{"paper_id":"03868785-140e-456e-852d-aa628540b94c","body_text":"S145\nScientific Sessions\nB\nScientific Sessions\n(B)\nSession numbers are prefixed by SS.\nPresentation numbers are prefixed \nby the letter B.\nSessions and abstracts are listed \nby days.\nThursday, March 7 .... 149\nFriday, March 8 ......... 215\nSaturday, March 9 ..... 265\nSunday, March 10 ..... 291\nMonday, March 11 ..... 321\nDOI\n \n10 1007/s13244-01 -03 228-x\nInsights Imaging (2013) 4 (Suppl 1):S1 –S S 45 384\n\nScientific Sessions\nS146\n C A D E F\n G\nB\n\nScientific Sessions\nS147\nA\n C D E F G\nB\nThursday, March 7\n\nScientific Sessions\nS148\n C A D E F\n G\nB\nConclusion: AVB relieves outflow obstruction in AS, resulting in balanced flow \nredistribution between NAV and AVB. It represents a valuable and safe alterna-\ntive in high-risk patients with AS ineligible for standard AV replacement or TAVI. \nB‑0003 10:48\nPre- and postinterventional evaluation of cardiac function in patients \nsuffering from mitral regurgitation using cardiac MRI \nP. Krumm, C.S. Zuern, T.H. Wurster, C. Bretschneider, S. Mangold, B. Klumpp, \nA. May, C.D. Claussen, U. Kramer; Tübingen/DE (patrickkrumm@gmail.com) \nPurpose: Consecutive mitral regurgitation after myocardial infarction and second-\nary ventricular dilatation results in a bad prognosis and high surgical risk due to \ncardiac comorbidity. Mitral clipping (MitraClip, Abbott Vascular) is a minimal-invasive \npercutaneous interventional palliative method to reduce mitral regurgitation. The \npurpose of this study was to evaluate pre- and postinterventional cardiac function \nand to quantify the degree of left atrial dilatation.\nMethods and Materials: 21 patients were prospectively included in this study. \nMagnetic resonance imaging (MRI) was performed before and 6 weeks after \nintervention. Cardiac function was evaluated using steady-state free precession \n(SSFP) cine sequences by assessment of enddiastolic volume (EDV), ejection \nfraction (EF). Planimetry of the left atrium (LA) was performed in identical slices in \nfour-chamber view. Paired statistical analysis was applied.\nResults: 16 patients underwent postinterventional MRI. In paired analysis, mean \ndifference in pre- and postinterventional MRI was for EDV -7.5 ml (95% upper \nconfidence interval [UCI] -1.0 ml, 95% lower CI (LCI) -14.1 ml); for EF +3.9% (UCI \n6.8%, LCI 1.0%); for LA -2.6 cm² (UCI -1.5 cm², LCI -3.8 ml) (p < 0.05).\nConclusion: The quantifiable left atrial dilatation decreased significantly as an \nindirect sign of reduced mitral regurgitation. EDV decreased in 81% of the patients. \nPostinterventional ejection fraction improved particularly in patients with initially \nlow EF, in two patients EF did not improve. This can be considered as success \nof the palliative intervention in seriously ill patients. The clinical benefit of a suc-\ncessful MitraClip intervention can be monitored and validated using MRI in clinical \nfollow-up examinations. \nB‑0004 10:57\nPre- and post-interventional analysis of myocardial strain in patients \nundergoing mitral valve clipping using cardiac MRI \nP. Krumm, C.S. Zuern, T.H. Wurster, A. Seeger, S. Mangold, B. Klumpp, \nC.D. Claussen, A. May, U. Kramer; Tübingen/DE (patrickkrumm@gmail.com) \nPurpose: Percutaneous interventional mitral clipping (MitraClip, Abbott Vascular) is \nperformed to reduce mitral regurgitation. Effects of the intervention on myocardial \nstrain were examined with a new feature tracking software.\nMethods and Materials: 20 patients were prospectively included in this study. \nMagnetic resonance imaging (MRI) was performed before and 6 weeks after suc-\ncessful intervention. Myocardial strain analysis was performed using a dedicated \nfeature tracking software (2D CPA MR, TomTec) based on steady-state free \nprecession (SSFP) cine sequences in four-chamber view (4CV) and short axis \n(SA). Longitudinal myocardial strain was evaluated quantitatively using the time-\nto-peak (T2P) and peak value analysis. Paired statistical analysis was applied for \npre- and post-interventional peak and T2P values for each myocardial segment \nand average values.\nResults: 15 patients underwent post-interventional follow-up MRI. In paired strain \nanalysis, arithmetic mean of differences for T2P was 63.3 ms (± 100, 7 ms), for \nstrain peak values 3.2% (± 8.2%). Arithmetic mean of differences for peak values \nin apical segment 17 was 12.16%, in segment 14 apical septal 9.2%. Arithmetic \nmean of differences for T2P in apical segment 17 was 103.8 ms, in segment 14 \napical septal 188.9 ms.\nConclusion: MitraClip intervention changes myocardial strain patterns: longitudinal \nstrain T2P was reached 63.3 ms later in post-interventional analysis. However, peak \nvalues in longitudinal strain increased, particularly in apical segments. Increased \nstrain values indicate a more effective myocardial contraction after clipping. A \nslower T2P for all myocardial segments might be due to the afterload is elevated \nrelatively by reducing the regurgitation fraction with mitral clipping. \n10:30 - 12:00  Room B \nCardiac \nSS 103 \nCT and MRI in preoperative and postoperative \nevaluation \nModerators: \nG.A. Krombach; Giessen/DE \nR. Sanz-Requena; Valencia/ES \nB‑0001 10:30\nMultiparametric functional MRI for postoperative follow-up in \npatients with the ROSS-procedure: comparison of the aortic root \nreplacement versus the subcoronary implantation technique \nC.O. Ritter1, U. Baier1, S.P. Sommer1, R. Leyh1, H. Köstler1, D. Hahn1, \nM.J. Beer2; 1 Würzburg/DE, 2Graz/AT (meinrad.beer@medunigraz.at) \nPurpose: The ROSS procedure is an elegant therapeutic alternative for repair of \nsevere aortic valve disease. Until now, only sparse information is available concern-\ning the outcome of the different surgical approaches like the aortic root replacement \n(ARR) or the subcoronary implantation (SC) technique.\nMethods and Materials: 62 consecutive MR examinations of 16 patients with \noperated severe aortic stenosis were acquired on a 1.5 T MR scanner 7-10 days \n(early), 3 (middle 1), 6 (middle 2) and 12 (late follow-up) months after ROSS opera-\ntion. 8 patients (43±11 yrs) had the ARR-technique, 8 patients (49±7 yrs) the SC. \nMorphometric and functional parameter were acquired by SSFP (cinematography, \nLGE) and GRE (flow analysis) sequences.\nResults: Regression of LV mass was observed in all patients (p < 0.01) at early \nand middle follow-up without difference between both techniques (p= 0.141). Only \nslight changes of LV ejection fraction were observed without differences between \nboth subgroups. Significant increases of the aortic orifice area were observed in \nthe early and middle follow-up, more pronounced for patients with the SC technique \n(4.6±1.4 cm2 ARR and 3.1±0.5 cm2 SC early follow-up versus 5.2±1.8 cm2 ARR \nand 4.0±1.1 cm2 middle follow-up). Mean aortic regurgitation was 11% with a slight \nincrease during follow-up. Mild pulmonary regurgitation was observed in 88% of \npatients (4.8±3.9 ml for all) without changes during follow-up.\nConclusion: We observed significant morphometric improvements in the first \nyear after the ROSS procedure irrespectively of the applied technique. Only mild \naortic and pulmonary regurgitation developed. Significant increases of the aortic \norifice area were observed.\nB‑0002 10:39\nFlow pattern evaluation of apico-aortic conduit (CORREX) in \nhigh-risk patients with severe aortic stenosis: a cardiac magnetic \nresonance (MR) investigation \nC. Mantini, A.R. Cotroneo, A. Tartaro, E. Di Gianfrancesco, C. Canosa, \nM. Foschi, D. Marinelli, G. Di Giammarco; Chieti/IT (c.mantini@rad.unich.it) \nPurpose: Aortic valve bypass (AVB) relieves AS connecting left ventricular apex \nto descending thoracic aorta by a valved conduit (CORREX™). AVB is performed \nthrough a left thoracotomy, preferentially without cardiopulmonary bypass. Final dis-\ntribution of flow through AVB and native aortic valve (NAV) is reported to be 60-70% \nto 30-40%, although very little is known about true hemodynamics, including blood \nflow distribution through the ascending and descending aorta after the procedure.\nMethods and Materials: Ten high-risk AS patients underwent AVB utilising \nCORREX™. In seven 30-day survivors, flow measurement was obtained using \nthrough-plane breath-hold phase-contrast MR sequences acquired in ascending \naorta (1 cm above the sinotubular junction), descending thoracic aorta (3 cm \nproximally and distally to conduit anastomosis) and at ventricular portion of the \nconduit. MR was performed either before (mean=2.5days; SD=2.4) and after surgery \n(mean=11.7days; SD=2.14). Post-procedural left ventricular stroke volume (LVSV) \nwas considered either discriminating the two left ventricular outflows and as a sum \ncompared to preoperative LVSV through native aortic valve. Flow gradient (FG) \nacross AVB was finally considered.\nResults: Average age of patients was 77.4±7.7yo. Average aortic valve area was \n0.62 (SD=0.21)cm2. LVSV through AVB was 68%±10% of total. We registered a \nstriking increase in postoperative LVSV even if it did not reach significance cause \na too small group of patients. The backward flow at NAV preoperatively did not in-\ncrease significantly after procedure (preop=3.7 ml; SD=2.4 vs postop=5.2; SD=6.4; \np=ns). No FG across AVB was recorded.\n\nS149\nA\n C D E F G\nB\nScientific Session\nThursday\nMethods and Materials: 38 patients with valvular prosthesis underwent contrast-\nenhanced 64-row cardiac MDCT (Lightspeed VCT, GE Medical Systems, Milwau-\nkee, USA) using a classical triphasic contrast injection protocol (iobitridol, Xenetix, \nGuerbet, France), within 2 days or less after a transthoracic ± transoesophageal \nechocardiogram. A total of 50 prostheses were explored including 23 mechanical \nand 17 bioprosthetic valves. According to echocardiogram, 2 groups were defined: \nnormal (n=27) and PVD (n=23) with 2 subgroups stenotic (n=15) and regurgitant \n(n=8). Multiplanar analysis of the MDCT dataset of these patients was performed \nduring diastole and systole blinded to the echocardiographic findings. The results \nwere compared to surgical data, when available (n=16).\nResults: MDCT demonstrated PVD in 29 cases: limitation in the opening/closure \nof the leaflets (12/2), annular tilting (8), calcification of leaflets (4), protrusive cal-\ncification of the ring (7), aspect of suture loosening (12), aspect of thrombosis (2) \nor pannus (4). MDCT found 22 PVD out of 23 in the PVD group and 6 PVD in the \nnormal group: sub-annular calcifications or pannus (3), perivalvular abscesses (3), \npseudoaneurysm (1). In 3 of the “normal group” who underwent further surgery, \nPVD was confirmed. MDCT was abnormal in 11/15 in the stenotic group and 8/8 \nin the regurgitant group.\nConclusion: MDCT is becoming a reliable and problem resolving complimentary \ntechnique in analyzing prosthetic valve dysfunction.\nB‑0008 11:33\nCardiac computed tomography angiography results in diagnostic \nand therapeutic change in prosthetic heart valve endocarditis \nJ. Habets1, W. Tanis1, L.A. van Herwerden1, W.P.T.M. Mali1, \nR.B.A. van den Brink2, B.A.J.M. de Mol2, S.A.J. Chamuleau1, R.P.J. Budde1; \n1Utrecht/NL, 2Amsterdam/NL (J.Habets@umcutrecht.nl) \nPurpose: Echocardiography plays a key role in diagnosing prosthetic heart valve \n(PHV) endocarditis but can miss signs of PHV endocarditis which advocates for \nnovel imaging techniques to improve diagnostic accuracy and patient outcome. The \naim of this study was to determine the complementary diagnostic value of cardiac \ncomputed tomography angiography (CTA) to the clinical routine workup including \ntransthoracic and transesophageal echocardiography (TTE/TEE) in patients with \nsuspected PHV endocarditis and assess its impact on patient treatment.\nMethods and Materials: A diagnostic prospective cross-sectional study which \nincluded patients with suspected PHV endocarditis. Besides the clinical routine \nworkup (including TTE/TEE), CTA was performed to assess its complementary \ndiagnostic and therapeutic value with an expert panel as reference standard. Diag-\nnostic accuracy was determined for PHV endocarditis in general, vegetations and \nperi-annular complications (mycotic aneurysms/abscesses) with surgical findings \nor clinical follow-up as reference standard.\nResults: Twenty-eight patients were included. Addition of CTA to the normal clinical \nroutine workup (including TTE and TEE) resulted in a diagnostic change in six pa-\ntients (21%) and treatment change in seven patients (25%). Diagnostic accuracy of \nroutine clinical workup plus CTA was superior to clinical routine workup alone for the \ndetection of PHV endocarditis in general, vegetations and peri-annular extension.\nConclusion: This study demonstrates that CTA and clinical workup including TTE \nand TEE are complementary in patients with PHV endocarditis. CTA changes treat-\nment strategy. Therefore, CTA imaging has to be performed after clinical routine \nworkup in every patient with suspected PHV endocarditis. \nB‑0009 11:42\nAnatomical variance of coronary venous system in dual source \ncomputed tomography \nM. Krupinski, M. Kuniewicz, J. Lelakowski, M. Irzyk, B. Laskowicz, \nM. Urbanczyk; Krakow/PL \nPurpose: The aim of the study was to assess the anatomical variance of coro-\nnary venous system using dual source computed tomography (DSCT) in patients \nscheduled for cardiac resynchronisation therapy (CRT).\nMethods and Materials: 32 patients (27 males, age 65 ±11 years) with heart failure \nwere included in the study. Anatomical variants were divided in three groups, de-\npendent on the continuity of the cardiac venous system at the crux cordis. Cardiac \nveins were analysed in order to determine their number, distance from coronary \nsinus, diameter and angle of insertion.\nResults: 16 (50%) patients revealed separate insertion of the coronary sinus (CS) \nand small cardiac vein in right atrium, 13 (40.5%) presented with continuity of an-\nterior and posterior venous system at the crux cordis and in three patients (9.5%) \nposterior interventricular vein (PIV) did not terminate to the CS. Posterior vein of \nthe left ventricle (PVLV) was present in all (100%) patients and left marginal vein \n(LMV) in 19 (59.4%) cases. The mean distance from CS to PVLV and LMV was \n30.8 ±15.1 mm and 73.2±18.8 mm, respectively. The angle of insertion of PVLV to \nB‑0005 11:06\nPressure overloaded right ventricles: importance of trabeculae in \nevaluation of RV function by CMR \nM.M.P. Driessen1, V.J.M. Baggen1, H.G. Freling2, F.J. Meijboom1, \nG.T. Sieswerda1, R.J. Snijder3, T. Leiner1, T.P. Willems2; 1Utrecht/NL, \n2Groningen/NL, 3Nieuwegein/NL (m.m.p.driessen-2@umcutrecht.nl) \nPurpose: Cardiac magnetic resonance imaging (CMR) is the preferred method to \nevaluate right ventricular (RV) volumes and function. This study aimed to determine \nthe impact and reproducibility of excluding trabeculae using semi-automatic software \non right ventricular (RV) volumes and function assessed by CMR in patients with \npressure overloaded RVs.\nMethods and Materials: Four groups of 20 patients (pulmonary hypertension, \narterial switch operation (ASO), tetralogy of Fallot (TOF), systemic RV) and 20 \nhealthy subjects underwent short-axis multislice cine CMR. After manual contour \ntracing, trabeculae were excluded from the blood volume using semi-automatic \npixel-intensity based software. Differences in volumes and function after excluding \ntrabeculae were tested using paired samples T-test. For intra- and interobserver \nagreement 25 datasets were re-analysed.\nResults: Exclusion of trabeculae from the blood volume resulted in diminished \nend-diastolic and end-systolic volumes. This led to a significantly larger difference \nin RV volumes and absolute ejection fraction of patient groups, 4.7 ± 1.6% in PH \npatients, 6.0 ± 1.5 in ASO patients, 7.2 ± 1.7 in TOF patients, and 10.1 ± 2.3% \nin the systemic RV group, than in controls (3.4 ± 0.8%). For both methods there \nwas a high inter- and intraobserver agreement in all measurements (correlation \ncoefficients > 0.9; narrow limits of agreement).\nConclusion: Exclusion of trabeculae and papillary muscles from the blood volume \nresults in a significant and clinically relevant change in RV volumes, RVEF and \nRV mass, for patients with pressure overloaded RVs. Using semi-automatic pixel-\nintensity-based software, exclusion of trabeculae from the blood volume can be \ndone reproducibly. \nB‑0006 11:15\nOpacification ratios to detect changes in coronary flow by computed \ntomography angiography - comparison between pre- and post-\nstented lesions \nP.B. Rizzi1, R.J. Cerci1, P. Lemos2, C.E. Rochitte2, I. Gottlieb3, R.T. George1, \nJ. Texter1, A.C. Lardo1, J.A.C. Lima1; 1Baltimore, MD/US, 2São Paulo/BR, \n3Rio de Janeiro/BR (paty.rizzi@gmail.com) \nPurpose: To test whether percutaneous coronary revascularization (PCI) improves \nthe opacification ratio between pre- and post-stenotic segments of coronary arteries \nusing 64-MDCT coronary angiography (CTCA).\nMethods and Materials: Twenty-one patients who underwent a CTCA prior to \nand a CTCA plus an invasive coronary angiography (ICA) after PCI were enrolled. \nLuminal CTCA opacification was measured in HU at no more than 3 mm proximal \nand distal to the stenosis or stents borders. Opacification ratio (ORCT) was defined \nas the ratio between distal over proximal measurements, and were also calculated \nfor two equivalent segments in normal vessels. A mathematical model, account-\ning for technical variables influencing contrast enhancement, was applied to each \nscan and compared to true measurements. Pre- and post-treatment ORCT were \ncompared using T-test.\nResults: Final analysis included 28 stenotic and 16 normal coronary segments. \nThere was significant improvement in mean stenotic ORCT values after PCI (ORCT \n(pre) = 0.82 (95%CI: 0.75, 0.89); ORCT (post)=0.94 (95%CI: 0.84, 1.0)), p= 0.014. \nORCT (pre) also differed from the ORCT in normal vessels (index ORCT (normal) \n= 0.94, 95%CI=(0.90, 0.99), p=0.002) and from the calculated theoretical ORCT \n(index ORCT (model)=0.95 (95%CI: 0.92, 0.07), p < 0.001). No significant differ-\nences were detected in normal vessels from index to follow-up scans (p=0.73), as \nwell as from those in comparison with theoretical ratios (p=0.95 and p=0.76; index \nand follow-up, respectively).\nConclusion: Coronary ORCTs across lesions show significant improvement after \nPCI. Theoretical models correcting variations in luminal enhancement due to techni-\ncal factors can serve as references for the measurements across stenotic segments.\nB‑0007 11:24\nAdditional value of cardiac computed tomography to assess \nprosthetic valvular dysfunctions \nA.A. Azarine, N. Hrynchyshyn, A. Samadi, L. Perdrix, G. Ashrafpoor, A. Redheuil, \nL. Macron, E. Mousseaux, B. Diebold; Paris/FR (arshid.azarine@egp.aphp.fr) \nPurpose: To evaluate the potential contribution of cardiac multidetector computed \ntomography (MDCT) on prosthetic valve dysfunctions (PVD).\n\nScientific Sessions\nS150\n C A D E F\n G\nB\nand perirhinal cortex) and higher-order cognitive functions (posterior cingulate and \nanterior prefrontal cortex).\nConclusion: The observed associations provide neuroanatomical-biological back-\nground for cognitive phenotypes in Unverricht-Lundborg disease. CTH analysis \ncan supply new information on visually normal MR images. Further evaluation is \nneeded for the application of CTH in individual patients. \nAuthor Disclosures:\nS. Suoranta: Research/Grant Support; EVO grants 5772751 and 5063523 from \nthe Kuopio University Hospital, Strategic Funding from the University of Eastern \nFinland from the UEF-Brain consortium.\nB‑0012 10:39\nLanguage impairment and reduced structural connectivity in \nRolandic epilepsy \nR. Besseling, J. Jansen, W.H. Backes; Maastricht/NL \n(r.m.h.besseling@gmail.com) \nPurpose: Rolandic epilepsy (RE) is a childhood epilepsy with mild seizure semiol-\nogy and epileptic discharges originating from the sensorimotor (Rolandic) area. \nA serious co-morbidity in RE is language impairment, for which we aim to find a \ncorrelate using structural connectivity.\nMethods and Materials: Diffusion MRI was performed at 3.0 Tesla and 2×2×2 mm \nvoxel size with b=1200 s/mm 2 and 66 diffusion gradient directions in 23 children \nwith RE with proven language deficits and 23 matched controls. Constrained \nspherical deconvolution provided voxel-wise tract orientations and whole-brain \ntractography (5M streamlines). For each of the 4 Rolandic areas (bilateral pre- and \npostcentral gyri), the streamlines to any of the 70 regions, obtained by automatic \ncortical parcellation (Freesurfer), were selected from the whole-brain tractogram. \nFor reliable connections (top 20% of number of streamlines), connectivity was \nquantified by tract fractional anisotropy (FA), compared between groups, and cor-\nrelated to language scores.\nResults: In the left hemisphere, reduced tract FA was found for connections \nbetween the Rolandic areas and inferior frontal gyrus (Broca’s area) and supra-\nmarginal gyrus (Wernicke’s area), but not for contralateral homologue regions. For \nthe aberrant connection between the left postcentral and inferior frontal gyrus, tract \nFA decreased with languages score in the RE group (p=0.04).\nConclusion: In RE structural connectivity between Rolandic and language areas \nis disturbed and correlates with the language dysfunction. This provides a neuronal \nlink between the location of the epileptic discharges and the language impairment. \nThis research was supported by the Dutch Epilepsy Foundation. \nB‑0013 10:48\nRelative contributory role of Interictal/Ictal SPECT, interictal PET, MR \nspectroscopy and T2 relaxometry in localisation of seizure focus in \ntemporal lobe epilepsies: a metaanalysis and systematic review \nV. Venugopal1, S.K. Puri1, I. Afshan1, A.D. Prabhu2; 1New Delhi/IN, 2Chennai/IN \nPurpose: To perform a meta-analysis to quantitatively assess the seizure localisa-\ntion potential of SPECT, PET, MR spectroscopy (MRS) and T2 relaxometry (T2R) \nin patients with temporal lobe epilepsy (TLE).\nMethods and Materials: A structured search strategy of PubMed, EMBASE, \nCochrane Central Register and other databases was used to English language \nstudies in which the diagnostic potential of FDG-PET, SPECT, MRS and T2R were \nassessed in patients with TLE. Studies were selected independently by three radi-\nologists. Quality Assessment of Diagnostic Accuracy Studies tool was employed to \nassess the quality of the studies. Meta-Disc version 1.4 was used to describe and \ncalculate sensitivity, specificity, summary receiver operating characteristic (SROC) \ncurves and area under the curve (AUC) for these modalities. The meta-analysis \nwas performed in accordance with the PRISMA guidelines.\nResults: The analysis noted gross heterogeneity among the studies regarding \nstudy design, methodology and interpretation criteria. A total of 54 studies met \nthe inclusion criteria. For ictal SPECT, interictal PET and interictal SPECT pooled \nsensitivity was 83 (95% CI 80-85) ,80 (95% CI 78-82) and 58%(95% CI 50-62), \nrespectively. For MRS and T2R, pooled sensitivity was 76 (95% CI 74-78) and \n79% (95 CI 76-81), respectively. Thus ictal SPECT had a slightly better sensivity, \nspecificity and odds ratio. However, SROC analysis showed the diagnostic value of \nictal SPECT in TLE has no significant difference compared with PET, MRS or T2R.\nConclusion: Although interictal SPECT is found to have a slightly better diagnostic \nvalue in this study, no statistically significant difference is seen in the diagnostic \npotential compared with other modalities. \ngreat cardiac vein (GCV) was 58° and for the LMV revealed 61.5°. The diameter \nof insertion of PVLV and LMV to GCV was 2.7±1.3 and 2.2±1.1, respectively. In \nsubsequently performed CRT procedure left ventricle (LV) lead was implanted in \nPVLV in 20 (62.5%) cases and in LMV in 12 (37.5%) patients.\nConclusion: Coronary venous system variance can be assessed in DSCT and its \nknowledge facilitates proper LV lead placement in CRT. \nB‑0010 11:51\nFeasibility of MRI in patients with implanted subcutaneous loop \nrecorder type REVEAL XT®: data from the surprise study \nL. Christensen, A. Christensen, H. Christensen; Copenhagen/DK \n(louisamchristensen@gmail.com) \nPurpose: Implanted devices such as pacemakers and loop-recorders have until \nrecently been a contraindication to MRI. MRI compatible loop recorders have \nbeen marketed, and the use of these devices is increasing. We aimed to report \nour experience with performing MRI in the patient population having received a \nMRI compatible loop-recorder in relation to a study protocol investigating the true \nfrequency of atrial fibrillation after stroke or TIA by implantation of a REVEAL XT® \nloop recorder (Medtronic Inc). subcutaneously on the thorax for up to 3 years of \ncontinuous monitoring.\nMethods and Materials: We retrospectively revised all MRI reports in this patient \ngroup during the study period and registered problems with performing the inves-\ntigation, including whether any reverse affects were reported.\nResults: Out of the 84 patients who have been implanted, 12 patients have had \nMRI, one patient on three occasions constituting a total of 15 MRIs; 13 examinations \nwere MRI of the brain, one of the knee and one of the heart. None of the patients \nexperienced any heat, pain or movement of the device; the MRI examination of the \nheart was cancelled due to the formation of artefacts on the images of the heart; \nan effect not reported using CT of the thorax/heart.\nConclusion: MRI appears not to cause any safety problems in the patients having \nthe REVEAL XT® implanted. Artefacts may occur in MRI investigation of the heart; \nhowever, CT can be used as an alternative in most cases.\nAuthor Disclosures:\nL. Christensen: Grant Recipient; Grant from Medtronic. Speaker; Speaker for \nMedtronic. H. Christensen: Research/Grant Support; Grant from Medtronic. \nSpeaker; Speaker for Medtronic.\n10:30 - 12:00 Room C \nNeuro \nSS 111 \nFrom structure to function \nModerators: \nS.J. Bakke; Oslo/NO \nB. Ertl-Wagner; Munich/DE\nB‑0011 10:30\nRegional cortical thickness is associated with neurocognitive \nprofile in progressive myoclonus epilepsy type 1 (EPM1, Unverricht-\nLundborg disease) \nS. Suoranta1, E. Niskanen2, M. Äikiä1, P. Koskenkorva1, M. Könönen1, \nR. Kälviäinen1, R. Vanninen1; 1Kuopio/FI, 2Vaasa/FI (sanna.suoranta@fimnet.fi) \nPurpose: To investigate the relationship between cortical thickness and neuro-\ncognitive function in patients with progressive myoclonus epilepsy type 1, EPM1.\nMethods and Materials: Sixty-three genetically verified EPM1 patients underwent \nT1-weighted 3-dimensional imaging. The regional cortical thicknesses (CTH) were \nanalysed. The patients were clinically evaluated using the Unified Myoclonus Rating \nScale (UMRS) test pattern. The Wechsler Adult Intelligence Scale (WAIS-R) was \nused to assess the patients’ neurocognitive abilities and intelligence. Patients were \ndivided into sub-groups by their myoclonus in action and global disability scores.\nResults: The EPM1 patients showed heterogeneous findings in clinical and \nneuropsychological evaluation; the mean myoclonus in action scores were 48.3 ± \n28.9, range 2−122 (maximum 160). Cognitive functioning of EPM1 patients varied \nfrom high average to defective, mean Full Scale IQ score was 80.2 ± 14.4, range \n50−114. No signs of memory impairment were found. Utilising the CTH analysis, \nwe observed that the EPM1 patients with a more severe form of the disorder had \nthinner cortex than the patients with no disability or milder form of the disease. The \naffected anatomical areas included those responsible for processing of verbal and \ncomplex visual data (Broca's and Wernicke's areas, fusiform gyrus, retrosplenial \n\nScientific Sessions\nS151\nA\n C D E F G\nB\nThursday\nMean SBP, DBP and PP were assessed over a 5-year period before longitudinal \nMRI scanning. WML progression was measured with a fully automated quantifica-\ntion method using two MRI scans 3.5 years apart. For the analyses we used linear \nregression models and evaluated adjustments for age, sex, cardiovascular factors \nand pre-existing WML volume. In addition, we evaluated WML progression related \nto control of hypertension.\nResults: Both SBP and DBP were significantly associated with annual WML \nprogression (0.08 (95%-CI: 0.03;0.14) mL/year per SD increase in SBP; and 0.08 \n(0.03;0.14) mL/year per SD increase in DBP). PP was only borderline significantly \nassociated with WML progression. After adjustment for pre-existing WML volume, \nonly SBP remained significantly associated: 0.08 (0.03;0.13), mL/year per SD. \nUncontrolled hypertensives had 0.17 (0.01;0.32) mL/year more progression than \ncontrolled hypertensives, and 0.14 (0.03;0.25) mL/year more than normoten-\nsives. There was no significant difference between controlled hypertensives and \nnormotensives.\nConclusion: Our results confirm that high blood pressure precedes WML progres-\nsion and further support control of high blood pressure as a way to prevent WML \ndevelopment.\nB‑0017 11:24\nMRI texture analysis in Unverricht-Lundborg disease reveals \nmore complex and heterogeneous textural appearance in thalami, \nputamen and amygdala than in controls \nK.K. Holli1, S. Suoranta2, E. Niskanen3, P. Dastidar1, H. Eskola1, R. Vanninen2; \n1T ampere/FI, 2Kuopio/FI, 3Vaasa/FI (sanna.suoranta@kuh.fi) \nPurpose: Unverricht-Lundborg disease (EPM1) caused by mutations in cystatin \nB gene is a rare autosomal recessive neurodegenerative disorder characterised \nby stimulus-sensitive myoclonus and tonic-clonic epileptic seizures. MRI of the \nbrain is usually normal at the time of diagnosis. Texture analysis (TA) allows one \nto calculate mathematical patterns, i.e. texture features from MR images which \ncan be used to detect, characterise and classify the possible underlying subtle \nchanges in deep grey matter in EPM1 patients.\nMethods and Materials: Ten EPM1 patients and ten age and sex matched control \nsubjects underwent three-dimensional T1-weighted MRI (1.5 T) of the brain. TA \nwas conducted with MaZda software. Spherical 3D volumes of interest (VOIs) \nwere placed bilaterally in the thalamus, caudate nucleus, putamen, amygdala, \nand hippocampus.\nResults: The deep grey matter structures were normal when assessed visually. \nTA revealed significantly differing (p < 0.05, Mann-Whitney U test) texture features \nin EPM1 patients. The features measuring complexities of image texture differed \nsignificantly bilaterally in thalami and in the right putaminal VOI indicating that \npatients have a more complex and heterogeneous textural appearance in these \nregions than controls. First-order histogram-based features measuring the intensity \nand contrast of given regions were also significantly different in thalamus, the right \nputaminal VOI and left amygdaloid VOI. No changes were found in hippocampi \nor caudate nuclei.\nConclusion: TA provides an additional and sensitive tool for extracting subtle \nstructural information from MR images of EPM1 patients. Our MRI TA findings \nwere parallel with previous studies with evoked potentials and PET, indicating \nthalamocortical abnormalities in EPM1.\nB‑0018 11:33\nStructural MRI-assisted diagnosis of major depressive disorder \nusing surface-based volumetric parameter classification approach \nL. Qiu, S. Lui, X. Huang, J. Zhang, X. Yang, Q. Yue, L. Zou, Q. Gong; \nChengdu/CN (qlh20050616@gmail.com) \nPurpose: To explore the diagnostic value of surface-based multiple morphometric \nparameters (including cortical thickness, pial area and volume) in first-episode, \ntreatment-naive major depressive disorder (MDD) patients.\nMethods and Materials: Thirst-one first-episode, treatment-naive MDD patients \nand 31 age, gender and years of education-matched controls were included in \npresent study. Image processing was performed using the Freesurfer software. \nThree morphometric parameters including volume, thickness and surface area at \neach spatial location on the cortical surface was used to discriminate depressed \npatients from controls using a support vector machine (SVM) analytic approach, \nand a spatially distributed pattern of regions with maximal classification weights \nwas identified.\nResults: In the right hemisphere, all the three morphometric parameters showed \nabove chance classification (accuracy for cortical thickness=78%, p²0.001; accuracy \nfor volume=72%, p²0.001; accuracy for pial area=66%, p²0.008) for first-episode-\ndepressed patients. While, in the left hemisphere, only cortical thickness (diag-\nB‑0014 10:57\nSubtle changes in normal appearing white matter precede \ndevelopment of white matter lesions \nB.F.J. Verhaaren, M. de Groot, R. de Boer, S. Klein, A. Hofman, \nA. van der Lugt, M.A. Ikram, W.J. Niessen, M.W. Vernooij; Rotterdam/NL \n(b.verhaaren@erasmusmc.nl) \nPurpose: It is unknown whether white matter lesions (WMLs) develop instantane-\nously in previously normal brain areas or whether development of WMLs is a gradual \nprocess, in which tissue changes are already present before they become apparent \non MRI as WMLs. We investigated whether WMLs in the general population are \npreceded by changes in the white matter.\nMethods and Materials: In 689 participants from the general population (mean age \n67 years), we performed two MRI scans (including DTI and FLAIR sequences) 3.5 \nyears apart using the same 1.5-T scanner. Using automated tissue segmentation, \nwe identified normal appearing white matter (NAWM) at baseline. We assessed \nwhich NAWM areas converted into WMLs during follow-up, and differentiated these \nareas into WML growth and de-novo WMLs. Fractional anisotropy (FA), mean \ndiffusivity (MD) and FLAIR intensity of areas converting to WMLs and areas of \npersistent NAWM were compared using three approaches: a whole-brain analysis, \na regionally matched approach and a voxel-wise approach.\nResults: All three approaches showed that low FA, high MD and high FLAIR inten-\nsity at baseline were associated with WML development during follow-up. Compared \nto persistent NAWM areas, NAWM areas converting to WMLs had lower FA (0.337 \nvs. 0.387, p < 0.001), higher MD (0.910*10-3 mm2/s vs. 0.729*10-3 mm2/s, p < \n0.001) and higher normalised FLAIR-intensity (1.233 vs. -0.340, p < 0.001). This \napplied to both NAWM areas of growing and de-novo WMLs.\nConclusion: Subtle white matter changes are present before WMLs develop. \nThis suggests that WMLs develop gradually and that WMLs are only the tip of the \niceberg of white matter pathology.\nB‑0015 11:06\nRetrograde degeneration of optic nerve and visual pathway in open \nangle glaucoma: a morphologic evaluation using 3 T MRI \nS. Sidek, F. A. Rahman, K. Rahmat, N. Mohd Ramli, N. Mohd Ramli; \nKuala Lumpur/MY (bhkimy_7@hotmail.com) \nPurpose: This study aimed at assessing glaucoma disease and the severity causing \nretrograde degeneration and atrophy of the optic nerve and optic radiation by using \nvolumetric assessment and diffusion tensor imaging with 3 T MRI. To measure the \noptic nerve volume, fractional anisotropy (FA) and mean diffusivity (MD) for optic \nnerve and optic radiation in patients with bilateral mild and severe glaucoma and \ncomparison made with normal subjects.\nMethods and Materials: 90 subjects with ages ranging from 40 to 80 years (30 \nnormal subjects, 30 mild glaucoma, 30 severe glaucoma) underwent 3 T MRI. Im-\nages were acquired with AX FSPGR 3D sequence (TE 1.868; TR 6.824 1.2 mm) \nand DTI. The acquired images were post-processed using NIFTI (Neuroimaging \nInformatics Technology Initiative) format. Using NeuRoi software, each optic nerve \nvolume was measured. Using Functool GE DTI software, the FA and MD values \nwere obtained from each optic nerve and optic radiation. We evaluated 180 optic \nnerves and 180 optic radiations.\nResults: Multiple comparisons show significant difference of the optic nerve volume \nand FA and MD of the optic nerve and optic radiation, between normal subject and \nmild glaucoma group (p²0.001), between normal subject and severe glaucoma group \n(p²0.001) and between mild glaucoma group and severe glaucoma group (p²0.001).\nConclusion: Retrograde degeneration of optic nerve and optic radiation occurs \nin glaucoma and the volume loss, reduction of the FA values and increasing MD \nvalues correlate with disease severity. These findings highlight the importance of \naggressive therapy for those patients at highest risk. \nB‑0016 11:15\nHigh blood pressure and cerebral white matter lesion progression in \nthe general population \nB.F.J. Verhaaren, M.W. Vernooij, R. de Boer, A. Hofman, W.J. Niessen, \nA. van der Lugt, M.A. Ikram; Rotterdam/NL (b.verhaaren@erasmusmc.nl) \nPurpose: High blood pressure is considered to be important in the development \nof cerebral white matter lesions (WMLs) in the elderly. Yet, current studies are still \nlimited in demonstrating causality. We sought to overcome these limitations in a \nlongitudinal MRI study.\nMethods and Materials: In 678 participants from the population-based Rotterdam \nScan Study, we investigated the relationship of systolic blood pressure (SBP), di-\nastolic blood pressure (DBP) and pulse pressure (PP) with annual WML progression. \n\nScientific Sessions\nS152\n C A D E F\n G\nB\n10:30 - 12:00 Room D1 \nChest \nSS 104 \nLung cancer: from tissue characterisation to \ntreatment \nModerators: \nE. Castañer; Sabadell/ES \nN. Tacelli; Brussels/BE \nB‑0021 10:30\nPrognostic value of CT perfusion parameters in patients with early \nstage resectable non-small cell lung cancer \nL. Calandriello, A.R. Larici, A. del Ciello, G. Rindi, G. Petrone, L. Bonomo; \nRome/IT (lcalan@hotmail.it) \nPurpose: To correlate perfusion parameters and histopathological factors with \nprognosis at 2-year follow-up in patients with resectable non-small cell lung cancer \n(NSCLC) who underwent CT perfusion (CTP) examination before surgery and to \ncorrelate perfusion parameters with histopathological factors.\nMethods and Materials: 20 patients with resectable NSCLC (stage IA-IIB) un-\nderwent CTP examination with 64 row CT and contrast medium injection before \nsurgery; blood flow (BF), blood volume (BV), and peak enhancement intensity \n(PEI) were calculated. The histopathological evaluation assessed each tumour’s \npathological stage (IA-IIIA), tumour grade (G1-G3) and extent of necrosis (< 10%-> \n10%). All patients underwent a 24-month follow-up yielding two Results: patients \nwith and without recurrent disease. The Chi-square, Mann-Whitney and Fisher \nexact test were used for statistics.\nResults: 5 patients had no recurrence of disease and 15 patients showed recurrent \ndisease at 24-month follow-up. Statistical analysis showed that CTP parameters \n(BF, BV and PEI) were significantly lower (p²0.05) in patients with relapse. Tumours \nwith higher grade (G2-3), more advanced stage (IIB.IIIA) and more extensive \nnecrosis (> 10%) were at higher risk of relapse (p²0.05). The analysis also showed \nsignificantly lower perfusion parameters (BF, BV and PEI) in patients with more \nextensive necrosis (> 10%) (p²0.05).\nConclusion: Perfusion parameters (BF, BV and PEI) have been shown to be \nsignificantly lower in patients with progressive disease at two-year FUP due to a \nmore extensive necrosis and so they could be regarded as predictive factors in \npatients with NSCLC eligible for surgery.\nB‑0022 10:39\nDynamic volume perfusion CT in patients with lung cancer: baseline \nperfusion characteristics of different histological subtypes \nJ. Shi1, C. Fink2, G. Schmid-Bindert3, L.R. Pilz3, P. Apfaltrer3, H. Haubenreisser3, \nU. Haberland4, S.O. Schönberg3, T. Henzler3; 1Shanghai/CN, 2Celle/DE, \n3Mannheim/DE, 4Forchheim/DE (thomas.henzler@medma.uni-heidelberg.de) \nPurpose: Recent studies indicate that baseline tumour perfusion may help to \nidentify patients responding to targeted therapy. This study prospectively evalu-\nated dynamic volume perfusion CT (dVPCT) tumour baseline characteristics of \nuntreated patients with lung cancer.\nMethods and Materials: 173 consecutive patients (131 men, mean-age 60.5±9 \nyears with newly diagnosed lung cancer underwent dVPCT prior to tumour biopsy. \nTumour blood volume (BV), blood flow (BF), mean transit time (MTT), permeability, \nsize and volume were quantitatively measured using the deconvolution model and \ncompared to histopathology. The Wilcoxon rank sum test and Pearson's correlation \nanalysis was used for statistical analysis.\nResults: Histopathology revealed adenocarcinoma (AC) in 88 patients, squamous \ncell carcinoma (SCC) in 54 patients, and small cell lung cancer (SCLC) in 31 \npatients. Tumour permeability was significantly different between AC, SCC and \nSCLC (all p < 0.05). Tumour BF was significantly higher in patients with AC than \nin patients with SCLC (p=0.001). No significant difference was found between AC \nand SCC, as well as between SCLC and SCC (both p> 0.05). Tumour BF and BV \nsignificantly correlated in all three tumour histologies (SCC: r=0.704, p < 0.001; \nSCLC: r=0.647, p < 0.001; AC: r=0.614, p < 0.001). Correlation of BF and perme-\nability was higher in patients with SCLC (r=0.643, p < 0.001) than in patients with \nAC and SCC (r=0.451, p < 0.001; r=0.213, p < 0.001, respectively). No meaningful \ncorrelations were found between dVPCT parameters and tumour size and volume.\nConclusion: dVPCT parameters significantly differ between AC, SCC and SCLC \nand are independent from tumour size and volume and thus provide additional \nfunctional information for staging and treatment planning.\nnostic accuracy=72%, p²0.001) and pial area (diagnostic accuracy=69%, p²0.003) \nprovided statistically significant classification for the first-episode, treatment-naive \nMDD patients.\nConclusion: Our results confirmed that volume-related parameters could dif-\nferentiate the first-episode, treatment-naïve MDD patients from controls, and the \nright cortical thickness provided highest prediction accuracy, which might be use-\nful for detecting early MDD. The spatial patterns detected using SVM may help \nfurther exploration of the specific genetic and neuropathological underpinnings \nof MDD as the three morphologic parameters are believed to be genetically and \nphenotypically independent.\nB‑0019 11:42\nResting-state networks, and peculiarities of the brain metabolism \nin patients with Parkinson’s disease (PD) and different level of \ncognitive impairment (CI): fMRI and 1H MRS study \nZ.Z. Rozhkova, O.M. Omelchenko; Kiev/UA (invivo@ukr.net) \nPurpose: We use fMRI data for characteristics of the cortical connectivity in the \nabsence of external input and MRS data for the characteristics of the local meta-\nbolic state of the brain.\nMethods and Materials: Three groups of PD patients are studied by fMRI and 1H \nMRS with 1.5 TSIGNA (GE). The 1st group (DPDG): 13 PD patients with dementia \n(MMSE< 25). The 2nd group (CIPDG): 15 PD patients with mild CI (30>MMSE³25). \nThe 3rd group (NPDG): 12 PD patients with normal cognitive function (MMSE> \n30). fMRI data are obtained with block design parametric paradigm of EPI: TR/\nTE=3000/56 ms, phases per location=72. Spectra are recorded in the white matter \nof the anterior (APCG), and in the posterior portions of cingulate gyrus (PPCG).\nResults: In the NPDG connections between the APCG and the PPCG, bilateral \ninferior parietal gyrus was found. In the NPDG activation of APCG decreased, but \nconnectivity patterns persisted. In CIPDG activated clusters were found precuneally, \nand in PPCG no connection to the parietal lobe or APCG was seen. In DPDG no \nactivation in PPCG but smaller clusters in the cuneal and precuneal region were \nfound. In APCG the mean values of NAA/Cr in DPDG, CIPDG, and NPDG are: \n(1.68+-0.02), (2.04+-0.03), and (2.32+-0.05); Cho/Cr: (0.84+-0.02), (0.81+-0.05), \nand (0.53+-0.03). In PPCG the mean values of NAA/Cr in DPDG, CIPDG, and \nNPDG are: (1.14+-0.12), (1.81+-0.02), and (1.98+-0.04), and Cho/Cr: (0.96+-0.02), \n(0.77+-0.03), and (0.68+-0.03). We have found the progressive decreasing NAA/\nCr in the PPCG and increasing of Cho/Cr for the patient of NPDG, CIPDG, and \nDPDG that is associated with poorer cognitive function.\nConclusion: Bringing together fMRI in the resting state and 1H MRS data we \nobtain very useful markers of neuronal dysfunction and neuronal loss in patients \nwith PD and different levels of CI. \nB‑0020 11:51\nRelationship among fractional anisotropy (FA) values, EEG activity \nand cognitive status in mild cognitive impairment (MCI) and \nAlzheimer’s disease (AD) patients \nF. Pitocco, G. Curcio, F. Scrascia, Y. Errante, A. Giona, C. Mallio, \nF. Vernieri, B. Beomonte Zobel, C. Quattrocchi, L. Scarciolla; Rome/IT \n(l.scarciolla@unicampus.it) \nPurpose: Our aim was to investigate the relationship of white matter DTI-derived \nmeasures with quantitative electroencephalographic (EEG) data and cognitive \nstatus in subjects affected by MCI and AD.\nMethods and Materials: 55 subjects (28 AD, 14 MCI and 13 healthy controls) \nunderwent a MRI (1.5T, Avanto, Siemens, Erlangen, Germany) protocol including \nDTI. FA was assessed in frontal, temporal and occipital white matter (WM) areas \nbilaterally and in the corpus callosum (genu and splenium). Subjects also underwent \na complete neuropsychological test evaluation and resting eyes-closed EEG for the \nquantitative study of its spectral content by means of fast Fourier transform (FFT). \nFFT was computed for different classical EEG bands (Delta, Theta, Alpha, Beta).\nResults: We found significant differences between patients and healthy controls: \nFA values on bilateral frontal lobe WM and genu of the corpus callosum (p < 0.001); \nDelta spectral power on central-temporal and frontal areas (p < 0.005); Theta spec-\ntral power on temporal areas (p < 0.03). These spectral power changes correlated \nnegatively with global cognitive functioning as measured by MMSE. The increase \nof Delta band in AD patients showed tendency to correlate with FA measures at \nthe bilateral frontal and temporal WM areas, while Theta band in MCI patients \ncorrelated with FA measures at the right frontal and left temporal WM areas and \nat the corpus callosum genu.\nConclusion: Our findings suggest that decrease of FA values of the white mat-\nter and the spectral power changes of EEG can together increase the diagnostic \nsensitivity in the detection of early degenerative dysfunction in AD. \n\nScientific Sessions\nS153\nA\n C D E F G\nB\nThursday\nB‑0025 11:06\nRadiogenomic approach to identify anaplastic lymphoma kinase-\npositive lung adenocarcinoma \nC. Jeong, H. Lee, J. Han, J. Jeong, K. Lee, K. Park, M.-J. Ahn, B.-T. Kim; \nSeoul/KR (chaejin.jeong@samsung.com) \nPurpose: A subset (3-7%) of non-small cell lung carcinomas (NSCLCs) harbors \nthe EML4-ALK fusion gene. The importance of recognising this gene rearrange-\nment was highlighted by clinical trials of crizotinib, the ALK inhibitor, showing \nencouraging clinical outcomes. The purpose of this study was to determine CT \nand metabolic characteristics in patients with ALK-positive NSCLCs and to devise \nan effective screening strategy.\nMethods and Materials: We retrospectively reviewed radiologic and clinicopatho-\nlogic data from patients with NSCLCs, in whom immunohistochemistry for ALK \nrearrangement was conducted. Patient characteristics and lesion size, marginal \ncharacteristics, solidity, density from CT, and SUVmax from PET-CT were assessed. \nPathologic features such as differentiation, histologic subtype, EGFR and KRAS \nmutation status were also reviewed.\nResults: Forty-one patients with ALK-rearranged NSCLCs tended to be younger \n(p<.001) than ALK-negative patients (n=180) and showed significant association \nwith no exposure to tobacco (p=.008). ALK-positive tumours were significantly \nless differentiated (p=.016). The SUVmax, lesion size, or tumour density did not \nsignificantly difference according to ALK status. Of ALK-positive tumours, only 29% \nshowed spiculated margin, whereas 57% of ALK-negative tumours had spiculated \nmargin (p=.002). Two histologic findings, namely the presence of signet-ring cells \n(44%) and abundant extracellular mucus (81%), helped explain the difference of \ntumour margin in ALK-positive tumours.\nConclusion: ALK-positive lung adenocarcinomas share certain clinical characteris-\ntics, and some radiologic findings may help identify cases for positive ALK testing. \nHowever, none of radiologic parameters were completely sensitive or specific to ALK \nrearrangement, and radiomorphology should not replace con firmatory molecular \nor immunohistochemical study. \nB‑0026 11:15\nMucinous vs nonmucinous adenocarcinoma in situ (AIS): imaging \nfeatures, EGFR mutation and EGFR gene copy number status, and \nprognosis \nD. Kim, H.-J. Lee, J. Wi, S. Lee, C. Park, J. Goo; Seoul/KR \n(phemuto_45@naver.com) \nPurpose: In IASCL/ATS/ERS classification, lung adenocarcinoma in situ (AIS) \nrefers to a small localised adenocarcinoma (.05).\nConclusion: Combination of tumour volume and texture parameters reflecting \nheterogeneity of the tumour blood supply more earlier helped predict treatment \nresponse in EGFR-mutant lung adenocarcinoma patients treated with EGFR TKIs. \n\nScientific Sessions\nS154\n C A D E F\n G\nB\nMethods and Materials: 20 patients (8 male, 12 female, age 38- 76, mean 66 \nyears) with suspected malignancy underwent percutaneous transthoracic CT-\nguided needle biopsy under local anaesthesia using dedicated large core biopsy \nneedles (10G Spirotome, Medinvents). Location and size of the tumour, number of \npleural passes, number of biopsies, and complications (pneumothorax, bleeding) \nwere recorded and compared to our standard core biopsy database (18G; n=121).\nResults: Location varied from pleural to hilar location. Mean tumour size was 2.8 \ncm (range 0.7 -9.2 cm). Only one pleural passage (mean pleura to lesion length \n3.0 cm (range 9.2 cm-0 cm) and one biopsy were necessary in all patients. Large \ncore biopsy was successful in 100% (18 G in 87%). Pneumothorax was found in \n50% (18 G in 51%). No clinically relevant complications were recorded, especially \nno hemoptoe occurred. Minor intraparenchymal bleeding was present in 10 of 20 \npatients (18 G in 60 of 121 patients).\nConclusion: Large core biopsy with 10G is technically feasible and safe. Our pre-\nliminary experience did not show higher complication rates compared to standard \n18G biopsy. Histological specimens obtained may increase confidence in patho-\nlogical diagnosis and might be helpful especially for further immunohistochemical \nand mutational analysis. \nB‑0030 11:51\nPrimary lung cancer treated using radiofrequency ablation: two-year \noutcome data \nJ. Beeson, N. Wickings, V. Anikin, S. Kaul, P. Dalal; London/UK \n(p.dalal@rbht.nhs.uk) \nPurpose: Percutaneous image-guided radiofrequency ablation (RFA) is being \nincreasingly used as an alternative treatment option for patients with inoperable \nprimary lung cancer (NSCLC), but there are little published outcome data. We report \nsafety and efficacy of RFA in patients with NSCLC (stages 1-4) at 1 and 2 years.\nMethods and Materials: Under general anaesthesia 38 patients underwent RFA \nof 50 pulmonary tumours. Survival was evaluated prospectively at 3, 6, 9.12 and \n24 months whilst complications were assessed 1 month post procedure.\nResults: There were no cases of procedure-related mortality. Complications in-\ncluded pneumothorax requiring intercostal drain (ICD) insertion (n=20, 53%), small \npneumothorax not requiring ICD (n=3, 8%) and pleural effusion (n=2, 5%). One-year \noverall survival and cancer specific (C/S) for tumours classified as Stage 1 (n=20) \nwere 100 and 100%, respectively. Stage 2 (n=7) 85% and 100%, respectively, and \nstage 4 (n=11) 64 and 73%, respectively. Two-year survival rates (overall & C/S) \nfor Stage 1 were 85 and 95%, in Stage 2 patients 43 and 86% and for those at \nStage 4, 45 and 64%, respectively.\nConclusion: RFA is a safe, effective and well-tolerated treatment option in patients \nwith inoperable lung cancer. Our study also shows that ablation therapy may be \nuseful in higher stage tumours. \n10:30 - 12:00 Room D2 \nInterventional Radiology \nSS 109 \nChemoembolisation and radioembolisation of liver \ntumours \nModerators: \nA. Denys; Lausanne/CH \nP.M. Paprottka; Munich/DE \nB‑0031 10:30\nRepeated transarterial chemoembolisation in the treatment of liver \nmetastases of colorectal cancer: local tumour control and survival data \nT. Gruber-Rouh, N.N.N. Naguib, M. Beeres, B. Bodelle, S. Zangos, \nN. Nour Eldin, R. Hammerstingl, T.J. Vogl; Frankfurt/DE \nPurpose: To evaluate local tumour control and survival data after transarterial \nchemoembolisation with different drug combinations in the palliative treatment of \nliver metastases in patients with colorectal cancer.\nMethods and Materials: A total of 564 patients (mean age,60.3 years) with unre-\nsectable liver metastases of CRC were repeatedly treated with chemoembolisation \nin 4-week intervals. In total, 3384 chemoembolisation procedures were performed \n(mean, 6 sessions per patient). Of 564 patients, 66.4% had multiple metastases, \n10.6% had one metastasis, 11.2% had two metastases, and 11.8% had three or \nfour metastases. The local chemotherapy protocol consisted of mitomycin C alone \n(43.1%), mitomycin C with gemcitabine (27.1%), mitomycin C with irinotecan \n(15.6%), or mitomycin C with irinotecan and cisplatin (15.6%). Embolisation was \nB‑0027 11:24\nValidation of a computed-tomography-based risk model for the \nprediction of cardiovascular disease in a lung cancer screening setting \nP.M. Jairam, P.A. de Jong, W.P.T.M. Mali, Y. van der Graaf; Utrecht/NL \n(pjairam@umcutrecht.nl) \nPurpose: The routine-radiological-risk (Triple-R) score is a radiological risk model \nfor the prediction of the absolute 5-year cardiovascular disease (CVD) risk. This \nscore is based on additional imaging findings in routine non-cardiovascular chest \ncomputed tomography (CT) scans. The triple-R score demonstrated good prediction \nof individual risk in hospital populations. Good performance of the triple-R score \nin a screening setting emerges the possibility to enhance the benefits of chest \nCT-based screening of heavy smokers. Adding Triple-R to lung cancer screening \nresults in multiple disease screening without the need for additional imaging. The \naim of the present study was to validate the Triple-R score within a lung cancer \nscreening setting.\nMethods and Materials: A case-cohort study was used within a lung cancer \nscreening trial. In a cohort of 3559 male participants, 263 fatal and non-fatal car-\ndiovascular events (cases) occurred during mean follow -up of 27 months (max. \n45 months). From the cohort, 341 subjects were randomly drawn (subcohort). Ac-\ncording to Triple-R, CT’s for the cases and subcohort were graded for left anterior \ndescending coronary, mitral valve and descending aorta calcifications and heart \nsize was measured. Discrimination and calibration was assessed over a mean \nfollow-up period of 27 months.\nResults: Mean age of cases and subcohort were, respectively, 62 (52-78) and \n61 (52-78) years. Discrimination was acceptable with a c-statistic of 0.68 (95%CI \n0.65-0.72). Triple-R demonstrated a good overall calibration.\nConclusion: CT-based cardiovascular Triple R score performed well in this lung \ncancer screening cohort, which is supporting future use in a clinical and lung \ncancer screening setting. \nB‑0028 11:33\nDiagnostic accuracy of virtual 18 F-FDG PET/CT bronchoscopy \nfor the detection of lymph node metastases in non-small cell lung \ncancer patients \nM.C. Herbrik1, C. Buchbender2, J. Treffert3, B. Geiger4, V. Hartung-Knemeyer1, \nH. Kühl1, G. Antoch2, M. Forsting1, T.A. Heusner2; 1Essen/DE, 2Düsseldorf/DE, \n3Knoxville, TN/US, 4Princeton, NJ/US (m.herbrik@gmx.de) \nPurpose: Bronchoscopically guided lymph node biopsy is a common procedure \nin bronchial carcinoma patients. To plan those biopsies a virtual “fly-through” 3D \nFDG-PET/CT bronchoscopy has been shown to be technically feasible. The di-\nagnostic accuracy of this procedure, using histopathology as reference standard, \nhas not been evaluated yet. The aim of this study was to determine the diagnostic \naccuracy of a virtual 3D FDG-PET/CT bronchoscopy for the detection of thoracic \nlymph node metastases in non-small cell lung cancer (NSCLC) patients.\nMethods and Materials: 30 consecutive NSCLC patients prospectively underwent \nwhole body FDG-PET/CT. From these data virtual 3D FDG-PET/CT bronchoscopies \nwere reconstructed. The sensitivity, specificity, the PPV, NPV and accuracy of FDG-\nPET/CT bronchoscopy for the detection of lymph node metastases were evaluated \non a compartment basis (according to Mountain and Dresler). Compartments with \nhigh rates of false positive results were identified. Histopathology (sampled by \nmediastinoscopy) served the standard of reference.\nResults: The sensitivity, specificity, PPV, NPV and accuracy of virtual FDG-PET/\nCT bronchoscopy for the detection of lymph node metastases were 74%, 82%, \n67%, 87% and 77%, respectively. In the 4L compartment there was a high rate \n(9/30) of false positive results.\nConclusion: Virtual “fly-through” 3D FDG-PET/CT bronchoscopy yields a relatively \nhigh diagnostic accuracy for the detection of regional lymph node metastases. It \nmay be used to plan bronchoscopically guided lymph node biopsies. Results of \nthis procedure in the localisation 4L should be rated with caution due a high rate \nof false positive results.\nB‑0029 11:42\nPercutaneous transthoracic CT-guided biopsy using large core \nneedles: initial experience \nU.C. Lalji, J.E. Wildberger, M. Bendek, M. Das; Maastricht/NL (u.lalji@mumc.nl) \nPurpose: The use of large core needle biopsy in percutaneous transthoracic \ninterventions may be advantageous in terms of histological evaluation (larger \nspecimens) and mutational analysis (more cells for analysis). The aim of this \nstudy was to retrospectively evaluate the success rate and safety in percutaneous \ntransthoracic CT guided needle biopsy using these devices.\n\nScientific Sessions\nS155\nA\n C D E F G\nB\nThursday\npatients. The 1-year survival rate after chemoembolisation was 68%, and the \n2-year survival rate was 36%. The median and mean survival times from the start \nof TACE treatment were 18 and 31.8 months. There was no statistically significant \ndifference between the three treatment protocols.\nConclusion: Chemoembolisation is a potentially palliative treatment option in \nachieving local control in selected patients with liver metastases from malignant \nmelanoma. \nB‑0034 10:57\nExperimental study on transarterial administration of survivin \nsiRNA combined with transarterial chemoembolisation in rats with \nhepatocellular carcinoma (HCC) \nT.J. Vogl1, J. Qian2, A. Tran1, E. Oppermann1, U. Imlau1, Y. Hamidavi1, \nH. Korkusuz1, W.O. Bechstein1; 1Frankfurt a. Main/DE, 2 Wuhan/CN \n(t.vogl@em.uni-frankfurt.de) \nPurpose: To evaluate the effects of transarterial administration of survivin siRNA \ncombined with transarterial chemoembolisation (TACE) for treating hepatocellular \ncarcinoma (HCC) in rats.\nMethods and Materials: Subcapsular implantation of a solid Morris hepatoma \n3924 A in the liver was carried out in 20 male ACI rats (day 0). Tumour volume (V1) \nwas measured by MRI (day 12). After laparotomy and retrograde placement of a \ncatheter into the gastroduodenal artery (day 13), the following different agents were \ninjected into the hepatic artery: TACE (0.1 mg of mitomycin+0.1 ml of lipiodol+5.0 \nmg of degradable starch microspheres)+2.5nmol survivin siRNA (n=10) (group A, \nn=10); TACE alone (group B, n=10). Tumour volume (V2) was assessed by MRI \n(day 25), tumour growth ratio (V2/V1) was calculated. Western blot analysis was \nperformed to assess the protein expression level of survivin in each treatment. The \nprogressional potential of the tumours was assessed for quantification of positive \nVEGF tumour cells via immunohistochemical analysis.\nResults: Mean tumour growth ratio (V2/V1) was 1.1313+0.1381 in group A, and \n3.1911+0.1393 in group B. Compared with group B, group A showed significant \ninhibition of tumour growth (P < 0.01). Survivin expression level was lower in \ngroup A than in group B. There was a significant difference between groups A and \nB in survivin expression by western blot analysis (P < 0.01). Higher expression \nof VEGF in HCC was observed in group B vs. group A by immunohistochemical \nexamination (P < 0.01).\nConclusion: Combined TACE and transarterial administration of survivin siRNA is \nmore effective than TACE alone for inhibiting the growth of HCC in rats. \nB‑0035 11:06\nRole of transarterial chemoembolisation as bridging strategy in T2 \nHCC patients on the waiting list \nE. Bozzi, I. Bargellini, F. Turini, A. Cicorelli, R. Cioni, C. Bartolozzi; Pisa/IT \n(elenabozzi@libero.it) \nPurpose: To retrospectively evaluate long-term outcomes of T2 stage HCC patients \nwho underwent orthotopic liver transplantation (OLT) after transarterial chemoem-\nbolisation (TACE), compared with patients transplanted without bridging therapy.\nMethods and Materials: The study included 168 cirrhotic patients (147 males, \nmean age 55.8 years) with T2 HCC, who underwent OLT from 1996 to 2010. In \npatients treated by TACE, latest CT examination prior to OLT was reviewed to \nassess tumour response according to mRECIST. Patients were divided into three \ngroups: A) no bridging therapy, B) complete response (CR) after TACE, C) partial \nresponse, stable or progressive disease after TACE. Overall (OS), recurrence-free \n(RFS) and disease-free (DFS) survivals were calculated by Kaplan-Meier analysis \nand compared by log-rank test.\nResults: Fifty-six patients were in group A, 60 patients in group B and 52 patients in \ngroup C; preprocedural data were comparable among groups. Five-year OS, RFS \nand DFS were 75.2%, 92.7% and 73.2%, respectively. Survivals were significantly \nhigher in group B compared with group C and comparable between group A and \nB. In tumours > 3 cm, DFS censored for peri-operative deaths (n=7) was higher in \ngroup B compared with group A (p=0.05).\nConclusion: In T2 transplanted patients, CR after pre-operative TACE represents \na favourable prognostic indicator for survival and tumour recurrence. TACE may \nbe beneficial for T2 HCC patients with overall tumour size > 3 cm.\nperformed with lipiodol and starch microspheres for vessel occlusion. Tumour \nresponse was evaluated with MRI. The change in tumour size was calculated and \nthe response was evaluated according to the RECIST. Survival rates from first \nchemoembolisation session were calculated according to the Kaplan-Meier method.\nResults: Evaluation of local tumour control resulted in partial response (n=94), \nstable disease (n=272), and progressive disease (n=198). The 1-year survival rate \nafter chemoembolisation was 62%, the 2-year survival rate was 28%, and the 3-year \nsurvival rate was 7%. Median survival was 14.3 months. There was no statistically \nsignificant difference between the three treatment protocols.\nConclusion: Chemoembolisation is a minimally invasive therapy option for pallia-\ntive treatment of liver metastases in patients with CRC, with similar results among \nthree chemoembolisation protocols.\nB‑0032 10:39\nHolmium-166 radioembolisation: results of a phase 1, dose \nescalation study in patients with unresectable, chemorefractory liver \nmetastases - the HEPAR trial \nM.L.J. Smits, J.F.W. Nijsen, M.A.A.J. van den Bosch, M.G.E.H. Lam, \nM.A.D. Vente, W.P.T.M. Mali, A.D. van het Schip, B.A. Zonnenberg, J.F. Prince; \nUtrecht/NL (j.prince@umcutrecht.nl) \nPurpose: Holmium-166 (166Ho) poly (L-lactic acid) microspheres are unique \nbecause their distribution can be imaged in vivo with both SPECT and MRI. In this \nphase 1 clinical trial, we aimed to assess the safety and the maximum tolerated \nradiation dose (MTRD) of 166Ho-RE in patients with liver metastases.\nMethods and Materials: Patients with unresectable, chemorefractory liver metas-\ntases were enrolled for intra-arterial 166Ho-RE. Patients were treated in cohorts \nof three, with escalating aimed whole-liver absorbed doses of 20 - 80 Gy. Cohorts \nwere extended to maximally six patients if dose-limiting toxicity occurred. Toxicity \nwas scored according to the Common Terminology Criteria for Adverse Events \nv.3 (CTCAE). Patients were assigned a dose in the order of study entry, with dose \nescalation until dose-limiting toxicity was encountered in at least two patients of \na dose cohort. The primary endpoint was the MTRD. The study is registered with \nClinicalTrials.gov, NCT01031784.\nResults: Fifteen patients underwent 166Ho-RE with mean estimated whole-liver \nabsorbed doses of 18 Gy (20-Gy cohort), 35 Gy (40-Gy cohort), 58 Gy (60-Gy \ncohort), and 73 Gy (80-Gy cohort). The 20-Gy cohort was extended to six patients \nbecause of the occurrence of a pulmonary embolism. In the 80-Gy cohort, dose \nlimiting toxicity was encountered in two patients. The MTRD was determined to \nbe 60 Gy.\nConclusion: 166Ho-RE is feasible and safe for the treatment of patients with unre-\nsectable and chemorefractory liver metastases and offers image-guided treatment. \n166Ho-RE should be performed with a aimed whole-liver absorbed dose of 60 Gy.\nAuthor Disclosures:\n J.F.W. Nijsen: Patent Holder; Patents regarding holmium microspheres. \nM.A.D. Vente: Employee; Sirtex Medical. A.D. van het Schip: Patent Holder; \nPatents regarding holmium microspheres. B.A. Zonnenberg: Patent Holder; \nPatents regarding holmium microspheres.\nB‑0033 10:48\nRepetitive transarterial chemoembolisation as a palliative treatment \noption for liver metastases from cutaneous malignant melanoma: \nindications, outcomes and role in patient’s management \nT. Gruber-Rouh, P. Weisser, N.N.N. Naguib, K. Eichler, M. Harth, S. Zangos, \nN-E.A. Nour-Eldin, T.J. Vogl; Frankfurt/DE \nPurpose: To evaluate local tumor control and survival data after TACE with three \ndifferent chemotherapeutic protocols in the palliative treatment of patients with liver \nmetastases from malignant melanoma.\nMethods and Materials: The study protocol was approved by the ethical commit-\ntee, and informed consent was obtained from all patients prior to treatment. A total \nof 67 patients (mean age, 55.2 years; range, 28-77 years) with unresectable liver \nmetastases of malignant melanoma who did not respond to systemic therapy were \nrepeatedly treated with TACE in 4-week intervals. In total, 456 chemoembolisation \nprocedures were performed (mean, 7 sessions per patient; range, 3-12 sessions). \nThe local chemotherapy protocol consisted of mitomycin alone (14.9%;n=10), \nmitomycin with gemcitabine (43.3%;n=29) or mitomycin, gemcitabine and cis-\nplatin (41.8%,n=28). Embolisation was performed with lipiodol and degradable \nstarch microspheres. Local tumor response was evaluated by MRI according \nto the modified RECIST criteria. Survival data were calculated according to the \nKaplan-Meier method.\nResults: The local tumor control was: partial response (PR) in 1.5% (n=1), stable \ndisease (SD) in 50.7% (n=34) and progressive disease (PD) in 47.8% (n=32) of \n\nScientific Sessions\nS156\n C A D E F\n G\nB\nB‑0038 11:33\nInitial RECIST tumour reduction as a predictive parameter for \ntransarterial chemoembolisation treatment success in patients with \nhepatocellular carcinoma \nD.B. Hasdemir, B.C. Meyer, N. Schweitzer, A. Vogel, C. von Falck, H. Rosenthal, \nF. Wacker, T. Rodt; Hannover/DE (hasdemir.davut@mh-hannover.de) \nPurpose: To test the hypothesis that initial tumour reduction based on RECIST crite-\nria in patients with intermediate stage hepatocellular carcinoma has prognostic value \nfor the maximum response to transarterial chemoembolisation (TACE) treatment.\nMethods and Materials: A data base review was performed for patients who \nunderwent TACE procedures at our institution over three consecutive years. 63 \nintermediate stage hepatocellular carcinoma patients with RECIST follow-up were \nidentified, who had no previous TACE. All patients were treated with a TACE pro-\ncedure (n=198) using doxorubicin and cisplatin as chemotherapeutic agents and \nlipiodol. Individual RECIST response throughout up to five TACE procedures was \ncorrelated to overall survival and maximum tumour response.\nResults: Patients received an average of 3.1 TACE procedures (SD 2.8). Kaplan-\nMeier analysis yielded a mean overall survival of 843 d (95% CI 682 - 1004 d). 19 \npatients (30.2%) did not show any response, 44 patients (69.8%) showed response. \nMaximum RECIST tumour response was assigned to individual treatment intervals \n(TACE 1: 19 patients (30.2%); TACE 2: 6 patients (9.5%); TACE 3: 8 patients \n(12.7%); TACE 4: 5 patients (7.9%); TACE 5: 0 patients (0%); 6 patients TACE \n6 - 17 (9.5%). A Pearson correlation was calculated between maximum tumour \nresponse and tumour response of the initial TACE procedures (TACE1: 0.606 (p \n< 0.01); TACE 2: 0.701 (p < 0.01); TACE 3: 0.498 (p < 0.05).\nConclusion: Initial RECIST tumour reduction shows significant correlation to \nmaximum tumour response. We conclude that it can be applied as a prognostic \nparameter for TACE treatment. \nB‑0039 11:42\nIntraprocedural parenchymal blood volume measurement using \nrepetitive C-arm CT in patient with hepatocellular carcinoma and \nbreast cancer during TACE: therapy response and evaluation \nT.J. Vogl, S. Blösser, P. Schäfer, E. Mbalisike, S. Zangos; \nFrankfurt a. Main/DE (t.vogl@em.uni-frankfurt.de) \nPurpose: To evaluate potential correlations between initial intraprocedural tumour \nblood volume measurement and prognostic parameters of patients with primary \nand secondary liver malignancies focusing on tumour response.\nMethods and Materials: 43 patients with liver malignancy from breast cancer \n(n=24), and hepatocellular carcinoma (HCC)/cholangiocellular carcinoma (CCC) \n(n=19) were included in this study. Each patient underwent an initial blood volume \nmeasurement using C-arm-CT and MRI followed by TACE+MRI in 4-week inter-\nvals. Images were evaluated by measuring and correlating tumour size in MRI and \nparenchymal blood volume (PBV) (RECIST).\nResults: The preinterventional blood volume measurement of breast cancer pa-\ntients demonstrated a mean blood volume of 94.05 ml/1000 ml (SD 43.6), whereas \n4-week follow-up PBV after TACE was 62.9 ml/1000 ml (-31.15 ml/1000 ml). Mean \ntumour regression after 3 TACEs was 14.52%. The HCC/CCC-groups showed \na mean initial PBV of 57.3 ml/1000 ml (SD 64.5). After TACE it was changed to \n82.2 ml/1000 ml (+24.9 ml/1000 ml increase); after second TACE PBV decreased \nto 73.32 ml/1000 ml) (-8.9 ml/1000 ml). In the breast cancer group, initial tumour \nblood-volume > 100 ml/1000 ml dropped by -9.06%, 50-100 ml/1000 ml dropped \nby -22.24% and < 50 ml/1000 ml dropped by -0.23% in size (based on initial PBV). \nIn the breast cancer group, postinterventional MRI follow -up showed stable dis-\nease (SD) in 21 patients, partial remission (PR) in 3 patients. In the HCC group, \n9 patients had SD, 2 patients had progressive disease (PD). In the CCC group, 7 \npatients had SD and 1 had PD.\nConclusion: The second PBV measurement in the breast cancer group is a sig-\nnificant predictor for tumour regression, whereas the HCC/CCC groups required 2 \nor more TACEs to show a decrease in blood volume and tumour size. \nB‑0036 11:15\nSemi-automatic volumetric tumour segmentation for hepatocellular \ncarcinoma: comparison between C-arm cone-beam computed \ntomography and MRI \nV. Tacher1, M. Lin2, M. Chao1, L. Gjesteby1, N. Bhagat1; 1Baltimore, MD/US, \n2Briarcliff Manor, NY/US \nPurpose: To evaluate the accuracy and reproducibility of a semi-automatic tumour \nsegmentation software in measuring tumour volume of hepatocellular-carcinoma \n(HCC) before the first trans-arterial chemo-embolisation (TACE) on contrast-\nenhancement magnetic-resonance-imaging (CE-MRI) and intra-procedural dual-\nphase C-arm cone-beam computed-tomography (DP-CBCT) images.\nMethods and Materials: 19HCCs were targeted in 19 patients (one per patient) \nwho underwent baseline diagnostic CE-MRI and an intra-procedural DP-CBCT. \nThe images were obtained from CE-MRI (arterial-phase of an intra-venous con-\ntrast medium injection) and DP-CBCT (delayed-phase of an intra-arterial contrast \nmedium injection) before the actual embolisation. Three readers measured tumour \nvolumes using a semi-automatic 3D-volumetric segmentation software which used \na region-growing method employing non-Euclidean radial basis functions. Segmen-\ntation time and spatial position were recorded. The tumour volume measurements \nbetween images sets were compared using linear-regression and Student t-test, and \nevaluated with Intraclass-Correlation analysis (ICC). The inter-rater Dice Similarity \nCoefficient (DSC) accessed the segmentation spatial localisation.\nResults: All 19 HCCs were analysed. On CE-MRI and DP-CBCT examinations, \nrespectively, 1.there was no statistically significant difference in the mean seg-\nmented tumour volumes (87±8 cm3[2-873] and 92±10 cm3[1-954],p=0.30) and the \nmean time required for segmentation (66±45seconds [21-173] and 85±34seconds \n[17-214],p=0.19), 2.the ICCs were 0.99 and 0.974, showing a strong correlation \namong readers, and the inter-rater DSCs showed a good to excellent inter-user \nagreement on the spatial localisation of the tumour segmentation (0.70±0.07 and \n0.74±0.05,p=0.07).\nConclusion: This study shows a strong correlation, accuracy and reproducibility \nof semi-automatic tumour segmentation software in measuring tumour volume on \nCE-MRI and DP-CBCT images. The use of the segmentation software on DP-CBCT \nand CE-MRI can be a valuable and highly accurate tool to measure the volume \nof hepatic tumours. \nB‑0037 11:24\nTranscatheter arterial chemoembolisation of hepatocellular \ncarcinoma in transplant patients: smaller bead diameter and \nhypervascularity lead to higher tumour necrosis \nM. Hakky, S. Amirifeli, C. Wald, C. Molgaard, H. Ahari; Burlington, MA/US \nPurpose: Transcatheter arterial chemoembolisation of hepatocellular carcinoma \n(HCC) with doxorubicin-loaded drug-eluting beads (DEB) is used as bridge therapy \nin patients awaiting transplant. Our purpose was to assess the influence of bead \nsize and tumour vascularity on degree of tumour necrosis and successful bridging.\nMethods and Materials: Consecutive Barcelona Clinic Liver Cancer Stage A \ntransplant listed patients with HCC underwent chemoembolisation. 13 patients \ntreated with “large” DEB of 300-500µm and 500-700µm diameter, 21 patients with \n“small” DEB of 100-300µm and 300-500µm diameter. Average age of small bead \npatients: 58.2±4.5 years, male:female ratio 86%:14% versus large bead patients: \n57.9±12.3 years, male:female ratio 85%:15%.Patients evaluated with imaging \nin 3-month intervals. Tumour vascularity assessed angiographically prior to first \nchemoembolisation. Explant pathology used to determine degree of necrosis.\nResults: 4/21 (19%) small bead patients and 3/13 (23%) large bead patients \nprogressed beyond transplant criteria. 8 small bead patients and 9 large bead \npatients were transplanted 184±101 and 169±96 days after chemoembolisation, \nrespectively. 4/8 (50%) small bead patients and 3/9 (33%) large bead patients had \nno arterial enhancement on imaging prior to transplant. The 4 small bead patients \nshowed complete pathologic necrosis versus only 2 out of the 3 large bead patients. \n2 small bead patients and 3 large bead patients had angiographically hypovascular \nlesions. Incomplete necrosis was seen in all 5/5 (100%) hypovascular lesions versus \n6/12 (50%) hypervascular lesions.\nConclusion: Chemoembolisation using smaller drug-eluting beads is associated \nwith improved ability to bridge early stage HCC patients to transplant. Relative \nhypovascular HCC responds less well to chemoembolisation independent of \nbead size. \n\nScientific Sessions\nS157\nA\n C D E F G\nB\nThursday\nB‑0042 10:39\nMR imaging of glenoid bone loss \nK.R. Lee, J.F. Griffith, W.A. Ng, M. Tong, S. Nimish; Hong Kong/HK \n(leekalok2909@yahoo.com.hk) \nPurpose: CT, using an en-face glenoid image, accurately quantifies glenoid bone \nloss in anterior shoulder dislocation. An anterior straight line and reduction in glenoid \nwidth are recognised CT signs of glenoid bone loss. It would be useful if MR could \nreplace CT in this respect, especially as a high-resolution en-face image of the \nglenoid can be obtained during standard MR assessment. This study investigates \nthe agreement between MR, CT and arthroscopy in measuring glenoid bone loss.\nMethods and Materials: Institutional approval for this study was granted. 176 \npatients (158 males, 18 females; mean 26.8±12.3 years) with anterior shoulder \ndislocation underwent both shoulder MRI and CT examination. 65 of these patients \nalso had arthroscopy performed. MR assessment of glenoid bone loss involved \nuse of a best-fit circle.\nResults: Excellent correlation existed between CT and MRI for length of anterior \nstraight line (r=0.97 p < 0.0001), glenoid width (r=0.95, p < 0.0001) and severity \nof glenoid bone loss particularly using best-fit circle width (r=0.82, p < 0.0001) \nrather than best-fit circle area (r=0.83, p < 0.0001). There was a marginally better \ncorrelation between the CT and the arthroscopy (r=0.91, p < 0.0001) than MR and \narthroscopy (r=0.84, p < 0.0001 a) for glenoid bone loss.\nConclusion: MR assessment, particularly using glenoid width, is almost as ac-\ncurate as CT assessment for glenoid bone loss. In general, MR can replace CT \nin this respect.\nB‑0043 10:48\nRotator cuff tendon tear size and retraction and quantification of \nmuscle fatty infiltration using chemical shift-based water-fat MR imaging \nS. Lee, L. Nardo, R. Lucas, D. Karampinos, J. Carballido-Gamio, A. Lai, \nC.B. Ma, T. Link, R. Krug; San Francisco, CA/US (Sonia.Lee@ucsf.edu) \nPurpose: This study aimed to define the relationship between rotator cuff tendon \ntear size and retraction and muscle fatty infiltration quantified using chemical shift-\nbased water-fat MR imaging.\nMethods and Materials: The shoulders of 50 patients (26 men, 24 women; mean \n52.44 years; range 17-65 years) with shoulder pain were imaged using 3 T MR \nscanner. Sequences included oblique-sagittal T1-, T2- and PD-weighted fast spin \necho (FSE), coronal and axial T2 FSE and a gradient echo with 6 echo shifts to \ngenerate fat fraction maps using the IDEAL algorithm. Two radiologists evaluated \nsupraspinatus, infraspinatus and subscapularis tendons according a 5-point scoring \nsystem: 0= normal; 1=tendinosis; 2 partial thickness tear; 3= full-thickness tear and \n4= full-thickness tear with retraction and graded muscles according to Goutallier \nclassification. Tears sizes were measured. The retraction was classified into (i) \nretraction< 1 cm; (ii) retraction > 1 cm, but lateral to the glenoid; and (iii) retraction \nmedial to the glenoid. Comparisons between IDEAL fat fraction values and tear \nvariables were assessed with Spearman Rank Correlation (SRC).\nResults: A significant correlation between the clinical grading and the fat fraction \nvalues was found for all the evaluated muscles: p < 0.0001, SCR of 0.75 and 0.70, \n0.68 for supraspinatus, infraspinatus and subscapularis muscles, respectively. The \nfatty infiltration values correlated with both size of the tear (p=0.031 SCR of 0.48), \nand with the degree of tendon retraction (p=0.015; SCR of 0.54).\nConclusion: Fat fraction using chemical shift-based water-fat MR imaging cor-\nrelates with rotator cuff tear size and degree of retraction. \nB‑0044 10:57\nComparison of 3D turbo spin-echo space sequences with \nconventional 2D MRI sequences to assess the shoulder joint \nJ.K. Kloth1, M. Winterstein1, M. Akbar1, E. Meyer2, D. Paul2, H.-U. Kauczor1, \nM.-A. Weber1; 1Heidelberg/DE, 2Erlangen/DE (jost.kloth@med.uni-heidelberg.de) \nPurpose: To determine the accuracy and reliability of three-dimensional (3D) \nintermediate- and T1-weighted turbo spin-echo (TSE) sampling perfection with \napplication-optimised contrasts using different flip-angle evolution (SPACE) \ncompared with conventional 2D sequences in assessment of the shoulder-joint.\nMethods and Materials: Ninety-nine subjects were examined on a 3-Tesla MRI \nsystem with both conventional 2D-TSE in T1-, T2- and fat-saturated proton-density \n(PD)-weighting (measurement time 26:12 min) and 3D-TSE SPACE in T1- and \nPD-weighting with 0.6 mm slide thickness (measurement time 15:52 min). All \nexaminations were assessed independently by two reviewers for pathologies of \nthe rotator cuff, biceps tendon, cartilage and bone-marrow, as well as the pres-\nence of effusion and bursitis. Concordance between 2D- and 3D-sequences and \ninter-observe agreement was evaluated using kappa statistics.\nB‑0040 11:51\nStudy on the effect of chemoembolisation combined with microwave \nablation for the treatment of hepatocellular carcinoma in rats \nT.J. Vogl1, J. Qian2, U. Imlau1, Y. Hamidavi1, H. Korkusuz1, \nE. Oppermann1, W.O. Bechstein1; 1Frankfurt a. Main/DE, 2 Wuhan/CN \n(t.vogl@em.uni-frankfurt.de) \nPurpose: To assess the effect of transcatheter arterial chemoembolisation (TACE) \ncombined with microwave ablation for the treatment of hepatocellular carcinoma \nin an animal model.\nMethods and Materials: All experiments were approved by the German govern-\nment and the Institutional Animal Research Review Board. After subcapsular liver \nimplantation of Morris Hepatoma 3924 A in 30 ACI rats, the animals were randomly \nassigned to three interventional treatment groups as follows: (A) TACE (0.1 mg \nof mitomycin + 0.1 ml of lipiodol + 5.0 mg of degradable starch microspheres) + \nmicrowave ablation (2450 MHz; 35 W, 45 s) (n=10); (B) TACE alone (control group \n1, n=10); (C) microwave ablation alone (control group 2, n=10). Tumour volume \nbefore (V1) and after the treatment (V2) was assessed by MRI and the tumour \ngrowth ratio (V2/V1) was calculated. Immunohistochemical analysis was performed \nfor quantification of positive MMP-9 and VEGF tumour cells in each treatment.\nResults: Mean tumour growth ratio was 1.3385 + 0.1949 in group A, 3.1901 + \n0.1323 in group B, and 4.1779 + 0.1862 in group C, respectively. Compared with the \nratio in groups B and C (controls), the ratio in group A showed significant reduction \nin tumour growth (P < 0.01). Lower expression of MMP-9 and VEGF in hepatocel-\nlular carcinoma was observed in group A vs. groups B and C (controls) (P < 0.05).\nConclusion: Treatment with combined TACE/microwave ablation, compared with \nthe treatment of TACE or microwave ablation alone, significantly inhibits tumour \ngrowth and intrahepatic metastases in an animal model of hepatocellular carcinoma.