to predict the stage of the lung
493
esear
ant Winner
s
ECR R
ch Gr
Winners
esearc
Resear
Grant
Purpose: To characterize breast lesions using in vivo proton MRS at 1.5 T and
ex vivo high-resolution magic angle spinning (HR-MAS) proton MRS at 9.4 T. To
investigate ex vivo HR-MAS proton MRS in assessing different choline compounds
in relation to pathologic findings.
Subjects and Methods: Nineteen patients scheduled for breast surgery were
enrolled to undergo proton MRS using at 1.5 T (Sonata, Siemens). A single-voxel
water- and fat-suppressed point resolved spin-echo sequence was used. Row
data were processed using a dedicated software Numaris 4, 2002B (Siemens
AG). During imaging-guided core-biopsy, one or two specimens (about 10 mg)
were obtained for HR-MAS proton MRS at 9.4 T (Bruker Spectrospin) using a
spectrometer equipped with a MAS probe. Samples were spun at 2.5 kHz and
acquisitions obtained using a one-dimensional spin-echo sequence with water
saturation (cpmgpr, Bruker).
Results: Out of 22 lesions in 19 patients were studied, core-biopsy pathologic
examination revealed 10 malignancies, 7 benignancies, and 5 of them are in
progress. In vivo MRS showed choline containing compounds (Cho) peak in all
the 10 malignancies and in 4 of 7 benignancies. While 19 tissue samples were
put in liquid nitrogen immediately after dissection and stored for MRS analysis,
HR-MAS proton MRS spectral analysis of 2 IDC showed Cho peaks near to
3.2 ppm different from those of a case of sclerosing adenosis.
Conclusion: Ex vivo 9.4 T HR-MAS MRS could be useful in solving the Cho
peak overlapping between benign and malignant lesions that we have in vivo at
1.5 T, increasing specificity.
Purpose: To determine potential, pitfalls and limitations of fUSI when used to

measure angiogenesis using a model of Wilms tumor in the nude mouse.
Methods and Materials: To date, Wilms tumors cells were injected under the left
kidney capsula of 20 nude mice. When tumors became detectable, 2 bolus with
2-107 and 1 with 4-106 microbubbles of SonoVue were manually injected and
fUSI was performed using a Sequoia (CPS, 14 Mhz). Continuous acquisitions at
Low-MI during the bolus and destruction-reperfusion sequences during the equilibrium phase were performed. A method to minimize respiratory motion artifacts
was developed. Time-linearized-intensity curves from different ROIs were computed. Peak-enhancement (PE), area-under-the-bolus-curve (AUC), initial slope
and plateau of the reperfusion curves were calculated. MVD and area of necrosis
were compared to fUSI results.
Results: Tumors reached a diameter > 5 mm in less than 14 days in 84% of mice.
Due to manual injection of microbubbles an average variation of 25 % of PE
and AUC was seen between 2 injections with the same dose. Attenuation was
negligible at the lowest dose but induced a strong loss of signal in the deep
cortex at higher dose. Vessels were 4-time more numerous in the cortex than in
the tumor leading to an average PE and AUC 8-time higher in cortex than tumor.
Conclusion: Initial stage permitted the development of tools able to correct respiratory motions and to automatically extract time-linearized-intensity curves. It
also emphasized some pitfalls that have to be taken into account to perform reliable fUSI.
Scientific Exhibits - ECR Research Grant Winners