\n10:30 - 12:00 Room E1 \nMusculoskeletal \nSS 110 \nShoulder and hand \nModerators: \nC. Schüller-Weidekamm; Vienna/AT \nM. Shahabpour;  Brussels/BE \nB‑0041 10:30\nDiagnosing adhesive capsulitis of shoulder on sonography alone: is \nit possible? \nA. Tandon, S. Dewan, S. Bhatt, A.K. Jain; New Delhi/IN (sakshii.21@gmail.com) \nPurpose: Adhesive capsulitis (AC) has been a diagnosis of exclusion on sonogra-\nphy due to lack of specific diagnostic criteria. Multiple static and dynamic parameters \nfor sonographic diagnosis of AC are introduced.\nMethods and Materials: Shoulder sonography was performed prospectively on \n60 patients with painful shoulder and 30 asymptomatic controls by two radiologists. \nStatic [coracohumeral ligament (CHL) thickness, increased soft tissue in rotator \ninterval] and dynamic parameters [restriction of abduction and external rotation] \nfor adhesive capsulitis were evaluated. Patients were divided into three groups: \nadhesive capsulitis (AC) (n=30), painful shoulders (PS) (n=30) and control group \n(CL) (n=30) based on MRI diagnosis.\nResults: Sonographic visualisation of CHL (96.7%) and its mean thickness (1.2 \nmm) were highest in the AC group (P < 0.01). A cut-off value of 0.7 mm was found \nto be accurate (sensitivity 93.1% specificity 94.4%) for diagnosing AC. Increased \nsoft tissue in the rotator interval was seen in the AC group (sensitivity 86.2%, spe-\ncificity 92.8%). On dynamic sonography, restriction of external rotation was specific \n(sensitivity of 96.7% and specificity 90%), whereas restriction in abduction was \nnon-specific (specificity 6.7%) for AC. Inter-observer agreement was substantial for \nCHL visualisation (kappa 0.66). The overall sensitivity and specificity sonography \nfor diagnosing adhesive capsulitis taking MRI as reference standard was 100% \nand 87%, respectively.\nConclusion: Sonography, using the stated static and dynamic parameters was \nhighly accurate in the diagnosis of adhesive capsulitis and in differentiating it from \nother causes of painful shoulder. It has the potential to be adopted as a first line \nmodality. \n\nScientific Sessions\nS158\n C A D E F\n G\nB\nB‑0047 11:24\nEvaluation of concomitant osseous carpal injuries in patients with \ndistal radial fractures in MDCT \nA. von Schneider-Egestorf, C. von Falck, B. Meyer, F. Wacker, H. Rosenthal; \nHannover/DE (amelievonschneider@hotmail.com) \nPurpose: To investigate the prevalence and type of concomitant carpal bone \nfractures in patients with acute intra-articular distal radial fractures.\nMethods and Materials: Evaluation of 1295 diagnostic MDCT scans of the wrist \nacquired between 01/2005 and 10/2011. The final study group included 603 patients \nwith acute distal radial fractures (Frykman III-VIII). All images were analysed in \nconsensus by a radiology resident and an experienced musculoskeletal radiologist.\nResults: 20.4 % of all patients with distal intraarticular radial fractures had simul-\ntan carpal fractures. Among the total number of 144 fractures, the most common \nfracture type was the dorsal avulsion fracture of the triquetrum (44.2%), followed \nby fractures of the lunate (14.6 %), trapezium fractures (11.1%), scaphoideum \nfractures (10.4%), hamate fractures (7.7%) and pisiforme fractures (4.9%). Sig-\nnificantly higher prevalence of fractures in the proximal carpal row. Trapezial ridge \nfractures were seen in 11 cases.\nConclusion: Intraarticular distal radial fractures are frequently associated with \nsimultan carpal fractures. Based on our findings the diagnostic MDCT is highly \nrecommended for patients with distal intraarticular radial fractures. \nB‑0048 11:33\nNormal anatomy and variants of the trapeziometacarpal joint at MR \nimaging in asymptomatic volunteers \nA. Hirschmann, R. Sutter, A. Schweizer, C.W.A. Pfirrmann; Zurich/CH \n(anna.hirschmann@balgrist.ch) \nPurpose: To prospectively characterise the MR anatomy and variants of the \ntrapeziometacarpal (TMC) joint in asymptomatic volunteers.\nMethods and Materials: 34 asymptomatic volunteers (17 women, 17 men, mean \nage 33.9±9.2years) underwent MR imaging of the thumb after approval by the lo-\ncal ethical committee. Two musculoskeletal radiologists independently classified \nvisibility and signal intensity (SI) characteristics of the anterior oblique (AOL/beak \nligament), the posterior oblique (POL), the intermetacarpal (IML) and the dorsoradial \nligaments (DRL) on a 3-point Likert scale. The thickness of all ligaments, cartilage \nintegrity and presence of joint fluid were assessed. The alignment of the first \nmetacarpal base with the trapezium was quantified on sagittal and coronal planes.\nResults: On intermediate-balanced fat-saturated images the POL (65%/74% reader \n1/reader 2) and DRL (58%/64%) were commonly of intermediate SI, while the IML \nhad a striated appearance in 91%/76% of subjects. The AOL showed a variable SI \n(36%/42% low,27%/27% increased,36%/30% striated). The IML was the thickest \nligament with a mean of 2.9 mm/3.1 mm and the DRL the thinnest (1.2 mm/1.4 mm). \nThere was a mean dorsal shift (1.8 mm/2.0 mm) and radial shift (2.8 mm/3.4 mm) \nof the metacarpal base. The AOL was significantly thicker in men (1.7 mm) than \nin women (1.2 mm, P=0.02). Radial shift was significantly larger in men (3.4 mm) \nthan in women (2.2 mm, P=0.02). No shift in palmar or ulnar direction was seen.\nConclusion: The TMC ligaments showed a considerable variability. The IML is \ntypically striated and thicker compared to the other ligaments. Radial and dorsal \nshift of the TMC joint is a normal finding at MR imaging.\nB‑0049 11:42\nSafety of dorsal wrist arthroscopy portals: a magnetic resonance study \nR. Cazzato, R. Del Vescovo, F. Giurazza, R.F. Grasso, B. Beomonte Zobel; \nRome/IT (r.delvescovo@unicampus.it) \nPurpose: Aim of our study was to assess and compare the distance of commonly \nused dorsal wrist arthroscopy portals to radial and ulnar neurovascular structures.\nMethods and Materials: 40 patients were prospectively evaluated with T1-weighted \nspin-echo (SE) magnetic resonance (MR) sequences in the coronal and transverse \nplanes of the radiocarpal joint. The distances between portals and nearest super-\nficial nerve branch and vascular bundle were measured. Statistical analysis of the \ndata was performed with SPSS.\nResults: The median age of patients was 39 years. The median distance of the \nnearest nerve branch to portal 1-2 was 2 mm; portal 3-4, 19.49 mm; portal 4-5, \n14.66 mm; portal 6/R, 9.66 mm; and portal 6/U, 4.33 mm. The median distance of \nthe nearest vascular bundle to portal 1-2 was 7.66 mm; portal 3-4, 9.66 mm; portal \n4-5, 8.49 mm; portal 6/R, 7.33 mm; and portal 6/U, 6.33 mm. In terms of distance \nto the nearest vascular bundle, the 3-4 portal was safer than the 1-2 portal (P < \n0.0001), 4-5 portal (P=0.008), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). In \nterms of distance to nearest nerve branch, the 3-4 portal was safer than the 1-2 \nResults: Concordance between 2D and 3D was almost perfect for tendinopathies \nof the rotator-cuff (κ=0.88), omarthrosis (κ=1) and adjacent bone marrow (κ=0.873) \nand substantial for rotator-cuff injuries (κ=0.621-0.726), tendinopathies of the biceps \ntendon (κ=0.787), effusion (κ=0.779), bursitis (κ=0.704) and well as cartilage tears \n(κ=0.719). Inter-observer agreement was almost perfect for omarthrosis (κ=1) \nand tendinopathies (κ=0.81), substantial for effusion (κ=0.701) and bone marrow \n(κ=0.778) but moderate and fair for the other mentioned pathologies. Kappa-\ncoefficients were generally higher for conventional 2D TSE sequences (0.333-1) \nwhen compared to 3D TSE SPACE sequences (-0.012-1).\nConclusion: Due to substantial and almost perfect concordance with conventional \n2D TSE sequences for common pathologies, shorter examination-time up to 11 min \nand therefore increasing patient comfort, shoulder MRI examination-time can be \nreduced by nearly 40% using 3D-SPACE without loss of information. \nAuthor Disclosures:\nH. Kauczor: Advisory Board; Siemens. Investigator; Boehringer Ingelheim. \nSpeaker; Siemens, Boehringer Ingelheim, Bayer, Bracco.\nB‑0045 11:06\nEvaluation of MR-arthrography in identifying bony Bankart lesions: \nusefulness of thin-slice T1 weighted GRE sequences \nG. Foti, E. Oliboni, L. Romano; Negrar/IT (eugenio.oliboni.84@hotmail.it) \nPurpose: To evaluate diagnostic accuracy of MR arthrography in identifying bony \nBankart lesions using as reference standard high-resolution CT.\nMethods and Materials: MR arthrogragraphy of 48 consecutive patients suffer-\ning from gleno-humeral instability and/or shoulder luxations were retrospectively \nreviewed by 2 readers in order to identify bony Bankart lesions. In addition to \nstandard protocol, thin-slice (0.8 mm) fat-saturated T1 GRE sequence was ac-\nquired on axial plane. MRI imaging findings were compared with high-resolution \nCT images, considered as reference standard, considering a value of p < 0.05 as \nstatistically significant. Also, additional findings regarding tendons and ligament \ninvolvement were assessed.\nResults: A bony Bankart lesion was identified in 14 of 48 patients using CT. At MRI, \nGlenoid fracture was correctly identified using standard protocol in 10/14 cases \n(71.4%), whereas it was depicted by thin-slice GRE sequence in 13/14 cases \n(sensitivity 92.8%); MRI pointed out no false-positive findings (specificity 100%). \nAssociated imaging findings included inferior gleno-humeral ligament tear (n=6), \nrecent Hill-Sachs humeral fracture (n=3), and rotator cuff partial tears (n=3). Thin \nslice T1-Weighed GRE sequence performed similarly to CT in identifying bony \nBankart lesions (p> 0.05), while it allowed obtaining better results if compared with \nthe standard sequences of our MR-arthrography protocol (p=0.025).\nConclusion: Thin-slice fat-saturated T1 GRE sequence at MR arthrography, allow-\ning multiplanar isotropic reconstructions, can be employed to depict bony Bankart \nlesions in patients suffering from gleno-humeral instability and shoulder luxations. \nB‑0046 11:15\nSuperior labral dimension of the glenoid labrum on direct MR \narthrography (MRA): relationship with presence of SLAP \nT. Im1, J.-A. Choi1, G. Lee1, J. Oh1, S. Hong2, H. Kang1; 1Seongnam/KR, \n2Seoul/KR (hifi310@gmail.com) \nPurpose: To evaluate the relationship between superior labral dimension of glenoid \nlabrum on direct MRA and SLAP lesion.\nMethods and Materials: Direct MRA of shoulder was performed in 295 patients \nfor chronic pain or instability, who underwent arthroscopy and whose records were \nreviewed. MR images were analysed by a radiologist; superior labral dimension was \nmeasured on coronal T1-weighted fat-suppressed (T1 FS) and non-fat-suppressed \n(T1WI) images, at the plane where long head of biceps tendon disappeared and \nlabrum appeared the largest. Transverse and longitudinal dimensions were meas-\nured as base and height of the inverted triangular-shaped superior labrum and \ncompared between patients who had SLAP on arthroscopy (SLAP group) vs. those \nwho did not (non-SLAP group). Statistical analysis was done using Student’s T-test.\nResults: In 295 patients, 132 patients (44.7%) had SLAP. Mean values of base \nand height of labrum on T1WI were 8.91 mm (SD 0.17) and 5.28 mm (SD 0.11) \nin SLAP group, 8.96 mm (SD 0.17) and 5.04 mm (SD.088) in non-SLAP group, \nrespectively. Mean values of base and height on T1 FS images were 8.68 mm (SD \n0.16) and 5.21 mm (SD 0.10) in SLAP group, 8.76 mm (SD 0.16) and 4.95 mm \n(SD 0.08) in non-SLAP group, respectively. In the SLAP group, the mean labral \nheight tended to be larger than that of non-SLAP group although the difference \nwas not statistically different.\nConclusion: Labral dimensions on coronal MRA showed no statistical difference \nbetween SLAP and non-SLAP patients; there was a tendency for height to be larger \nin SLAP group than in non-SLAP group.\n\nScientific Sessions\nS159\nA\n C D E F G\nB\nThursday\nConclusion: Ultrasound was insensitive for diagnosing appendicitis, contrary to \nthe findings in most of the available literature. A substantial proportion of patients \nwith “normal” scans had acute appendicitis. Although ultrasound remains useful in \nidentifying co-existing abdominal pathology, clinical evaluation and blood markers \nshould play the primary role in diagnosis.\nB‑0052 10:39\nAdded value of ultrasound re-evaluation for patients with equivocal \nCT findings of acute appendicitis: a preliminary study \nJ. Sim, H. Kim, J. Yeon, B. Suh, K. Kim, Y. Ha, S. Paik; \nSungnam-si, Gyeonggi-do/KR (sunnyandluna@naver.com) \nPurpose: A prospective study to estimate the additional diagnostic value of ultra-\nsound (US) re-evaluation for patients with equivocal computed tomography (CT) \nfindings of acute appendicitis.\nMethods and Materials: Between April 2011 and October 2011, a total of 869 \nconsecutive patients with suspected appendicitis who were referred for CT were \nincluded in the study. The likelihood of appendicitis was prospectively catego-\nrised into five categories. US re-evaluation was recommended for patients in the \nequivocal appendix and probably not appendicitis groups. The overall negative \nappendectomy rate of study period was compared with the rate during the same \nperiod of the previous year, and negative appendectomy rates of the US and non-\nUS evaluation groups were also compared.\nResults: Among 869 patients, 71 (8.2%) patients had equivocal finding of ap-\npendicitis and 63 (7.9%) patients diagnosed as probably not appendicitis. The \nsensitivity and specificity of CT combined with US re-evaluation (100% and 98.1%, \nrespectively) among patients with confirmed appendicitis exceeded those of CT \nonly (93%, 99%; equivocal group considered as negative appendicitis and 100%, \n89.9%; as positive, respectively), and this was statistically significant (P < 0.0001). \nAfter adding US re-evaluation, the overall negative appendectomy rate in our \ninstitution decreased from 3.4% to 2.3%.\nConclusion: For patients with equivocal CT findings of acute appendicitis, US \nre-evaluation can improve diagnostic accuracy and decrease the rate of negative \nappendectomies.\nB‑0053 10:48\nReduced Z-axis coverage at multidetector-row CT to decrease \nradiation dose and maintain diagnostic accuracy in adults suspected \nof acute appendicitis \nN. Brassart1, C. Winant2, D. Tack3, P. Gevenois1, V. de Maertelaer1, C. Keyzer1; \n1Brussels/BE, 2Mons/BE, 3Baudour/BE (nbrassar@gmail.com) \nPurpose: To compare diagnostic performance of two reduced Z-axis coverages \nto that on the abdomen and pelvis for the diagnosis of acute appendicitis as well \nas alternative diseases at unenhanced CT.\nMethods and Materials: This study included 152 patients suspected of appendi-\ncitis who were enrolled in two ethical-committee-approved previous trials. Based \non scans covering the entire abdomen and pelvis (L-set), two additional sets of \nimages were generated with two reduced Z-axis coverages: 1°) from the top of the \niliac crests to the upper aspect of the pubis (S-set); and 2°) from the diaphragmatic \nroots to the upper aspect of the pubis (M-set). Two readers independently coded \nduring separate sessions the appendix visualisation, measured its diameter, and \nproposed a diagnosis (appendicitis or alternative disease). Final diagnosis was \nbased on surgical findings or clinical follow-up. Pearson chi-square, Fisher exact, \nMc Nemar tests, and logistic regression were used.\nResults: Forty-six patients had a definite diagnosis of appendicitis and 53 an \nalternative diseases. For the diagnosis of appendicitis, sensitivity, specificity, posi-\ntive and negative predictive values, and accuracy were not significantly different \nbetween sets for both readers (p from 0.857 to 1.000). The probability of giving a \ncorrect alternative diagnosis was lower on S-set than on L-set (OR:0.573, p=0.009) \nfor both readers, but there was no significant difference between L- and M-set \n(p=0.824), Z-axis coverage being reduced by 25% on M-set.\nConclusion: Restricted coverage could be recommended for the diagnosis of \nappendicitis as well as alternative diseases, whereas pelvic focused CT is insuf-\nficient for alternative diseases. \nportal (P < 0.0001), 4-5 portal (P < 0.0001), 6/R (P < 0.0001), and 6/U portals (P < \n0.0001). No statistical significant differences were found between the two genders.\nConclusion: In wrist arthroscopy, the 3-4 portal is safer than any other dorsal \nportal, followed by the 4-5 portal. The 1-2 and 6/U portals are the most dangerous \nin terms of proximity to neurovascular structures. \nB‑0050 11:51\nComparison of three-dimensional indirect isotropic MR arthrography \nand conventional MR arthrography for the diagnosis of rotator cuff tears \nJ. Lee, Y. Yoon, S. Ji; Seoul/KR (zhyun84.lee@samsung.com) \nPurpose: To compare the diagnostic accuracy of a three-dimensional (3D) indi-\nrect isotropic T1-weighted fast spin-echo (FSE) MR arthrography with that of a \nconventional two-dimensional (2D) sequences of indirect MR arthrography for the \ndiagnosis of rotator cuff tears.\nMethods and Materials: 149 patients who had undergone indirect shoulder MR \narthrography followed by arthroscopic surgery were enrolled. Both conventional \n2D and 3D isotropic T1-weighted FSE sequences were performed. Two radiolo-\ngists evaluated the images for the presence of supraspinatus-infraspinatus and \nsubscapularis tendon tears. Using the arthroscopic findings as the reference \nstandard, the statistical differences between the sensitivities, specificities, and \naccuracies of both methods were analysed by McNemar test. Kappa values were \nalso analysed to compare accuracy of grading supraspinatus-infraspinatus tendon \ntear between both methods.\nResults: Arthroscopy confirmed 123 supraspinatus-infraspinatus tears and 75 \nsubscapularis tears. The sensitivity and specificity of conventional sequences were \n95% and 87%, respectively, for supraspinatus-infraspinatus tears, 78% and 91% \nfor subscapularis tears. The sensitivity and specificity of 3D sequence were 95% \nand 89%, respectively, for supraspinatus-infraspinatus tears, 81% and 91% for \nsubscapularis tears. There were no significant differences between two methods. \nThe kappa values for grading supraspinatus-infraspinatus tear were 0.704 between \nconventional sequences and arthroscopic findings, 0.666 between 3D sequence \nand arthroscopic findings, and 0.829 between conventional and 3D sequences. \nThe diagnostic accuracies for grading supraspinatus-infraspinatus tendon tear \nwere not significantly different.\nConclusion: 3D indirect isotropic MR arthrography may show similar accuracy \nfor the diagnosis of rotator cuff tears as conventional indirect MR arthrography \nwith shorter imaging time.\n10:30 - 12:00 Room E2 \nGI Tract \nSS 101a \nAcute bowel diseases: challenges and solutions \nModerators: \nJ. Dormagen; Oslo/NO \nS. Leschka; St. Gallen/CH \nB‑0051 10:30\nThe emperor’s new clothes? An evaluation of the accuracy of \ntransabdominal ultrasound in diagnosing acute appendicitis \nP. Yoong1, C.A. Johnson2, S. Fernando1, J.W. Graham1; 1King’s Lynn/UK, \n2London/UK (c.a.yoong@gmail.com) \nPurpose: To determine the accuracy of transabdominal ultrasound in diagnosing \nacute appendicitis.\nMethods and Materials: A retrospective review of ultrasound reports was per-\nformed between December 2007 and May 2012 (54 months). Scans were included \nin the study when the keyword “appendix” or “appendicitis” was present. Using \nestablished positive ultrasound findings for appendicitis, scans were divided into \nthree groups: “positive”, “indeterminate” and “negative”. Correlation was made with \nhistopathology reports and clinical notes. The sensitivity, specificity, positive and \nnegative predictive values were calculated.\nResults: There were a total of 317 ultrasound scans (314 patients). 89.6% (n=284) \nwere performed by a consultant radiologist. The mean patient age was 26.2 (range \n2-89) years and 82.6% (n=262) were female. 40% of scanned patients (n=127) \nproceeded to have an appendicectomy during their admission. There was a sen-\nsitivity of 23% and specificity of 93% for the diagnosis of histologically confirmed \nacute appendicitis. 37% (40/110) of patients with negative scans showed acute \nappendicitis on histology.\n\nScientific Sessions\nS160\n C A D E F\n G\nB\ndifferent time-points 3 rats for each group were imaged with 7T MRI, euthanized \nand macroscopically/histologically analysed.\nResults: In the first hour it was not possible to detect MRI findings that helped in \ndistinguishing these two conditions: in both groups hyper-intense signal in T2-W \nsequences in the intestinal wall was detected, as well as the presence of free \nfluid. In the second hour, the MRI begun to show differences: in the group II, in the \n100% of the rats, the hypotonic reflex ileus (HRI) was found, whereas this finding \nwas not present after SMV occlusion. In the fourth hour the congested mesentery \nis detectable only in those rats with SMV occlusion while the paralytic ileus was \nvisible in both groups from the sixth hour. Only in 1 case of VMI was observed wall \npneumatosis after eighth hours.\nConclusion: Results of this study suggest that the analysis of mesentery and the \npresence/absence of the HRI analysed by MRI may help in distinguishing between \nthese two conditions. \nB‑0058 11:24\nNon-occlusive mesenteric ischaemia (NOMI) with and without \nreperfusion: CT features useful for diagnosis and their prognostic value \nM.A. Mazzei1, G. Imbriaco1, S. Guerrini1, N. Cioffi Squitieri1, E. Foderà1, \nD. Berritto2, P. Mercuri1, F.G. Mazzei1, L. Volterrani1; 1Siena/IT, 2Naples/IT \n(mamazzei@gmail.com) \nPurpose: NOMI is a dynamic condition. Its appearance at imaging may be different \ndepending on the time in which CT examination is performed and on the presence \nof reperfusion event. The aim of our work has been to assess the efficacy of MDCT \nfor the diagnosis of NOMI, with and without reperfusion event.\nMethods and Materials: Clinical and imaging data from 20 patients (16 males, \n4 females) with a dismissal summary of NOMI were retrospectively reviewed. All \npatients had at least 1 abdominal MDCT examination (n=28) followed by surgery \n(n=8), autopsy (n=2), angiography (n=1) or endoscopy (n=9). The CT scans were \nevaluated for evidence of vessels, mesentery, bowel and cavity features. The mean \ndiameter of the SMA of NOMI cases were compared with that of 30 controlled cases.\nResults: The average SMA diameter of NOMI cases were statistically smaller \nthan that of controls (K-S test: D=0.75, Prob=3.7E-08). A correlation between the \nreperfusion event and mesenteric fat stranding (p=0.026), bowel wall thickening \n(p=3.2E-05) and high attenuation of the bowel wall on unenhanced CT images \n(p=2.8E-04) was demonstrated by Fisher’s exact tests. Normal mesenteric vessels \nplus wall thickening was significantly correlated with lower mortality (p= 0.034).\nConclusion: The evaluation of mesentery, bowel and peritoneal CT features, in \naddition to the vessel findings will supply additional information to recognise NOMI \nand in discriminating the presence of a reperfusion event. \nB‑0059 11:33\nDiagnosis of acute arterial mesenteric ischaemia with and without \nreperfusion using 7T-MRI in an animal model \nD. Berritto1, F. Iacobellis1, M.P. Belfiore1, M.A. Mazzei2, L. Saba3, M. Scaglione4, \nS. Cappabianca1, A. Rotondo1, R. Grassi1; 1Naples/IT, 2Siena/IT, 3Cagliari/IT, \n4Castel Volturno/IT (daniela.berritto@libero.it) \nPurpose: This study, based on an animal model, was designed to define the evo-\nlution of 2 different mechanisms of acute arterial mesenteric ischaemia (AAMI): \nthe acute occlusion of superior mesenteric artery (SMA) and the acute occlusion \nfollowed by reperfusion, and to investigate the MRI findings in a timeline.\nMethods and Materials: Eight rats underwent SMA ligation and then divided into \ntwo groups. In group.i. the ischaemia was maintained for 8 hours; in group II, 1 \nhour after SMA occlusion the ligation was removed, and the following reperfusion \nwas monitored for 8 hours. MRI was performed using a 7-T MRI system.\nResults: Free fluid, hypotonic reflex ileus, dilated loops gas-fluid filled and bowel \nwall hyperintensity are always present in all rats with mesenteric ischaemia inde-\npendently from the mechanism. Exploring the 2 mechanisms (presence\\absence \nof reperfusion) we found that in those rats without reperfusion the signal intensity \nis normal at the first and second hour and becomes hyper-intense at the fourth \nand eighth hour; after reperfusion the hyper-intense signal is clearly visible form \nthe first hour. Another MRI finding is the presence of bowel wall thickening that \nis visible from the second hour in case of reperfusion, but was never found in the \ntimeline in those rats without reperfusion. These 2 findings suggest that the early \nhyper-intensity of the wall in T2-W sequence and bowel wall thickening may be \nconsidered signs of acute mesenteric ischaemia with reperfusion.\nConclusion: Results of this preliminary study in animal model suggest that MRI \ncan adequately assess the different pathological changes that occur in the AAMI \nwithout or with reperfusion. \nB‑0055 10:57\nThe effectiveness of multidetector computed tomography in patients \nthat underwent immediate intestinal resection due to acute abdominal pain \nM. İnci, F. Özkan, S. Bozkurt, M. Yüksel, O. Peker; Kahramanmaraş/TR \n(drfatihinci@gmail.com) \nPurpose: The aim of this study was to evaluate the role and additional diagnostic \ncontribution of multidetector computed tomography (MDCT) findings in patients with \nacute abdominal pain caused by small and large bowel pathologies that required \nimmediate intestinal resection.\nMethods and Materials: A total of 42 patients who were admitted to our hospital’s \nemergency room between January 2011 and July 2012 with a complaint of acute \nabdominal pain caused by non-traumatic small and large bowel pathologies and \nwho underwent immediate intestinal resection were included in our study. The \ndefinitive diagnosis and MDCT findings of patients were retrospectively reviewed.\nResults: Of these patients, 23 (54.8 %) were males and 19 (45.2 %) were females. \nThe mean age was 49±3.4 years, ranging from 29 to 64 years. The sensitivity of \nMDCT in diagnosing intestinal pathologies leading to acute abdominal pain and \nwhich required immediate intestinal resection was 93.7, 83.3, and 85.7% in pa-\ntient groups of intestinal perforation, acute mesenteric ischaemia, and intestinal \nobstruction, respectively. A total concordance between the MDCT findings and \ndefinitive diagnosis was found in 37 of 42 cases; partial discordance was seen in \n3 of 42 cases (7.1%) and total discordance was seen in 2 of 42 cases (4.7%). The \noverall sensitivity of MDCT in the diagnosis of intestinal pathologies that required \nimmediate intestinal resection was found to be 88.1%.\nConclusion: MDCT is a rapid, reliable, highly accurate and cost-effective modality \nin the differential diagnosis of small and large bowel pathologies leading to acute \nabdominal pain and requiring immediate intestinal resection. \nB‑0056 11:06\nIn the evaluation of patients with obscure gastrointestinal bleed, \ndoes MDCT angiography have a role? \nC.B. Kulkarni, S. Moorthy, S.K. Pullara, R.R. Kannan, P.V. Ramchandran, \nS. Srinivasan; Kochi/IN (drchinmaykulkarni@gmail.com) \nPurpose: To prospectively determine the sensitivity of MDCT angiography in \ndetecting and diagnosing the cause of obscure gastrointestinal bleed (OGIB).\nMethods and Materials: Our study included 50 patients (males 30, females 20) \nin the age range of 3-82 years (average age: 58.52 years) who were referred to \nour department as part of their workup for clinically evident gastrointestinal (GI) \nbleed or as part of workup for anaemia. All patients underwent conventional upper \nendoscopy and colonoscopy. Following a noncontrast scan, all patients underwent \ntriple-phase contrast CT scan using a 64-slice CT scan system. The diagnostic \nperformance of MDCT was compared with the results of capsule endoscopy, 99m-\ntechnetium-labelled red blood cell scintigraphy (99mTc-RBC scintigraphy), digital \nsubtraction angiography and surgery whenever available.\nResults: The sensitivity, specificity, positive predictive value, and negative pre-\ndictive values of MDCT for detection of bleed were 72.2, 42.8, 81.2, and 44.4%, \nrespectively. Capsule endoscopy was done in 15 patients and was positive in 10 \npatients; it had a sensitivity of 71.4%. Eleven patients had undergone 99mTc-RBC \nscintigraphy prior to CT scan, and the result was positive in seven patients (sensitiv-\nity 70%). Digital subtraction angiography was performed in only eight patients. All \nexcept one patient showed findings consistent with the lesions detected on MDCT.\nConclusion: MDCT angiography is a sensitive tool that allows rapid detection and \nlocalisation of OGIB. It can be used as the first-line investigation in patients with \nnegative endoscopy and colonoscopy studies. MDCT and capsule endoscopy have \ncomplementary roles in the evaluation of OGIB. \nB‑0057 11:15\nVenous mesenteric ischaemia vs acute arterial mesenteric ischaemia \nwith reperfusion: similarities and differences \nD. Berritto1, F. Iacobellis1, M.P. Belfiore1, M.A. Mazzei2, L. Saba3, R. Di Mizio4, \nS. Cappabianca1, A. Rotondo1, R. Grassi1; 1Naples/IT, 2Siena/IT, 3Cagliari/IT, \n4Penne/IT (daniela.berritto@libero.it) \nPurpose: To explore similarities and differences between venous mesenteric is-\nchaemia and the reperfusion after acute arterial occlusion in an experimental model \nstudied by a 7T MRI system, establishing radiological findings that may help to \ndistinguish between these 2 conditions and select the correct therapeutic approach.\nMethods and Materials: Thirty rats were divided in two groups that underwent \ndifferent surgical models and a monitoring of ischaemic damage. Group.i. un-\nderwent superior mesenteric vein (SMV) ligation, whereas group II underwent \nsuperior mesenteric artery (SMA) ligation followed by reperfusion after 1 hour. At \n\nScientific Sessions\nS161\nA\n C D E F G\nB\nThursday\nB‑0062 10:39\nAcute changes in rectal cancer perfusion CT parameters during \nshort-course radiotherapy correlate with radiological response to therapy \nJ.M. Franklin, E.J. Hill, T. Pwint, F.V. Gleeson, R.A. Sharma, E.M. Anderson; \nOxford/UK (jamiemfranklin@hotmail.com) \nPurpose: Acute perfusion changes measured with perfusion CT (pCT) have been \nshown to predict subsequent response to chemoradiotherapy. The purpose of this \nstudy was to assess pCT as a predictive test for subsequent radiological response \nto short course radiotherapy (SCRT) in patients with rectal cancer.\nMethods and Materials: Seven patients were recruited to this pilot study. All \npatients had baseline pCT and repeat pCT on day 4-6 SCRT (25Gy/5[[Unable to \nDisplay Character: ♯]]), before delivery of the radiotherapy fraction. pCT \nwas performed on a GE Lightspeed VCT 64-slice CT using a standardised protocol. \nBlood volume (BV), blood flow (BF) and mean transit time (MTT) were derived \nwithin tumour ROI. MR imaging with high-resolution T2W sequences was performed \nbefore and 8 weeks after treatment and used to assess treatment response.\nResults: One patient was excluded from analysis due to an inadequate base-\nline pCT. Patients with complete MRI response to SCRT (n=3) had an average \npercentage (%) decrease in MTT (-25.3%; range -4.5% to -36.3%) and average \n% increase in BF (+65.3%; range +26.4 to +97.0%). Conversely, non-complete \nresponders (n=4) had an average % increase in MTT (12.4%; range -35.3% to \n+66.7%) and average % decrease in BF (-1.6%; range -26.1 to +39.5%). There \nwas a trend toward a significant difference in BF changes from baseline between \ncomplete and non-complete responders (p=0.06; Student’s T-test).\nConclusion: An acute increase in tumour blood flow following SCRT in patients \nwith rectal cancer is associated with a complete radiological response at 8 weeks. \nB‑0063 10:48\nCT perfusion for evaluation of early treatment response of liver \nmetastases after 90Y-radioembolisation \nC.S. Reiner, F. Morsbach, B.-R. Sah, N. Schäfer, T. Pfammatter, H. Alkadhi; \nZurich/CH (caecilia.reiner@usz.ch) \nPurpose: To evaluate computed tomography (CT) perfusion for the assessment \nof early treatment response after 90Y-radioembolisation of patients with liver \nmetastases.\nMethods and Materials: 17 consecutive patients (10 males, 7 females; age range, \n35-79y) with liver metastases underwent dynamic contrast-enhanced CT liver per-\nfusion (128-slice dual source CT, four-dimensional spiral mode, scan range 14.8 cm, \n15 scans, cycle time 3 seconds) before and 4 weeks after 90Y-radioembolisation. \nThe parameter arterial liver perfusion (ALP) was calculated from CT perfusion and \ntumour diameters were measured. Success of 90Y-radioembolisation was evalu-\nated on follow-up imaging (mean follow-up time 124 days) based on the Response \nEvaluation Criteria in Solid Tumours (Version 1.1). The paired t-test was used to \ncompare the tumour parameters pre- and post-90Y-radioembolisation for different \nresponse groups.\nResults: In the responder group (n=6) mean ALP pre- 90Y-radioembolisation was \n34.02±12.48 and significantly decreased to 20.40±11.00 ml/100 ml/min post-\n90Y-radioembolisation (p=0.029). In the non-responder group (n=11) mean ALP \npre-90Y-radioembolisation was not significantly different from mean ALP post-\n90Y-radioembolisation (12.08±7.96 vs. 15.80±9.37 ml/100 ml/min, p=0.064). The \nmean tumour diameter showed no significant difference between pre- and post-90Y-\nradioembolisation for both groups (responder: p=0.242, non-responder: p=0.107).\nConclusion: CT perfusion shows early decrease of ALP in liver metastases \nresponding to 90Y-radioembolisation, while tumour diameter remains unchanged \nearly after treatment. Hence, CT perfusion may be a valuable technique for early \nresponse assessment after 90Y-radioembolisation. \nB‑0064 10:57\nFirst-pass perfusion CT on 256-detector row CT in the quantitative \nassessment of perfusion map for solid malignant neoplastic liver \nlesions: preliminary results \nO. Minutolo, D. Ippolito, A.C. Cadonici, P.A. Bonaffini, C.R.G.L. Talei Franzesi, \nS. Sironi; Monza/IT (orazio.minutolo@yahoo.com) \nPurpose: To determine the value of CT perfusion technique as diagnostic tool in \nthe assessment of lesions vascularization parameters in patients with neoplastic \nliver disease.\nMethods and Materials: A total of 50 lesions histologically proven hepatocellular \ncarcinoma and 30 liver metastases were evaluated with 256-slice scanner CT \nperfusion technique (Brilliance iCT Philips). Perfusion CT images were acquired \nat a single liver level with following protocol (16 slice/scan; total of 40 scans; bolus \nB‑0060 11:42\nThe potential benefit of abdominal CT to help differentiate between \nstrains of clostridium difficile \nS.N. Reddy, S. Taori, I.R. Poxton, F. Ewing, D. Brown, J.T. Murchison; \nEdinburgh/UK \nPurpose: Severe Clostridium difficile infection (CDI) is increasingly being assessed \nby computed tomography (CT). Our aim was to assess imaging findings in patients \naffected by different C. difficile strains.\nMethods and Materials: All C. difficile positive faecal samples from 1 August \n2010 to 31 July 2011 were cultured and PCR ribotyped. A retrospective review of \nprospectively collected clinical and radiological data was then performed on all \npositive, symptomatic, hospitalised adult in-patients.\nResults: 453 CDI patient episodes were identified in 350 symptomatic patients. \nOverall 72 CT-scans were performed, 55 scans demonstrated colonic involvement, \nwith pancolitis in only 31%. Colonic changes were present in 35% of episodes \nprior to the availability of a C. difficile positive result (median 2 days). Ribotype \n001 (73 episodes) was the commonest identified C. difficile strain and a CT was \nperformed in only 11%, compared with ribotype 078, the 6th commonest strain (19 \nepisodes) where CT was performed in 52%. Patients with 078 had a greater colonic \nwall thicknesses (median 16 mm) compared with the remaining cohort (median \n11 mm). Ascites was present in 64% of the scanned 078 patients compared with \n31% in the remaining cohort.\nConclusion: CDI should be considered in the differential diagnosis of colitides, \neven prior to a C.  difficile positive result. Increased colonic wall thickness and \nascites were more common in the 078 episode group with a greater proportion of \nCT scans performed. 078 appears to stimulate a greater inflammatory response \nwithin the colon, which has not been previously described. \n10:30 - 12:00 Room F1 \nOncologic Imaging \nSS 116 \nPerfusion CT and MRI: ready for clinical practice \nModerators: \nS. Delorme; Heidelberg/DE \nF.A. Gallagher; Cambridge/UK \nB‑0061 10:30\nFunctional MRI changes in follow-up after external beam radiation \ntherapy of the prostate \nA.M. Weidner; Mannheim/DE (anja.weidner@medma.uni-heidelberg.de) \nPurpose: To evaluate changes visible in different magnetic resonance imaging \n(MRI) modalities in patients with prostate cancer after radiation therapy (RT).\nMethods and Materials: 43 examinations in 15 patients including T2-weighted \nimaging (T2), diffusion-weighted imaging (DWI), dynamic contrast-enhanced imag-\ning (DCE) and spectroscopy (MRS) before and at several time points after RT were \nperformed. Apparent diffusion coefficient (ADC) values, plasma flow (PF), mean \ntransit time (MTT), maximum choline+creatine/citrate-ratio (CC/CR) and number \nof pathological spectra were evaluated.\nResults: In initial MR we found a signal loss in T2, a decreased ADC, a decreased \nMTT and voxel with increased CC/CR in prostate cancer. Signal loss in T2-weighted \nimaging in benign tissue was partially reversible after radiation, cancer areas \nequalled benign tissue. In prostate cancer nodules we found a significant increase \nin ADC from a mean value of 835 x10-6 mm2/s on initial MRI to 1527 x10-6 mm2/s \nmore than 2 years after RT. PF decreased from 38 ml/100 ml/min to 5 ml/100 ml/min \nand MTT increased significantly from 78 s to 254 s in prostate cancer nodules. No \nchanges were found for PF and MTT in benign tissue. MRS showed inconsistent \nresults with a tendency for decreased CC/CR from 2.5 to 1.0 and a decrease in \nnumber of pathological voxel from 100% to 20%. PSA decreased to values less \nthan 2 ng/ml in all patients.\nConclusion: We found characteristic changes in every MRI modality after RT. \nMRS showed inconsistent results, so it might be less useful for RT monitoring \nthan DWI or DCE. \n \n\nScientific Sessions\nS162\n C A D E F\n G\nB\npermeability-surface area product (PS) were calculated applying maximum slope \nand modified Patlak approaches. Quantitative analysis of perfusion parameters \nand qualitative assessment for the presence of motion artefacts before and after \nautomated motion correction was performed by two independent readers.\nResults: 28 intraabdominal and 22 intrathoracic lesions were assessed. Motion \nartefacts were significantly reduced after automated motion correction (p < 0.001). \nBetween baseline and follow-up scan, perfusion CT showed a significant reduction \nof BF (159±74 vs. 78±52 ml/100 mg/min, p < 0.001), BV (19±10.2 to 10.8±7.4 ml/100 \nml, p < 0.001), but not of PS (20.1±11.5 to 15.6 ±11.6 ml/min/ml p=0.17). A high \ncorrelation was found between the 2 observers regarding quantitative perfusion \nparameters (r = 0.92; p < 0.001).\nConclusion: Perfusion parameters measured in mRCC patients before and early \nafter the start of antiangiogenic therapy are reproducible between different readers. \nAutomated software-based motion correction significantly improves image quality \nin acquisitions with long breathhold times. \nAuthor Disclosures:\nA. Sterzik: Research/Grant Support; Bayer AG Healthcare. M. Staehler: \nSpeaker; Bayer AG, GlaxoSmithKline. A. Graser: Advisory Board; Siemens AG, \nPfizer Pharma, Bayer AG. Speaker; Siemens AG, Pfizer Pharma, Bracco, Bayer \nAG, Guerbet.\nB‑0067 11:24\nEarly vs late recurrent glioblastomas: added value of T1-weighted \nperfusion MR imaging compared with T2-weighted perfusion MR imaging \nS.J. Kang, H.S. Kim, S.J. Kim, C.G. Choi; Seoul/KR (marie0975@hanmail.net) \nPurpose: To determine whether dynamic contrast-enhanced (DCE) perfusion MR \nimages have added value in distinguishing early (< 12 weeks after chemoradiation) \nor late (> 12 weeks after chemoradiation) recurrent glioblastomas (RGMs) from \ntreatment-related changes (TRCs), compared with dynamic susceptibility contrast \n(DSC) perfusion MR images.\nMethods and Materials: This study was approved by the IRB. Conventional, \nDSC, and DCE MR images in 99 patients with RGMs and 82 patients with TRCs \nwere retrospectively reviewed. Two experienced neuroradiologists independently \nreviewed conventional plus DSC MR images (image set 1) and, 10 weeks later, \nreviewed conventional plus DCE MR images (image set 2) to differentiate RGM \nfrom TRC based on the scoring system of tumour perfusion volume fraction (TPVF). \nThe TPVF was segmented using optimum 50% cutoff value derived from bimodal \nhistogram. The alternative free-response receiver operating characteristic curve  \n(Az) analysis and weighted kappa statistics were obtained to evaluate reader \nperformance and agreement.\nResults: The optimum 50% cutoff values for differentiating early and late RGMs \nfrom TRC were 1.69 and 1.53 for normalised cerebral blood volume and 0.062 and \n0.057 for normalised wash-in, respectively. In late recurrence, the two observers \ndemonstrated significant improvement in Az, sensitivities, and specificities from im-\nage set 1 to set 2. In early recurrence, Az, sensitivities, and specificities increased \nwith the addition of DCE images but did not reach statistical significance. Interob-\nserver agreement increased from image set 1 to set 2 (0.65 vs 0.76).\nConclusion: DCE perfusion MR imaging significantly improve the diagnosis of \nlate RGM compared with DSC perfusion MR imaging.\nB‑0068 11:33\nMonitoring the antivascular effects of a novel multimodal therapy \nwith dynamic contrast-enhanced MRI (DCE-MRI) in an experimental \nhuman squamous cell carcinoma model \nA. Sterzik, P. Paprottka, P. Zengel, S. Roßpunkt, \nE. Baloch, M. Moser, M.F. Reiser, K. Nikolaou, C. Cyran; \nMunich/DE (alexander.sterzik@med.uni-muenchen.de) \nPurpose: To investigate with immunohistochemical validation whether DCE-MRI is \nuseful for monitoring the antiangiogenetic effects of a novel experimental multimodal \ntherapy on pharyngeal squamous cell carcinoma xenografts in rats.\nMethods and Materials: Athymic rats (n=14) with subcutanously implanted human \nhypopharynx-carcinoma-cells (FaDu) were assessed with 3-T dynamic gadobutrol-\nenhanced MRI at baseline on d0 and after a 7-day course of a novel therapy \nregimen, consisting of combined weight-adapted daily administration of the COX-II-\ninhibitor Celecoxib® (25 mg/kg), the matrix metalloproteinase-inhibitor Galardin® (50 \nmg/kg) and the uPA-inhibitor Mesupron® (0.03 mg/kg). Quantitative measurements \nof tumour blood flow (tBF), tumour blood volume (tBV) and permeability-surface \narea product (PS) were calculated, using a two-compartment model. DCE-MRI \nvalues were correlated with immunohistochemical results.\nResults: tBF as well as tBV in triple-therapy animals dropped significantly from \nday 0 to day 7 (tBF: 37.8±15 to 21.3±7.1 ml/100 ml/min; p < 0.01; tBV: 17.1±4.4 to \ninjection of 50 ml of iodinated contrast with flow rate of 5 ml/sec). Philips’s worksta-\ntion was used to generate colour permeability maps showing perfusion of enhancing \ntumours. The parameters were calculated pixel-by-pixel using maximum slope \nmethod, and quantitative maps of arterial and portal perfusion were created. The \nfollowing parameters were calculated: hepatic perfusion (HP), peak enhancement \nintensity (PEI), time to peak (TTP) and blood volume (BV). Correlation between \nCT perfusion parameters and clinical pathological classification was performed.\nResults: The quantitative analysis of 50 HCCs lesions showed the following values: \nHP (ml/s/100 g): 47±13.8; PEI (HU): 39.6±30.1; TTP (sec): 18.7±4.1 and BV (ml/100 \nmg): 22.5±4.6.The corresponding values calculated in liver metastases were: HP \n(ml/s/100 g): 16.1±14.3, PEI (HU): 24.23±26.25, TTP (sec): 15.58±4.90, BV (ml/100 \nmg): 3.47±3.85. A significant (p < 0.001) increase of HP, PEI, TTP and BV was \nobserved in HCC lesions in comparison with metastases, due to neoangiogenesis \nassociated with HCC growth, and in relation to necrotic phenomenon that typically \noccurs in metastatic lesion.\nConclusion: CT perfusion technique represents a complementary diagnostic \ntool that offers quantitative information about arterial and portal perfusion of liver \ntumours, and a feasible technique that provides an in vivo information about the \nmicrovascular structures related to biological changes in liver tumours.\nB‑0065 11:06\nCT perfusion imaging in stage II-III non-small cell lung cancer \npatients undergoing chemo-radiotherapy-evaluation of metabolic \ntumour activity \nM. Das, B. Reymen, P. Lambin, H. Sharifi, J.E. Wildberger, D. De Ruysscher, \nW. van Elmpt; Maastricht/NL (m.das@mumc.nl) \nPurpose: Perfusion CT techniques have been developed to quantify vasculature \ninside tumours, whereas FDG-PET/CT shows the metabolic activity. We investi-\ngated whether the metabolic active regions of primary non-small cell lung cancer \n(NSCLC) tumour show different vasculature properties compared with metaboli-\ncally active regions.\nMethods and Materials: Twelve patients with stage II-III NSCLC from two clinical \ntrials (10 from NCT01024829 and 2 from NCT01210378) prior to (chemo-) radio-\ntherapy treatment were evaluated. On the same day, patients underwent FDG-PET/\nCT (Siemens Biograph 40 PET/CT) and perfusion CT imaging (Siemens Definition \nFlash CT). Tumour volumes were delineated on the FDG-PET/CT scans by a \nradiation oncologist. FDG-PET/CT and perfusion CT imaging were registered and \nmetabolic uptake regions on the FDG-PET/CT were defined in 2 regions inside \nthe primary tumour: low (0-50% of the maximum SUV) and high metabolic uptake \n(> 50% of the maximum SUV). Blood flow (BF), blood volume (BV) and perme-\nability (PMB) were calculated for the entire tumour (Siemens Volume Perfusion \nCT software tool).\nResults: Differences (mean±1SD) were observed between low and high metaboli-\ncally active regions: average BF (ml/100 ml/min) was 28±23 vs. 41±29 (p=0.012), \nand average BV (ml/100 ml) was 4.7±3.2 vs. 7.1±4.4 (p=0.007), PMB_A (ml/100 \nml/min) was 13±19 vs. 20±27 (p=0.002).\nConclusion: CT perfusion imaging is capable of differentiating between tumour \nregions that are metabolically active showing increased blood flow, blood volume \nand permeability and those with less metabolic activity. These findings yield the \npotential to use perfusion imaging in staging and follow -up of NSCLC for anti-\nangiogenic therapy. \nAuthor Disclosures:\nM. Das: Consultant; Medrad. Grant Recipient; Siemens, Bayer. Speaker; \nSiemens, Bayer, Medrad. J.E. Wildberger: Consultant; Medrad, Bayer, \nSiemens. Grant Recipient; Bayer, Siemens. Speaker; Medrad, Bayer, Siemens.\nB‑0066 11:15\nImaging of antivascular effects of multikinase inhibitors (MKI) in \npatients with metastatic renal cell cancer (mRCC) using dynamic \ncontrast- enhanced CT (DCE-CT, perfusion CT): a pilot study \nA. Sterzik, M. Staehler, J. Casuscelli, M. Karpitschka, F. Schwarz, M.F. Reiser, \nA. Graser; Munich/DE (alexander.sterzik@med.uni-muenchen.de) \nPurpose: To assess the early antivascular effects of MKIs in patients with mRCC \nwith DCE-CT.\nMethods and Materials: 20 patients with mRCC underwent perfusion CT imag-\ning of representative metastatic lesions using 4D-spiral mode acquisition: 10 cm \nz-axis coverage, acquisition time 41 sec, 100 kVp (abdomen), 80 kVp (chest), 100 \nmAs, on a dual-source CT scanner. Two subsequent DCE-scans were performed \nbefore and 7 days after start of treatment with Sunitib (Sutent®; n=15) or Pazopanib \n(Votrient®; n=5). Therapy-induced changes of tumour perfusion were quantitatively \nassessed using a volumetric approach. Blood flow (BF), blood volume (BV) and \n\nScientific Sessions\nS163\nA\n C D E F G\nB\nThursday\nMaximum difference of AIUC30 and PE between the AIFOrton and AIFpCT was \ntypically greater than maximum variability observed between AIFpCT (mean maxi-\nmum difference AIUC30 0.96mM[[Unable to Display Character: ]]min vs \n0.76mM[[Unable to Display Character: ]]min, p=0.23; mean maximum \ndifference PE 2.66mM vs 2.15mM, p=0.39).\nConclusion: Peak enhancement of AIFOrton differed significantly from AIFpCT, \nwhile there was no significant intra-patient variability of AIFpCT. Incorporating a \npatient-specific AIFpCT into dceMRI analyses may thus improve pharmacokinetic \nmodelling. \n10:30 - 12:00 Room F2 \nBreast \nSS 102 \nBreast MRI: improving accuracy and tissue \ncharacterisation \nModerators: \nR. Schulz-Wendtland; Erlangen/DE \nM. Telesca; Rome/IT \nB‑0071 10:30\nBI-RADS®-adapted combined contrast-enhanced magnetic \nresonance and diffusion-weighted imaging reading for \nmultiparametric imaging of breast lesions at 3 T improves diagnostic \naccuracy \nK. Pinker-Domenig, H. Bickel, T.H. Helbich, S. Gruber, S. Trattnig, W. Bogner; \nVienna/AT (katja.pinker-domenig@meduniwien.ac.at) \nPurpose: To develop and assess a combined reading for contrast-enhanced \nmagnetic resonance (CE-MRI) and diffusion-weighted imaging (DWI) adapted to \nthe Breast Imaging Reporting and Data System (BI-RADS) for multiparametric \nMRI of the breast at 3 T.\nMethods and Materials: 247 patients with histopathologically verified breast le-\nsions were included in this IRB-approved prospective study. All patients underwent \nCE-MR and DWI at 3 T. MRI was classified according to BI-RADS and assessed \nfor apparent diffusion coefficient (ADC) values. A reading method that adapted \nADC thresholds to the assigned BI-RADS classification was developed. Sensitiv-\nity, specificity, diagnostic accuracy and the area-under-curve were calculated. BI-\nRADS-adapted reading was compared to previously published reading methods in \nthe same population. Inter- and intra-reader variability was assessed.\nResults: Sensitivity of BI-RADS-adapted reading was not different from the high \nsensitivity of CE-MRI (p=0.4). BI-RADS-adapted reading maximized specificity \n(89.4%), which was significantly higher compared to CE-MRI (p < 0.001). Previ-\nously published reading methods did not perform as well as the BI-RADS-adapted \nreading except for a logistic regression model. BI-RADS-adapted reading was \nmore sensitive in NMLE and was more robust to inter- and intra-reader variability.\nConclusion: Multiparametric 3 T MRI of the breast using a BI-RADS-adapted \nreading is fast, simple to use and significantly improves the diagnostic accuracy \nof MRI of the breast.\nB‑0072 10:39\nThe additional value of expert reading of 3 Tesla breast MRI in \npatients with microcalcifications on mammography \nL.G. Merckel1, H.M. Verkooijen1, N.H.G.M. Peters1, R.M. Mann2, W.B. Veldhuis1, \nK.M. Duvivier1, T. van Dalen1, P.H.M. Peeters1, M.A.A.J. van den Bosch1; \n1Utrecht/NL, 2Nijmegen/NL (L.G.Merckel-2@umcutrecht.nl) \nPurpose: Ductal carcinoma in situ (DCIS) is mainly diagnosed through microcalci-\nfications detected on mammography. We investigated the added diagnostic value \nof 3 T breast MRI in patients presenting with microcalcifications on mammography.\nMethods and Materials: Between January 2006 and May 2009, 141 patients with \nmammographically detected microcalcifications underwent contrast-enhanced \n3 T breast MRI before undergoing breast biopsy in the context of a multicentre \nrandomised trial (MONET trial). All histologically confirmed index lesions were \nreviewed by an expert breast radiologist according to the BI-RADS ® lexicon. \nAdded diagnostic value of breast MRI was evaluated using receiver-operating \ncharacteristic (ROC) analysis. Furthermore, it was investigated which BI-RADS \ndescriptors were most strongly associated with the diagnosis of pure DCIS in \npatients with microcalcifications.\nResults: Overall 52/141 (37%) lesions turned out to be malignant; 30 (21%) patients \nhad pure DCIS and 22 (23%) had mixed or pure invasive breast cancer. Expert \n7.7±3.3 ml/mg; p < 0.01). No significant effects on PS were noticed in either therapy \nor control group (p> 0.05). Immunohistochemical analysis showed a markedly \nreduced tumour vascularity in the therapy group (CD31+ cell count: 534±88 vs. \n1228 ±309;p < 0.05) with fewer proliferating cells (%Ki-67+ cells: 17.9 ±3.9% vs. \n21.9±3.5%; p < 0.05), resulting in a delayed tumour growth (p < 0.05). Modest but \nsignificant correlations could be found between tBF/tBV and immunohistochemical \ntumour vascularity (tBF: r=0.66; p < 0.01; tBV: r=0.54; p < 0.05) as well as tBV and \nimmunohistochemical tumour proliferation (r=0.56;p < 0.05).\nConclusion: DCE-MRI seems a suitable tool for non invasive monitoring the anti-\nvascular effects of this new therapy regimen in this experimental setting. \nAuthor Disclosures:\nA. Sterzik: Research/Grant Support; Bayer Schering Healthcare. C. Cyran: \nResearch/Grant Support; Bayer Schering Healthcare.\nB‑0069 11:42\nFractional 3D quantification of early contrast-enhancing tumour \nfractions on dynamic MRI acquisitions in soft tissue sarcoma: \nprospective comparison with partial tissue-stained pathological \ntumour viability estimates \nA.K. Singh, W. Cai, A. Imanzadeh, S. Saini, G. Harris; Boston, MA/US \n(ahsingh@partners.org) \nPurpose: To assess the feasibility and accuracy of dynamic MRI-based viable-\nappearing tumour fraction quantification by advanced post processing methods \nin treated and excised soft-tissue sarcomas by comparing with pathologically \nderived-viable tumour fraction estimates obtained by partial tissue staining method.\nMethods and Materials: In this on-going prospective study, post-gadolinium, \ndynamic T1-weighted sequence from MRI data sets of 16 treated for pathologi-\ncally proven soft-tissue sarcomas was performed 2-5 days before surgical exci-\nsion. Dynamic post contrast sequences where recurring series of 15-20 second \nacquisitions that were acquired repetitively for 7 minutes after start of injection \nwere subjected to automated post processing for quantification of viable tumour. \nPost excision pathology percentage estimate for viable tumour tissue was taken as \nstandard of reference for comparing MRI-derived viable tumour tissue estimates \nusing correlation and Bland Altman (BA) analysis.\nResults: In all the 16 cases, the viable-appearing tumour volume percentage \nderived from MRI dynamic contrast acquisitions was within 1.96 standard devia-\ntion (SD) [-82.0 to 115.7] of the BA plot indicating similarity to pathological tumour \nviability estimates and good correlation (r=0.774; p < 0.0001; 95% confidence \ninterval= 0.7421 to 0.9772). There were 4 outliers outside 95% confidence limits \nof agreement in the BA plot.\nConclusion: 3D-Quantification of MR early contrast-enhancing and wash out \nfractions in soft-tissue sarcoma showed similarity to percentage of tumour viability \nestimate reported on pathology report post-tumour excision in this on-going pro-\nspective study and thus may provide a more objective measurement for assessing \ntissue viability pending validation on a larger cohort. \nAuthor Disclosures:\nG. Harris: Advisory Board; Fovia Inc.\nB‑0070 11:51\nA perfusion CT-derived patient-specific arterial input function for \npharmacokinetic modelling of dynamic contrast-enhanced MRI \nJ.M. Franklin, M. Enescu, E.J. Hill, R.A. Sharma, J.A. Schnabel, F.V. Gleeson, \nE.M. Anderson; Oxford/UK (jamiemfranklin@hotmail.com) \nPurpose: Pharmacokinetic modelling of dynamic contrast-enhanced MRI (dceMRI) \ndata requires estimation of the arterial input function (AIF). Due to the methodo-\nlogical challenges of deriving an individual patient AIF directly from dceMRI, a \npopulation-averaged AIF is typically used, e.g. AIFOrton. This study aimed to as-\nsess the variability and benefit of an AIF derived directly from contemporaneous \nperfusion CT (pCT) examinations.\nMethods and Materials: Eight patients with rectal cancer had dceMRI and pCT \nexaminations twice before and once following pelvic radiotherapy (25Gy/5[[Unable \nto Display Character: ♯]] in one week). AIFs were derived from the pCT data \n(AIFpCT) by modelling the time-attenuation curves of external iliac arteries. The \npeak enhancement (PE) and area under the initial uptake curve in the first 30s \n(AIUC30) was computed for each AIF. ANOVA and t-test analyses were used to \nassess variation of AIFpCT and compare AIFpCT and AIFOrton for each patient.\nResults: There was no significant intra-patient variability of AIUC30 (p=0.75) or \nPE (p=0.63) between AIFpCT. A significant difference was observed between the \naverage AIFpCT over the three time points and AIFOrton PE (p=0.023), but no \nsignificant difference between the average AIFpCT and AIFOrton AIUC30 (p=0.17). \n\nScientific Sessions\nS164\n C A D E F\n G\nB\nB‑0075 11:06\nApparent diffusion coefficient (ADC) measurements of breast \nlesions: most suspect area versus complete lesion assessment \nP.A.T. Baltzer1, M. Dietzel2, J.L. Halder3, W.A. Kaiser3; 1Vienna/AT, 2Erlangen/DE, \n3Jena/DE \nPurpose: Diffusion-Weighted Imaging (DWI) is an increasingly used quantitative \nimaging technique in breast MRI. For the analysis of dynamic-contrast-enhance-\nment a careful examination of lesions is standard of care, as the most suspicious \nenhancing part of the lesion (“hotspot”) provides the best diagnostic information. \nAccordingly, we investigated whether such “hotspots-analysis” might be beneficial \nfor the assessment of DWI in breast lesions.\nMethods and Materials: Consecutive DWI examinations of the breast (1.5 T, \ndedicated breast coil, TR 3500 ms, TEeff 80 ms, b-values: 0, 1000s/mm2) of \npatients referred due to unclear/suspicious findings were investigated in this \nIRB-approved study. ADC values were calculated by scanner software. Regions \nof Interest were drawn around enhancing lesions (ROIl) and the most suspicious \nlesion subpart (lowest ADC value, ROIs) on ADC maps by two blinded observers \nin consensus. Reference standard was histopathology or imaging follow -up > 24 \nmonths. Diagnostic accuracy was compared by ROC analysis.\nResults: Included were 144 lesions (102 malignant, 42 benign) in 127 patients. \nArea under the ROC curve was significantly (P=0.006) higher for ROIs (0.884) \ncompared with ROIl (0.834).\nConclusion: Our systematic comparison revealed a higher diagnostic accuracy \nof ADC values obtained from lesion subparts showing the highest diffusion restric-\ntion. These results encourage careful ADC sampling of breast lesions instead of \ncomplete lesion ADC averaging. \nB‑0076 11:15\nCombined contrast-enhanced MRI (CE-MRI) and 3D multivoxel \nproton magnetic resonance spectroscopy (3D-1H-MRSI) at 3 Tesla \nenables an improved characterisation of breast tumours \nK. Pinker-Domenig, S. Gruber, W. Bogner, B. Brück, H. Bickel, P.A.T. Baltzer, \nT. Helbich; Vienna/AT (katja.pinker@meduniwien.ac.at) \nPurpose: To develop and assess a combined reading for CE-MRI and 3D-1H-MRSI \nat 3 Tesla in patients with breast tumours.\nMethods and Materials: In this IRB-approved prospective study 113 patients with \nan imaging abnormality were examined at 3 T with 3D-1H-MRSI (10 x 10 x 10 mm; \nTA 11 min) followed by a T2-weighted and a high resolution T1-weighted sequence \nwith a single dose of contrast agent (Dotarem, Guerbet). Lesion morphology and \nEH-kinetics were assessed and classified according to BIRADS. 3D-1H-MRSI \nfindings were defined as positive if the SNR of the choline resonance peak was \n³2.55. For the combined reading a lesions was classified as malignant if at least \ntwo of three values, i.e. lesion morphology, enhancement kinetics, and SNR were \npositive. Sensitivity, specificity and diagnostic accuracy of CE-MRI, 3D-1H-MRSI \nand the combined reading were calculated. Histopathology was used as the \nstandard of reference.\nResults: There were 39 benign and 74 malignant lesions. Median SNR of the benign \nand malignant lesions was 0.95 and 9.98. CE-MRI alone had a sensitivity of 97%, \na specificity of 64% and diagnostic accuracy of 86%. Using an SNR threshold of \n2.55 MRSI had a sensitivity of 93%, a specificity of 92% and diagnostic accuracy \nof 92%. Using the combined imaging protocol we kept an excellent sensitivity of \n97%, increased specificity from 64% to 74% as compared with CE-MRI resulting \nin a diagnostic accuracy of 89%.\nConclusion: Combined CE-MRI and 3D-1H-MRSI at 3 T allows an increase in \nspecificity while maintaining the excellent sensitivity of MRI of the breast.\nB‑0077 11:24\nApplication of breast MRI vs. classical prognostic factors to predict \nsurvival in patients with primary breast cancer \nM. Dietzel1, P.A.T. Baltzer2, R. Zoubi3, H. Habrecht4, C. Jerowski4, \nI.B. Runnebaum4, W.A. Kaiser4; 1Erlangen/DE, Jena/DE, 2Jena/DE, Vienna/AT, \n3Bielefeld/DE, Jena/DE, 4Jena/DE (dietzelmatthias2@hotmail.com) \nPurpose: To identify the potential of breast MRI vs. classical prognostic factors to \npredict disease-related death in breast cancer.\nMethods and Materials: Patients receiving pre-therapeutic MRI staging of primary \nbreast cancer during 4 consecutive years at our primary care multidisciplinary breast \ncancer centre were included. In each patient classical prognostic factors were \nidentified (TNM-staging, tumour typing, tumour grading, progesterone/estrogen \nreceptors [%], HER2NEU score, associated DCIS component) and follow-up was \nperformed. The endpoint was defined as disease-related death. For quantitative \nMRI reading in addition to baseline characteristics and conventional imaging led \nto a strong improvement in AUC from 0.62 (95% CI 0.52-0.71) to 0.82 (95% CI \n0.74-0.90). Non-mass classification was positively associated (p < 0.05) with the \npresence of pure DCIS when compared with non-malignant lesions. Segmental \nnon-mass-like enhancement had the highest predictive value (82%, 95% CI 48-97) \nfor the presence of DCIS.\nConclusion: 3 T breast MRI of mammographically detected microcalcifications is of \nadded diagnostic value for the diagnosis of DCIS when performed by expert radiolo-\ngists and if classification is based upon the ACR BI-RADS® lexicon for breast MRI. \nB‑0073 10:48\nWhich threshold level is appropriate for analysis of the computer-\naided detection system of breast MRI? Effect of pathologic tumour \ncharacteristics and biological markers \nS. Song1, B. Seo1, K.-W. Hwang2, K. Cho3, O. Woo3; 1Ansan/KR, 2Incheon/KR, \n3Seoul/KR (akaeuny@hanmail.net) \nPurpose: The purpose was to investigate which threshold is appropriate for CAD \nanalysis for breast MRI and whether pathologic characteristics and biological \nmarkers influence the CAD analysis.\nMethods and Materials: We evaluated preoperative MRI with CAD of 132 breast \ncancers (82 invasive cancers and 50 DCIS) who underwent surgical treatment. \nTwo breast radiologists analysed CAD findings and measured the tumour extent \nat three types of thresholds, 30, 50, and 100%. To assess which threshold would \nbe appropriate, we compared the measured tumour extents at each threshold. We \nassessed whether pathologic or biologic findings could influence the results of CAD \nanalysis. Spearman rank correlation and Pearson’s Chi-square test were used.\nResults: For invasive cancers, mean tumour size was 22.28 mm on pathologic \nexamination and 22.57 mm on MRI. The size of invasive cancers on the CAD \nanalysis was 21.80 mm at 30% threshold, 18.68 at 50% and 9.67 at 100%. For \nDCIS cases, mean tumour size was 24.96 mm on pathologic examination and 25.80 \nmm on MRI. The size of DCIS was 27.06 mm at 30% threshold, 21.54 at 50% and \n8.28 at 100%. These differences were statistically significant (P < 0.05). For both \nof invasive cancers and DCIS cases, 30% threshold was the best to demonstrate \nwhole tumour extent. For invasive cancers, CAD analysis was influenced by tumour \ngrade. For DCIS, CAD analysis was influenced by biologic marker.\nConclusion: In CAD analysis, 30% threshold is the most appropriate for both \ninvasive cancers and DCIS. Tumour grade and biological markers can influence \ntumour detection on the CAD system.\nB‑0074 10:57\nThe additional value of diffusion-weighted imaging (DWI) in MR-\nmammography: should we still look at curves? \nP.A.T. Baltzer1, M. Dietzel2, J.L. Halder3, W.A. Kaiser3; 1Vienna/AT, 2Erlangen/DE, \n3Jena/DE \nPurpose: For differential diagnosis of breast lesions in dynamic contrast-enhanced \nMRI, morphology on enhanced early phase (EP) images and enhancement curve \ntypes (EP and delayed phase, DP) are assessed. Accordingly, the major part \nof the dynamic images is used for assessment of DP only. Diffusion-Weighted \nImaging (DWI) is an alternative and fast quantitative technique. We investigated \nwhether integration of Apparent Diffusion Coefficient (ADC) values may replace \nacquisition of DP images.\nMethods and Materials: Consecutive breast MRI examinations (1.5 T, dynamic \nenhanced T1w images, temporal resolution 1 min., DWI: 2 b-values: 0&1000s/\nmm2, ADC calculated automatically) of consecutive patients classified as BI-RADS \n3-5 in mammography/ultrasound were investigated in this IRB-approved study. EP \nenhancement (%) and DP Washout (%) were analysed. Classification accuracy \nof single parameters and possible combinations was investigated using ROC and \nbinary logistic regression analysis. Reference standard was histopathology or \nimaging follow-up > 24 months.\nResults: Included were 127 patients showing 144 lesions (102 malignant, 42 be-\nnign). Highest Area under the ROC curve (AUC) was reached by single-parameter \nWashout (0.849) and ADC (0.884). Combination of initial enhancement and ADC \nreached highest AUC of 0.898 without significant differences to ADC values only \n(P> 0.05).\nConclusion: Analysis of DP data in a clinical setting does not add quantitative \nvalue for lesion differentiation if compared with DWI measurements. A protocol \nincluding only initial enhancement and DWI measurements would take about 5 min. \nexamination time and would also allow morphologic lesion assessment. \n\nScientific Sessions\nS165\nA\n C D E F G\nB\nThursday\nResults: 194 breast cancer masses from 191 women were evaluated. Analysis \nfor the most suspicious enhancement kinetics pattern showed no statistical cor-\nrelation with any of the receptor subtypes. There was higher tumour component \nby percentage volume showing early rapid enhancement in estrogen receptor \n(ER) negative (64.1% vs 53.6%, p =0.013), progesterone receptor (PR) negative \n(65.4% vs 52.5%, p=0.001) and triple negative tumours (65.3% vs 54.6%, p=0.028) \ncompared to ER positive, PR positive and non-triple negative tumours, respectively.\nConclusion: Volumetric analysis of MRI enhancement kinetics was more useful \nin showing the vascular properties of breast tumours. The analysis revealed that \nER negative, PR negative and triple-negative malignant masses had a greater \nvolume containing rapid type initial enhancement.\n10:30 - 12:00 Room G/H \nGenitourinary \nSS 107 \nProstate imaging \nS. Morozov; Moscow/RU \nJ. Richenberg;  Brighton/UK \nB‑0081 10:30\nReliability of the PI-RADS scoring system for functional prostate MRI \nM. Quentin, L. Schimmoeller, C. Arsov, R. Rabenalt, R. Lanzman, G. Antoch, \nP. Albers, D. Blondin; Düsseldorf/DE (michael.quentin@med.uni-duesseldorf.de) \nPurpose: Recently the European Society of Urogenital Radiology (ESUR) pub-\nlished guidelines to standardise prostate MRI. These guidelines contain a simple \n5-point scale scoring system called (PI-RADS, prostate imaging, reporting, and \ndata system) for estimating the probability of a lesion to be malignant. This recom-\nmendation has not been validated so far which is the aim of the present study.\nMethods and Materials: 167 lesions which have been histologically confirmed \nwith MRI-guided prostate biopsy were retrospectively scored by three blinded \nradiologists using the PI-RADS scoring system. 56 lesions revealed prostate \ncancer, while 108 lesions were benign. Inter-observer reliability was evaluated \nusing Kappa statistics (ĸ).\nResults: With respect to T2-weighted images, diffusion weighted imaging (DWI) \nand dynamic contrast-enhanced imaging (DCE-MRI) ĸ were 0.55, 0.64, and 0.65, \nrespectively. ĸ values in tumour were higher in T2-weighted images, and in DWI \nthan those in non-tumour lesions. A total score of ten or more points in summa-\ntion of the individual scores of each sequence as the cut off for malignancy was \nleading to 86% sensitivity, 68% specificity, 58% positive predictive value, and 90% \nnegative predictive value.\nConclusion: The use of the PI-RADS scoring system for functional prostate MRI \nis feasible and comes along with a good inter-observer reliability. \nB‑0082 10:39\nPreoperative multiparametric magnetic resonance imaging \n(mp-MRI) reduces positive surgical margins after robotic-assisted \nlaparoscopic prostatectomy (RALP): experience in 136 patients \nS. Alessi, G. Petralia, G. Musi, A. Alconchel, G. Bardo, S. Raimondi, G. Renne, \nO. De Cobelli, M. Bellomi; Milan/IT (Sarah.Alessi@ieo.it) \nPurpose: To investigate whether preoperative multiparametric magnetic resonance \nimaging (mp-MRI) reduces positive surgical margins after robotic-assisted laparo-\nscopic prostatectomy (RALP).\nMethods and Materials: The study was approved by the local ethics committee \nand all patients gave their informed consent. Between March 2011 and May 2012, \n136 consecutive patients (median age: 61.1 yr, range: 47-73) with biopsy-proven \nprostate adenocarcinoma were prospectively enrolled in the study, undergoing \nmp-MRI before RALP. Mp-MRI imaging was performed at 1.5 T, including anatomic \nT2-weighted images, diffusion weighted (DW) and dynamic contrast-enhanced \n(DCE) sequences. All patients were retrospectively matched with a group of 136 \ncontrols who underwent RALP without preoperative mp-MRI. Paired t-tests and \nthe non-parametric Wilcoxon signed rank test were used to compare age, PSA \nand Gleason Score between cases and controls. Percentages of positive margins \nin each group were compared with the McNemar’s test. P values < 0.05 were \nconsidered statistically significant for all tests. The post-operative histopathological \nexamination was used as the standard of reference for the presence of positive \nsurgical margins.\nResults: In the 136 enrolled patients, 12 (8.82%) had positive surgical margins. \nAmong the 136 controls, 25 (18.38%) had positive margins. We found evidence of \nanalysis of breast MRI a dedicated CAD software was used (computer-aided \nanalysis). It enables semi-automatic analysis of enhancement characteristics of \nthe whole tumour (3D analysis of early vs. delayed phase) and the “hot-spot” (i.e. \nvoxel with highest washin/washout ratio). Potential of breast MRI characteristics \nvs. classical prognostic factors to predict disease-related death was investigated \nseparately and in combination using Cox regression. To identify significant and \nindependent predictors for disease-related death, backward feature selection was \napplied (pentry/removal: < 0.05/> 0.01).\nResults: Two-hundred and twenty-three patients were included (disease-related \ndeath: n=24/10.8%; censored: n=187/83.9%; loss to follow-up: n=12/5.4%). Mean \nfollow-up was 4.7years. If tested separately, CR analysis identified significant \npotential both for breast MRI and classical prognostic factors to predict disease-\nrelated death (p < 0.001). If breast MRI characteristics and classical prognostic \nfactors were used in combination, predictive performance could be further increased \nsignificantly (p < 0.05): after feature selection five classical prognostic factors \n(TNM stage, tumour typing, HER2NEU score) and six breast MRI characteristics \n(hot-spot: time to peak enhancement, washout ratio; 3D analysis: tumour volume; \ntumour voxels showing washout plus weak/intermediate washin and tumour voxels \nshowing plateau and weak washin) remained in this final model as significant and \nindependent coefficients (p < 0.05).\nConclusion: Breast MRI has a significant potential to predict disease-related \ndeath in breast-cancer patients. It not only can be used as a stand-alone tool for \nthis task but also adds significant predictive value to classical prognostic factors \nto stratify this endpoint.\nB‑0079 11:33\nDiagnosis of breast lesions using proton MR-spectroscopy at 1.5 \nand 3 Tesla: a systematic review and meta-analysis \nP.A.T. Baltzer1, M. Dietzel2, W.A. Kaiser3; 1Vienna/AT, 2Erlangen/DE, 3Jena/DE \nPurpose: To perform a systematic review and meta-analysis to estimate the ac-\ncuracy of breast proton magnetic resonance spectroscopy (MRS) in the diagnosis \nof breast lesions and to identify variables that influence accuracy of MRS.\nMethods and Materials: A comprehensive search of the Pubmed database was \nperformed on articles listed until 01/06/2012. The medical subjects heading (MeSH) \nand text words for the terms “breast”, “spectroscopy” and “magnetic resonance” \nwere used. Investigations including > 10 subjects at 1.5 T or 3 T applying 1D sin-\ngle voxel MRS or spatially resolved MRS for differentiation between benign and \nmalignant breast lesions were eligible. A reference standard had to be established \neither by histopathology or imaging follow-up ³12 months.\nResults: Nineteen studies were used for general data pooling, including 1183 \npatients and 1198 lesions (773 malignant, 452 benign). Pooled sensitivity and \nspecificity were 73% (95% CI 70-76%) and 88% (95% CI 85-91%), respectively. \nPooled diagnostic odds ratio (DOR) was 34.30 (95% CI 16.71-70.43). For breast \ncancer versus benign lesions, the sROC´s AUC of MRS was 0.88 and the point \nQ* was 0.81. There was evidence of between studies heterogeneity regarding \nsensitivity and DOR (P < 0.001). No significant influences of higher field strength, \npostcontrast acquisition or qualitative against quantitative MRS measurements were \nidentified. Egger´s test confirmed significant publication bias in studies including \nsmall numbers of patients (P < 0.001).\nConclusion: Breast MRS shows variable sensitivity and high specificity in the \ndiagnosis of breast lesions independent from the technical MRS approach. Due to \nsignificant publication bias, pooled diagnostic measures might be overestimated. \nB‑0080 11:42\nVolumetric assessment of MRI enhancement kinetics of invasive \nbreast cancers with a post-processing software with correlation of \nhormonal receptor subtypes \nL.C.H. Leong1, E. Gombos2; 1Singapore/SG, 2Boston, MA/US \nPurpose: The aim of the study was to use an MRI computer-aided detection post-\nprocessing software to assess the enhancement patterns by percentage tumour \nvolume in invasive breast cancers of different hormonal receptor subtypes.\nMethods and Materials: Pathology database search was performed on women \nwith newly diagnosed breast cancers confirmed by core biopsies and had breast \nMRI assessment from March 2005 to March 2009. Only malignancies presenting \nas breast masses were included for the analysis. In-situ cancers, rare types of \nbreast cancers such as metaplastic carcinoma or phyllodes tumour and non-\nepithelial malignancies were excluded. Enhancement kinetics data were analysed \nprospectively for the worst enhancement pattern and enhancement patterns by \npercentage tumour volume. The findings were then compared against the ER, PR, \nHer2 and triple negative hormonal receptor subtypes.\n\n6FLHQWLILF\u00036HVVLRQV\n6\u0014\u0019\u0019 &$' ( ) *%\n%\u0010\u0013\u0013\u001b\u0018\u0003 \u0014\u0014\u001d\u0013\u0019\n\u0016\u00037\u0003PXOWL\u0010SDUDPHWULF\u0003XOWUDKLJK\u0003E\u0003YDOXHV\u0003\u000bE\u0003\u0015\u0013\u0013\u0013\f\u000305\u0003LPDJLQJ\u0003IRU\u0003\nGHWHFWLRQ\u0003DQG\u0003ORFDOLVDWLRQ\u0003RI\u0003SHULSKHUDO\u0003DQG\u0003WUDQVLWLRQ\u0003]RQH\u0003SURVWDWH\u0003\nFDQFHU\u0003\n*\u0011\u00030DQHQWL\u000f\u00030\u0011\u00031H]]R\u000f\u00036\u0011\u0003$OWREHOOL\u000f\u00030\u0011\u0003$QWRQLFROL\u000f\u00036\u0011\u0003&DSXDQL\u000f\u0003*\u0011\u00036LPRQHWWL\u001e\u0003\n5RPH\u0012,7\u0003\u000bJXJJL#WLVFDOL\u0011LW\f\u0003\n3XUSRVH\u001d\u0003 7 R\u0003 UHWURVSHFWLYHO\\\u0003 GHWHUPLQH\u0003 WKH\u0003 DFFXUDF\\\u0003 RI\u0003 7\u0015\u0003 ZHLJKWHG\u000e':,\u0003 \u000b\u0014\u0013\u0003\nE\u0010YDOXH\u0003 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05\u0010*%\u0003 YHUVXV\u00037586\u0010*%\u0003 LQ\u0003\nSURVWDWH\u0003FDQFHU\u0003GLDJQRVLV\u0011\n0HWKRGV\u0003DQG\u00030DWHULDOV\u001d\u0003:H\u0003GHYHORSHG\u0003D\u0003GHFLVLRQ\u0003DQDO\\WLF\u0003WUHH\u0003ZLWK\u0003D\u00030DUNRY\u0003\nPRGHO\u0003WR\u0003FRPSDUH\u0003WKH\u000305,\u0010VWUDWHJ\\\u0003ZLWK\u00037586\u0010*%\u0011\u0003,QSXW\u0003GDWD\u0003ZHUH\u0003GHULYHG\u0003IURP\u0003\nV\\VWHPDWLF\u0003OLWHUDWXUH\u0003VHDUFKHV\u0003\u000b7586\u0010*%\u0003DFFXUDF\\\u000f\u0003WUDQVLWLRQ\u0003SUREDELOLWLHV\u000f\u0003XWLOL\u0010\nWLHV\u0003GLIIHUHQW\u0003WUHDWPHQW\u0003RSWLRQV\u000f\u0003VXUYLYDO\u0003GDWD\f\u000f\u0003PHWD\u0010DQDO\\VLV\u0003\u000b05,\u0003DFFXUDF\\\f\u000f\u0003DQG\u0003\nH[SHUW\u0003 RSLQLRQ\u0003 \u000bGHFLVLRQ\u0003 WUHH\u0003 DQG\u0003 FRVW\u0003 LQIRUPDWLRQ\f\u0011\u0003 :H\u0003 SHUIRUPHG\u0003 D\u0003 VHQVLWLYLW\\\u0003\nDQDO\\VLV\u0003WR\u0003DVVHVV\u0003WKH\u0003XQFHUWDLQW\\\u0003VXUURXQGLQJ\u0003WKH\u0003HIIHFWV\u0003DQG\u0003RYHUDOO\u000f\u0003GLDJQRVWLF\u000f\u0003\nDQG\u0003WUHDWPHQW\u0003FRVWV\u0011\u0003:H\u0003SORWWHG\u0003D\u0003FRVW\u0010HIIHFWLYHQHVV\u0003DFFHSWDELOLW\\\u0003FXUYH\u0003WR\u0003SUHVHQW\u0003\nWKH\u0003SUREDELOLW\\\u0003D\u0003VWUDWHJ\\\u0003LV\u0003FRVW\u0010HIIHFWLYH\u0003RYHU\u0003GLIIHUHQW\u0003ZLOOLQJQHVV\u0003WR\u0003SD\\\u0003YDOXHV\u0011\n5HVXOWV\u001d\u00037 RWDO\u0003H[SHFWHG\u0003PHDQ\u0003FRVW\u0003SHU\u0003SDWLHQW\u0003RYHU\u0003\u0014\u0013\u0003\\HDUV\u0003RI\u000305,\u0003VWUDWHJ\\\u0003\u000b½\u0003\n\u0016\u0014\u0013\u0019\f\u0003ZHUH\u0003ORZHU\u0003WKDQ\u0003WKRVH\u0003IRU\u0003WKH\u00037586\u0010*%\u0003\u000b½\u0003\u0016\u0015\u0016\u0016\f\u0011\u00034$/ 2) \nwere 5.6 kPa for RTSWE and 7.3 kPa for TE. Sensitivity and specificity were 78.6% \n(59.0-91.7) and 89.7% (75.8-97.1) for RTSWE, and 69.0% (49.2-84.7) and 83.3% \n(68.6-93.0) for TE, respectively.\nConclusion: These results show that RTSWE is accurate in identifying patients with \nsignificant fibrosis. With both TE and RTSWE, healthy volunteers show significant \nlower values with respect to patients with no significant fibrosis. \nB‑0093 10:48\nMR elastography for predicting progression of cirrhosis \nU. Motosugi, T. Takamura, T. Ichikawa, K. Sano, H. Morisaka, S. Ichikawa, \nT. Araki; Yamanshi/JP (utaroh-motosugi@nifty.com) \nPurpose: To assess the efficacy of MR elastography in predicting progression of \ncirrhosis, in patients with Child-Pugh class A disease.\nMethods and Materials: A total of 131 patients with type C hepatitis and Child-\nPugh class A disease were included. All patients underwent MR elastography and \nliver function tests and were followed up every 3 months, for re-evaluation of their \nChild-Pugh class. The endpoint was set to the time when the Child-Pugh class A \nof the patients progressed to class B. Univariate and multivariate Cox proportion \nhazards models were used to determine the independent risk factor for cirrhosis \nprogression.\nResults: The median follow-up period was 18 months (range 3[[Unable to Display \nCharacter: ‒]]27 months). Results of multivariate Cox proportional hazards \nanalysis showed that liver stiffness measured by MR elastography was an independ-\nent risk factor for predicting cirrhosis progression as well as prothrombin activity. \nThe progression rate was significantly higher in patients with liver stiffness of > \n5.4 kPa than in those with liver stiffness of ²5.4 kPa (log rank test, p < 0.001). The \nrate of cirrhosis progression to Child-Pugh class B per year-person was 44.8% \nin patients with liver stiffness of > 5.4 kPa, whereas it was 5.5% in patients with \nliver stiffness of ²5.4 kPa.\nConclusion: Liver stiffness measured by MR elastography was an effective pre-\ndictor of progression of cirrhosis from Child-Pugh class A to B disease in patients \nwith type C hepatitis.\nB‑0094 10:57\nEvaluation of shear wave elastography for liver fibrosis quantification\nA. Guibal, T. Lefort, C. Cohen-Bacrie, G. Renosi, J. Scoazec, J. Dumortier, \nP. Valette; Lyon/FR \nPurpose: Shear wave elastography (SWE) is a new method for quantitative tissue \nelasticity evaluation. The purpose of this study was to evaluate SWE used for liver \nfibrosis quantification.\nMethods and Materials: One hundred and seventy patients (aged 21-82, mean \n56 years) who have had liver biopsy as part of their follow -up for chronic liver \ndisease or transplantation were included in the study. Supersonic shear imaging \n(SSI) was performed before biopsy. The average of 3 consecutive measurements \n\nScientific Sessions\nS169\nA\n C D E F G\nB\nThursday\nmetabolic syndrome, diabetes and cardiovascular disease. There is a need to \nfind a biomarker which proves to be reliable, non-invasive and easy to perform \nin clinical practice.\nMethods and Materials: Our aim was to know whether serum alanine aminotrans-\nferase (ALT) is a reliable biomarker of liver fat content in NAFLD, and to determine \nif the current threshold of normality for ALT is appropriate to assess the presence \nof liver fat. This is a cross-sectional, randomised, prospective, population-based \nstudy. We studied 120 healthy subjects with alcohol consumption less than 50 g/\nweek. Quantification of liver fat content was by spectroscopy 1H MR 3 T. 5% of \nliver fat content as the upper limit of normal for the diagnosis of hepatic steatosis.\nResults: There was an excellent positive correlation between liver fat content \nand serum levels of ALT (r = 0.73, p < 0.0001). Results of the backward step-wise \nregression analysis showed that serum ALT was the most important predictor of \nhepatic steatosis (ß coefficient=3.25). All subjects with ALT values > 37 U/L had \nhepatic steatosis (PPV:100%) and none of the subjects with ALT < 20 U/L had \nsteatosis (NPV: 100%). ROC curves were created; the best cut-off value for the \ndiagnosis of NAFLD was ALT: 23 U/L (sensitivity: 94.67%, specificity 73.91%, PPV: \n85.84%, NPV: 89.47%).\nConclusion: Serum ALT levels could be a reliable biomarker of NAFLD if the upper \nlimit of normal for ALT is set at 23 U/L. \nB‑0100 11:51\nAbsolute quantification of phosphorus compounds in the liver on a \nclinical 3 T scanner \nA. Laufs1, R. Livingstone2, S. Kahl1, B. Nowotny1, B. Klueppelholz1, \nG. Giani1, J. Bunke3, J.-H. Hwang1, M. Roden1; 1Düsseldorf/DE, 2Vellore/IN, \n3Hamburg/DE (alessandra.laufs@uni-duesseldorf.de) \nPurpose: Hepatic energy metabolism plays an important role in insulin resistance \nand liver diseases. The aim was to establish a robust and fast method to detect \nand to quantify liver ATP content in molar concentrations for use in a clinical set-\nting, i.e. large cohort studies.\nMethods and Materials: Healthy volunteers (n=86; 58 ± 12 years; BMI: 25.6 ± 3.1 \nkg/m²) consented to the approved protocol. All experiments were performed on a \n3-Tesla MRI scanner (Philips Achieva 3.0 T X-series, The Netherlands). 31P spectra \nwere acquired using a 14-cm diameter 31P surface coil, with the built-in 1H body \ncoil used for NOE enhancement and decoupling (TR: 4 sec; acquisition time: 13 \nminutes). Localisation in the liver was achieved using ISIS. Separately, intra- and \ninterday variability were measured on 6 volunteers. The absolute quantification was \nestablished using matching phantoms and an external reference (MPA).\nResults: All peaks were well resolved with the mean SNR (γ-ATP) of 16. The \nconcentrations were found to be 1.97 ± 0.61 mmol/l (phosphomonoester), 7.80 ± \n2.11 mmol/l (phosphodiester), 1.97 ± 0.52 mmol/l (inorganic phosphate) and 2.70 \n± 0.59 mmol/l (γ-ATP). The intra- and interday reproducibility was 4.5%, respec-\ntively, 1% (PME) 9%, respectively, 10% (PDE), 11%, respectively, 2% (Pi) and 9%, \nrespectively, 3% (γ-ATP).\nConclusion: The absolute quantification for large cohort studies has been suc-\ncessfully established on a clinical scanner. The obtained concentrations from \nthis study agree with the concentrations from previous studies. Thus, the current \nmethod can reliably detect concentration changes above 10% in phosphorus \ncompounds in human liver. \n10:30 - 12:00 Room L/M \nPhysics in Radiology \nSS 113 \nMulti modality imaging and MR safety \nModerators: \nO. Ciraj-Bjelac; Belgrade/RS \nO. Speck; Magdeburg/DE \nB‑0101 10:30\nMR tumour perfusion measurements: dual echo versus multi-echo \napproach \nV. Hietschold, M. Riebisch, A. Abramyuk, M. Laniado, N. Abolmaali; \nDresden/DE (Volker.Hietschold@Uniklinikum-Dresden.de) \nPurpose: Gadolinium chelates (CM) lead to concentration-dependent shortening \nof T1 as well as T2 * relaxation times. T1 shortening is more influenced by the \ninterstitial CM, whereas T2 * contains more information about the capillaries. By \nsequence weighting, the one or other aspect can be pronounced, by means of \nfor F4 (Se:83.3%, Sp:79.7%, PPV:96.8%, NPV:83%). Discordance between RE \nand histology was observed in 28 (27.5%) patients.\nConclusion: Using RE measurements, contrast-enhanced MRI can accurately \nstage LF in CLD patients. Histologically proven steatosis, inflammation and iron \nload have no influence on the enhancement. \nB‑0097 11:24\nDifferential portal venous flow response to terlipressin in normal and \ncirrhotic rats: non-invasive assessment using phase-contrast MRI \nM. Chouhan, A. Bainbridge, N. Davies, R. Mookerjee, R. Jalan, \nS. Walker-Samuel, M. Lythgoe, S. Punwani, S.A. Taylor; London/UK \n(manil.chouhan@gmail.com) \nPurpose: Portal venous flow (PVF) measurement using phase-contrast MRI (PC-\nMRI) is technically feasible at 9.4T. The purpose of this study was to assess the \nsensitivity of PC-MRI to expected changes in portal flow after terlipressin adminis-\ntration and study the functional response in normal and cirrhotic rats.\nMethods and Materials: Eight Sprague-Dawley rats were randomised to bile duct \nligation (BDL) procedure (n=4) or sham laparotomy (n=4). After 4 weeks, PVF was \nmeasured using respiratory-gated 2D PC-MRI (2 mm slice thickness, 10° flip angle \nand 22 cm/s velocity encoding) with a 9.4T Agilent system. Terlipressin (known to \nreduce PVF) was administered intravenously at a dose of 10mcg/100 g and PC-\nMRI measurements repeated sequentially for 30-40 minutes post-administration. \nBulk PVF was normalised to explanted liver weight, obtained after termination of \nthe experiment. Data were analysed using paired and unpaired Student t-tests.\nResults: Baseline liver weight normalised mean PVF in sham (143.53±14.42 ml/\nmin/100 g) vs BDL (79.51±44.74 ml/min/100 g) rats was not statistically significant \n(p=0.059). The reduction in PVF post-terlipressin was significant in sham (mean \nreduction of 63.48±14.28 ml/min/100 g; p < 0.05), but not in BDL (mean reduction of \n55.44±35.71 ml/min/100 g; p=0.053) rats. Significant differences in post-terlipressin \nnadir PVF in sham (80.05±20.18 ml/min/100 g) vs BDL (24.07±14.66 ml/min/100 \ng) rats were, however, demonstrated (p < 0.05).\nConclusion: Expected reductions in PVF were detected non-invasively using PC-\nMRI in both normal and cirrhotic rats. Data are suggestive of a lower baseline PVF \nin cirrhotics, which go on to demonstrate a different, more labile haemodynamic \nresponse to terlipressin compared with normal rats. \nB‑0098 11:33\nEvaluation of T1rho as a potential MR biomarker for liver cirrhosis: \ncomparison of healthy control subjects and patients with liver cirrhosis \nI. Rauscher1, C. Ganter1, P. Martirosian2, E.J. Rummeny1, K. Holzapfel1; \n1Munich/DE, 2Tübingen/DE \nPurpose: The purpose of this study was to compare mean liver T1rho values in \npatients with liver cirrhosis and healthy control subjects in order to evaluate T1rho \nas a potential MR biomarker for liver cirrhosis.\nMethods and Materials: Ten healthy control subjects (6 female, 4 male) and 17 \npatients with clinically diagnosed and/or biopsy-proven liver cirrhosis (4 female, \n13 male) were examined at 1.5 T (Magnetom Avanto, Siemens). T1rho-weighted \nimages were acquired using a 2D Turbo FLASH sequence (TR/TE 3000/1.31 ms, \nFA 8°, FoV 309x380 mm, resolution 2x2x6 mm, acquisition time 15s) with Spin-Lock \npreparation. T1rho maps were calculated from five breath-hold measurements, \nperformed with different Spin-Lock times (4, 8, 16, 32, 48 ms). Mean liver T1rho \nvalues of healthy control subjects and patients with liver cirrhosis were calculated \nby two radiologists in consensus and were compared using two-tailed student t-test. \nIn addition, a receiver operating characteristic (ROC) curve analysis was performed \nto evaluate the utility of mean liver T1rho for the prediction of liver cirrhosis.\nResults: Mean liver T1rho values in patients with liver cirrhosis (57.7 ms ± 8.1 \nms) were significantly higher than those of healthy control subjects (48.6 ms ± 3.5 \nms; p=0.006). According to the ROC analysis at a threshold value of 51.4 ms the \nsensitivity and specificity of mean liver T1rho in predicting liver cirrhosis were 86.7 \nand 88.9%, respectively. The area under the ROC curve was 0.87.\nConclusion: Mean liver T1rho values in patients with liver cirrhosis were signifi-\ncantly higher than in healthy subjects suggesting a potential role of liver T1rho as \na MR biomarker for liver cirrhosis. \nB‑0099 11:42\nBiomarkers of nonalcoholic fatty liver disease diagnosed by 1H SRM 3 T \nJ. Martin-Rodriguez, J. Arrebola, J. Gonzalez-Calvin; Granada/ES \n(joseluismartin.rx@hotmail.com) \nPurpose: Epidemiological studies showed that non-alcoholic fatty liver disease \n(NAFLD) is a possible precursor of cirrhosis and it has been associated with \n\nScientific Sessions\nS170\n C A D E F\n G\nB\nto standard MR-AC (ACin_opp) in the skeletal system. Maximum changes in SU-\nVmax were observed for (ACcort) in the upper spine: from 0.7±0.2 to 3.0±0.4 and \nthe femoral head: from 0.2±0.1 to 1.4±0.4. Changes in MR-AC had no prominent \nimpact on SUV changes: neither in reference soft tissues nor in three PET-positive \nsoft tissue lesions in the pelvis and neck.\nConclusion: Standard MR-AC without accounting for bone attenuation appears \nacceptable for whole body PET/MR imaging when bony lesions are not the primary \ndiagnostic targets. \nAuthor Disclosures:\nT. Beyer: Employee; cmi-experts GmbH, cmi-experts GmbH.\nB‑0104 10:57\nAssessment of the performance of TOF-PET and PET \nreconstructions on edge definition of cold regions in the presence of \nsolitary hot spots and low count-rate studies \nY. Bouchareb1, M. Masoomi2, M. Newell1; 1London/UK, 2Portsmouth/UK \n(byassine06@yahoo.co.uk) \nPurpose: To investigate an additional requirement in low count rate studies which \nis to define the edges of cold regions in the presence of solitary hot spots.\nMethods and Materials: Phantom PET/CT scans were performed on the Philips \nGemini TOF scanner. In low count rate studies corresponding to typical clinical \nscans of obese patients and gating or dynamic studies, it is crucial to consider \naccurate TOF reconstruction kernels, number of iterations and number of subsets. \nThe NEMA image quality phantom was used; spheres 10, 17 and 28 mm were \nfiled with F-18 and spheres 13, 22 and 37 mm were filled with water. Spheres to \nbackground (2.1 kBq/mL) ratio was 4:1 (total activity was 22.6 MBq). Three TOF-\nListMode-EM reconstructions using 3 iterations (20 and 33 subsets) and kernel \nwidth of 14.1 cm and 18.7 cm were performed. Images were also reconstructed \nusing non-TOF (LOR-RAMLA and 3D-RAMLA) methods for comparison. Activity \nline profiles (ALP), contrast recovery coefficients (CRC) and Noise were used to \nanalyse the reconstructed images.\nResults: ALP extracted through diameters of cold spheres indicated an improve-\nment of 5, 11 and 15% in TOF-ListMode-EM reconstructed sphere diameters \nover nonTOF-LOR-RAMLA (3 ietrations/33 subsets), nonTOF-LOR-RAMLA (3 \niterations/20 subsets) and nonTOF-3D-RAMLA reconstructions, respectively. The \nTOF-ListMode-EM reconstruction using 18.7 cm kernel and 3 iterations with 33 \nsubsets achieved the highest CRC for spheres of diameters <= 28 mm and better \nbackground noise reduction.\nConclusion: TOF-ListMode-EM reconstruction with stated kernel width, number of \niterations and subsets improves edge definition of cold regions and image contrast \nin low count studies (e.g. gated imaging). \nB‑0105 11:06\nThe incidence of biological effects from 3.0 Tesla (T) MRI compared \nto 1.5 T: an observational study in 911 consecutive outpatients \nF. Alghamdi, P. Bertrand, L. Barantin, M.A. Lauvin, X. Cazals, F. Domengie, \nR. Bibi, D. Herbreteau, J.-P. Cottier; T ours/FR (faisal.gh.30@gmail.com) \nPurpose: To compare the acute biological effects of a 3.0 Tesla (T) magnetic \nresonance imaging (MRI) to 1.5 T MRI\nMethods and Materials: After MRI examination, 911 patients (449 with 3.0 T MRI \nand 462 with 1.5 T MRI) were presented with a verbal rating scale questionnaire \nconsisting of 11 symptoms related to MRI examination. Chi-square tests were \nused to assess the relationship between the strength of the magnetic field (MF) \nand the incidence of the symptoms. A P value of <.05 was considered significant.\nResults: There was no statistically significant relationship between the strength of \nthe MF and the incidence of the symptoms related to static MF exposure, such as \nvertigo (P =.13), nausea (P =.35), headache (P =.21), and a metallic taste (P =.64). \nA warm feeling induced by radiofrequency (RF) was significantly higher in the 3.0 \nT MRI (P <.0001) with a significant correlation between the mean specific energy \nabsorption rate (SAR) and a warm feeling in the 3.0 T MRI (P <.0001). Numbness/\ntingling related to the gradient MF was significantly higher in the 3.0 T MRI (P =.027).\nConclusion: The thermal effect induced by the RF and the numbness/tingling \ninduced by the gradient field were significantly higher in the 3.0 T MRI than in the \n1.5 T MRI. There was no statistically significant difference between the symptoms \nrelated to static MF exposure from the 3.0 T MRI and 1.5 T MRI. \ndouble echo sequences both effects can be separated one from the other. We \npresent an extension of this concept to multi-echo measurements.\nMethods and Materials: Brain perfusion measurements were performed in 10 \npatients as part of an ongoing study investigating the reproducibility of perfusion \nparameters on a 3 Tesla MR scanner (Siemens Magnetom Verio). Three slices were \nrecorded with a temporal resolution of 2 s by means of a four echo FLASH sequence \n(TR = 52 ms, TE = 1.2/5/10/15 ms, alpha = 30 ¼ 70°). Evaluations of contrast to \nnoise ratios (CNR) during the bolus passage of Omniscan (GE Healthcare) through \ndifferent tissues were done with an inhouse software written in IDL (Exelis VIS).\nResults: The CNR is improved by a factor of about 1.8 calculating delta-R2* from \nfour echoes compared to calculations based on two echos. Signal intensity estima-\ntions for TE = 0 do not significantly benefit by the increased number of echoes.\nConclusion: Multi-echo measurements allow for a larger dynamic range of T2 * \nshortening compared to single or double echo sequences, at the same time giving \nmore signal. By extending the concept to keyhole and/or EPI sequences, covering \nof entire tumours could be achieved. \nB‑0102 10:39\nPET/MR imaging of the pelvis in the presence of endoprostheses: \nreducing image artefacts and increasing accuracy through inpainting \nC.N. Ladefoged, F. Andersen, S. Keller, J. Löfgren, A.E. Hansen, S. Holm, \nL. Hojgaard, T. Beyer; Copenhagen/DK (thomas.beyer@cmi-experts.com) \nPurpose: In combined PET/MR, attenuation correction (AC) is performed indirectly. \nImplant-induced susceptibility artefacts challenge MR-based AC. We evaluate the \naccuracy of MR-AC in PET/MR patients with metallic endoprostheses.\nMethods and Materials: We select patients with uni- or bi-lateral endoprostheses \nfrom 100 consecutive referrals for whole body (WB) PET/MR imaging (mMR, \nSiemens Healthcare). Simultaneous WB-PET/MR scanning was performed at 120 \nmin p.i. of 300 MBq [18 F]-FDG: 4 min/bed including Dixon Water Fat segmenta-\ntion (DWFS)). MR-AC was performed using a) original MR-images (DWFS), b) as \na) with implant-induced air-pockets filled with soft-tissue, c) as b) superimposed \nwith co-registered endoprostheses from CT and d) as a) with implant-induced air-\npockets filled with metal. PET reconstruction after MR-AC (a-d) used AW-OSEM \n(3iterations, 21subsets, 2 mm Gaussian) on 344-matrices. Mean/max standardised \nuptake value (SUVbw) was calculated from interest volumes with 40% isocontour \nlevels over the hips, pelvic muscle and bladder.\nResults: In 100 patients we found 1 and 2 uni- and bi-lateral endoprosthesis, \nrespectively. Associated MR artefacts were much larger than the implants: 20.9% \nversus 2.5% of the attenuating voxels in (a) of the central hip region.\nMR-AC using (b) and (c) recovered FDG-distribution pattern compared to uncor-\nrected PET (noAC) images and (a), while (d) resulted in severe overestimation (> \n470% SUVmax). The relative changes in SUVmax/mean in the reference regions \n(bladder, pelvic muscle) from (b-d) compared to (a) were insignificantly small.\nConclusion: Endoprostheses cause PET/MR artefacts and bias PET quantification. \nArtefacts and bias can be corrected by automated inpainting with a single soft-\ntissue composition prior to MR-AC, thus restoring quantitative activity distribution.\nAuthor Disclosures:\nT. Beyer: Founder; cmi-experts GmbH.\nB‑0103 10:48\nCombined PET/MR imaging: the effect of ignoring bone during MR-\nbased attenuation correction in oncology imaging \nJ. Saa, J. Löfgren, R. Sersar, M. Aznar, C. Ladefoged, F. Andersen, R. Larsen, \nT. Beyer; Copenhagen/DK (thomas.beyer@cmi-experts.com) \nPurpose: In combined PET/MR, PET attenuation correction (AC) is based on tis-\nsue segmentation following in-/opposed phase MR imaging (in_opp). Bone tissue \nis not represented in routine MR-based AC (MR-ACin_opp). We evaluate PET \nquantification accuracy following MR-AC without and with accounting for bone \ntissue using separate CT.\nMethods and Materials: Nine whole-body patients underwent an [18 F]-FDG-\nPET/CT exam (mCT, Siemens) followed by a PET/MR scan (mMR, Siemens) at \n119 min p.i. of 300 MBq [18 F]-FDG. PET (/MR) images were reconstructed using \nstandard MR-AC (ACin_opp) and four modified MR-AC maps. These were created \nby co-registering (b-spline) the CT images to (ACin_opp) and adding CT bone mask \nvalues representing cortical bone: 1200 HU (ACcort), spongiosa bone: 350 HU \n(ACspong), average CT value (ACmean) and original CT values (ACorgCT). PET \nimages were reconstructed after MR-AC using AW-OSEM (3iterations, 21subsets, \n2 mm Gaussian) on 344-matrices. Mean/max standardised uptake values (SUVbw) \nwere calculated in anatomical reference regions and PET-positive lesions.\nResults: Mean CT attenuation was (734±158)HU (min/max 475/900 HU). Visual \nassessment of the different AC-PET images indicated most prominent differences \n\nScientific Sessions\nS171\nA\n C D E F G\nB\nThursday\nResults: In the evaluated literature the implant test conditions were generally \nfocused on patient scanning, usually considering patient table moving into the \ngantry at low speed a few cm/s, perpendicularly to the field lines of the magnetic \nfringe field. However, implanted in a worker, during movement at normal walking \nspeed near the magnet bore any implant is exposed to extremely high magnetic \nfield gradients, which for metallic non ferromagnetic implants results in an oppos-\ning force due to Lenz’ law.\nConclusion: In general MR-testing procedures of medical implants certified as “MR \nsafe” for patient examination in mid-field scanners (1.5 T - 3.0 T) do not consider \nthe possible hazardous effect of Lenz’ law on metallic devices implanted in workers \nduring activities near the magnet bore.\nWe suggest including into the implant and device compatibility test the particular \nworker’s scenario too. \nB‑0109 11:42\nSwedish national study on modality choice and justification of CT, \nMRI and US examinations in children \nB. Isberg1, H. Jorulf2, U. Svahn1, S. Richter1, W. Leitz1; 1Stockholm/SE, \n2Uppsala/SE (bengt.isberg@ptj.se) \nPurpose: The aim of this retrospective study was to evaluate the level of justification \nregarding choice of method for computed tomography (CT), magnetic resonance \nimaging (MRI) and ultrasound (US) as well as the quality of requests for examina-\ntions of children in Sweden.\nMethods and Materials: Request forms from all Swedish hospitals were collected \nfor CT, MRI and US examinations (N=3149) of children, performed during 2 weeks \nin 2011. 18 physicians choose examination based on request information and \njudged quality. All requests were evaluated by at least 2 observers. Outcomes \nwere assessed for health care regions and levels, examined body parts, age \nclasses and gender.\nResults: 96 % of requests were considered adequate. In 51% of CT, 68% of MRI \nand in 88% of US examinations the observers agreed on the same examination \nas requested and performed by the hospital. In 14% of CT, 5% of MRI and in 2% \nof US examinations the observers agreed on examinations, not being the same \nas requested and performed. In 30% of CT, 24% of MRI and in 9% of US the \nobservers disagreed, at least one observer choose another examination than \nrequested and performed.\nConclusion: The level of agreement on examination can be considered as an \nestimation of the level of consensus. The low level of agreement for CT mandates \nincreased efforts in making guidelines to improve routines and to reduce radiation \ndoses to patients. This study was initiated and funded by the Swedish Radiation \nProtection Authority, Department of Radiation Protection/ Medical Exposures. \nB‑0110 11:51\nIn vitro comparison of ultrasound-based elastography techniques \nS. Franchi-Abella1, J.-M. Correas2, C. Elie2; 1Le Kremlin-Bicêtre/FR, 2Paris/FR \n(stephanie.franchi@bct.aphp.fr) \nPurpose: Ultrasound elastography techniques are based on two different physical \nprincipal: strain and Shear Wave Velocity (SWV). The purpose of this study was \nto assess the performance of these two techniques in vitro on a calibrated elastic-\nity phantom using five ultrasound diagnostic imaging system to improve clinical \ncomprehension and use of elastography.\nMethods and Materials: An operator performed all acquisitions on a tissue-\nmimicking phantom developed for elastography calibration (CIRS 049 A) containing \nspherical inclusions embedded in an homogeneous background (BG) of known \nelasticity (30 ± 5 kPa). Two inclusions were harder than the BG and two were softer \n(44±6 kPa, 75 ± 10 kPa, 12 ± 3 kPa and 18±4 kPa). Protocol was performed using \nhigh-frequency linear transducer on four different inclusions. Qualitative assessment \nwas done on elastograms. Semiquantitative measurements were based on the ratio \nof strain or elasticities between the BG and each inclusion and were compared \nwith theoretical ratio. Quantitative evaluation was performed with SWV techniques.\nResults: All techniques are adequate when assessing whether or not an inclusion \nis harder or softer than the BG. Semi-quantitative ratio of stiffness between two \nstructures is not reproducible and strongly depends on the manufacturer. It is more \naccurate for SWV techniques. Direct quantitative evaluation of stiffness using SWV \nexhibits biases for soft targets but can still be used to precisely measure stiffness \nif bias is taken into account.\nConclusion: Limitations and advantages of the different elastography techniques \nmust be known while performing an elastography acquisition in clinical practice. \nB‑0106 11:15\nStatic magnetic fields in 1.5 and 3 T MR scanners do not influence \nperception of pain and touch compared with placebo exposition \nA. Pomschar, K. Kamm, R. Ruscheweyh, R. Laubender, M.F. Reiser, A. Straube, \nB. Ertl-Wagner; Munich/DE (Andreas.Pomschar@med.uni-muenchen.de) \nPurpose: Potential biological effects of static magnetic fields have been in the \nfocus of public debate with the European Physical Agents (Electromagnetic Fields) \nDirective 2004/40/EC having the potential to seriously limit MR imaging in Europe. \nData on potential effects are still very scarce. We aimed to investigate the influence \nof homogeneous static magnetic fields in 1.5 and 3 Tesla MR scanners on pain \nand touch perception compared with placebo exposition.\nMethods and Materials: 18 healthy volunteers (age: 23 ± 1.8 years, 9 females) \nunderwent three experimental sessions on separate days in randomised order, \nusing field strengths of 0T (placebo scanner), 1.5 T and 3 T. Participants were \nblinded to field strength. No imaging sequences were acquired. In each session, \na Quantitative Sensory and Pain Testing programme was performed before and \nafter a 10-min exposure to the static magnetic field. It included thresholds for \nmechanical detection, mechanical pain, pressure pain, heat pain and phasic heat \npain intensity ratings. A linear mixed-effects model was used for statistical analysis.\nResults: For 1.5 and 3 T compared with the placebo control, statistical analysis \nrevealed no significant effect of the magnetic field for all tested qualities, thresholds \nfor mechanical detection (p=0.82/0.09), mechanical pain (p=0.83/0.53), pressure \npain (p=0.97/0.28), heat pain (p=0.53/0.38) and phasic heat pain intensity ratings \n(p=0.56/0.75).\nConclusion: Short exposure to static magnetic fields in clinical 1.5 T and 3 T MRI \nscanners had no significant effect on pain and touch perception compared with \na placebo exposure. \nB‑0107 11:24\nSafety and efficiency of low-field magnetic resonance imaging in \npatients with cardiac rhythm management devices \nC. Schukro, M. Lee; Vienna/AT \nPurpose: Low-field magnetic resonance imaging (MRI), i.e. MRI with a magnetic \nfield strength < 0.5 Tesla, has been reported to be safe in patients with pacemakers; \nhowever, there are no data about the safety of low-field MRI in patients with im-\nplantable cardioverter defibrillators (ICD) and/or cardiac resynchronization therapy \n(CRT). We aimed to investigate the safety and efficiency of routine low-field MRI \nin patients with different devices for cardiac rhythm management (i.e. pacemakers \nand ICD, including devices with CRT).\nMethods and Materials: MRI scans of 191 regions of interest were evaluated \nwith a field strength of 0.2 Tesla in 167 patients (62.3% male; age at MRI scan \n75.9±9.2 years; time since device implantation 4.1±3.2 years) with cardiac rhythm \nmanagement devices (152 pacemakers, 8 ICD, 4 ICD with CRT, and 3 CRT pace-\nmakers). This analysis included 27 pacemaker-dependent patients (16.2%), 20 \npatients with 1.5-Tesla-MR conditional pacemakers (12%) and 10 patients with \nabandoned leads (6%).\nResults: Except for one examination, which was interrupted because of recur-\nrent severe nausea, all MRI scans could be analysed efficiently. No induction of \narrhythmia or inhibition of pacemaker function occurred. Compared to the device \ninterrogation before MRI, there were no significant changes in battery voltage \n(2.85±0.13 V, before and after MRI), pacing capture threshold, sensing of intrinsic \nECG, lead impedance, and ICD-shock impedance after completed examination.\nConclusion: Low-field MRI examinations (0.2 Tesla) were safe and efficient in \npatients with devices for cardiac rhythm management, even in case of pacemaker-\ndependency or the presence of abandoned leads.\nB‑0108 11:33\nPossible hazardous effect of “MR safe” metallic implants for workers \nN. Oberhofer1, P. Ferrari2; 1Bolzano/IT, 2Mattarello/IT (nadia.oberhofer@asbz.it) \nPurpose: to investigate if test conditions for medical implants certified as “MR safe” \nfor patient examination also consider the extremely high gradient field exposure \nof devices implanted in MR-workers during their activities near the magnet bore \nand possible hazards.\nMethods and Materials: Starting from a case report of a nurse with a nitinol \n(nickel-titanium alloy) stapes piston implant certified as suitable for MR exam until \n3 T, reporting a strong, several days’ persisting pain after she had approached a \n1.5 T gantry, some databases dedicated to the MR compatibility of devices have \nbeen consulted. Reference literature for MR testing of different implants has been \nanalysed with respect to test conditions.\n\nScientific Sessions\nS172\n C A D E F\n G\nB\nB‑0113 10:48\nMeta-analysis and systematic review of the predictive value of \ncarotid plaque haemorrhage by magnetic resonance imaging on \ncerebrovascular events \nT. Saam1, H. Hetterich1, V. Hoffmann2, C. Yuan3, M. Treitl1, M. Dichgans1, \nH. Poppert1, M.F. Reiser1, F. Bamberg1; 1Munich/DE, 2Neuherberg/DE, \n3Seattle, WA/US (T obias.Saam@med.uni-muenchen.de) \nPurpose: Several small studies suggested that MR-based identification of carotid \nplaque haemorrhage (CPH) is associated with the occurrence of cerebrovascular \nevents. Thus, we conducted a systematic review and meta-analysis to determine \nprecise estimates of the predictive value of CPH for cerebrovascular events.\nMethods and Materials: We searched PubMed, EMBASE and the Cochrane Li-\nbrary through February 2012 for studies that followed > 35 individuals after baseline \nMRI. Independent observers abstracted information on population characteristics, \nMR techniques, outcome events and study quality. Risk estimates of the presence \nof CPH (T1w hyperintensities) for cerebrovascular events (TIA, stroke, amaurosis \nfugax) were derived in random effect regression analysis and causes of hetero-\ngeneity were determined in meta-regression analysis. Also, publication bias was \nassessed using funnel plots.\nResults: Among 218 published articles, we identified 8 eligible studies including \n689 participants (73.1±2.5 years, 77.9% male) who underwent carotid MRI (all 1.5 \nT). Prevalence of CPH was high (49.0%). Over a median follow-up of 19.6 months, \n108 cerebrovascular events occurred (15.7% event rate). Presence of CPH was \nassociated with a ~6-fold higher risk for events (HR: 5.69; 95%-CI: 2.98-10.87) with \na trend for heterogeneity (p=0.07) but no evidence of publication bias (p> 0.05). \nEvent rate in subjects with detectable CPH was 30.6%.\nConclusion: Presence of CPH on MRI strongly predicts cerebrovascular events \ndespite heterogeneity in populations, endpoints, and categorisation of MRI findings. \nHomogenization of future studies is warranted to allow for sufficient assessment \nof level of evidence for intervention trials.\nB‑0114 10:57\nGenetic loci for coronary calcification and serum lipids relate to \naortic and carotid calcification \nD. Bos, M.A. Ikram, A. Isaacs, B.F.J. Verhaaren, A. Hofman, C.M. van Duijn, \nJ.C.M. Witteman, A. van der Lugt, M.W. Vernooij; Rotterdam/NL \n(d.bos@erasmusmc.nl) \nPurpose: Atherosclerosis in different vessel beds shares lifestyle and environmental \nrisk factors. We investigated whether this also holds for genetic risk factors. Hence, \nwe used genetic loci for coronary artery calcification (CAC) and serum lipid levels \n- one of the strongest risk factors for atherosclerosis - to assess their relationship \nwith atherosclerosis in different vessel beds.\nMethods and Materials: In 1,987 persons from the population-based Rotterdam \nstudy we used three SNPs (single nucleotide polymorphisms) for CAC and 132 \nSNPs for total cholesterol, low-density lipoprotein cholesterol, high-density lipopro-\ntein cholesterol or triglycerides. To quantify atherosclerotic calcification, as marker \nof atherosclerosis, all participants underwent non-enhanced CT of the aortic arch \nand carotid arteries. We investigated associations between genetic risk scores of \nthe joint effect of the SNPs and calcification.\nResults: The joint effect of CAC-SNPs was associated with larger calcification \nvolumes in all vessel beds [difference in calcification volume per SD increase in \ngenetic risk score 0.15 (95% CI: 0.11; 0.20) in aorta, 0.14 (95% CI: 0.10; 0.18) in ex-\ntracranial carotids, 0.11 (95% CI: 0.07; 0.16) in intracranial carotids]. The joint effect \nof total cholesterol-SNPs, LDL-SNPs and of all lipid SNPs together was associated \nwith larger calcification volumes in both the aortic arch and the carotid arteries, \nbut attenuated after adjusting for the lipid fraction and lipid lowering medication.\nConclusion: The genetic basis for carotid artery calcification overlaps with the \nmost important loci of coronary artery calcification. Furthermore, serum lipids share \na genetic predisposition with both calcification in the aortic arch and the carotid \narteries, providing novel insights into the aetiology of atherosclerosis.\nB‑0115 11:06\nIs carotid intima-media (IMT) and extra media thickness (EMT) \na surrogate marker of early atherosclerosis in patients with \ninflammatory bowel disease? \nA. Oikonomou, E. Astrinakis, P. Zezos, N. Courcoutsakis, A. Mpampali, \nI. Karatzoglou, G. Kouklakis, P. Prassopoulos; Alexandroupolis/GR \n(aoikonom@med.duth.gr) \nPurpose: IMT, EMT and echogenicity of the intima-media complex (EC) reflect \nearly changes in the arterial wall and may appear years before atherosclerotic \n10:30 - 12:00 Room N/O \nVascular \nSS 115 \nCarotid plaque evaluation \nModerators: \nM.A. Aschauer; Graz/AT \nD. Filippiadis;  Athens/GR \nB‑0111 10:30\nArterial stiffness is associated with carotid intraplaque haemorrhage \nin the general population: the Rotterdam study \nM. Selwaness, Q. van den Bouwhuijsen, F.U.S. Mattace-Raso, G. Verwoert, \nA. Hofman, O.H. Franco, J.J. Wentzel, J. Witteman, A. van der Lugt; \nRotterdam/NL (m.selwaness@erasmusmc.nl) \nPurpose: Aging and vascular risk factors are important determinants of carotid \nintraplaque haemorrhage (IPH), but whether arterial stiffness is linked to IPH is \nunknown. In a population-based study, we investigated the association between \narterial stiffness, as assessed by pulse wave velocity (PWV), and carotid athero-\nsclerotic plaque composition.\nMethods and Materials: Overall, 1,059 participants from the general population \nwith wall thickening (> 2.5 mm) on ultrasound underwent PWV measurement \nand 1.5 T magnetic resonance imaging (MRI) for carotid plaque characterisation. \nMultisequence scanning was used to assess the presence of IPH, lipid core and \ncalcification in both carotid arteries. Generalized estimation equation analyses, \nadjusted for age, gender, mean arterial pressure (MAP), heart rate (HR), carotid \nwall thickening and traditional cardiovascular risk factors were used to assess the \nassociation between PWV and plaque characteristics.\nResults: The mean age of the subjects was 74.5±8.0 (53.3% men). Atherosclerotic \nplaques were present in 1,978 carotid arteries, of which 552 (28%) had IPH. PWV \nadjusted for age, gender, MAP and HR was associated with the presence of IPH \n(OR per SD, 1.22; 95% CI, 1.06-1.40) and calcification (OR per SD 1.15; 95% CI, \n1.00-1.31), but not with the presence of a lipid core. However, only IPH remained \nsignificant after additional adjustment for traditional cardiovascular risk factors (OR \nper SD, 1.19; 95% CI, 1.03-1.39).\nConclusion: PWV, appears to be an independent determinant of IPH. The current \nfindings suggest that arterial stiffness contributes to the development of different \natherosclerotic plaque characteristics. \nB‑0112 10:39\nEvaluation of carotid atherosclerotic plaque with lab-based x-ray \nphase-contrast imaging \nH. Hetterich1, S. Fill1, M. Willner2, F. Bamberg1, J. Herzen2, \nA. Hipp2, M.F. Reiser1, F. Pfeiffer2, T. Saam1; 1Munich/DE, \n2Garching/DE (holger.hetterich@med.uni-muenchen.de) \nPurpose: Grating-based phase-contrast imaging (gb-PCI) is a novel imaging \ntechnique that uses the phase-shift information of x-rays passing through matter. \nThis technique provides an excellent soft tissue contrast and might therefore be-\ncome a valuable tool for vessel wall imaging. The aim of this experimental ex-vivo \nstudy was to evaluate the potential of gb-PCI for atherosclerotic plaque imaging \nin human carotid arteries.\nMethods and Materials: Seven postmortem human carotid artery specimens were \nimaged at a laboratory set-up using a conventional broadband x-ray tube and a \ngrating interferometer followed by histology processing. Gb-PCI and histology data \nwere matched using anatomical landmarks. Signal characteristics of necrotic core \n(NC), fibrous cap (FC), intraplaque haemorrhage (IPH) and calcifications (Ca) were \nestablished by reviewer 1. Sensitivity, specificity and accuracy of gb-PCI for plaque \ndetection and the potential for accurate plaque quantification were assessed by \nreviewers 2 and 3.\nResults: We found characteristic signal criteria in all analysed plaque components. \nApplying these criteria gb-PCI had a good sensitivity for the detection of FC/NC, \nIPH and Ca (all > 80%) and excellent specificity and accuracy (all > 90%) with \ngood inter-reader agreement ([[Unable to Display Character: к]]³0.72, p < \n0.0001). There were excellent correlations for quantitative measurements of FC, \nNC and Ca between gb-PCI and histopathology (R³0.92). Inter-reader reproduc-\nibility was excellent with ICC³0.98 for all measurements.\nConclusion: Gb-PCI can identify and quantify atherosclerotic plaque components \nin a lab-based set-up with excellent correlation to histopathology.\n\nScientific Sessions\nS173\nA\n C D E F G\nB\nThursday\nrienced reviewers for both sides and for common and internal carotid artery (CCA/\nICA), respectively. The modified remodelling index (RI) was calculated by dividing \nthe outer vessel area at the site of the carotid plaque by the lumen area measured \non TOF images in a normal reference segment distally (ICA) or proximal (CCA).\nResults: The CCA on the symptomatic side compared to the asymptomatic side \nhad significantly larger maximum necrotic core and haemorrhage areas (P < 0.01). \nNo other significant differences were found. The ICA on the symptomatic side \ncompared to the asymptomatic had significantly larger wall, maximum necrotic core \nand haemorrhage areas (P < 0.01). No other significant differences were found. \nMore specifically, the RI did not differ significantly either in the CCA (1.61 vs. 1.61, \nP=0.8) or in the ICA (2.57 vs. 2.34, P=0.23).\nConclusion: In this series of subjects no association was found between expansive \nremodelling and ischaemic stroke. \nB‑0118 11:33\nDetermination of the vascular input function using magnitude or \nphase-based MRI: influence on dynamic contrast-enhanced MRI \nmodel parameters in carotid plaques \nR.H.M. van Hoof1, M.T.B. Truijman1, E. Hermeling1, R.J. van Oostenbrugge1, \nR.J. van der Geest2, M.J.A.P. Daemen3, J.E. Wildberger1, \nW.H. Backes1, M.E. Kooi1; 1Maastricht/NL, 2Leiden/NL, 3Amsterdam/NL \n(r.vanhoof@maastrichtuniversity.nl) \nPurpose: A reliable vascular input function (VIF) is important for quantitative \nanalysis of atherosclerotic carotid plaque microvasculature using dynamic contrast-\nenhanced (DCE) MRI. In tumour imaging and brain perfusion studies, it has been \ndemonstrated that a phase-based VIF (ph-VIF) is less sensitive to flow artefacts \ncompared to magnitude-based VIF (m-VIF). The purpose is (1) to compare m-VIF \nand ph-VIF and (2) to investigate the influence of different VIFs on DCE MRI model \nparameters in carotid plaques.\nMethods and Materials: 21 patients with 30-99% carotid stenosis underwent 3 T \nDCE MRI. Data from four patients, scanned with a high temporal resolution were \nused to construct group-averaged m-VIF and ph-VIF of the jugular vein. The other \n17 patients were used for calculating Ktrans (measure of plaque microvasculature) \nusing m-VIF and ph-VIF. The effect of neglecting flow on the m-VIF was estimated \nusing the Bloch equations.\nResults: Peak concentrations of m-VIFs were on average 4-fold lower than for \nph-VIFs (p < 0.001). Despite these differences, strong and significant correlation \nbetween Ktrans determined using group averaged m-VIF and ph-VIF was found \n(Pearson’s correlation 0.91, p < 0.001). Taking into account a theoretical flow of 8 \ncm/sec, the discrepancy in peak concentration of m-VIF and ph-VIF disappeared.\nConclusion: Our data suggest a strong influence of flow when calculating m-VIF \nof the jugular vein. Despite this, strong correlation between Ktrans parameters de-\ntermined using m-VIF and ph-VIF was found. It is expected that a phase-based \nVIF results in a quantitative more realistic value of Ktrans. \nB‑0119 11:42\nLow does CT angiography using iterative reconstruction for the \nassessment of carotid artery stenosis \nL. Crush, M. O’Keeffe, B. Normoyle, F. O’Neill, E.M. Canniff, P.D. Mc Laughlin, \nS. O’Neill, O. O’Connor, M.M. Maher; Cork/IE (lcrush03@gmail.com) \nPurpose: To assess the feasibility of low-dose CT angiography (CTA), with a sub-\nstantial dose reduction of 50%, using iterative reconstruction in the assessment \nof patients suspected of carotid artery stenosis (CAS).\nMethods and Materials: Following approval by Institutional Research Ethics Com-\nmittee, twenty patients referred for the assessment of CAS were recruited. CTA \nof the carotid arteries was performed on a 64-slice CT scanner (General Electric, \nLightSpeed XTE). To facilitate a robust gold standard, each patient received two \nCT scans, a conventional dose (CD) scan (50-70% standard protocol dose) and a \nlow-dose (LD) protocol (30-50% standard protocol dose). CD and LD studies had \na combined 100 ml of iodinated contrast followed by 20 ml saline. The dose length \nproduct (DLP) for CD and LD was noted and the effective dose (ED) calculated. In-\ntravascular attenuation, contrast to noise ratio (CNR), signal to noise (SNR) ratio and \n% stenosis of the internal carotid artery (ICA) were estimated by two radiologists.\nResults: The mean DLP for CD and LD were 687.96 mGycm vs 341.32 mGycm \n(p < 0.001). LD resulted in a 49.6% reduction in effective dose (p < 0.001). While \nthere was a statistically significant decrease in CNR and SNR in the LD protocol, \noverall image quality remained satisfactory. There was agreement between CD \nand LD for all occluded ICAs (n=7) and for estimation of % stenosis (less than 3% \ndifference) in 7 of 8 cases (87%).\nConclusion: Low-dose CTA with ASIR reconstruction can achieve a radiation \ndose reduction approaching 50% while maintaining image quality and diagnostic \naccuracy. \nplaque has formed correlating with cardiovascular risk factors. The present study \naims at investigating whether there are differences in the carotid wall thickness \nand echogenicity between patients with IBD and well-matched healthy controls by \nhigh-resolution ultrasonography of the carotid arteries.\nMethods and Materials: 31 IBD patients (19 male, mean age: 36.9 yrs, crohn/\nUlcerative colitis: 19/12, 17 smokers) and 29 healthy controls (15 male, mean age: \n36.1 yrs, 16 smokers) underwent high-resolution ultrasonography of the carotid \narteries. The following variables were recorded in bilateral common carotid arteries: \n1) IMT at 5, 10 and 15 mm from the carotid bulb, 2) EMT (the distance between \nthe common carotid wall and the internal jugular vein) and 3) EC.\nResults: Common carotid artery IMT (0.000 < p < 0.01, T-test) and EMT (p < \n0.001, T-test) were significantly higher in IBD patients compared with controls. \nNo difference in EC was found between IBD patients and controls. No difference \nin IMT, EMT and EC was found between Crohn's and ulcerative colitis patients. \nSmokers IBD patients had significantly higher IMT and EMT values than smokers \ncontrols (0.002 < p < 0.022, T-test).\nConclusion: IBD appears to be a risk factor for development of early atherosclerosis \nas showed by greater values of carotid IMT and EMT in IBD patients compared \nwith healthy controls irrespective of smoking history and type of IBD disease. \nB‑0116 11:15\nAssessment of microvasculature in atherosclerotic plaque with \ndynamic contrast-enhanced-MRI: model comparison, reproducibility \nand validation with histology \nM.E. Kooi1, M.E. Gaens1, R.H.M. van Hoof1, J.C. Sluimer1, S. Heeneman1, \nM.J.A.P. Daemen2, J.E. Wildberger1, R.M. Kwee1, W.H. Backes1; 1Maastricht/NL, \n2Amsterdam/NL (eline.kooi@mumc.nl) \nPurpose: Dynamic contrast-enhanced (DCE)-MRI can be used to identify athero-\nsclerotic plaques with increased microvasculature, which is thought to be an \nimportant feature of plaque vulnerability. The purpose is to compare four pharma-\ncokinetic models (Tofts, Extended Tofts, Patlak, and Extended Graphical model) \nfor their ability to describe DCE-MRI of plaques, to determine the scan-rescan \nreproducibility, and to validate the results with histology.\nMethods and Materials: Forty-five consecutive patients with 30-99% carotid \nstenosis underwent DCE-MRI. Plaque enhancement was measured dynamically \nusing a gadolinium-based contrast agent. Pharmacokinetic parameters (K trans, \nve, vp) were determined by fitting the models to concentration-time curves. The \nrelative fit errors and parameter uncertainties were determined to find the most \nsuitable model. Sixteen patients were scanned twice to determine the reproduc-\nibility. Carotid endarterectomy specimens of sixteen patients were collected for \nhistologic validation.\nResults: Relative fit uncertainties for K trans and vp were 10±1% (mean±SE) and \n20±2%, respectively, for the Patlak model, which was significantly lower than for the \nother models. The reproducibility (coefficient of variation) for the Patlak model was \n16% for Ktrans and 26% for vp. Significant correlations were found between Ktrans and \nplaque microvasculature as quantified by histology (Pearson’s ρ=0.72, p=0.005).\nConclusion: The Patlak model is most reliable to describe carotid plaque en-\nhancement. Correlation with histology validated K trans as an indicator of plaque \nmicrovasculature and the reproducibility of Ktrans was good.\nAuthor Disclosures:\nM.E. Kooi: Research/Grant Support; Grant from CTMM (Parisk), financed \nby public and private funding (e.g. Philips Healthcare contributed to private \nfunding).\nB‑0117 11:24\nEffect of expansive arterial remodelling on clinical presentation and \nplaque composition: an in vivo MRI study of the carotid arteries \nA. Helck1, M. Buchholz1, A. Rominger1, C. Yuan2, M.F. Reiser1, K. Nikolaou1, \nM. Dichgans1, A. Karpinska1, T. Saam1; 1Munich/DE, 2Seattle, WA/US \n(andreas.helck@med.uni-muenchen.de) \nPurpose: Expansive remodelling is considered to be a feature of vulnerable \natherosclerotic plaques in coronary arteries. Most knowledge of carotid lesions is \nbased on endarterectomy specimens which do not provide insight into remodelling \npatterns. Via MRI, we sought to evaluate the association between ischaemic stroke \nand expansive remodelling.\nMethods and Materials: 54 patients with carotid plaques (³2 mm thickness by \nultrasound) and unilateral ischaemic stroke in the territory of the ICA were included. \nAll patients received black-blood 3.0 Tesla- MRI with fat-saturated pre-/post-contrast \nT1w-, PDw-, T2w- and TOF-images using surface coils and parallel imaging \ntechniques. Quantitative measurements of lumen, wall, outer wall, haemorrhage, \ncalcification and necrotic core were determined by consensus-reading of 2 expe-\n\nScientific Sessions\nS174\n C A D E F\n G\nB\nbenchmarking over time and offers a basis of reference for optimising the training \nof radiology residents in emergency centres. \nB‑0122 10:39\nTraumatic aortic injury: what is changing? \nJ.M. Artigas1, M. Martí De Gracia2, J.A. Soto3, A. Garcia-Valiente1, M. Marini4, \nP. Parrilla1; 1Zaragoza/ES, 2Madrid/ES, 3Boston, MA/US, 4A Coruña/ES \n(jmartigas@salud.aragon.es) \nPurpose: To emphasize the role of MDCT in traumatic aortic injury (TAI), including \nMDCT-based grading systems and current clinical work-up.\nMethods and Materials: Review of our last 21 cases of TAI studied with MDCT \nin light of recent literature.\nResults: TAI usually appeared as a result of motor vehicle accidents and predomi-\nnantly affected aortic isthmus in young males (average: 41 years), most often in \nthe context of severe multiple trauma (ISS average: 43). Our cases were classified \nretrospectively into four groups according to MDCT findings, mainly aortic contour \npreservation. Grade I: intimal tear, thrombus, or intramural haematoma < 1 cm, \nwithout aortic external contour abnormality (2 cases/9, 5%); grade II: the same find-\ning, but > 1 cm (large intimal flap) (2/9, 5%); grade III: presence of pseudoaneurysm \n(9/43%); grade IV: aortic wall rupture with active contrast extravasation, regardless \nof the presence or not of a pseudoaneurysm (8/38%). The presence of hypotension \nand mediastinal haematoma thicker than 15 mm was also considered. Mortality in \ngroups I and II was largely related to other severe associated injuries. Survival for \ngroups III and IV was 50% and 33%, respectively. Survivors were younger people \n(mean: 25 years) without haemodynamic instability on arrival at ED and no other \nlife-threatening associated injuries.\nConclusion: TAI is a dynamic process. Whole body MDCT evaluation eliminates \nthe need for conventional angiography and while prospective validation becomes \navailable, the proposed classification system allows to decide between immediate \nsurgical/endovascular repair, a more conservative approach with initial medical \ntreatment and delayed repair, or nonsurgical management with follow-up imaging.\nB‑0123 10:48\nComparison between dedicated coronary CT angiogram and triple \nrule out using 320 multislice CT in cases of acute chest pain \nY. Ragab, H. Hamza, H. Awadalla; Cairo/EG (yragab61@hotmail.com) \nPurpose: To compare between dedicated and triple rule-out CT angiography (CTA) \nregarding the quality of coronary artery opacification using 230 multidetector CT.\nMethods and Materials: 18 dedicated coronary CT angiographic studies and 18 \ntriple rule-out CT angiographic studies were included. Two radiologists, blinded \nto type of CTA, scored coronary artery image quality. Up to 14 coronary artery \nsegments were scored for motion artefacts, grading from 1 (no motion artefact) \nto 4 (severe motion artefact). The quality of opacification was also scored. The \naverage of all segments and dedicated larger and smaller coronary artery seg-\nments was compared.\nResults: The average motion-artefact scores per vessel segment for dedicated \nand triple rule-out studies were 1.54 and 1.61, respectively (P =.5). For larger seg-\nments, the average motion-artefact score was 1.32 for dedicated CTA compared \nto 1.46 for triple rule-out CTA (P =.2). The average coronary artery opacification \nfor dedicated studies was 1.04 for all segments and 1.02 for larger segments, \ncompared to triple rule-out studies, which had scores of 1.07 (P =.4) for all seg-\nments and 1.05 (P =.4) for larger segments. No statistically significant differences \nin favour of dedicated CTA were identified.\nConclusion: The quality of images obtained by triple rule-out CTA is comparable \nto that of dedicated coronary CTA, showing no statistically significant difference in \nmotion artefacts or opacification. So it may be an alternative and useful diagnostic \nstudy in a selected group of patients with acute chest pain. \nB‑0124 10:57\nCan the presence of active or recent bleeding in CT angio of acute \nlower intestinal bleeding be predicted? \nM. Marti de Gracia1, J.M. Artigas Martín2, J.A. Soto3, A. Borobia1, \nA. Vicente1, G. Garzón1; 1Madrid/ES, 2Zaragoza/ES, 3Boston, MA/US \n(mmarti.hulp@salud.madrid.org) \nPurpose: To identify factors that predict the presence of recent or active bleeding \n(ROAB) at CTA performed for acute lower intestinal bleeding (ALIB).\nMethods and Materials: Prospective study (24 months) that included patients with \nALIB and CTA as the first test. A three-phase MTDC protocol was used. Two radiolo-\ngists determined if signs of ROAB were present. Variables studied were: transfusion \nB‑0120 11:51\nDetermining the vulnerable plaque: correlation between 18 F-FDG \nPET and dynamic contrast-enhanced MRI in atherosclerotic plaques \nof symptomatic patients \nM.T.B. Truijman, R.M. Kwee, R.H.M. van Hoof, R.J. van Oostenbrugge, \nW.H. Mess, J.E. Wildberger, W.H. Backes, J.A. Bucerius, M.E. Kooi; \nMaastricht/NL (martine.truijman@mumc.nl) \nPurpose: Identifying vulnerable atherosclerotic plaques in symptomatic patients \nwith moderate (30-69%) carotid artery stenosis can contribute to clinical decision \nmaking. Hallmarks of plaque vulnerability are inflammation and increased neovas-\ncularisation. Inflammation can be assessed with 18F-FDG PET, while neovasculari-\nsation can be quantified with dynamic contrast-enhanced (DCE) MRI. We aimed \nto investigate the correlation between inflammation as assessed by 18F-FDG PET \nand neovascularisation as assessed by DCE-MRI.\nMethods and Materials: Fifty-eight patients with transient ischaemic attack (TIA) \nor minor stroke in the carotid territory and ipsilateral carotid plaque causing a \nmoderate stenosis were included. All patients underwent 1.5 T multi-sequence \nMR imaging. Quantification of neovascularisation was done using a custom-made \nMatlab program which calculates Ktrans. A 3D PET-CT scan was performed on all \npatients one hour after injection of 2.75 MBq/kg body weight 18F-FDG. Dedicated \nfusion software was used to calculate mean blood-normalised 18F-FDG standard \nuptake values (SUV) of the plaque.\nResults: Of the 58 patients, 9 were excluded due to poor image quality of the \nDCE-MRI. In total, we analysed 49 patients. The mean Ktrans and mean normalised \nSUV were 0.110 (±0.027) and 1.446 (±0.255), respectively. We found a weak but \nsignificant positive correlation between the mean normalised SUV and the mean \nKtrans (Spearman’s r=0.302, p=0.035).\nConclusion: There is a weak but significant positive correlation between Ktrans, \nwhich is a marker for neovascularisation and SUV, which is a marker for inflam-\nmation. Future studies are warranted to investigate whether DCE-MRI and/or 18 \nF-FDG PET can be used to predict cerebrovascular events.\n10:30 - 12:00 Room P \nEmergency Radiology \nSS 117 \nAn update on emergency thoraco-abdominal \nimaging \nModerators: \nB. Feragalli; Chieti/IT \nA. Huete; Santiago/CL \nB‑0121 10:30\nEmergency CT: what is missed at first reading? \nA. Platon, G. Varnay, C.D. Becker, P.-A. Poletti; Geneva/CH \n(alexandra.platon@hcuge.ch) \nPurpose: To evaluate the accuracy of the preliminary CT interpretation made by \nthe radiology residents in the emergency department.\nMethods and Materials: During four periods of 20 consecutive days, attending ra-\ndiologists prospectively recorded any disparity between their own CT interpretation \n(reference standard) and the preliminary interpretation delivered by the emergency \nradiology residents. Disparities were recorded during both regular hours and on-call \ntime. A misinterpretation was considered major when potentially life-threatening \nwithin hours after admission. The total number of CT performed during the survey \nwas recorded and further classified into neuroradiological and body examinations. \nA rate of disparities was calculated for all CT examinations and also for body and \nneuroradiological cases.\nResults: A total of 3044 emergency CT examinations were performed during \nthe survey: 1568 (51%) were body CT and 1476 (49%) neuroradiological cases. \nDisparities were reported in 145 (4.8%) of all CT examinations: 0.8% (25/3044) \nwere major misinterpretations (17 body, 8 neuro). There were 100/1568 (6.3%) \ndisparities reported in body CT versus 45/1476 (3%) in neuroradiological examina-\ntions (p=0.001). No significant difference was found when comparing disparities \nrecorded during regular working hours (47/1083 (4.3%)) versus on-call period \n(98/1961 (5%)), p=0.47.\nConclusion: Our results show that disparities occur most frequently in emer-\ngency body CT examinations, but major disparities represent a small proportion \nof all misinterpretations. The detailed analysis of our data allows comparison and \n\nScientific Sessions\nS175\nA\n C D E F G\nB\nThursday\nof distal embolisation group and augmented embolisation group was 10.9% and \n6.6% respectively (p=0.481). None developed splenic abscess.\nConclusion: Augmented embolisation is effective and safe for treating BSI. A \nlarger series of study are needed to prove that it is more successful than distal \nembolisation.\nAuthor Disclosures:\nY. Wong: Research/Grant Support; Chang Gung Medical Research Project. \nL. Wang: Research/Grant Support; Chang Gung Medical Research Project. \nC. Wu: Research/Grant Support; Chang Gung Medical Research Project. \nH. Chen: Research/Grant Support; Chang Gung Medical Research Project.\nB‑0127 11:24\nDiagnostic performance of MDCT in the evaluation of bowel \nobstruction: can the radiologist’s experience make a difference? \nA. Ferri, R. Basilico, N. Civitareale, A. Lella, V. Calamita, A. Cotroneo; Chieti/IT \nPurpose: To evaluate the diagnostic performance of MDCT in the detection of site \nand cause of bowel obstruction and in the diagnosis of bowel wall ischaemia or \ninfarction, by assessing the added value of the radiologist’s experience.\nMethods and Materials: We retrospectively analysed the MDCT reports of 127 \npatients admitted to our hospital for the clinical suspect of bowel obstruction and \nwe included 98 patients with MDCT, surgical and histological diagnosis of bowel \nobstruction. We calculated the diagnostic accuracy of the MDCT reports in the \nevaluation of the cause and the site of obstruction and the sensitivity, specificity \nand diagnostic accuracy values in the detection of bowel wall ischaemia or infarc-\ntion. An experienced abdominal radiologist reviewed the MDCT examinations and \ncompared her results with the original MDCT reports.\nResults: Bowel obstruction causes were adhesions (36.3%), neoplasms (22.7%), \nhernias (13.6%), volvulus (12.5%) and other causes (14.7%). The diagnostic ac-\ncuracy in determining the cause of bowel obstruction was 88.7% for the MDCT \nreports and 91% for the experienced reader; the diagnostic accuracy for the site of \nobstruction was high for both MDCT reports (91.2%) and the experienced reader \n(93.5%) with values of 71% and 80%. The sensitivity, specificity and diagnostic \naccuracy of MDCT reports in identifying bowel wall ischaemia or infarction were, \nrespectively, 73, 96% 90%: the sensitivity value significantly increased to 82% for \nthe abdominal radiologist.\nConclusion: MDCT is very accurate in diagnosing the cause and the site of bowel \nobstruction. The radiologist’s experience in abdominal disease represents an added \nvalue in the diagnosis of bowel wall ischaemia or infarction. \nB‑0128 11:33\nDiagnosis of bowel obstruction performed by MSCT in emergency \ndepartment compared with the surgical findings \nE. Capalbo, F. Sajadidhekrodi, M. Cosentino, M. Peli, M. Lovisatti, A. Kluzer, \nS. Fornari, M. Cariati; Milan/IT (emanuelacapalbo@tiscalinet.it) \nPurpose: To evaluate the diagnostic performance of MSCT performed in emergency \ndepartment, and to characterise side and type of bowel obstruction compared with \nsurgical findings.\nMethods and Materials: In first semester of 2012 we performed 686 abdominal \nCT in patients came to our emergency department with clinical suspect of acute \nabdomen. The exams were performed with contrast medium, using a GE 16 slices. \nWe have selected 91 positive exams for bowel obstruction performed in 57 men \nand 34 women, mean age 62.4 years (range 19-87). We calculated sensitivity, \nspecificity, positive (PPV) and negative (NPV) predictive values and diagnostic \naccuracy. Diagnostic concordance of nature and site has been evaluated using \nK Cohen’s coefficient.\nResults: The causes of bowel obstruction are: 27% inflammation, 24% at full \nspeed, 14% tumours, 11% volvulus, 8%, hernias 7% invaginations, 3% gallstone \nileus and 1% fitobezoar. The diagnosis of nature is indeterminate in 5% of patients. \nThe localisation has been in 41% to small intestine, 34% to sigma/rectum and 21% \nto colon in particular 8% to right and 13% to left. The site is not properly defined in \n4% of cases. The sensitivity of MSCT is 92.5%, specificity is 84.6%, PPV 94.8%, \nNPV 88.5%, and diagnostic accuracy 90.5%. The K Cohen’s coefficient is 0.83 for \nnature and 0.91 for site of bowel obstruction.\nConclusion: MSCT identifies the intestinal obstruction, both cause and localisa-\ntion, with a good concordance compared with surgical definitive diagnosis. It is \ntoday the gold-standard diagnostic in emergency department to define the patient’s \ntherapy planning. \nAuthor Disclosures:\nE. Capalbo: Author; Emanuela Capalbo.\nrequirements, the use of anticoagulant/anti-platelet therapy or coagulopathy, cause \nand location of the bleed. Data were analysed, and ROC curves were derived.\nResults: 130 patients (64 W, 66 M) with median age of 76 years were included. \nCTA findings were: active bleeding (n=53), recent bleeding (n=17), potential \ncause of bled (n=45), negative (n=15). Patients received anticoagulants (n=38), \nanti-platelet therapy (n= 23), coagulopathy (n=14), normal coagulation (n=55), \ntransfusion (n=76). Cause of bleeding was: colitis (n=33), neoplasms (n=19), di-\nverticula (n=21), vascular lesion (n=28), others (n=14), systemic disease (n= 10), \nno cause (n=5). Lesion Location was: small bowel (n=16), right-transverse colon \n(n=25), descending-recto-sigmoid colon (n=59), multi-focal (n=14), stomach (n=1), \nno clear location (n=15). There was a statistically significant (SS) association (p \n<.0.001) between the need for transfusions and the likelihood of finding ROAB. The \nassociation between anticoagulant/anti-platelet therapy, coagulopathy, gender or \nage and positive CTA findings was not SS. Lesions in the right colon, small bowel \nand vascular lesions had a higher likelihood of a positive CTA finding.\nConclusion: The need for transfusion therapy is a predictor of a positive finding \nof ROAB in CTA of ALIB.\nB‑0125 11:06\nAccuracy of the AAST organ injury scale as a CT imaging checklist \nfor traumatic liver and spleen injuries \nG. Homann1, C.M. Toschke2, P. Gaßmann3, U. Hanning1, W. Heindel1, V. Vieth1; \n1Münster/DE, 2Ahlen/DE, 3Mainz/DE (georgandreas.homann@ukmuenster.de) \nPurpose: Detection of abdominal injury is a very important component in trauma \nmanagement, so an accelerated assessment of liver and spleen injuries including \ntheir degree of severity is necessary. There is a good case to believe that in stress \nsituations this subjective performance results in diagnostic mistakes. Structured \nobjective scores as the Organ Injury Scale (OIS) drawn up by the AAST are a \nvaluable guidance for objective trauma assessment. Aim of our study was to \nevaluate retrospectively whether a structured approach using the OIS differs to \nreal-time-diagnosis.\nMethods and Materials: The OIS was applied by an experienced radiologist on \nCT data of 53 patients which underwent CT laparotomy after abdominal trauma. \nThese results were correlated with the original text of the initial CT findings. Finally, \nwe compared both with the intraoperative findings gathered from the surgery report.\nResults: Regarding the original CT report we found a mean divergence of 0.68 ± \n0.8 to the OIS found in the surgery report for liver injuries (0.69 ± 1.17 for spleen \ninjuries). In comparison with the structured approach, where we detected a di-\nvergence of 0.8 ± 0.68 (0.47 ± 0.77 for spleen injuries). There was no significant \ndifference, but we detected a lower rate of over-diagnoses in both approaches.\nConclusion: A structured approach to abdominal trauma using an imaging checklist \ndoes not lead to a significantly higher detection rate, but reduces the rate of over-\ndiagnoses and may be more precise in grading the severity grade plus streamlines \nthe emergeny-CT-procedure.\nB‑0126 11:15\nComparison of efficacy and safety between distal embolisation \nand augmented embolisation techniques for treating blunt splenic \ninjuries with active haemorrhage \nY.-C. Wong, L.-J. Wang, C.-H. Wu, H.-W. Chen; T aoyuan/TW \nPurpose: To compare the efficacy and complication between distal embolisation \nand augmented embolisation (distal and proximal embolisations) techniques for \ntreating blunt splenic injuries (BSI).\nMethods and Materials: Within a two-year period, 26 consecutive patients of BSI \nin whom haemodynamics was stable but CT showed contrast extravasation were \nincluded in this prospectively study. We randomised them into distal embolisation \ngroup and augmented embolisation group. They were followed up twice by CT \nat 1 week and 3 months after embolisation. We compared their demographics, \ninjury grades, clinical parameters, hemograms, successful rates and splenic infarct \nvolumes between the two groups. Embolisation failure was defined as persistent \nhypotension that required surgery or detection of splenic contrast extravasation \non follow-up CT. Complication was defined as post-embolisation splenic infarct \nor splenic abscess.\nResults: All underwent first follow-up CT, 24 underwent second follow-up CT. Of \n26 patients, 17 received distal embolisation, 9 received augmented embolisation. \nTheir basic demographics, CT injury grades, clinical parameters and hemograms \ndid not differ. Their mean systolic blood pressure was significantly elevated after \nembolisation. Two (2/17, 12%) of the distal embolisation group failed and required \na second augmented embolisation. None of the augmented group failed but the \ndifference did not reach statistical significance. The mean splenic infarct volume \n\nScientific Sessions\nS176\n C A D E F\n G\nB\n10:30 - 12:00 Room Q \nRadiographers \nSS 114 \nImportance of education in practice \nModerators: \nR. Ribeiro; Lisbon/PT \nT. Roding; Haarlem/NL \nB‑0131 10:30\nRisk management in radiology: applying failure mode effects and \ncriticality analysis in computer tomography \nM. Antoniutti, C. Maso, N. Vecchiato, S. Doratiotto; Treviso/IT \nPurpose: This study intended to verify the usefulness of the application of failure \nmode and effects analysis criticality (FMECA) in the computed tomography (CT) \nprocess.\nMethods and Materials: A multidisciplinary safety team conducted an FMECA to \nidentify and reduce the criticality, the near misses and errors in the CT process. The \nsix sequential steps in the FMECA process are applied: define the topic, assemble \na safety team, develop a process map, conduct a risk analysis for each subprocess, \ndevelop and implement an action plan to redesign the process, monitor, sustain, \nshare, and reevaluate the improvement. Each failure mode identified was scored \naccording to its potentiality, the severity and the impact with the risk priority number \n(RPN). The RPN is given by the product of the numerical ratings of the severity, \nthe probability of occurrence, and the probability of detection.\nResults: Failure modes with higher RPN were: homonyms within the scheduler \nCT (RPN: 360), sending images in the PACS under the name of a homonymous \n(RPN: 360), sending images in PACS for reporting but not for displaying (RPN: \n280), incomplete filling of forms (RPN:192), sending incomplete images of the PACS \n(RPN:160), it is not always possible to standardise protocols body CT (RPN:160) \nand reflux of contrast medium in saline (RPN:126). These failure modes were \nprioritized for corrective action in the CT process.\nConclusion: FMECA is an effective and reliable method to pro-active examine \ncomplex processes in the radiology department, and CT is used as an particular \nexample for which FMECA process. \nB‑0132 10:39\nHow important is the experience in breast imaging for radiographers \nperforming breast-MRI? \nP. Clauser, V. Londero, C. Molinari, R. Girometti, S. Da Dalt, C. Zuiani, \nM. Bazzocchi; Udine/IT (clauser.p@hotmail.it) \nPurpose: To evaluate whether radiographers’ experience in breast imaging helps \nin reducing significant artefacts when acquiring dynamic breast-MRI.\nMethods and Materials: One experienced radiologist prospectively evaluated a \ntotal of 270 breast-MRI examinations performed by three different radiographers \n(R1, R2 and R3) over the period September 2011-June 2012 (90 examinations \neach). R1 had a 5-year experience in breast-MRI and 15 years of experience in \nbreast imaging; R2 and R3 had no specific training in breast imaging, and 5- (R2) \nand 2-year (R3) experience in breast MRI. For each examination the radiologist, \nwho was blinded to radiographer’s experience, was asked to assess the presence \nor absence of significant artefacts, defined as motion artefacts affecting image \nquality and/or diagnostic evaluation. The prevalence of significant artefacts in R1, \nR2 and R3 examinations was tested with the Chi-square test.\nResults: Significant artefacts were found in 45/270 examinations \n(16.6%;CI95%=12.7-21.6%). In particular, significant artefacts affected 6/90 \nexaminations (6.6%;CI95%=3.1-13.8%) performed by R1, 22/90 examinations \n(24.4%;CI95%=16.7-34.2%) performed by R2 and 17/90 (18.8%, CI95%=12.1-\n28.2%) performed by R3, with a significant difference between R1 and R2 (p < 0.05).\nConclusion: Artefacts potentially affecting image quality and diagnostic evaluation \nare less frequent in breast-MRI examinations performed by those radiographers \nwho combine experience in breast imaging with specific experience in breast-MRI. \nA possible explanation is a better understanding of disease specific problems and \nof the importance of empathise with the patient. \nB‑0129 11:42\nAccuracy of ultrasonographic diagnosis of acute appendicitis in \npregnant women \nN. Kokhanovsky, A.-R. Zeina, N. Reindorp, A. Levit-Kantor, Y. Glick, A. Nachtigal; \nHadera/IL (nataliakoh@hotmail.com) \nPurpose: To assess the reliability and value of the sonographic examinations in \nthe diagnosis of acute appendicitis in pregnant women.\nMethods and Materials: We obtained sonographic examinations performed on 68 \npregnant women with suspected acute appendicitis retrospectively for 16 months \n(Sep. 2008 - Feb. 2010). The average age of study subjects was 27.3 years, with \nan average gestational age of 26 weeks. Sonography was the first imaging modality \nemployed. Surgery or clinical follow -up was the gold standard for the evaluation \nof sonographic performance. All examinations were performed using grey-scale \ngraded compression in the left lateral decubitus position. The sonographic criteria \nfor acute appendicitis were detection of a noncompressible, blind-ended, tubular, \nstructure measuring greater than 6 mm in maximal diameter.\nResults: 4 patients had positive sonographic findings of acute appendicitis \n(5.9%). Sonographic findings were correlated with surgical findings and clinical \nfollow-up. The diagnosis was confirmed in all 4 patients (100%). In the 64 patients \nwith negative sonographic findings of acute appendicitis, the result for 1 patient \n(1.6%) proved false-negative, whereas the remaining 63 (98.4%) improved on \nclinical follow-up. Accordingly, sensitivity was 80.0%, specificity was 100% and \noverall accuracy was 98.5%. Moreover, in 4 out of the 64 patients with negative \nsonographic findings for acute appendicitis, a different pathologic finding such as \nacute pyelonephritis was identified.\nConclusion: Our experience suggests that ultrasonographic examination with \nthe optimal study protocol is a highly accurate method for the diagnosis of acute \nappendicitis in pregnant women and should be performed as the first imaging test. \nB‑0130 11:51\nQuality assessment of out sourced after-hours computed \ntomography teleradiology reports in a central London University Hospital \nJ. Hohmann1, P. de Villiers1, C. Urigo2, D. Sarpi1, C. Newerla3, J. Brookes1; \n1London/UK, 2Lugano/CH, 3Basle/CH (jhohmann@uhbs.ch) \nPurpose: The study assessed the quality of out sourced after-hours computed \ntomography teleradiology service reports.\nMethods and Materials: We evaluated 1028 patients over a time period of five \nmonths (437 females, 591 males, mean age: 51 years) who were referred either \nby the A&E or by the other in-house departments from 7 pm to 8 am for different \nreasons. Reporting was done by a teleradiology service provider located in the \nUK and Australia. Reports were assessed during the routinely performed morning \nmeeting by a panel of in-house radiologists. Assessment was done by a five-point \nagreement scale (5 = “No disagreement”, 1 = “.unequivocal potential for serious \nmorbidity or threat to life”). In 811 (79%) patients no disagreement was found, 164 \n(16%) were rated as category 4, 40 (4%) as category 3 (“.likelihood of harm is \nlow”). In 13 (1.3%) patients a decision of category 2 was made (“.strong likelihood \nof moderate morbidity but not threat to life”). No category 1 decision was made. A \nfollow-up of the category 2 patients was done.\nResults: In 8 (0.8%) patients the in-house reports were correct, in 2 (0.2%) pa-\ntients the teleradiology service provider was right and in 3 (0.3%) patients the final \ndiagnoses remained unclear.\nConclusion: There was a small rate (0.8%) of proven serious misinterpretations by \nthe teleradiology service provider, but these were less than in comparable studies \nwith preliminary in-house staff reports (1.6-24.6%). \n\nScientific Sessions\nS177\nA\n C D E F G\nB\nThursday\nC-arm. Staff without lead shields exit the room. Lead shields for all patients were \nused in 58% of cases. Pregnant staff member was transferred to other duties (61%).\nConclusion: There is a lack in radiation protection education. The right way to use \nof radiation dosimeter is not clearly understood in all operating theatre units. The \nuse of radiation in operating theatres in Finland needs improvements. \nB‑0136 11:15\nInformation-seeking behaviour of radiographers \nL. Sancho1, A.F.C.L. Abrantes1, L.P.V. Ribeiro1, R.P.P. Almeida1, S.I. Rodrigues1, \nC.A. Silva2; 1Faro/PT, 2Evora/PT (luis.sancho@sapo.pt) \nPurpose: Understand how the radiographers act when faced with information \nneeds resulting from the professional practice. Identify the preferences and infor-\nmational habits of these individuals, as well as ascertain their capabilities in the \nuse of electronic information resources.\nMethods and Materials: A 33-question self-applied questionnaire was used as the \ninstrument to explore radiographers’ information needs and behaviour. A total of 142 \nvalid questionnaires were collected in health institutions across the country. The \ndata was than interpreted and statistically analysed using the Statistical Package \nfor the Social Sciences V.20 software.\nResults: 86% of radiographers admit to having experienced, throughout practice \non medical environment, informational needs that led them to consult one or \nmore sources. The search for information is mostly done through the use of non-\nspecialized sources (e.g. Google) (57%). Although 73% of respondents claim to \nconduct research activities in electronic databases, 22% mentioned the need to \nlearn more about research strategies. The use of specialized health libraries is \nindicated by a minority of radiographers (10%). However, books are still present \nin 90% of these professionals’ private collections.\nConclusion: The majority of radiographers use informational sources to suppress \ndoubts related to the practice in radiology. Nevertheless, their knowledge on this \nmatter is still relatively elementary, and a better learning of the searching resources \nis needed so radiographers can justify their professional actions with solid and valid \nscientific basis (evidence-based radiology). \nB‑0137 11:24\nDose reduction in computer tomography, the effects of technologist \ntraining on the number of extra anatomic images \nT.W.F. Pappot, M.E.J. Pijl; Arnhem/NL (Tpappot@rijnstate.nl) \nPurpose: To determine the effects of technologist training on the number of images \nbeyond the intended anatomic area of interest.\nMethods and Materials: In two 4-week periods, one before and one after a \n10-minute technologist training, all body CTs were evaluated. Techs were made \naware of dose issues arising from images beyond boundaries as prescribed in \nprotocols. Dose length product (DLP), the total number of reconstructed images \nand the number of images cranial and caudal of the prescribed protocol were noted. \nScans, short of prescribed anatomic coverage, were also counted. Pathological \nfindings in extra anatomic images were noted. Dose per image was calculated: \nDLP / total number of images. Effective DLP (within anatomic boundaries) and \nextra DLP (beyond anatomic boundaries) were calculated.\nResults: In total 571 examinations were evaluated, 287 prior to the tech training \nand 284 after. There were no significant statistical differences between both pe-\nriods in patient characteristics or scan type. Before and after training the median \nnumber of effective images was equal (133; p=.51) and the median effective DLP \nwas similar (232 vs 237 mGy.cm; p=.59). The median number of extra images per \nscan decreased 53% from 15 prior to training to 6 after (p <.001). Accordingly, the \nextra DLP was reduced 50% (p <.001). The number of too short scans increased \nfrom 14 (4.9%) to 25 (8.7%) (p=.06). No additional pathological findings were \ndetected in extra anatomic images.\nConclusion: Brief technologist training results in a significant (p <.001) decrease \nin the number of extra anatomic images in body CT. \nB‑0138 11:33\nEvidence-based practice in radiology \nM. Dias1, A.F.C.L. Abrantes1, C.A. Silva2, R.P.P. Almeida1, L.P.V. Ribeiro1, \nJ. Pinheiro1, K.B. Azevedo1; 1Faro/PT, 2Evora/PT (rui_ppa@hotmail.com) \nPurpose: This study aimed to evaluate the radiographers’ knowledge on evidence-\nbased radiology, how they conduct their research on this thematic and how they \napply it.\nMethods and Materials: A self-applied questionnaire made by Ahonen & Liikanen \n(2010) to assess evidence-based radiology was applied to radiographers working \nin public hospitals and healthcare centres. Data analysis was made by descrip-\nB‑0133 10:48\nRadiography authorship: a European and international review \nB. Snaith; Wakefield/UK (bev.snaith@midyorks.nhs.uk) \nPurpose: To establish the current authorship within international radiography \njournals and identify publication themes, patterns of authorship and geographical \nspread.\nMethods and Materials: A bibliometric review was performed of articles published \nover 8 years (2004-11) in 4 international English-language radiography journals: \nthe Journal of Medical Imaging and Radiation Science, Radiography, South African \nRadiographer and The Radiographer. Each journal encompasses both diagnostic \nand therapy disciplines. Analysis of article type and subject was compared at a \njournal, author and country level.\nResults: 835 articles met the inclusion criteria, with 1999 contributing authors \nand 43 countries represented. European authors contributed 43.8% (n=366/835) \nof all articles; however, variation was noted in author and country productivity. Of \nthe European originating articles 50.8% (n=186/366) were presenting the findings \nof research, with the remainder comprising Journal (29.5%); Clinical (13.9%) or \nOpinion (13.9%) articles.\nConclusion: Europe is well established in radiography publication; however vari-\nation exists and strategies to explore further expansion will be discussed. \nAuthor Disclosures:\nB. Snaith: Other; Editorial board member and reviewer.\nB‑0134 10:57\nThe influence of clinical placement setting on academic achievement \nwithin an undergraduate diagnostic radiography programme \nE. Lewis, M. Hardy; Bradford/UK (e.lewis2@bradford.ac.uk) \nPurpose: Practice-based learning within the clinical setting forms a substantial part \nof diagnostic radiography degree courses within the UK. Previous studies have \nattempted to evaluate the quality of the clinical learning environment by examining \nstudent perceptions without considering the impact upon academic achievement. \nThis CoRIPS funded study attempts to objectively measure the impact of substantive \nclinical placement on the academic progression and achievement of undergraduate \nradiography students whilst controlling for demographic variables.\nMethods and Materials: This study examined data from 6 consecutive cohorts of \nstudents (178 students in total) at a single UK Higher Education Institution (HEI) \nwhere students are allocated to one of 6 Hospital Trusts for the majority of their \nclinical placement. Data were compiled retrospectively from student academic \nrecords and random effects analytical modelling was undertaken to control for \ndemographic variables, including age, ethnicity, gender and baseline academic \nqualification. Degree classification and aggregated mean mark for each year of the \nprogramme were used as a measure of academic achievement and progression.\nResults: Initial analysis suggests that the mean academic progression from year 1 \nto year 3 varies between clinical placements. Further analysis of the data is ongoing \nbut will consider each of the variables independently and in combination to provide \nan insight into the different influences on academic performance.\nConclusion: Academic achievement is a universal measure of success. However, \nthe impact of clinical placement on learning success has not been previously \nconsidered in radiography undergraduate education.\nB‑0135 11:06\nUse of radiation in operating theatres in Finland \nP. Heikkilä1, A. Henner1, P. Tenkanen-Rautakoski2, M. Pirinen2, S.-M. Ahonen1; \n1Oulu/FI, 2Helsinki/FI (anja.henner@oamk.fi) \nPurpose: Nurses and medical doctors use mobile C-arms in operating theatres. \nAim of this study was to find out how much radiation and which procedures are \nused and who is responsible for radiation safety.\nMethods and Materials: The data were collected in spring 2012 by an electronic \nquestionnaire made for this survey. 31 operating theatre units answered the enquiry. \nSeven sections were included in questionnaire: radiation user’s organisation, use \nof radiation, C-arm techniques, radiation dose monitoring of the staff, use of radia-\ntion shields, radiation protection during pregnancy (patient or the staff member), \nsafe use of radiation.\nResults: There was lack in training. Responsibilities in radiation user’s organisation \nwere divided; radiation safety officer was mostly physicist or radiologist. Physicist \nwas responsible for quality assurance. Practical nurse or nurse was mostly in \ncharge of the use of C-arm. Radiation was used with orthopaedic and traumatologi-\ncal procedures by surgeon, nurse or practical nurse. 84% of the respondents had \npersonal dose monitoring and the dosimeter was placed on thyroid shield, apron or \nleft arm. Group dosimeters were used either on the shields or they were hanged on \n\nScientific Sessions\nS178\n C A D E F\n G\nB\nstudy can be a starting point for future investigations into this matter to understand \nthe reason for this shouting lack of knowledge in relation to ADR. \n10:30 - 12:00 Room Z \nComputer Applications \nSS 105 \nIT infrastructure, learning support and teleradiology \nModerators: \nB. Gibaud; Rennes/FR\nA. Simisker; Tartu/EE \nB‑0141 10:30\nDevelopment of the ViSion ontology \nD.J. Vining1, U. Salem1, C. Popovici2, L. Jiang3, C. Duran1, A. Pitici2, I. Aghenitei2, \nM. Jurca2, R. Rosu2; 1Houston, TX/US, 2Chapel Hill, NC/US, 3Beijing/CN \n(dvining@mdanderson.org) \nPurpose: Radiology reporting is often practiced in English but the translation of \nreports to native languages could be beneficial to patients. Furthermore, diagnoses \nmust be coded with standardised ontologies (i.e., controlled vocabularies with de-\nfined relationships) to enable electronic medical records. We present a structured \nreporting solution with an integrated ontology tool that is capable of automatically \ntranslating and coding reports.\nMethods and Materials: We developed a reporting system, called ViSion, which \nallows a radiologist to capture key images, tag images with anatomy and pathology \nterms and assemble a multimedia structured report. The terminology employed \nhas been developed with an integrated ontology tool. The anatomy terms are \norganised in a hierarchy, and each anatomy is associated with a set of patholo-\ngies. The pairing of anatomy and pathology terms comprises a diagnosis. Each \ndiagnosis can be further described with secondary characteristics. The ViSion \nontology was created in English but translated to foreign languages using Google \nTranslate followed by a radiologist’s review. Hence, the ability to translate a Vi-\nSion structured report to multiple languages becomes a trivial task. Furthermore, \nall of the diagnoses have been crossed-referenced to other standardised medical \nontologies (e.g., ICD-10-CM).\nResults: The ViSion ontology currently consists of 906 anatomy terms, 1472 pa-\nthology terms, 1380 secondary characteristic terms and 5653 anatomy-pathology \nterm combinations constituting unique diagnoses. Each term has been translated \nto foreign languages and cross-referenced to other ontologies.\nConclusion: ViSion is a multimedia structured reporting system that operates \nin multiple languages and provides a method to automatically code radiological \ndiagnoses. \nAuthor Disclosures:\nD.J. Vining: Founder; VisionSR, Inc. C. Popovici: Employee; Eloquentix, Inc. \nA. Pitici: Employee; Eloquentix, Inc. I. Aghenitei: Employee; Eloquentix, Inc. \nM. Jurca: Employee; Eloquentix, Inc. R. Rosu: CEO; Eloquentix, Inc.\nB‑0142 10:39\nIT infrastructure to support secondary use of routinely acquired \nclinical imaging data for research \nK. Leung, F. Van der Lijn, H.A. Vrooman, W.J. Niessen, M.C.J.M. Sturkenboom; \nRotterdam/NL (k.y.e.leung@erasmusmc.nl) \nPurpose: To exploit the ever increasing quantity of routinely acquired imaging \ndata generated in clinical practice for research, we propose an infrastructure for \nthe automated anonymization, extraction and processing of image data stored in \nclinical data repositories.