maturation, then specificity, sensitivity and accuracy and positive predictive values were calculated for each sequence.
Results: Correlations with GA were significant for LLSIRs on all sequences, for
LGSIRs on T2wTSE (TE=100 ms and TE=140 ms), and T2wFFE sequences.
LLSIRs were significantly different between fetuses with mature lung and all age
groups of fetuses with immature lung on T2wTSE (TE=100 ms) and on T1wFFE.
LGSIRs showed significant differences only for immature lungs, on T2wTSE
(TE=100 ms and TE=140 ms) and on T2wFFE sequences. Positive predictive
values over 80% were found in T2wTSE (TE=100 ms and 140 ms), T1wFFE and
FLAIR sequences.
Conclusion: SIRs were found to be valuable in monitoring normal fetal lung
maturation MR imaging. LLSIRs appear to be most sensitive to differentiate between mature and immature lung, especially on T2wTSE and on T1wFFE sequences.
C-815
Automatic quantification of bronchi using MDCT: Comparison of FWHM
and EDCE methods on computerized simulations and in vivo bronchi
P.-Y. Brillet1, A. Saragaglia2, C.I. Fetita 2, C. Beigelman-Aubry3, S. Dreuil3,
F. Prteux2, P.A. Grenier3; 1Bobigny/FR, 2Evry/FR, 3Paris/FR
Purpose: Our objective was to compare two segmentation approaches, FWHM
vs. EDCE, permitting quantification of bronchial lumen (LA) and wall (WA) areas.
Methods and Materials: Three-dimensional bronchial computerized simulations
were generated by taking into account different realistic configurations, namely,
various sizes and shapes, vascular contact, 3D orientation, partial volume effect
and scanner point spread function. In vivo data was acquired in 3 patients evaluated
by MDCT, consisting of 37 segmental and subsegmental bronchi, each one being
imaged along 10 cross-sectional thin slices. FWHM and EDCE were applied on
both synthetic and natural databases.
Results: On bronchial simulations, EDCE provided more accurate measurements
than FWHM with variations to predicted values below 5%. On in vivo data, EDCE
provided more reproducible evaluation of LA than FWHM and a lower 10% variation
rated in measurements between 2 contiguous slices (p 0.0001 and p = 0.004,
for LA and WA, respectively).
Conclusion: Using MDCT, EDCE provides a more accurate and reproducible
automatic quantification of LA and WA than FWHM. We highlight the need to
obtain an average value from several measurements in order to minimize the
variations of results between contiguous thin-slices.
494

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Abdominal Viscera (Solid Organs) ............. 322

Scientific and Educational Exhibits

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of the ERCP retrospectively analyzed CT images. The following findings were

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Purpose: To clarify the natural course of LDA, on dynamic CT in chronic liver

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CT and MR findings of the various causes of hepatic capsular retraction: A

Hypervascular hyperplastic nodule in severe alcoholic liver disease and

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biopsy, after a median observation time of 16 months (range, 2-72). In these

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Detecting pathology in hepatic transplants with Doppler ultrasound: A

Evaluation of optimum contrast enhancement by MDCT for hepatic tumor

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Pathologic-radiologic correlation of cystic and cystic-like tumors of the

Learning Objective: To learn the spectrum of cystic lesions of the pancreas. To

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Abdominal Viscera (Solid Organs)

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CT and MRI manifestations of pathologies with fatty components from head

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Spectrum of splenic diseases associated to siderotic nodules: MR

The development and delivery of a postgraduate programme of study for

Learning Objectives: To review the different splenic conditions associated to

Learning Objectives: To learn protocols that take maximum advantage of the

Optimized protocols for contrast-enhanced multidetector CT of the

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Comparison of the diffusion-weighted images using STIR or CHESS as fat

Purpose: To evaluate the role of vascular asymmetry at contrast-enhanced MR

Purpose: The usefulness of diffusion-weighted images (DWI) in the detection

Scientific and Educational Exhibits

Conclusion: The possibility of using a high T1-relaxivity agent for breast MR

Scientific and Educational Exhibits

Segmentally-distributed mammary carcinomas on dynamic MR images:

Methods and Materials: We retrospectively reviewed 47 preoperatively performed

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Scientific and Educational Exhibits

Multislice-CT angiography for preoperative planning of deep inferior

Scientific and Educational Exhibits

lactation are benign in etiology. It is necessary for a prompt evaluation of them

Scientific and Educational Exhibits

Are cancers detected by arbitration different from cancers detected without

Learning Objectives: To offer a detailed pictorial review of metastasis to the

Scientific and Educational Exhibits

Scientific and Educational Exhibits

Scientific and Educational Exhibits

Magnetic Resonance Imaging

Methods and Materials: 24 patients with symptomatic aortic stenosis and no

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Scientific and Educational Exhibits

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Heart transplant patients: Coronary artery evaluation by multi-detector

Learning Objectives: 1. To review the major techniques currently used to stent

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Methods and Materials: 1073 Chinese adult patients undergoing 16-detector

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Learning Objectives: To understand limitations and artifacts of CT coronary