\nMethods and Materials: As proof of principle, we used this infrastructure to imple-\nment a pipeline for measuring brain volumes in clinical MRI. This fully automated \nsystem consists of four steps: subject selection using PACS query, anonymization \nof privacy sensitive information and removal of facial features, quality assurance on \nDICOM header and image information, and biomarker extraction. 1114 examinations \nwere selected based on MRI protocol: dementia (246), multiple sclerosis (446) and \na general healthy elderly population study (422). We evaluated the effectiveness \nof the infrastructure in accessing and successfully extracting biomarkers from \nroutinely acquired clinical imaging data. To prove the validity, we compared brain \nvolumes from dementia and multiple sclerosis patients with the healthy population.\nResults: Success rates of 82.5%, 82.3% and 100% are achieved for the three \nprotocol groups, respectively, indicating large amounts of routinely acquired clini-\ncal imaging data can be used for research purposes. In line with the literature, \ntive statistics, T-student tests for comparing groups, and Mann-Whitney tests for \nverifying hypothesis and item relations.\nResults: Most radiographers completely agree (37.5%) or partially agree (40%) \nthat evidence-based radiology makes part of their job requirements, but only 32.5% \nconsider it absolutely useful for developing their skills. Most research projects and \npapers (72.5%) are done by radiographers during their degree to develop their \nknowledge and quality of services rendered. Age and academic degree do not have \nstatistical significance (p < 0.05) for evidence-based radiology; however, there is a \nslight increase for radiographers with higher academic degrees and for those who \nhave greater access to research papers and literature.\nConclusion: Evidence-based practice is not applied by most radiographers as \na work method; however, the underlying knowledge on this thematic suggests \nit would be well received and developed to enhance skill, knowledge and the \ndepartment general quality. \nB‑0139 11:42\nRadiographers quality assurance work: resistance and cooperation \nR. Gullien, J.G. Andersen, A.E. Haakull; Oslo/NO (uxraul@ous-hf.no) \nPurpose: Explaining the radiographer-chosen improvement initiatives in quality \nassurance work (QAW), adjustment and progression of these initiatives and chang-\ning possible resistance to cooperation.\nMethods and Materials: Different implementation strategies and improvement \ninitiatives were used in the QAW to prevent a feeling of insecurity, threatening, \nuneasiness, less valuable, to avoid conflicts and to enable education, training, \nself-assessment, improve oneself. Manager implements measurements, strategies \nand improvement initiatives. The employees came up with suggestions of actions, \nbrainstorm. Voting was performed and top three were selected. Combination of \nsuggested and specific initiatives over time: continuous individual feedback over \ntime (baseline, after implementation, follow-up), individual assessment measured by \nexperience in mammography, theoretical and practical training, lectures, examples, \nindividual positioning training, reading guidelines and articles, individual feedback on \npositioning technique, tailored training for new employees, different checklist for em-\nployees (new/”old”, inexperienced/experienced), checklist for updating knowledge, \nself-study, workshops, training in self-evaluation, new internal guidelines, frequent \nfeedback if necessary, practical training with supervisor, temporarily get another \nkind of work, meetings and discussions, inform about QAW when job interview.\nResults: Positive changes in cognition, self-knowledge, personal skills, confidence \nin the situation, comfortable, demystified, attitude change; related to knowledge \nand awareness. Teamwork manager and employee with focus on improvement \nwork and differentiate between work and employee.\nConclusion: Using various strategies are beneficial, different methods to meet \ndifferent needs. Top-down, bottom-up, threat-relaxation, tentative-participation, \nresistance-cooperation. Dialogue and cooperation between staff and management; \nbetween the radiographers are essential for success.\nB‑0140 11:51\nRadiographers’ knowledge about adverse reactions to iodinated \ncontrast media \nA. Santos, L. Capitolina, I. Silva, A. Saraiva; Coimbra/PT \n(adelinosantos@estescoimbra.pt) \nPurpose: EudraVigilance-Pharmacovigilance is a data processing network and \nmanagement system for reporting and evaluating suspected adverse reactions of \nmedicinal products in the European Economic Area. The main purpose of this paper \nis to assess the level of knowledge of radiographers relatively adverse reactions \nof iodinated contrast media (ICM).\nMethods and Materials: An original electronic survey was used, which is com-\nposed of four dimensions of study to gauge radiographers’ knowledge regarding \nthe chemistry of ICM (I), potential adverse reactions (II), possible procedures to \nbe taken in emergency situations (III) and actions to be taken under the National \nPharmacovigilance System (IV), in a first phase. And throughout various European \ncountries (Northern, Central and Mediterranean), in a second stage.\nResults: Only 11.5% of respondents were able to correctly answer the four ques-\ntions on chemistry of ICM. However, a significant relationship between those who \nknow the classification of ADR and who has knowledge of chemistry ICM still exists. \nConcerning the procedures to be taken in case of ADR, we found that only 13.3% \nof subjects were able to correctly identify usual emergency procedures in this type \nof situation and, regrettably, only 3% of the sample proved able to correctly identify \nall adverse reactions suggested by the questionnaire.\nConclusion: The only method that enables epidemiological continuing surveillance \nsafety of all drugs is the spontaneous reporting of adverse events. This pioneer \n\nScientific Sessions\nS179\nA\n C D E F G\nB\nThursday\nB‑0145 11:06\nThe liver imaging atlas: an interactive multimodality web-based \nreference and educational resource of liver imaging \nO. Kolokythas, S. Zaidi, S. Osman, A.P. Tornow, T.T. Pham, \nS. Bastawrous, G.S. Phillips, P. Bhargava, D.L. Coy; Seattle, WA/US \n(orpheus@u.washington.edu) \nPurpose: To create an interactive reference of liver imaging that includes a \ncomprehensive spectrum of liver pathology in CT, MR and ultrasound imaging \nmodalities. We have developed and demonstrate an interactive imaging tool that \nis freely available via the world wide web with the aim to address these diagnostic \nand educational challenges.\nMethods and Materials: A web-based editing and entering tool was developed to \nallow systematic uploading and annotation of CT, MR and ultrasound cases with \nhepatic pathology. A user interface was developed to allow for various search modes \nand presentation schemes of multimodality imaging pathology.\nResults: The interactive website www.liveratlas.org allows the authors to upload \nand categorise liver imaging cases by their modality-specific imaging features \nand diagnostic categories by means of an innovative tagging system. This system \nenables users to search, filter, and display cases by selecting imaging features, \ndisease categories, diagnosis, or by entering search terms as free text. A quiz mode \nfeature allows radiology educators and trainees to use the atlas as a teaching or \nself-assessment tool. Cases can be shared via email or saved as a bookmark, \nallowing users and educators to prepare presentations or training sessions.\nConclusion: The website www.liveratlas.org is an interactive comprehensive refer-\nence tool to rapidly and effectively access comprehensive CT, MR and ultrasound \nimaging of liver pathology. It allows radiologists in training and in practice to find \nexamples of common and rare pathologies, explore and focus their differential \ndiagnoses in specific clinical scenarios, test themselves and select cases to save \nand share. \nAuthor Disclosures:\nO. Kolokythas: Advisory Board; Philips Healthcare. Consultant; Philips \nHealthcare. Equipment Support Recipient; Philips Healthcare, Supersonic \nImagine. Grant Recipient; Bracco Diagnostics.\nB‑0146 11:15\nEvaluation of teleradiology and telemedicine regarding financial and \npersonnel benefit for regions with low population density \nM.C. Spoerl, N. Hosten; Greifswald/DE (mark_spoerl@hotmail.com) \nPurpose: The benefit of telemedicine and especially teleradiology are numerous. \nWe conducted an analysis concerning financial benefits and staffing policy.\nMethods and Materials: Regional telemedicine projects from a pool of 52 \ntelemedicine systems at 14 facilities were analysed, focused on interdisciplinary \ntumourboards in Greifswald and Eberswalde, where specialists such as radiolo-\ngists, radiotherapists and pathologists are required to attend. Statistic data including \ncases discussed, external cases discussed, speaking time of external participants, \ndemonstration of imaging and total duration was collected. The study also evalu-\nates acquisition and maintenance costs compared with reduction of travel and \npersonnel expenses.\nResults: Acquisition costs for a telemedicine setup vary between 7,800 Euro for a \ndesktop setup and between 25,000 and 40,000 Euro for a conference room setup \n(Cisco Systems, San Francisco). In addition maintenance costs of about 9% of the \nacquisition costs occur. Representing telemedical solutions for low-density areas, \nthe Eberswalde tumourboard processes an average of 35 cases per week with \nup to 10 external cases. A reduction in travel distance of 24,300 kilometres and \na reduction of travel time of 362 hours annually can be achieved. Converted into \ntravel expenses and saved medical labour time it results in 25,000 Euros annually.\nConclusion: Telemedicine and especially teleradiology are sufficient tools to guar-\nantee the best medical care to areas with low population density and a deficit of \nmedical experts like Mecklenburg-West Pomerania and the Barnim Plateau. They \nprovide a economic method to reduce costs and optimise staffing difficulties. This \nProject was financed by INTERREG IV A. \nB‑0147 11:24\nFast search for radiology cases in hospital systems via content-\nbased image retrieval \nG. Langs1, R. Donner1, M. Holzer1, D. Markonis2, H. Mueller2, E. Birngruber1; \n1Vienna/AT, 2Sierre/CH (georg.langs@meduniwien.ac.at) \nPurpose: Efficient and quick access to comparable cases and corresponding \nradiology reports is crucial during radiological assessment and increases quality. \nCurrently, in most cases search queries within a PACS are limited to meta data. \nbrain volumes (expressed as percentages of intracranial volume) were found to \nbe significantly smaller in patients scanned under dementia (79.7%) and multiple \nsclerosis (81.4%) protocols, when compared with healthy controls (82.8%).\nConclusion: This demonstrates that quantitative image biomarkers can be reliably \nextracted from routinely acquired clinical imaging data. This enables secondary \nuse of clinical images for quantitative biomarker discovery at a hitherto unprec-\nedented scale. \nB‑0143 10:48\nInteractive methods improve radiology long-term learning \nJ.C. Pueyo, J. Etxano, P. Slon, R. Zalazar, J. Ros, L. García del Barrio, \nG. Bastarrika, A. Villanueva; Pamplona/ES (jetxano@unav.es) \nPurpose: Personal remote response systems (clickers) have shown to be an \ninteresting tool to encourage participation. The aim of this study is to evaluate \nwhether the use of clickers improves learning and retention of radiology within a \ngroup of medical students.\nMethods and Materials: 175 medical students attended 17 radiology lessons. \nEach lesson was about 145 radiological images. At the beginning of each lesson, \nstudents have a PDF with all the images corresponding to that day. At the end of \neach lesson, there were five interactive questions of those images using clickers. \nThree months later, there was an examination with multiple-choice questions. \nHalf of the questions were images that had already been interactively worked \nwith clickers. The other half were images of the PDFs not worked with clickers. \nIncorrect answer value was -0.25. To evaluate the difference in the degree of \nlearning achieved between both methods, we analysed the index of correct and \nfalse answers of each group.\nResults: The averages of the correct answers were significantly higher in the \ngroup of interactive teaching than in the passive education group (63 vs 53%, p \n< 0.005). The percentage of incorrect answers of the interactive teaching group \nwas significantly lower than in the other (23.4 vs. 27.4 p < 0.05). The percentage \nof unanswered questions was significantly lower in the interactive group (13% vs \n19.5% p < 0.005).\nConclusion: Interactive learning with remote response devices (clickers) is an \neffective method in teaching radiology, because it significantly improves learning \nand retention of knowledge. \nB‑0144 10:57\nThe radiology events register (RaER): incident reporting in radiology \nC. Mandel1, T. Schultz2, N. Hannaford2, J. Grimm3; 1Melbourne/AU, \n2Adelaide/AU, 3Sydney/AU (mandel@ausdoctors.net) \nPurpose: Incident reporting is a vital tool in high-risk industries. Adoption in health-\ncare is patchy and lags behind other industries. This paper provides an overview \nof the establishment of a radiology incident reporting system in Australia and New \nZealand and the issues associated with encouraging healthcare professionals to \nreport incidents.\nMethods and Materials: In 2006 the Royal Australian and New Zealand College \nof Radiologists established an incident-reporting database, the radiology events \nregister (RaER), the first dedicated radiology incident reporting system. The source \nof incident reports and incident trends over time have been analysed.\nResults: Over 4000 incidents have been recorded, including data transferred \nfrom other organisations’ incident databases. A variety of strategies have been \nimplemented to increase reporting and include: convening a biennial conference; \npromotion in lectures; publication of case reports; the use of incentives; and the \nmandating of reporting as part of training. Given the large numbers of radiology tests \nand procedures performed each year, and the estimated rate of adverse events \nin healthcare services, the majority of incidents are not being reported in RaER. \nThe low numbers of reports per month are consistent with significant barriers to \nreporting that need to be overcome.\nConclusion: Incident reporting is an essential safety tool in healthcare. Radiology \ncan benefit from dedicated incident databases, but convincing radiologists and \nother healthcare providers to report incidents is a significant hurdle. Leadership, \nfeedback, promotion, incorporation of findings into daily practice, incentives and \neducation are essential to encourage reporting. \n\nScientific Sessions\nS180\n C A D E F\n G\nB\nConclusion: Diagnostic radiology expert networks is attractive to improve com-\nmunication, in particular during double-reading. It can also improve the educational \nprocess, fast-track reporting, expert consultation as well as providing a more patient \n-oriented regional equality, potentially resulting in better treatment of diseases that \nrequires multidisciplinary and multi-institutional communication. \nAuthor Disclosures:\nP. Asp: Employee; RxEye AB. H. Walfridsson: Owner; ICOX. U. Hertin: \nEmployee; RxEye AB. Owner; RxEye AB.\n14:00 - 15:30 Room C \nHead and Neck \nSS 208 \nHead and neck cancer: functional imaging and \nhybrid modalities \nModerators: \nN. Abolmaali; Dresden/DE \nS. Steens; Nijmegen/NL \nB‑0150 14:00\nCT perfusion of head and neck lymph nodes: differentiation between \nuntreated and treated lymphoma \nA.M. Tawfik1, N.M. Batouty1, A.A. Razek1, S. Eteiba1, M.A. Shaheed1, T.J. Vogl2; \n1Mansoura/EG, 2Frankfurt a. Main/DE (ahm_m_tawfik@hotmail.com) \nPurpose: To evaluate whether CT perfusion (CTp) of cervical nodal lymphoma \ncould be used to differentiate between viable lymphoma tissue in primary untreated \nlymphoma and non-viable scar tissue after completion of therapy.\nMethods and Materials: 64-multislice CTp of the head and neck was performed \nfor ten patients with cervical nodal lymphoma before receiving any treatment and \nnine patients after finishing chemotherapy treatment for lymphoma, who were in \ncomplete remission and met the inclusion criterion of CT and clinical evidence \nof previously enlarged cervical lymph nodes. All patients had pathologic proof of \nlymphoma. Quantitative values of blood flow (BF), blood volume (BV), mean transit \ntime (MTT) and permeability surface area product (PS) for cervical lymphoma nodes \n(1 to 5 enlarged nodes for each patient) were calculated using deconvolution-based \nCTp software. Values were statistically compared between untreated (23 nodes) \nand treated lymphoma nodes (17 nodes).\nResults: The mean BF, BV and PS were significantly higher and MTT significantly \nlower for untreated than treated lymphoma nodes, all p values < 0.0001. The mean \nBF values were 128.5 and 40 ml/100 g/min, mean BV 7.8 and 1.6 ml/100 g, mean \nPS 22.6 and 1.6 ml/100 g/min and the mean MTT vales were 2.6 and 4.1 seconds \nfor untreated and treated lymphoma nodes, respectively.\nConclusion: Untreated lymphoma nodes are characterised by significantly higher \nBF, BV and PS and lower MTT than treated lymphoma nodes. CTp may be used \nfor assessment of the activity of lymphoma and identification of residual activity \nafter treatment.\nB‑0151 14:09\nPrediction of treatment response in head and neck carcinomas \nusing IVIM-DWI: evaluation of lymph node metastasis \nT. Hauser1, M. Essig2, F.B. Laun1, M. Münter3, A. Jensen1, K.H. Fritsche1, \nB. Stieltjes1; 1Heidelberg/DE, 2Erlangen/DE, 3Stuttgart/DE \nPurpose: To obtain diffusion and microperfusion measures in lymph node metas-\ntases of head and neck squamous cell carcinomas (HNSCC) using intravoxel inco-\nherent motion (IVIM) imaging. These parameters were used to characterise lymph \nnodes in the staging phase and longitudinal follow-up was performed to evaluate \nthe potential predictive value of these parameters considering therapy response.\nMethods and Materials: Thirteen patients with lymph node metastases of histologi-\ncal confirmed locally advanced HNSCC were examined using diffusion weighted \nimaging (DWI) before a combined radiotherapy. DWI imaging was performed at 3 \nT using eight different b-values ranging from 0 to 800 s/mm2. A follow-up period of \nat least 10.5 months (range: 10.5-25.5 months) was available in all patients. One \npatient with a macroscopically necrotic lymph node was excluded from analyses. An \nROI analysis was performed in all patients. Using the IVIM approach, the perfusion \nfraction f and the diffusion coefficient D were extracted.\nResults: A locoregional failure (LRF) was present in 3 of 12 patients within \n10.5-month follow-up. The initial f-value was significantly higher (p < 0.01) in pa-\ntients with LRF (14.5 ± 0.6% vs. 7.5 ± 2.7%). The initial diffusion coefficient D did \nThis limits the effectiveness of searches, since they do not use visual information \nin the images, such as patterns that correspond to specific diseases.\nMethods and Materials: We present a computational framework for content-based \nimage and report retrieval of radiological data. The system searches for cases that \nexhibit similar pathology patterns and displays them together with the radiology \nreports. It fully automatically identifies the anatomical location of an image and \nretrieves cases with similar pathology. We performed evaluation with approximately \n61.000 image series sampled from a hospital PACS (3 TB of imaging data).\nResults: The system identified the position of a query case with a median error of \n2.4 cm within a search time below a second. On a pilot set, lung pathology retrieval \nachieved 67% correct diseases in the top ranked 3 cases.\nConclusion: A fast and efficient way to retrieve relevant data from hospital image \ndata bases improves reporting quality and speed in radiology. Retrieval plays an \nincreasingly important role in the clinical radiology environment. The computational \nsystem performs retrieval based on image content and is able to provide results \nthat match in both anatomy and pathology. It supports radiologists to find relevant \ncases based on regions of interest in a matter of seconds, even if no specific \nkeywords are given. \nB‑0148 11:33\nInternet-based surveys among referring in-hospital clinicians \nand radiologists: a useful tool to evaluate report quality and \ninterdisciplinary co-operation \nC. Neumann, O. Khalifa, D. Tscholakoff, G. Mostbeck; Vienna/AT \n(christian.neumann.nch@wienkav.at) \nPurpose: To evaluate expectations of and satisfaction with radiology reports of \nclinicians and radiologists according to COVER/ROVER (JML Bosmans et al, \nRadiology 2011) and quality of interdisciplinary co-operation (IC) with departments \nof radiology in 2 major tertiary community hospitals.\nMethods and Materials: Adopted COVER/ROVER and IC surveys (surveymonkey.\ncom, Portland, OR/US) were e-mailed to 533 referring physicians and 26 radiolo-\ngists of hospital A (1081 beds) and to 300 physicians and 12 radiologists of hospital \nB (1120 beds). Regarding the IC questionnaire, 37 questions were formulated \ncovering aspects of scheduling, interdisciplinary communication, access to reports \nand images, security aspects, radiation protection and contrast media knowledge.\nResults: COVER response rates were 17.3% and 20.3% in hospitals A and B, \nrespectively. ROVER response rates were 53.8%/91.7%. IC-survey response rate \nby clinicians was 13.5%/16.0%. Results of COVER were similar in hospitals A and \nB and compared well with Bosmans et al regarding structure of reports, urge for \nimmediate reporting of acute findings, need for a conclusion and recommendations \nfor further management. ROVER surveys stress the importance of learning how \nto write reports. The IC results were different between hospitals A and B regard-\ning scheduling and interdisciplinary communication. There is a need for clinician \ntraining in IT applications for access to images and reports.\nConclusion: Our ROVER/COVER results emphasize the key role of in-hospital \nradiology as a gatekeeper in the diagnostic work-up and interdisciplinary commu-\nnication. The IC survey helps to identify friction points between radiology, referring \nphysicians and IT staff.\nB‑0149 11:42\nCross regional diagnostic radiology network for preoperative \nassessment of colorectal cancer: preliminary experiences \nL.C.O. Blomqvist1, C. Kling-Hassler1, A. Sjövall1, T. Almqvist1, P. Asp1, \nH. Walfridsson2, R. Sundqvist1, U. Hertin1; 1Stockholm/SE, 2Sollentuna/SE \n(lennart.k.blomqvist@ki.se) \nPurpose: To assess the effect on quality of radiological reports when performed \nas part of a regional expert colorectal cancer diagnostic network.\nMethods and Materials: Radiologists from ten different institutions in the Stock-\nholm-Gotland region, with two million inhabitants, are recruited. After a work-shop \nand separate teaching sessions, the radiologists form a virtual network responsible \nfor reporting preoperative cross-sectional imaging in patients with newly diagnosed \ncolorectal cancer, including access to double-reading and on-line expert consulta-\ntion. The network uses a common web-based RIS/PACS system with streaming \ntechnology enabling real-time communication with direct feedback.The project is \ndivided into two phases where radiologists in the baseline phase are reporting to \nthe individual institutions and a network phase where the reports are performed \nscheduled collectively in the network. In the network phase, the radiologist also \nhave the opportunity to discuss general issues weekly together.\nResults: After integration of the individual RIS/PACS system the radiologist are, \nat the time of writing, collecting data for the baseline phase.\n\nScientific Sessions\nS181\nA\n C D E F G\nB\nThursday\nB‑0154 14:36\nThe role of MRI and FDG PET/CT imaging in the detection of \nunknown primary tumours with cervical metastases \nA. Lévai; Budapest/HU \nPurpose: Our aim was to assess the usefulness of PET/CT and MRI in the detection \nof unknown primary tumour in patients with malignant cervical lymphadenopathy.\nMethods and Materials: 421 patients were referred for FDG PET/CT with suspect-\ned or known malignancy in the head and neck region from 2006 to 2012. 43 patients \nhad undergone correlative MRI within 2 months of FDG PET/CT. Histopathology \nfindings were used to evaluate the performance of FDG PET and MRI. We used \nstandardised score system to classify radiological findings in PET /CT and MRI.\nResults: In identification of the primary tumour site MRI succeeded in 52%, and \nPET /CT in 53%. MRI had 4 false-negative cases, while PET/CT had only 1. Of the \n43 patients, 3 had primary carcinoma other than the head and neck. The primary \ntumour stage was determined low except for 2 cases, where PET/CT understaged \nthe disease. In 6 cases, PET/CT and MRI revealed different nodal stage. Details \nof nodal characteristics were detectable more with MRI.\nConclusion: PET/CT and MRI both appeared similarly accurate in the detection \nof an occult primary tumour in the head and neck, as well as in estimation of the \nnodal stage. PET/CT was beneficial in detecting distant disease and second primary \ntumour. MRI was more predictive in detection of primary cancers. The criterias of \nour standardised characterisation score system that we used in PET /CT and MRI \ncan be a path for radiologists and nuclear medicine physicians to analyse images \nof cervical metastasis of an unknown primary tumour. \nB‑0155 14:45\nDiffusion-weighted MR imaging in characterisation of head and neck \nlesions \nF.U. Öztürk, F.Y. Dönmez, F. Kural, S. Çetiner, M. Ağıldere; Ankara/TR \n(drkural@hotmail.com) \nPurpose: The purpose of our study is to evaluate the usefulness of diffusion-\nweighted imaging (DWI) in the tissue characterisation of head and neck lesions, \nto investigate the difference in apparent diffusion coefficient (ADC) values for \ndistinguishing malignant and benign head and neck lesions, lymphoma and carci-\nnoma, malignant lymph nodes and benign lymph nodes, and to determine cut-off \nvalues for these distinctions.\nMethods and Materials: This study included 95 head and neck lesions in 88 \npatients. Routine MR imaging and DWI were performed on a 1.5 T MR unit using \nsingle-shot echo-planar imaging with b factors of 0, 400 and 800 sec/mm2. ADC \nvalues were calculated and the groups were compared using Kruskal-Wallis test.\nResults: There was a statistically significant difference between malignant and \nbenign lesions, lymphoma and carcinoma, and malignant lymph nodes and benign \nlymph nodes. When an ADC value of 1.13x10-3 mm2/s or lower was used for pre-\ndicting malignancy, the sensitivity, specificity and accuracy were 85.7%, 71.7% and \n78.9%, respectively. If an ADC value of 0.85x10-3 mm2/s was used as a threshold \nvalue for differentiating lymphoma from carcinoma the best results were obtained \nwith an accuracy of 83.7%, sensitivity of 92.9% and specificity of 78.3%. When an \nADC value of 0.95x10-3 mm2/s was used as a threshold value for differentiating \nmalignant lymph nodes from benign lymph nodes the highest accuracy of 82.8%, \nwith 90.5% sensitivity and 71.4% specificity was obtained.\nConclusion: DWI can reliably be used to characterise head and neck lesions \nbased on their ADC values.\nB‑0156 14:54\nComparison of contrast-enhanced PET/CT and PET/MRI with only \nT2-weighted images in patients with head and neck cancer - how \nmuch MR information is needed in PET/MRI? \nF.P. Kuhn, M. Hüllner, S.S. Kollias, G.K. Von Schulthess, P. Veit-Haibach; \nZurich/CH (felix.kuhn@usz.ch) \nPurpose: In general, in MRI contrast media is given for lesion detection and \ncharacterisation. In multi-modality imaging, the information about malignancy may \nderive from the PET-component. We evaluated if a single T2-weighted (T2w) MR \npulse sequence in PET/MRI might be equivalent to contrast-enhanced (ce) PET/\nCT for lesion characterisation in patients with head and neck cancer.\nMethods and Materials: Eighty consecutive patients referred for primary staging \nor re-staging of head and neck cancer underwent sequential whole body 18 F-FDG \nPET with CT-based attenuation correction, ceCT and 2-point Dixon-based T2w axial \nMRI (IDEAL pulse sequence, GE Healthcare) of the head and neck in a tri-modality \nPET/CT-MR system. PET-positive lesions were assessed by CT and MRI for their \nanatomical localisation, conspicuity and additional information for characterisation.\nnot differ significantly (p = 0.37) between the two groups (0.97 ± 0.15 x10-3 mm²/s \nvs. 0.88 ± 0.14 x10-3 mm²/s).\nConclusion: Our results indicate that a high initial perfusion fraction f in lymph \nnodes may predict poor treatment response in patients with HNSCC due to \nlocoregional failure. The baseline diffusion coefficient D showed no significant \ndifferences between groups.\nB‑0152 14:18\nCombined perfusion-diffusion-weighted MRI for staging of recurrent \npapillary thyroid cancer: a feasibility study \nK.N.A. De Paepe, R. Hermans, F. De Keyzer, V. Vander Poorten, \nS. Nuyts, E. Hauben, B. Decallonne, M. Bex, V. Vandecaveye; Leuven/BE \n(katja.depaepe@uzleuven.be) \nPurpose: To evaluate diffusion-weighted (DWI) and dynamic contrast-enhanced \n(DCE) magnetic resonance imaging (MRI) for diagnosis of recurrent papillary thyroid \ncancer (PTC) in comparison to ultrasound and peroperative and histopathological \nfindings.\nMethods and Materials: Twenty-eight patients with suspicion for recurrent PTC \nunderwent 3 T MRI, including DWI (b=0-50-100-500-750-1000 sec/mm 2) and \nDCE-MRI (25 runs; 6 seconds each; pre-, during and post-contrast). Interpreta-\ntion criteria were: b1000-DWI for detection of soft tissue lesions and lymph nodes \n(LN); characterisation with apparent diffusion coefficient (ADC) calculated from \nall (ADCavg), low (ADClow) and high b-values (ADChigh); characterisation by \nDCE-MRI with arterial slope (AS), area under the curve (AUC) and c-peak. The \nADC and DCE-parameters of tumoural and benign lesions were compared with \na Mann-Witney U test. Receiver-under-the-operator-curve analysis determined \na threshold from which the accuracy of functional MR-imaging was compared to \nultrasound in correlation to histopathology.\nResults: Only ADChigh and AS showed statistical difference between recurrent \ntumour and benign lesions (ADChigh: p=0.002; AS: p < 0.0001). Per-neck region, \nb1000-DWI combined with AS yielded highest sensitivity of 93% with 98% specifi-\ncity. Ultrasound showed a sensitivity of 72% and specificity of 98%. Per patient, \nfunctional MRI corrected ultrasound in only 4 patients for diagnosing tumour recur-\nrence. However, functional MRI findings correctly changed treatment planning in \n13 of 28 patients [excluding tumour recurrence (n=2), mediastinal metastatic LN \n(n=5), laryngeal metastasis (n=2), ipsilateral nodal skip metastasis to level II (n=2), \ncontralateral nodal metastases (n=2)].\nConclusion: Combining b1000-DWI with DCE-MRI may show additional value to \nultrasound for diagnosing and planning treatment in recurrent PTC. \nB‑0153 14:27\nDiagnostic evaluation of patients with squamous cell cancer of the \nhead and neck after free flap reconstructions - the usefulness of \nfunctional imaging techniques \nM. Członkowski, A. Trojanowska, P. Trojanowski, J. Klatka, A. Drop; Lublin/PL \n(m.czlonkowski@interia.pl) \nPurpose: To evaluate patients operated on head and neck squamous cell cancer \nand reconstructed using free tissue transfer flaps\nMethods and Materials: We evaluated 34 patients with T4 tumours of oral cavity, \noropharynx, hypopharynx and larynx. All patients underwent surgical resection of \nthe tumour and reconstruction with free tissue transfer flap: musculocutaneous, \nfasciocutaneous, osseous and osseocutaneous. Patients underwent post-operative \nradiotherapy. In the whole group we performed CT and/or MR study 3, 6 and 12 \nmonths after the completion of therapy. In patients suspected for recurrence based \non CT/MR findings, MR diffusion-weighted imaging and CT perfusion were addition-\nally performed. In case of positive findings these patients were qualified for surgery.\nResults: In 11 out of 35 patients imaging study was suggestive for recurrence (4 \nnodal and 7 local). In this group additional functional imaging was performed. MR \nDWI and CT perfusion findings were indicative of nodal recurrence in two cases \nand patients were operated on. Recurrence was not proven on histology in either \ncase. In 7 patients with suspected local recurrence additional functional imaging was \nperformed in 5 cases and the recurrence has been proven histologically in 3 cases.\nConclusion: We have to be aware that functional imaging may be of little value in \npatients reconstructed with free flaps. Although diagnostic imaging plays a prime \nrole in post-treatment follow-up, positive findings must be evaluated with caution. \nCareful reading together with ENT surgeon is vital.\n\nScientific Sessions\nS182\n C A D E F\n G\nB\n81.8% and 94.5%, PPV 65.5% and 85.7% and NPV 91.2% and 93.8%. Evaluation \nof the single PET part from PET/CT revealed highest sensitivity of 95.7%, whereas \nevaluation of the sole MRI component from PET/MRI showed best specificity of \n96.4%. There was a high interrater agreement in all modalities (Cohen’s kappa \ncoefficient: 0.61 - 0.82).\nConclusion: PET/MRI of patients with head and neck cancer yielded good di-\nagnostic capability, similar to PET/CT. Further studies on larger cohorts to prove \nthese first results seem justified. \nB‑0159 15:21\nDiagnostic accuracy of 18F-FDG-PET/CT and fused 18F-FDG-PET-MR \nimages for T and N staging of primary oral malignancies \nP. Heusch1, C. Buchbender1, C. Sproll1, J. Terjung2, A. Scherer1, \nG. Antoch1, J. Handschel1, T.A. Heusner1; 1Düsseldorf/DE, \n2Essen/DE (philipp.heusch@med.uni-duesseldorf.de) \nPurpose: To compare 18F-FDG-PET-MRI (PET and MRI fused on a software basis) \n18F-FDG-PET/CT regarding their diagnostic performance in primary tumour (T) and \nnodal (N) staging in patients with oral malignancies.\nMethods and Materials: 20 patients [8 females, 12 males, age 65 ±10 years] before \noral tumour resection and bilateral neck dissection prospectively underwent 18F-\nFDG- PET/CT and 3 Tesla MRI. PET datasets were fused with contrast-enhanced \nT1-weighted MR images using a special software (Medifusion™). The sensitivity, \nspecificity, positive predictive value (PPV), negative predictive value (NPV) and \naccuracy for the correct T stage and N stage were calculated for 18F-FDG-PET/CT, \n18F-FDG-PET-MRI and 18F-FDG-PET-MRI side-by-side with DWI. Histopathology \nserved as the reference standard.\nResults: The sensitivity, specificity, PPV, NPV and accuracy for determining the \ncorrect T stage was 46%, 40%, 63%, 25% and 44% for 18F-FDG PET/CT, 50%, 50%, \n75%, 25% and 50% for 18F-FDG-PET-MRI and 36%, 40%, 57%, 22% and 38% for \n18F-FDG-PET-MRI plus DWI, respectively. The respective values for determining \nthe correct N stage were 36%, 43%, 50%, 30% and 39% for 18F-FDG-PET/CT, \n46%, 43%, 56%, 33% and 44% for 18F-FDG-PET-MRI and 46%, 57%, 63%, 40% \nand 50% for 18F-FDG-PET-MRI plus DWI. There were no significant differences \nbetween the results of 18F-FDG-PET/CT, 18F-FDG-PET-MRI and 18F-FDG-PET-MRI \nplus DWI (p>.05).\nConclusion: Software-based 18F-FDG-PET-MRI and 18F-FDG-PET-MRI plus DWI \ncompared to 18F-FDG-PET/CT images may not increase the diagnostic accuracy \nregarding the correct T and N stage in patients with oral malignancies. \n14:00 - 15:30 Room D1 \nChest \nSS 204 \nAirways and infiltrative lung diseases \nModerators: \nG.R. Ferretti; Grenoble/FR \nC. Mueller-Mang; Vienna/AT \nB‑0160 14:00\nHow does iterative image reconstruction effect emphysema \nquantification with chest CT? \nH. Jafarov1, C. Fink2, H. Haubenreisser1, M. Meyer1, \nP. Apfaltrer1, S.O. Schönberg1, T. Henzler1; 1Mannheim/DE, \n2Celle/DE (hashim.jafarov@umm.de) \nPurpose: Emphysema quantification with chest CT is crucial for surgical and \ninterventional therapy but highly influenced by image noise and reconstruction \nkernels. Thus, we prospectively evaluated the effect of iterative reconstruction (IR) \non emphysema quantification with chest CT.\nMethods and Materials: Chest CT raw data of 39 patients referred for emphysema \nquantification were reconstructed with standard filtered back projection (FBP) and \nan IR technique (IRIS, Siemens) using corresponding soft, medium sharp and sharp \nreconstruction kernels (B30, B50, B70 and I30, I50, I70). Each data set was ana-\nlysed using dedicated software for emphysema quantification (Pulmo-3D, Siemens). \nThe following parameters were automatically analysed and compared between the \ndifferent reconstructions: volume of the segmented lung (LV), mean lung density \n(MLD), full-width at half-maximum of the frequency distribution of lung-densities \n(FWHM), ratio of pixels with low attenuation (-950 HU=Emphysema index, EI).\nResults: LV and MLD showed no significant differences between FBP and IR \nas well as between the different reconstruction kernels (all p> 0.05). In contrast, \nResults: In 38 patients with at least one PET-positive lesion, 60 lesions were evalu-\nated. No significant difference was found between T2w and CT regarding lesion \nlocalisation and size. Furthermore, no significant difference was found between \nT2w and CT regarding conspicuity of tumours (Wilcoxon signed rank test, p=0.16) \nand PET-positive lymph nodes (p=0.16). In CT, fewer artefacts (7%) reduced the \ndiagnostic confidence compared to T2w (23.2%). Overall lesion characterisation \nwith T2w was considered superior to CT in 32% of lesions, equal to CT in 56% \nand inferior to CT in 12%.\nConclusion: PET/MRI with only axial T2w images and without the application of \ncontrast media has the potential to replace cePET/CT as the primary diagnostic \nimaging tool for the evaluation of head and neck cancers. \nAuthor Disclosures:\nG.K. Von Schulthess: Advisory Board; GE Healthcare. Consultant; Icon \nMedical Imaging plc. Research/Grant Support; GE Healthcare. Speaker; \nOccasional remunerated speaker for GE Healthcare and others.\nB‑0157 15:03\nComparison of contrast-enhanced PET/MRI and contrast-enhanced \nPET/CT in patients with head and neck cancers \nF.P. Kuhn, M. Hüllner, S.S. Kollias, G.K. Von Schulthess, P. Veit-Haibach; \nZurich/CH (felix.kuhn@usz.ch) \nPurpose: PET/MR has the potential to become a powerful tool in clinical oncologi-\ncal imaging. The purpose of this prospective study was to evaluate the diagnostic \nperformance of contrast-enhanced (ce) MRI in patients with head and neck cancers \nin comparison with ceCT to characterise PET-positive lesions.\nMethods and Materials: Eighty consecutive patients referred for primary staging or \nre-staging of head and neck cancers underwent sequential whole body 18 F-FDG \nPET with CT-based attenuation correction (AC), contrast-enhanced CT and con-\nventional diagnostic MRI (2-point Dixon-based T2- and native/contrast-enhanced \nT1-weighted sequences) of the head and neck in a tri-modality PET/CT-MR system. \nPET-positive lesions were assessed by CT and MRI for their anatomical localisation, \nconspicuity and additional information for characterisation.\nResults: In 38 patients with at least one PET-positive lesion, 60 lesions were evalu-\nated. No significant difference was found between MRI and CT regarding lesion \nlocalisation. MRI performed significantly better than CT regarding conspicuity of \ntumors (Wilcoxon signed rank test, p < 0.01) and similarly regarding conspicuity \nof PET-positive lymph nodes (p=0.08). In CT, fewer artefacts (7%) reduced the \ndiagnostic confidence compared to MRI (16%). Overall lesion characterisation \nwith MRI was considered superior to CT in 33% of lesions, equal to CT in 58% \nand inferior to CT in 9%.\nConclusion: CeMRI outperformed ceCT in terms of conspicuity and characterisa-\ntion of PET-positive head and neck tumor lesions and performed similarly in cervical \nlymph node assessment. Hence, cePET/MRI has the potential to replace cePET/CT \nas the primary diagnostic imaging tool for the evaluation of head and neck cancers. \nAuthor Disclosures:\nG.K. Von Schulthess: Advisory Board; GE Healthcare. Consultant; Icon \nMedical Imaging plc. Research/Grant Support; GE Healthcare. Speaker; \nOccasional remunerated speaker for GE Healthcare and others. \nB‑0158 15:12\nInitial clinical results of simultaneous PET/MRI in comparison with \nPET/CT in patients with head and neck cancer \nP. Stumpp, K. Kubiessa, S. Purz, M. Gawlitza, \nA. Kühn, K.G. Steinhoff, A. Boehm, R. Kluge, T. Kahn; \nLeipzig/DE (patrick.stumpp@medizin.uni-leipzig.de) \nPurpose: Describing diagnostic capability of simultaneous PET/MRI in comparison \nwith PET/CT and their single components CT, MRI and PET in an initial prospective \nstudy based on 17 patients with head-and-neck cancer.\nMethods and Materials: 17 patients with head-and-neck cancer received an \n18F-FDG-PET/CT for staging or follow -up and an additional simultaneous PET/\nMRI scan with a whole body imaging part and a dedicated examination of the \nneck. Sole MRI, CT and PET components of the multimodal acquisitions plus the \nPET/MRI and PET/CT examinations were evaluated independently, blinded and \nin a randomised order by two readers. Results were compared with the reference \nstandard, and sensitivity, specificity, positive (PPV) and negative predictive value \n(NPV) were calculated.\nResults: 23 malignant tumours and 55 benign changes were found with the refer-\nence standard. For PET/CT the two reader groups showed a sensitivity of 78.3% \nand 87%, a specificity of 85.5% and 89.1%, a PPV of 71.4% and 75% and a NPV \nof 90.7% and 94%. For PET/MRI sensitivity was 78.3% and 82.6%, specificity \n\nScientific Sessions\nS183\nA\n C D E F G\nB\nThursday\nB‑0163 14:27\nThe effect of inspiration on airway dimensions measured in CT \nimages from the Danish Lung Cancer Screening Trial \nJ. Petersen1, M.M.W. Wille2, L.H. Thomsen2, A. Feragen1, A. Dirksen2, \nM. de Bruijne3; 1Copenhagen/DK, 2Hellerup/DK, 3Rotterdam/NL (phup@diku.dk) \nPurpose: Airway dimensions measured from CT are increasingly being used to \ninvestigate diseases such as chronic obstructive pulmonary disease (COPD). \nIn this study, we investigate the effect of differences in inspiration level on such \nmeasurements in voluntary inspiration breathhold scans.\nMethods and Materials: We selected from the Danish Lung Cancer Screening \nTrial 978 subjects without COPD who were scanned annually for 5 years with low-\ndose multi-slice CT. Using in-house developed software, the lungs and airways \nwere automatically segmented and corresponding airway branches were found in \nall scans of the same subject using image registration. Mixed effect models were \nused to predict the relative change in lumen diameter (LD) and wall thickness \n(WT) in airways of generation 0 (trachea) to 6 based on relative changes in the \nsegmented total lung volume (TLV).\nResults: On average, 1.0, 2.0, 3.9, 7.6, 15.0, 25.0 and 27.3 airways per subject \nwere included from generations 0, 1, 2, 3, 4, 5 and 6, respectively. Relative changes \nin LD were positively related to changes in TLV and coefficients increased with \ngeneration: 0.20 (+-0.02), 0.19 (+-0.02), 0.21 (+-0.01), 0.25 (+-0.01), 0.29 (+-0.01), \n0.34 (+-0.01), 0.37 (+-0.01). Relative changes in WT were inversely related to \nchanges in TLV and generation: -0.01 (+-0.02), 0.01 (+-0.01), -0.02 (+-0.01), -0.03 \n(+- 0.01), -0.05 (+-0.01), -0.09 (+- 0.00), -0.08 (+-0.00).\nConclusion: Subjects who inspire deeper prior to scanning tend to have larger LD \nand smaller WT. This effect is more pronounced in higher generation airways. Thus, \nadjustment for inspiration level is needed to accurately assess airway dimensions. \nAuthor Disclosures:\nM. de Bruijne: Grant Recipient; AstraZeneca.\nB‑0164 14:36\nChronic bronchitis in large airway: airway wall measurements on \nthin-slice low-dose CT \nX. Xie, A.E. Dijkstra, J.M. Vonk, M. Oudkerk, H.J.M. Groen, R. Vliegenthart; \nGroningen/NL (x.xueqian@rad.umcg.nl) \nPurpose: Chronic bronchitis (CB) is usually caused by smoking and characterised \nby chronic inflammation and remodelling of the airway wall, commonly in large air-\nways. The study purpose is to determine differences in airway wall thickness (AWT) \nand wall area percentage (WA%) between subjects with and without CB symptoms.\nMethods and Materials: 50 heavy smokers with CB symptoms (cough, mucus, \ndyspnoea and wheezing) and 50 heavy smokers without CB symptoms were \nrandomly selected from 1,413 participants in a lung cancer screening trial. Airway \nwalls were measured on images in thin-slice low-dose CT with a dedicated software \ntool, for airways with a luminal diameter ³5 mm in 5 selected bronchi (RB1, RB4, \nRB10, LB1+2 and LB10). Differences in measurements between the groups were \nassessed by t-test. The association between CB symptoms and AWT and WA% \nwas analysed using multiple linear regression adjusted for age, body mass index, \nsmoking habit, amount of emphysema, and lung function.\nResults: Mean AWT measured at 5 bronchi was 1.55±0.44 mm and 1.42±0.40 mm \nin subjects with and without CB symptoms, respectively (P < 0.001). WA% was \n47±12% and 43±11%, respectively (P < 0.001). With adjustment for confounders, \na significant positive association between both airway wall measurements (AWT \nand WA%) and CB symptoms was found for airways with a luminal diameter from \n5 to 10 mm (P < 0.01). In airways with a luminal diameter ³10 mm, no significant \nassociation was found (P> 0.05).\nConclusion: Patients with chronic bronchitis symptoms have thicker airway walls \nof airways between 5 and 10 mm diameter, not in larger diameter. \nB‑0165 14:45\nValue of inspiratory and expiratory lung volume und lung density for \ndetection of bronchiolitis obliterans syndrome (BOS): a feasibility study \nS. Dettmer1, O. Otten1, C. de Wall1, J.-M. Kuhnigk2, F. Wacker1, H.-O. Shin1; \n1Hannover/DE, 2Bremen/DE (sabine-dettmer@t-online.de) \nPurpose: To evaluate whether quantitative assessment of lung density and volume \nin computed tomography (CT) show differences in patients with and without BOS \nafter lung transplantation.\nMethods and Materials: 210 CT examinations were carried out in lung transplant \npatients in full inspiration/expiration using a 64 row MDCT (120 kVp, rotation time \n0.8 s, pitch 0.984, collimation 1.25 mm, reconstruction increment 1 mm, standard \nreconstruction kernel). 26/184 examinations were performed in patients with/with-\nFWHM and EI both showed statistically significantly lower values using IR instead \nof standard FBP (FWHM: B30/I30=111.3 vs. 92.1; B50/50=167.6 vs. 115; B70/\nI70=197.8 vs. 137.5; EI: B30/I30=4.8 vs. 2.8; B50/50=11.3 vs. 5.8; B70/I70=20 vs. \n6.6). There was a significant lower variation between the different kernels using IR \nwhen compared to FBP. Image noise was reduced by 27% when compared to FBP.\nConclusion: Variation of quantitative emphysema chest CT parameters between \ndifferent reconstruction kernels is significantly reduced with IR when compared to \nFBP and may increase the robustness for therapy planning.\nB‑0161 14:09\nAssessing pulmonary perfusion in emphysema: automated \nquantification of perfused blood volume in dual-energy CTPA \nF.G. Meinel, A. Graef, S.F. Thieme, F. Bamberg, C. Neurohr, M.F. Reiser, \nT.R.C. Johnson; Munich/DE (felix.meinel@med.uni-muenchen.de) \nPurpose: To determine whether automated quantification of lung perfused blood \nvolume (PBV) in dual-energy computed tomography pulmonary angiography (DE-\nCTPA) can be used to assess the severity and regional distribution of pulmonary \nhypoperfusion in emphysema.\nMethods and Materials: We retrospectively analysed 40 consecutive patients \n(mean age 67 ± 13 years) with pulmonary emphysema, no cardiopulmonary co-\nmorbidities and a DE-CTPA negative for pulmonary embolism. Automated quan-\ntification of global and regional pulmonary PBV was performed using the syngo \ndual-energy application (Siemens Healthcare). We further quantified the global and \nregional percentage of voxels with a CT density <-900 HU. Emphysema severity \nwas rated visually and pulmonary function tests were obtained by chart review.\nResults: Global pulmonary PBV showed a moderate but highly significant nega-\ntive correlation with residual volume (RV) in % of predicted RV (r=-0.62, p=0.002, \nn=23) and a positive correlation with forced expiratory volume in 1 second (FEV1) \nin % of predicted FEV1 (r=0.67, p < 0.001, n=23). Global PBV values strongly cor-\nrelated with diffusing lung capacity for carbon monoxide (DLCO, r=0.80, p < 0.001, \nn=15). Pulmonary PBV values decreased with visual emphysema severity (r=-0.46, \np=0.003, n=40). Moderate negative correlations were found between global PBV \nvalues and parenchymal hypodensity in a per-patient (r=-0.63, p < 0.001, n=40) \nand per-region analyses (r=-0.62, p < 0.001, n=40).\nConclusion: DE-CTPA allows simultaneous assessment of lung morphology, \nparenchymal density and pulmonary PBV. In patients with pulmonary emphysema, \nautomated quantification of pulmonary PBV in DE-CTPA can be used for a quick, \nreader-independent estimation of global and regional pulmonary perfusion, which \ncorrelates with pulmonary function tests.\nAuthor Disclosures:\nT.R.C. Johnson: Equipment Support Recipient; Siemens Healthcare. Research/\nGrant Support; Bayer Healthcare.\nB‑0162 14:18\nDensitometry on MDCT in cystic fibrosis: radiological evidence for \nemphysema \nM.O. Wielpütz1, O. Weinheimer2, M. Eichinger1, M. Wiebel1, J. Biederer1, \nH.-U. Kauczor1, C.-P. Heussel1, M.A. Mall1, M. Puderbach1; 1Heidelberg/DE, \n2Mainz/DE (mark.wielpuetz@web.de) \nPurpose: The present study was conducted to employ computational densitometry \nbased on multi-detector computed tomography (MDCT) of the chest to characterise \nand quantify emphysema in cystic fibrosis (CF), identical to its routine clinical ap-\nplication in chronic-obstructive pulmonary disease (COPD). Results were validated \nagainst pulmonary function testing (PFT, i.e. forced expiratory volume in 1 s percent \npredicted [FEV1%], residual volume [RV] and total lung capacity [TLC]). Patients \nwithout lung disease (NORMAL) served as controls.\nMethods and Materials: MDCT from n=41 CF (median FEV1%=46, median age \n20a) and n=20 NORMAL (FEV1%=102, 30a) were subjected to densitometry. \nLung volume (LV) and emphysema volume (EV) were segmented (threshold -950 \nHounsfield units), and the emphysema index was computed (EI). All results were \ncorrelated with paralleled PFT (median gap 0d, range 0-73d).\nResults: Mean LV was 4681 ml in CF and 3967 ml in NORMAL (n.s). Significant EV \nwas found in CF (mean 457 ml) compared to NORMAL (78 ml) (p < 0.05). Median \nEI was elevated to 7% in CF patients, but 1% in NORMAL. EI correlated well with \nFEV1% in CF (rs=-0.55) and NORMAL (rs=0.67), but with RV (rs=0.69), and RV/\nTLC (rs=0.47) in CF only (p < 0.05). Importantly, EI increased markedly with age \nin CF (rs=0.67, p < 0.001), starting at 13a.\nConclusion: Our results indicate the development of progressive emphysema in \nchronic CF, which should be considered for new therapeutic approaches. Densi-\ntometry may introduce new quantitative and prognostic parameters into severity \nassessment of CF lung disease.\n\nScientific Sessions\nS184\n C A D E F\n G\nB\ntracted using a non-rigid image registration tool (HepaCare, Siemens, Forchheim, \nG). Subtraction data were analysed using syngo PulmoCT-Software (Siemens).\nResults: One animal had to be excluded from data analysis due to problems dur-\ning intubation. Oxygen saturation in the krypton group was 99.3% vs. 99.1% after \nxenon inhalation (p=0.4993). Corresponding values for heart rate were 128±36 \nand 132±38, respectively (p=0.6036). Xenon resulted in an average 34.6±6.4 HU \nincrease of enhancement, whereas krypton achieved a mean increase of 21.9±1.9 \nHU in enhancement (p=0.0055).\nConclusion: The use of krypton for lung ventilation imaging appears to be feasible \nand safe. Despite the use of a markedly higher concentration of krypton, enhance-\nment is significantly lower when compared with xenon CT ventilation imaging, but \nthe use of krypton could avoid unwanted side-effects of xenon.\nAuthor Disclosures:\nA.H. Mahnken: Research/Grant Support; Siemens. Speaker; Bayer. G. Jost: \nEmployee; Bayer Healthcare. H. Pietsch: Employee; Bayer Healthcare.\nB‑0168 15:12\nQuantification of idiopathic pulmonary fibrosis by semiquantitative \nHRCT score: correlation between radiologists and pulmonary \nfunction tests \nL. Navarro Vilar, M.L. Domingo Montañana, R. Peris Sanchez, \nE. Fernandez Fabrellas, C. Ramírez Fuentes, J. Vilar Samper; Valencia/ES \n(linavi85@gmail.com) \nPurpose: Measuring the extent of idiopathic pulmonary fibrosis by a visual high-\nresolution computed tomography (HRCT) score method and its assessment. \nCorrelation between score evaluation of radiologists and its correlation with the \npulmonary function tests.\nMethods and Materials: Thirty-five patients with IPF were analysed retrospectively \nusing HRCT and pulmonary function tests at diagnosis onset. In the HRCT images, \nthe lungs were divided into six zones (upper, middle and lower zones of the right \nand left lung). The images were scored by consensus of the two radiologists on a \nscale of 0-6 based on four patterns of pulmonary fibrosis: ground glass, reticular \nabnormalities, distortion and honeycombing. The score was applied as follows: 0 \n(absent), 1 (²10%), 2 (11-20%), 3 (21-30%), 4 (31-40%), 5 (41-50%) or 6 (> 51%). \nThese scores were also summed into a pattern CTtotalscore. Pulmonary function \ntests were performed within 1 month and included %FEV1, %FVC, FEV1/FVC, \ntotal lung capacity (%TLC), diffusing lung capacity for carbon monoxide (%DLCO) \nand DLCO adjusted for alveolar volume (KCO). Statistical analysis was made using \nPearson's correlation.\nResults: We found a significant correlation between radiologists for the total score \n(r=0.9), ground glass (r=0.92), reticular abnormalities (r=0.48) and distortion (r=0.64) \n(p < 0.01). There was a significant correlation between the extent of honeycombing \npattern and DLCO (r=-0.48, p=0.004). The total score is correlated with DLCO% \n(r=-0.41, p=0.01) and TLC (r=-0.36, p=0.03).\nConclusion: The visual score HRCT, with high correlation between radiologists, \nallows a reliable quantification of the extent and severity of the IFP. The honey-\ncombing score and the total HRCT score show the highest correlation with the \npulmonary function tests. The DLCO reflects better the severity of the disease.\nB‑0169 15:21\nHigh-resolution computed tomography (HRCT) of the lungs in brain \ndead pigs: a feasibility study \nG. Bozovic1, S. Steen1, T. Sjöberg1, C. Schaefer-Prokop2, J. Verschakelen3, \nQ. Liao1, R. Siemund1, I. Björkman-Burtscher1; 1Lund/SE, 2Amersfoort/NL, \n3Leuven/BE (Gracijela.Bozovic@med.lu.se) \nPurpose: Brain death has adverse effects on lung perfusion and ventilation with \npossible damage of lung parenchyma pre-transplantation. We wanted to assess \nbrain dead subjects treated with a new drug regime with HRCT as a pre-transplant \nwork-up.\nMethods and Materials: Eleven pigs were decapitated (DC) assuring brain death, \nattached to ventilator and treated with a new drug regime optimising circulation \nthereby preventing lung edema. Thirteen non-decapitated pigs (N-DC) attached \nto ventilator, supported with conventional treatment served as controls. All were \nmonitored 24h and thereafter examined with chest HRCT. Images were analysed \nby two radiologists using a pre-defined questionnaire assessing parenchymal \nand airway changes. In consensus, an overall conclusion inferred presence of \nedema, infection/atelectasis or airway pathology. Severity was estimated with a \nsubjective scale.\nResults: After 24h there were no significant differences between the groups re-\ngarding mean arterial pressure (MAP), arterial oxygen/fraction of inspired oxygen \n(PaO2/FiO2), amount of infused fluid, urine production or clinical signs of edema. \nout BOS. Lung volume (vol), mean lung density (MLD), 10 th, 20th, 30th, 40th, 50th \npercentile (P10-P50), peak, full width half maximum (FWHM), percentage of high \n(>-300 HU, HAV) and of low attenuation values (<-950 HU, LAV) were assessed \nwith dedicated software (MeVis Pulmo). Measurements of patients with/without \nBOS and patients without BOS with normal (FEV1> 90% of baseline, BOS0)/slightly \nreduced values for FEV1 (FEV1 81-90% of baseline, BOS0-p) were compared \nwith independent t-test.\nResults: Vol, MLD, P10, P20, P40, P50, peak, and FWHM (p²0.005) in expira-\ntion scan as well as difference in volume between inspiration and expiration (p < \n0.001) were significantly different in patients with/without BOS. In inspiration, P10 \n(p=0.017), FWHM (p=0.036) and LAV (p=0.026) showed significant differences at \nhigher levels. Comparing patients with BOS0 and BOS0-p, P10 might be used for \ndistinction (p=0.029).\nConclusion: Expiratory lung volume and density showed significant differences \nin patients with/without BOS. P10 value might be used as an imaging biomarker \nfor early detection of BOS.\nAuthor Disclosures:\nS. Dettmer: Grant Recipient; Integrated Research and Treatment Center \nTransplantation at Medical School Hannover. C. de Wall: Grant Recipient; \nIntegrated Research and Treatment Center Transplantation at Medical School \nHannover. H. Shin: Grant Recipient; Integrated Research and Treatment Center \nTransplantation at Medical School Hannover.\nB‑0166 14:54\nValue of density mappings in computed tomography for detection of \nbronchiolitis obliterans syndrome (BOS) \nS. Dettmer, T. Kaireit, O. Solyanik, C. de Wall, F. Wacker, H.-O. Shin; \nHannover/DE (sabine-dettmer@t-online.de) \nPurpose: The aim of this study was to prospectively evaluate the diagnostic value \nof density mappings for detection of BOS following lung transplantation.\nMethods and Materials: 132 CT examinations were carried out in lung transplant \npatients in full inspiration / expiration using a 64-row MDCT (120 kVp, rotation time \n0.8 s, pitch 0.984, collimation 1.25 mm, reconstruction increment 1 mm, standard \nreconstruction kernel). 27 / 105 examinations were performed in patients with / \nwithout BOS (BOS 0: 80, BOS 0p: 25, BOS 1: 11, BOS 2: 5, BOS 3: 11). The as-\nsessment of AT was performed using both, a threshold-based method in expiration \n(HU range: -910 HU to -850 HU) and density mappings of HU values in inspiration \nand expiration after registration applying a threshold of -910 HU to -750 HU and HU \ndifferences ² 70 HU between expiration and inspiration. With both methods, meas-\nurements of patients with / without BOS were compared with independent t-test.\nResults: AT quantified with density mappings was significantly different in patients \nwith / without BOS. Mean AT was 28% in patients with BOS and 18% in patients \nwithout BOS. Comparing patients with and without BOS AT might be used for \ndistinction (p=0.002). AT quantified with the standard threshold-based method also \nshowed differences between both groups, but with a lower significance (p=0.019).\nConclusion: Measurement of AT with density mappings of HU-values showed a \nsignificantly better distinction between patients with / without BOS than the standard \nthreshold-based method. \nAuthor Disclosures:\nS. Dettmer: Grant Recipient; Integrated Research and Treatment Center \nTransplantation at Medical School Hannover. C. de Wall: Grant Recipient; \nIntegrated Research and Treatment Center Transplantation at Medical School \nHannover. H. Shin: Grant Recipient; Integrated Research and Treatment Center \nTransplantation at Medical School Hannover.\nB‑0167 15:03\nFeasibility of krypton ventilation for CT imaging of lung ventilation: \npreliminary animal data \nA.H. Mahnken1, G. Jost2, H. Pietsch2; 1Marburg/DE, \n2Berlin/DE (mahnken@med.uni-marburg.de) \nPurpose: To assess the feasibility and safety of krypton ventilation imaging by \nintra-individual comparison to xenon ventilation CT.\nMethods and Materials: Seven male New Zealand white rabbits (4.4-6.0 kg) were \nincluded in this study. After intubation and mechanical ventilation unenhanced CT \nscans were obtained in end-inspiratory breath-hold. Thereafter, xenon (30%) and \nkrypton (70%) ventilation CT was performed in random order. After 2-minute wash-\nin of gas “A” CT imaging was performed (128x0.6 mm; 80 kV; 140 mAseff). After \na 30-minute wash-out period and another 2-minute wash-in of gas “B” another CT \nscan was performed using the same scan protocol. Heart rate and oxygen saturation \nwere measured. Unenhanced and krypton or xenon data were registered and sub-\n\nScientific Sessions\nS185\nA\n C D E F G\nB\nThursday\nPCa was detected. In the follow -up no new PCa was diagnosed and the surveil-\nlance rate of patients with a detected PCa was 100%.\nConclusion: Combined mpMRI and MRGB is feasible, improves diagnostic ac-\ncuracy and obviates false-negative biopsies for early diagnosis of PCa. \nB‑0172 14:18\nMRI-guided biopsy of the prostate: evaluation of patient acceptance \nand adverse effects \nT. Franiel, N. Egbers, C. Schwenke, A. Maxeiner, C. Stephan, B. Hamm; \nBerlin/DE (tobias.franiel@charite.de) \nPurpose: To evaluate the acceptance, adverse effects, and complications of \nprostate biopsy guided by magnetic resonance imaging (MRI-GB) compared with \nbiopsy guided by transrectal ultrasound (TRUS-GB).\nMethods and Materials: Fifty-four men with persistent suspicion of prostate cancer \nand at least one negative TRUS-GB underwent MRI of the prostate in the setting \nof a prospective clinical study. Subsequently, targeted biopsy of suspicious areas \nwas performed using MRI guidance (range of biopsy specimens, 1-9). One week \nafter outpatient MRI-GB, patients were administered a questionnaire by telephone. \nThe questionnaire items included pain intensity compared with prior TRUS-GB \nperformed in accordance with current guidelines, haematuria, hemospermia, rectal \nbleeding, fever, chills, and other complications. Finally, patients were asked for an \noverall assessment with regard to the preferred biopsy procedure.\nResults: MRI-GB was preferred by 65% (35/54) of the patients, and 82% (44/54) \nstated that they would undergo MRI-GB again. Pain intensity and duration of \nbleeding were significantly lower for MRI-GB compared with TRUS-GB (p < 0.01). \nHaematuria was the most common side effect of both biopsy methods (MRI, 59%; \nTRUS, 80%). Complications of MRI-GB were arterial bleeding and infection with \nfever in one case each. After TRUS-GB, epididymitis developed in one case and \ninfection with fever in two cases.\nConclusion: Patients prefer MRI-GB of the prostate to TRUS-GB due to lower \npain intensity and fewer side effects, indicating that MRI-guided biopsy is a suit-\nable option for patients with persistent suspicion of prostate cancer after prior \nnegative TRUS-GB.\nAuthor Disclosures:\nB. Hamm: Advisory Board; Siemens, BAYER.\nB‑0173 14:27\nMRI+US fusion-guided prostate biopsy and ablation \nH. Amalou, S. Xu, P. Pinto, B. Wood; Bethesda, MD/US (amalouh@cc.nih.gov) \nPurpose: To demonstrate status of clinical trial using fusion guidance for IR pro-\ncedures and show the feasibility of MRI + ultrasound fusion guidance for prostate \nbiopsy and laser ablation.\nMethods and Materials: Over 600 patients underwent fusion-guided biopsy of \nthe prostate based upon pre-procedural MRI imaging and PSA suspicion. Fusion-\nguided laser ablation was studied in custom phantoms with CT, MRI, and ultrasound \nconfirmation of laser ablation zones.\nResults: Fusion guidance significantly increased the cancer detection rate versus \nrandom blind sextant biopsy alone. Gleason scores correlated with imaging findings. \nBiopsy locations could be mapped to specific locations on the MRI for later use in \npatients undergoing watchful waiting. Laser ablation can be performed accurately \nwith ultrasound guidance and with MRI + ultrasound guidance without requiring \nthe physical presence of the MRI gantry.\nConclusion: Fusion guidance for focal prostate biopsy adds value for certain \nprostate cancer patients and prostate cancer thermal ablation with laser can be \nguided by fusion imaging without an MRI gantry. \nAuthor Disclosures:\nH. Amalou: Patent Holder; NIH may own IP in the field. Research/Grant \nSupport; Cooperative research and development agreement NIH and Philips \nHealthcare. S. Xu: Patent Holder; NIH may hold IP in the field. Research/\nGrant Support; NIH and Philips Healthcare have a cooperative research and \ndevelopment agreement. P. Pinto: Patent Holder; NIH may have IP in the field. \nResearch/Grant Support; NIH and Philips have a cooperative research and \ndevelopment agreement. B. Wood: Patent Holder; NIH may have intellectual \nproperty in the field. Research/Grant Support; NIH and Philips Healthcare have \na cooperative research and development agreement.\nBoth groups showed parenchymal changes in a comparable extent (consolidation in \n6/11 (DC) and 10/13 (N-DC) and GGO in 6/11 (DC) and 9/13 (N-DC), respectively). \nOverall conclusion appraised the presence of oedema in 2/11 (DC) but none of the \nN-DC pigs, signs of old/ recent infection in 6/11 (DC) and 7/13 (N-DC) and possible \nhypersensitive pneumonitis in 1/13 (N-DC).\nConclusion: After 24h, there were no significant differences in clinical and imaging \nfindings between the groups supporting the successful hemodynamic optimising \nwith the new drug regime. HRCT allows evaluation of pre-transplant lungs. \n14:00 - 15:30 Room D2 \nInterventional Radiology \nSS 209 \nAblation and biopsy of the prostate and the kidney \nModerators: \nJ.J. Fütterer; Nijmegen/NL \nJ. Kettenbach; Berne/CH \nB‑0170 14:00\n1.5 T magnetic resonance-guided transgluteal biopsies of the \nprostate in patients with clinically suspected prostate cancer: \ntechnique and feasibility \nB. Bodelle, N.N.N. Naguib, K. Eichler, T.J. Vogl, S. Zangos; \nFrankfurt/DE (bbodelle@googlemail.com) \nPurpose: Feasibility and safety of magnetic resonance-guided prostate biopsies \n(MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic \nregions (CSRs).\nMethods and Materials: 25 men who were clinically suspected for prostate cancer \nwith elevated prostate-specific antigen (PSA) levels and at least one prior negative \ntransrectal ultrasound-guided prostatic biopsy (TRUSBx) underwent diagnostic MRI \nof the prostate. CSRs were identified and MRGBx with a transgluteal approach in a \nlarge closed-bore 1.5-T MR system were manually performed in coaxial technique. \nSuccess rate, biopsy findings, side effects, procedure time, repositioning of the \nneedle guide and the length of the biopsy channel were documented. Follow -up \nwas performed after 24 months.\nResults: 40 CSRs were detected (n=25). All MRGBx procedures were technically \nsuccessful. Biopsies per CSR: 3.3±1.5 (range, 1-7). Histopathological analysis: \nadenocarcinoma in 35% (14 of 40), acute or chronic prostatitis in 30% (12 of 40), \nadenofibromyomatous changes in 22.5% (9 of 40) and no identifiable pathology \nin 17.5% (7 of 40) of CSRs. Pathological overlap for chronic prostatitis and ad-\nenofibromyomatous changes in one patient with biopsies in 2 CSRs. No missed \nprostate cancer after MRGBx in follow-up. Mean procedure time was 31±7 minutes \n(range, 21-46 minutes). Side effects were hematuria (n=7), hematospermia (n=3), \ncombined hematuria/-spermia (n=2), infection (n=1).\nConclusion: MRGBx with a transgluteal approach is feasible, safe and a promising \ntechnique for histological clarification of prostate cancer in patients with elevated \nPSA after negative TRUSBx. MRGBx offers a reasonable alternative to repeated \nTRUSBx for clarification of prostate cancer.\nB‑0171 14:09\nMagnetic resonance-guided biopsy (MRGB) in combination with \nmultiparametric MRI (mpMRI) after negative transrectal guided \nultrasound (TRUS) biopsy of the prostate \nS. Polanec, T. Helbich, K. Pinker-Domenig, S. Leitner, P. Brader; Vienna/AT \nPurpose: The performance of mpMRI after previous negative TRUS biopsy \nresulted in a better diagnostic accuracy and has increased the opportunities for \nimage-guided techniques like MRGB. We hypothesise that MRGB obviates false-\nnegative biopsies. The purpose of our study was to demonstrate the feasibility of \ncombined mpMRI and MRGB of the prostate and to assess diagnostic accuracy.\nMethods and Materials: Forty-one patients (mean age of 65 years, range 44-75 \nyears; mean PSA level: 8.17 ng/ml, range from 0.7-30.3 ng/ml) were enrolled in this \nIRB-approved study and subjected to combined mpMRI and MRGB. All patients \nhad at least one prior negative TRUS biopsy. MRGB was performed in a closed \n1.5T MR unit and the needle was inserted rectally. All patients had a follow -up \nbetween 2 and 61 months.\nResults: Prostate cancer (PCa) was detected in 11 patients (26.9%) with a me-\ndian Gleason score of 7 (range from 6-9). The PCa occurred in nine cases in the \nperipheral zone and one in the transition zone and central zone. In 30 patients no \n\nScientific Sessions\nS186\n C A D E F\n G\nB\nResults: RFA was technically possible for all patients. Mean follow -up was 38.8 \nmonths (range : 18-78 months). Primary and secondary technique effectiveness \nwere 95.2 and 98.4% per patient, respectively, and one-session complete ablation \nwas obtained for all tumours smaller than 2 cm. The rates of local tumour progres-\nsion and metastasis evolution were, respectively, 3.2 and 9.7% per patient. There \nwas no difference in glomerular filtration rate from baseline before procedure at 2 \nand 6 months. The major complication rate was 5.9% per session.\nConclusion: Based on these mid-term results, percutaneous renal RFA seems to \nbe safe and effective with interesting nephron-sparing results. \nB‑0177 15:03\nRetrospective study of renal tumors treated with radio frequency \nablation at Uppsala University Hospital since 2007: which factors \naffect ablation results? \nV. Acosta Ruiz, A. Magnusson, P. Dahlman, E. Brekkan, M. Lönnemark; \nUppsala/SE (vanessa.acosta_ruiz.6628@student.uu.se) \nPurpose: To identify the factors leading to complete tumor ablation. Our hypothesis \nwas that electrode placement and tumor size could be factors that affected ablation \nsuccess. Radio frequency ablation is a relatively new method used for treatment \nof renal masses. Several studies have identified factors that affect ablation results; \nlarger (> 3 cm) and centrally located tumors are more often prone to recurrence.\nMethods and Materials: 52 percutaneous CT guided RFA treated renal tumors \nwere retrospectively studied. Patients were followed up with contrast-enhanced \nCT scans at 3, 6, 12 months and yearly after treatment. Collection of data included \npatient demographics, tumor data (detection method, renal anatomical position, \nhistopathological diagnosis, size), RFA treatment data (electrode placement) and \nfollow-up results (tumor relapse). Data was statistically analyzed using the Mann \nWhitney and Fischer’s exact tests.\nResults: After a first ablation session 75% tumors were completely ablated. \nReablation of incompletely ablated tumors increased total success rate to 85%. \nIncompletely ablated tumors had a greater median tumor diameter, a shorter mean \ndistance to the collecting system and a greater percentage of clear cell carcinomas \nin comparison to completely ablated tumors. Electrode placement was more often \ncategorised as optimal for the complete (92%) than the incomplete ablated tumor \ngroup (60%).\nConclusion: Small tumor size (< 3 cm), optimal electrode placement and a long \ndistance to the collecting system (> 10 mm) seem to be factors that increase the \nfrequency of complete ablation. These variables may be useful to assess in the \nfuture when considering potential patients for RFA. \nB‑0178 15:12\nIrreversible electroporation (IRE) of the pig kidney with involvement \nof the renal pelvis - technical aspects, clinical outcome and 3d lesion \nanalysis \nC.M. Sommer, M.F. Wachter, S. Fritz, D. Vollherbst, U. Stampfl, N. Bellemann, \nT. Gockner, T. Mokry; Heidelberg/DE (christof.sommer@med.uni-heidelberg.de) \nPurpose: To evaluate irreversible electroporation (IRE) of the pig kidney with \ninvolvement of the renal pelvis.\nMethods and Materials: IRE was performed with a commercial system. In 10 \nkidneys of 5 pigs, 1 or 2 IRE (s) of the central renal tissue with involvement of the \nrenal pelvis was/were performed. Different applicator configurations were used: 2 \napplicators (n=11; I), 3 applicators (n=2; II) or 6 applicators (n=3; III). One hour after \nIRE, pigs underwent contrast-enhanced CT with subsequent sacrifice. Technical \naspects (applicator spacing, tip exposure), clinical outcome (complications, blood \nsamples) and 3d lesion analysis (short axis, volume, circularity) were performed.\nResults: Applicator spacing and tip exposure were 14.3±2.8 mm and 20 mm in \nI, 12.3±1.9 mm and 20 mm in II, and 16.4±3.5 mm and 30 mm in III, respectively. \nIn III, 2 small perirenal haematomas were identified. Damage to pelvic structures \nwas not observed on CT and gross pathology. Before and within 1 hour after IRE, \ncreatinine, haemoglobin, white blood cell count, creatine kinase MB, pulse rate, \nmean arterial blood pressure and ECG were not significantly different. Lesion short \naxis and volume were 20.6±3.6 mm and 5.4±1.8 cm3 in I, respectively, 31.9±8.2 mm \nand 12.2±5.5 cm3 in II, and 39.3±2.4 mm and 68.8±10.0 cm3 in III with significant \ndifferences (p < 0.01 and p < 0.01). Circularity was 0.8±0.2 (0.6-0.9) in I, 0.7±0.1 \n(0.6-0.9) in II, and 0.7±0.1 (0.6-0.8) in III without significant differences.\nConclusion: IRE of the pig kidney with involvement of the renal pelvis is feasible \nand safe. There is no negative impact on the clinical outcome. Lesion size is \nsignificantly different depending on applicator configuration. \nB‑0174 14:36\nNon-invasive focal therapy of organ confined prostate cancer: \nphase I study using magnetic resonance guided focused ultrasound \ntechnology and excision pathology for efficacy assessment \nA. Napoli, V. Panebianco, M. Anzidei, F. Boni, V. Noce, L. Bertaccini, \nG. Cartocci, F. Ciolina, C. Catalano; Rome/IT (alessandro.napoli@uniroma1.it) \nPurpose: To assess safety and initial effectiveness of non-invasive high-intensity 3 \nT MR-guided focused Ultrasound (MRgFUS) treatment of localised prostate cancer \nin a phase I, treat and resection designed exploratory study.\nMethods and Materials: On the basis of a power analysis, 11 patients with biopsy-\nproven focal T2 prostate cancer (low-to-intermediate risk: Gleason max 3+4), \nconfirmed on a previous multiparametric MR exam, including dynamic contrast \nenhanced (DCE) imaging, underwent MRgFUS. All patients were scheduled to \nlaparoscopic prostatectomy; MRgFUS treatment was carried out on MR identifi-\nable lesions (max 2) using a patient-specific energy and real-time MR thermometry \nmonitor for correct location. Non-perfused volume (VPV) in the post-ablative MRI \nwas than compared with excision pathology for necrosis assessment.\nResults: No significant complications were observed in all subjects during or \nimmediately after the procedure. Procedure was validated by pathologist that \ndemonstrated extensive coagulative necrosis at the site of sonication surrounded \nby normal prostatic tissue with inflammatory changes; these features positively \ncompared with immediate post-ablative MRI scan and NPV. At histology 10 pa-\ntients were free of residual viable tumour within the treated area; in the remaining \npatient, 10% of residual tumour was observed within the NPV. There was a variable \namount of isolated cancer tissue within non-treated parenchyma that was identifi-\nable neither at MRI nor at biopsy.\nConclusion: Conclusion Results of our Phase I study suggest MRgFUS ablation \nas a safe and effective modality to determine > 90% necrosis of identifiable prostate \ncancer; other prospective studies are needed to extend success rate in larger cohort. \nB‑0175 14:45\nTechnical challenges, pitfalls and obstacles on performing prostatic \nartery embolisation for benign prostatic hyperplasia \nH.A.M.R. Rio Tinto, T. Bilhim, L. Fernandes, J. Pereira, J.M. Pisco; Lisbon/PT \nPurpose: To evaluate the pre-embolisation workup and the safety of prostatic arte-\nrial embolistion (PAE) for prostatic benign hyperplasia (BPH) and its implications \nduring and after the procedure.\nMethods and Materials: Our patient evaluation includes clinical history and ex-\namination, severity of low urinary tract symptoms with IPSS, quality of life (QoL), \nerectile/sexual function, uroflowmetry, digital examination, transrectal ultrasound \nand PSA. An Angio-CT (CTA) is performed in patients within the inclusion criteria \nto assess vascular anatomy. We selectively catheterise the prostatic artery and \nembolise. The end points are near stasis in prostatic vessels and obliteration of \nprostatic artery supply observed in the control angiogram. Follow -up of clinical \nparameters is performed at one, three and six months, one and two years.\nResults: In more 300 cases performed by now we achieved technical success in the \nlarge majority of patients with a clinical failure of about 20-30%. In more than 95% \nof cases we find a very good correlation between the anatomical data obtained with \nCTA and digital subtraction angiography (DSA). In more than 50% of cases we found \nimportant anastomosis with direct implications during the embolisation procedure.\nConclusion: PAE is a challenging and safe procedure to treat benign prostatic \nhyperplasia. Clinical evaluation and CTA are essential as pre-embolisation workup. \nB‑0176 14:54\nMid-term results of percutaneous image-guided radiofrequency \nablation of renal tumours \nP. Balageas, F. Cornelis, Y. Le Bras, J.-M. Ferrière, A. Ravaud, N. Grenier; \nBordeaux/FR (balageaspierre@gmail.com) \nPurpose: To evaluate the mid-term survival and outcomes after radiofrequency \nablation (RFA) of renal tumours.\nMethods and Materials: Institutional review board approval was obtained for this \nsingle institution retrospective study; informed patient consent was not required \naccording to local laws. Between 2002 and 2009, 93 patients (112 tumours), with \na median age of 73.5 years (20-87), consecutively treated with percutaneous ra-\ndiofrequency ablation under US or CT-guided were selected from our institutional \ndatabase. After a subset analysis, 62 patients (71 tumours) meet the inclusion \ncriteria for survival and oncological efficacy including 25 patients (40.3%) with \nsolitary kidney and 7 cystic cancers. Maximal tumour diameters were between 8 \nto 46 mm (median: 23 mm).\n\nScientific Sessions\nS187\nA\n C D E F G\nB\nThursday\nB‑0181 14:09\nDo sagittal and coronal alignment of the hindfoot change in upright \nweight-bearing position? Comparison of upright weight-bearing and \nsupine non-weight-bearing computed tomography \nA. Hirschmann, C.W.A. Pfirrmann, N. Espinosa, G. Klammer, F.M. Buck; \nZurich/CH (anna.hirschmann@balgrist.ch) \nPurpose: To prospectively quantify changes in the coronal and sagittal alignment \nof the hindfoot between upright weight-bearing computed tomography (WBCT) \nand supine non-weight-bearing CT (NWBCT).\nMethods and Materials: Institutional Review Board approval and informed consent \nof all patients were obtained. WBCT and NWBCT scans of the foot were obtained \nof 22 patients (8 women, 14 men; median age 46 years, range 19-75 years) us-\ning a conventional 64-row CT unit (Philips Brilliance 64, Best, Netherlands) for \nNWBCT and a novel cone-beam extremity CT for WBCT (Verity, Planmed, Helsinki, \nFinland). Two musculoskeletal radiologists independently performed the following \nmeasurements: hindfoot alignment angle (HFA); fibulocalcaneal (FCD) and medial \ntalocalcaneal (TCD) distance in the coronal plane; talocalcaneal overlap (TCO), \nnaviculocalcaneal distance (NCD) in the sagittal plane. Significant changes between \nWBCT and NWBCT were sought using Wilcoxon signed-rank test. A p value of < \n0.05 was considered statistically significant.\nResults: Significant differences were found for all measurements between WBCT \nand NWBCT. Measurement results were as follows (WBCT/NWBCT): HFA (median \n20.2°/19.5° valgus, range 4.9-84.0°/-1.3°-53.0°, mean difference 6.3°, p = 0.036), \nFCD (median 0 cm/0.4 cm, range -1.2-1.1 cm/-0.8-1.5 cm, mean difference 0.4 \ncm, p = 0.001), TCD (median 0.2 cm/0.3 cm, range 0.1-0.6 cm/0.1-0.7 cm, mean \ndifference 0.1 cm, p = 0.004), TCO (median 0.1 cm/0.5 cm, range -0.3-1.1 cm/-0.3-\n2.1 cm, mean difference 0.4 cm, p = 0.001), NCD (median 1.6 cm/2.9 cm, range \n0.8-2.9 cm/0.7-2.2 cm, mean difference 0.3 cm, p = 0.007).\nConclusion: Sagittal and coronal alignments of the hindfoot significantly change \nin upright weight-bearing position. Differences can be visualised and measured \nusing WBCT.\nB‑0182 14:18\nMRI in plantar plate disease evaluation: diagnostic value of ‘stress test’ \nC. Ottonello, I. D’Ambrosio, P. Giuliani, P. Ronconi; Rome/IT \n(ottonello@seram.org) \nPurpose: To evaluate the role of MRI, even in joint hyperextension, “stress test” \n(ST), in the study of plantar plate (PP) disease.\nMethods and Materials: 20 patients (10 symptomatic, 58.7 ± 9.4 years, 10 \nasymptomatic, 59.5 ± 10.0 years) performed MRI (Artoscan, Esaote, Genoa, Italy), \nin standard position and with ST. Adjacent flexor tendon was also evaluated. All \nsymptomatic patients were subjected to surgery.\nResults: Asymptomatic patients: 1/10 was positive for PP disfunction (dorsal \nsubluxation demonstrated only on ST), without plantar plate tear. Symptomatic \npatients: 6/10 demonstrated plantar plate tear/disfunction on standard MRI and \non ST, 2/4 negative for PP tear on standard examination showed the lesion only \non ST, 2/4 negative for PP tear both on standard examination and ST showed \ndorsal subluxation on ST due to microinstability for plantar plate failure, without \ntear. Surgical revision confirmed the plantar plate tear in MRI positive cases (on \nMRI standard and/or on ST); in the 2 MRI negative cases surgery confirmed PP \nlaxity without tear. No significant flexor tendons tear in 20/20.\nConclusion: Standard RM reported in asymptomatic patients specificity 100% \nand high NPV (90%), incremented by the ST (NPV and specificity 100%). In \nsymptomatic patients PP evaluation on standard MRI reported sensitivity 50%, \nwhile ST increased sensitivity to 100%; in the evaluation of dorsal subluxation of \nmetatarsophalangeal joint, the sensitivity was 60% (standard RM) but reached \n100% with ST. Therefore, ST would seem to significantly increase MRI diagnostic \naccuracy in the evaluation of PPD. \nAuthor Disclosures:\nC.M. Sommer: Research/Grant Support; This study was technically and \nfinancially supported by AngioDynamics® Inc., Queensbury, USA. S. Fritz: \nResearch/Grant Support; This study was technically and financially supported by \nAngioDynamics® Inc., Queensbury, USA.\nB‑0179 15:21\nRetrograde ureteral stent exchange: comparison between the direct \ngrasping and the simple snare technique \nR. Cazzato, R. Grasso, G. Luppi, E. Faiella, R. Del Vescovo, F. Giurazza, \nB. Beomonte Zobel; Rome/IT (r.cazzato@unicampus.it) \nPurpose: To compare the modified-snare (MS) technique and the direct-grasping \n(DG) technique during retrograde exchange of double-J ureteral stent under \nfluoroscopic guidance.\nMethods and Materials: 44 patients (24 men, 20 women; mean age, 68.9 years; \nrange, 40-85 years) were included. Ureteral obstructions were due to compression \nby pelvic malignancies. All stents had been previously placed via an anterograde \napproach through percutaneous nephrostomy sites. Stents were retrieved by either \nthe MS or the DG technique. Time needed to grasp each single stent was recorded. \nFisher’s test was performed to compare procedural time with both techniques. A \np value < 0.05 was considered significant.\nResults: A total of 68 ureteral stents were successfully exchanged in 44 patients. \nAll stents were successfully externalised either with the MS technique (42 stents \nin 28 patients) or with the DG technique (26 stents in 16 patients). The mean time \nneeded to retrieve a ureteral double-J stent was 4.4 min (range, 3-7 min) for the \nDG technique and 7.8 min (range, 4-12 min) for the MS technique (p = 0.029).\nConclusion: Compared to the MS technique, the DG technique is an easier, \nquicker and less expensive technique for retrograde exchange of ureteral stents.\n14:00 - 15:30 Room E1 \nMusculoskeletal \nSS 210 \nLower limb: tricks for improved imaging \nModerators: \nA. Klauser; Innsbruck/AT \nL.M. Sconfienza; Milan/IT \nB‑0180 14:00\nMR imaging of articular cartilage at the ankle: utility of axial traction \nJ.S. Bauer, P. Jungmann, C. Schäffeler, M. Sauerschnig, A. Mann, T. Baum, \nE.J. Rummeny, K. Wörtler; Munich/DE \nPurpose: To determine the impact of axial traction during MR imaging of the ankle \ncartilage at 3.0 T in volunteers with respect to motion artefacts, image quality and \ncartilage surface delineation.\nMethods and Materials: Optimised coronal and sagittal T1-weighted (w) turbo \nspin echo (TSE) sequences with a DRIVE pulse (in-plane spatial resolution 0.21 \nmm), a sagittal fat-saturated intermediate-weighted (IMfs) TSE sequence and a \n3D gradient echo sequence were acquired at 3.0 T in 8 volunteers with and with-\nout axial traction of 6 kg. Joint space width was measured at four locations in the \ntibiotalar joint. Motion artefacts, general image quality, delineation of the cartilage \nsurface, cartilage matrix and the confidence of diagnosing cartilage pathology \nwere evaluated independently by two radiologists. Differences were assessed \nusing a Wilcoxon test.\nResults: With axial traction, joint space width increased significantly (1.7±0.5 mm \nvs. 0.3±0.2 mm). Consequently, delineation of the cartilage surface was rated su-\nperior in 7/8 volunteers (p < 0.05). No differences were found in motion artefacts, \ngeneral image quality, and artefacts within the cartilage matrix (p> 0.1). Comparing \nthe different sequences, Cartilage surface and matrix was best visualised by the \nT1-w TSE sequences with a DRIVE pulse (surface average of all regions and read-\ners in sag T1-DRIVE vs. IMfs on a four-point scale 1.3±0.6 vs. 3.0±1.0, p < 0.05).\nConclusion: Axial traction of 6 kg increases the joint space width at the tibiotalar \njoint, and thus better visualises the articular cartilage surface. Highest spatial \nresolution and visualisation of both cartilage surface and matrix were achieved by \na T1-w TSE sequence with a DRIVE pulse. \n\nScientific Sessions\nS188\n C A D E F\n G\nB\nResults: All affected subjects were women between 14 and 52 years old (mean age: \n40). Ischiofemoral space was significantly narrower in patients with ischiofemoral \nimpingement when compared with control subjects (13.1 ± 4.06 mm vs 24.9 ± \n4.55 mm, respectively; p < 0.01). Quadratus femoris space was also significantly \nnarrower in affected subjects (9.4 ± 2.97 mm vs 16.4 ± 1.08 mm; p < 0.01). Incli-\nnation angle was not statistically different (p> 0.05). The degree of oedema and \nfatty infiltration was inversely proportional to values of ischiofemoral and quadratus \nfemoris space. The interobserver agreement (ĸ) was 0.8 for ischiofemoral space, \n0.63 for quadratus femoris space and 0.53 for inclination angle.\nConclusion: Ischiofemoral impingement can be accurately diagnosed following \nanatomic and imaging MR criteria. \nB‑0186 14:54\nUS-guided viscosupplementation of the hip: therapeutic efficacy in \npatients affected by femoro-acetabular impingment \nC. Martini1, F. Lacelli2, E. Fabbro1, G. Ferrero1, G. Serafini2; 1Genoa/IT, \n2Pietra Ligure/IT (chiarapio@libero.it) \nPurpose: US-guided viscosupplementation is a safe and effective therapy for symp-\ntomatic osteoarthritis (OA) of the hip and it allows to replace NSAIDs therapy and \nto delay prosthetic intervention. Femoro-acetabular impingement (FAI) is a cause \nof OA. The purpose of this work is to evaluate the efficacy of viscosupplementation \nas therapy of OA in patients affected by femoro-acetabular impingement.\nMethods and Materials: 352 patients selected by orthopaedists for hip pain and \nplain films signs of OA (degrees II-IV of K-L) underwent viscosupplementation \n(4 ml of intermediate weight hyaluronic acid for three times every 30days). Each \npatient was evaluated before the treatment and 1, 3, 6 and 12 months after the \ntreatment by means of VAS and Oxford Score. Hence, these patients were divided \ninto responsive (increase Oxford score=/> 10 and/or reduction VAS0/> 3) and \nnon-responsive (increase Oxford score< 10 and/or reduction VAS0< 3). Then we \nretrospectively evaluated the plain films of the hip these patients had done before \nthe therapy, in order to find the signs of FAI.\nResults: 281/352 (79.8%) patients were included into the “responsive” group; \n71/352 (20.2%) in the “non-responsive” one. In the “responsive” group we found \nsigns of FAI on the plain films of 37/281 patients (11.4%); in the “non-responsive” \nin 43/71 (60.5%).\nConclusion: Despite viscosupplementation is an effective therapy of OA, there is \nan high prevalence of non-responsive among patients affected by FAI.\nB‑0187 15:03\nA new way to measure lower limb length and alignment using 3D \nmodels based on biplanar linear radiography: a comparison with \nmeasurements on supine CT scans and upright full-length radiographs \nR. Guggenberger, C.W. Pfirrmann, P. Koch, F. Buck; Zurich/CH \n(romanguggenberger@yahoo.de) \nPurpose: To compare lower limb length and alignment angle on supine computed \ntomography (CT), upright full-length radiography (UFR) and 3D models based on \nupright biplanar radiography (BLR).\nMethods and Materials: IRB-approved study involving 51 consecutive patients (22 \nmale, 29 female; mean age 68.8years; range 43-92years) scheduled for total knee \nreplacement. Lower limb length and alignment angles were measured on CT, UFR \nand 3D models based on BLR using standard and extended length measurements \nby two independent readers. Measurements of different modalities were compared \nby paired t-tests, Pearson correlation coefficients and Bland-Altman analyses.\nResults: Mean limb lengths were 783 mm (SD±56.1 mm, range 639-927 mm), \n785 mm (SD±53.0 mm, 655-924 mm), 780 mm (SD±55.4 mm, 633-921 mm) and \n783 mm (SD±55.9 mm, 636-924 mm) for CT, UFR and 3D models using standard \nand extended measurements, respectively. Mean alignment angles were 2.3° \n(SD±5.5°, range -12°-20°), 2.5° (SD±6.7°, -17°-18°), 3.4° (SD±6.6°, -14°-18°), \nrespectively. Length and angle measurements differed significantly when comparing \nstandard 3D models to CT and UFR, respectively (p < 0.001). Pearson correlation \ncoefficients were 0.992, 0.993, 0.995 and 0.998 for limb length and 0.968, 0.983 \nand 0.984 for angle measurements in CT, UFR and 3D models, respectively. \nBland-Altman analyses for CT and UFR compared to 3D models showed a small \npositive mean difference in length using standard measurements (2.7 mm, SD±5.5; \n5.4 mm, SD±13.1) and a small negative mean difference in angle measurements \n(-1.1°, SD±2.5; -0.9°, SD±3.1). No bias for length measurements was seen using \nextended measurements.\nConclusion: Upright 3D models allow for lower limb length and alignment angle \nmeasurements comparable supine CT scans and UFR. \nB‑0183 14:27\nStable or unstable tear of the medial meniscus of the knee: can \nweight-bearing MRI solve the problem? \nA. La Marra, S. Mariani, E. Costantini, A. Conchiglia, A. Barile, C. Masciocchi; \nL’Aquila/IT (alicelm@hotmail.it) \nPurpose: To assess the role of 1.5 T, dedicated low-field standard and upright-MRI \nin the evaluation of stable or unstable tears of medial meniscus in comparison \nwith arthroscopy.\nMethods and Materials: We retrospectively reviewed and analysed 20 MRI exams \n(group A) of normal knee and 77 MRI exams (group B) of knee with clinical evidence \nof tears of the medial meniscus. In the same session, after conventional 1.5 T and \n“dedicated” 0.27T supine MRI exam, the patients underwent upright weight-bearing \nexamination with the same dedicated MRI unit. In all cases sagittal and coronal SE \nT1-W were used. All patients underwent arthroscopy within 21 days from MRI exam.\nResults: In group A, no statistically significant anatomical modifications of shape, \nintensity and position of the medial meniscus between standard 1.5 T, dedicated \nsupine and upright MRI were observed. In group B, the images acquired in the \nsupine position (dedicated and 1.5 T MRI) documented in 31 cases a traumatic tear \n(group B1) and in 46 cases a degenerative tear (group B2). In group B1, weight-\nbearing MRI showed presence of unstable tear only in 19 out 31 cases. In group \nB2, weight-bearing MRI showed a degenerative unstable meniscal tear only in 29 \nout of 46 cases. Arthroscopy confirmed weight-bearing MRI diagnosis in all cases.\nConclusion: Our preliminary results show that upright weight-bearing MRI has \nwide potentials for the study of dynamic modifications in case of meniscal stable \nor unstable tear.\nB‑0184 14:36\nPeriosteal high volume image-guided injection of recalcitrant medial \ncollateral ligament injuries: a retrospective case series analysis \nO. Drumm, O. Chan, P. Malliaras, D. Morrissey, N. Maffulli; London/UK \n(odrumm@yahoo.co.uk) \nPurpose: We evaluate a novel injection method, periosteal high volume image-\nguided injection, in the management of recalcitrant medial collateral ligament \n(MCL) injury of the knee.\nMethods and Materials: The injection, comprising 10 ml of local anaesthetic with \n25-50 mg of hydrocortisone, is directed at the periosteal attachment of the MCL. 28 \npatients in total received the intervention between June 2009 and November 2011 \nat a London hospital. Each was asked to complete a study-specific questionnaire \nincluding a visual analogue scale (VAS) and the International Knee Documenta-\ntion Committee (IKDC) subjective knee form (to describe symptoms pre-injection \nand at follow-up).\nResults: 68% of patients responded (n=19). Three patients were omitted accord-\ning to the exclusion criteria. 31.3% of patients (n=5) were professional athletes. \nMean duration of symptoms was 5.4 (SD=6.6) months. Patients reported a mean \nimprovement on the VAS of 75.4% (SD=23.7). There was a significant improvement \nin IKDC scores (mean difference of 42%, SD=14.2) pre- and post-injection (p=0.01). \n62.5% of patients (n=10) had returned to their previous level of sport at follow-up \nincluding all the professional athletes. Knee symptoms returned to normal in 50% \n(n=8), and improved substantially in a further 37.5% (n=6). The remaining 12.5% \n(n=2) experienced an initial improvement but symptoms recurred.\nConclusion: Periosteal high volume image-guided injection is a useful treatment \nfor recalcitrant MCL injury, a common sports injury that can result in lengthy periods \nof missed training and competition. Results are encouraging, particularly amongst \nthe professional athletes studied.\nB‑0185 14:45\nIschiofemoral impingement, do you want to believe? \nR. Prada, R. Oca, A. Rocha, L. Fernández, M. Costas, G. Tardáguila; Vigo/ES \n(roqueoca@hotmail.com) \nPurpose: To find out if there are anatomic and imaging MR criteria to diagnose \nischiofemoral impingement.\nMethods and Materials: 290 MRIs of the hip were retrospectively reviewed from \nAugust 2011 to September 2012. A total of 9 ischiofemoral impingement were \ndiagnosed and 20 normal patients were included as control. Ischiofemoral space, \nquadratus femoris space and femoral inclination angle were measured independ-\nently by two blinded musculoskeletal radiologists. The degree of oedema and fatty \ninfiltration in the quadratus femoris muscle were also assessed visually. Differences \nin ischiofemoral space, quadratus femoris space and femoral inclination angle were \nstudied between pathological and control cases. The interobserver reliability was \nobtained for quantitative variables.\n\nScientific Sessions\nS189\nA\n C D E F G\nB\nThursday\n14:00 - 15:30 Room E2 \nGI Tract \nSS 201a \nBowel imaging: protocol optimisation and \nintervention \nModerators: \nV. Cantisani; Rome/IT \nP. Popovic; Ljubljana/SI \nB‑0190 14:00\nAbdominal and pelvic CT: is positive enteric contrast still \nnecessary? Preliminary results of a clinical investigation \nS. Kammerer, A. Knauer, B. Buerke, C. Schuelke, W.L. Heindel, J. Wessling; \nMünster/DE (sara.kammerer@ukmuenster.de) \nPurpose: Evaluating diagnostic accuracy in abdominal CT depending of enteric \npreparation with positive, neutral and without contrast.\nMethods and Materials: Abdominal MSCT (1.5 mm slice thickness, 85 seconds \nscan delay) of the first 1000 patients were included. Patients were classified into \nthree groups: A. positive enteric contrast with barium sulphate (n=351), B. neutral \nenteric contrast with mineral water (n=373) and C. without any enteric contrast \n(n=276). Independent evaluation by two radiologists included segmental delineation \nof the intestine and the influence of enteric preparation on diagnosis and reliability \nusing three-point confidence scales. Furthermore, confidence for delineation of \ndedicated enteric pathologies (stratification, etc). was noted. For statistical analysis \ndatasets were assigned to five groups: oncology, inflammation, vascular, trauma \nand GI-pathology using appropriate methods.\nResults: Overall, there was no difference for segmental delineation from duodenum \nto rectum between patients with positive, neutral and without enteric contrast (p> \n0.05). The influence of enteric contrast on diagnosis was rated low in all groups (no \ninfluence; 976/1000, p> 0.05). Inferior performance was observed in a subgroup of \n32 patients with mesenteric abscesses and fistulas prepared with neutral or without \nenteric contrast. In 177/1000 examinations specific pathologic enteric findings were \nobserved with no statistical difference between the three groups.\nConclusion: The preliminary results suggest that positive enteric contrast may be \nreplaced by neutral water in abdominal and pelvic CT, whereas no enteric contrast \npreparation seems to be inferior. However, positive enteric contrast should be further \napplied in patients with suspected extramural inflammatory disease.\nB‑0191 14:09\nValue of oral effervescent powder administration for multidetector \nCT evaluation of the oesophagus \nK.I. Ringe, S. Meyer, F. Wacker, H.-J. Raatschen; \nHannover/DE (ringe.kristina@mh-hannover.de) \nPurpose: To assess the value of oral effervescent powder administration for CT \nevaluation of the oesophagus, quantitatively and qualitatively.\nMethods and Materials: 42 patients (27m/15f, mean age 57y) referred for thoraco-\nabdominal staging CT were included in this prospective IRB-approved study. \nContrast-enhanced imaging was performed on a 64-slice CT-scanner after oral \nadministration of 3 g effervescent powder immediately before image acquisition. \nOesophageal distension was assessed at three levels (proximal/middle/distal) \nby volumetry of the inner (ID) and outer diameter (OD). Two blinded readers \nseparately evaluated oesophageal distension in the corresponding segments on a \nthree-point scale. At an interval of two weeks, both readers in consensus decided \non the number of diagnostic oesophageal segments in each patient in terms of \nthe possibility to decide upon a potentially underlying pathology. Findings were \ncompared with results from a matched control group. Quantitative and qualitative \nresults were compared (T-Test, Mann-Whitney U Test). Inter-observer variability \nwas calculated (weighted-Cohen-κ).\nResults: ID and OD were significantly larger in all oesophageal segments after \neffervescent powder administration as compared to the control group (p < 0.05; \nmean ID: 1.13 vs. 0.14, mean OD: 2.17 vs. 1.26). Further, oesophageal distension \nwas rated significantly better, with a good inter-observer variability (mean weighted \nκ=0.75). At consensus evaluation, 93 oesophageal segments (74%) were rated \nas diagnostic in the effervescent group, versus 49 segments (38%) in the control \ngroup (p < 0.0001).\nConclusion: Correctly timed oral administration of effervescent powder results \nin good distension of the oesophagus, allowing readily assessment of the wall \nat contrast-enhanced CT as compared to studies without effervescent powder. \nB‑0188 15:12\nDynamic contrast-enhanced MRI can assess vascularity within \npseudarthrotic clefts and predicts good clinical outcome \nM.-A. Weber1, K. Bloess1, I. Burkholder2, D. Bender1, \nG. Schmidmaier1, H.-U. Kauczor1, O. Schoierer1; 1Heidelberg/DE, \n2Zweibrücken/DE (MarcAndre.Weber@med.uni-heidelberg.de) \nPurpose: To prospectively evaluate whether dynamic contrast-enhanced (DCE) \nMRI can assess vascularity within pseudarthrotic clefts and predicts clinical outcome \nbetter than the clinical non-union scoring system (NUSS).\nMethods and Materials: Sixty-four patients (mean age, 49.3 years) with non-\nunion of an extremity fracture in computed-tomography received 3-Tesla MRI \nincluding DCE (coronal T1-weighted fat-saturated VIBE, TR/TE=3.76/1.35 ms, 17 \nmeasurements, 2 mm slice thickness) after 0.1 mmol/kg body-weight of gadoterat. \nWe assessed vascularity within the pseudarthrotic cleft using a region-of-interest \nanalysis. Signal intensity curves were subdivided into those with more intense \ncontrast-agent uptake in the pseudarthrotic cleft than in normal adjacent muscle \ntissue (vascularised non-union) and those with similar or less uptake. The pharma-\ncokinetic parameters of the Tofts model (Ktrans, Kep, iAUC, Ve) were correlated \nto the clinical outcome at one-year follow-up (n=37).\nResults: Despite inserted osteosynthesis material, DCE parameters could be \nevaluated in n=60 at first visit. Sensitivity/specificity of vascularised non-unions as \nindicator of good clinical outcome was 77.3%/46.7% compared to 95.5%/26.7% \nusing NUSS. Logistic regression revealed non-significant impact of NUSS on clini-\ncal outcome (p=0.27, odds ratio=0.97). At first examination, median iAUC (initial \narea under the enhancement curve) was 24.13 in patients with good outcome \ncompared with 10.96 in non-responders (p=0.032), while Ktrans, Kep, and Ve \nwere not significantly different. Using a receiver operating characteristic analysis, \nsensitivity/specificity of iAUC at the optimal cut-off value of 17.5 to predict outcome \nwas 68.2%/76.9%. All pharmacokinetic parameters did not change significantly at \nthe one-year control (n=18).\nConclusion: DCE MRI can assess vascularity in pseudarthrotic clefts. A vascu-\nlarised non-union indicates good clinical outcome.\nB‑0189 15:21\nOsteoidosteoma - post-procedural MR-imaging characteristics \nfollowing percutaneous MR-guided laser ablation in an open 1.0 Tesla MRI \nS. Fuchs, B. Gebauer, L. Stelter, M. Maurer, D. Renz, P. Schwabe, B. Hamm, \nF. Streitparth; Berlin/DE (simon.fuchs@charite.de) \nPurpose: Imaging-guided thermal ablation has become the therapy of choice \namong the different treatment strategies of symptomatic Osteoid Osteoma le-\nsions. In this descriptive, prospective study, our objective was to evaluate typical \npost-procedural MR-imaging characteristics following MR-guided laser ablation \nof Osteoid Osteoma.\nMethods and Materials: 35 patients with Osteoid Osteoma treated with MR-guided \nlaser ablation underwent follow -up MR-Imaging immediately after the procedure \nas well as after 3, 6, 12, 24, 36 and 48 months. Imaging protocol included fat-\nsaturated T2w SPIR TSE, non-contrast and contrast-enhanced T1w TSE images \nand subtraction images. MR images were jointly reviewed by two radiologists, \nregarding the appearance of treated areas, nidal enhancement and presence of \nside effects such as bone oedema and soft tissue enhancement. Imaging was \ncorrelated to clinical status.\nResults: Mean follow -up time was 13.9 months. 28 patients showed a post-\nprocedural target-sign appearance with subsequent “positive inward fusion” of \nthe different zonal compartments. Post-procedural MR-imaging can support \nevaluation of therapeutic success. Characteristic MR findings correlated well with \nthe clinical status.\nConclusion: Interpretation of post-procedural follow -up MR-imaging after laser \nablation of Osteoid Osteoma may contribute to understanding of histopathological \npost-therapeutic changes and cornerstones of therapeutic success. \n\nScientific Sessions\nS190\n C A D E F\n G\nB\nResults: The mean value of Dmax obtained by surgical specimen was 57.45 mm \n(range 10-250) versus 70.73 mm (range 16-195.3) of Dmax measured through \nMDCT. If the Dmax values were stratified into three groups (group 1 smaller than \n45 mm, group 2 between 45 and 80 mm, group 3 bigger than 80 mm), a correlation \nwith MDCT results of 62.22, 65.90 and 100%, respectively, was found.\nConclusion: MDCT is an accurate technique to obtain an appropriate preoperative \ndefinition of Dmax, within the limits of tumour bigger than 45 mm. The revaluation \nof each case with Dmax smaller than 45 mm will supply additional information \nabout the discrepancy (retraction of the stomach following immersion into formalin, \ndiffusion in the submucosal layer). \nB‑0195 14:45\nPercutaneous endoscopic gastrostomy (PEG) and jejunostomy (PEJ) \nplacement guided by CT fluoroscopy with or without simultaneous \nendoscopy in otherwise untreatable patients \nC.G. Trumm1, R.-T. Hoffmann2, R.A. Lang3, H. Winter1, R. Weidenhagen1, \nK.-W. Jauch1, M.F. Reiser1, F.W. Spelsberg1; 1Munich/DE, 2Dresden/DE, \n3Ottobeuren/DE (christoph.trumm@med.uni-muenchen.de) \nPurpose: Percutaneous endoscopic gastrostomy (PEG) or jejunostomy (PEJ) is \nsubstantial for patients with swallowing disorders to maintain enteral nutrition or to \npalliatively decompress intractable small bowel obstruction. Endoscopic placement \ncan be impossible due to previous (gastric) operation, obesity, hepato-splenom-\negaly, peritoneal carcinosis, inadequate transillumination or obstructed passage. \nComputed tomography (CT) fluoroscopic guidance with or without endoscopy \ncan enable the placement of a PEG/PEJ if endoscopically guided placement fails.\nMethods and Materials: 101 consecutive patients were referred to our depart-\nment for feeding support (n=87) or decompression (n=14). Reasons were: ENT \ntumour (n=51), oesophageal cancer (n=19), mediastinal mass (n=2), and neuro-\nlogical disorders (n=15). Decompression tubes were placed because of cancer \n(n=13) or Crohn’s disease (n=1). The following approaches were chosen: I. CT \nfluoroscopy and simultaneous gastroscopy (n=61), II. CT fluoroscopy and infla-\ntion of the stomach via nasogastric tube (n=29), and III. direct puncture under CT \nfluoroscopic guidance (n=11).\nResults: CT fluoroscopy-guided PEG/PEJ was feasible in 89 of 101 patients. No \nprocedure-related mortality was observed. One tube was misplaced into the colon \nin a patient with a history of gastrectomy. No complication was seen after removal. \nMinor complications were dislodgement (n=17), peristomal leakage (n=7), wound \ninfection (n=1), superficial skin infection (n=6) and tube obstruction (n=2).\nConclusion: CT fluoroscopy-guided PEG/PEJ is feasible and safe, and provides \nadequate feeding support or decompression. It offers the benefits of minimally \ninvasive therapy even in patients with contraindications to established endoscopic \nmethods, combining the advantages of both techniques. Long-term complications \n- mainly tube-related problems - are easily treated.\nB‑0196 14:54\nCT assessment of post-resection arterial stumps for right-sided \ncolorectal cancer: a potential marker of quality of resection? \nT.L. Kaye, D.G. Jayne, N.P. West, D.J.M. Tolan; Leeds/UK \n(thomas.kaye@leedsth.nhs.uk) \nPurpose: There is evidence that the quality and extent of colonic resection af-\nfects tumour recurrence rates and patient survival. This is currently evaluated by \npathological analysis of the resected specimen. Analysis of post-resection arterial \nstumps via routine follow-up CT could act an alternative in vivo marker.\nMethods and Materials: Staging and follow-up CT scans from 156 patients with \nright-sided colorectal tumours were analysed. Pre-operative arterial anatomy and \npost-operative arterial stumps were demonstrated using multi-planar reformats \nand volume rendering techniques. Methods of stump identification, stump length \nand stump orientation were recorded.\nResults: Ileocolic (98.7%), middle colic (94.2%) and right colic artery (23.7%) \nidentification was comparable with catheter angiogram studies. Mean time interval \nbetween staging and analysed follow -up CT was 25 months. Post-resection ile-\nocolic stumps were consistently identified (88.4% of cases). In the vast majority \nof cases this was via a thrombosed vessel (97%). There was a wide variation in \nileocolic stump length (2.5 - 74.3 mm, mean 27.6 mm, standard deviation 13.5 mm).\nConclusion: To the best of our knowledge this is the largest study to date demon-\nstrating arterial stumps post colonic cancer resection. It is the first to consistently \nidentify stumps years after colonic resection using routine surveillance (portal \nvenous) CT. CT-based stump length analysis may therefore have potential as an \nin vivo marker of extent and quality of surgical resection. \nB‑0192 14:18\nProspective study of using balloon duodenography catheters in CT \nenteroclysis for small bowel diseases \nK.C.H. Lau, L.M.F. Tee; Hong Kong/HK \nPurpose: To determine the usefulness of using balloon duodenography catheters \n(BDC) for CT enteroclysis (CTE), with a comparison of small bowel distension in \nusing BDC and nasogastric catheters (NC). One of the limitations of CTE is the \nsuboptimal distension of the bowels, especially the distal ileum. Using BDC, there \nis less reflux of contrast into the stomach and should have more contrast in the \ndistal small bowel.\nMethods and Materials: The study protocol was approved by the HA KWC re-\nsearch and ethics committee and all patients gave written informed consent for the \nexamination and this study. From May 2011 to July 2012, CTE was performed in \n60 consecutive patients with random allocation of 27 patients using BDC and 33 \npatients using NC. All catheter insertions and CTE examinations were performed \naccording to department protocol. Small bowel distension was differentiated into \nfour regions (proximal jejunum, distal jejunum, proximal ileum and distal ileum) and \ngiven a score from 1 to 3 (1 - < 20 mm, 2 - 20-30 mm, 3 - > 30 mm).\nResults: Distension of proximal and distal ileum was better with BDC than NC (p \n< 0.05: statistically significant difference). No significant difference was present \nfor others sites (p> 0.05).\nConclusion: Our study shows statistically significant better distension of the \nproximal and distal ileum, with the use of BDC when compared with NC. This is of \nparticular use, as the distal ileum is a common site of small bowel diseases. With \nbetter bowel distension, this would suggest that using BDC would help to further \nimprove the accuracy of CTE. \nB‑0193 14:27\nRole of preoperative imaging with multidetector computed \ntomography (MDCT) in the management of patients with \ngastroesophageal reflux disease (GERD) symptoms, candidate to \nsleeve surgical revision \nM. Rengo, D. Caruso, F. Vecchietti, M.M. Maceroni, G. Silecchia, A. Laghi; \nLatina/IT (marco.rengo@gmail.com) \nPurpose: To evaluate if multidetector computed tomography (MDCT) can be helpful \nand useful in the decision-making process in sleeve patients with gastroesopha-\ngeal reflux disease (GERD) symptoms and to demonstrate the reproducibility and \naccuracy of the technique.\nMethods and Materials: Twenty-three patients submitted to LSG, complaining up-\nper GI symptoms and/or weight regain and scheduled for a sleeve surgical revision \nwere investigated. All patients underwent MDCT scan, upper GI barium swallow \nstudy and endoscopy. MDCT was compared with barium and endoscopy features \nas concern: oesophageal dilatation, neo-fundus development and volume, hiatal \nhernia, sleeve size in toto and atrum dilatation. All patients underwent laparoscopic \nsleeve revision. Surgical findings were considered “as gold standard”.\nResults: A total of 21 patients with hiatal hernia, neo-fundus or sleeve dilatation \nunderwent surgical correction. All findings identified at MDCT were confirmed \nby intraoperative findings. The presence of hiatal hernia was significantly under-\nestimated by both barium and endoscopy with a sensitivity of 57.1% and 50%, \nrespectively (P=0.04, P=0.02).\nConclusion: MDCT is an accurate method for the detection of hiatal hernias and \nquantification of gastric volumes and can be considered as non invasive method \nto guide surgery. \nB‑0194 14:36\nAccuracy of MDCT in preoperative definition of maximum tumour \ndiameter in patients with gastric cancer \nM.A. Mazzei, S. Guerrini, N. Salvini, P. Mercuri, A. Parrinello, N. Cioffi Squitieri, \nD. Marrelli, F.G. Mazzei, L. Volterrani; Siena/IT (mamazzei@gmail.com) \nPurpose: The maximum tumour diameter (Dmax) is a prognostic factor in patients \nwith gastric cancer, considering its dependence on the depth of invasion. The aim of \nour work has been to evaluate the accuracy of MDCT in the preoperative definition \nof Dmax in patients with gastric cancer, assuming surgical specimen measurements \nas gold standard, in order to obtain a pre- surgery prognostic evaluation.\nMethods and Materials: Pre-surgery CT examinations of 104 patients (mean age \n68.81, range 25-90) with diagnosis of gastric cancer were evaluated retrospectively \nand in a blind fashion by a radiologist with expertise in the oncologic field. The Dmax \nmeasured was obtained through 2D multiplanar curved reconstruction (ADW 4.6 \nGE Healthcare). The results were compared with macroscopic data after surgery.\n\nScientific Sessions\nS191\nA\n C D E F G\nB\nThursday\nB‑0199 15:21\nPilot study to assess the diagnostic performance of MRI in the \nidentification of adhesions between the abdominal wall and small \nbowel loops, using a time-efficient protocol \nA. Gupta, A. Hansmann, P.F.C. Lung, R. Tandon, R. Ilangovan, M. Marshall; \nMiddlesex/UK (anikahansmann@nhs.net) \nPurpose: Abdominal adhesions following surgery are the commonest cause of small \nbowel obstruction and may complicate subsequent surgery. Accurate identification \nof adhesions has been reported using MR fluoroscopy sequences. We report our \nresults utilising a time-efficient protocol.\nMethods and Materials: 10 patients scheduled for open colorectal surgery and who \nhad undergone previous abdominal surgery were recruited over 4 months (mean \nage 44, range 29-59). The abdomen was divided into 9 segments prior to MR and \nsurgery enabling accurate correlation. Using a 1.5 T scanner (SiemensAvanto), T2 \nsagittal, axial, sagittal true-FISP 30s cine sequences were obtained (slice thickness \n1 cm), in inspiration, expiration and abdominal strain. Scanning time was 8 min. \nAdhesions were identified by finding angulation, fixation or altered peristalsis. 4 \nreaders analysed the images independently, providing a consensus opinion on the \nnumber and location of adhesions. Laparotomy was the gold standard.\nResults: 90 abdominal segments were evaluated with adhesions identified in 44% \nat laparotomy and 34% on consensus MR. 31 segments demonstrated adhesions \non MR; 74% correlated at surgery, whilst the remainder were found in adjacent \nsegments (26%). Using a 2x2 table, sensitivity was 60%, specificity 86%, with \npositive and negative predictive values of 77% and 73%, respectively. Overall \naccuracy was 74%.\nConclusion: Our results suggest utilisation of a time-efficient MR protocol in \nidentifying adhesions between the bowel and anterior abdominal wall is feasible \nin a busy unit, and may represent a non-invasive application in the research of \nadhesion-preventative techniques. Reader performance rose during our study and \nfurther improvements may be realised in a larger trial.\n14:00 - 15:30 Room F1 \nOncologic Imaging \nSS 216 \nNew biomarkers for tumour quantification \nModerators: \nC.J. Herold; Vienna/AT \nC. Keyzer; Brussels/BE\nB‑0200 14:00\n3D CT-histogram analysis enables distinguishing affected and FDG-\nnegative lymph nodes in patients with lung cancer \nP. Flechsig1, C. Kratochwil1, J. Moltz2, C.-P. Heussel1, R. Talanow1, \nH.-U. Kauczor1, U. Haberkorn1, F.L. Giesel1; 1Heidelberg/DE, 2Bremen/DE \nPurpose: Patients with lung cancer often suffer additional chronic lung diseases, \nand often these patients present with FDG avid mediastinal lymph nodes due to \ninflammatory reasons rather than malignancy. FDG-PET is the leading imaging \nmodality for N-staging in lung cancer patients; however, in patients with doubtful \nFDG-PET status, 3D CT histogram analysis might give an additional value to \ndiagnostic imaging. In this investigation 3D CT histogram analysis was used to \nidentify metastatic lymph node involvement in lung cancer patients in correlation \nto FDG-PET/CT.\nMethods and Materials: 38 lymph nodes from 32 patients aged 43-76 years \ndiagnosed with lung cancer were investigated. FDG-PET/CT was performed \nprior to surgery/biopsy according to clinical schedule. Lymph node assessments \nwere acquired using FDG-uptake and 3D CT histogram analysis on the basis of \nnon-enhanced CT scans. For computing the histograms, the lymph nodes were \nsegmented by a semi-automatic algorithm; the segmentation result was corrected \nmanually if required in certain cases. Both imaging findings were correlated with \nthe results from the histological gold standard study.\nResults: 21 positive and 17 negative histologically proven lymph nodes were \nsuccessfully analysed by 3D CT histogram. The histological positive lymph nodes \npresented a median CT HU value of 34.5 while histological negative lymph nodes \npresented a median CT HU value of 7.6. Findings were independent of the FDG-\nuptake value.\nConclusion: 3D histogram analysis seems to be a very promising and valuable \nimaging surrogate for N-staging stratification in patients with lung cancer with \ndoubtful glucose uptake in FDG-PET.\nB‑0197 15:03\nEvaluation of Crohn’s disease recurrence in patients with ileocolic \nanastomosis: value of computed tomography enterography with \nwater enema \nF. Paparo, M. Revelli, C. Puppo, I. Garello, L. Bacigalupo, \nL. Rollandi, R. Piccazzo, A. Garlaschi, G.A. Rollandi; Genoa/IT \n(francesco.paparo@galliera.it) \nPurpose: To investigate the value of computed tomography enterography with water \nenema (CTE-WE) in the assessment of the status of the anastomotic site in patients \nwith Crohn’s disease (CD) who had previously undergone ileocolic resection.\nMethods and Materials: 51 CTE-WE examinations of CD patients (mean age: \n52.8±13.3 years; 26 [51%] men and 25 women [49%]) with ileocolic anastomosis \n(latero-lateral = 10 [19.61%], termino-lateral = 27 [52.94%], termino-terminal = 14 \n[27.45%]) were retrieved from our institutional radiology database, and reviewed \nin consensus by two gastrointestinal radiologists. The presence of CD anasto-\nmotic recurrence and its phenotype (inflammatory, stricturing, penetrating), and \nthe presence of inflammatory lesions involving other bowel segments beside the \nanastomotic site were recorded. Endoscopy and medical records were used as \nreference standards.\nResults: CT signs of CD recurrence were detected in 45 patients, including: 32 \n(71.12%) isolated anastomotic recurrences, 11 (24.44%) anastomotic recurrences + \nsynchronous inflammatory lesions (SILs), 2 (4.44%) inflammatory lesions not involv-\ning the anastomotic site. Phenotypes of the 43 CD anastomotic recurrences were: \n22 (51.1%) inflammatory (non-stricturing non-penetrating), 16 (37.2%) stricturing, \n4 (9.3%) penetrating. No relation was found between the phenotype of CD recur-\nrence and the type of the anastomosis (LL, TL, TT) (P = 0.1252; Chi-square test).\nConclusion: CTe-WE allowed a complete characterisation of the anastomotic \nsite and the detection of SILs, which had a relatively high prevalence in our study \ncohort (24.44%).\nB‑0198 15:12\nCrohn’s disease activity: correlation of inflammatory mediators with \noverall small-bowel motility \nS. Bickelhaupt1, S. Pazahr1, J.M. Froehlich1, R. Cattin2, H. Bouquet3, G. Rogler1, \nP. Frei1, A. Boss1, M. Patak1; 1Zurich/CH, 2Biel/CH, 3Berne/CH \nPurpose: Active Crohn’s disease (CD) increases the level of inflammatory mark-\ners of which C-reactive protein (CRP) and calprotectin are commonly used to \nmonitor disease activity. The aim was to evaluate the correlation between CRP \nand calprotectin levels and overall small bowel motility in patients with Crohn’s \ndisease assessed with MRI.\nMethods and Materials: 13 patients with Crohn’s disease (4f/9m, mean 42y) \nwere included in this IRB-approved prospective study. MRI (1.5-T, Philips Achieva) \nwas performed after a 1-h preparation of 1000 ml Mannitol-Solution (3%). Cine \nT2w-2D-SSFP motility acquisitions (TR 2.47/TE 1.23/250 ms slice repetition time) \nwere performed in free breathing over 69-84sec. Randomly chosen small-bowel \nsegments were analysed in two abdominal quadrants using dedicated MR-motility \nassessment software (Motasso). Contraction frequency, amplitude, luminal diameter \nand amplitude diameter ratio (occlusion ratio, ADR) were evaluated as well as \nCRP (ngl/ul) and Calprotectin (ug/g) levels. Pearson’s correlation was calculated.\nResults: Calprotectin was determined in mean 12 days (SEM±10.09) before, CRP \n15 days (SD±28.80) before MRI. A significant inverse linear correlation was found \nbetween the contraction frequency and both the level of CRP (r=-0.701, p=0.008) \nand calprotectin (r=-0.805, p=0.001). Expansion of the mean small bowel diam-\neter significantly correlated with calprotectin levels (r=0.857, p=< 0.001) but not \nwith CRP (r=0.447, p=0.126). The absolute amplitude of the contractions did not \ncorrelate neither with the level of CRP (r=-0.527, p=0.064) nor with calprotectin \n(r=-0.612, p=0.026). The ratio describing relative luminal occlusion during contrac-\ntion (ADR) significantly correlated with calprotectin (r=0.736, p=0.004) and with \nCRP (r=0.577, p=0.039).\nConclusion: Alterations of overall small bowel motility during active phases of CD \nsignificantly correlate with the level of calprotectin and CRP. \nAuthor Disclosures:\nH. Bouquet: Employee; Fromer Employee of SOHARD AG. \n\nScientific Sessions\nS192\n C A D E F\n G\nB\nmeasured on FDG-PET. Treatment response was evaluated after three cycles of \nplatinum-based chemotherapy, according to RECIST. The predictive value of texture \nand PET parameters have been investigated by multivariate analysis.\nResults: Fourteen out of 25 patients were non-responders (4 progressors, \n10 stable disease). Combining heterogeneity and SUV in a unique parameter \n(heterogeneity*SUV), the latter was significantly higher in responders than in \nnon-responders (medians 192.7 vs 92.8, respectively; p0< 0.0001) and showed \na high predictive value: odds ratio (probability of response) of third vs first tertile \nwas 49 (p0.003). Responses in first tertile were 1/8, in the second 3/9, in the third \n7/8 (p0.007, p for trend 0.003). Tumour heterogeneity alone showed a significantly \nweaker predictive value, while SUV alone was not predictive of treatment response.\nConclusion: The combination of texture features of tumour heterogeneity on CECT \nand the metabolic information provided by FDG-PET has the potential to be an \nindependent predictor of response to first-line chemotherapy in advanced NSCLC. \nIn particular, tumour SUV combined with heterogeneity provides an additional value \ncompared with tumor heterogeneity alone. \nB‑0204 14:36\nTexture analysis of advanced non-small cell lung cancer on contrast-\nenhanced computed tomography: prediction of the response to the \nfirst-line chemotherapy \nM. Ravanelli, M. Morassi, D. Farina, E. Roca, R. Maroldi; Brescia/IT \n(marcoravanelli@hotmail.it) \nPurpose: To assess whether tumour heterogeneity, quantified by texture analysis \non contrast-enhanced CT (CECT), can predict the response to chemotherapy in \nadvanced non-small cell lung cancer (NSCLC).\nMethods and Materials: Fifty-three pre-treatment CECT studies of patients with \nadvanced NSCLC who had undergone first-line chemotherapy were retrospectively \nreviewed and analysed. Treatment response was evaluated after three cycles of \nplatinum-based chemotherapy, according to RECIST. Tumour uniformity on CT \nimages has been assessed by a three-step method: image thresholding; multiscale \nfiltering by Laplacian-of-Gaussian filter; quantification of texture features on filtered \nimages using first-order statistics. The predictive and prognostic values of resulting \ntexture parameters have been investigated by multivariate analysis.\nResults: Thirty-one out of 53 patients were non-responders (7 progressors, 24 \nwith stable disease). Average overall survival was 13 months (4-35), minimum \nfollow-up was 12 months. In the adenocarcinoma group (n=31), the tumour uniform-\nity multiplied by the grey-level of unfiltered images (GL*uni index) has been shown \nto be the unique independent variable predictive of treatment response. Dividing \nthe GL*uni index (8.5-46.6) into tertiles, lesions in the second and the third tertiles \nhad a 8-fold higher probability of treatment response compared to those in the \nfirst (p0.02). TNM stage, sex, age and performance status did not show predictive \nvalue. No association between texture features and response to treatment was \nobserved in the non-adenocarcinoma group. GL*uni index was not prognostic.\nConclusion: Texture features of tumour heterogeneity on CECT images in \nadvanced lung adenocarcinoma has the potential to be a predictive indicator of \nresponse to platinum-based chemotherapy. \nB‑0205 14:45\nTextural analysis of lymphoma on unenhanced computed \ntomography: initial evidence for a relationship with tumour glucose \nmetabolism, stage, end of treatment status and survival \nS. Babikir, B. Ganeshan, A.M. Groves, I. Kayani; London/UK \n(b.ganeshan@ucl.ac.uk) \nPurpose: To provide initial evidence in lymphoma for a relationship between tumour \nheterogeneity, as assessed by CT texture analysis (CTTA), and tumour glucose \nmetabolism, stage, end of treatment status (EOTS) and survival.\nMethods and Materials: This retrospective, pilot study comprised 50 consent-\ning lymphoma patients with consecutive routine 18 F-fluorodeoxyglucose (FDG) \nPET-CT scans. Texture analysis using TexRAD, (a commercially available texture \nanalysis software), of non-contrast-enhanced CT images with lesions involved: 1) \nimage filtration extracting fine, medium and coarse texture-scales, and 2) texture \nquantification using proportion positive pixels (PPP), standard-deviation (SD), \nand kurtosis (K). Corresponding tumour FDG uptake (standardised uptake value \n(SUVavg and SUVmax)), clinical-stage and EOTS from PET-CT and clinical re-\nports were collected. Survival was assessed by optimised Kaplan-Meier analysis.\nResults: 7, 19, 9 and 15 patients had stages I, II, III and IV, respectively. Fine \nto coarse textures correlated with SUVavg (baseline-scan: SD at coarse-scale, \nrs=0.362 p=0.011; interim-scan: PPP at medium-scale, rs=-0.766 p=0.0001) and \nclinical-stage (baseline-scan: K at fine-scale, rs=0.424 p=0.002). Baseline coarse \ntextures predicted EOTS (PPP at coarse-scale, p=0.006; K at coarse scale, p= \nB‑0201 14:09\nTumour vascularization imaging without contrast agents: the \npotential of IVIM-MRI \nM. Iima1, O. Reynaud2, T. Tsurugizawa2, L. Ciobanu2, J.-R. Li2, F. Geffroy2, \nB. Djemai2, D. Le Bihan2; 1Kyoto/JP, 2Gif-sur-Yvette/FR (mamiiima1@gmail.com) \nPurpose: To investigate the potential of IVIM MRI to evaluate perfusion and diffusion \nin a 9L glioma rat brain tumour model using a 17.2T MRI scanner.\nMethods and Materials: 14 fischer rats were studied. IVIM MRI images were \nacquired with 72 b values (25 b values; 2 to 160 s/mm², 35 b values; 172.5 to 935 \ns/mm², and 12 b values; 1150 to 3025 s/mm²). The signal attenuation curve was \nfirst fitted using a biexponential diffusion model to estimate slow and fast com-\nponents fraction (fslow, Dfast and Dslow) of the pure diffusion part of the signal \n(for b> 500s/mm²). Then, the diffusion component was removed from the signal \nand the remaining signal was fitted using the IVIM model for b< 200 s/mm² to get \nestimates of perfusion fraction, f, and pseudo-diffusion, D*. Fitting was performed \non a ROI basis and on a pixel-by-pixel basis to generate diffusion and perfusion \nmaps. All rats were killed and histology (CD31) was obtained for comparison with \nIVIM parameters.\nResults: IVIM maps clearly highlighted areas with high and low fraction perfusion \nwithin tumours which were generally heterogeneous, as confirmed by histology. \nInterestingly, we found a negative correlation between the IVIM perfusion fraction \nand fslow, suggesting that cell density in high perfused areas is less than in other \ntumour parts and normal brain tissue.\nConclusion: This study confirms that IVIM MRI can delineate high perfusion areas \nin tumours and provide information on tissue structure from diffusion parameters.\nB‑0202 14:18\nIntravoxel incoherent motion (IVIM) diffusion-weighted MRI for \nmonitoring the therapeutic efficacy of a vascular disrupting agent \n(CKD-516) in rabbit VX2 liver tumours \nI. Joo, J. Lee, J. Han, B. Choi; Seoul/KR \nPurpose: To evaluate the diagnostic value of intravoxel incoherent motion (IVIM) \ndiffusion-weighted imaging (DWI) in the quantitative assessment of therapeutic \nefficacy of a vascular disrupting agent (VDA) (CKD-516) in rabbit VX2 liver tumours.\nMethods and Materials: In 29 VX2 liver tumour-bearing rabbits (23 in the treated \ngroup and 6 in the control group), IVIM-DWIs were performed at a 3 T scanner \nusing 12 b values before and 4 hours, 24 hours, 3 days, and 7 days after CKD-516 \nadministration. Apparent diffusion coefficient (ADC) and true diffusion coefficient \n(D), pseudo-diffusion coefficient (D*), and perfusion fraction (f) of tumours were \ncompared between the control and treated groups and among time points. Cor-\nrelation between change in tumour size and IVIM-DWI parameters was analysed \nto determine which IVIM-DWI parameters can be predictors for tumour response.\nResults: The treated group showed a significantly larger increase in ADC at 24 \nhours, a decrease of D* at 4 hours, and a decrease of f at 4 hours and 24 hours, \nthan did the control group (P < 0.05). In the treated group, compared to baseline \nvalues, D* and f significantly decreased at 4 hours and then recovered at 24 hours \nand D significantly increased at 24 hours (P < 0.005). In addition, the greater \ndecrease in f at 4 hours correlated with the smaller increase in tumour size during \nthe 7 days (rho=0.53, P=0.04).\nConclusion: The therapeutic effect induced by VDA could be effectively evaluated \nusing IVIM-DWI, and f could be an early predictive indicator for tumour response. \nAuthor Disclosures:\nI. Joo: Research/Grant Support; The current study was supported by Grants \nby Chong Keun Dang Corp., Seoul, Korea. J. Lee: Research/Grant Support; \nThe current study was supported by Grants by Chong Keun Dang Corp., Seoul, \nKorea.\nB‑0203 14:27\nTexture analysis on contrast-enhanced computed tomography \ncombined with FDG-PET in predicting the response to chemotherapy \nof advanced non-small cell lung cancer \nM. Ravanelli, F. Ferraroni, D. Farina, M. Morassi, P. Tessitore, P. Rossini, \nR. Maroldi; Brescia/IT (marcoravanelli@hotmail.it) \nPurpose: To assess whether tumour heterogeneity, quantified by texture analysis on \ncontrast-enhanced CT (CECT), combined with FDG uptake at PET-CT can predict \nthe response to chemotherapy in advanced non-small cell lung cancer (NSCLC).\nMethods and Materials: Pre-treatment CECT studies and FDG-PET studies of \ntwenty-six patients with advanced NSCLC who had undergone first-line chemo-\ntherapy were retrospectively reviewed and analysed. Tumour heterogeneity was \nmeasured by texture analysis on CECT images; mean SUV from each patient was \n\nScientific Sessions\nS193\nA\n C D E F G\nB\nThursday\nB‑0208 15:12\nScatter amplitude is a good landmark for tumour localisation and \ntreatment assessment in time-domain diffuse optical tomography \nduring neo-adjuvant chemotherapy in breast cancer \nM. Van de Giessen, B.E. Schaafsma, J.R. Kroep, M.N.J.M. Wasser, \nC.J.H. Van de Velde, B.P.F. Lelieveldt, J. Dijkstra, A.L. Vahrmeijer; Leiden/NL \n(m.vandegiessen@lumc.nl) \nPurpose: Neo-adjuvant chemotherapy response may be monitored in a non-\ninvasive way using multi-spectral diffuse optical tomography (DOT). A clinically \nfeasible measurement method in these 3D volumes is proposed and compared \nwith previously published whole breast measurements.\nMethods and Materials: Twelve breast cancer patients were included, which \nreceived neo-adjuvant chemotherapy. Four DOT scans were obtained: before \ntherapy, after 3 and 9 weeks and pre-operative (18 weeks). Deoxyhaemoglobin \n(Hb), oxyhaemoglobin (HbO2) and percentages water and lipids were measured \nin volumes as measured in DCE-MRI scans before therapy, centred on areas of \nhigh scattering amplitude and approximate location in pre-treatment DCE-MRI and/\nor x-ray mammography. Patients were divided in responders and poor responders \nbased on post-operative pathological assessment.\nResults: Responders (R) and poor responders (PR) showed statistically signifi-\ncant (P < 0.05) different development of Hb values at 3, 9 and 18 weeks within \nmeasurement volumes relative to the first DOT scan: 0.66/1.08 (R/PR, 3 weeks), \n0.56/1.07 (9 weeks), 0.55/1.48 (18 weeks). For HbO2 results were similar, but only \nsignificant for 9 and 18 weeks: 0.71/1.03 (3 weeks), 0.53/0.89 (9 weeks), 0.56/1.06 \n(18 weeks). Percentages water and lipids were not significantly different. Whole \nbreast measurements did not show statistically significant differences for Hb and \nHbO2 between responders and poor responders.\nConclusion: Using the scatter amplitude to determine the tumour location in DOT \nvolumes enables the measurement of Hb and HbO2 such that these parameters \ndiffer significantly between responders and poor responders. This potentially al-\nlows effectiveness assessment of neo-adjuvant treatment in breast cancer patients \nalready at 3 weeks. \nB‑0209 15:21\nSoftware validation of metastatic sarcoma lesion assessment using \nCT volumetric density tumour trajectory \nL.R. Folio1, V.M. Derderian1, E.C. Jones1, M.S. Merchant1, A.M. Venkatesan1, \nE. Lotan2; 1Bethesda, MD/US, 2T el Hashomer/IL (vana.derderian@nih.gov) \nPurpose: Recent studies suggest that tumour assessment methods accounting for \nboth tumour density and volume (SACT, MASS, Choi) add value beyond assessing \naxial dimensions (RECIST) or selective regions of interest (ROI). We have devel-\noped a comprehensive tumour response method termed Total Volume of Viable \nTumour (TVVT) that assesses rate of change in Hounsfield unit (HU) density over \ntreatment course (tumour trajectory), thereby quantifying viable tumour burden as a \nVolume of Interest (VOI). Steeper trajectories may translate to earlier determination \nof response versus progression.\nMethods and Materials: We evaluated the efficacy of experimental volume/HU \n(TVVT) software and criteria within our Picture Archiving and Communication Sys-\ntem (Carestream Health, Rochester, NY) to circumscribe, segment and characterise \nvolumetric density distribution throughout all parts of measurable lesions on CT. \nComparison of response and tumour trajectory assessment between RECIST \ncriteria and TVVT was performed in a test set of 10 patients with various sarcomas \nunder radiologist supervision. Histograms depicting range and absolute HU for \nwhole tumor volumes were analysed on a subset of patients.\nResults: Preliminary investigation shows feasibility of semi-automatic segmenta-\ntion to outline and quantify density distribution in whole tumour volumes. Initial \nassessment of our set of metastatic lesions suggests that hypervascular sarcomas \nare a worthwhile study cohort. Histogram shifts appear to correlate with qualitative \nvisual estimates of tumor necrosis whereas RECIST diameters demonstrate little \nor no differences.\nConclusion: Comprehensive tumour analysis using volumetric density algorithms \nsuch as TVVT should more accurately reflect tumour burden and trajectory over \nselective linear or ROI measurements, leading to improved image-based tumour \nstaging and response assessment. Semi-automated quantification of whole tumour \nburden should decrease inter-observer measurement variability, enabling more \nconvenient, reliable imaging results for multiple contiguous vascular metastases. \n0.032). Median (range) overall and disease-free survival was 34 (8-52) and 31 (3-\n56) months, respectively. Medium texture-scale predicted overall (baseline-scan: \nK, p=0.0002, interim-scan: K, p=0.0008) and disease-free survival (baseline-scan: \nK, p=0.0031, interim-scan: K, p=0.046). SUVmax predicted disease-free survival \n(baseline-scan: p=0.024). Clinical-stage did not predict EOTS and survival.\nConclusion: Evidence provided suggests that CTTA offers an objective measure-\nment of lymphoma severity on CT. The potential risk stratification and prognostic \nassessment implications may allow optimal selection of PET-CT candidates in \nlymphoma. \nAuthor Disclosures:\nB. Ganeshan: Shareholder; Shareholder and director of TexRAD Ltd, an \nimaging software company that is developing and commercialising the texture \nanalysis software considered in this study.\nB‑0206 14:54\nImprovement in both sensitivity and specificity of readers with next \ngeneration of mammography CAD \nV. Nikitin, I. Lossev, A. Filatov, N. Bagotskaya; Longmont, CO/US \n(vadim.nikitin@parascript.com) \nPurpose: The purpose of the study was to compare radiologist performance for \nscreening mammography with and without Parascript® AccuDetect® computer-\naided detection (CAD) software.\nMethods and Materials: Each of 240 mammography cases (including 120 cancer \ncases and 120 normal cases) was reviewed by 12 radiologists without and with \nCAD (AccuDetect, version 6.1). The mammography cases were obtained with GE \nSenographe Essential and Philips MicroDose Mammography L30 full-field digital \nmammography systems. Each radiologist initially interpreted a case without CAD \nnoted the findings and assigned BI-RADS category 0, 1 or 2 to the case. For \neach radiologist, the unassisted interpretation was “locked” before the radiologist \nturned on the CAD marks. After turning on the CAD marks, the radiologist could \nadd, remove or adjust the findings noted on the unassisted interpretation as well \nas change the BI-RADS score for the case. Sensitivity and specificity calculations \nfor unassisted and CAD-assisted interpretations were based on the BI-RADS \ncategory assignment dichotomization: (BI-RADS = 0) versus (BI-RADS = 1 or 2).\nResults: Average increase in sensitivity due to assistance of CAD is 1.5%, which \ntranslates into 18.8% of those initially missed cancers that were recognised with \nCAD assistance. Average increase in specificity due to assistance of CAD is 4.9%. \nBoth increases in sensitivity and specificity are statistically significant.\nConclusion: The study demonstrates that both sensitivity and specificity of radiolo-\ngists increased with assistance of AccuDetect CAD system. \nAuthor Disclosures:\nV. Nikitin: Employee; Parascript. I. Lossev: Employee; Parascript. A. Filatov: \nEmployee; Parascript. N. Bagotskaya: Employee; Parascript.\nB‑0207 15:03\nAssessing the contribution of hypoxia to R2* differences between \ncancerous and normal prostate tissue \nA. Johnson, A. Latifoltojar, V. Hamy, H. Fitzke, K. Shmueli, S. Punwani; \nLondon/UK (aj372@cam.ac.uk) \nPurpose: R2* BOLD MRI is proposed as a potential tool for mapping tumour \nhypoxia in prostate cancer. However, R2* has a complex relationship with tissue \noxygenation that remains unexplored in prostate cancer. R2* is the sum of R2 \n(primarily reflecting tissue structure) and R2’ (highly sensitive to static magnetic field \ninhomogeneities, e.g. from deoxyhaemoglobin). Whilst R2* changes are observed \nfor prostate cancer, they may reflect tissue structure or oxygenation differences. \nThis study aimed to clarify the nature of R2* change by quantifying and comparing \nR2* and its components (R2 and R2’) for cancerous and normal prostate tissue.\nMethods and Materials: Twenty patients underwent 1.5 T multi-parametric (mp) \nprostate MRI (DWI, DCE and T2-weighted), supplemented by dual echo-time T2* \nand T2 quantitation and followed by biopsy. Tumour and healthy regions of inter-\nest (identified on mp-MRI and confirmed by biopsy) were contoured in consensus \nby two experienced observers on matched T2- and T2*-weighted images. Mean \nR2*, R2 and R2’ were calculated and compared between cancerous and normal \ntissue using the student’s t-test.\nResults: R2* and R2 were significantly greater for cancer than normal tissue (R2*: \n18 ± 5 s-1 [mean ± SD] vs. 13 ± 7 s-1 respectively, p = 0.0130; R2: 11 ± 2 s-1 vs. \n6 ± 2 s-1 respectively, p < 0.0001). No significant difference was found in R2' (7 ± \n4 s-1 vs. 7 ± 7 s-1 respectively, p = 0.5597).\nConclusion: Prostate tumour R2* values predominantly reflect differences in R2 \n(tissue structure) and not R2’ (tissue hypoxia). \n\nScientific Sessions\nS194\n C A D E F\n G\nB\nmen for diagnosis, especially when receptors have to be studied in defining the \norigin of axillary lymph node metastases. \nAuthor Disclosures:\nR. Salvador: Speaker; Member of the medical Advisoy Board of Philips \nHealthcare.\nB‑0212 14:18\nGadofosveset-enhanced axillary MRI for nodal staging in breast cancer \nR. Schipper, M.B.I. Lobbes, L.M. van Roozendaal, C.J.G. Castro, B. de Vries, \nE.M. Heuts, K.B.M.I. Keymeulen, M.L. Smidt, R.G.H. Beets-Tan; Maastricht/NL \n(marc.lobbes@mumc.nl) \nPurpose: Aim of this study was to determine the diagnostic performance of gado-\nfosveset-enhanced MRI for axillary lymph node staging in breast cancer patients.\nMethods and Materials: Ten women diagnosed with invasive breast cancer un-\nderwent both non-enhanced and gadofosveset-enhanced 3DT1-weighted MRI. A \nradiologist, blinded for clinical data, evaluated all lymph nodes with regard to size, \nmorphologic features and gadofosveset uptake. Lymph nodes depicted on MRI were \nmatched with nodes removed during surgery. Nodal status was investigated by a \nblinded pathologist. Sensitivity, specificity, PPV, and NPV values were calculated.\nResults: A total of 152 lymph nodes were extracted during sentinel lymph node bi-\nopsy or axillary lymph node dissection of which 116 were matched with lymph nodes \ndepicted on MRI. Histopathological examination resulted in 21 macro-metastases \nand 8 micro-metastases. With contrast-enhanced MRI, 20 lymph nodes were rated \nas true positive, 83 as true-negative, 4 as false positive, and 9 as false negative. \nThis resulted in an overall node-by-node sensitivity, specificity, PPV and NPV of, \nrespectively, 67% (95% CI 49-80), 95% (95% CI 89-98), 83% (95% CI 64-93) and \n89% (95% CI 81-94). If ignoring micro-metastases, MRI showed a sensitivity of \n87% (95% CI 68-96) and a specificity of 96% (95% CI 89-98). Calculated PPV and \nNPV were 83% (95% CI 64-93) and 97% (95% CI 90-99), respectively.\nConclusion: This feasibility study concerning gadofosveset-enhanced MRI of \naxillary lymph nodes showed promising initial results. These results warrant larger \nstudies to confirm these promising results.\nB‑0213 14:27\nAssessment of 18 Fluorodesoxyglucose positron emission \ntomography (18 FDG PET-CT) vs contrast-enhanced magnetic \nresonance imaging at 3 Tesla (3 T CE-MRI) for lymph node staging in \nbreast cancer patients \nH. Magometschnigg, H. Bickel, G.J. Wengert, G. Karanikas, P. Brader, \nK. Pinker-Domenig; Vienna/AT \nPurpose: To assess sensitivity and specificity of prone breast 18FDG-PET-CT for \ndetection of lymph node metastases and to compare it with 3 T CE-MRI of the breast.\nMethods and Materials: 74 patients with breast cancer were included in this \nIRB-approved prospective study. All patients underwent 3 T CE-MRI and 18FDG-\nPET-CT of the breast in the prone position. Patients were injected with ca. 300 \nMBq 18F-FDG. CT data were only used for attenuation correction. In MRI lymph \nnodes were considered positive for malignancy if there was enlargement > 1 cm, \nthickened cortex, loss of fatty hilum, matted nodes or an irregular node contour. In \nPET-CT a lymph node was classified as positive when 18FDG-uptake was greater \nthan blood-pool activity. The evaluation of nodes was performed on a patient-by-\npatient basis. All nodes were histopathologically verified.\nResults: 18FDG-PET-CT achieved a sensitivity of 79% and a specificity of 98%. \nPPV was 0.95 (CI 0.76-0.99), and NPV was 0.91 (CI 0.8-0.96). Diagnostic accuracy \nwas 0.92. CE-MRI had a sensitivity of 74% and a specificity of 84%. PPV was 0.68 \n(CI 0.48-0.83) and NPV was 0.88 (CI 0.76-0.94). Diagnostic accuracy was 0.81. \n24 nodes were positive and 50 nodes were negative for malignancy. The mean \nSUVmax of lymph node metastases was 5.52 (range 1.14 - 12.75).\nConclusion: 18FDG-PET-CT improves identification of lymph node metastases as \ncompared with 3 T CE-MRI. In patients with lymph nodes classified as malignant \nby 18FDG-PET-CT of the breast a sentinel lymph node biopsy can be omitted and \nsurgeons can proceed immediately to ALND. \n14:00 - 15:30 Room F2 \nBreast \nSS 202 \nImprovements in preoperative staging of breast \ncancer \nModerators: \nR.A. Kubik-Huch; Baden/CH \nA. Zytoon; Shebin El-Kom/EG \nB‑0210 14:00\nUsefulness of ultrasonography (US) and ultrasonography-guided \nfine-needle aspiration biopsy (FNAB) for axillary staging in breast \ncancer: is the breast imaging reporting and data system (BI-RADS) \ncategorisation applicable? \nH. Ahn, S. Kim, B. Yun, M. Kim, M. Jang, S. Park, S.-W. Kim, E. Kang; \nGyeonggi-do/KR (ach0224@gmail.com) \nPurpose: To evaluate accuracy of US and US-guided-FNAB for diagnosing axil-\nlary metastasis in breast carcinoma patients and to determine applicability of the \nBI-RADS categorisation.\nMethods and Materials: We retrospectively reviewed data on 858 patients who \nunderwent preoperative or prechemotherapy axillary US for axillary staging from \nJanuary 2009 to December 2011. US-guided FNAB was performed if lymph nodes \nshowed any suspicious findings according to the BI-RADS categorisation: even \ncortical thickening with preserved hilum, category 4a (C4a); even cortical thickening \nwith compressed hilum or uneven cortical thickening with preserved hilum, C4b; \nuneven cortical thickening with compressed hilum, C4c; hypoechoic mass with loss \nof hilum, C5. US and FNAB findings were compared using sentinel lymph node \nbiopsy (SLNB) and axillary lymph node dissection (ALND) data.\nResults: Of 858 patients, 212 (24.7%) showed suspicious nodes on US and \nunderwent US-guided FNAB. Of these 212 patients, 91 (42.9%) showed positive, \n112 (52.8%) showed negative, and 9 showed insufficient findings on FNAB. Of 858 \npatients, 767 patients either with normal axillary US (n = 646) or without positive \nfindings on FNAB (n = 121) underwent SLNB. Of these patients, 169 (22%) had \nmetastatic lymph node. Of 91 patients with positive FNAB findings, 57 underwent \nneoadjuvant chemotherapy and 34 underwent ALND. The sensitivity, specificity, \nPPV and NPV of US were 47.6%, 86%, 60.4% and 79.7%, respectively. The PPV \nof US was 26.3% in C4a, 67.4% in C4b, 46.4% in C4c, 93.3% in C5. The sensitiv-\nity, specificity, PPV and NPV of US-guided-FNAB were 71.7%, 100%, 100% and \n70.2%, respectively.\nConclusion: Axillary US showed high specificity and NPV. A categorisation similar \nto BI-RADS could be applicable for assessing axillary metastasis in breast cancer \npatients.\nB‑0211 14:09\nImproving diagnostic yield in axillary lymphadenopathy sampling: \ncore biopsy and vacuum-assisted core biopsy \nR. Salvador, X. Salvador, I. Miranda, O. Dominguez, L. Romero; Barcelona/ES \n(rafasalvador@telefonica.net) \nPurpose: To analyse and compare the tolerance of the method and the results \nobtained by sampling axillary lymph nodes with two different devices: large-needle \n(CB) and vacuum-assisted core biopsy (VACB), directed to patients where previous \nfine needle aspiration (FNAB) has failed to obtain material, or those with different \ncancers to determine the origin of the metastasic node.\nMethods and Materials: 22 consecutive patients, suspicious or proved to have \nbreast cancer were included, all of them with enlarged lymph nodes and signed \nthe informed consent. The two groups were alternatively sampled by large needle \n(14G) core biopsy and vacuum-assisted needle (14G) biopsy to obtain 2 cylinders \nin each procedure. Eleven patients in each group. The size of the sample (weight), \nas well as the time of the procedure from the injection of anaesthetic to the final \ncollection of the 2 samples was recorded. Discomfort, as well as the acceptance \nof the method was also recorded and scored in a 4-grade scale.\nResults: The size of the samples obtained by vacuum-assisted method was bigger \nthan that by core-needle (between twice and three times bigger). But the time for \nboth procedures was similar (always 4-5 minutes). No differences were found in \npain or any discomfort and tolerance of the method.\nConclusion: Vacuum-assisted axillary lymph node biopsy is a procedure to obtain \nsamples at least as safely as with core-needle biopsy and deserves bigger speci-\n\nScientific Sessions\nS195\nA\n C D E F G\nB\nThursday\nMethods and Materials: 567 breast cancer patients between 2009 and 2011 \nunderwent preoperative AxUS. Suspicious nodes as per protocol were biopsied, \nnegative axillae proceeded to sentinel lymph node biopsy (SLNB). Patients were \nstratified based on number of abnormal nodes identified on AxUS (1, 2, > 2 nodes) \nand the number on final histology was noted. Sensitivity, specificity, positive predic-\ntive and negative predictive values for AxUS-FNAC/core biopsy were calculated.\nResults: 266 (46.9%) patients had positive axillary nodes on final histology with \n169 detected by AxUS-FNAC (sensitivity 86.2%, specificity 100%, PPV 100%, NPV \n68.6%). Patients with nodal metastases identified by AxUS-FNAC had a mean nodal \nburden of 7.1 nodes on histology (SEM=0.6, 95% CI=5.9-8.3; 1 node identified on \nAxUS=4.8 nodes on final histology, 2 nodes on AxUS=9.9 nodes, > 2 nodes=9.6 \nnodes) with correlation between AxUS and histology node numbers (r=0.39, 95% \nCI=0.24-0.51, p-value< 0.0001). AxUS-FNAC detected 63.5% of node positive \npatients. Mean nodal burden of patients diagnosed on SLNB with negative AxUS \nor FNAC was 2.4 nodes.\nConclusion: The Z011 trial questioned the role of AxUS in preoperative axillary \nstaging of breast cancer in cases with ²2 positive SLN. In this study, a single \nFNAC positive node correlated with 4.8 nodes on final histology suggesting that \nAxUS continues to be essential in guiding appropriate management of the axilla \nin breast cancer.\nB‑0217 15:03\nSurgical impact of preoperative breast MRI in women under 40 \nA. Porto1, A. Petrillo1, R. Fusco1, S. Filice1, M. D’Aiuto1, R.M. Trimboli2, \nF. Sardanelli2; 1Naples/IT, 2San Donato Milanese/IT (annamaria.porto@libero.it) \nPurpose: Evaluate surgical impact of preoperative MRI in young patients.\nMethods and Materials: We reviewed a single-institution database of 283 con-\nsecutive patients under 40 treated for breast cancer. Excluding 37 patients (13%) \nwho received neoadjuvant chemotherapy, 124/246 (50%) underwent conventional \nimaging (CI), mammography/ultrasonography (CI-group), whereas 122/246 (50%) \nunderwent CI and dynamic breast MRI (CI&MRI-group). Pathology of surgical \nspecimens served as reference standard. χ2 and McNemar tests were used.\nResults: Mastectomy rate was 110/246 (45%) overall, 46/124 (37%) for CI group \nand 64/122 (52%) for CI and MRI group (p =0.015). Of 122 CI and MRI patients, 46 \nwould have undergone mastectomy due to CI, while MRI determined 18 additional \nmastectomies, increasing mastectomy rate from 38% to 52% (p < 0.021). In the CI \ngroup, 9 patients had multifocal, multicentric, synchronous or bilateral cancers, 9 \n(100%) at mammography and 8 (89%) at ultrasound; 2 mastectomies were due to \nfalse positives at both conventional tests (2/124, 1.6%). In the CI and MRI group, \n30 patients had multifocal, multicentric, or synchronous bilateral cancers, 5 (17%) at \nmammography, 15 (50%) at ultrasound, and 29 (97%) at MRI (3 only MRI-detected \nsynchronous bilateral cancers) (p < 0.002); 2 mastectomies were due to MRI false \npositives (rate 2/122, 1.6%, not significantly different from CI group, p=0.987).\nConclusion: MRI was more sensitive than CI for multifocal, multicentric, or syn-\nchronous bilateral cancers. The additional mastectomy rate due to MRI was 14%. \nAdding MRI, the percentage of young patients conservatively treated remained \nnear to 50%. By using solely CI or using CI and MRI, the inappropriate mastectomy \nrate was equal or lower than 2%. \nB‑0218 15:12\nImaging features in mammography and breast ultrasound are related \nto HER-2 receptor over-expression of primary invasive breast cancer \nA. Adams1, K.G.A. Gilhuijs1, K.E. Pengel2, C.E. Loo2, W.P.T.M. Mali1, S.G. Elias1; \n1Utrecht/NL, 2Amsterdam/NL (a.adams@umcutrecht.nl) \nPurpose: To investigate what mammography and ultrasound imaging features are \nrelated to over-expression of the HER-2 receptor in invasive breast cancer. These \nfeatures could give insight in molecular basis of imaging phenotype, facilitate pre-\nbiopsy patient recruitment for early-phase HER-2 targeting molecular imaging trials, \nand ultimately aid in predicting therapy response and prognosis.\nMethods and Materials: Mammography and breast ultrasound imaging features \nof 598 early invasive breast cancers were scored according to the 4th edition of the \nBI-RADS lexicon, HER-2 status was determined on surgical specimens. Relevant \nimaging features to predict HER-2 over-expression were first identified by con-\nducting a systematic review and meta analysis, and then applied in multivariable \nlogistic regression models.\nResults: HER-2 over-expression was found in 80 cancers (13%). On multivariable \nanalysis, the presence of microcalcifications (OR 3.5, 95% CI 2.1-5.8) on mam-\nmography, and posterior mass attenuation (OR 0.5, 95% CI 0.3-0.9) on ultrasound \nwere strong, independent predictors. Less strong predictors were breast density \ncategory 3/4 (OR 0.9, 95% CI 0.5-1.6) and mass presence (OR 0.8, 95% CI 0.4-\n1.4) on mammography, and circumscribed mass margin (OR 0.8, 95% CI 0.3-2.1) \nB‑0214 14:36\nImaging of axillary lymph nodes in breast cancer patients: How do \nenhancement kinetics of contrast-enhanced lymph nodes apparent \non dynamic MR-mammography correlate with standardised uptake \nvalue of 18 F-FDG PET/CT? \nJ. Krammer, C.G. Kaiser, A. Schnitzer, S.O. Schönberg, K. Wasser; \nMannheim/DE (Julia.Krammer@umm.de) \nPurpose: Focusing on contrast-enhanced lymph nodes (LN) apparent on dynamic \nMR-mammography (dMRM) we intended to answer the following questions: 1) Is \nthere a correlation between the maximum standardised uptake value (SUVmax) \nof 18 F-FDG PET/CT and maximum signal-intensity increase as well as type of \nsignal-intensity curve (1-3) on dMRM? 2) Do contrast-enhanced LN negative on \n18 F-FDG PET/CT have a significantly lesser signal-intensity increase and/or lower \ncurve grading on dMRM compared to 18 F-FDG PET/CT positive LN?\nMethods and Materials: 25 breast cancer patients who underwent both 18 F-FDG \nPET/CT and dMRM were analysed. The mean study interval between the exami-\nnations was 7 days. The signal-intensity increase and curve type of axillary LN ³ \n0.5 cm in short-axis and with predominant contrast enhancement on dMRM were \nanalysed and correlated with the SUVmax on 18 F-FDG PET/CT.\nResults: 30 LN in 21 patients were 18 F-FDG PET/CT positive. There was no \ncorrelation between the maximum signal-intensity increase and SUVmax of these \nLN (r=0.04, p=0.05). 14 LN in 9 patients did not show an appropriate correlate on \n18 F-FDG PET/CT (not visible or SUVmax²blood pool). These LN did not reveal \na significantly lower curve grading or lesser signal-intensity increase compared to \nLN positive on 18 F-FDG PET/CT.\nConclusion: There is no association between the uptake of 18 F-FDG and the \nvascularisation of axillary LN on contrast-enhanced dMRM as signal-intensity in-\ncrease and curve type do not correlate with SUVmax. Unspecific contrast-enhanced \nLN on dMRM negative on 18 F-FDG PET/CT can frequently show enhancement \nkinetics equivalent to those rated positive on 18 F-FDG PET/CT. \nB‑0215 14:45\nUltrasound elastography in the diagnostic assessment of axillary \nlymph nodes in women presenting to a breast imaging centre \nL. Sim, L. Leong; Singapore/SG (gdrssj@sgh.com.sg) \nPurpose: To evaluate the performance of elastography in distinguishing benign \nand metastatic axillary lymph nodes.\nMethods and Materials: 67 women with 72 sonographically visible axillary lymph \nnodes undergoing biopsy at our breast imaging centre were evaluated independ-\nently with conventional ultrasound, elastography and combined ultrasound and \nelastography (CEUS). The elastogram was classified as benign or malignant, based \non the strain pattern, the length and area ratios of the lesion seen on elastography \nversus ultrasound. Validation of radiological diagnosis was by histopathology. \nThe sensitivity, specificity, PPV, NPV and accuracy of each test were compared \nindividually and with CEUS. To obtain a parameter for diagnostic performance, \nROC curves were plotted.\nResults: Of the 72 axillary lymph nodes biopsied, 33 had metastases and 39 were \nbenign. The sensitivity, specificity and accuracy of conventional ultrasound were \n93.9%, 30.8% and 59.7%, respectively. The sensitivity, specificity and accuracy of \nelastography were 93.9%, 97.4% and 95.8%, respectively, and that of combined \nultrasound and elastography were 97%, 92.3% and 94.4%, respectively. The \nsensitivities of all 3 tests were similar but the specificity and accuracy obtained by \nelastography and CEUS were significantly better than conventional ultrasound (P \n< 0.0005). Elastography correctly diagnosed 96% of histologically benign lymph \nnodes which were deemed malignant on ultrasound.\nConclusion: The use of elastography alone or combined with ultrasound has a \nhigher specificity and accuracy than conventional ultrasound in evaluating axil-\nlary lymph nodes. Given the high specificity of elastography, biopsy could have \nbeen avoided in 96% of cases classified as malignant on ultrasound but benign \non elastography. \nB‑0216 14:54\nThe Z011 trial: is this the end of axillary ultrasound in the pre-\noperative assessment of breast cancer patients? \nT.P. Farrell, M. Stenson, P.A. Carroll, M. Griffin, E.M. Connolly, S.A. O’Keeffe; \nDublin/IE (farreltp@tcd.ie) \nPurpose: To evaluate correlation between the number of abnormal nodes on axillary \nultrasound (AxUS) and final nodal burden on histology and calculate the sensitivity, \nspecificity and utility of AxUS-FNAC in preoperative axillary staging in breast cancer.\n\nScientific Sessions\nS196\n C A D E F\n G\nB\nB‑0221 14:09\nRespiratory syncytial virus-related encephalitis: brain MR study with \ndiffusion imaging \nA. Pak, S. Suh, G. Son, Y. Lee, H. Seo, K. Kim, B. Eun, N. Lee, H. Seol; \nSeoul/KR (suppy@korea.ac.kr) \nPurpose: Respiratory syncytial virus (RSV) is a common pathogen of acute res-\npiratory infection causing significant morbidity and mortality in childhood. Among \nthe major complications, encephalitis has been sporadically reported. We describe \nthe incidence, clinical and MRI imaging findings of RSV-related encephalitis in \nthis report.\nMethods and Materials: We retrospectively reviewed the medical records and \nimaging findings of patients with RSV-positive enzyme assay, admitted at the \npaediatric department in three urban tertiary-care hospitals of our medical centre \nfor 7 years. There were 3856 cases with a diagnosis of RSV-bronchiolitis. Among \nthem, 28 (28/3856, 0.73%) had taken brain MRI due to neurologic symptoms. 8 \nof 28 (28.6%) showed positive imaging findings. 5 of 8 positive MR imaging cases \nrevealed non-RSV related pathology such as SDH, diffuse brain atrophy due to \nstatus epilepticus, periventricular leukomalacia, pre-existed ventriculomegaly, \nhypoxic brain injury.\nResults: There were three RSV-related encephalitis. The incidence of this entity \nis 0.08% (3/3856) for RSV positive enzyme assay, 10.7% (3/28) for brain MRI \nexamination, and 37.5% (3/8) for abnormal MRI findings. The imaging findings \nof RSV-related encephalitis are as following: rhombenmesencephalitis pattern, \nrhombenmesencephalitis with acute disseminated encephalitis pattern, and limbic \nencephalitis pattern.\nConclusion: Encephalitis rarely occurs with RSV bronchiolitis. However, when \nbrain MR is needed in suspicion of neurologic involvement, RSV encephalitis \nis not uncommon among abnormal MR cases and mimics other viral and limbic \nencephalitis on imaging study. Physicians should be aware of this entity for proper \ndiagnosis and neurologic care of RSV-positive patients.\nB‑0222 14:18\nCortical-juxtacortical lesions in clinically isolated syndromes: \ndistribution and diagnostic value \nJ.P. Salazar, C. Auger, D. Pareto, R. Mitjana, M. Tintore, J. Corral; Barcelona/ES \nPurpose: To evaluate presence and spatial distribution of cortical-juxtacortical le-\nsions in patients with a clinical isolated syndrome (CIS) by using MRI-based lesion \nprobability maps and to determine its impact to demonstrate lesion dissemination \nin space (DIS) according to the 2010 McDonald criteria for multiple sclerosis (MS).\nMethods and Materials: 65 CIS patients aged between 20 and 50 years old \n(mean 35.9 years) who underwent brain and spinal cord 3 T MRI within the first \nfive months after symptoms onset. The following sequences were obtained: 1) \nPD and T2-weighted; 2) T2-fast FLAIR; 3) Un-enhanced and contrast-enhanced \nT1-weigthed; and 4) 3D double inversion-recovery. Cortical-juxtacortical lesions \nin each patient were identified, manually outlined and segmented into a binarized \nmask. A cortical-juxtacortical MRI-based lesion probability map was obtained. The \n2010 McDonald criteria for DIS were assessed in each patient.\nResults: Cortical-juxtacortical lesions were identified in 24 patients (60%). Frontal \nlobe was the most affected area with an incidence of 37% of the lesions. Temporal \nand parietal lobes had also a significant incidence (20% and 23%). According to \nthe MS 2010 McDonald diagnostic criteria, identification of cortico-juxtacortical \nlesion contributed to demonstrate DIS in 20%.\nConclusion: Cortical-juxtacortical lesions are a common MRI finding in patients \nwith CIS, predominantly involving the frontal, parietal and temporal lobes. Its \ndemonstration has a high relevance for demonstrating DIS according to the MS \n2010 McDonald diagnostic criteria. \nB‑0223 14:27\nRegional MRI perfusion measures predict motor/executive function \nin patients with clinically isolated syndrome \nE. Papadaki, P. Simos, T. Panou, V. Mastorodemos, E. Amanakis, T. Maris, \nA. Karantanas, A. Plaitakis; Iraklion/GR (fpapada@otenet.gr) \nPurpose: The aim of this study is to explore whether CNS hemodynamic distur-\nbances, detected in patients with clinically isolated syndrome (CIS), correlate with \nexecutive function.\nMethods and Materials: Thirty CIS patients and forty-three healthy subjects \nmatched for age, gender, education level, FSIQ, and place of residence were \nadministered computerized tests of visuomotor learning and set-shifting ability. \nRegional cerebral blood volume (CBV), cerebral blood flow (CBF), and mean \ntransit time (MTT) values were estimated using the dynamic susceptibility contrast-\nand irregular mass shape (OR 1.3, 95% CI 0.8-2.1) on ultrasound. The area under \nthe ROC curve was 0.69 (95% CI 0.63-0.75, p < 0.001), and 0.67 after adjustment \nfor over-optimism. Post-test probabilities of HER-2 over-expression were 23-37% \nfor cancers with calcifications, without posterior mass attenuation, and 5-10% for \ncancers without calcifications, with posterior mass attenuation.\nConclusion: Microcalcifications on mammography, and posterior acoustic attenu-\nation of masses on ultrasound were predictors of HER-2/neu over-expression, \nindicating that imaging characteristics reflect molecular expression patterns in \nbreast cancer.\nB‑0219 15:21\nIs availability of breast MRI-guided intervention associated with \nimproved results of breast MRI screening of the contralateral breast \nin women with newly diagnosed breast carcinoma? \nV. Freitas1, S. Kulkarni2, S. Ghai2, R. Fleming2, A. Scaranelo2, P. Crystal2; \n1Rio De Janeiro/BR, 2T oronto, ON/CA (pavel.crystal@utoronto.ca) \nPurpose: The aim of this study was to evaluate the association between availability \nof MRI-guided breast intervention and yield of contralateral screening breast MRI \nin women with newly diagnosed breast carcinoma.\nMethods and Materials: Results of 1621 consecutive preoperative breast MRI \nstudies were compared between periods without (2004-2006) and with (2007-2010) \nMRI-guided intervention capabilities.\nResults: MRI detected otherwise occult contralateral cancers in 38 (2.3%) of \n1621 patients. Cancer detection rate in 2007-2010 was 2.8% (30/1073) which is \nsignificantly higher (p <.04) than 1.5% (8/548) cancer detection rate in 2004-2006. \nMRI performed at the time when MRI-guided intervention was available detected \nDCIS in 23% (7/30) of all cancers versus 13% (1/8) of DCIS detected at the time \nperiod when MRI-guided biopsy was not available. Mean size of 23 invasive can-\ncers diagnosed in 2007-2010 was 15 mm (range 4-71 mm) versus mean size of \n21 mm (range 7-39 mm) for 7 invasive cancers diagnosed in 2004-2006. Small \ncancers (DCIS and invasive cancers < 10 mm) comprised 53% (16/30) of cancers \ndiagnosed in 2007-2010 versus 25% (2/8) of cancers diagnosed in 2004-2006. \nRate of benign image-guided biopsies for MRI-detected lesions in 2007-2010 was \n3.7% (40/1073) similarly to the 3.6% (20/548) of benign biopsies in 2004-2006.\nConclusion: Availability of MRI-guided intervention is associated with higher cancer \ndetection yield and higher number of otherwise occult DCIS and small invasive \ncancers detected by screening MRI of the contralateral breast in women with newly \ndiagnosed breast carcinoma. \n14:00 - 15:30 Room G/H \nNeuro \nSS 211 \nInfection and inflammation \nModerators: \nE. Marco de Lucas; Sancibrian/ES \nG. Schroth; Berne/CH \nB‑0220 14:00\nEvaluation of plaque detection and optimum time of enhancement in \nacute attack multiple sclerosis after contrast injection \nH. Hashemi, H. Ghanaati, S. Behzadi, M. Harirchian, M. Yaghoobi, M. Shakiba, \nA. Jalali, K. Firouznia; T ehran/IR (k_firouznia@yahoo.com) \nPurpose: This study aimed at evaluating the characteristics of multiple sclerosis \n(MS) plaques (number, size and signal intensity) and also to detect the optimum \ntime of enhancement after injection of Gadobutrol.\nMethods and Materials: Sixty-two relapsing-remitting type MS patients, (56 fe-\nmales, 6 males) with the mean age of 31 ±7 years were enrolled into this study. The \npatients underwent T1 weighted magnetic resonance imaging (MRI) scan without \ncontrast. Subsequently, Gadobutrol was injected (0.1 mmol/kg) and MRI scanning \nwas repeated after 30 seconds, 5, 10, 15 and 30 minutes of Gadobutrol injection.\nResults: Enhancing plaques were seen in 42 patients. The mean number of \nenhancing plaques was 4± 8 plaques after 30 seconds of contrast injection. This \nfigure increased to 7 ±13 plaques after 15 minutes and 6±10 plaques after 30 \nminutes. The signal intensity and size of plaques increased progressively, and the \nmaximum signal intensity and plaque size were seen after 30 minutes (p < 0.001).\nConclusion: The maximum number of enhancing plaques in MS patients was \ndetected 15 minutes after contrast administration and the size and signal intensity \nof the lesions also increased remarkably at this time. \n\nScientific Sessions\nS197\nA\n C D E F G\nB\nThursday\nConclusion: SVS and MVS provide similar metabolites among pyogenic brain \nabscesses subjects, and they possess comparable ability for diagnosing pyogenic \nbrain abscesses.\nB‑0227 14:54\nDirectional diffusivity changes describing micro-structural damage \nin normal appearing and lesioned cervical cord white matter in \nmultiple sclerosis \nN. Berkovitz, P. Gottlieb, S. Tal; Zrifin/IL (nadavber@gmail.com) \nPurpose: To evaluate the DTI parameters of relapsing-remitting multiple sclero-\nsis (RRMS) patients and the normal appearing cervical spinal cord (NASC) with \nfocus on Eigenvalue data. Longitudinal diffusivity (λ1) has been associated with \naxonal loss and Wallerian degeneration while transverse diffusivity (λ2, λ3) with \ndemyelination.\nMethods and Materials: DTI of the cervical spine was performed. DTI parameters \nwere measured bilaterally at the level of C2-3 in anterior, lateral and posterior spinal \ncord regions of interest (ROIs). Values were compared between white matter in \nNASC and white matter (NWM) in non-MS patients. When existing, a single cervi-\ncal MS lesion was measured. Values were correlated with clinical parameters of \nEDSS and disease duration.\nResults: There were 10 RRMS and 7 control patients. Eight lesions were measured. \nAnterior ROIs showed a significantly lower FA considered to contain grey matter. \nNASC had significant higher mean λ1, λ2 and ADC values than NWM. Lesions \nhad significantly higher λ2, λ3 and lower FA values than NASC. Lesions were \nhigher in λ1, λ2 and ADC with a lower FA than NWN, without anterior ROIs. FA \nchanges between NASC and lesions correlated with λ2 and λ3. FA in NASC and \nNWM show correlation with λ1, λ2 and λ3. Clinical parameters did not correlate.\nConclusion: NASC shows an increased longitudinal and transverse diffusivity \ncompared to NWM. In lesions, the transverse diffusivity is increased, reducing FA. \nNASC shows both axonal and myelin-related damage while for a focal lesion it is \nthe myelin damage that has increased significantly.\nB‑0228 15:03\nCognitive deficits in clinically isolated syndrome correlate with \nperfusion changes indicative of inflammation \nE. Papadaki, P. Simos, T. Panou, V. Mastorodemos, E. Amanakis, T. Maris, \nA. Karantanas, A. Plaitakis; Iraklion/GR (fpapada@otenet.gr) \nPurpose: Cognitive deficits occur in patients with clinically isolated syndrome \n(CIS), which represents the earliest clinical stage of multiple sclerosis (MS), but \ntheir pathophysiology remains unclear. The aim of this study was to investigate the \nrelation between hemodynamic measurements and memory function in patients \nwith CIS and relapsing remitting-multiple sclerosis (RR-MS).\nMethods and Materials: Thirty patients with CIS, thirty RR-MS patients and \nforty-three healthy subjects, matched for age, gender, education level, and FSIQ, \nwere administered tests of short-term and working memory for digits, passages \nand geometric patterns. Using the dynamic susceptibility contrast-MRI (DSC-MRI) \ntechnique, cerebral blood volume (CBV), cerebral blood flow (CBF), and mean \ntransit time (MTT) values were estimated in twenty cerebral regions of interest, \nplaced in normal appearing white matter (NAWM) and normal deep gray matter \n(NDGM) structures, bilaterally.\nResults: Both CIS and RR-MS groups showed significantly impaired scores on \nverbal working memory and secondary verbal memory. In CIS patients, globally \nelevated CBV and MTT values were detected, while their memory performance \ncorrelated inversely with CBV values in the left frontal NAWM, right thalamus, right \ncaudate and corpus callosum, brain structures known to be involved in cognitive \nfunction.In contrast, among RR-MS patients, correlations of CBV values with \nmemory indices were positive in the right frontal and periventricular NAWM and \nin the caudate.\nConclusion: As the hemodynamic changes, detected in CIS, are indicative of \ninflammation, the observed cognitive disturbances may relate to widespread brain \ninflammatory processes that prevail in early MS.\nB‑0229 15:12\n3 T MRS alterations in brain metabolism in HAART-naive HIV infection \nA. Trofimova, T. Trofimova, G. Kataeva, S. Medvedev, N. Belyakov, \nV. Rassokhin, A. Korotkov, E. Malakhova; St. Petersburg/RU \n(suhackaya@yandex.ru) \nPurpose: To study regional changes in brain metabolites during early HIV infection \ncompared with later stage HIV infection and HIV-seronegative controls.\nenhanced T2*-weighted MRI (DSC-MRI) technique in 20 regions of interest in \nnormal appearing white matter (NAWM) and normal deep grey matter (NDGM) \nstructures bilaterally, that serve as integral components of brain circuits responsible \nfor visuomotor learning and executive functions.\nResults: CIS patients showed significantly elevated reaction time (RT) on both \ntasks, while their CBV values were globally increased. Significant, positive cor-\nrelation coefficients were found between error rates on the inhibition condition of \nthe visuomotor learning task and CBV values in both thalami and occipital, and \nperiventricular NAWM, bilaterally. On the set shifting condition of the respective task \nsignificant positive associations were found between CBV values in the semioval \ncentre and periventricular NAWM bilaterally and error rates, between CBF values \nin both thalami and error rates, and between CBF values in the left parietal NAWM \nand right caudate and RT.\nConclusion: Impaired executive function in CIS patients, including inhibition and \nset shifting abilities, correlated positively with elevated regional CBV values thought \nto reflect active widespread brain inflammatory processes.\nB‑0224 14:36\nThe “central vein sign”: is there a place for susceptibility-weighted \nimaging in possible multiple sclerosis? \nT. Kau, M. Taschwer, M. Schönfelder, J.R. Weber, K.A. Hausegger; \nKlagenfurt/AT (t.kau@gmx.at) \nPurpose: Susceptibility-weighted imaging (SWI) may have the potential to depict \nthe perivenous extent of white matter lesions (WMLs) in multiple sclerosis (MS). \nWe aimed to assess the discriminatory value of the “central vein sign” (CVS).\nMethods and Materials: In a lesion-based 3 T MRI study, 28 WMLs in 14 patients \nwere prospectively included applying the following criteria: 1) at least one circum-\nscribed lesion > 5 mm, 2) not more than eight non-confluent lesions > 3 mm. FLAIR \nimages served as gold standard for the identification of WMLs which were classified \nas periventricular, subcortical, or infratentorial. Only defined WMLs with a maximum \ndiameter of > 5 mm were correlated with their SWI equivalent for CVS evaluation.\nResults: Five patients fulfilled the revised McDonald criteria for MS and nine \npatients were given an alternative diagnosis with non-MS-WMLs most probably \nrepresenting focal gliosis. A total of 28 lesions > 5 mm (19 MS-WMLs and 9 non-\nMS-WMLs) were detected. Consensus reading found a central vein in 16 out of 19 \nMS-WMLs (84%) and in one out of nine non-WMLs (11%), respectively. The CVS \nproved to be a highly significant discriminator (p < 0.001) between MS-WMLs and \nnon-MS-WMLs with a sensitivity, specificity, positive and negative predictive values, \nand accuracy of 84%, 89%, 94%, 73%, and 86%, respectively. The frequency of \nCVS positive lesions was highest in the periventricular zone (7/10), even more \nmarkedly in MS-WMLs alone (6/7). Inter-rater agreement was good (kappa=0.77).\nConclusion: Even though the CVS is not exclusively found in MS-WMLs, SWI \nmay be a useful adjunct in patients with possible MS.\nB‑0225 14:45\nSingle- and multi-voxel proton spectroscopy in patients with \npyogenic brain abscess \nP.-H. Lai, C.-W. Ko, S.-H. Hsu, J.-H. Fu, P.-C. Wang, H.-B. Pan; Kaohsiung/TW \n(pinghonglai@gmail.com) \nPurpose: The purpose of our study was to evaluate the equivalence of multi-voxel \nspectroscopy (MVS) and single-voxel spectroscopy (SVS) in the detection of the \nmetabolites of pyogenic abscesses.\nMethods and Materials: The magnetic resonance spectroscopy (MRS) criteria for \ndiagnosing pyogenic abscesses are presence of cytosolic amino acids (AAs) with \nor without lactate (Lac), succinate (Suc), acetate (Ac), and lipid (Lip). Forty-two \npatients with pyogenic abscesses were studied using SVS and MVS methods. The \nabscess cavity was evaluated by SVS and MVS. Two neuroradiologists reviewed \nthe MRS data. A κ value was calculated to express inter-reader agreement of the \nabscesses metabolites. After consensus judgment of two readers, diagnostic ac-\ncuracy was calculated on MVS with SVS as reference. A κ value was calculated \nto express inter-technique agreement of the abscesses metabolites.\nResults: Resonance of AAs with or without other metabolites was observed in \n76% abscesses on SVS and MVS. The consistency of spectral interpretation of \nthe two readers was very good (κ ranged from 0.95 to 1). After consensus judg-\nment of two readers, sensitivities and negative predictive values of MVS ranged \nfrom 91% (Ac) to 100% (AAs, Suc, Lac, Lip) with SVS as reference. Specificity \nand positive predictive values of MVS were 100% for detecting all five metabolites. \nThe inter-technique κ values of the two readers in consensus were very good (κ \nranged from 0.90 to 1).\n\nScientific Sessions\nS198\n C A D E F\n G\nB\nB‑0231 14:09\nAccuracy of contrast-enhanced imaging in the pretransplantation \nstaging of hepatocellular carcinoma (HCC) and pathologic predictive \nfactors of HCC recurrence after liver transplantation (LT) \nG. Besutti, A. Pecchi, M. De Santis, G. Tarantino, F. Di Benedetto, P. Torricelli; \nModena/IT (giulia.besutti@libero.it) \nPurpose: To assess the accuracy of imaging in HCC pretransplantation staging, \nwith pathologic evaluation of the explanted liver as the reference standard and to \nidentify pathologic predictive factors for HCC recurrence after LT.\nMethods and Materials: 175 patients who underwent LT for HCC between October \n2004 and November 2011 and survived more than 2 months were included. 119 of \nthem had previously undergone locoregional therapies or resection. Imaging find-\nings were retrospectively evaluated on pretransplantation contrast-enhanced CT/\nRM performed within 75 days before LT (mean 42 days). Histopathological findings \nwere obtained by a review of the pathologic reports. Incidence of recurrence was \nevaluated. Pathologic predictive factors for recurrence and association between \npretransplantation imaging and explanted liver pathology were estimated by using \nlinear regression analysis and χ2 test.\nResults: A significant association was found between imaging and pathology in \nthe assessment of the presence of viable tumour (p²0.001, also in patients who \nundergone previous local therapies), number of nodules (p²0.001), diameter of \nthe largest nodule (p²0.001), overall size (p²0.001) and lobar distribution (p=0.03). \nRecurrence was found in 24 (13.7%) patients. A significant association was found \nbetween imaging detection of viable tumour and HCC recurrence (p=0.002). Patho-\nlogical findings associated with recurrence were the presence of viable tumour \n(p=0.003), HCC type rather than combined HCC-cholangiocarcinoma (p²0.001), \ncapsule contact (p²0.001) and vascular invasion (p²0.001).\nConclusion: Contrast-enhanced imaging can be considered accurate in the \npretransplantation staging of HCC. Presence of viable tumour, HCC type, capsule \ncontact and vascular invasion were predictive factors for HCC recurrence after LT. \nB‑0232 14:18\nDetection of HCC and liver metastases with BR14: final results of a \nmulticentre phase IIA study \nJ. Hohmann1, A. Müller2, J. Skrok3, K.-J. Wolf2, A. Martegani4, C.F. Dietrich5, \nT. Albrecht2; 1Basle/CH, 2Berlin/DE, 3Baltimore, MD/US, 4Como/IT, \n5Bad Mergentheim/DE (jhohmann@uhbs.ch) \nPurpose: The study was primarily designed to find the optimal dose range of BR14 \nto detect malignant focal liver lesions. Secondary objectives were the evaluation of \nthe safety profile and comparison with contrast-enhanced MRI (CE MRI).\nMethods and Materials: 25 patients (9f, 16m, mean age: 66y) with known HCC \nor liver metastases were examined in three centres during a time period of three \nmonths. Each patient underwent a baseline and at least three contrast-enhanced \nUS (CEUS) with ascending dose levels (0.25 ml, 1.0 ml, 4.0 ml) of BR14. CE MRI \nwas done 4 weeks prior or post-study examination. Lesions were recorded in on a \nliver map, with respect to localisation, size and suggested lesion type. Examination \nquality was documented and safety parameters were assessed.\nResults: The number of lesions detected with BR14 CEUS increased with dose, \nwhile the number of missed lesions and the lesion size decreased. Despite the \nincreasing contrast enhancement no other image quality parameter showed a \nsubstantial difference. No significant changes were found for the analysed safety \nparameters and no serious adverse events were reported.\nConclusion: We finally conclude that the recommended dose level of BR14 is \nbetween 1.0 ml and 4.0 ml for which the lesion detection was comparable to the \nCE MRI. In addition, we found a higher number of especially small lesions with \nhigher doses of BR14 which might be due to a higher sensitivity of CEUS for the \ndetection of liver metastases. However, this is an interesting and debatable finding. \nAuthor Disclosures:\nJ. Hohmann: Grant Recipient. T. Albrecht: Grant Recipient.\nB‑0233 14:27\nIntegrating contrast-enhanced sonography (CEUS) in the follow-up \nalgorithm of patients with percutaneously ablated hepatocellular \ncarcinoma (HCC) \nO. Catalano, P. Vallone, V. Granata, F. Izzo, V. Albino, A. Nunziata, A. Petrillo; \nNaples/IT (orlandcat@tin.it) \nPurpose: HCC patients treated with percutaneous ablation require close follow-up \nfor detecting tumour recurrence. We illustrate our single-centre experience on using \nCEUS as a follow-up tool alternated with CT.\nMethods and Materials: 2D 1H MR spectroscopy (TE 144) with a preselected \nvolume at the supraventricular level was performed in 15 patients with early HIV \ninfection (plasma level of CD4-lymphocytes more than 350 cells per mcl., HAART \nnaive); 19 patients with later stage of HIV (without HAART/neurologic impairment) \nand 20 HIV-seronegative controls. Protocol included ax T2, ax FLAIR, 3DT1 \npre-, postcontrast. Metabolites ratios were analysed in white and grey matter in \n3 anatomic regions of both hemispheres - anterior and posterior frontal, parietal. \nStatistics were calculated using STATISTICA software package, factorial ANOVA \nwith p < 0.01.\nResults: Naa/Cr was decreased in white matter in both early HIV (2,100±0.25), later \nHIV (2,107±0.26) when compared with HIV-negative controls (2,174±0.27). In the \ncortex Naa/Cr was decreased in anterior frontal region in early HIV (1,577±0.017), \nlater HIV (1,604±0.015) compare with HIV-negative controls (1,652±0.017). Naa/\nCho was decreased in white matter in early HIV (2,068±0.44), later HIV (2,153±0.45) \nwhen comparedwith controls (2,335±0.44) and was decreased in grey matter \nin early HIV (1,878±0.44), later HIV (1,929±0.39) compared with HIV-negative \ncontrols (1,985±0.38). There was no difference between HIV groups in Naa/Cr, \nNaa/Cho. Cho/Cr was significantly different in 3 groups, most increased in early \nHIV (1,058±0.20) compared with later HIV (1,001±0.15) and controls (0.950±0.14) \nwithout regional predominance.\nConclusion: The results suggest that HIV infection produces brain metabolites \nalterations early in the course of disease, with predominance of inflammatory \nchanges in early HIV infection.\n14:00 - 15:30 Room I/K \nAbdominal Viscera \nSS 201b \nHepatocellular carcinoma: diagnosis and \nmanagement \nModerators: \nG. Brancatelli; Palermo/IT \nM. Bruegel; Munich/DE \nB‑0230 14:00\nIntravoxel incoherent motion diffusion-weighted MR imaging of \nhepatocellular carcinoma: correlation with enhancement degree and \nhistological grade \nS. Woo, J. Lee, J.-H. Yoon, I. Joo, J. Han, B. Choi; Seoul/KR \n(j_crew7@hotmail.com) \nPurpose: To compare intravoxel incoherent motion (IVIM)-derived parameters \nwith the apparent diffusion coefficient (ADC) in predicting the histological grade of \nhepatocellular carcinomas (HCC), and to evaluate the relationship between IVIM-\nderived parameters and arterial enhancement (AE) degree.\nMethods and Materials: This retrospective study was IRB approved and informed \nconsent was waived. Forty patients with 42 surgically confirmed HCCs underwent \ndiffusion-weighted imaging (DWI) with eight b-values (0-800 sec/mm2). ADCtotal, \nD (diffusion coefficient), D* (pseudodiffusion coefficient), and f (perfusion fraction) \nwere calculated. Two radiologists determined the enhancement degree in consen-\nsus and the percentage of AE of HCCs. The relationship between the parameters \nand histological grade and AE was assessed using Spearman’s or Pearson’s cor-\nrelation test. Receiver operating characteristics (ROC) analysis of discrimination \nbetween fair and poor grade HCCs was performed for D and ADCtotal.\nResults: D and ADCtotal were both significantly correlated with histological grade: \nr=-0.604, p  < 0.001 and r=-0.448, p=0.002, respectively. D and ADCtotal were \nboth significantly lower in poor (D=0.99 ± 0.13 x 10 -3 mm2/s, ADC=1.13 ± 0.14 \nx 10-3 mm2/s) than in fair grade HCCs (D=1.18 ± 0.16 x 10 -3 mm2/s, ADC=1.25 \n± 0.17 x 10 -3 mm2/s) (p < 0.001, p=0.029, respectively). However, ROC analysis \ndemonstrated a greater Az value of D (0.836) for differentiating poor grade HCCs \nfrom fair grade HCCs than ADCtotal (0.733) (p=0.037). The percentage of AE and \nf were correlated (r=0.621, p < 0.001).\nConclusion: IVIM-derived diffusion coefficient of HCCs showed significantly better \ndiagnostic performance in predicting histological grade than ADCtotal, and signifi-\ncant correlation was observed between f and the percentage of AE.\n\nScientific Sessions\nS199\nA\n C D E F G\nB\nThursday\nResults: Twenty-one out of 54 patients had a residual disease and values of \nperfusion parameters measured within tumour tissue were: REA 44.66, RVE \n60.50, RLE 52.72, ME 553.21, MRE 65.95 and TTP 140.61. The same parameters \ncalculated in those correctly treated were: REA -1.24, RVE 5.93, RLE 16.9, ME \n203.24, MRE 25.78, TTP 165.87. A significant difference (p < 0.001) was found \nfor all the evaluated parameters between residual viable tumour tissue (p < 0.001) \ncompared to successfully treated lesions, due to the presence of residual arterial \nvascular structure in viable portion of treated HCC.\nConclusion: MRI perfusion images is a useful non-invasive tool in quantitative \nand qualitatively assessment of patients with treatment response of HCC lesions.\nB‑0236 14:54\nDiagnostic efficacy of combined dynamic perfusion MRI with ADC \nmapping in the assessment of therapeutic effects of HCC-treated \nlesions: preliminary results \nD. Ippolito, C. Trattenero, P. Bonaffini, C. Capraro, R. Corso, S. Sironi; Monza/IT \n(davide.atena@tiscalinet.it) \nPurpose: To correlate kinetic parameters derived from dynamic contrast-enhanced \nMR perfusion imaging with apparent diffusion coefficient (ADC) for the assessment \nof multiparametric approach to interventional treatment of HCC lesions.\nMethods and Materials: Fifty-four patients with known cirrhotic liver disease and \nbiopsy-proven diagnosis of HCC lesion, that underwent TACE or RFA treatment, \nwere prospectively enrolled. MR study was performed 4 weeks after treatment \nand consists of multiplanar standard protocol with T2 and T1 sequences, dynamic \ncontrast-enhanced (THRIVE), using a 1.5 T MRI system (Achieva, Philips), including \nalso diffusion weighted imaging (DWI). Philips’s workstation was used to generate \ncolour permeability maps showing perfusion of enhancing tumours and quantitative \nADC maps. After placing regions of interests (ROIs) on the site of maps which best \ncorresponded to the enhanced regions of lesion, the following parameters were \ncalculated: relative enhancement, maximum enhancement, maximum relative \nenhancement, time to peak and ADC values. Correlation between MR imaging, \nparametric values and clinical pathological classification was statistically analysed.\nResults: Sixteen out of 54 patients had residual disease and values of parameters \nmeasured within residual tumour tissue were: REA 44.66, VE 60.50, RLE 52.72, \nME 553.21 (%), MRE 65.95 (%), TTP (s) 140.61, and 982.21±103.93x10 -3 mm2/\nsec. Corresponding values obtained in the remaining 26 cases, correctly treated, \nwere: REA -1.24, RVE 5.93, RLE 16.9, E 203.24, RE 25.78, TTP 165.87 and \n1682.72±149.74 x10-3 mm2/sec. A significant difference (p < 0.001) was found for all \nobtained parameters between residual viable tumour tissue (p < 0.001) compared \nto successfully treated lesion, due to the presence of residual arterial vascular \nstructure in viable portion of treated HCC.\nConclusion: This feasibility study shows that quantitative multiparametric MR \nimages analysis could provide an in vivo marker of biological characteristics of \nHCC useful in assessing the therapeutic treatment response.\nB‑0237 15:03\nRecurrence patterns of hepatocellular carcinoma (HCC) after \nliver transplantation (LT) and variations in dynamic imaging and \nhistopathological characteristics between the primary and the \nintrahepatic recurrent HCC \nG. Besutti, A. Pecchi, M. De Santis, G. Tarantino, F. Di Benedetto, P. Torricelli; \nModena/IT (giulia.besutti@libero.it) \nPurpose: To describe the patterns of recurrence of HCC after LT and to evaluate \nthe variation in imaging and histopathological characteristics between the primary \nHCC and the intrahepatic recurrence.\nMethods and Materials: 24 cases of recurrent HCC on a total of 175 patients \nwho underwent LT for HCC between October 2004 and November 2011 were \nreviewed. Imaging characteristics of the primary HCC were retrospectively evalu-\nated on dynamic contrast-enhanced imaging (CT/MRI) performed within 75 days \nbefore LT (mean 42 days). Patterns and characteristics of recurrence were retro-\nspectively evaluated on follow-up dynamic contrast-enhanced imaging (CT/MRI). \nHistopathological characteristics of the primary HCC and recurrence were obtained \nby a review of the pathologic reports. The association between the variations in \nhistopathological and imaging characteristics of primary and recurrent HCC was \nestimated using linear regression analysis.\nResults: The initial recurrence was extrahepatic in 14 (58.3%, lung, bone, lymph \nnodes, brain, spleen, adrenal), intrahepatic in 7 (29.2%) and both intrahepatic and \nextrahepatic (peritoneum, lung, bone, lymph nodes) in 3 (12.5%) patients. Of 14 \npatients with initial or late intrahepatic recurrence, 2 (14.3%) showed a variation \nin imaging characteristics between the primary HCC (hypervascular) and the \nrecurrence (hypovascular), 1 (7.1%) showed a variation in histopathological char-\nMethods and Materials: During 2005-2011 588 patients with 1-3 HCCs were \ntreated with radiofrequency ablation (alone or combined with ethanol injection). \nPatients had complete ablated tumours at 1 mo. CT was followed-up serially, using \nalternated CEUS (one sulphur hexafluoride-based microbubbles injection per lobe) \nand CT every 3 months. The following patterns of recurrence were considered: A, \nenhancing tissue within the lesion; B, enhancing tissue adherent to the lesion; C, \nenhancing tissue within the same liver segment of the treated nodule; D, enhanc-\ning tissue within a different segment (progression). Patients with positive CEUS \nunderwent confirmatory CT (standard reference).\nResults: Median follow-up was 29 months. There were 221 recurrences. Three \npattern A recurrences (2 detected by CEUS and 1 by CT), 86 pattern B recurrences \n(44 detected by CEUS and 42 by CT), 70 pattern C recurrences (32 detected by \nCEUS and 38 by CT), and 62 pattern D recurrences (23 detected by CEUS and \n39 by CT). CT detected additional nodules in 16/101 patients with positive CEUS.\nConclusion: CEUS follow-up of HCC patients after ablation is feasible. Since 72% \nrecurrences develop in the same segment of the necrotic nodule, CEUS proves to \nbe effective despite the less comprehensive liver survey compared to CT. Including \nCEUS in patient follow-up may allow decreasing the number of CT examinations. \nB‑0234 14:36\nHepatocellular carcinoma (HCC) treated with transarterial \nchemoembolisation (TACE): volume CT perfusion (VCTP) imaging in \nthe detection of early changes - preliminary results \nJ. Steiner, T. Wimmer, D. Bohlsen, F. Quehenberger, H. Schöllnast; Graz/AT \n(juergensteiner1@gmx.at) \nPurpose: To describe the early changes after transarterial chemoembolisation \n(TACE) of hepatocellular carcinomas (HCC) using volume CT perfusion (VCTP) \nimaging.\nMethods and Materials: This prospective study was approved by the Institutional \nReview Board and informed consent was obtained from all patients. VCTP imag-\ning was performed in 11 patients who underwent TACE of HCC. VCTP imaging \nof the HCC was performed on the day before TACE and 5 - 7 days after TACE \nto assess early changes. All VCTP studies were performed on a 320 channel CT \nscanner (Aquilion One, Toshiba Medical Systems) and perfusion of the HCC was \ncalculated using commercial body perfusion software (Toshiba Medical Systems). \nTube voltage was 100 kV, tube current was 100 mA, and rotation time was 0.5 \nsec. Hepatic arterial flow (HAF), portal venous flow (PVF), and hepatic arterial \nflow fraction (HAFF) of the HCC were calculated before and after TACE. Perfusion \nvalues before and after TACE were compared using the t-test.\nResults: Mean HAF (±SD) decreased from 121 ± 76 to 95 ± 21 mL/min/100 mL \n(22%, p=0.210), mean PVF (±SD) increased from 174 ± 79 to 259 ± 190 mL/\nmin/100 mL (50%, p=0.064), and HAFF decreased from 46 ± 13 to 37 ± 12 % \n(20%, p < 0.002).\nConclusion: VCTP imaging is a non-invasive technique for evaluation of the early \nchanges of HCC after TACE and may be used as imaging tool to assess early \nresponse. Especially the HAFF may be an accurate parameter for assessment \nof early response. \nB‑0235 14:45\nRole of dynamic contrast-enhanced perfusion MR imaging in \nmonitoring of patients with HCC lesions treated by radiofrequency \nablation or transarterial chemoembolisation \nC. Trattenero, D. Ippolito, M. Colombo, P.A. Bonaffini, R. Corso, S. Sironi; \nMilan/IT (chiaratratte@gmail.com) \nPurpose: To prospectively investigate the role of dynamic contrast-enhanced (DCE) \nperfusion MR imaging in detection of blood flow changes related to therapeutic \neffects of transarterial chemoembolisation (TACE) and radiofrequency ablation \n(RFA) in patients with HCC lesions.\nMethods and Materials: Fifty-four patients with known cirrhotic liver disease and \nbiopsy-proven HCC lesions that underwent TACE or RFA treatment were prospec-\ntively enrolled in our study. Upper abdominal MRI examination (1.5 T Achieva, \nPhilips) with multiplanar T2 and T1 sequences and dynamic contrast-enhanced \nTHRIVE was performed about 1 month after the treatment. Philips’s workstation was \nused to generate colour permeability maps showing perfusion images of hepatic \nparenchyma and of treated lesions that were compared with T2, T1 weighted images \nand THRIVE sequences. After placing region of interest (ROI) in normal hepatic \nparenchyma, correctly treated lesions and along the contours of HCC recurrence \nlesions, following parameters were calculated and statistically analysed: relative \narterial, venous and late enhancement (RAE, RVE, RLE), maximum enhancement \n(ME), maximum relative enhancement (MRE) and time to peak (TTP).\n\nScientific Sessions\nS200\n C A D E F\n G\nB\n14:00 - 15:30 Room L/M \nPhysics in Radiology \nSS 213 \nInnovations in CT technology and data processing \nModerators: \nC. Leidecker; Forchheim/DE \nR. Padovani; Udine/IT \nB‑0240 14:00\nPerformance evaluation of a new CT detector with minimal electronic \nnoise for low dose abdominal perfusion imaging \nE. Klotz, U. Haberland, B. Schmidt; Forchheim/DE \nPurpose: 80 kV are not routinely used for abdominal CT perfusion imaging with \nconventional detectors because non-linear effects occur when the electronic \nnoise of the detector becomes larger than the photon noise. We evaluated a new \ndetector design (Stellar, Siemens Healthcare) with minimal electronic noise for \nthis application.\nMethods and Materials: Inserts with iodine concentrations of 0.5 and 1.0 mg/\nml were placed in a 30 cm water-phantom and examined with 100 kV and 80 kV \non two otherwise identical scanners equipped with a conventional and a Stellar \ndetector (SOMATOM Definition Flash). Scans were performed using standard and \nperiodic spiral dynamic mode (10 repetitions) varying image mAs from 15 to 250 \n(CTDI 0.3 to 5 mGy). We measured iodine contrast and noise. Dose normalised \ncontrast-to-noise ratio CNRn = contrast/(noise*sqrt (dose)) was used as an objec-\ntive measure for comparison.\nResults: CNRn at 80 kV was at least 8% lower for the conventional detector at all \ndose settings. Electronic noise became dominant at 60 mAs and CNRn decreased \nby another 35% at 15 mAs with increasingly prominent artefacts. For the Stellar \ndetector CNRn did not decrease by more than 5% down to 15 mAs and there were \nno relevant image artefacts. Using 80 kV the same CNR of the clinical default set-\nting (100 kV, 120 mAs) was obtained at 65% of the dose.\nConclusion: The Stellar detector allows the routine use of 80 kV for abdominal \nperfusion imaging. For identical CNR this reduces the dose by 35% compared \nto 100 kV.\nAuthor Disclosures:\nE. Klotz: Employee; Siemens Healthcare, Germany. U. Haberland: Employee; \nSiemens Healthcare, Germany. B. Schmidt: Employee; Siemens Healthcare, \nGermany.\nB‑0241 14:09\nPerformance of a next-generation solid-state detector with fully \nintegrated readout electronics for MDCT: quantitative analysis \nof image quality and radiation exposure reduction potential in \ncomparison with its predecessor \nG. Pahn, L.-S. Veloza, H.-P. Schlemmer, H.-U. Kauczor, W. Stiller; \nHeidelberg/DE (gregor.pahn@med.uni-heidelberg.de) \nPurpose: Quantitative assessment of image quality and radiation exposure reduc-\ntion potential of a next-generation solid-state MDCT detector with fully integrated \nreadout electronics in comparison with its predecessor.\nMethods and Materials: Using standard CT image quality phantoms and an \nautomated quantitative image quality analysis software developed in-house, im-\nage quality and radiation exposure (RE) of an MDCT system (Somatom Definition \nFlash, Siemens) either equipped with UFC™ or new “Stellar” detectors has been \nassessed for different combinations of acquisition and reconstruction parameters. \nSubsequently, measurements and analysis were repeated for “Stellar” detectors \nwithout altering parameters apart from noise-weighted reduction of tube current-\ntime product resulting in image noise levels equal to those achieved when using \ntheir predecessor.\nResults: Image noise of both detectors was comparable for small absorption cross-\nsections (Øwater=24 cm) while being 18-35% lower for large ones (Øwater=40 cm) \nwhen using “Stellar” detectors. CT number stability and uniformity declined with \nincreasing subject cross-section, particularly at 80 kVp, though not as much for \n“Stellar” detectors. When noise of “Stellar” acquisitions was increased to UFC™ \nlevels, RE reduction of 28-54% was achieved. For the “Stellar” detector CNR was \nslightly higher (same RE) or slightly lower (reduced RE), while spatial resolution \nwas always equal for both detectors (up to 20 lp/cm at MTF10%).\nConclusion: Overall image quality improves when a next-generation MDCT detec-\ntor is employed instead of using its predecessor. For acquisition settings intrinsically \nacteristics (from moderate to poor differentiation), but no association was found \nbetween imaging and histopathological variations.\nConclusion: The most common pattern of recurrence was extrahepatic location, \nfollowed by intrahepatic recurrence and both intrahepatic and extrahepatic diffusion. \nVariations in dynamic-imaging characteristics of intrahepatic recurrence were not \nassociated with variations in histopathological characteristics.\nB‑0238 15:12\nAccuracy of mRECIST versus RECIST 1.1 in predicting outcome in \nhepatocellular carcinoma treated with Sorafenib \nG. Gallusi, M. Di Martino, C. Lombardo, M. Del Monte, R. Di Miscio, A.F. Attili, \nC. Catalano; Rome/IT (dimase81_6@hotmail.com) \nPurpose: Both in SHARP and Asia-Pacific trials, a poor radiological response rate \n(RRR) (p=0.17 and 0.05, respectively), assessed with RECIST, contrasted with a \nsignificant elongation of overall survival (OS) (p=0.014 and 0.001, respectively) in \npatients treated with Sorafenib. So far, reliable criteria to determine the response \nof hepatocellular carcinoma (HCC) to Sorafenib are lacking. The aim of this study \nwas to compare RECIST1.1 and mRECIST ability in the estimation of the response \nto therapy in patients with advanced HCC treated with Sorafenib.\nMethods and Materials: From August 2008 to July 2012, 58 cirrhotic patients \nwith advanced HCC received Sorafenib at starting dose of 400 mg bid and were \nfollowed until death occurred. Using RECIST1.1 and mRECIST, 27 patients who \nhad undergone a 4-phase CT scan/dynamic MR before and after (30-100 days) \nthe start of treatment were retrospectively analysed. RRR was evaluated according \nto RECIST1.1 and mRECIST, to determine the ability of each method in predicting \nthe response of HCC to Sorafenib, taking OS as end-point.\nResults: The objective response [OR= complete response (CR) + partial response \n(PR)], stable disease (SD) and progressive disease (PD) rates according to RE-\nCIST1.1 and mRECIST were 14%, 25%, 59% and 25%,18%, 55%, respectively. In \nCR+PR versus SD+PD patients, median OS was 24.3 months (both with RECIST1.1 \nand mRECIST) versus 10.9 (with RECIST1.1) and 10.1 months (with mRECIST). \nOR was significantly associated with OS only according to mRECIST (p=0.007).\nConclusion: RRR according to mRECIST, but not to RECIST1.1, sensibly cor-\nrelates to outcome in cirrhotic patients with HCC treated with Sorafenib.\nB‑0239 15:21\nCould antiplatelet therapy prevent hepatocellular carcinoma? 7 Tesla \nliver magnetic resonance imaging study in a mouse model of hbv-\nrelated chronic hepatitis \nP. Marra, A. Esposito, G. Sitia, A. Palmisano, T. Canu, F. De Cobelli, \nL.G. Guidotti, A. Del Maschio; Milan/IT (marrapaolo87@libero.it) \nPurpose: A dysfunctional T-cell response in chronic hepatitis B (CHB) causes \ncellular injury and viral persistence with increased risk of hepatocellular carci-\nnoma (HCC). Accumulation of virus-specific cytotoxic lymphocytes in the liver \nis promoted by platelets. To assess the effectiveness of antiplatelet therapy in \nhepato-carcinogenesis prevention we used preclinical liver magnetic resonance \nimaging (MRI) in a mouse model of CHB.\nMethods and Materials: 220 transgenic mice with CHB were randomised to \nreceive placebo (Vehicle = 110 mice) or the experimental therapy with aspirin and \nclopidogrel (Asp/Clo = 110 mice). 220 healthy transgenic mice formed two control \ngroups (Sham = 110 irradiated mice; Ctrl = 110 unmanipulated mice). 20 mice per \ngroup underwent in vivo liver MRI at 9 and 15 months after CHB induction with a 7 \nTesla scanner. Fat-sat T2w turbo-RARE and T1w RARE sequences were acquired \nafter intravenous administration of Gd-EOB-DTPA (Primovist®). The remaining mice \nwere used for biochemical, histological and survival analysis.\nResults: In-vivo MRI demonstrated a significant reduction in incidence of HCC in \nthe Asp/Clo versus placebo group both at 9 months (5% vs 20%, p < 0.001) and 15 \nmonths (30% vs 65%, p < 0.001). At the same time points HCC/total-liver volume \nratio was, respectively, 3.8 and 5.4 fold smaller in Asp/Clo mice (p < 0.001). Accord-\ningly histological analyses revealed that Asp/Clo therapy reduced immunopathology, \nhepatocellular regeneration and fibrosis. The experimental therapy also improved \nsurvival (mice died at day 520: 75% Vehicle vs 20% Asp/Clo, p < 0.0005).\nConclusion: A prophylactic therapy with aspirin and clopidogrel in transgenic mice \nwith CHB inhibits hepato-carcinogenesis and improves survival. \n\nScientific Sessions\nS201\nA\n C D E F G\nB\nThursday\nAuthor Disclosures:\nS. Wirth: Speaker; GE Healthcare.\nB‑0244 14:36\nInfluence of sinogram affirmed iterative reconstruction of CT data \non image noise characteristics and low-contrast detectability in \ncomparison with filtered back projection: an objective approach \nC. von Falck1, V. Bratanova1, T. Rodt1, B. Meyer1, S. Waldeck2, F. Wacker1, \nH.-o. Shin1; 1Hannover/DE, 2Koblenz/DE (c.v.falck@gmx.de) \nPurpose: To systematically evaluate the influence of sinogram-affirmed iterative \nreconstruction (SAFIRE) of MDCT data on image noise and low-contrast detectabil-\nity using an objective approach.\nMethods and Materials: A low-contrast phantom for MDCT was scanned on a \n128-slice scanner at different dose levels (25.50,100,150,200 mAs). The datasets \nwere reconstructed using the standard kernel B30f (FBP) and an iterative algorithm \n(SAFIRE). A software phantom was used to insert virtual lesions with a contrast of \n-20 HU. Low-contrast detectability was determined using the multiscale structural \nsimilarity index (MS-SSIM*).\nResults: The use of SAFIRE led to an improvement in lesion detectability for all \ndose levels and lesions sizes. The relative improvement of low-contrast perform-\nance as compared with the FBP was inversely related to the dose level, declining \nfrom 208%(±37%), 259%(±30%) and 309%(±35%) at 25 mAs to 106%(±6%), \n119%(±9%) and 123%(±8%) at 200 mAs for SAFIRE filter strengths of 1.3 and \n5, respectively (p < 0.05). There was no statistically significant influence of lesion \nsize. The datasets reconstructed using SAFIRE reached at least the low-contrast \nperformance of the datasets reconstructed with FBP at a relative dose of 50%. The \nuse of SAFIRE led to a shift of noise granularity towards a coarser image noise \nwhile higher dose levels showed a shift towards finer noise.\nConclusion: The use of SAFIRE improves low-contrast detectability when \ncompared with FBP allowing for a dose reduction of approximately 50% without \ncompromising low-contrast detectability or spatial resolution. The unfamiliar imag-\ning appearance of iteratively reconstructed datasets may in part be explained by \na different, coarser noise characteristic. \nAuthor Disclosures:\nC. von Falck: Research/Grant Support; Visage Imaging, Siemens Healthcare. \nT. Rodt: Research/Grant Support; Visage Imaging. B. Meyer: Research/\nGrant Support; Visage Imaging. F. Wacker: Research/Grant Support; Siemens \nHealthcare, Visage Imaging. \nB‑0245 14:45\nCTDI measurements using radiochromic films \nN. Tomic, N. Sharoubim, F. DeBlois, J. Seuntjens; Montreal, QC/CA \n(nada.tomic@mail.mcgill.ca) \nPurpose: We demonstrate a new method for computed tomography dose index \n(CTDI) measurements acquired on computed tomography (CT) scanners using \nXR-QA model radiochromic film dosimetry system. The method was tested com-\nparing CTDI values measured and CT scanner listed for six different CT scanners \nat various locations.\nMethods and Materials: Dose profiles were measured with XR-QA radiochromic \nfilm strips, sandwiched between acrylic rods cut in half and placed within CTDI body \nphantom. Films strips were scanned before and after irradiation with the Epson \nPerfection V500 photo scanner in reflective mode. The reference dosimetry system \nwas calibrated in terms of air kerma in air. The measured reflectance change is \nconverted into air kerma using a calibration curve. Air kerma was converted into \nabsorbed dose using the appropriate ratio of mass-energy absorption coefficients \nwater-to-air for a given beam quality, defined by half-value layer following the \nAAPM TG-61 protocol.\nResults: Dose values for each of the five CTDI phantom film positions were \nobtained by averaging dose profiles from each film piece over the length of 10 \ncm, and were used to calculate weighted CTDIvol. The average difference for \nsix scanners between calculated and listed CTDIvol was 3.9% with a maximum \nobserved difference of 6.9%.\nConclusion: In contrast to ionisation chamber measurement, the proposed method \nrequires only a single exposure, does not need stem effect correction, and provides \nan acceptable accuracy in comparison to CT scanner listed CTDI values. Measured \ndose profiles allow for measurements of DLP and peak doses at the same time. \nassociated with high image noise the new detector exhibits much lower noise \nlevels, offering great potential for radiation exposure reduction without adversely \naffecting overall image quality. \nAuthor Disclosures:\nH.-U. Kauczor: Advisory Board; Siemens Medical Solutions. Investigator; \nBoehringer Ingelheim. Speaker; Siemens Medical Solutions, Boehringer \nIngelheim, Bayer, Bracco. W. Stiller: Equipment Support Recipient; Siemens \nMedical Solutions.\nB‑0242 14:18\nIntegrated circuit detector technology in abdominal computed \ntomography: value in obese patients \nF. Morsbach1, S. Bickelhaupt1, S. Raetzer1, B. Schmidt2, H. Alkadhi1; 1Zurich/CH, \n2Forchheim/DE \nPurpose: To assess the effect of an integrated circuit (IC) detector for abdominal \nCT imaging in obese patients on image quality.\nMethods and Materials: An abdominal phantom with various extension rings was \nused simulating abdominal diameters of up to 600 mm. The phantom was scanned \non a CT equipped with either conventional discreet circuit detector (DC) or with \nan IC detector (at 120 kVp and 150 mAs/75 mAs). Datasets were reconstructed \nwith filtered back projection (FBP) and iterative reconstruction (IR). Images were \nevaluated by two blinded readers based on image quality and image noise. Image \nnoise was additionally assessed in 20 patients undergoing abdominal CT with the IC \ndetector who underwent previous CT at similar protocol setting with a DC detector.\nResults: Readers found improvements in image quality and subjective image \nnoise in IC detector-acquired images compared with the DC detector in the larg-\nest phantom, regardless of reconstruction algorithm. Objective image noise was \nalso significantly (P < 0.001) reduced for the largest phantom. A noise reduction \nof up to 44.5% was achieved for the IC detector when scanned with 75 mAs and \nreconstructed with IR as compared with DC detector-acquired images. In patients, \nnoise was significantly (P < 0.05) reduced by on average 6.4% with the IC detector. \nA significant correlation was found between noise and abdominal diameter in DC \ndetector images (r=0.604, P=0.005), whereas no such correlation was found for \nthe IC detector (P=0.060).\nConclusion: Use of an IC detector appears particularly beneficial for abdominal \nCT imaging in large body diameters by reducing image noise. \nB‑0243 14:27\nComparison of filtered back projection (FBP) with hybrid and \niterative reconstruction algorithms (HIR and IR) in low dose \nprotocols including high and low kV settings in CT angiography by \ntesting the detectability of simulated endoleak and thrombus in a \nphantom study \nZ. Deák, J. Grimm, F. Mück, M. Treitl, M.F. Reiser, S. Wirth; \nMunich/DE (zsuzsanna.deak@med.uni-muenchen.de) \nPurpose: To evaluate the dose reduction potential of HIR and IR in comparison \nwith FBP.\nMethods and Materials: An anthropomorphic cardiac phantom (QRM Corp., Ger-\nmany) was scanned using a 64-row MDCT scanner (CT 750HD; GE-Healthcare, \nUSA). The phantom’s calcification insert was replaced with a model simulating a \nstented aortic aneurysm with endoleak and intraluminal thrombus. Images were \nobtained at tube voltages of 120 kV, 100 kV and 80 kV using automated tube current \nmodulation with incrementally increasing noise indices (NI=16, 25, 34, 43, 52, 61, \n70) adjusted to a primary reconstruction slice thickness of 2.5 mm. After acquisition, \nimages of 0.625 mm slice thickness were secondarily re-reconstructed with FBP, \nHIR (ASIR® with 50% blending, GE-Healthcare) and IR (Veo®, GE-Healthcare). \nTwenty-one radiologists blinded to image reconstruction methods independently \nanalysed the detectability of simulated vascular pathologies (endoleaks < 1 cm² \nand intraluminal thrombus < 3 mm). Contrast-to-noise ratio was measured for the \nstented aorta. A two-by-two table was used to calculate sensitivity, specificity value.\nResults: Sensitivity and specificity for vascular pathologies were > 90% with FBP \nat 3.45 mGy, 1.23 mGy and 1.46 mGy, with HIR at 1.83 mGy, 0.84 mGy and 1.02 \nmGy, with IR at 0.41 mGy, 0.46 mGy and 0.55 mGy, at 120 kV, 100 kV and 80 kV. \nCNR of aorta showed corresponding results.\nConclusion: Simulated vascular pathologies were generally detectable at higher \nnoise level than suggested by manufacturer. In comparison to FBP, the iterative \nand hybrid reconstruction algorithm allowed for a dose reduction by 88% and 47% \nat 120 kV, 63% and 32% at 100 kV and 70% and 30% at 80 kV, respectively, in \nour phantom study.\n\nScientific Sessions\nS202\n C A D E F\n G\nB\nwas scanned with a multi-slice CT (MSCT) and a cone-beam CT (CBCT). A Matlab \nprogram was written for analysing image data and producing directional, radially \naveraged (rMTF) and frequency-wise averaged (fMTF) curves. 10% fMTF value \nin XY-plane for both devices was compared with corresponding values measured \nwith a tungsten wire reference method.\nResults: 10% fMTF value in XY-plane was 0.71±0.01 lp/mm for the MSCT whereas \nfor the CBCT it was 1.82±0.12 lp/mm. Reference value for the MSCT was 0.68 lp/\nmm and for the CBCT 1.71 lp/mm. 10% fMTF value over the full solid angle for the \nMSCT was 0.74±0.03 lp/mm and for the CBCT 2.00±0.23 lp/mm.\nConclusion: Directional MTF evaluation provides similar results as the standard \nmethod. However, it can be expanded to describe scanner’s spatial resolution over \nthe full solid angle without increasing the scanning time. Combined with fMTF’s \nversatility and method’s easy implementation in a clinical environment, the 3D MTF \nserves modern CT imaging well. \n14:00 - 15:30 Room N/O \nVascular \nSS 215 \nMajor vessel imaging \nModerators: \nW.R. Jaschke; Innsbruck/AT \nO. Pellerin; Paris/FR \nB‑0250 14:00\nLow dose runoff CTA: what protocol is preferred without special \nreconstruction algorithms? \nE. Kondratyev, G. Karmazanovsky; Moscow/RU (evgenykondratiev@gmail.com) \nPurpose: To compare two low-dose scanning protocols, and to estimate effects on \nthe signal, noise, effective radiation dose (ED), quality of acquired data.\nMethods and Materials: 90 patients were divided into three groups. The scanning \nprotocol was 120 kVp 200 mAs in first group, 80 kVp 200 mAs in second group, \nand 120 kV 50 mAs in third group, special reconstruction algorithms have not \nbeen used. For quantitative and qualitative evaluation we used visual scores (1-\n3), mean arterial attenuation, noise, contrast-to-noise ratio (CNR) in three arterial \nsegments and ED.\nResults: The BMI ranged from 21 to 38 kg/m2 and were not significantly different \nbetween groups (p=0.07, 0.614, 0.297, respectively). The mean intraarterial at-\ntenuation in 1, 2, 3 groups was 315±6 HU, 448±76 HU, 334±33 HU, respectively, \nbut significantly higher in second group (p=0.0003). Noise in second group (64±20 \nHU) was significantly higher than that in third group (45±14 HU, p=0.0002), and first \ngroup (29±8.5 HU, p=0.0002). The CNR in second (6.64±2.3) and third (6.36±2.1) \ngroups was significantly lower than that in first group (11.7, p=0.0001). Image \nquality was comparable between three techniques, except aorto-iliac segment in \nsecond group. Effective dose was 27.1±5.9mZv, 8.1±1.8mZv and 6.4±1.02mZv, \nrespectively, differences were significant (p=0.0001).\nConclusion: Average radiation dose reduction up to 77% was achieved using “80 \nkV” and “50 mAs” protocol providing sufficient image quality. Application of the 80 \nkV protocol in people with BMI> 30 is limited, especially in evaluation of aorto-iliac \nsegment due to higher noise and attenuation levels. While at 50 mAs protocol such \nlimitation is not observed. This allows to recommend it as the preferred protocol for \nlow-dose runoff CTA in case of special reconstruction algorithms.\nB‑0251 14:09\nValue of contrast-enhanced MRA of the peripheral arteries at 3 T: \nresults of a large European multicentre trial comparing meglumine \ngadoterate to gadobutrol-MRA with DSA \nC. Loewe1, J. Arnaiz2, D. Krause3, L. Marti Bonmati4, M. Aschauer5, A. Tartaro6, \nM. Lombardi7, M. Burrel8, R. Izzillo9; 1Vienna/AT, 2Santander/ES, 3Dijon/FR, \n4Valencia/ES, 5Graz/AT, 6Chieti/IT, 7Pisa/IT, 8Barcelona/ES, 9Saint-Denis/FR \n(christian.loewe@meduniwien.ac.at) \nPurpose: This subanalysis of a multicentre trial aimed to assess the value of \ncontrast-enhanced MRA at 3 T for diagnosis and treatment planning in peripheral \narterial occlusive disease (PAOD).\nMethods and Materials: This multicentre trial including 189 patients was prima-\nrily aimed to compare the degrees of agreement in stenosis detection between \ncontrast-enhanced MRA and DSA using two different contrast agents (Dotarem® \nor Gadovist®). In this subanalysis, parameters related to stenosis detection and \ngrading, specificity, sensitivity, positive/negative predictive values calculation (ac-\nB‑0246 14:54\nPhysical characterisation of iterative reconstruction algorithms in \ncomputed tomography and assessment of image quality for the \noptimisation of a dual-energy abdominal protocol \nL. Berta, L. Mascaro, M. Cataldo, R. Maroldi; Brescia/IT (berta.luca@gmail.com) \nPurpose: To assess the quality of CT images reconstructed with sinogram affirmed \niterative reconstructions (SAFIRE) and comparing their performances with Iterative \nreconstructions in image space (IRIS) and standard filtered back projection (FBP) \nalgorithms on a Siemens Somatom Definition Flash. Results were used to optimise \na dual energy (DE) abdominal protocol.\nMethods and Materials: FBP, IRIS and the 5 strength levels in SAFIRE (S1-S5) \nreconstructions were characterised in contrast, noise and spatial resolution for \nmedium-smooth filters using a tungsten wire in air, water and Catphan phantoms. \nStandard deviation (SD), contrast-to-noise ratios (CNR), noise power spectra \n(NPS), modulation transfer function (MTF), and the non-prewhitening matched filter \nsignal-to-noise ratio (SNRNPW), a quasi-ideal observer metric in the frequency \ndomain assumed to be the most reliable image quality reference, were calculated \nfor all kernels and used for dose saving evaluations.\nResults: The highest CNR in DE protocol resulted with a composition factor of 0.6. \nCompared to FBP, the average SD reductions were 51±2% with SAFIRE S5 and \n30±2% with IRIS kernels. A shift towards low frequencies in the NPS was found for \nall iterative filters, giving to images a different texture. Differences between MTF \nvalues were within 5% in all FBP-Iterative coupled filter comparisons. The optimal \nkernels, from SNRNPW analysis of abdominal protocol, resulted I31-S5 for SAFIRE \nand I-44 for IRIS with a potential dose reduction of 42% and 30%, respectively.\nConclusion: Iterative reconstructions and DE acquisition strongly improve image \nquality reducing the noise and improving the contrast without affecting the spatial \nresolution.\nB‑0248 15:03\nThe impact of tube voltage, scan direction and beam collimation on \nthe performance of automatic tube current modulation systems in \npaediatric and adult CT \nN. Buls1, J. Schoenaers2, G. Van Gompel1, K. Nieboer1, J. de Mey1; 1Jette/BE, \n2Hasselt/BE (Nico.Buls@uzbrussel.be) \nPurpose: To report on the impact of CT scan parameter settings on the perform-\nance of an Automatic Tube Current Modulation system for paediatric and adult CT.\nMethods and Materials: A previously designed phantom was used which has an \nellipsoidal cone shape with varying diameters that represents infant to adult sizes \nover five age categories (0-5y, 5-10y, 5-15y, 15-20y). Phantom material consists \nof two-component polyurethane prepolymer that shows an excellent attenuation \nagreement with ICRU-44 soft tissue for typical CT photon spectra. The impact of \nfollowing scan parameters was assessed on a 750HD scanner (GE Healthcare): \nbeam width, scan direction and tube voltage. ATCM performance was evaluated \nby assessing the noise variance in a central region of interest (2 cm) over the \ndifferent age categories.\nResults: For all tube potentials, the noise variance (mean VAR = 1.38) was signifi-\ncantly lower (p < 0.05) when the phantom was scanned in the craniocaudal direction \ncompared with the caudocranial direction (mean VAR = 1.66). In the craniocaudal \ndirection, a 80 kVp scan resulted in the lowest noise variance (VAR = 0.49) for \nthe smallest age category (0-5y), whereas a 120 kVp scan showed the highest \nvariance (VAR = 0.64). This in contrary to the largest age group (15-20y) where \nthe 120 kVp scan resulted in the lowest noise variance (VAR = 0.58), compared \nwith 80 kVp (VAR = 0.82). The beam collimation width selection (20 and 40 mm) \nhad no impact on noise variance\nConclusion: The phantom can be used for assessment and optimisation of ATCM \nsystems for patients of various sizes \nB‑0249 15:12\n3D spatial resolution evaluation of clinical CT using a spherical phantom \nT. Mäkelä, V. Sairanen, J.I. Peltonen, M. Kortesniemi; Helsinki/FI \n(viljami.sairanen@helsinki.fi) \nPurpose: Computed tomography (CT) scanners used in clinical imaging provides \nthree-dimensional data and versatile visualisations for diagnostic use. However, \nthe standard spatial resolution evaluation using the modulation transfer function \n(MTF) is often measured parallel to Cartesian axes and thus does not represent all \npossible directions. The aim of the study was to investigate the feasibility of using \na spherical contrast phantom and directional MTF in the resolution assessments.\nMethods and Materials: The contrast phantom consisted of a Teflon (PTFE) sphere \nwith a diameter of 20±0.05 mm placed within a polystyrene shell. The phantom \n\nScientific Sessions\nS203\nA\n C D E F G\nB\nThursday\nwere categorised as having either high thrombus SI (group I) or low thrombus SI \n(group II). Aneurysm expansion rates were expressed as the change in aneurysm \nsurface area (mm2) per day between baseline and follow-up.\nResults: Interobserver agreement was high for the assessment of thrombus with \nhigh SI Kappa = 0.93). Patients in group.i. (n=8) had higher aneurysm expansion \nrate compared with patients in group II (n=13) (0.84 ± 0.5 vs. 0.38 ± 0.5 mm2/day, \nrespectively; P = 0.03). Baseline maximal diameter was similar for both groups \n(P = 0.2).\nConclusion: AAA with high thrombus SI on T1w TFE MRI, which indicates unor-\nganised haemorrhagic thrombus, is associated with higher AAA expansion rates. \nWe conclude that thrombus morphology can play an important role in the evolution \nof AAA and that MR thrombus imaging may be a valuable tool for risk stratifica-\ntion of AAA. This study was founded by the Dutch Heart Foundation (2008B042). \nB‑0254 14:36\nCT angiography of abdominal aorta with low kV CT protocol and low \ncontrast medium volume: a feasibility study \nC.R.G.L. Talei Franzesi, D. Ippolito, P. Bonaffini, A.C. Cadonici, A. Masetto, \nS. Sironi; Monza/IT (ctfdoc@hotmail.com) \nPurpose: To reduce the radiation dose exposure and contrast medium volume us-\ning low-kV CT angiography protocol (100 kV; 40 ml) in the evaluation of abdominal \naorta, maintaining high diagnostic performance.\nMethods and Materials: A total of 60 patients with abdominal vascular disease \nwere prospectively enrolled. All patients underwent 256MDCT scan examination \nof abdominal aorta (Brilliance iCT, Philips). 30 patients were scanned using low-\ndose radiation protocol (100 kV; automated tube current modulation) and ultra-\nlow-contrast volume (40 ml; 4 ml/s; 350 mgI/ml) and a control group of 30 patients \nunderwent standard CT-angiography protocol (120 kV; automated tube current \nmodulation) and standard contrast volume (120 mL). Density measurements were \nperformed on abdominal aorta, renal arteries and common iliac arteries. The radia-\ntion dose exposure (dose length product, DLP), the intravessels density and the \nsignal-to-noise ratio (SNR) were calculated, compared and statistically analysed.\nResults: All exams were considered diagnostic, allowing the correct visualisation of \nmain aortic branch and vascular wall. Higher density measurements were obtained \nin low-kV protocol: mean attenuation value of abdominal aorta 343 HU, renal arteries \n331 HU and common iliac arteries; in comparison to control group: mean value of \nabdominal aorta 319 HU, renal arteries 294 HU and common iliac arteries 323 HU. \nA reduction of 65% (p < 0.05) of radiation dose exposure in low-kV protocol (335 \nDLP; 5.8 CTDIvol) was obtained among control group (973 DLP; 19.4 CTDIvol).\nConclusion: Low kV protocol and ultra-low contrast medium volume (40 mL) re-\nduce the radiation exposure (over 65%) and the renal damage, allowing a relevant \nreduction of contrast material volume, enabling to evaluate more easily young \npatients or patients with renal failure.\nB‑0255 14:45\nAn international multi-centre comparison of the non-contrast MR \nangiography technique time-spatial labelling inversion pulse (time-\nSLIP) against contrast-enhanced CT angiography for assessing \nrenal artery stenosis: the renal artery contrast-free trial (REACT) \nT.S.E. Albert1, I. Parienty2, V. Catala3, H. Xue4, V. Katabathina5, J.E. Lopera5, \nZ.Y. Jin4, N. Yellin1, M. Akahane6; 1Monterey, CA/US, 2Antony/FR, 3Barcelona/ES, \n4Beijing/CN, 5San Antonio, TX/US, 6T okyo/JP (timothy.albert@gmail.com) \nPurpose: The non-contrast-enhanced MR angiography (NC-MRA) technique \ntime-SLIP may provide a safe alternative for evaluating renal artery stenosis \n(RAS). This international multi-centre trial tested the hypothesis that NC-MRA is \naccurate and robust for assessing RAS in comparison to contrast-enhanced CT \nangiography (CTA).\nMethods and Materials: Four centres (US, Europe, Asia) enrolled 64 patients \n(average ± SD: 58 ± 13 years, 34 (53%) males). Each patient received an abdominal \nCTA and abdominal NC-MRA using time-SLIP with balanced SSFP . All images were \nvisually assessed for quality (arterial signal intensity) and absence or presence \nof RAS ( 50% stenosis). In addition, arteries with any visible disease \nhad stenotic severity quantified. Two blinded readers evaluated each study. No \narteries were excluded from the analysis.\nResults: NC-MRA image quality was excellent in 46/64 patients (72%) and good in \n15/64 patients (23%). Using CTA as ‘gold-standard’ 21 of 128 arteries (16.4%) had \nRAS. NC-MRA correctly classified 15/21 with RAS and correctly classified 97/107 \nas not having disease (/=70% and NC-MRA 0.05). The five-point score was higher in the standard CTAA protocol (P < \n0.05). The inter-reader agreement regarding the dichotomized diagnostic versus \nnondiagnostic scale was similar (P > 0.05) between two groups.\nConclusion: GSI CTAA with image reconstruction at 50 kev allows a significant \nreduction of 60% iodine load while improving intravascular signal intensity, main-\ntaining SNR and with comparable radiation dose.\n>/=70% and CTA 25 mm) was compared using κ-statistics.\nResults: Aortic valve hinge-points were correctly identified in 47/50 patients (94%). \nMean effective annulus diameter was 24.5±2.3 mm by model-based analysis and \n24.6±2.2 mm by manual assessment (p=n.s). Excellent correlation was found \nbetween both methods (r=0.98, p < 0.01). Bland-Altman analysis revealed no \nsystematic bias. Agreement for prosthesis sizing was found in 44/50 patients \n(κ=0.80). Mean analysis time was significantly (p < 0.001) reduced for model-based \nmeasurements (28±11sec vs. 92±13sec).\nConclusion: Semi-automated morphologic aortic annulus quantification derived \nfrom an aortic valve model enables fast and accurate procedural planning in excel-\nlent agreement with manual planimetry and has the potential to improve cardiac \nimaging workflow in the evaluation of patients prior to TAVR. \nAuthor Disclosures:\nD. Bernhardt: Employee; Siemens. R. Ionasec: Employee; Siemens. T. Flohr: \nEmployee; Siemens. U.J. Schoepf: Consultant; GE; Bracco, Bayer Healthcare, \nMedrad.\n14:00 - 15:30 Room P \nCardiac \nSS 203 \nPlanning cardiac interventions \nModerators: \nI. Arkhipova; Moscow/RU \nP. Mildenberger;  Mainz/DE \nB‑0260 14:00\nAnatomical angulation between the long axis of the left ventricle and \nleft ventricular outflow tract as possible predictor of postprocedural \ncomplications in patients undergoing transapical aortic valve implantation \nB. Foldyna, M. Haensig, C. Lücke, D. Holzhey, S. Nitzsche, M. Borger, \nF.W. Mohr, M. Gutberlet, L. Lehmkuhl; Leipzig/DE (b.foldyna@gmail.com) \nPurpose: To examine whether the angle between the left ventricular long axis \nand left ventricular outflow tract (αLV-LVOT) allows prediction of the occurrence of \nparavalvular leakage (PL), its impact on procedural time and elevated postopera-\ntive CK-MB levels in patients undergoing transapical valve implantation (TA-AVI).\nMethods and Materials: 75 consecutive high-risk patients with severe aortic \nstenosis scheduled for TA-AVI were included. All patients underwent preoperative \ncardiac computed tomography (CT) and received Edwards-SapienTM prosthesis. The \nαLV-LVOT was measured in systole and diastole using multiplanar reconstruction \nof the preoperative MSCT data. The αLV-LVOT was correlated to occurrence of the \nPL, to the procedure duration and postoperative CK-MB levels. All measurements \nwere performed by two experienced radiologists to calculate interobserver variability.\nResults: Cardiac CT was available in 75 patients (age 81.9±5.8 years, 71% female). \nThe mean αLV-LVOT was 61.8±9.8° and 61.3±10.1° in systole and diastole, respec-\ntively, without a significant change during the cardiac cycle. Paravalvular leakage \nwas found in a total of 35 patients (I°=29 /38.7%, II°=6 /8%, III°=0). Patients with \nrelevant (³II°) paravalvular leakage showed significantly steeper mean αLV-LVOT \nthan patients without or I° paravalvular leakage (Mean difference: 12.2°±4.1°; p < \n0.001). The αLV-LVOT was not associated with the prolonged procedural time nor \nthe postoperative CK-MB levels (p=n.s).\nConclusion: In TA-AVI the αLV-LVOT angle had a significant effect on the occur-\nrence of paravalvular leakage. A steeper angle was associated with a significant \nhigher grade of PL; thus, it might have a significant impact on the future design of \nvalve stents and new delivery devices. \nB‑0261 14:09\nTemporal dynamics of the aortic root and the aortic valve: \nimplications for transcatheter aortic valve implantation \nT. Jurencak, B. Kietselaer, C. Mihl, V. Van Ommen, L. van Garsse, J. Wildberger, \nM. Das; Maastricht/NL (t.jurencak@gmail.com) \nPurpose: To determine temporal changes of dimensions of the aortic root and the \naortic valve during the cardiac cycle and to investigate its effect on Transcatheter \nAortic Valve Implantation (TAVI) therapy planning.\nMethods and Materials: MDCT examination with retrospective ECG-gating was \nperformed in 52 consecutive patients referred for pre-TAVI assessment. Images \nwere reconstructed at eleven time points throughout the cardiac cycle. Ten anatomi-\ncal structures within the aortic root and the aortic valve were measured at each time \npoint. Temporal changes for each structure were evaluated by paired-samples T-test \nand annular changes in dimensions were investigated in respect to prosthesis sizing.\nResults: Four out of ten anatomical structures show significant changes in di-\nmension (p < 0.05) during the cardiac cycle. We observed significant dimensional \nchanges in the shortest diameter of the aortic annulus (Δ=3.7±1.3 mm); the sino-\ntubular junction (Δ=2.9±1.1 mm); the aortic root at the left coronary ostium level \n(Δ=3.5±0.9 mm) and the aortic sinus diameter (Δ=2.8±0.9 mm), respectively. The \nlargest dimensions were measured at 20 % of the RR interval. Prosthesis sizing \nbased on systolic or diastolic measurements would lead to selection of a different \nvalve size in more than 20 % of subjects.\nConclusion: Temporal changes in annular dimensions can have important impact \non prosthesis sizing. Imaging in systole (20 % RR interval) provides maximal aortic \nroot dimension measurements and should therefore be used for prosthesis sizing. \n\nScientific Sessions\nS206\n C A D E F\n G\nB\nMethods and Materials: This study was IRB approved and HIPAA compliant. Three \nradiologists with 8 years, 5 years, and 12 months of experience in reading CCTA, \na first year radiology resident, and an interventional cardiologist without previous \nexperience independently analysed two case series of 50 catheter-correlated \nCCTA studies for coronary artery stenosis (0%, ²49%, 50%-74%, 75%-99%, or \n100%). Results of the first case series were unblinded and presented along with \ncatheter angiography results to each reader before proceeding to the second \nseries. Diagnostic accuracy on a per-segment basis was compared for all readers \nand both case series, respectively.\nResults: Correlation coefficients between CCTA and catheter angiography initially \nranged between good (r=0.87) and poor (r=0.26), depending on reader experience, \nand significantly (p < 0.05) improved in the second case series (range: r=0.91 to \nr=0.51). Diagnostic accuracy was significantly (p12 months of experience (range: \n97.8-96.5%) as compared to the inexperienced readers (range: 90.7-93.1%)) and \nonly slightly (p=0.26) increased in the second case series. However, PPV signifi-\ncantly (p < 0.05) increased. For both inexperienced readers diagnostic accuracy \n(range: 95.6-95.9%) significantly (p < 0.05) increased and equalized (p=0.04) in \nthe second case series, but sensitivity and PPV still remained rather low (range: \n62.7-66.1% / 78.0-84.1%).\nConclusion: The level of experience is the strongest determinant of proficiency \nin CCTA interpretation. Limited one-time training improves proficiency, but not to \nclinically satisfactory levels. \nAuthor Disclosures:\nJ.M. Kerl: Speaker; Siemens AG. U.J. Schoepf: Other; Research Consultant, \nBayer AG Research Grant, Bayer AG Research Consultant, Bracco Group \nResearch Grant, Bracco Group Research Consultant, General Electric Company \nResearch Grant, General Electric Com. R.W. Bauer: Speaker; Siemens AG. \nB‑0267 15:03\nUtility of cardiac magnetic resonance in the identification of patients \neligible for early implantation of cardioverter defibrillator after acute \nmyocardial infarction \nE. Belloni1, E. Emanuele2, G. Marchesi3, D. Aschieri3, S. Ferraro3, E. Michieletti3, \nG.Q. Villani3, P. Scagnelli1; 1Castel San Giovanni/IT, 2Robbio/IT, 3Piacenza/IT \n(belloni.elena@alice.it) \nPurpose: To evaluate the utility of cardiac magnetic resonance (CMR) in early \nidentification of irreversible left ventricle (LV) damage after acute myocardial \ninfarction (AMI) and in prediction of absent future improvement of LV ejection \nfraction (LVEF), to identify who should benefit from early implantable cardioverter \ndefibrillator (ICD) implantation.\nMethods and Materials: 29 patients underwent CMR within 5±3 days after first \nrevascularized AMI and at 3 months. The number of LV wall segments with transmu-\nral necrosis (TN) and microvascular obstruction (MO) at LE imaging was evaluated. \nMO was defined as hypointensity within a hyperintense LE area. Patients were \nsubdivided in 2 groups according to the LVEF at Cine imaging: gr.1=LVEF²35% \n(n=10); gr.2=LVEF> 35% (n=19).\nResults: In the acute phase, the number of segments with TN and MO was higher \nin gr.1 than in gr.2 (TN:gr.1=6.1±0.5, gr.2=2.5±2.8, unpaired t-test, P < 0.001; MO: \ngr.1=3.1±2.3, gr.2=1.0±1.9, unpaired t-test, P=0.02). In the whole group of 29 \npatients, the number of segments with TN and MO correlated inversely with LVEF \n(TN: Spearman's rho=-0.79, P < 0.001) (MO: Spearman's rho=-0.59, P < 0.001). \nAt 3 months, LVEF decreased in gr.1 and increased in gr.2 (gr.1: from 33.1±2.2% \nto 29.6±3.2%, paired t-test, P =0.017) (gr.2: from 50.0±9.4% to 54.4±8.4% paired \nt-test, P =0.006).\nConclusion: At CMR, the presence of TN (with or without MO) in at least 6 LV wall \nsegments in patients with LVEF²35 immediately after AMI seemed to be correlated \nwith irreversibile myocardial damage and absent LVEF improvement at 3 months. \nCMR could be a useful tool in the stratification of patients with revascularized AMI, \nto identify who should benefit from early ICD implantation.\nB‑0268 15:12\nOptimisation of contrast injection protocol for CT angiography in \ntranscatheter aortic valve implantation (TAVI): preliminary results \nD. Di Marco1, M. Giglio2, R. Fachechi1, S. Sironi1, P. Spagnolo2; 1Monza/IT, \n2Milan/IT (daniela.dimarco@gmail.com) \nPurpose: To evaluate the feasibility of a BMI-adjusted injection protocol on vessel \nattenuation and image quality for CT angiography of patients referred for TAVI.\nMethods and Materials: 64-MDCT angiography with retrospective gating was \nperformed in 45 patients with a BMI-adapted contrast medium (CM) bolus: BMI \n< 22, 40 mL CM at 3.5 mL/s; 22.1-26.5, 55 mL at 4.5 mL/s; > 26.6, 70 mL at 5.5 \nmL/s. 45 control patients matched for BMI who had previously undergone routine \nB‑0264 14:36\nDimensions of the aortic root and the aortic valve for transcatheter \naortic valve implantation: non-ECG-triggered multi-detector CT \nhigh-pitch scans compared with retrospectively ECG-gated low-pitch \ncardiac scans \nT. Jurencak, B. Kietselaer, C. Mihl, P. Nelemans, V. Van Ommen, L. van Garsse, \nJ. Wildberger, M. Das; Maastricht/NL (t.jurencak@gmail.com) \nPurpose: To compare low-pitch retrospectively ECG-gated (gated) and high-pitch \nnon-ECG-triggered (non-gated) multidetector CT (MDCT) protocols in terms of \nmeasurements of the aortic root and the aortic valve and consequently prosthesis \nsizing in Transcatheter Aortic Valve Implantation (TAVI).\nMethods and Materials: 46 consecutive TAVI candidates underwent MDCT exami-\nnation with retrospectively gated helical scanning of the aortic valve region followed \nby a non-gated whole aorta CT angiography. Eleven anatomical structures within \nthe aortic root and the aortic valve which are deemed to be crucial for TAVI planning \nwere measured throughout the cardiac cycle and compared with measurements \nfrom non-ECG-gated scans. Differences in annular dimensions measured in both \ntypes of scans were tested in terms of relevance for prosthesis sizing.\nResults: Substantial differences in measurements were found for the aortic root \nat the right coronary ostium level (p < 0.05), the sinotubular junction and the aortic \nsinuses diameter (p < 0.001). The maximal annular dimensions occur in early \nsystole. Measurements of diameters in high-pitch scans agree only to diastolic \nimages. However, measurements of annular perimeter in non-ECG-triggered high-\npitch scans agree to systolic images. The highest agreement in prosthesis sizing \naccording to measures from both CT protocols in systole and diastole was noted \nif annular perimeter was followed.\nConclusion: Even though the results of annular perimeter are comparable at first \nglance, only a dedicated gated CTA protocol offers the full potential to perform all \nmeasurements at the optimal time point and should be recommended for pros-\nthesis sizing in TAVI. \nB‑0265 14:45\nIs aortic valve calcium distribution a predictor for outcome after \ntranscutaneous aortic valve implantation? \nP. Apfaltrer1, G. Schymik2, T. Germann1, H. Schroefel2, M. Meyer1, \nC. Fink1, S.O. Schönberg1, T. Henzler1; 1Mannheim/DE, \n2Karlsruhe/DE (paul.apfaltrer@umm.de) \nPurpose: To examine possible relationships between severity of aortic valve cal-\ncification, the degree of aortic-valve-regurgitation (AVR) and occurrence of MACE \nevents after transcatheter-aortic-valve-implantation (TAVI).\nMethods and Materials: 58 patients (25 men, 83.3±6.1 years) with symptomatic \naortic stenosis were included in this study. 15 patients received a CoreValve® \naortic valve prosthesis and in 43 patients an Edwards SAPIEN™ prosthesis was \nimplanted. Prior to TAVI, all patients underwent a thoracic-pelvine ECG-gated-CT-\nangiography for therapy planning. The aortic-valve calcification score (AS) and \naortic-valve calcium volume (AV) was measured and compared to post-procedural \nAVR measured by echocardiography and to the 30-day incidence of major-adverse-\ncardiac-events (MACE).\nResults: The overall incidence of MACE after TAVI was 29.3%. There was no \nsignificant correlation between the amount of AS and AV and MACE after TAVI \n(both p> 0.05). Post-interventional AVR did not correlate with pre-procedural \nmeasured AS and AV (both p> 0.05). Patients with post-procedural AVR showed \nno significant differences in AS and AV than patients without evidence of AVR after \nTAVI (698.5±113.6 vs. 658.8±114.1 and 1.20±0.78 vs. 1.30±0.95; both p> 0.05).\nConclusion: The degree of aortic-valve calcification is neither associated with \nMACE nor with post-procedural AVR after TAVI. Further risk scores are required \nto predict patient outcomes after TAVI. \nAuthor Disclosures:\nG. Schymik: Consultant; Edwards Lifescience. Speaker; dwards Lifescience, \nPhilips, Medtronic.\nB‑0266 14:54\nInfluence of observer experience and training on proficiency in \ncardiac CT interpretation \nJ.M. Kerl1, U.J. Schoepf2, R.W. Bauer1, P. Costello2, T.J. Vogl1, C. Herzog1; \n1Frankfurt a. Main/DE, 2Charleston, SC/US (matthias.kerl@kgu.de) \nPurpose: To assess the influence of experience and training on the proficiency \nin coronary CT angiography (CCTA) interpretation of practitioners with different \nlevels of experience.\n\nScientific Sessions\nS207\nA\n C D E F G\nB\nThursday\ntarget noise SD12.5 and FBP reconstruction) and referred to follow -up chest CT \nwithin two months were enrolled. AEC (SD25) integrated with AIDR3D was used \nin follow-up chest CT protocol (group B), the raw data of which were reconstructed \nagain with FBP (group C). The max/min mAs of each subject and their correlation \nwith BMI were investigated to validate whether system could personalise tailor tube \ncurrent. The chest images were divided into upper, middle and lower parts which \nwere evaluated separately by two radiologists with 3-point scale (3-good, 2-ac-\nceptable, 1-poor). Image noise was measured in these parts with 8-mm diameter \nROI placed on specific anatomic structures. Effective dose (ED) was compared.\nResults: In group B, max/min mAs correlated positively with BMI (p=0.001); image \nquality scores of upper, middle and lower part of chest (lung kernel: 2.90, 2.90, \n2.90, p=1.000; mediastinum kernel: 2.63, 2.60, 2.69, p=0.710) showed no significant \ndifference, the mean noise of which was 32.01, 32.35, 34.09 for lung/16.58, 14.37, \n16.66 for mediastinum. More cases in group B than in group C achieved diagnostic \n(scored³2) image quality (100%, 96% vs 100%, 40.82% for lung and mediastinum, \nrespectively). CTDI, DLP, ED of group B was much lower than group A (1.371 vs \n10.435 mGy, 51.09 vs 394.555 mGy*cm, 0.72 vs 5.52mSv), 87% radiation dose \nwas saved in the follow-up chest CT.\nConclusion: Personalised low dose chest CT is feasible by applying AIDR 3D \nintegrated AEC techniques, which could reduce 87% radiation dose compared \nwith conventional exam and achieve uniform image quality.\nB‑0271 14:09\nFeasibility of low dose protocol at 640-slice dynamic volume CT for \ndiagnosing central airways narrowing \nZ.-X. Ding, Z. Wang; Hangzhou/CN (wang12345zhen@sina.com) \nPurpose: To compare the radiation dose and image quality of the central airways \nusing 640-slice dynamic volume CT at two different protocols.\nMethods and Materials: Sixteen patients with small BMI (BMI < 25) underwent \n640-slice dynamic volume CT examinations. Eight patients employed 100kv \nprotocol, acquisition time, 5.1 seconds; and remaining eight objects employed \n80kv protocol, acquisition time, 5.2 seconds. Image acquisition time was selected \naccording to Texp time (from maximal end-inspiration to the end of forceful ex-\nhalation). MPR and 3D reconstruction images were created, and reviewed by \ntwo experienced radiologists with blinded, who measured the tracheal lumen to \ndetermine the presence of central airways narrowing. The 3D reconstruction of \nconfidence was graded on a 4-point scale from 0 (no confidence) to 3 (highest of \nconfidence. The MPR noise was assessed by measuring the SD of the pre-sternal \nsoft tissue. The DLP was used to compare radiation doses.\nResults: The MPR image noise was ranked higher for CT images of 80 KV protocol \nthan 100 KV protocol. There was no significant difference in confidence between \n80KV and 100 KV protocol ( P > 0.05). Excessive central airway collapse (reduc-\ntion > 30%) was seen in 3 patients with tracheomalacia and remaining 13 subjects \nhad centre airway stenosis. DLP of 80KV protocol was 244.9 mGy.cm and 100KV \nprotocol was 539.8 mGy.cm.\nConclusion: The 640-slice dynamic volume CT is a promising method for diagnos-\ning central airway narrowing. The 80KV protocol performs as well as the 100KV \nprotocol for the 4D dynamic imaging in small BMI objects.\nB‑0272 14:18\nConducting a national diagnostic reference level survey for \ncomputed tomography examinations: the Portuguese experience \nJ. Santos1, S. Foley2, G. Paulo1, M.F. McEntee3, L. Rainford2; 1Coimbra/PT, \n2Dublin/IE, 3Sydney/AU (joanasantos@estescoimbra.pt) \nPurpose: Research has shown that CT technology, if not correctly applied, has \nradiation protection implications. This study aimed to identify the frequency of CT \nexaminations, current protocols and establish national diagnostic reference levels \n(DRLs) for commonly performed paediatric examinations.\nMethods and Materials: A national contact list was formulated and a website \ncreated. A questionnaire survey of practice across all CT sites was completed, \npreceded by a pilot study and invitations to the clinical sites inviting participation. \nDemographic data were collated, collected over a seven-month period and proto-\ncols were reviewed (including methods of paediatric age categorisation). The 75th \npercentiles for CT volume index (CTDIvol) and dose-length product (DLP) values \nof commonly performed examinations were identified.\nResults: A 21% response rate resulted from the national survey, from which 55% \nwere public institutions. Head (22%), thorax (10%) and abdominal (12%) CT ex-\naminations were identified as the most commonly performed. National DRLs are \nrecommended in CTDIvol (mGy) and DLP (mGy.cm) for the head 75 mGy/1010 \nmGy.cm, thorax 13.6 mGy/470 mGy.cm and abdomen 18.3 mGy/800 mGy.cm, \nrespectively. Specific paediatric protocols and age categorisation methods varied \nMDCT-examination with a fixed CM protocol of 100 ml at 5 ml/s served as refer-\nence group. Two radiologists independently evaluated the image sets in terms of \ndiagnostic confidence (based on a 3-point scale) and arterial contrast opacification \nin Hounsfield units (HUs). Attenuation values in the ascending aorta and in the \naorto iliac vessels were measured and correlated with BMI; the results in the two \nprotocol groups were compared.\nResults: there was no significant difference between image quality grade and \nmean attenuation values of the two groups (346 ± 82 HU vs 357 ± 63 HU; p not \nsignificant). Without BMI adaptation, vessels attenuation correlated strongly with \nBMI (r = -0.61; p < 0.001). No correlation between BMI and vessel attenuation (r \n= - 0.22; p not significant) was found with the BMI-adapted protocol.\nConclusion: the BMI-adjusted injection protocol allows a significant reduction of the \namount of CM injected while maintaining image quality. It should be recommended \nin high-risk TAVI patients in order to avoid unnecessarily high iodine administration \nand prevent radiocontrast-induced nephropathy. \nB‑0269 15:21\nAssessment of aortic valve area in patients with severe aortic \nstenosis using cardiac dual-source computed tomography: \ncomparison with transthoracic echocardiography and cardiac \nmagnetic resonance \nH. An, S. Ko, H. Hwang, M. Song, J. Choi, J. Shin; Seoul/KR \n(erantis@hanmail.net) \nPurpose: To compare aortic valve area (AVA) in severe aortic stenosis (AS), using \ndual-source CT (DSCT) in comparison with transthoracic echocardiography (TTE) \nand cardiac MR (CMR) and to determine whether degree of valvular calcification \nis related to planimetric AVA obtained with DSCT.\nMethods and Materials: 114 patients (66 male, mean age 60 years) with severe \nAS who underwent TTE, DSCT and CMR were included in the study. The AVA \nestimated by planimetry (DSCT, CMR) and continuity equation (TTE). Mean AVAs \nmeasured by each method were compared with paired t-test, Bland-Altman analysis \nand correlation coefficient. Valvular calcium grade and calcium volume score on \nDSCT were correlated with planimetric AVA by DSCT and valvular morphologic \ncharacteristics.\nResults: The mean AVA derived by DSCT, TTE and CMR were 0.94±0.16, \n0.80±0.17, and 0.80±0.15 cm 2, respectively. DSCT-derived AVA correlated fairly \nwith TTE-derived (r=0.46) and moderately with CMR-derived (r=0.65). There was \ngood (r=0.74, p < 0.001) agreement between valvular calcium grade and volume \nscore. DSCT-derived AVA correlated fairly (r=0.39 and 0.30, respectively, p < 0.01) \nwith valvular calcium grade and volume score. DSCT-derived AVA with severe \ndegree of valvular calcification (n=38, 0.86±0.16 cm 2) was significantly smaller \nthan those of no (n=6, 1.06±0.17 cm 2), mild (n=31, 1.0±0.15 cm 2) and moderate \n(n=39, 0.94±0.13 cm2) degree of calcification. There was no difference in valvular \ncalcium score between bicuspid (n=59) and tricuspid (n=55) valves (2489±2242 \nversus 1928±1459, p=0.116). TTE-derived AVA was smaller in BAV (0.76±0.18 cm2) \nthan TAV (0.83±0.14 cm2) but DSCT-(0.92±0.16 cm2 and 0.96±0.15 cm2) and CMR \n(0.78±0.16 cm2 and 0.81±0.12 cm2)-derived AVAs were not different.\nConclusion: DSCT significantly overestimates the AVA compared to TTE and \nCMR in calcified severe AS. Both degree and volume score of valvular calcification \nassociate fairly with AVA on DSCT. \n14:00 - 15:30 Room Q \nRadiographers \nSS 214 \nManaging quality and dose in CT \nModerators: \nE. Agadakos; Athens/GR \nA. Yule; Cardiff/UK \nB‑0270 14:00\nPersonalised low dose chest CT applying adaptive iterative dose \nreduction algorithm (AIDR 3D) integrated automatic exposure control \ntechniques with 320-slice MDCT: initial clinical trial \nX. Chen; Guangzhou/CN (hoshi_chen@tom.com) \nPurpose: To investigate the feasibility of individualised low dose chest CT with \nAIDR3D integrated automatic exposure control (AEC) techniques.\nMethods and Materials: 48 subjects (age: 13-84 yrs; BMI: 15.62-30.84) who \nunderwent chest CT previously with conventional protocol (group A:AEC with \n\nScientific Sessions\nS208\n C A D E F\n G\nB\norgans as eye lens. The main goals of this study were to evaluate the influence of \ndifferent paediatric head CT protocols, used in Portugal and Denmark, regarding \nCT dose values and eye lens exposure.\nMethods and Materials: A CT Siemens Somatom Definition AS 64 slices was used \nand after a quality control, CTDI (CT dose index) and DLP (dose length product) \nvalues were determined. Different protocols were applied in a paediatric phantom \nand some exposure parameters were changed. The dose values in the eye lens \nwere measured using an Unfors EDD -30 dosimeter. Radiologists from Portugal \nand Denmark blindly assessed the image quality obtained with different protocols.\nResults: The best compromise between image quality and CTDIvol (75.71 mGy) \nand DLP (513 mGy.cm) values was observed in the supra tentorial image of the \nPortuguese protocol, with a change of slice thickness to 5 mm. According to the \nresults obtained, the eye lens dose values decrease (20.98 %) when the gantry \norientation is supra-orbital-meatal.\nConclusion: The best image is not necessarily the one that has higher dose. This \nstudy enabled a cooperation and exchange of experiences between Portuguese and \nDanish students, where they have developed good practices in paediatric head CT. \nB‑0276 14:54\nInfluence of different arm positioning of MSCT of chest by apply \nautomatic tube current modulation technique \nZ.-X. Ding, Z. Wang; Hangzhou/CN (wang12345zhen@sina.com) \nPurpose: The purpose of this study was to examine the influence of different arm \npositioning on automatic tube current modulation of multi-slice CT on chest image \nquality and radiation dosage.\nMethods and Materials: Sixty patients underwent scanning by using Care Dose \n4D thorax CT protocol in which both arms were raised above the shoulder region \nusing standard-position (Group 1) and postural manoeuver (Group 2), respectively. \nObjective and subjective image quality was assessed. Individual recorded the \nCTDIV values and the tube current-time product per exposed section. Effective \nradiation dose was calculated.\nResults: Compared with the image quality in the standard-position group, the im-\nage quality in the postural manoeuver group was decreased on subjective image \nquality but within acceptable diagnostic limits. The average effective dose in the \npostural manoeuver group was 3.37 mSv; the dose in the standard-position was \n17% lower than this.\nConclusion: Both arms were raised above the shoulder region scanning using Care \nDose 4D thorax CT protocol can reduce the overall dosage to patients and the image \nquality without adverse influences, and may be more feasible in clinical practice.\nB‑0277 15:03\nThe effectiveness of lead apron for radiation protection in CT \nN. Weber, P. Monnin, C. Elandoy, S. Ding; Lausanne/CH \n(nicolas.weber@hesav.ch) \nPurpose: To determine the effectiveness of lead shielding for radiation protection \nin CT.\nMethods and Materials: Three 32-cm diameter CTDI (PMMA) phantoms, of 15 \ncm long, placed side by side, were scanned over a length of 28 cm with a GE 64 \nCT scanner. Absorbed dose was estimated with thermoluminescent dosimeters \npositioned in the middle, and at two levels in periphery of the phantom (1 cm inside): \ntop and bottom. Additionally, the dose was measured on the surface of the phantom \n(“skin dose”). TLD were placed over a length of 28.5 cm, with 14.5 cm in the scat-\nter field. Three acquisitions were performed: 1) without lead apron, 2) with a lead \napron at 0 cm from the edge of the primary field and 3) with a lead apron at 2.5 cm.\nResults: In scattered radiation, no significant difference of dose was found be-\ntween without shielding and with the apron at 0 cm, in the middle of the phantom. \nHowever, in the presence of the apron the dose is lowered by as much as 12% \nat the bottom of the phantom, whereas the skin dose is increased by 10% (tunnel \neffect). This indicates that the scanner table is the main source of external scattered \nradiation. When the apron is placed at 2.5 cm, the results are intermediate to the \none obtained with the shielding at 0 cm and without shielding.\nConclusion: The effectiveness of lead shielding is very low and limited to regions \nnear the scanner table.\nconsiderably, therefore paediatric CT DRLs were not defined based on this survey \nand optimisation research is continuing for paediatric examinations.\nConclusion: Portuguese DRLs for adult CT examinations have been identified \nand recommended based on the national survey. The majority are higher than \nEuropean recommendations, suggesting substantial potential for optimisation. A \nlack of standardisation of practice for paediatric CT examinations was identified \njustifying further research.\nB‑0273 14:27\nComparison of image quality between left and right arm injection of \ncontrast agent in computed tomography of carotid arteries \nD. Hribar, N. Djuric, S. Sterzaj, T. Holc, M. Kovacic, A. Janezic; Ljubljana/SI \n(dejan.hribar@kclj.si) \nPurpose: Artefacts in carotid computed tomography (CTA) can degrade image \nquality and may be related to the arm side where contrast agent is injected. The \nobjective of this study is to evaluate the differences in image quality with the use \nof left versus right-arm injection side.\nMethods and Materials: 50 patients were included in the study (27 males, 23 \nfemales, age 67.6 ± 12.65 years). 40-MSCT was used (spiral technique, 120 kV, \n150 mAs, AEC, slice thickness 0.75 mm, reconstruction increment 0.4 mm). All \npatients received 80 mL of CM followed by a 40-mL saline chaser bolus, both \nadministered IV at 4 mL/sec. Contrast agent was injected either into the right arm \n(n=25) or into the left arm (n=25). We determined the relationship between the \ninjection side and the intensity of perivenous streak artefacts and venous reflux.\nResults: Streak artefacts in the aortic arch and at the origin of the great vessels \nwere demonstrated in 80% of patients with left arm injection (55% without influence \non the diagnosis, 35% with possible influence). There was significantly less artefacts \nin patients with right-arm injection (44% all without influence on the diagnosis). \nThe amount of refluxed contrast agent was slightly greater with left-arm injection \n(40%) versus right-arm injection (32%).\nConclusion: Our results are similar to other researches. Perivenous streak ar-\ntefacts and venous reflux could not be prevented with right- or left-arm injections \nalthough right-arm injection of contrast agent may provide better image quality in \nCT angiography of carotid arteries.\nB‑0274 14:36\nDose assessment in paediatric head computed tomography examinations \nC.L.D.C. Fernandes, S.I. Rodrigues, A.F.C.L. Abrantes, L.P.V. Ribeiro, \nR.P.P. Almeida, C.A. Silva, K.B. Azevedo; Faro/PT (cindy_lineuza@hotmail.com) \nPurpose: To determine if the doses used in paediatric head CT scanning are ap-\npropriate and according to the reference dose levels by International Commission \non Radiological Protection (ICRP) and Département federal de l’intérieur (DFI).\nMethods and Materials: A retrospective study was conducted in two radiology \ndepartments from public hospitals using a sample of 535 patients under 15 years \nsubmitted to head CT examinations between 2008 and 2011, performed with dif-\nferent equipments: Somatom Emotion 2 (n=100), Somatom Emotion 6 (n=250) and \nSomatom Emotion 16 (n=185). The influence of patient age and cephalic perimeter \nwere considered. Multiple data analysis was used in order to assess radiation dose \nlevels and the concordance of these with diagnostic reference levels.\nResults: The results were obtained for four different paediatric groups, divided \naccording to patient age: less than 1 year; 1 to 5 years; 6 to 10 years and 11 to 15 \nyears. The mean values obtained of dose length-product from some groups are \nlower than the diagnostic reference levels (720 mGy.cm from 6 to 10 years and \n807 mGy.cm from 11 to 15 years). However, until 5 years the values are higher \nthan the recommendations (569 mGy.cm for less than 1 year and 590 mGy.cm \nfrom 1 to 5 years).\nConclusion: This work identifies possible gaps and all possible methods should be \napplied to reduce the radiation dose provided without deteriorating image quality. \nA set of recommendations are needed to optimise the radiation dose since the \nchildren have a superior radiosensitivity.\nB‑0275 14:45\nDose values in eye lens in paediatric brain computed tomography: \ninfluence of different protocols \nC. Carriço1, M. Inácio1, A. Kristiansen2, M. Larsen2, J. Santos1, S. Holm2, \nG. Paulo1; 1Coimbra/PT, 2Odense/DK (catarina.carrico@hotmail.com) \nPurpose: The number of head computed tomography (CT) examinations in paedi-\natrics had an exponential increase. Taking into account the highest radiosensitive \nof children tissues and organs, radiology departments should permanently optimise \nCT protocols in order to minimize exposure, especially to more radiosensitive \n\nScientific Sessions\nS209\nA\n C D E F G\nB\nThursday\nbody mask is classified into 4 classes (fat, water, air, and outliers) by a multivari-\nate Gaussian intensity model, regularized by a Markov random field. To increase \nrobustness to image variability, the statistical model parameters are automatically \nupdated with the EM algorithm. The air voxels are rejected from the mask and the \nadipose tissue segmentation is refined using a new 3-class Gaussian intensity \nmodel. To separate SAT from VAT, an intra-abdominal mask is created by calculating \nthe convex hull around the water tissue (water fraction of at least 50%).\nResults: The adipose tissue quantification is, even under heavy motion, visually \nsatisfactory. It is, moreover, highly consistent over the two datasets of each subject, \nas demonstrated by the high ICC (r=0.997) and the small difference in fat, SAT, and \nVAT percentage of total body volume of 0.26%, 0.14%, and 0.12%, respectively.\nConclusion: An automatic adipose tissue quantification method based on spatially \nregularized multivariate Gaussian mixture models is demonstrated to provide \nconsistent measurements for SAT and VAT.\nB‑0281 14:09\nComputational texture analysis in interstitial lung disease: \ncomparison of descriptors and classification accuracy \nJ. Ofner1, C. Mueller-Mang1, A. Burner1, D. Markonis2, \nA. Depeursinge2, H. Mueller2, G. Langs1; 1Vienna/AT, 2Sierre/CH \n(joachim.ofner@meduniwien.ac.at) \nPurpose: The purpose of this work is the comparison of local texture features for \nfully automated quantification of Interstitial Lung Disease (ILD) related pathologi-\ncal tissue in High Resolution Computed Tomography (HRCT) images. Different \nfeatures are compared, and a method for the identification of an optimal feature \nset for discrimination of lung texture classes is proposed.\nMethods and Materials: The approach was evaluated on 97 HRCT images of \npathological lung tissue. Slice thickness was 1 mm and inter-slice distance 10 \nmm. Regions of normal and four pathologic patterns (emphysema, ground glass, \nfibrosis, micronodules) were annotated by two radiologists. We extracted sets of \ntexture features (Local Binary Patterns (LBP), Haralick features, wavelets, textons) \nand evaluated the classification performance on voxel level and region level with \na tenfold cross validation. A Random Forest classifier was used as classifier, and \ncorresponding feature importances served as feature selection criterion.\nResults: On voxel level Haralick features performed best with 69.59% classification \naccuracy (chance level: 20%). On region level LBPs reached the highest clas-\nsification performance of 77.45%. The most discriminative features of the texture \nclasses are intensity histogram values in the range between -1024 and -800 HU.\nConclusion: Experiments reveal that LBPs on region level outperform classical and \ncomputationally more complex co-occurrence matrices. Furthermore, intensity is \nan essential feature for description of ILD-related textures. In general region-level \nfeatures outperform voxel-level features. \nB‑0282 14:18\nQuantification of correlations between somatostatin receptors \nexpression in biopsies from neuroendocrine tumours and PET/CT \nuptake values in the context of personalised medicine \nM. Athelogou1, D. Kaemmerer2, A. Lupp3, V. Prasad4, R. Schoenmeyer1, \nG. Binnig1, R. Baum2; 1Munich/DE, 2Bad Berka/DE, 3Jena/DE, \n4Berlin/DE (mathelogou@definiens.com) \nPurpose: Somatostatin receptors (SSTR) are expressed in nearly all neuroen-\ndocrine tumours (NET), especially in gastroenteropancreatic NET (GEP-NET). \nDiagnosis, prognosis and treatment of NET patients are primarily based on SSTR \nexpression and PET/CT. Therefore objective quantifications of scoring methods \nand correlations between PET/CT uptake values and SSTR expression in biopsies \nare needed. A method for such quantifications is introduced.\nMethods and Materials: Automated image analysis is used for the detailed \nquantification of SSTR expression in each virtual slide from NET biopsies of 30 \npatients by using Definiens software. Tumour regions are separated from non-\ntumour regions and staining intensity is calculated. Cells, nuclei and membranes \nare segmented and classified. The results are correlated with SSTR expression \nscoring calculated by visual inspection. All the previous data are correlated with \ncorresponding PET/CT uptake values.\nResults: Image analysis results of 237 virtual SSTR stained tissue slides show \npositive correlations with visual calculated SSTR expression scoring (p-values < \n0.005). Correlations between the PET/CT uptake values and SSTR image analysis \nresults show also p-values < 0.05.\nConclusion: Automated image analysis is used to quantify correlations between \npatient data of in vivo and in vitro modalities like PET/CT and SSTR expression. \nThese results are very promising and quantitatively support our hypothesis of a \n“strong correlation” between SSTR stained biopsy tissue and PET/CT uptake \nvalues. This quantification is necessary for diagnosis and prognosis to establish \npatient individual treatment for NET and especially for GEP-NET. \nB‑0278 15:12\nOptimisation of local diagnostic reference levels in head computed \ntomography \nM. Monteiro, A. Carvalho, J. Matias, J. Santos; Coimbra/PT \n(mmonteiro@estescoimbra.pt) \nPurpose: The increasing use of computed tomography (CT) scans resulted in the \nexposure of patients to high level exposure to ionising radiation compared with other \nmodalities. Considering the frequency of head CT examinations, the establishment \nof diagnostic reference levels (DRL) and optimisation of dose levels without loss \nof diagnostic image quality is crucial.\nMethods and Materials: The local DRLs of head CT in a public hospital of the center \nof Portugal were established by the analyses of patients CT dose index (CTDI) and \ndose length product (DLP) values. To the optimisation process a anthropomorphic \nstandard patient phantom (Radon Woman) was used and image quality was sub-\nsequently evaluated by radiographers with more than 15 years of CT experience.\nResults: We obtained a reduction in the value of CTDI up to 38% without significant \nloss of image quality for diagnostic purposes in comparison with hospital protocol \nused in this institution.\nConclusion: Through the optimisation of the head protocol the CT dose values in \npatient can be reduced maintaining the image quality for diagnostic. \nB‑0279 15:21\nComparison of radiation dose and image quality between sequential \nand spiral brain CT \nI. Pace, F. Zarb; Msida/MT (francis.zarb@um.edu.mt) \nPurpose: To evaluate and compare sequential CT to spiral CT examinations of \nthe brain in terms of radiation dose and image quality.\nMethods and Materials: The study was carried out prospectively on 40 patients \nreferred for brain CT. Radiation dose and image quality data were gathered from \nan equal number of CT examinations performed with either sequential (n=20) or \nspiral (n=20) techniques. Radiation dose data in terms of CTDIvol and DLP were \nrecorded by the scanning radiographers at the end of each examination. A CT brain \nimage evaluation set was compiled which was evaluated by four radiologists. The \nradiologists evaluated the quality of the images by visually grading the reproduc-\ntion of anatomical structures as outlined in EUR 16262: European guidelines on \nquality criteria for CT.\nResults: Mean CTDIvol and DLP readings were significantly higher (p < 0.05) for \nsequential scans over spiral scans (CTDIvol: 22.06 mGy vs. 14.94 mGy and DLP: \n304.60 mGycm vs. 229.10 mGycm). The mean image quality grading scores for \nall criteria for the sequential technique were significantly (p < 0.05) higher than \nthose obtained by the spiral technique.\nConclusion: Spiral acquired CT brain images have lower radiation doses. The \nquality of the images produced using this technique, however, produces images of \na lower quality to those obtained using the sequential technique. Further research \nis recommended investigating whether the level of image quality produced by the \nspiral technique is sufficient for diagnosis in order for patients to benefit from as-\nsociated radiation dose reductions.\n14:00 - 15:30 Room Z \nComputer Applications \nSS 205 \nQuantitative image analysis and optimisation \nModerators: \nL. Faggioni; Pisa/IT \nM. Fatehi; Tehran/IR \nB‑0280 14:00\nConsistent automatic adipose tissue quantification in MR abdomen \nimages \nD. Smeets, W. Van Hecke, D. Loeckx; Leuven/BE (dirk.smeets@icometrix.com) \nPurpose: The amount and distribution of body fat are well-known health risk fac-\ntors. For use as clinical biomarker, an accurate and reproducible quantification, \ndifferentiating between visceral (VAT) and subcutaneous adipose tissue (SAT), is \nindispensible. This is performed by the proposed method.\nMethods and Materials: Four datasets of 2 subjects, each containing T1 water \nand fat images are acquired using Dixon-based fat suppression. First, a coarse \nbody mask is obtained by thresholding and morphological operations. Next, the \n\nScientific Sessions\nS210\n C A D E F\n G\nB\ntermined the number of alerts triggered, based on the currently used, exclusively \nstudy description-based threshold method. The default setting of this threshold \nis twice the median for each separate descriptor. Then, logical combinations of \nstudy description and protocol were made and linked by a RSNA Radlex elements, \nfor a total of 62% of all examinations. The mapped data sets were then used to \ndetermine the number of alerts triggered when using a threshold method based \non a combination of study description and acquisition protocol. The impact of both \nstrategies on relevant dose information was assessed.\nResults: Considering only the relevantly mapped scans, we found a 51% decrease, \nfrom 959 to 466 alerts, using the Radlex-based alert triggering. Of these, 23 (5%) \nwere not previously reported by the old method. The new alerts could all be at-\ntributed to patient or examination-related factors. Of the 470 alerts (49%) that were \nno longer reported, none were found to have any clinical relevance.\nConclusion: The combination of study description and acquisition protocol in the \nthreshold method for CT dose measurements helps to decrease the number of \nalerts, while maintaining patient safety.\nAuthor Disclosures:\nJ. Valette: Employee; SerphyDose. A. Jomier: Employee; SerphyDose.\nB‑0286 14:54\nA patient dose managing solution identifies erroneous parameter \nsettings in CT acquisition protocols, and contributes towards \nlowering radiation exposure \nT. De Bondt1, Q. Collier1, R. Salgado1, M. Geldof1, F. Deferme1, J. Valette2, \nA. Jomier2, W. Van Hecke1, P.M. Parizel1; 1Antwerp/BE, 2Mutzig/FR \n(timo.debondt@ua.ac.be) \nPurpose: To optimise CT protocols and parameter settings, by comparing the \nradiation dose between 2 different CT scanners of the same type.\nMethods and Materials: Using dedicated software (DoseWatch®), dose informa-\ntion from CT examinations performed on two 64-slice LightSpeed VCT scanners \nover an 7-month period was prospectively evaluated. We compared the adminis-\ntered radiation doses for 61 equivalent acquisition protocols on the 2 machines, \nand identified acquisition protocols in which there was a significant dose variation. \nFor these protocols, we performed a rigorous imaging parameter check, including \ncomparison of the number of examinations, acquisition types, number of irradiation \nevents, mA, KVp, scanning length, exposure time and pitch factor. These data were \nthen linked to the protocol setup.\nResults: We found significant parameter variations in 5 out of 61 CT acquisition \nprotocols. In 4 cases, the variations could not be attributed to a difference in the \nacquisition protocol set-up, and a thorough inspection did not lead to any improve-\nment. For 1 acquisition protocol (helical skull), we found that the noise index was \nerroneously configured on one of the CT machines. After correction of this param-\neter, the median dose length product (DLP) on this machine was reduced from \n771 mGy.cm to 446 mGy.cm (42% decrease), based on measurements during 2 \nmonths prior to correction (148 cases) and 5 months after correction (364 cases).\nConclusion: The use of a patient dose managing system for CT can identify \nsuboptimal parameter settings, and helps to significantly reduce the radiation dose \nwithout loss of relevant diagnostic information.\nAuthor Disclosures:\nJ. Valette: Employee; SerphyDose. A. Jomier: Employee; SerphyDose.\nB‑0287 15:03\nEvaluation of the quality of abdominal computed tomography \nimages reconstructed with iterative reconstruction technique \nL. Henriksson, A. Persson, M. Sandborg; Linköping/SE (lilian.henriksson@lio.se) \nPurpose: Image quality evaluation of abdominal computed tomography (CT) \nexaminations reconstructed with filtered back projection (FBP) and Sinogram af-\nfirmed iterative reconstruction (SAFIRE).\nMethods and Materials: The study included 110 examinations from our RIS/PACS \nsystem, out of which 55 had been reconstructed with FBP and 55 with SAFIRE. \nAutomated tube current modulation had been activated with 30 % lower quality \nreference mAs (qRef mAs) for SAFIRE. Comparisons were made regarding radia-\ntion dose (volume CT dose index, CTDIvol), image noise and subjective image \nquality. Criteria based on the European guidelines on quality criteria for computed \ntomography were used for the subjective assessment. A pilot study including 16 \nexaminations was performed before the main study as preparation for the subjective \nassessment. CTDIvol and image noise were compared using a two-tailed Student’s \nt-test (p < 0.001 was considered significant). Visual grading characteristics (VGC) \nwere used to evaluate the subjective image assessment. Interobserver agreement \nwas assessed using Cohen's linearly weighted kappa (κ).\nB‑0283 14:27\n3D analysis CT software in volumetric and densitometric analysis of \nurinary stones \nM. Moschetta, A. Scardapane, M. Telegrafo, G. Angelelli, A.A. Stabile Ianora; \nBari/IT (marco.moschetta@gmail.com) \nPurpose: To assess the reliability of 3D analysis CT software in determining urinary \nstones volume and density.\nMethods and Materials: CT images of 140 patients for a total of 219 urinary stones \n(116 calyceal, 22 pelvic, 81 ureteral) were evaluated. All exams were performed us-\ning a 320 MDCT with a low dose protocol and without injection of contrast material. \nCT scans were independently evaluated by two expert radiologists. For each stone, \nvolumetric [SV (stone volume) = l (length) x w (width) x t (thickness) x π x 0.52 ] and \ndensitometric [selecting a ROI on axial plane] measurements were calculated. The \nobtained data were then compared with the measurements performed by the 3D \nanalysis CT software (Vitrea fX 2.1). Differences between the two systems were \nevaluated by the analysis of variance (Anova) test. The interobserver agreement \nwas calculated using the Cohen’s kappa (k) test.\nResults: The volumetric and densitometric measurements of urinary stones ob-\ntained without 3D analysis software showed a lower interobserver agreement (k = \n0.54) than that resulting from the use of the software (k = 0.98). Statistical significant \ndifferences were found between volumetric and densitometric measurements as \nperformed with and without the 3D software for each urinary stone (p < 0.05).\nConclusion: Volumetric and densitometric evaluation of the urinary stones pro-\nvided by 3D analysis software is reliable and reproducible and could significantly \ninfluence the therapeutic choices.\nB‑0284 14:36\nThe 3DSlicer open-source platform for segmentation, registration, \nquantitative imaging and 3D visualisation of biomedical image data \nS. Pujol1, S. Pieper2, R. Kikinis1; 1Boston, MA/US, 2Cambridge, MA/US \n(spujol@bwh.harvard.edu) \nPurpose: 3DSlicer is an open-source platform for medical image computing and \nimage-guided intervention used in biomedical and clinical research worldwide. The \nsoftware aims at delivering cutting-edge medical image analysis technology to \nthe clinical and scientific community. This abstract introduces translational clinical \nresearchers to the capabilities of 3DSlicer.\nMethods and Materials: 3DSlicer is a multidisciplinary platform that integrates \nstandard radiological viewing capabilities and state-of-the-art tools for segmenta-\ntion, registration, quantitative analysis and 3D visualisation of multi-modal imaging \ndata. 3DSlicer is developed through a multi-institution effort of several large-scale \nconsortia, including NA-MIC,NAC and NCIGT. The platform is built upon a set of \nopen-source software packages allowing developers to create tools within a robust \narchitectural framework. 3DSlicer integrates 97 modules, and is freely available for \nWindows, Linux and MacOS under a BSD-style open-source license. Hands-on \nworkshops based on the comprehensive training compendium of the software are \ndelivered on a regular basis at national and international venues. 3DSlicer’s ex-\ntensible architecture allows plugin development, such as SlicerRT for radiotherapy \nresearch and SlicerIGT for image-guided therapy.\nResults: 3DSlicer is being used in numerous academic institutions and research \nlaboratories worldwide. Clinical applications include neurosurgery, prostate cancer, \natrial fibrillation, Huntington’s disease and traumatic brain injury. More than 2,000 \nclinicians and scientists have attended 3DSlicer training workshops, and the latest \nversion of the software 3DSlicer version 4 has been downloaded over 37,000 times \nsince its release in late 2011.\nConclusion: 3DSlicer is a multi-institution effort of several large-scale consortia \nto share and disseminate the latest advances in medical image computing to \nclinical researchers.\nB‑0285 14:45\nCan the CT acquisition protocol be used in combination with the \nstudy description to optimise patient dose tracking for CT examinations? \nT. De Bondt1, Q. Collier1, R. Salgado1, M. Geldof1, F. Deferme1, J. Valette2, \nA. Jomier2, W. Van Hecke1, P.M. Parizel1; 1Antwerp/BE, 2Mutzig/FR \n(timo.debondt@ua.ac.be) \nPurpose: To improve the dose alert triggering mechanism for CT scans, in order \nto decrease the incidence of irrelevant alerts and increase the reporting of clini-\ncally relevant alerts.\nMethods and Materials: We prospectively evaluated dose information for CT \nexaminations on two scanners using dedicated software (DoseWatch®), over a \n7-month period (10273 studies). We selected the most common studies and de-\n\nScientific Sessions\nS211\nA\n C D E F G\nB\nThursday\nResults: CTDIvol and image noise was significantly lower for the SAFIRE examina-\ntions, compared to the FBP examinations (p < 0.001). VGC showed significantly \nbetter results for the SAFIRE examinations regarding the visual reproduction of \nthe kidney contours, the intrahepatic vessel contours and for the overall diagnos-\ntic acceptability (95% CI of 0.6052-0.7408, 0.6272-0.7546 and 0.5237-0.6687, \nrespectively). A varying interobserver agreement was found (κ 0.094 to 0.763).\nConclusion: The scan and examination parameters used for the SAFIRE ex-\naminations in this study made it possible to lower the qRef mAs by 30 % without \nimage quality loss. \nB‑0288 15:12\nImproved image quality of virtual non-contrast dual-energy CT \nimages using a new iodine subtraction algorithm \nA. Helck, N. Hummel, F. Meinel, S.F. Thieme, M.F. Reiser, A. Graser, \nT.R.C. Johnson; Munich/DE (andreas.helck@med.uni-muenchen.de) \nPurpose: To evaluate a new algorithm for calculation of virtual non-contrast im-\nages (VNC) from dual-energy CT scans and determine whether VNC can replace \nnon-contrast scans.\nMethods and Materials: 43 patients received a contrast-enhanced dual-energy \n(DE) CT of the abdomen in portal venous phase. VNC were calculated using the \nstandard VNC (sVNC) and a new VNC algorithm (nVNC). Overall image quality, \nidentifiability of vessels and homogeneity of liver parenchyma were graded by \ntwo experienced radiologists in consensus using a 5-point rating scale with a true \nnon-contrast CT (tNC) scan as standard of reference (1=no difference; 2=minimal, \nnon-relevant difference; 3=visible but diagnostically irrelevant difference; 4=relevant \ndifference; 5=obvious difference). Image noise was measured in liver parenchyma, \nretroperitoneal fat and aortic lumen. Wilcoxon signed-rank non-parametric test was \nused to assess statistical significance.\nResults: The nVNC was superior compared to the standard VNC regarding overall \nimage quality and identifiability of vessels (2.4 vs. 3.2/p < 0.001 and 1.4 vs. 1.9/p \n< 0.001), whereas no significant difference was observed concerning the homo-\ngeneity of the liver parenchyma (nVNC: 2.5/sVNC 2.4). There was no significant \ndifference regarding image noise with an average value of 7.5 HU (nVNC) and 7.4 \nHU (sVNC), respectively, compared to 9.8 HU (tNC).\nConclusion: The new algorithm provides a better image quality and an improved \nassessment of vessels and small structures. The nVNC images represent adequate \nsubstitutes for TNC images, rendering an omission of non-contrast acquisitions \nfeasible, corresponding to a substantial dose reduction.\nB‑0289 15:21\nImage quality of monoenergetic low-keV datasets for lower extremity \ndual-energy CT angiography \nS. Sudarski, D. Schneider, P. Apfaltrer, S.O. Schönberg, T. Henzler; \nMannheim/DE (sonja_sudarski@gmx.de) \nPurpose: To compare image quality of conventional 120-keV polyenergetic im-\nages (PEIs) and monoenergetic images (MEIs) for dual-energy CT angiography \n(DE-CTA) datasets of the lower extremity.\nMethods and Materials: We retrospectively evaluated DE-CTA datasets obtained \nfrom 18 patients (13 men, 67±10 years). MEIs were calculated in 10-keV intervals \nfrom 120 to 40 keV using the 80- and 140-keV image data. Attenuation and image \nnoise were measured in the external iliac, femoral, popliteal and one lower leg artery. \nContrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were calculated for \neach vessel. Differences in these parameters were compared between the differ-\nent monoenergetic datasets. The two best MEIs were compared to 120-keV-PEIs.\nResults: SNR and CNR of 70- and 60-keV MEIs were highest when compared to \nother low-keV MEIs. In 70-keV MEIs, CNR in external iliac, femoral and popliteal \narteries was higher compared to PEIs (+29%, +19% and +12%; p < 0.05), while \nCNR did not change in lower leg arteries (p> 0.05). SNR in external iliac and lower \nleg arteries was equal in 70-keV MEIs and PEIs, while in femoral and popliteal \narteries it was lower (-9%, -10%; p < 0.05). 60-keV MEIs showed a higher CNR \nin lower leg arteries compared to PEIs (+17%; p < 0.05), while SNR did not differ \n(p> 0.05). In the other three arteries, 60-keV MEIs showed significantly not only \nhigher CNR but also lower SNR.\nConclusion: In lower extremity DE-CTA studies, 60- and 70-keV MEIs show im-\nproved CNR at equal SNR levels compared to conventional PEIs. Thus, reduction \nof radiation dose seems to be achievable without compromising image quality. \n\nScientific Sessions\nS212\n C A D E F\n G\nB\n\nScientific Sessions\nS213\nA\n C D E F G\nB\nFriday\nFriday, March 8\n\nScientific Sessions\nS214\n C A D E F\n G\nB\nB‑0292 10:48\nAIDR improves characterisation of sub-centimetre pulmonary GGO \non low dose HRCT \nS. Hashemi Amroabadi1, H. Mehrez2, R.S. Cobbold1, \nN.S. Paul1; 1T oronto, ON/CA, 2Markham, ON/CA \n(sayedmasoud.hashemiamroabadi@mail.utoronto.ca) \nPurpose: Persistent sub-centimetre GGO are pre-malignant. HRCT improves \ndetection of small nodules and low dose CT (LDCT) reduces patient exposure but \nboth decrease CNR essential for characterisation of small GGO. We investigate \nthe use of adaptive iterative dose reduction (AIDR) in low dose HRCT (LD-HRCT) \nfor diagnosis of small GGO.\nMethods and Materials: LDCT (120 kV, 25 mAs, 64 x 0.5 mm) was used in 3 \nstages: 1) computer-simulated lung nodules 5, 8 and 10 mm spheres each of CT# \n100, -630 and -800 HU; 2) identical synthetic nodules, placed in an anthropomorphic \nchest phantom and 3) 22 in vivo pulmonary nodules (13 GGO, 9 solid); 5.1 mm \ndiameter (4.0-6.9), mean CT# -327 HU (8 to -738). Raw data reconstructions are \nas follows (slice thickness/overlap mm): 0.5/0.5, 1/1, 2/1, 2/2, 3/1, 4/2, 4/4, 5/2.5 \nand 5/5 with FBP. In vivo images were also reconstructed with AIDR. CT# and CNR \nwere determined for each protocol.\nResults: CT# accuracy decreases with increased slice thickness for all nodules: \n5/5 reconstructions decrease CT# > -400 HU for 5 mm solid (+100 HU) nodules \nand ~ -130 HU for 5 mm GGO (-630 HU and -800 HU), Spearman's coefficient \n= -1.0, p < 0.005. HRCT (< 3.0/1.5 mm) has accurate nodule CT# (error< 10%). \nAIDR increases CNR for GGO nodules by 63%, for solid nodules by 45% and \nimproves accurate CT# with LD-HRCT compared to FBP (paired-test, p < 0.0001).\nConclusion: CNR for sub-centimetre GGO is improved with 3/1.5 mm reconstruc-\ntions for FBP and AIDR. AIDR enhances CNR by 45-6% and improves accuracy \nin GGO diagnosis with LD-HRCT.\nAuthor Disclosures:\nH. Mehrez: Employee; Toshiba Medical Systems.\nB‑0293 10:57\nComparison of capabilities for differentiating malignant SPNs from \nbenign SPNs among dynamic first-pass perfusion area-detector CT, \ndynamic first-pass MRI and FDG-PET/CT \nY. Ohno1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nY. Fujisawa2; 1Kobe/JP, 2Ohtawara/JP (yosirad@kobe-u.ac.jp) \nPurpose: To compare differentiation capability of malignant nodules from benign \nnodules among dynamic first-pass perfusion area-detector CT (perfusion ADCT) \nanalysed by newly developed and previously developed models, dynamic first-pass \nMRI and FDG-PET/CT.\nMethods and Materials: 45 consecutive patients (26 males, 19 females) with 85 \nnodules underwent dynamic perfusion ADCT, dynamic MRI at 1.5 T scanner, PET/\nCT, and microbacterial and/or pathological examinations. 85 nodules were clas-\nsified into two groups based on the final diagnoses: malignant (n=62) and benign \nnodules (n=23). For quantitative assessment of perfusion CT, nodule perfusions \nby single-input maximum-slope model (NPSMS) and dual-input maximum slope \nmodel (NPDMS) were calculated. For semi-quantitative assessment of dynamic \nMRI, maximum enhancement ratio (MER) and maximum slope of enhancement \nratio (MSER) were calculated according to the past literatures. On PET/CT, maxi-\nmum value of SUV (SUVmax) was determined. To compare diagnostic capability \namong all indexes, ROC analyses were performed, and feasible threshold values \nwere determined. Finally, sensitivity, specificity and accuracy were compared with \neach other using McNemar’s test.\nResults: Area under the curves of NPDMS (Az=0.85) and MSER (Az=0.83) were \nsignificantly larger than that of SUVmax (Az=0.72, p < 0.05). When feasible thresh-\nold values adopted, accuracy of NPDMS (87.1 [78/85]%) was significantly higher \nthan that of NPSMS (80.0 [68/85]%) and SUVmax (75.3 [64/85]%).\nConclusion: First-pass ADCT analysed by dual-input maximum slope model was \nsignificantly more accurate method for differentiation of malignant nodules from \nbenign nodules than that by single-input maximum slope model and PET/CT, and \nat least as valuable as dynamic first-pass MRI.\nAuthor Disclosures:\nY. Ohno: Research/Grant Support; Toshiba Medical Systems, Bayer Pharma, \nPhilips Healthcare. T. Yoshikawa: Research/Grant Support; Toshiba Medical \nSystems. S. Matsumoto: Research/Grant Support; Toshiba Medical Systems. \nY. Fujisawa: Employee; Toshiba Medical Systems.\n10:30 - 12:00 Room D1 \nChest \nSS 504 \nLung nodules \nModerators: \nS. Diederich; Düsseldorf/DE \nN. Karabulut; Denizli/TR \nB‑0290 10:30\n70 kV computed tomography of the thorax: valence for computer-\nassisted nodule evaluation and radiation dose - first clinical results \nB. Schulz1, B. Bodelle1, T. Lehnert1, F. Al-Butmeh1, M. Sedlmair2, \nR. Banckwitz2, D. Klement1, T.J. Vogl1, M.J. Kerl1; 1Frankfurt a. Main/DE, \n2Erlangen/DE (mail@borisschulz.com) \nPurpose: To evaluate radiation dose and efficiency of computer-assisted detection \n(CAD) technique of pulmonary nodules in low dose chest CT performed at 70 kVp.\nMethods and Materials: CAD was performed upon chest CT with 70 kVp and \n100 kVp (gold standard) at a tube current of 87 mAs (collimation: 64x0.6 mm). \nDetection rate for pulmonary nodules and size measurements of both techniques \nwere compared to each other. Radiation dosage in terms of effective dose (E) was \nmeasured using an Alderson-Rando Phantom.\nResults: 74 patients with 301 nodules were included in the study. CAD detection \nrate was similar for 70 kVp (94.5%) and 100 kVp (92.4%). Mean transversal nodule \ndiameter was 5.5 mm (70 kVp), respectively, 5.7 mm (100 kVp) with an average \nvolume of 0.12 ml (both techniques). Derived from the phantom measurements pa-\ntient examinations resulted in an E of 0.51mSv (70 kVp), resp., 2.02mSv (100 kVp).\nConclusion: 70 kVp low dose chest CT is suitable for CAD-based lung nodule \nanalysis at a quarter of the radiation burden of the standard technique. Based on \nthe accurate CAD measurements 70 kVp CT can be used for detection of pulmonal \nlesions and follow-up examinations.\nAuthor Disclosures:\nM. Sedlmair: Employee; Siemens Healthcare. R. Banckwitz: Employee; \nSiemens Healthcare. M.J. Kerl: Consultant; Siemens Healthcare.\nB‑0291 10:39\nImproved accuracy of lung cancer diagnosis for fast-growing lung \nnodules in CT lung cancer screening by optimisation of volume-\ndoubling time cut-off \nM.A. Heuvelmans1, M. Oudkerk1, G.H. De Bock1, X. Xie1, P.M.A. Van Ooijen1, \nM.J.W. Greuter1, P.A. De Jong2, H.J.M. Groen1, R. Vliegenthart1; 1Groningen/NL, \n2Utrecht/NL (m.a.heuvelmans@student.rug.nl) \nPurpose: To investigate whether optimisation of volume-doubling time (VDT) cut-\noff for fast-growing nodules in a lung cancer screening trial can improve accuracy \nof lung cancer diagnosis.\nMethods and Materials: All subjects underwent at least two low-dose computed \ntomography (CT) scans during the baseline-round screening and regular second-\nround screening in year 2 of the NELSON lung cancer screening study and were \nreferred to a pulmonologist because of a solid nodule with volume ³50 mm 3 and \nVDT < 400 days. Histology was the reference for diagnosis, or, to confirm benignity, \nstability of the nodule volume on subsequent CT scans for at least two years after \nreferral to a pulmonologist. Nodule volume and VDT were semi-automatically cal-\nculated by software. Reduction of false-positive rate was evaluated at maintained \nsensitivity for lung cancer diagnosis with the VDT cut-off of 400 days as reference.\nResults: 68 fast-growing nodules were included (61 individuals), of which 27 \nnodules (40%) were malignant. Mean follow -up of non-resected benign nodules \nwas 4.4 (range 2.7-5.7) years. The optimal VDT cut-off for the 3-month follow-up \nCT in the baseline round was 232 days. Using this cut-off, false-positive referrals \nreduced by 33% (20 versus 30 false-positive referrals). For the regular second-\nround screening, VDTs varied more among malignant nodules, precluding lowering \nof the VDT cut-off of 400 days.\nConclusion: Lowering the VDT cut-off of the 3-month follow -up CT in baseline \nlung cancer screening from 400 to 232 days may reduce false-positive referrals, \nwithout apparent loss in sensitivity. \n\nScientific Sessions\nS215\nA\n C D E F G\nB\nFriday\nMIA, invasive adenocarcinoma, and the extents of invasive carcinoma component \nwere quantified. Association between imaging parameters and pathologic clas-\nsification was examined.\nResults: 177 patients (98%) were pathologic stage 1 A, and 2 were 1B and the \nother one was 2 A. Of all 190 tumours, 38 were AIS (20%), 56 were MIA (29%), \nand 96 were invasive adenocarcinoma (51%). Based on univariate analysis, tumour \nsize in lung setting, uniformity, and entropy were able to significantly separate \ntumours according to pathologic classification, whereas TDR, volume, mass, or \nSUVmax were not. On multivariate analysis, uniformity and entropy were remained \nas independent factors to stratify the pathologic subgroups of patients (odds ratio \n[OR] = 0.001, P =.007, and OR = 2.4, P =.01, respectively).\nConclusion: Texture parameters on CT imaging metrics, reflecting tumour hetero-\ngeneity, appear to help stratify pure GGN lung adenocarcinoma.\nB‑0297 11:33\nNon-solid, part-solid or solid? Classification of pulmonary nodules \nin thoracic CT by radiologists and a computer-aided diagnosis system \nC. Jacobs1, E.M. van Rikxoort2, J.-M. Kuhnigk1, E.T. Scholten3, \nP.A. de Jong4, C. Schaefer-Prokop5, M. Prokop2, B. van Ginneken2; \n1Bremen/DE, 2Nijmegen/NL, 3Haarlem/NL, 4Utrecht/NL, 5Amersfoort/NL \n(colin.jacobs@mevis.fraunhofer.de) \nPurpose: Classifying pulmonary nodules into solid, part-solid and non-solid is \ncrucial for patient management. A computer algorithm is compared to a radiolo-\ngist on a large data set obtained from a multi-center lung cancer screening trial.\nMethods and Materials: Low-dose chest CT scans (16x0.75 mm, 120-140 kVp, 30 \nmAs) with part-solid, non-solid, and solid nodules with a diameter between 7 and \n30 mm were randomly selected from two sites participating in the Dutch-Belgian \nNELSON lung cancer screening trial. The set contained 137 scans, including 50 \npart-solid, 50 non-solid and 52 solid nodules. The nodule-type recorded in the \nscreening database was used as a reference standard. An automated classification \nsystem for characterisation of nodules was designed using morphometric features. \nThe accuracy of the computer algorithm was evaluated in three ways: classifying \nnodules (1) as solid or subsolid, (2) as solid, part-solid or non-solid, and, (3) for the \nsubsolid lesions only, as part-solid or non-solid. An experienced thoracic radiologist \nindependently performed the same classification.\nResults: The accuracy of the automated system to differentiate between solid and \nsubsolid nodules was 0.88, compared to 0.95 for the radiologist. The computer clas-\nsified the nodules as solid, part-solid or non-solid with an accuracy of 0.72 versus \n0.80 for the radiologist. The software reached an accuracy of 0.71 in differentiating \npart-solid from non-solid nodules, where the radiologist had an accuracy of 0.77.\nConclusion: A novel automated characterisation tool for pulmonary nodules shows \npromising performance and could aid radiologists in selecting the appropriate \nworkup for pulmonary nodules. \nAuthor Disclosures:\nC. Jacobs: Research/Grant Support; MeVis Medical Solutions AG.\nB‑0298 11:42\nSolid pulmonary nodules detected by low-dose CT: effect of semi-\nautomatic software on volumetry in vitro and in vivo \nY. Zhao, M. Dorrius, P. van Ooijen, M. Oudkerk, R. Vliegenthart; Groningen/NL \n(r.vliegenthart@umcg.nl) \nPurpose: This study aimed at comparing accuracy of semi-automatic software sys-\ntems for volumetry and volume doubling time (VDT) calculation of solid pulmonary \nnodules, detected by low-dose computed tomography (CT).\nMethods and Materials: Scans were obtained from an anthropomorphic lung \nphantom with 60 artificial solid nodules (volume:65-905 mm3) and from 25 partici-\npants of the NELSON lung cancer screening trial. Semi-automated software (P1) \nwas used for volumetry of the artificial nodules to evaluate accuracy of measured \nvolumes. Subsequently, NELSON participants with at least one pulmonary nodule \non the baseline and consecutive screening CT were randomly selected. The volume \nof each pulmonary nodule was determined for both time points using P1 and two \nadditional software packages (P2 and P3). Manual modification was performed if \nsoftware assessment was visually inaccurate. Pulmonary nodules were classified \naccording to the NELSON categorisation protocol based on size and VDT.\nResults: P1 accurately assessed the volume of the artificial nodules, with mean \nvolume underestimation of 4±6%. The participants had 147 pulmonary nodules \n(P1-derived volume:12-437 mm3). Significant volume differences were found be-\ntween software packages (p < 0.001). Compared with P1, P2 and P3 overestimated \nvolume by a mean of 38±24% and 50±22%, respectively. At baseline, there was \nconsensus on nodule size categorisation in 80% for P1-P2 and 74% for P1-P3. At \nB‑0294 11:06\nCan dual-energy index help to differentiate malignant and benign \nlesions of lung? \nA. Kannivelu, S. Srinivasan, H.S. Teh, H.T. Koay, C.H.A. Tan, T.W. Choy, \nK.K. Yeow, S.K.J. Lim; Singapore/SG (sivasu2@gmail.com) \nPurpose: To determine the feasibility of dual-energy index in the differentiation of \nmalignant and benign lesions using their attenuation values obtained in 100 kVp \nand 140 kVp images.\nMethods and Materials: Forty-three consecutive patients who had lung lesions \ndetected on dual-energy CT thorax imaging (SOMATOM Definition FLASH, Siemens \nAG, Erlangen, Germany) and histopathological finding were analysed. Images \nwere acquired at 100 kVp and 140 kVp. CT Hounsfield units (HU) at 100 kVp, 140 \nkVp were measured, and dual-energy index (DEI) was calculated. Results were \nanalysed using ANOVA and independent sample t-test.\nResults: Thirty-one patients had malignant lesions (adenocarcinoma (ADC), n=19; \nsquamous cell carcinoma (SCC), n=7; others (OTH), n=5), and 12 patients had \nbenign lesions. Mean DEI values of malignant and benign groups were 0.00981 \n(±0.00442) and 0.00472 (±0.00255), respectively (P < 0.05). In malignancy group, \nmean DEI values of individual subgroups were 0.01097 ± 0.00486 (ADC), 0.007046 \n± 0.00152 (SCC) and 0.00981 ± 0.00256 (OTH), respectively. Difference between \nthe ADC and the SCC subgroups was found to be statistically significant (P < 0.05).\nConclusion: Dual-energy index obtained using dual-energy CT imaging may pro-\nvide an objective quantitative parameter in characterisation of lung lesion, allowing \ndistinction between a malignant tumour from benign lesion, as well as differentiation \nof different histological subtype of malignant lung lesions.\nB‑0295 11:15\nFeatures of resolving and non-resolving indeterminate pulmonary \nnodules on follow-up CT: the NELSON study \nY. Zhao, M. Dorrius, M. Heuvelmans, P. van Ooijen, M. Oudkerk, R. Vliegenthart; \nGroningen/NL (m.a.heuvelmans@student.rug.nl) \nPurpose: This study aimed at analysing computed tomography (CT) features \nassociated with resolution of indeterminate pulmonary nodules in low-dose CT \nlung cancer screening.\nMethods and Materials: The Dutch Belgium Trial for Lung Cancer Screening \nStudy (NELSON) was institutional review board approved. For this retrospective \nevaluation of indeterminate pulmonary nodules found at baseline, patient consent \nwas waived. Indeterminate nodules were re-examined by CT at 3 months. Regular \nrepeat screening CT rounds were at years 2, 4 and 6. This study included only solid, \nintraparenchymal nodules. A nodule was defined as resolving if it had completely \ndisappeared on a subsequent CT. Nodule resolution was regarded as spontane-\nous, not the effect of treatment. CT features of resolving nodules and non-resolving \n(stable and malignant) nodules were compared.\nResults: At baseline, 1059 solid, intraparenchymal nodules (805 participants) were \nidentified as indeterminate. During subsequent screening rounds, 9.3% (99/1059) \nof the nodules disappeared, 75.8% of these before the 3-month CT and 93.0% \nbefore the year 2 screening. Non-peripheral nodules and nodules with non-smooth \nmargin were more likely to resolve than peripheral and smooth nodules (19.7 vs \n7.6%, p < 0.001, and 13.6 vs 7.5%, p < 0.005, respectively).\nConclusion: Resolving pulmonary nodules share CT features with malignant \nnodules. A 3-month repeat CT for indeterminate pulmonary nodules can identify \nmost resolving nodules. \nB‑0296 11:24\nStratification of pure ground-glass opacity (GGO) nodular lung \nadenocarcinoma using quantitative analysis of CT imaging metrics \nto select patients for limited-resection more precisely \nJ. Son, H. Lee, J. Kim, J. Han, K. Lee, O. Kwon, B. Kim, H. Kim, Y. Shim; \nSeoul/KR (jiye.son@samsung.com) \nPurpose: To determine whether quantitative analysis of CT imaging metrics can \nhelp differentiate among adenocarcinoma in situ (AIS), minimally invasive adeno-\ncarcinoma (MIA), invasive adenocarcinoma showing pure ground-glass nodule \n(GGN) on CT scan.\nMethods and Materials: We reviewed CT and PET images of tumours and \npathologic specimens from 180 consecutive patients who underwent complete \nresection for lung adenocarcinomas showing GGN with little solid component on \nCT. Tumour size in lung setting/mediastinal setting, tumour disappearance ratio \n(TDR), volume, mass, skewness/kurtosis on the histogram, and texture parameters \n(uniformity and entropy) were assessed from CT, and SUVmax was measured on \nPET. On pathology, the histopathological classification was determined as AIS, \n\nScientific Sessions\nS216\n C A D E F\n G\nB\nConclusion: Our study confirmed that CAS can be considered a valid method for \nthe treatment of the carotid pathology; nevertheless patient’s accurate evaluation \nis mandatory. \nB‑0301 10:39\nAdditional value of mechanical thrombectomy devices in thrombo-\nembolic complications during endovascular occlusion of intracranial \naneurysms \nM.H.J. Voormolen, T. van der Zijden, T. Menovsky, P.N.M. Parizel; Antwerp/BE \n(maurits.voormolen@uza.be) \nPurpose: Evaluation of mechanical thrombectomy devices during endovascular \nocclusion of intracranial aneurysms.\nMethods and Materials: Thrombo-embolic events are one of the most frequent \ncomplications of endovascular occlusion of intracranial aneurysms, For small, not \nflow obstructing thrombus we use Aggrastat (Tirofiban) intravenous. Until recently, \nintra-arterial thrombolysis was one of the few interventional methods to dissolve \nthe thrombo-occlusion of intracranial arteries, but with a high risk of haemorrhage. \nMechanical thrombectomy devices (MTD) for stroke treatment became available \nin our hospital from 2010. In our hospital, 495 endovascular occlusions of 445 in-\ntracranial aneurysms have been performed in 377 patients from January 2006 until \nAugust 2012. In our series we retrospectively evaluated the results of intra-arterial \nthrombectomy versus thrombolysis in per procedural thrombo-occlusive events.\nResults: Overall, 54 patients (11%) had thrombo-embolic events, of whom 27 \n(5.5%) had permanent neurological events or death. In 17 cases (3.4%) a thrombo-\nocclusion of a major intracranial artery occurred. In 10 cases intra-arterial thromboly-\nsis was used, resulting in 5 deaths (50%), 3 permanent neurological deficits (30%) \nand 2 patients without sequel. Since October 2010, 7 mechanical thrombectomies \nhave been done (4 Trevo stents, 3 Solitaire stents), resulting in one permanent \nneurological deficit (14%), 1 TIA and 5 patients without clinical sequel. We had no \ntechnical MTD problem or problems with the occluded aneurysms.\nConclusion: Thrombo-embolic occlusion of intracranial arteries during endovas-\ncular aneurysm occlusion can be a potential lethal complication. Intra-arterial \nthrombolysis has a very high complication rate. Mechanical thrombectomy devices \nremove the thrombus safe and with good clinical outcome. \nB‑0302 10:48\nStent-assisted endovascular occlusion of intracranial aneurysms \nM.H.J. Voormolen, T. Van der Zijden, T. Menovsky, P. Parizel; Antwerp/BE \n(maurits.voormolen@uza.be) \nPurpose: Evaluation of additional stent support during endovascular occlusion \nof intracranial aneurysms: indications, procedural complications and follow-up.\nMethods and Materials: From January 2006 until August 2012, 71 intracranial \naneurysms in 58 patients (42 females, 16 males; mean/median age 54 years (range \n20-79)) were treated in our hospital by endovascular occlusion with stent support: \nSAH (3), dissecting aneurysm (3), neurological deficit (16), incidental finding (19), \nadditional to bled aneurysm (9) and additional coiling (21). Aneurysms ranged \nin maximal size between 2 and 30 mm (mean/median 9 mm). Aneurysms were \nlocated in the cavernous sinus (n=14), supraclinoid internal carotid artery (n=33), \nanterior communicating artery (n=3), middle cerebral artery (n=2), pericallosal \nartery (n=2) and posterior circulation (n=17). Patients were preloaded with aspirin \nand clopidogrel (multiplate test control). Clinical and angiographic follow -up was \ndone at 3- to 12-month intervals after treatment.\nResults: Single stents were placed in 49 cases, 2 stents in 12 and flow-diverter \nstents in 10. In 14 cases no additional coil aneurysm occlusion was performed. \nSeventeen procedural complications occurred (24%): 3 thrombo-embolic, 5 in-stent \nthrombosis, 3 haemorrhages, 3 side-branch occlusions and 3 technical device \nproblems. Most had no clinical sequel, but 2 patients died (3%) and 5 patients had \npermanent neurological deficit (7%). Five aneurysms (7%) needed second addi-\ntional stenting during follow-up. Mean follow-up was 9 months (range 0-39 months).\nConclusion: Endovascular intracranial aneurysm occlusion with stent assistance \nis a delicate procedure with a higher complication rate compared to regular coil \nocclusion. However, this technique is useful in complex otherwise difficult or un-\ntreatable intracranial aneurysms.\nfollow-up, consensus on VDT categorisation was present in 27% for P1-P2 and \n26% for P1-P3.\nConclusion: Accurate volumetry of pulmonary nodules can be performed with \nsemi-automated software. Different software packages yield significantly different \nvolumetry results, most pronounced in case of VDT determination. \nB‑0299 11:51\nFeasibility of training radiographers to detect nodules in CT lung \ncancer screening \nA. Nair1, N. Gartland1, B. Barton1, E. Ifeakor1, J. Hodgkinson1, R. Vliegenthart2, \nP.A. de Jong3, M. Prokop4, A. Devaraj1; 1London/UK, 2Groningen/NL, \n3Utrecht/NL, 4Nijmegen/NL (arjun7764@gmail.com) \nPurpose: To evaluate the feasibility of training radiographers for the task of detecting \nlung nodules on CT, and assess the effect of continuous feedback.\nMethods and Materials: Four experienced CT radiographers were tutored on the \nappearances of lung nodules and their mimics. 100 CTs obtained from the NELSON \ntrial were then arbitrarily divided into subsets of 10. Radiographers were asked to \nidentify all nodules. After each subset, a radiologist reviewed the radiographers’ \nreadings and provided feedback. The sensitivity and specificity of radiographers’ \nreadings were calculated for each subset. The reference standard included all \npositive nodules identified by the NELSON trial readers, as well as extra nodules \nidentified by the radiographers that were classified as genuine nodules by two UK \nLung Screening trial (UKLS) radiologists in consensus.\nResults: Of 417 opacities (14-79 per subset), 282 (67.6%) nodules formed the \nreference standard. The median (and individual) radiographers’ sensitivity and \nspecificity over the 100 scans were 62.1% (39.7%, 48.6%, 75.5% and 78.0%) and \n67.7% (63.9%, 65.3%, 70.1% and 74.3%), respectively. Sensitivity and specificity \nvaried between 22.7-86.4% and 50.0-92.9%, respectively, in the first subset, to \n48.0-88.0% and 35.0-80.0%, respectively, in the final subset, showing no consistent \ntrend between subsets (p=0.0005-1.0000).\nConclusion: Initial radiographer performance in lung nodule detection is highly \nvariable. Some readers are capable of achieving accuracy rates similar to those \nreported for radiologists. However, after initial training no learning effect was \ndemonstrated, indicating that initial radiographer performance may be guided by \npre-existing ability and experience.\n10:30 - 12:00 Room D2 \nInterventional Radiology \nSS 509 \nNeurovascular and spine interventions \nModerators: \nE.R. Gizewski; Innsbruck/AT \nL. Pierot; Reims/FR \nB‑0300 10:30\nCarotid artery stenting: results and analysis of a single-centre \nexperience after 12 years \nF. Fanelli, A. Cannavale, E. Boatta, M. Corona, C. Cirelli, F.M. Salvatori; \nRome/IT (alessandro.cannavale@hotmail.com) \nPurpose: To report 12-year experience in carotid artery stenting (CAS) with cerebral \nprotection devices evaluating technical aspects, results and outcomes.\nMethods and Materials: 636 patients who underwent CAS with a minimum \nfollow-up of 6 months were retrospectively analysed. CAS Indications were in ac-\ncordance with the NASCET criteria. A bilateral CAS was performed in two sessions \nin 47 patients. A cerebral protection device (CPD) was used in 94.7% of the cases \nwhereas no CPDs were employed in 36 cases (5.3 %) for anatomical complexity. \nPre and post CAS medication was administered according to standard protocols.\nResults: Technical success was achieved in all cases. After a mean follow-up of \n76±32.4 months, 478 patients (70%) are alive, with a 30-day mortality of 1.9%. \nIn-stent restenosis occurred in 9/683 cases (1.3%) and solved with angioplasty \nin 2/9 cases (22%) or re-stenting in 7/9 (78%). Primary patency rate was 98.7%; \nsecondary patency rate 100%. Neurological events occurred in 3.2% of cases. \nResults were analysed correlating neurological complications with the operator's \nexperience, plaque morphology and patient's age. Neurological disorders were 1.9 \n% in asymptomatic patients and 4.5% in symptomatic ones (p=0.001) and they \nproved to be higher in older patients (> 80y) 6.4% vs 2.7% of patients < 80 years \n(p < 0.05). The overall neurological adverse events were 6.1% in the presence \nof complex plaque morphology and 1.0% in case of stable plaques (p < 0.001).\n\nScientific Sessions\nS217\nA\n C D E F G\nB\nFriday\nwithin 3 months after the procedure. A total of 91 high signal lesions on DWI were \nserially numbered and the signal change on conventional MRI in the follow -up \nwas evaluated. The quantitative parameters on DWI (location, volume and value \nof apparent diffusion coefficient: ADC) for each lesion were measured. We used \nFisher exact test and the Mann-Whitney U test to compare differences between \ntwo groups; statistical significance was assigned when p < 0.05.\nResults: There was statistically significant difference in the presence of DWI le-\nsions (multiple: 65% versus single: 100%, p=0.03). In each lesion, the volume was \nsignificantly small (0.074±0.019 cm 3 versus 0.149±0.113 cm 3, p=0.009) and the \npermanent signal change was less observed in multiple antiplatelets use (5.2% \nversus 24.5%, p=0.02). There was negative correlation between the volume and \nthe value of ADC (r=-0.48, p <.0001).\nConclusion: Periprocedural use of multiple antiplatelet agents is expected to re-\nduce the volume of thromboembolism and permanent signal change in the follow-up. \nB‑0306 11:24\nMR-guided lumbosacral nerve root injection therapy using an open \n1.0 Tesla MRI system: a clinical investigation \nF. Streitparth1, M. De Bucourt1, T. Hartwig1, T. Walter1, M. Maurer1, \nD. Renz1, B. Gebauer1, B. Hamm1, U. Teichgräber2; 1Berlin/DE, \n2Jena/DE (florian.streitparth@charite.de) \nPurpose: To evaluate the accuracy, safety and efficacy of MR-guided periradicular \nnerve root injection therapy using an open 1.0 Tesla MRI system with fast dynamic \nimaging.\nMethods and Materials: Between April 2008 and November 2011 a total of 249 \nMR-guided periradicular nerve root injections were performed in 141 patients suf-\nfering from lumbosacral radicular pain. All interventions were performed in an open \n1.0 Tesla MRI. An interactive PDw TSE sequence was used for real-time guidance. \nAn in-room monitor, wireless MR-mouse for operator-controlled multiplanar naviga-\ntion, a flexible surface coil and MR-compatible 20-G needle were used. Informed \nconsent was obtained from all patients. Clinical outcome was evaluated by clinical \nfollow-up and questionnaire prior to injection therapy (baseline) and to 6 months \nafter using a numeric visual analog scale (VAS).\nResults: All procedures were technically successful. No major complications oc-\ncurred. At 6 months, of 103 patients (57 males, 46 females; mean age, 49.5; range, \n20-80) enrolled in the outcome analysis, 14.6% reported complete remission of \nradicular pain, 53.4% significant relief of pain, 22.3% mild relief and 9.7% no relief \nof pain. We found a significant decrease of the VAS-score from pre-intervention to 6 \nmonths follow-up (p <.0001). No significant difference in outcome was seen between \npatients with degenerative foraminal stenoses and patients with herniated disks.\nConclusion: MR fluoroscopy-guided periradicular injection therapy of the lum-\nbosacral spine under open 1.0 Tesla MRI-guidance is accurate, safe and efficient \nin the symptomatic treatment of radicular pain.\nB‑0307 11:33\nVertebral split fractures: the role of percutaneous vertebroplasty \nL. Huwart1, O. Hauger2, P.-Y. Marcy1, P. Foti1, M.-E. Amoretti1, \nP. Brunner3, N. Amoretti1; 1Nice/FR, 2Bordeaux/FR, 3Monaco/MC \n(huwart.laurent@wanadoo.fr) \nPurpose: The treatment of vertebral split fractures remains controversial, con-\nsisting of either corset or internal fixation. The aim of this study was to evaluate \nCT- and fluoroscopy-guided percutaneous vertebroplasty in the management of \nvertebral split fractures.\nMethods and Materials: Institutional Review Board approval and informed consent \nwere obtained for this study. Sixty-two consecutive adult patients who had post-\ntraumatic vertebral split fractures (A2 according to the AO classification) without \nneurological symptoms were prospectively treated by percutaneous vertebroplasty. \nAll these procedures were performed by an interventional radiologist under com-\nputed tomography (CT) and fluoroscopy guidance using only local anaesthesia. \nPostoperative outcome was assessed using the visual analogue scale (VAS) and \nOswestry disability index (ODI) scores.\nResults: Vertebroplasty was performed on thoracic and lumbar vertebrae. The \nfilling of the vertebral body was satisfactory in 100% of the patients, with seven \ndiscal cement leakages (14%). The mean VAS measurements ± standard deviation \n(SD) significantly decreased from 7.9 ± 1.5 preoperatively to 3.3 ± 2.1 at 1 day, 2.2 \n± 2.0 at 1 month, and 1.8 ± 1.4 at 6 months (P < 0.001). The mean ODI scores ± \nSD had also a significant improvement: 62.3 ± 17.2 preoperatively and 15.1 ± 6.0 \nat the 6-month follow-up (P < 0.001). Radiological union was observed within the \n6 months following vertebroplasty in all the cases.\nConclusion: The results of our study showed that type A2 vertebral fractures could \nbe successfully treated by CT- and fluoroscopy-guided percutaneous vertebroplasty \nwith an excellent functional recovery.\nB‑0303 10:57\nLong-term results of microsurgical and endovascular therapy of \nintracranial aneurysms in patients following subarachnoid haemorrhage \nK. Bojanowski1, J. Baron2, B. Kostkiewicz1, M. Zawadzki1, J. Walecki1; \n1 Warsaw/PL, 2Katowice/PL (jerzy.walecki@cskmswia.pl) \nPurpose: The aim of this paper was to evaluate long-term clinical outcomes and \nradiologic findings in patients following microsurgical treatment and endovascular \nembolisation of intracranial aneurysms.\nMethods and Materials: A total of 66 subjects aged 20 - 75 (42 women and 24 \nmen) were evaluated. Patients were divided into two groups according to the type \nof procedure they underwent: 36 patients had open surgery and 30 patients had \nundergone endovascular embolisation. The assessment was performed from 6 \nmonths to 4 years after treatment. All patients underwent a follow -up cerebral \narteriography and clinical evaluation.\nResults: A total occlusion or a neck remnant was discovered in a majority of patients \nfollowing microsurgical procedures and endovascular treatment (94% and 3% in \ncontrast to 87% and 7%, respectively). No recurrent aneurysms were revealed. The \nMann-Whitney U test did not reveal any statistical significance in long-term treatment \nresults regarding self-reliance (p-value=0.2). The amount of blood extravasated fol-\nlowing the rupture of an aneurysm was a significant independent factor influencing \nthe clinical outcome and determined the long-term results in both groups (p-value< \n0.05). A correlation between a patient's age and the clinical outcome following a \nmicrosurgical procedure was proved. The outcome was better in younger patients \n(p-value< 0.05). This was not observed in patients after endovascular treatment.\nConclusion: Microsurgical and endovascular therapy are comparable methods \nfor treating cerebral aneurysms; however, embolisation is correlated with a higher \nrate of complications in elderly patients. The final clinical outcome depends on the \namount of extravasated blood following a subarachnoid haemorrhage.\nB‑0304 11:06\nEmbolisation of cerebral aneurysms with hydrogel-coated coils: \nsystematic review and meta-analysis \nA. Pałys, Z. Serafin, W. Lasek; Bydgoszcz/PL (serafin@cm.umk.pl) \nPurpose: Hydrogel-coated coils for endovascular treatment of cerebral aneu-\nrysms were developed to reduce the risk of aneurysm recurrence and the rate \nof retreatment. The aim of this review was to verify the efficacy and safety of \nhydrogel-coated coils.\nMethods and Materials: A literature search was performed by two independ-\nent researches for papers published up to August 2012 on follow -up results of \nintracranial aneurysm embolisation with hydrogel-coated coils. Analysis included \naneurysm presentation at follow -up compared to initial treatment result, the rate \nof rebleeding and retreatment, and specific complications. Pooled rates of major \nrecurrences and total recurrences were calculated.\nResults: Of 41 articles on the use of hydrogel-coated coils for embolisation of \ncerebral aneurysms, 13 (1575 aneurysms) were included. Significant heteroge-\nneity was found regarding patients populations, methods of aneurysm coiling, \nfollow-up schedules, and recurrence definitions. A cumulative follow-up rate was \n76% (95% CI, 74-78%, range 51-100%). Pooled major recurrence rate was 13% \n(95% CI, 11-15%, range 2-27%) and pooled total recurrence rate was 17% (95% \nCI, 15-19%, range 3-29%). Control groups consisting of aneurysms treated with \nbare platinum coils were analysed in only in four articles (436 aneurysms). Pooled \nmajor recurrence rate for bare platinum coils was 33% (95% CI, 28-38%) and was \nsignificantly higher than this for hydrogel-coated coils.\nConclusion: Embolisation of cerebral aneurysms with hydrogel-coated coils results \nin lower rate of major recurrence, than with bare platinum coils. More high-quality \nstandardised prospective studies are needed to define specific indications for the \nuse of hydrogel-coated coils. \nB‑0305 11:15\nEffect of antiplatelet therapy on radiographic outcome of positivity \non diffusion-weighted imaging in elective endovascular coiling of \nunruptured cerebral aneurysm \nT. Matsushige, K. Shinagawa, Y. Akiyama, T. Okazaki, S. Sakamoto, Y. Kiura, \nK. Sugiyama, K. Kurisu; Hiroshima/JP \nPurpose: Our aim was to evaluate the radiographic outcome of high signal le-\nsions on diffusion-weighted imaging (DWI) in the elective endovascular coiling of \nintracranial unruptured aneurysm with analysing the correlation in periprocedural \nantiplatelet therapy.\nMethods and Materials: We retrospectively reviewed 33 patients initially undergo-\ning coiling of unruptured aneurysm between 2007 and 2012. The mode of antiplate-\nlet therapy was categorised into two groups: single in 13 patients and multiple in \n20. All patients underwent 3.0 Tesla MRI, scheduled before, 24-48 hours after and \n\nScientific Sessions\nS218\n C A D E F\n G\nB\nplasma (PRP) to treat tendinopathy in a murine model of patellar and Achilles \ntendinopathy, and to evaluate its local toxicity.\nMethods and Materials: Thirty rats (120 patellar and Achilles tendons) were \nused for the study. We induced tendinosis (T+) in 80 tendons by injecting under \nultrasonography (US) guidance Collagenase 1® (day 0=D0, patellar=40 and \nAchilles=40). Clinical examination and tendon US were performed at D3, im-\nmediately followed by either PRP (PRPT+, n=40) or physiological serum (PST+, \nn=40, control) US-guided intratendinous injection. Follow-up at D6, D13, D18 and \nD25 using clinical, US and histology, and comparison between the 2 groups were \nperformed. To study PRP toxicity, we compared the 40 remaining normal tendons \n(T-) after injecting PRP in 40 (PRPT-).\nResults: All PRPT+ showed a better joint mobilization compared to PST+ at D6 \n(p=0.005), D13 (p=0.02), D18 (p=0.003) and D25 (p=0.01). Similar results were \nfound regarding US and histology, with thinner diameters (D6, p=0.003; D25, \np²0.004) and less disorganised collagen fibres and neovessels (D6, p=0.003; \nD25, p=0.0003) in PRPT+ compared to PST+. Comparison between PRPT- and \nT- showed no PRP toxicity on tendon (p=0.18).\nConclusion: Our study suggests that mono-injection of PRP in tendinosis rapidly \naccelerates tendon’s healing, with no local toxicity.\nB‑0311 10:39\nHigh volume image-guided injections in patellar tendinopathy \nS.L. Morton, O. Chan, D. Morrissey, J. King, T. Crisp, N. Maffulli; London/UK \nPurpose: To quantify the effect of high volume image-guided injection (HVIGI) to \nmanage recalcitrant patellar tendinopathy (PT).\nMethods and Materials: 20 patients with proximal PT after failed conservative \nmanagement were recruited (mean symptom duration 19.8 months). 12 males \n(n=11) were followed retrospectively over 9 months; 8 males (n=8) were followed \nprospectively over 12 weeks. The diagnosis of PT was confirmed with ultrasound \nand power Doppler (average thickness of prospective subjects 10.3 mm, aver-\nage neovascularisation 3.8 on modified Ohberg scale). All subjects were injected \nunder real-time ultrasound guidance with 10 ml of 0.5% Marcaine mixed with 25 \nmg hydrocortisone followed by a mean of 30 ml normal saline at the interface \nbetween the PT and Hoffa’s body, adjacent to the area of neovascularisation. \nThe same supervised rehabilitation programme was followed by all patients. The \nVISA-P questionnaire was administered for pre-injection severity and at follow-up.\nResults: There was instant resolution of neovascularisation in all subjects. The \nVISA-P score statistically significantly improved from a mean of 45.5 to 64.0 for (p \n< 0.01), which is likely to be clinically significant. The retrospective data increased \nby 19.9 points compared to 16.4 in the prospective subjects followed over a shorter \ntime period. Over 60% of the prospective subjects agreed/strongly agreed that \ntheir symptoms/strength had improved, with over 33% returning to their required \nlevel of sport within 12 weeks.\nConclusion: High volume image-guided injections should be considered in the \nmanagement of recalcitrant chronic PT. Randomised controlled trials are needed \nto consolidate these findings.\nB‑0312 10:48\nBiomechanical properties of the calcaneal tendon in vivo assessed \nby transient shear wave elastography \nS. Aubry1, J.-R. Risson1, A. Kastler2, B. Barbier-Brion1, M. Runge1, B. Kastler1; \n1Besancon/FR, 2Clermont-Ferrand/FR (radio.aubry@free.fr) \nPurpose: To assess elastic and anisotropic properties of normal calcaneal tendon \nin vivo by transient shear wave elastography (SWE).\nMethods and Materials: This study was approved by Institutional Review Board, \nand written informed consent was obtained from all volunteers. Eighty healthy \nsubjects over 18 were prospectively included. Data on patients’ height, weight, \nsporting activities and take-off foot were assessed. The thickness, width and \ncross-sectional area of the calcaneal tendons were measured on axial grayscale \nultrasound. The shear wave propagation velocity (Vmean) was measured by three \nradiologists on axial and sagittal SWE images at four different degrees of ankle \nflexion, enabling to calculate elasticity modulus (Emean), and relative anisotropy \ncoefficient (A) values.\nResults: In complete plantar flexion, Vmean was 6.8±1.4m.s -1 and 5.1±0.8m.s-1, \nrespectively, on the sagittal and axial SWE image, resulting in an elastographic \nanisotropy A of 0.38±0.31. Emean was equal to 147.6±62.6kPa and 78.7±26.9kPa \non the sagittal and axial SWE image, respectively. Men and young people had \nsignificantly harder tendons. The best interobserver correlation coefficient of Emean \nand Vmean was 0.43 and 0.46, respectively, in the sagittal SWE for position 1. \nVmean and Emean significantly increase when the tendon is stretched by ankle \nB‑0308 11:42\nPercutaneous vertebroplasty in vertebra plana: does the presence of \nintravertebral cleft impact the efficiency of the procedure? \nL. Huwart1, P.-Y. Marcy1, P. Foti1, M.-E. Amoretti1, O. Hauger2, \nP. Brunner3, N. Amoretti1; 1Nice/FR, 2Bordeaux/FR, 3Monaco/MC \n(huwart.laurent@wanadoo.fr) \nPurpose: The purpose of this study was to assess if the presence of intravertebral \ncleft impact the efficiency of percutaneous vertebroplasty in 100 adult patients \nwith vertebra plana.\nMethods and Materials: 100 adult patients (28 men and 72 women; mean age: \n83 years) with vertebra plana were prospectively treated by CT- and fluoroscopy-\nguided percutaneous vertebroplasty under only local anaesthesia. A 13-gauge \n10-cm Trocar t’am (Thiebaud, France) was placed into the vertebral body with \nunilateral approach. Then polymethylmethacrylate was injected intra-vertebrally: \nif present, the intravertebral cleft should be filled. Follow-up was done using visual \nanalogue scale (VAS) for the severity of pain at day 1, 1 month, 6 months and 1 year.\nResults: Vertebra plana ranged from D6 to L4 with 82% at the thoracolumbar \njunction. In the group with cleft (n = 58/100 patients), VAS scores ± standard de-\nviations (SDs) were: preoperatively, 8.1 ± 1.5; at day 1, 1.3 ± 1.4; at 1 month, 1.2 \n± 1.2; at 6 months, 1.3 ± 1.4; and at 1 year, 1.6 ± 1.5. In the group without cleft (n \n= 42), VAS scores ± SDs were: 7.5 ± 1.2, 2.4 ± 2.1, 2.0 ± 1.8, 1.9 ± 1.6 and 2.0 ± \n1.7. The decrease between pre- and post-operative VAS values was significantly \nhigher in the group with cleft than without it (p < 0.05 in all cases).\nConclusion: Percutaneous vertebroplasty could be safe and effective in patients \nwith vertebra plana, with better results when intravertebral cleft was present.\nB‑0309 11:51\nPercutaneous ablation of spinal osteoid osteoma: report of 37 patients \nG. Tsoumakidou, J. Garnon, I. Enescu, X. Buy, A. Gangi; Strasbourg/FR \n(gtsoumakidou@yahoo.com) \nPurpose: To evaluate the efficacy and safety of percutaneous image-guided laser \nablation of spinal osteoid osteoma.\nMethods and Materials: From 1994 till December 2011, 37 patients (mean age: \n23 years, min: 5, max: 45) with spinal osteoid osteoma (mean nidus size: 8 mm) \nunderwent percutaneous laser ablation. Procedures were performed under spinal \nor general anaesthesia under combined CT and fluoroscopic guidance. Mean \ndistance from the closest nerve root was 7.5 mm (min: 1 mm, max: 40 mm). In \n22 patients, the nidus was close to a nerve root or the spinal cord (distance less \nthan 7 mm) and temperature monitoring and active cooling were necessary. An \naverage energy of 1260 J was delivered using an infrared diode laser generator, \nwith a 2-Watt continuous power.\nResults: Percutaneous laser ablation was technically feasible in all cases. Pri-\nmary clinical success (complete pain relief) was noted in all cases. Two patients \npresented a recurrence and were re-treated percutaneously successfully. No \nneurological complications were observed. Mean follow-up was 69 months (max: \n210 months, min: 2 months).\nConclusion: Percutaneous laser ablation of spinal osteoid osteoma can be \nachieved safely. Use of thermal insulation and temperature monitoring techniques \nis mandatory to protect the adjacent nervous structures. \n10:30 - 12:00 Room E1 \nMusculoskeletal \nSS 510 \nTendon, muscle and tissue composition \nModerators: \nJ. Healy; London/UK \nA. Mileto; Durham, NC/US \nB‑0310 10:30\nEfficacy of intra-tendinous injection of platelet-rich plasma to treat \ntendinosis: comprehensive assessment on a murine model \nB. Dallaudiere1, M. Lempicki1, L. Pesquer2, P. Meyer2, E. Schouman-Claeys1, \nJ.-M. Serfaty1; 1Paris/FR, 2Bordeaux/FR (bendallau64@hotmail.fr) \nPurpose: Tendinopathy shows early disorganized collagen fibres with neo-ang-\niogenesis on histology. Peri-tendinous injection of corticosteroid is the commonly \naccepted strategy despite the absence of inflammation in tendinosis. The aim of \nour study was to assess the potential of intratendinous injection of platelet-rich \n\nScientific Sessions\nS219\nA\n C D E F G\nB\nFriday\nB‑0315 11:15\nPostmortal 31P magnetic resonance spectroscopy of the skeletal \nmuscle: a-ATP/Pi ratio as a forensic tool? \nJ. Yamamura1, T.M. Schidt1, R. Fischer1, Z.J. Wang2, M. Lorenzen1; \n1Hamburg/DE, 2Dallas, TX/US \nPurpose: Phosphor magnetic resonance spectroscopy (31P MRS) is an established \nmethod for metabolic examinations of resting and exercising skeletal muscle. The \naim of this study was to investigate the temporal pattern of phosphor metabolites \nin the Adductor magnus muscle post mortem and to check the value of MRS as a \nforensic tool especially for the determination of the time of death.\nMethods and Materials: 21 corpses, died of natural cause, were examined \n(13 m, 8; age: 70.5 ±8.7y, weight 74±18 kg). A control group of 3 male subjects \n(mean: 38.7 ± 24.5 y, range: 24-67y, mean body weight: 81±17 kg) was examined \nat a single time point. 31P MRS was performed on a 1.5 T MRI (TR 700 ms, TE \n0.35 ms, averages 256, flip angle 90°). A standard 31P surface coil in the patient \ntable, placed under the thigh, was employed. To measure the concentration of the \nphosphor metabolites scans were repeated in intervals of one hour over a period \nfrom 2 to 24 h post mortem (p.m). The core temperature was rectally measured \nthroughout the MRI examination.\nResults: The mean core temperature decreased from 36.0 °C to 25.7 °C. In vivo \nand ex vivo spectra showed characteristically different metabolite concentrations. \na-ATP/Pi ratio decreased exponentially from 0.445 to 0.032 (r2=0.997, p < 0.001).\nConclusion: There is a characteristic postmortal time pattern of the phosphor \nmetabolites. Especially the a-ATP/Pi ratio could be useful as a forensic tool because \nof its significant exponential postmortal time course. \nB‑0316 11:24\nVisceral fat by DXA: current methods and potential clinical implications \nA. Bazzocchi, D. Diano, F. Ponti, A. Andreone, C. Sassi, U. Albisinni, G. Battista; \nBologna/IT (dani84.dd@libero.it) \nPurpose: Our aim was to investigate the potential impact of visceral fat assessment \nby DXA in the clinical management of patients submitted to different therapeutic \nprograms for obesity.\nMethods and Materials: We prospectively recruited 169 patients affected by \nobesity and submitted to medical and/or surgical treatment. Body mass index \n(BMI) and body composition were analyzed with anthropometric and whole-body \nDXA evaluations simultaneously performed at baseline and after one year. A new \nsoftware available to estimate android visceral fat was applied to last-generation \nDXA equipment.\nResults: Ninety-one patients ruled out the study. Among patients ending the \nfollow-up period (28-males, 50-females, 53.4±13.0-year-old, 40.5±9.1-Kg/m2) BMI \ndecreased in 69/78-88.5% controls, while regained in 9/78-11.5%. An opposite trend \nbetween BMI and total fat mass/non-bone lean mass (TFM/TLM), android ratio \n(AFM/ALM), and android visceral/subcutaneous fat (V/S) was found in 7/78-9.0%, \n11/78-14.1% and 31/78-39.7%, respectively. BMI was significantly correlated with \nTFM/TLM and AFM/ALM (r=0.717 and 0.713 respectively), while it was far from \na statistically significant connection with V/S (r=0.011, p=0.896). Although slightly \nbetter correlations were demonstrated between TFM/TLM (and AFM/ALM) and \nV/S, these were extremely low (r=0.146, p=0.061). The corresponding values for \nΔBMI and ΔDXA measures showed similar results.\nConclusion: The evolution of the most important metabolic markers of body \ncomposition is not predictable by the only BMI. Moreover, a wide range of variation \nis observed in relationships between DXA measures and BMI. Today, DXA has \nreached a new important frontier in the analysis of body composition, bridging the \nhistorical gap of visceral fat assessment. \nB‑0317 11:33\nPost-exercise intramyocellular acetylcarnitine levels in endurance \ntrained and sedentary subjects measured with 1H-MRS \nL. Lindeboom, B.M.W. Brouwers, T. van de Weijer, C.I.H.C. Nabuurs, M.E. Kooi, \nM.K.C. Hesselink, P. Schrauwen, J.E. Wildberger, V.B. Schrauwen-Hinderling; \nMaastricht/NL (eline.kooi@mumc.nl) \nPurpose: Long echo time acquisition strategies facilitate the determination of \nacetylcarnitine concentration in skeletal muscle in vivo with 1H-magnetic resonance \nspectroscopy (MRS). Rapid post-exercise normalisation of acetylcarnitine in the ex-\nercised muscle may be indicative of good tuning of substrate supply and use, as we \nexpect to find in endurance trained subjects. We therefore investigated the effect of \nacute exercise on acetylcarnitine concentrations in trained and sedentary subjects.\nMethods and Materials: Four endurance trained and four sedentary subjects \ncycled for 30 minutes at 50% of their predetermined Wmax. Acetylcarnitine con-\ndorsiflexion. The maximal values in sagittal SWE were Vmean=16.1±0.7m.s -1, \nEmean=779.5±57.1kPa and A =1.87±0.72.\nConclusion: SWE allows the elastic properties of the calcaneal tendon to be \nevaluated quantitatively in vivo, but interobserver reproducibility is questionable. \nIt confirms the tendinous elastographic anisotropy and stiffness augmentation of \nstretched tendon, although age and sex may influence these properties.\nB‑0313 10:57\nMuscle elastography in patients affected by multiple sclerosis \nG. Illomei, G. Spinicci, M. Arru, M. Marrosu; Cagliari/IT \n(giovanni.illomei@radiologiadelcorso.it) \nPurpose: The purpose of the study was to investigate the use of real time elas-\ntography in evaluating the muscle stiffness comparing to Ashworth scale. The aim \nof the study is to create an elastography score for MS patients.\nMethods and Materials: We investigated 101 MS patients, 61 women and 40 \nmen. Disability score assessed by Expanded Disability Status Score of Kurtzke \nscale ranged from 0 and 8.5 with a mean value of 3.5. In all patients a neurological \nexamination was performed and referred to Ashworth scale score by a neurolo-\ngist. All patients underwent real time elastography on Esaote my Lab Twice with \ntransducer with a high frequency probe 4-13 MHz. The muscles examined were \nquadriceps of both legs. The study was a double-blinded one, and it was approved \nby local Ethic Committee.\nResults: There was full concordance between the Ashworth scale evaluation \nand elastography score. However, patients classified as score 0 in the Ashworth \nscale can be spitted in 0a (total normality of muscle fibers elasticity) and 0b (initial \ncompromising of muscle fibers elasticity). The main result of the study was the \ncreation of an elastography score of muscle stiffness in MS patients that can be \ncompared with Ashworth scale.\nConclusion: Ashworth scale is at present the only method to evaluate muscle stiff-\nness in MS patients. Our study demonstrated for the first time that it is possible to \nhave an imaging method to assess this clinical examination giving new possibilities \nto follow the evolving of the disease in these patients. \nB‑0314 11:06\nDixon-based MRI for assessment of muscle-fat content in-vitro and \nin patients with achillodynia in comparison to healthy volunteers \nM.A.F. Fischer, C.W.A. Pfirrmann, N. Espinosa, D.A. Raptis, F.M. Buck; \nZurich/CH (michaelalexander.fischer@usz.ch) \nPurpose: To prospectively evaluate dual gradient-echo MRI with dixon-based \ngeneration of fat-/water-images (MRIDIXON) for quantification of the muscle-fat \ncontent (MFC) in-vitro and in patients with achillodynia compared to asymptomatic \nvolunteers.\nMethods and Materials: MRIDIXON was used to measure the MFC of 15 phan-\ntoms containing titrated mixtures of organic muscle/fat from 0-100% as well as of \nthe gastrocnemius (DixonGASTRO) and tibialis anterior (DixonTIBIALIS) muscles \nin 30 patients (13 women; mean age, 57±15 years) with achillodynia and in 20 \nmatched asymptomatic volunteers (10 women; mean age, 30±14 years) at 1.5 T. \nAccuracy of MRIDIXON in quantification of MFC was assessed in-vitro as well as \nin-vivo using single-voxel MR-spectroscopy (MRS) as the standard of reference. \nDixonGASTRO and DixonTIBIALIS were related to visual grading of the MFC \n(grades 0-4) in both muscles (VisualGASTRO and VisualTIBIALIS).\nResults: Correlation of MFC derived from MRIDIXON, phantoms and MRS was \nexcellent with correlation coefficient (R2) ranging from 0.93 to 0.99 and mean meas-\nurement bias ranging from -0.1 to +0.8%. Mean DixonGASTRO/DixonTIBIALIS \nwas 7.0±4.7/4.9±2.3 in patients and 3.6±0.7/3.6±0.5 in volunteers. VisualGASTRO/\nVisualTIBIALIS ranged from 0 to 2/0 to 3 and 0 to 1/0 to 1, respectively. No significant \ndifference was seen for DixonTIBIALIS between patients and volunteers (p=.07), \nwhereas DixonGASTRO was significantly higher in patients (p <.01). Both, Visual-\nGASTRO and VisualTIBIALIS did not differ in patients and volunteers (all, p>.05).\nConclusion: MRIDIXON allows for accurate quantification of MFC and demon-\nstrates a significantly higher fat content in the gastrocnemius muscle in patients \nsuffering of achillodynia than in asymptomatic volunteers, outer performing visual \nassessment of MFC. \n\nScientific Sessions\nS220\n C A D E F\n G\nB\nand disappeared after more than 12 months. The unloading-findings were more \nsevere at the patella and femur than at the tibia (p < 0.001). High scores of sever-\nity were associated with confluent and patchy patterns (SCR=0.923, p < 0.01 and \nKT= 0.877 p < 0.01).\nConclusion: Bone marrow changes at the knee related to disuse are most promi-\nnent 2-6 months following unloading when both patchy and confluent hyperintense \npatterns are present. Manifestations of unloading are most prevalent within the \npatella and the femur and associated with increased vascularity. \n10:30 - 12:00 Room F1 \nOncologic Imaging \nSS 516 \nCutting edge imaging in oncology: when and how? \nModerators: \nK. Coenegrachts;  Bruges/BE \nE.J. Rummeny; Munich/DE \nB‑0320 10:30\nVirtual 3D 18 F-FDG PET/CT panendoscopy for assessing the upper \nairways of head and neck cancer patients: initial results \nP. Heusch1, C. Buchbender1, B. Geiger2, J. Treffert3, T. Lauenstein4, \nM. Forsting4, G. Antoch1, T.A. Heusner1; 1Düsseldorf/DE, 2Princeton, NJ/US, \n3Knoxville, TN/US, 4Essen/DE (philipp.heusch@med.uni-duesseldorf.de) \nPurpose: To evaluate whether a virtual 3D 18 F-FDG PET/CT panendoscopy is \ntechnically feasible and can be used for a non-invasive visualisation of the upper \nairways and pharyngeal and laryngeal malignancies.\nMethods and Materials: From whole body 18 F-FDG PET/CT datasets includ-\ning a dedicated head and neck investigation protocol of 40 consecutive patients \n(mean age: 61 ± 9 years) with histopathologically proven pharyngeal and laryngeal \nmalignancies virtual 3D 18 F-FDG PET/CT panendoscopies were reconstructed \nusing an investigational software application. The feasibility to completely assess \nspecific spaces of the upper airways by a virtual \"fly-through\" and to detect primary \ntumours was tested; the time for an automated segmentation of the virtual 18 F-\nFDG PET/CT panendoscopies was measured.\nResults: The nasopharynx, oropharynx, laryngopharynx, epiglottis, subglottis and \nthe tracheobronchial tree were accessible in all 40, the laryngopharynx, aryepiglot-\ntical folds, piriform sinus, glottis, and oral cavity in 37, 37, 37, 33 and 16 patients, \nrespectively. In all 12 patients with restricted fiberoptical evaluation due to a primarily \nintubation the subglottical space was entirely accessible via virtual panendoscopy. \nThe primary tumour was depicted in 36/40 patients (90%). The mean processing \ntime for virtual 18 F-FDG PET/CT panendoscopies was 145 ± 98s.\nConclusion: Virtual 18 F-FDG PET/CT panendoscopy of the upper airways is \ntechnically feasible and can detect pharyngeal and laryngeal malignancies. The tool \nallows for a complete evaluation of the subglottical space when optical panendos-\ncopy is incomplete due to intubation. It may be used for planning endoscopy-guided \nbiopsies and surgery in the future.\nB‑0321 10:39\n18 F-FLT- PET in the diagnosis of gastric cancer \nT. Staniuk1, M. Studniarek2, W. Zegarski1, E. Srutek1, B. Malkowski1; \n1Bydgoszcz/PL, 2Bojano/PL (mstud@gumed.edu.pl) \nPurpose: The aim of the study was to evaluate the usefulness of 18 F-FLT PET/\nCT in the detection and differentiation of gastric cancer.\nMethods and Materials: 94 consecutive patients with newly diagnosed advanced \ngastric cancer were examined with FLT PET. For quantitative and comparative \nanalysis, the maximal standardised uptake value (SUVmax) was calculated for \nthe tumours and not invaded gastric wall. On the basis of pathological assessment \nof removed specimen the tumours were divided into 4 groups: adenocarcinoma \ntubulare (G2 and G3), mucinous adenocarcinoma, undifferentiated carcinoma and \nadenocarcinoma tubulare p. mucocellulare. This is not purely WHO classification, \nit is applied in our oncology center.\nResults: For each of the four types of gastric cancer (N cases) the minimal, \nmaximal and mean value of SUVmax (SD) was found: adenocarcinoma tubulare \n(57), SUVmax 1.5-23.1 (7.46±4.57), mucinous adenocarcinoma (17), SUVmax \n2.3-10.3 (5.5±2.4)*, undifferentiated carcinoma (6), SUVmax 3.1-13.6 (7.28±3.25), \nadenocarcinoma tubular p. mucocellulare (14), SUVmax 2-25.3 (7.7±6.99) and \nnormal gastric wall (22), SUVmax 1.01-2.55 (1.84±0.35). It significantly differs from \nAdenoCa tubular and normal gastric wall and from all types of tumour. All gastric \ncentrations were determined dynamically before and after exercise using a whole \nbody MRI-system (Achieva, 3 T, Philips Healthcare). Point-RESolved spectroscopy \n(PRESS) was used to acquire spectra from a voxel in the M. vastus lateralis. The \ntotal creatine (t-Cr) peak was used as internal reference. Post-exercise acquisition \nof spectra started approximately 15 minutes after cycling.\nResults: Exercise-induced elevations of acetylcarnitine levels were similar in both \ngroups (Δpost-pre 3.1±1.9 mmol/kg wet weight (ww)). However, post-exercise \nacetylcarnitine kinetics were significantly different (p < 0.05). In sedentary subjects, \nthe concentration continued to increase during recovery towards a plateau at 40 \nminutes (8.5±0.3 mmol/kgww). In contrast, the acetylcarnitine concentration started \nto decrease from 5.8±0.5 mmol/kgww at 20 minutes after exercise in the trained \nsubjects towards 4.4±1.0 mmol/kgww at 40 minutes.\nConclusion: We demonstrate the dynamic character of acetylcarnitine in a situ-\nation of changing substrate demand/supply. The current protocol can differentiate \nbetween two metabolically different groups, which opens a window towards inves-\ntigation of acetylcarnitine in relation to metabolic flexibility and insulin resistance.\nB‑0318 11:42\nIn vivo differentiation of muscle precursor cells using MR relaxometry \nN.C. Chuck, F. Azzabi Zouraq, D. Eberli, A. Boss; Zurich/CH \n(natalie.chuck@usz.ch) \nPurpose: To assess the differentiation process of muscle precursor cells (MPCs) \napplying magnetic-resonance-imaging (MRI) relaxometry and diffusion measure-\nments in a mouse model in correlation with histology, immunohistochemistry and \norgan bath.\nMethods and Materials: Human MPCs were isolated from biopsies of the M.rectus \nabdominis. The MPCs were mixed with a collagen carrier and injected subcutane-\nously in nude mice. Animals with collagen-only-injections served as controls. MRI \nwas conducted on a 4.7T small-animal-scanner (Bruker BioSpec) at 5 time points \nbetween day 3 and 21 post-injection. Relaxometry measurements comprised T1 \nand T2 measurements using multi-echo-spin-echo (TE 11-99 ms) and saturation-\nrecovery-sequences (recovery time 118-4000 ms) and T2* quantification with a \nmulti-echo-gradient-echo-sequence (TE1 = 4.5 ms, ΔTE = 7 ms, 12 echoes). \nDiffusion imaging was performed with a spin-echo-sequence including diffusion \ngradients with b=0.400 and 800s/mm 2. Relaxation times and ADC values were \nmeasured in the skeletal muscles. Evaluations were performed with custom-made \nMatlab scripts. Animals were harvested after 28 days and the engineered muscle \ntissue was assessed by histology, organ-bath and immunofluorescence.\nResults: Relaxation and diffusion properties of the engineered tissue could reliably \nbe measured at all time points. Relaxometry measurements revealed a decrease \nof T1, T2 and T2* relaxation-time during differentiation (initial measurement: T1 \n2242.6 ms±116, T2:224.3 ms±66, T2*:33.5 ms±4; final measurement: T1:1386.64 \nms±88, T2:31.9 ms±4, T2*:10.8 ms±0.8), thereby approaching the physiological \nrelaxation properties of muscular tissue. ADC showed a decrease from 2.24 mm2/\ns±0.26 to 1.51 mm2/s±0.05. Cell differentiation and myofibre formation was con-\nfirmed by histology, immunohistochemistry and contractility confirmed by organ bath.\nConclusion: We demonstrated that MRI relaxometry measurements are able \nto describe the differentiation of muscle precursor cells. This method might offer \nthe possibility to non-invasively assess the effectiveness of cellular therapies for \nmuscular disorders in near future. \nB‑0319 11:51\nMRI findings of the bone marrow related to unloading with \nlongitudinal follow-up \nL. Nardo1, D. Sandman1, W. Virayavanich1, S. Lee1, A. Lai1, L. Zhang2, \nR. Souza1, M. Guindani2, T. Link1; 1San Francisco, CA/US, 2Houston, TX/US \n(lorenzo.nardo@ucsf.edu) \nPurpose: To longitudinally evaluate bone marrow changes on MRI related to \nunloading in patients with 3-to-6 weeks of lower extremity unloading.\nMethods and Materials: 112 MRI knee examinations in 30 patients (14 men, 16 \nwomen, aged 20-53 years) were performed following 3-6 weeks of ipsilateral lower \nextremity unloading related to knee or ankle injury. All patients had MRI studies \nbefore the unloading period and consecutive MRI follow-up studies 1.5-2 months, \n2-6 months, 6-12 months and > 12 months after unloading. Bone marrow signal \nabnormalities were analysed by 3 radiologists on T2 FSE sequences and scored \naccording to (i) severity of signal abnormalities, (ii) morphology and (iii) increased \nvascularity in the knee joint. In addition to Mcnemar's test, Spearman rank correla-\ntion test (SRC) and Kendall's tau (KT) comparing individual scores were calculated.\nResults: All 30 patients presented abnormal bone marrow findings after unload-\ning which were characterised by increasing severity and vascularity with a peak \nat 2-6 months (p < 0.001). These findings decreased within one year (p < 0.001) \n\nScientific Sessions\nS221\nA\n C D E F G\nB\nFriday\nCR and RD (mADC 1.20±0.07x10-³ mm²/s vs 1.17±0.06x10-³ mm²/s; P> 1) were \nobserved. All CR had local inflammation at histology.\nConclusion: ADC is early indicator of tumour response in patients with advanced \ncervical cancer. \nB‑0324 11:06\nThe value of DWI in differentiating ocular tumours from retinal detachment \nK. Erb, G. Willerding, M. Taupitz, B. Hamm, P. Asbach; \nBerlin/DE (katharina.erb@charite.de) \nPurpose: Most patients with an ocular tumour present with retinal detachment. \nIt can be difficult to distinguish ocular tumours from retinal detachment with non-\ncontrast and contrast-enhanced T1- and T2-weighted sequences due to retinal \neffusion. In this study, we hypothesize that DWI can help to differentiate ocular \nmelanoma from retinal detachment.\nMethods and Materials: Thirty patients with ocular melanoma were prospectively \ninvestigated with ocular MRI including DWI in this IRB approved study. On the \nDWI of different b values (b = 0, 1000 mm²/sec) a ROI was placed into the ocular \ntumour and another ROI into the retinal detachment. ADC values of the ROIs \nwere calculated.\nResults: Twenty-three patients (61%) had retinal detachment. The mean ADC in \nocular melanoma (922 x 10-6 mm²/sec) differs significantly from the mean ADC in \nretinal detachment (2035 x 10-6 mm²/sec).\nConclusion: DWI helps significantly to delineate ocular melanoma from retinal \ndetachment. Therefore, we recommend including DWI in ocular MRI if an ocular \ntumour is suspected. \nB‑0325 11:15\nDosimetric impact of MR vs CT delineation of boost volume in breast \ncancer \nM. Betti, L. Orlandini, C. Biagini, M. de Liguoro, F. Mungai, L. Natale, L. Cionini; \nSesto Fiorentino/IT (margherita.betti@lacittadellasalute.it) \nPurpose: Postoperative radiotherapy after conservative surgery in breast cancer \nusually includes focal over irradiation (boost) to the surgical bed (SB). Localisation \nof SB with CT results is difficult in several cases due to insufficient intrinsic con-\ntrast between soft tissues provided by this imaging modality. To prevent marginal \nmisses large boost volume are delineated, resulting in an increase of dose to \nnormal tissue. MR imaging provides superior soft tissue contrast and the potential \nto better differentiate between normal tissue and SB. The purpose of this study \nis to evaluate how MR imaging contouring dosimetrically affect the radiotherapy \ntreatment, compared to CT.\nMethods and Materials: 12 boost volumes were drawn on CT and on MR images, \nelastically co-registered with MiradaRtx System. RT treatment plan was optimised \nfor standard and hypofractionated schedules, using CT volumes as baseline. The \ntarget volume dose distribution on CT and MR were compared and dose volume \nhistograms (DVHs) cutoff point V98% (volume covered by 98% of prescription \ndose) was used at this purpose.\nResults: The volumes of the SB varied considerably from CT to MR (concordance \nindex between 0.36 and 0.68). The dosimetrical difference between MR and CT \nboost dose in terms of V98% ranged between 10% and 30% for both standard \nand hypo-fractionated plans. The analysis revealed smaller differences in V98% \nwhen boost volumes were delineated on MR image.\nConclusion: MR imaging to delineate SB volume may add to the accuracy in \ndelivering boost dose. \nB‑0326 11:24\nPET/MR vs PET/CT in lung cancer N staging: initial experience with a \nthree-segment model attenuation correction \nA. Kohan, C. Rubbert, J.L. Vercher Conejero, S. Partovi, R. Jones, K. Herrmann, \nP. Faulhaber; Cleveland, OH/US (aak107@case.edu) \nPurpose: Current attenuation correction (AC) methods for PET/MRI include a \nT1-weighted imaging and segmentation model accounting for air, soft tissue and \nlung (3-segment model) and a Dixon 5 segment model of air, lung, bone, soft tis-\nsue and fat. Staging of lung cancer with PET/MRI may be challenging since both \nprimary tumour and adenopathies occur at tissue interfaces between soft tissue \nand lung. Particularly, N-staging may be affected by errors in segmentation. The \npurpose of this study was to assess the accuracy of PET/MRI in determining nodal \nstage in lung cancer patients.\nMethods and Materials: Eleven patients with suspected or known lung cancer \nwere enrolled in our IRB-approved protocol to undergo both PET/MR and PET/CT \nfor (re)staging of lung cancer at the same time point. Data of both examinations \ncancer types showed higher accumulation of FLT than non infiltrated gastric wall as \nmeasured by SUVmax. Only tumours with relatively low cellular density (mucinous \ntype) accumulated FLT significantly less than other ones.\nConclusion: This cancer type has different clinical cours and a different way of \ndissemination, so we conclude that FLT PET can be useful in predicting prognosis, \nplanning treatment and monitoring response in patients with gastric cancer. \nB‑0322 10:48\nFirst clinical experience in restaging of patients with recurrent \nprostate cancer by 11C-choline-PET/MR: comprehensive diagnostic \nMR protocol and comparison with 11C-choline-PET/CT \nM. Eiber, M. Souvatzoglou, E.J. Rummeny, M. Schwaiger, A.J. Beer; \nMunich/DE (matthias.eiber@tum.de) \nPurpose: Whole body integrated PET/MR might provide an alternative imaging \ntool to 11C-choline-PET/CT for restaging prostate cancer.\nMethods and Materials: 34 patients underwent a single injection/dual imaging \nprotocol on a PET/CT scanner (5 min pi) and a subsequent PET/MR scan (Sie-\nmens Biograph mMR; Ø47 min pi). PET/MR were performed in 3-4 bed positions \nincluding simultaneous MR acquisition of a coronal Dixon-T1w-VIBE for attenuation \ncorrection, a coronal T1w-SE and a axial fat-sat T2w-haste-sequence. During an \nadditional PET scan over the pelvis axial/coronal T2w, axial DWI (b values: 0, 400, \n800s/mm2) and axial T1w-TWIST-DCE-sequences were acquired. Finally, the whole \nbody was covered with axial contrast-enhanced fat-saturated T1w-GRE sequences. \nPET/MR and PET/CT were read independently and all suspicious lesions (local \nrecurrence, lymph node and bone metastases) were rated on a three-point-scale \n(1: definitely a metastasis, 2: probably a metastasis, 3: indeterminate).\nResults: Despite a considerable longer imaging time for 11C-choline-PET/MR (Ø42 \nmin) compared to PET/CT (Ø21 min) the protocol was well tolerated by all patients. \nDetection rate for local recurrence was substantially higher and more conclusive \nfor PET/MR which detected 18 regions in 12 patients (rating 1.215) compared to \nPET/CT with 12 regions in 8 patients (rating 1.325). For lymph node metastases a \nnearly similar performance was found with 52 and 55 regions, respectively (rating \n1.180 and 1.637). PET/MR detected bone metastases in 17 regions in 5 patients \n(rating 1.183), whereas PET/CT found 14 regions in 4 patients (rating 1.045). PET/\nMR was able to demonstrate choline-negative non-sclerotic bone metastases in \ntwo patients which were not identified by PET/CT.\nConclusion: These data indicate that 11C-choline-PET/MR is diagnostic feasible \nfor restaging of prostate cancer with potential higher detection rates for local recur-\nrence and bone metastases. \nAuthor Disclosures:\nM. Eiber: Speaker; Siemens AG. E.J. Rummeny: Grant Recipient; Philips. \nM. Schwaiger: Research/Grant Support; DFG, EU. Speaker; Siemens AG. \nA.J. Beer: Grant Recipient; DFG. Speaker; Siemens AG.\nB‑0323 10:57\nApparent diffusion coefficient for evaluating early tumour response \nto neoadjuvant chemo-radiotherapy in locally advanced cervical \ncancer: correlation with histopathology. Preliminary results \nM. Miccò, A.L. Valentini, B. Gui, A.M. De Gaetano, M. Iacobucci, L. Bonomo; \nRome/IT (marta.iacobucci@gmail.com) \nPurpose: To evaluate diagnostic accuracy of diffusion-weighted magnetic reso-\nnance imaging (DWI) in predicting response to neo-adjuvant chemo-radiotherapy \n(nCRT) in patients with locally advanced cervical carcinoma using apparent dif-\nfusion coefficient (ADC). Cervical lesions ADC were correlated with post-surgical \nhistopathology.\nMethods and Materials: 24 women (FIGO>IB Bulky) underwent MRI and DWI \nprior to, after 2 weeks and at the end of nCRT, using 1.5 T scanner. Cervical le-\nsion volume and ADC were measured at each assessment. Radical hysterectomy \nwas performed 4 weeks after MRI. Treatment response was determined based on \nhistopathology and was classified as complete response (CR), residual (RD) or \nstable disease (SD). Mean ADCs (mADC), ADC increase and volume reduction \n(VR) rates were compared using histopathology as reference standard\nResults: According to histology, 13/24 (54%) had CR, 11/24 (46%) had RD < 1 \ncm. 2 patients presented SD. Before therapy, in the study population mADC was \n0.96±0.06x10-³ mm²/s but it was lower in SD (0.76±0.1x10-³ mm²/s). After 2 weeks \nof nCRT, mADC correlated with tumour response: a) in CR with 23% percent \nchange (1.20±0.02x10-³ mm²/s vs 0.98±0.06x10-³ mm²/s; P < 0.001); b) in RD \nwith 10% percent change (1.05±0.02x10-³ mm²/s vs 0.93±0.06x10-³ mm²/s; P < \n0.001). Tumour volume decreased in CR and RD with reduction rate of 48% and \n46%, respectively. At the end of CRT, no significant differences on ADC between \n\nScientific Sessions\nS222\n C A D E F\n G\nB\n(521/698), significantly higher using AVCB and MPRs (P <.001). The average \nreading time decreased from 85 to 43 seconds (P <.001).\nConclusion: Advanced visualisation of cancellous bone significantly increases the \nability to detect bone metastases and reduces the time for diagnosis. \nAuthor Disclosures:\nD.F. Toth: Patent Holder. H. Ringl: Patent Holder.\nB‑0329 11:51\nComparison of the utility of whole body MRI with and without \ncontrast-enhanced quick 3D and double RF fat suppression \ntechniques, conventional whole body MRI, PET/CT and conventional \nexamination for assessment of recurrence in NSCLC patients \nY. Ohno1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nS. Satou2, K. Sugimura1; 1Kobe/JP, 2Ohtawara/JP (yosirad@kobe-u.ac.jp) \nPurpose: To compare diagnostic capabilities for the assessment of recurrence in \nnon-small cell lung cancer (NSCLC) patients by contrast-enhanced whole body \nMRI (CE-WB-MRI) with and without CE-Quick 3D and double RF fat suppression \ntechnique (DFS), FDG-PET/CT and conventional radiological examinations.\nMethods and Materials: A total of 134 pathologically proven and completely \nresected NSCLC patients (78 males, 56 females; mean age: 72 years) underwent \nFDG-PET/CT, CE-WB-MRI with and without Quick 3D and DFS at 3 T as well as \nconventional radiological examinations. The probability of recurrence was as-\nsessed with a 5-point scoring system on a per-patient basis, and final diagnosis \nwas made by consensus between two readers. The capability for overall recurrence \nassessment by all the methods was compared by means of ROC analysis and their \nsensitivity, specificity and accuracy by means of McNemar’s test.\nResults: Although areas under the curve did not show any significant differences, \nspecificity (100%) and accuracy (95.5%) of CE-WB-MRI with CE-Quick 3D and DFS \nwere significantly higher than those of FDG-PET/CT (specificity: 93.6%, p=0.02; \naccuracy: 89.6%, p=0.01) and conventional radiological examinations (specificity: \n92.7%, p=0.01; accuracy: 91.0%, p=0.03). In addition, specificity of CE-WB-MRI \nwithout CE-Quick 3D and DFS (100%) was significantly higher than that of FDG-\nPET/CT (p=0.02) and conventional radiological examinations (p=0.01).\nConclusion: Specificity and accuracy of CE-WB-MRI with CE-Quick 3D and DFS \nfor assessment of recurrence in NSCLC patients are at least as high as, or higher \nthan those of others.\nAuthor Disclosures:\nY. Ohno: Research/Grant Support; Toshiba Medical Systems. M. Nishio: \nResearch/Grant Support; Toshiba Medical Systems. T. Yoshikawa: Research/\nGrant Support; Toshiba Medical Systems. S. Matsumoto: Research/Grant \nSupport; Toshiba Medical Systems. S. Satou: Employee; Toshiba Medical \nSystems. \n10:30 - 12:00 Room F2 \nBreast \nSS 502 \nElastography and other advances in breast \nultrasound \nModerators: \nD. Djilas-Ivanovic;  Sremska Kamenica/RS \nP. Skaane; Oslo/NO \nB‑0330 10:30\nQuantitative shear wave elastography: evaluating an additional use \nwith conventional ultrasound in diagnosis of breast lesions \nJ. Moon, K.-S. Jung, S. Koh, J.-Y. Jung; Anyang-si/KR (geenie-m@hanmail.net) \nPurpose: We assessed whether the additional use of quantitative shear wave \nelastography (QSWE) would improve diagnostic accuracy of conventional ultra-\nsound (US).\nMethods and Materials: Two experienced radiologists performed conventional US \nand QSWE of 115 patients with 133 lesions. BI-RADS categories were assessed \nand quantitative lesion elasticity was measured in terms of Young’s modulus \n(kPa) for each lesion. Pathologic results were reference standard. We compared \ndiagnostic accuracy of conventional US and US with QSWE, including sensitivity, \nspecificity and area under the curve (AUC) using a receiver operating character-\nistic (ROC) curve analysis. In addition, we prospectively investigated two values, \nwere randomised and analysed by four blinded readers independently (2 radiolo-\ngists; 2 nuclear physicians; 4, 15, 6 and 12 yrs of experience). JACC guidelines \nwere applied to determine N stage. Kappa statistics were performed to compare \nobserver performance for PET/CT and PET/MRI, respectively.\nResults: For the N staging in PET/CT, inter-observer agreement was almost perfect \nwith a kappa of 0.86. Inter-observer agreement with PET/MRI was still substantial \nyielding a kappa of 0.70.\nConclusion: Despite our small study population, PET/MR with a three-segment \nmodel AC showed promising results with a substantial inter-reader agreement for \nN staging only slightly inferior to PET/CT. Interpretation of PET/MRI might still be \nsubject to a learning curve and optimisation of AC methods. \nAuthor Disclosures:\nA. Kohan: Research/Grant Support; Philips Healthcare. C. Rubbert: Research/\nGrant Support; Philips Healthcare. J.L. Vercher Conejero: Research/\nGrant Support; Philips Healthcare. S. Partovi: Research/Grant Support; \nPhilips Healthcare. R. Jones: Research/Grant Support; Philips Healthcare. \nK. Herrmann: Research/Grant Support; Philips Healthcare. P. Faulhaber: \nResearch/Grant Support; Philips Healthcare.\nB‑0327 11:33\nIncidental findings in the general adult population using whole body \nMRI as a screening method \nS. Ulus, E. Karaarslan; Istanbul/TR (silaulus@hotmail.com) \nPurpose: Whole body MRI (WB-MRI) is a safe and reliable imaging method and \nis recommended as an advanced check-up procedure. The aim of this study is to \ndescribe the technique and to evaluate incidental findings in asymptomatic adult \npopulation.\nMethods and Materials: Between March 2008 and December 2011, 118 consecu-\ntive subjects (71 males, 47 females, mean age 47.4) undergoing thorough check-up \nwere prospectively included in the study. MRI was performed with Siemens Mag-\nnetomAvanto (SQ engine, 45 mT/sec) with 205 cm moving table, parallel imaging \nand automatic image composing software. Statistical analysis was performed \nwith NCSS. For comparison of quality data, Chi-square and odds ratio were used.\nResults: In 80 subjects (67%), 114 benign (63.5%) and 6 malign (3.5%) lesions \nwere detected. Six subjects underwent operation (5%) for adrenal carcinoma, renal \ncarcinoma, pancreatic mucinous cystadenoma, intradural schwannoma (2), and \nenchondroma of the femur. In one subject, tuberculosis pneumonia was detected \nand medical treatment was given. In 3 subjects focal nodular hyperplasia of the \nliver, and in one an unclassified solid mass in spleen were encountered and they \nare in follow -up. The most common incidental lesions were liver cyst (12), liver \nhaemangioma (9), renal cyst (13), and thyroid nodule (6). No significant difference \nwas observed for the incidence of benign and malign lesions between subjects \naged ³40 years and < 40 years (p=0.209 and p=0.898, respectively).\nConclusion: 7% of the population screened by WB-MRI underwent further surgical \nand medical treatment. WB-MRI is a useful and non-invasive tool for the detection \nof incidental lesions in asymptomatic subjects.\nB‑0328 11:42\nBone metastasis at a glance: a new advanced visualisation algorithm \nfor fast and easy detection in thoracoabdominal CT \nD.F. Toth, M. Toepker, M.E. Mayerhoefer, J. Furtner, U. Asenbaum, G. Karanikas, \nM. Weber, C. Czerny, H. Ringl; Vienna/AT (daniel.toth@meduniwien.ac.at) \nPurpose: To retrospectively assess the detection rate of bone metastases in \nthoracoabdominal CT achieved by the combined reading of advanced visualisa-\ntion of cancellous bone (AVCB) and multiplanar reformats (MPRs) compared with \nreading MPRs only.\nMethods and Materials: The study was approved by the local Institutional Review \nBoard. 156 consecutive patients with confirmed cancer that received a whole body \nPET/CT examination for clinical purposes were included (n=156; 93 male and 63 \nfemale patients; mean age, 59.8y ± 14.9; range, 11-85y). The CT scan of these \nexaminations was subjected to the AVCB algorithm that segmented the bones, \nremoved the cortical layer, and allowed a free view on the cancellous bone. The \nPET images served as part of the reference standard only. 15 patients were used \nas a training set. Four radiologists independently evaluated the remaining patients \nby reporting half of the patients using AVCB and MPRs together, and the other half \nusing MPRs only. Radiologists were blinded to patient names and patient order \nwas randomised. Results were compared to a standard of reference created by \none senior radiologists and one nuclear medicine specialist. Logistic regression \nwas used for statistical analysis.\nResults: 349 lesions were found in 103 patients, with 203 classified as malignant. \nThe detection rate for all bone lesions was 35% (247/698) for MPRs and, at 74% \n\nScientific Sessions\nS223\nA\n C D E F G\nB\nFriday\nB‑0334 10:57\nInfluence of menopause in women on breast elasticity measured by \nelasticity parameters with sonoelastography \nX. Wang, Y. Wang, P. Xu; Shanghai/CN (wangxiaohong426@yahoo.com.cn) \nPurpose: To assess the value of elasticity parameters on breast sonoelastography \nby influence of menopause factor.\nMethods and Materials: 286 female patients (premenopausal vs postmenopau-\nsal: 192 vs 108) with 300 breast lesions were conducted routine ultrasound and \nelastographic ultrasound preoperatively. The elastic parameters of strain ratio (SR, \nSR1 was calculated using the same-level and normal-appearing breast region as \nreference; SR2 was calculated using the subcutaneous fat as reference) were then \nobtained, with the pathologic diagnosis served as golden standard. The sensitivity, \nspecificity, and area under the curve were analysed by receiver operating charac-\nteristic (ROC) curve with or without the influence of menopause factor.\nResults: Histopathology revealed 180 malignant and 120 benign lesions. Without \nthe factor of menopause, SR1 and SR2 exhibited moderate diagnostic performance \n(area under the curve, 0.803 vs 0.782). When the modified SR1 cutoff points of \n2.35 and 2.52 were used in the groups of premenopausal and postmenopausal, \nrespectively, the sensitivity, specificity and accuracy were remarkably improved \n(79.2%, 92%, 85.7% vs 64.2%, 81.4%, 77.3%, p  <  0.05). No statistical differ-\nences were found in the diagnostic value of SR2 with or without the influence of \nmenopause factor (sensitivity, specificity and accuracy: 59.2%, 77.8%, 70.3% vs \n70%, 73.9%, 72.7%).\nConclusion: Menopause has an important influence on breast elasticity measured \nby elasticity parameters, especially in SR1. Taking this factor into consideration \nmay help to improve the diagnostic performance of breast sonoelastography in a \nmore comprehensive way.\nB‑0335 11:06\nStiffness measured by Shear Wave elastography: a biomarker of the \nearly chemotherapy response in a human breast cancer model? \nF. Chamming’s, M. Le Frère-Belda, v. Fitoussi, L. Pidial, H. Latorre-Ossa, \nJ.-L. Gennisson, O. Clément, C.-A. Cuenod, L.S. Fournier; Paris/FR \n(foucauld.chammings@egp.aphp.fr) \nPurpose: To assess if stiffness as measured by shear-wave elastography (SWE), \ncould be an early biomarker of response to chemotherapy in a breast cancer model.\nMethods and Materials: A human invasive ductal carcinoma was implanted sub-\ncutaneously in 10 athymic female mice. After 8 weeks of growth, 2 tumours were \nremoved for baseline pathological analysis and 8 were treated by oral chemotherapy \nduring 5 weeks. Ultrasound was performed every week before and during treatment, \nusing a superficial 8-MHz probe. Maximum diameter and mean elasticity value of \nthe tumor were measured. Kinetics of changes in diameter and elasticity before \nand under treatment were calculated as the slope of diameter or elasticity over \ntime. At the end of the treatment, tumours were removed for pathological analysis.\nResults: Before treatment, we observed a progressive stiffness increase along \ntumour growth (slope: 8.8 kPa/week). Under chemotherapy, we observed an \nearly stabilisation of tumour stiffness (slope: -0.8 kPa per week). Furthermore, a \nsignificant decrease of elasticity values was seen after four weeks of treatment \n(p=0.03). We also observed an early progressive decrease of diameter showing \nthat there was a good response to treatment. After five weeks of treatment, we \nobserved modifications of the pathological features of the tumor, i.e. mainly a \ndecrease of cellular density.\nConclusion: In our model, we observed an early stabilisation of tumour elasticity \nwith an inversion of elasticity slope under treatment showing that SWE could be \nan interesting tool to assess early tumor response to chemotherapy. \nAuthor Disclosures:\nF. Chamming’s: Grant Recipient; Société Française de Radiologie. Other; \nSupersonic imagine. J. Gennisson: Consultant; Supersonic Imagine. \nB‑0336 11:15\nSONAZOID® (perflubutane) microbubble-enhanced ultrasound for \ndifferential diagnosis of breast lesions: pooled analysis of phase 2 \nand 3 clinical studies \nY. Miyamoto1, T. Ito2, E. Takada3, T. Hirai4, K. Omoto5, R. Sekiguchi3, T. Okuno6, \nS. Kanazawa1, F. Moriyasu1; 1T okyo/JP, 2Osaka/JP, 3 Tochigi/JP, 4Nara/JP, \n5Saitama/JP, 6Kobe/JP (miyamoto@jikei.ac.jp) \nPurpose: Two clinical studies (Phase 2 and Phase 3) were performed to assess \nthe efficacy and safety of contrast-enhanced ultrasound withSONAZOID ® (Per-\nflubutane) microbubbles for differential diagnosis of breast lesions compared with \nunenhanced ultrasound and contrast-enhanced MRI.\nmean elasticity and maximum elasticity of each lesion, which are the most reliable \nindicators in QSWE.\nResults: For differentiation of malignant from benign lesions, conventional US was \nassociated with sensitivity of 100%, specificity of 43.6% and the AUC was 0.718. \nThe AUC was 0.8909 for mean elasticity values and 0.8880 for maximum elastic-\nity values. The cutoff value was 60.7 kPa for mean elasticity values, with 84.4% \nsensitivity and 90.1% specificity. The cutoff value for maximum elasticity was 81.3 \nkPa, with 88.1% sensitivity and 88.12% specificity. Additional use of QSWE with \nconventional US was associated with a sensitivity of 97.0%, specificity of 92.0%, \nand accuracy of 75.2%.\nConclusion: Additional use of QSWE increases the diagnostic accuracy of con-\nventional US. Both mean elasticity and maximum elasticity show no difference as \na decisive value but optimal cutoff points of these two values are different. \nB‑0331 10:39\nQuantitative ShearWave ultrasound elastography: initial experience \nin palpable breast masses \nS. Hari, S. Naga, A. Dhar, M. Jana; New Delhi/IN\nPurpose: To determine the appearance of breast masses at shear wave elastog-\nraphy (SWE) and to assess the correlation between quantitative values of lesion \nstiffness and pathologic results.\nMethods and Materials: Using the Aixplorer® ultrasound (US) system (Super-\nSonic Imagine, Aix en Provence, France), 144 breast masses were identified in \n131 consecutive patients. Two orthogonal elastography images were obtained \nof each mass. Quantitative lesion elasticity was measured in terms of the Young \nmodulus (in kilopascals). Pathologic results were available in all cases. B-mode US \nimages were classified according to ACR-BI-RADS. BI-RADS categories 1-3 were \ntaken as benign while BI-RADS categories 4 and 5 were classified as malignant.\nResults: All breast lesions were detected at SWE. The mean elasticity value for \nbenign lesions (n=91) was 29.89kPa (SD27.24) while that for malignant lesions \n(n=53) was 188.97 (SD 63.22). The mean size of the lesions on US was 23.63 mm \nwith (SD15.39). A cut-off mean elasticity point of 92.25 kPa was set as threshold \nfor benign/malignant differentiation using receiver operating curve. The sensitivity, \nspecificity, PPV, NPV and accuracy of conventional ultrasound versus SWE were \n96.2% vs 96.2%, 80.2% vs 95.6%, 73.9% vs 92.7%, 97.3% vs 97.7% and 86.1% \nvs 95.8%, respectively. Complicated cysts were differentiated from solid lesions be-\ncause they had elasticity values of 0 kPa (no signal was retrieved from liquid areas).\nConclusion: The elasticity values of benign and malignant lesions were signifi-\ncantly different allowing for accurate characterisation. The diagnostic performance \nof SWE is comparable with B-mode US, with SWE having a superior specificity.\nB‑0332 10:48\nCan the ring sign improve the performance of shearwave \nelastography in benign/malignant differentiation of screen detected \nsolid breast masses? \nM. Szewcyk-Bieda, A. Evans, S. Vinnicombe, P. Whelehan, K. Thomson; \nDundee/UK (a.z.evans@dundee.ac.uk) \nPurpose: Shear wave elastography (SWE) can differentiate benign from malignant \nsolid breast masses. Small, low-grade cancers can have benign (low) mean stiffness \nvalues but often show a ring of slightly stiffer tissue around the lesion. We aimed to \nestablish whether taking the presence of a ring sign to indicate malignancy improves \nthe discriminatory performance of SWE in screen detected solid breast masses.\nMethods and Materials: The ring sign was defined as the presence of stiffer bor-\nders on at least 2 aspects of the lesion. The presence or the absence of the ring \nsign was independently assessed by two breast radiologists, blinded to pathology \noutcomes, in a consecutive series of 145 screen-detected solid masses. A third \nradiologist arbitrated in discordant cases. The discriminatory performance of SWE \nusing a threshold mean stiffness value of 50 kilopascals (kPa) was compared \nwith taking either a threshold mean stiffness of 50 kPa or a ring sign as positive.\nResults: Of 145 masses, 42 were benign and 103 were malignant. In 122 (84%), \nthe ring sign findings of two radiologists were concordant. For mean stiffness \nthreshold of 50 kPa, sensitivity was 83% and specificity was 55%. When either \nmean stiffness over 50 kPa or a ring sign was counted as positive, sensitivity was \n91% and specificity was 45%. The increase in sensitivity was statistically significant \n(Fisher’s exact test, p=0.048). The drop in specificity was not (p=0.25).\nConclusion: The ring sign can improve the sensitivity of shear wave elastography \nin differentiating benign from malignant screen-detected solid breast masses. \n\nScientific Sessions\nS224\n C A D E F\n G\nB\nno sonographic correlates, [[Unable to Display Character: fi]]ve could be \nbiopsied by marking MRI information onto the body surface using RVS.\nConclusion: Our results suggest that the additional use of RVS on second-look \nsonography signi[[Unable to Display Character: fi]]cantly increases the \nsonographic detection rate of MRI-detected lesions without operator dependence. \nB‑0339 11:42\nTargeting accuracy of real-time virtual sonography (RVS) in \nsonographic identification of enhancing lesions in breast MRI \nS. Nakano, K. Fujii, M. Yoshida, J. Kousaka, Y. Mori, T. Ando, R. Tetsuka, \nT. Fukutomi, T. Ishiguchi; Nagakute/JP (snakano1@aichi-med-u.ac.jp) \nPurpose: The purpose of this study was to evaluate the targeting accuracy of RVS \nto sonographically identify enhancing lesions by breast MRI.\nMethods and Materials: Between December 2008 and May 2009, RVS was per-\nformed in 51 consecutive patients with 63 enhancing lesions. MRI was performed \nwith the patients in the supine position using a 1.5-T imager with a body surface \ncoil to achieve the same position as with sonography. To assess the accuracy of the \nRVS, the following three issues were analyzed: (i) The sonographic detection rate of \nenhancing lesions, (ii) the comparison of the tumor size measured by sonography \nand the MRI-MPR and (iii) the positioning errors as the distance from the actual \nsonographic position to the expected MRI position in 3-D.\nResults: Among the 63 enhancing lesions, 42 (67%) lesions were identi[[Unable \nto Display Character: fi]]ed by conventional B-mode, whereas the re-\nmaining 21 (33%) initial conventional B-mode occult lesions were identi[[Unable \nto Display Character: fi]]ed by RVS alone. The sonographic size of the \nlesions detected by RVS alone was signi[[Unable to Display Character: fi]]\ncantly smaller than that of lesions detected by conventional B-mode (p < 0.001). \nThe mean tumor size provided by RVS was 12.3 mm for real-time sonography and \n14.1 mm for MRI-MPR (r=0.848, p < 0.001). The mean positioning errors for the \ntransverse and sagittal planes and the depth from the skin were 7.7, 6.9 and 2.8 \nmm, respectively. The overall mean 3D positioning error was 12.0 mm.\nConclusion: Our results suggest that RVS has good targeting accuracy to directly \ncompare a sonographic image with MRI results without operator dependence. \n10:30 - 12:00 Room G/H \nGenitourinary \nSS 507 \nNew frontiers in GU imaging \nModerators: \nG. Hagen; Oslo/NO \nC.M.A. Hoeks; Nijmegen/NL \nB‑0340 10:30\nFunctional evaluation of transplanted kidneys using arterial spin \nlabelling (ASL) MRI at 1.5 T and 3 T: results in 105 patients \nR.S. Lanzman, D. Blondin, P. Heusch, P. Bilk, P. Kröpil, F. Miese, G. Antoch, \nH.-J. Wittsack; Düsseldorf/DE (rotemshlomo@yahoo.de) \nPurpose: The purpose of our study was to investigate arterial spin labelling (ASL) \nMRI for functional assessment of transplanted kidneys at 1.5 T and 3 T.\nMethods and Materials: 105 renal allograft recipients (mean age 50.8 ± 14.7 years) \nwere included in this study. ASL MRI was performed at 1.5 T (n=71) and 3 T (n=34) \nusing a single-slice paracoronal FAIR TrueFisp sequence (30 averages, inversion \ntime 1200 ms, slice thickness 8 mm, matrix 128 x 128). For quantification of ASL \nperfusion, T1 relaxation times were determined at 1.5 T and 3 T using the variable \nflip angle approach. ROIs were drawn by a single reviewer on ASL parameter \nmaps for quantification of cortical perfusion. ASL perfusion was correlated with \nallograft function as determined by the estimated glomerular filtration rate (eGFR) \nand compared between patients with good or moderate allograft function (group \na; eGFR > 30 ml/min/1.73 m²) and patients with heavily impaired allograft function \n(group b; eGFR ² 30 ml/min/1.73 m²).\nResults: ASL perfusion and eGFR were comparable at 1.5 T (36.1 ± 22.6 ml/\nmin/1.73 m² and 237 ± 101 ml/100 g/min) and 3 T (42.3 ± 22.2 ml/min/1.73 m² \nand 248 ± 66 ml/100 g/min). ASL perfusion was significantly higher in group a \n(283.9 ± 59.4 ml/100 g/min) as compared to group b (195.6 ± 62.0 ml/100 g/min) \n(p < 0.0001). ASL perfusion values exhibited a significant correlation with eGFR \n(r=0.59, p < 0.0001).\nMethods and Materials: A total of 151 patients were enrolled at 5 centers in \nJapan. All patients provided written informed consent before entering the studies. \nUnenhanced ultrasound, contrast-enhanced ultrasound, and contrast-enhanced \nMR images were independently assessed by three blinded reviewers, who viewed \nthe different images in a randomised sequence and were also blinded to subject \ncharacteristics. The observation period for safety assessment was 3 days after the \ncontrast agent administration.\nResults: Among 140 patients included in the diagnostic analysis, the accuracy of \ncontrast-enhanced ultrasound (86.7%) was significantly higher than that of unen-\nhanced ultrasound (66.9%) and contrast-enhanced MRI (69.5%) (both p < 0.001). \nSensitivity and specificity of contrast-enhanced ultrasound (92.9%, 84.0%) were \nalso superior to unenhanced ultrasound (86.5%, 58.5%) and contrast-enhanced \nMRI (86.5%, 62.2%) (sensitivity: p=0.177 and p=0.160) (specificity: both p < \n0.001). The incidence of adverse events was 9.9%, with adverse drug reactions \nin 3.3% (all mild).\nConclusion: Compared with unenhanced ultrasound and contrast-enhanced MRI, \ncontrast-enhanced ultrasound with SONAZOID ® (Perflubutane) microbubbles \nachieved significantly better diagnostic accuracy and specificity for breast lesions \nwithout causing serious adverse reactions.\nB‑0337 11:24\nUS-based automated breast volume scanner (ABVS): improvement \nof breast lesion detection in 51 patients - initial study \nX. Wang, Y. Wang, P. Xu; Shanghai/CN (wangxiaohong426@yahoo.com.cn) \nPurpose: To investigate the clinical application of ultrasound (US)-based automated \nbreast volume scanner (ABVS) in detection of breast lesions.\nMethods and Materials: Conventional handheld ultrasound, US-based ABVS \nand mammography were performed on 41 patients with 65 breast lesions by three \ndifferent physicians. Two other physicians blinded to the results of conventional \nultrasound, mammography and histopathology obtained the number of lesions \ndetected by the three devices, respectively. All the lesions were then classified \naccording to ACR BI-RADS assessment categories. Sensitivity, specificity, and ac-\ncuracy were then calculated, with histopathology serves as the reference standard.\nResults: US-based ABVS showed the best detection ability among the three modali-\nties. The number of breast lesions depicted by conventional handheld ultrasound, \nUS-based ABVS and mammography were 65, 67, and 48, respectively. ABVS \nhelped to confirm all the subjects detected by the other two devices only, and two \nmore lesions were found as well. More importantly, 3 (18.8%) mammographically \noccult breast cancers were detected by ABVS. The retraction phenomenon in the \ncoronal view was highly suggestive of malignant tumour in diagnosis. The sensitivity, \nspecificity, and accuracy of conventional handheld ultrasound were 75.0% (12/16), \n87.8% (43/49), and 84.6% (55/65), respectively. However, ABVS displayed high \nspecificity and accuracy (93.9% [46/49], 89.2% [58/65], respectively).\nConclusion: US-based automated breast volume scanner greatly improves the \ndetectable rate of breast lesions. With standardised workflow and good reproduc-\nibility, ABVS is expected to be a potential frontier in breast screening in the future. \nB‑0338 11:33\nUseful of real-time virtual sonography (RVS) on the evaluation of \nMRI-detected lesions of the breast in second-look sonography \nS. Nakano, K. Fujii, M. Yoshida, J. Kousaka, Y. Mori, T. Ando, R. Tetsuka, \nT. Fukutomi, T. Ishiguchi; Nagakute/JP (snakano1@aichi-med-u.ac.jp) \nPurpose: The aim of this study was to verify the utility of second-look sonography \nusing real-time virtual sonography (RVS), a coordinated sonography with an MRI \nsystem that uses an image fusion technique on the sonographic evaluation of \nMRI-detected lesions of the breast.\nMethods and Materials: Of the 196 consecutive patients who were examined with \nbreast MRI in our hospital, those patients who underwent second-look sonography \nto identify MRI-detected lesions were enrolled in this study. MRI was performed us-\ning a 1.5-T imager with the patient in a supine position. To assess the ef[[Unable to \nDisplay Character: fi]]cacy bene[[Unable to Display Character: fi]]ts \nof RVS, the correlations between lesion detection rates on second-look sonography \nusing conventional B-mode or RVS were analysed.\nResults: Of the 196 patients, 55 (28 %) demonstrated 67 lesions initially detected \nby MRI, followed by second-look sonography. The detection rates of 24 malignant \nand 43 benign lesions were 33 % (8/24) and 23 % (10/43) by conventional B-mode; \nRVS increased these rates signi[[Unable to Display Character: fi]]cantly, \nto 92 % (22/24) and 88 % (38/43), respectively (p < 0.001). Interestingly, 61 % of \nMRI-detected lesions were situated around mammary fascia, and 90 % of these \nwere detected with second-look sonography using RVS. Of the seven lesions with \n\nScientific Sessions\nS225\nA\n C D E F G\nB\nFriday\nMethods and Materials: In a retrospective study, 21 patients with non-tumorous \nincreased signal intensity of the kidneys on DWI sequences (b=800s/mm2) and \ncorresponding ADC-decrease was identified. As a control group served 60 patients \nwithout clinical signs of renal infection. All patients underwent routine MRI-protocol \nof the abdomen including EPI-sequence for the DWI (b.0/400/800), T2w HASTE, \nT1w VIBE post-contrast (Dotarem). Confirmation of renal infection was established \non the basis of clinical criteria. T1w- and T2w-images were assessed and compared \nto DWI for the presence of altered signal and the degree of the visibility of pathology \nwas graded on an three-point scale.\nResults: In all 21 patients with positive DWI-findings, a renal infection could be \nconfirmed while none of the patients in the control group showed a suspicious signal \npattern on DWI. T2w-imaging and contrast-enhanced T1w-imaging displayed obvi-\nous pathologic signal in 3/21 (14%) and 11/19 (58%) patients, slightly pathologic \nsignal in 17/21 (81%) and 7/19 (37%), respectively. No pathologic change was seen \nin 1/21 (4%) and 1/19 (5%). The median visibility score of 2 for the DWI-imaging and \nthe T1w-images was significantly higher than the median visibility score of 1 for the \nT2w-imaging (p=0.0001 (DWI vs. T2w) and p=0.078 (T1w vs. T2w). No significant \ndifferences were found between the visibility scores of T1w imaging and DWI.\nConclusion: DWI of the kidneys seems to be highly sensitive for the detection of \ninfections within the kidney.\nAuthor Disclosures:\nH.J. Michaely: Advisory Board; Siemens Body MR.\nB‑0344 11:06\nDCE-MRI assessment of kidney function and renal masses: single \nslice versus whole organ/tumour \nM. Notohamiprodjo, A.D. Helck, S. Winter, M. Staehler, \nM. Braunagel, M. Ingrisch, M.F. Reiser, K. Nikolaou; \nMunich/DE (mike.notohamiprodjo@med.uni-muenchen.de) \nPurpose: To investigate feasibility dynamic-contrast-enhanced (DCE)-MRI as-\nsessment of kidney function and renal masses on a single slice compared with \ninvestigation of the whole organ or tumour.\nMethods and Materials: Fourteen patients with renal tumours (11 renal cell car-\ncinomas, 2 angiomyolipoma, 1 oncocytoma) before and after partial nephrectomy \nunderwent DCE-MRI at 3 T (Magnetom VERIO, Siemens Healthcare Sector) with \na time-resolved angiography with stochastic trajectories (TWIST)-sequence (voxel-\nsize 2.6x2.6x2.6 mm3, temporal resolution 2.5 mm) with half-dose Gadobutrol (Bayer \nHealthcare Pharmaceuticals). 28 kidney datasets and 14 tumour datasets were \nassessed using in-house built IDL-software PMI 0.4. Using 2-compartment-models \nwith semi-automated segmentation, renal perfusion and filtration as well as tumour \nperfusion and permeability were calculated for a single central Region-of-interest \non a single slice or the whole organ or tumour. Statistical analysis was performed \nwith paired t-tests and Pearson´s correlation coefficient.\nResults: There were no significant differences between single slice / whole kidney \n(plasma-flow 275.8±105.6 vs. 234±96.7 ml/100 ml/min, plasma-volume 28.2±8.9 \nvs. 25.0±9.0 ml/100 ml, glomerular-filtration-rate 16.9±9.2 vs. 15.9±8.0 ml/100 ml/\nmin) as well as between single slice/ whole tumour (plasma-flow 122.5±85.6 vs. \n120.5±95.2 ml/100 ml/min, plasma-volume 18.9 vs. 13.0 ml/100 ml and permeability-\nsurface-product 5.4±7.9 vs. 5.4±8.3 ml/100 ml/min). Correlations between single \nslice and whole organ/ tumour was were excellent and significant for all parameters \n(r = 0.95 to 0.99, p < 0.01).\nConclusion: Single slice assessment of kidney function and renal masses with \nDCE-MRI does not show significant differences to the more time-consuming analy-\nsis of the whole organ/ tumour. Incorporation of single slice analysis of DCE-MRI \ndata in future studies appears feasible and justifiable. \nB‑0345 11:15\nIn vivo sodium (23Na) imaging of the human kidneys at 7.0T: \npreliminary results \nS. Haneder1, V. Juras2, H.J. Michaely1, S.O. Schönberg1, S. Trattnig2, Š. Zbýň2; \n1Mannheim/DE, 2Vienna/AT \nPurpose: To evaluate the feasibility of in vivo high-resolution (HR) 23Na imaging \nof the renal cortico-medullary 23Na gradient and to measure 23Na-T2* relaxation \ntimes in human kidneys at an ultra-high field strength of 7.0T.\nMethods and Materials: In this prospective, IRB-approved study, 8 healthy \nvolunteers (4 females, 4 males; mean age 29.0 ± 3.5 years) were scanned on a \n7.0T whole body MR system (Siemens, Erlangen, Germany). For HR 23Na-MRI a \n3D gradient-echo-sequence with variable echo time scheme (vTE-GRE) (spatial \nresolution-4x4x5 mm3; 24 slices; TE=4.19 ms; mean TR=49 ms; mean averages=34; \nmean measurement time-41:57 min) was used. The T2* times were calculated using \na multi-echo 3D vTE-GRE sequence (resolution-4x4x15 mm3; 12 slices; 10 echoes; \nConclusion: Cortical ASL perfusion values correlate significantly with allograft \nfunction, highlighting the potential of ASL MRI for functional evaluation of renal \nallografts at 1.5 T and 3 T.\nB‑0341 10:39\nAssessment of novel chemokine-directed therapy of renal allograft \nrejection in a murine animal model with multiparametric functional MRI \nM. Notohamiprodjo, A. Kalnins, M. Kolb, A. Wagner, M.F. Reiser, K. Nikolaou, \nJ. Andrassy; Munich/DE (mike.notohamiprodjo@med.uni-muenchen.de) \nPurpose: Renal allograft rejection is associated with chemokine ligand 2 (CCL2)-\ndependent glomerular and interstitial macrophage recruitment. CCL2 blockade with \nthe Oligonucleotide/Spiegelmer mNOX-E36-3’PEG inhibits leucocyte recruitment. \nThe purpose of this study was to evaluate MR renography and diffusion-weighted \nimaging (DWI) for assessment of this novel chemokine-directed therapy in an \nexperimental murine animal model.\nMethods and Materials: An orthotopic renal transplant mouse-model with acute \nallograft rejection (balb/c into C57/BL6) was used. 5 animals were treated with \nlow-dose cyclosporin A in combination with mNOX. 7 animals did not receive \ntreatment. 3 syngenic controls (C57/BL6 into C57/BL6) were performed. Imaging \nwas conducted at 3 T with a dedicated mouse coil. Diffusion-weighted imaging was \nperformed with b values ranging 0 to 800 s/mm2. MR renography was performed \nwith a TWIST-sequence with a temporal resolution of 1.5 seconds following a bolus \nof 10µl gadobutrol in 100µl NaCl. Significance between subgroups was assessed \nwith Wilcoxon´s rank-sum test.\nResults: Syngenic allograft showed substantially higher plasma flow (53.2±17.2 \nml/100 ml/min) and significantly lower (p < 0.05) ADC (1.20±0.02 mm2/s) than \nnative kidneys (44.1±7.1 ml/100 ml/min and 1.29±0.09 mm2/s). Allograft-ADC \nof treated animals (0.98±0.14 mm2/s) was substantially higher than of untreated \nanimals (0.76±0.17 mm2/s). Cortical plasma flow (24.5±5.5 ml/100 ml/min) was \nsignificantly lower (p < 0.05) for untreated animals compared to treated animals \n(37.4±7.6 ml/100 ml/min). Volume of distribution and mean transit time did not \nshow significant differences between the subgroups.\nConclusion: Chemokine-directed treatment ameliorates acute renal allograft \nrejection. Functional MRI is able to non-invasively assess these therapy effects \nin this experimental model and holds high potential to become an alternative to \ninvasive organ biopsy.\nB‑0342 10:48\nAssesment cisplatin-induced interstitial nephropathy using \ndiffusion-weighted MRI \nR. Del Vescovo, F. Giurazza, R.L. Cazzato, C.L. Piccolo, R.F. Grasso, \nB. Beomonte Zobel; Rome/IT (r.delvescovo@unicampus.it) \nPurpose: To assess the potential of noninvasive diffusion-weighted magnetic \nresonance imaging (DW-MRI) to depict interstitial kidney changes in patients (pts) \nunder cisplatin-based chemotherapy.\nMethods and Materials: We analysed ADC maps of 34 oncologic patient (5 \nwoman and 29 men; mean age 56 years; 50% affected by advanced lung cancer) \ntreated with cisplatin-based chemotherapy comparing with age- and sex-matched \ncontrol group’s ADC maps. The creatinine clearance (CrCl) used to determinate \nrenal function was based on the formula of Crockfort (normal value > 60 mL/min). \nThe ADC values were calculated using a ROI positionated manually on the cortex \nof each pole in axial and coronal images. For statistical analysis t-test was used. \nA p value of less than 0.05 was considered significant.\nResults: There was no anatomical difference visible with conventional MR imag-\ning of the cortex and medulla relationship. In pts treated with cisplatin there was a \nreduction of ADC values in the cortex, but no significant changes in medulla. The \nADC values of healthy volunteer were significantly higher comparing with patients \ntreated with cisplatin (p < 0.04). There was no significant difference between the \nADC values of left and right kidney in each patient except in one who present a \nunilateral ureteral obstruction. No significant correlation was found between the \ncreatinine clearance and ADC values obtained in both groups.\nConclusion: DW-MRI may allow a noninvasive detection of changes in kidneys in \npts with interstitial nephropathy during and after chemotherapy treatment. \nB‑0343 10:57\nValue of diffusion-weighted-MR-imaging for the detection of nephritis \nH.J. Michaely1, M. Reichert1, B. Henninger2, S. Haneder1, S.O. Schönberg1; \n1Mannheim/DE, 2Innsbruck/AT (henrik.michaely@umm.de) \nPurpose: To evaluate diffusion-weighted-MR-imaging (DWI-MRI) for the detection \nand assessment of infectious renal disease.\n\nScientific Sessions\nS226\n C A D E F\n G\nB\nB‑0348 11:42\nBridging septa in T2-weighted MRI of healthy volunteers: is there an \nassociation with the peri- and pararenal fat thickness? \nB. Mensel, R. Bülow, F. Weber, J.-P. Kühn, N. Hosten, K. Hegenscheid; \nGreifswald/DE (birger.mensel@uni-greifswald.de) \nPurpose: To analyse the distribution of perirenal bridging septa (BS) and their \ncorrelation with para- and perirenal fat thickness (PPFT).\nMethods and Materials: 200 healthy volunteers (76 men and 124 women) with \na mean age of 50.7±13.2 years underwent T2-weighted imaging of the abdomen. \nTwo observers rated the BS according to a 4-point scale (0= no BS visible to \n3=maximum extent of BS). In addition, the PPFT was measured on T1-weighted \nimages. For both variables a possible correlation was evaluated and analysis of \nthe intra- and interobserver variability was performed.\nResults: In 94 subjects (47.0%) BS were visible. Male subjects showed BS \nstatistical significantly more often compared to female subjects (P < 0.001). The \ndistribution according to the stage of BS was: stage 1: 40 (20.0%), stage 2: 23 \n(11.5%) and stage 3: 31 (15.5%) subjects. The PPFT was greater in men (14.19 \nmm, IQR: 9.39-20.61 mm) compared to women (7.32 mm, IQR: 6.04-11.30 mm, P \n< 0.001). Corresponding correlation coefficients between the stage of BS and PPFT \nwere r=0.780 (P < 0.001) and r=0.431 (P < 0.001). Greater PPFT was related to a \nhigher stage of BS in both sexes (P < 0.001) with significant differences between \nall adjacent stages for male subjects (P < 0.05). Female subjects showed signifi-\ncant differences only between stage 0 and 1 (P < 0.05). Intra- and interobserver \nvariability for the stage of BS and PPFT was very good.\nConclusion: A higher PPFT is associated with higher BS stage. MRI allows a \nreliable classification of PH and PPFT measurement.\nB‑0349 11:51\nFeasibility of 3 T MR diffusion tensor imaging (DTI) for \nreconstructing anatomic connectivity of sacral plexus \nV. Iotti1, A. Pecchi1, L. Nocetti1, F. Fiocchi1, C. Alboni2, P. Torricelli1; 1Modena/IT, \n2Sassuolo/IT (valeiotti@yahoo.it) \nPurpose: To investigate the feasibility of reconstructing anatomic connectivity of \nsacral plexus using 3 T-MR diffusion tensor imaging (MR-DTI) with three-dimen-\nsional (3D) tractography approach.\nMethods and Materials: 3 T-MR-DTI was performed on 10 women volunteers. \nThe sequence was acquired on oblique axial plane parallel to the sacrum, from \nthe level of the L4 nerve to the coccyges. Main diffusion directions reflecting the \nfibre orientation were determined using a Sense-SSEPI with diffusion-sensitised \ngradients (b600 mm2s-1) along 16 directions. A deterministic bre-tracking algorithm \nwas used to show fibre architecture, compared with anatomic atlas. Three ROIs \nwere placed at different levels of the spinal cord nerves: one in the middle of each \ntract-of-interest, accompanied by “AND” selection ROIs at both ends of the nerve \ntract ROI. Diffusion-weighted Ssh-EPI images are processed on a dedicated work-\nstation for data pre-processing with MedINRIA deterministic software.\nResults: Tractography of the sacral plexus was feasible for all 10 volunteers, \ngiving 3D insight into the general anatomy and organisation of the nerves L4 to \nS4. Main artefacts in fibre reconstruction, caused by bladder over-distension, by \npresence of air in rectum and by constant small movements due to breathing \nand/or spontaneous contractions of pelvic organs, never invalidate the feasibility \nof tractography. Fibres were reconstructed from medulla to the pelvic course of \nmain branches of sacral-plexus nerves. Emerging branches of pudendal nerve \nwere found in 6 volunteers.\nConclusion: 3 T-MR-DTI allows a precise anatomic reconstruction of lumbar-sacral \nplexus. These findings are encouraging for using DTI as a mean to investigate \nsacral-plexus, especially in female pelvis. \nTE=2.64 ms to 60.42 ms; TR=75 ms; 24 averages; measurement time=46:50 min). \nAll HR images were corrected for inhomogeneous sensitivity of coil. The 23Na-SNR \nvalues are given on a pixel-by-pixel basis for 20 mm from the renal cortex in the \ndirection of the medullary pyramid. The T2* maps were calculated by fitting the \n23Na signal decay mono-exponentially on a pixel-by-pixel basis using least squares \nfitting routine written in IDL.\nResults: The mean cortico-medullary 23Na-SNR for all 16 healthy kidneys increased \nfrom the renal cortex (34.1 ± 10.2) towards the renal medullary pyramid (88.8 ± \n20.9). The cortico-medullary increase ranged inter-individually from 50.8 to 65.7%. \nThe mean 23Na-T2* of all volunteers was 19.9 ± 1.8 ms.\nConclusion: The feasibility of ultra-high field, HR 23Na-MRI of healthy human \nkidneys was demonstrated. Moreover, high 23Na-SNR provided by 7.0T allowed \nthe in vivo measurements of 23Na-T2* times in human kidneys for the first time. \nB‑0346 11:24\nArterial spin labelling for the prostate: initial experience at 3 T MRI \nS. Takahashi1, N. Aoyama1, T. Kimura2, K. Kitajima1, Y. Ueno1, S. Sato3, \nK. Sugimura1; 1Kobe/JP, 2Otawara/JP, 3Osaka/JP (staka@med.kobe-u.ac.jp) \nPurpose: To assess the value of ASL-perfusion MRI for the prostate using dynamic \ncontrast-enhanced (DCE) study findings as the reference standard.\nMethods and Materials: 22 male patients (mean age 69.2 ± 7.6 years) with \nsuspected prostate cancer were prospectively included in this study. Single-slice \n2D-pulsed ASL images were acquired during our routine prostate screening protocol \non a 3 T MRI unit, including the DCE study. First, ROI was drawn for the obturator \nmuscle on a control image of ASL sequence (Scont.ref). Then, ROIs were drawn \nfor the femoral artery, the obturator muscle, the normal PZ and the regions where \nDCE showed early enhancement on the tagged ASL image. These values were \ndivided with Scont.ref, yielding an ASL ratio (ASLR). Analysis of the variance was \nperformed to assess differences in ASLR for each tissue or region. A radiologist \nscored the degree of enhancement on DCE and compare to the contrast ratio of \nASLR and the visual assessment of ASL signals.\nResults: A mean ASLR of the femoral artery was 15.8±6.9%, where those of the \nnormal PZ and the obturator muscle were 0.6±0.5%, and 0.6±0.5%, respectively. On \nthe other hand, the enhanced regions on DCE showed a mean ASLR of 0.98±1.0%. \nVisual assessment of the ASL image detected 7 out of 12 well-enhanced regions. \nContrast ratio of ASLR demonstrated significant positive correlation to the degree \nof enhancement on DCE (Spearman; r=0.54, p=.007).\nConclusion: ASL may allow detecting the region of the higher tissue blood flow \nin the prostate without contrast materials.\nAuthor Disclosures:\nT. Kimura: Employee; Toshiba Medical systems. S. Sato: Employee; Toshiba \nMedical systems.\nB‑0347 11:33\nA new look at the female pelvis: ultra-high-field (7T) MR imaging \nL. Umutlu, O. Kraff, A. Fischer, S. Kinner, S. Maderwald, M. Forsting, M.E. Ladd, \nT.C. Lauenstein; Essen/DE (Lale.Umutlu@uk-essen.de) \nPurpose: Aim of this study was to investigate the feasibility of contrast-enhanced \n7 Tesla MRI of the female pelvis.\nMethods and Materials: 10 healthy female volunteers were examined on a 7T \nwhole body MR system (Magnetom 7T, Siemens) utilising an 8-channel transmit/\nreceive radiofrequency body coil. The examination protocol included 1) T1w fs 2D \nFLASH, 2) dynamic T1w fs 3D FLASH, 3) T2w TSE sequences. For qualitative \nimage analysis of T1w MRI, the delineation of pelvic anatomy, pelvis vasculature, \ntissue contrast and overall image quality was assessed and for T2w MRI the zonal \nanatomy of the uterus and the conspicuity of the ovaries were evaluated (five-\npoint-scale analysis: 5 = excellent to 1 = non-diagnostic). Image impairment due \nto various artefacts was assessed. Contrast ratios between junctional zone and \nmyometrium were obtained via ROI analysis for T2w MRI.\nResults: Of all three sequences, 2D FLASH MRI offered best overall image qual-\nity (mean contrast-enhanced 4.75) and highest tissue contrast (mean contrast-\nenhanced 4.92). For the T1w sequences, 2D FLASH imaging was rated with higher \nscores for all assessed structures than 3D FLASH MRI. T2w TSE imaging provided \na moderate to high conspicuity of the zonal anatomy of the uterus with mean scores \nranging from 3.5 for endometrium to 4.67 for myometrium. Overall image impairment \nwas rated strongest for T2w MRI (2.95) and least for 2D FLASH MRI (mean 4.24).\nConclusion: Our results indicate the successful transformation of the associated \nhigh SNR into high spatiotemporal resolution T1w pelvis MRI at 7 T and valuable \nnon-contrast diagnostics of pelvis vasculature. \n\nScientific Sessions\nS227\nA\n C D E F G\nB\nFriday\nB‑0352 10:48\nValue of monoenergetic low KV dual-energy CT datasets for \nimproved image quality of cervical and cerebral CT-angiography \nD. Schneider, P. Apfaltrer, H. Haubenreisser, M. Meyer, \nS. Sudarski, C. Fink, S.O. Schönberg, T. Henzler; \nMannheim/DE (david.schneider@stud.uni-heidelberg.de) \nPurpose: High vessel attenuation as well as a high contrast-to-noise (CNR) \nratio is a prerequisite for highly diagnostic cervical and cerebral CT-angiographic \nexaminations. The purpose of this study was to evaluate the value of calculated \nlow-kV-monoenergetic dual-energy CT (DECT) angiographic datasets.\nMethods and Materials: 41 patients (21 men, mean age 58 ±14) that underwent \nDECT-angiography of the cervical (n=7) or cerebral vessels (n=34) were retro-\nspectively included in this study. 80 and 140-kV DECT data were used to calculate \nlow-kV monoenergetic image datasets from 120 to 40 keV (10-keV intervals). Vessel \nand soft tissue attenuation and image noise were measured in various regions of \ninterest and the CNR was subsequently calculated. Differences in image attenuation \nand CNR were compared between the different monoenergetic datasets. Vessel \nattenuation and CNR of the best monoenergetic datasets were then compared to \nconventional 120-kV polyenergetic datasets.\nResults: In comparison to conventional polyenergetic 120-kV datasets, above all, \n60-keV monoenergetic cervical datasets yielded to a significant increase in vessel \nattenuation and CNR (+40%, +18%; all p < 0.01). For cerebral vessel assessment, \nin particular 70-keV monoenergetic datasets improved vessel attenuation and \nCNR (+3%, +10%; all p < 0.01) when compared to conventional 120-kV datasets.\nConclusion: Calculated 60-keV monoenergetic image data significantly improves \nvessel attenuation as well as the CNR of cervical DECT-angiographic studies, \nwhereas 70-kV monoenergetic datasets are favourable to improve vessel attenua-\ntion and the CNR of cerebral DECT-angiographic studies. Thus, lowering the amount \nof iodinated contrast-material might become feasible using monoenergetic-low-kV \nimages, which is particularly important for combined perfusion and angiography \nprotocols.\nB‑0353 10:57\nBlack blood MRI in patients with and without suspected primary \nangiitis of the central nervous system \nT. Saam, T. Pfefferkorn, M. Habs, C. Opherk, A. Straube, \nM. Dichgans, M.F. Reiser, K. Nikolaou, J. Linn; \nMunich/DE (T obias.Saam@med.uni-muenchen.de) \nPurpose: Single case reports suggest that black blood MRI (T1-weighted fat \nand blood suppressed sequences with and without contrast injection; BB-MRI) \nmay visualise intracranial vessel wall contrast enhancement in primary angiitis \nof the central nervous system (PACNS). In this single-centre observational pilot \nstudy we prospectively investigated the value of BB-MRI in the diagnosis of large \nartery PACNS.\nMethods and Materials: In this prospective, mono-centric study 12 patients with \nsuspected large artery PACNS received a standardised diagnostic programme \nincluding BB-MRI. 10 patients without any evidence of PACNS and without in-\ntracranial stenosis served as control group. Vessel wall contrast enhancement \nwas graded (grade 0-2) by two experienced readers blinded to clinical data and \ncorrelated to the final diagnosis.\nResults: Four of 12 included patients received a final diagnosis of PACNS. All of \nthem showed moderate (grade 1) to strong (grade 2) vessel wall contrast enhance-\nment at the sites of stenosis. A moderate (grade 1) vessel wall CE grade was also \nobserved in 6 of the remaining 8 patients in whom alternative diagnoses were \nmade: arteriosclerotic disease (n=4), intracranial dissection (n=1), and Moyamoya \ndisease (n=1). None of the patients in the control group had vessel wall contrast \nenhancement.\nConclusion: Our pilot study demonstrates that vessel wall contrast enhancement \nis a frequent finding in PACNS and its mimics, but it is absent in patients without \nevidence of intracranial vascular disease. Larger trials will be necessary to evaluate \nthe utility of BB-MRI in the diagnostic workup of PACNS.\nB‑0354 11:06\n3 T MRI reveals extra- and intracranial involvement in giant cell \narteritis (GCA) \nS. Siemonsen, C. Brekenfeld, T. Klink, J. Fiehler, T. Bley; \nHamburg/DE (s.siemonsen@uke.uni-hamburg.de) \nPurpose: Vessel wall enhancement (VWE) of the superficial extracranial arteries \ncan be frequently detected in GCA by high-resolution MRI. The frequency and \namount of intracranial, intradural involvement is still unclear. We hypothesized \n10:30 - 12:00 Room L/M \nNeuro \nSS 511 \nStroke-related arterial disease \nModerators: \nE. Avdagic; Sarajevo/BA \nP. Barsi; Budapest/HU \nB‑0350 10:30\nAtherosclerotic calcification is related to cognitive decline: the \nRotterdam study \nD. Bos, M.W. Vernooij, A. Hofman, G.P. Krestin, J.C.M. Witteman, \nA. van der Lugt, M.A. Ikram; Rotterdam/NL (d.bos@erasmusmc.nl) \nPurpose: Increasing evidence suggests that vascular disease, and as such \natherosclerosis, may play an important role in the pathogenesis of cognitive \nimpairment and dementia. In this study, we investigate the relationship between \narterial calcification, as marker of atherosclerosis, in four vessel beds and cognitive \ndecline over a 6.4-year interval.\nMethods and Materials: From the population-based Rotterdam study, 2,413 par-\nticipants (mean age 69.5 years) underwent computed tomography of the coronaries, \naortic arch, extracranial and intracranial carotid arteries to quantify atherosclerotic \ncalcification. Cognitive function was assessed at baseline and at follow-up (mean \nfollow-up time: 6.4 years) using MMSE and a neuropsychological test battery that \nassessed the following domains: global cognition, memory, executive function, \ninformation processing speed and motor speed. Per participant, we calculated \nthe difference between both time points in standardised scores for each cognitive \ndomain. Relationships between atherosclerotic calcification and cognition were \nassessed using linear regression models and adjusted for relevant confounders \n(age, sex, education, APOE-e4-status and cardiovascular risk factors).\nResults: Calcification in all vessel beds, except in the extracranial carotid arteries, \nwas associated with a decreased MMSE score. Larger calcification volumes were \nalso associated with a decrease in global cognitive function and executive func-\ntion. Most prominent were the associations of intracranial carotid calcification with \nglobal cognition and executive function [multivariable-adjusted cognitive decline per \nSD increase in calcification volume -0.03 (95%CI: -0.06; -0.01) and -0.03 (95%CI: \n-0.06; -0.01), respectively].\nConclusion: Atherosclerotic calcification, in particular intracranial carotid artery \ncalcification, is an important risk factor for cognitive decline and thus potentially \nalso for dementia.\nB‑0351 10:39\nDoes clinical severity in acute stroke reliably predict large \nvessel occlusion? Results from a prospective cohort study of CT \nangiography (CTA) in hyper-acute stroke \nC. Hansen, C. Ovesen, H. Christensen, I. Havsteen, J. Nielsen, A. Christensen; \nCopenhagen/DK (hchr0039@gmail.com) \nPurpose: The availability of endovascular services is increasing, but still not \navailable in the majority of TPA centres. The aim of this study was to describe the \nrelations between NIHSS and large vessel occlusions in patients with hyper-acute \nischaemic stroke.\nMethods and Materials: A prospective single hospital registry based on con-\nsecutive patients admitted for TPA work up with routine CTA was started on July \n1, 2009; this analysis is based on patients admitted before December 2011. Bis-\npebjerg University Hospital has a TPA-service with a catchment area of app. 1.7 \nmio. inhabitants on even dates. CT scans are performed using 64-section MDCT \n(Brilliance-64, Philips Healthcare) with CTA from the aortic arch to the vertex. All \nimages were systematically reviewed by a blinded neuroradiologist; sensitivity, \nspecificity, positive predictive value and negative predictive value were calculated \nat all levels of NIHSS.\nResults: Five-hundred and seventy-three patients with acute ischaemic stroke were \nentered into the registry. At a NIHSS score equal to or larger than 10, the sensitivity \nwas equal to 43.8%, the specificity was 89.6% the positive predictive value was \n63.2% and the negative predictive value was 89.6% in predicting an acute occlusion.\nConclusion: If the cut off is set at NIHSS 10, there is a 10% risk of missing an oc-\nclusion and a 37% risk of transporting a patient with a TPA drip for no reason. The \nrelation is between occurrence of large vessel occlusions and NIHSS is a continuum.\n\nScientific Sessions\nS228\n C A D E F\n G\nB\nintracerebral haematoma, 8 TCI and 12 MI. Kaplan-Meier curves for recurrent stoke \nand death, recurrent stroke alone and death alone stratified for degree of calcifica-\ntion showed a significant difference between the 4 groups with increasing number \nof events with increasing degree of calcification. In univariate analysis, the risk of \nthe combined endpoint of death or recurrence was increased in patients with any \ndegree of calcifications, HR 1.76 (95% CI: 1.15-2.86, p=0.006).\nConclusion: ICC predicts death and vascular recurrences after ischaemic stroke. \nB‑0357 11:33\nIntracranial artery stenosis on CT angiography (CTA) predicts poor \noutcome after stroke: results from a prospective cohort study \nC. Ovesen, H. Christensen, A.-M. Abild, C. Hansen, I. Havsteen, J. Nielsen, \nA. Christensen; Copenhagen/DK (hchr0039@gmail.com) \nPurpose: Intracranial stenosis has been reported a risk factor of recurrent stroke. \nWe investigated if intracranial stenosis predicted vascular events (stroke, myocardial \ninfarction, TIA) and death in a Danish population of patients with ischaemic stroke.\nMethods and Materials: Cerebral CT (CT-C) and CT-angiography (CTA) (from \nconsecutive patients admitted with acute ischaemic stroke to our institution in the \nperiod from April 2009 to December 2011 and followed up till August 2012) were \nincluded into the analysis. Intracranial stenosis was graded after standardised \nWASID criteria. Recurrence (stroke, myocardial infarction, TIA) was identified \nbased on discharge cards, and recurrence or death constituted a poor outcome.\nResults: A total of 661 patients were included into the analysis, of whom 86 had a \ntotal of 91 stenoses: in 51 patients: 30-50% stenosis, in 24: 50-70%, and in 16: > \n70%. Mean follow-up was 701 days (range 238-1192 days), 13 patients were lost \nto follow-up, all visitors to Denmark. Fifty-three patients died within the follow -up \nperiod; 42 suffered recurrent ischaemic stroke, 18 intracerebral haematoma, 8 TCI \nand 12 MI. Kaplan-Meier curves for time to recurrence or death stratified for degree \nof stenosis showed significant difference between groups (log rank test, P=0.009). \nIn univariate analysis, any degree of stenosis increased the risk of poor outcome \nhazard ratio (HR) 1.8 (95% CI: 1.15-2.81, P=0.01). Patients with > 70% stenosis \nshowed the highest risk of poor outcome, HR 3.3 (95% CI: 1.45-7.7, p=0.004).\nConclusion: Intracranial stenosis increases the risk of poor outcome. Stenosis > \n50% was observed in 6% of patients.\nB‑0358 11:42\nContribution of the temporal maximum intensity projection (tMIP) \ndatasets for measurement of the middle cerebral artery (MCA) \nocclusion and predictive value for results of systemic thrombolytic \ntherapy \nJ. Baxa, R. Tupý, V. Rohan, B. Kreuzberg, J. Ferda; Pilsen/CZ \n(baxaj@fnplzen.cz) \nPurpose: The goal of retrospective study was to compare possibilities to measure \nthe extent of MCA occlusion (thrombus length) in patients with acute stroke and \npredictive value for recanalization and clinical outcome after systemic therapy.\nMethods and Materials: We analysed 63 patients with MCA occlusions (25 males, \naverage age 72.3 years, range 23-91 years) detected with multimodal CT exami-\nnation (non-contrast CT, perfusion CT and conventional CTA). Conventional CTA \n(slice 0.6 mm) and temporal maximum intensity projection (tMIP) datasets (slice \n1.5 mm) reconstructed over the full time span from volume CT perfusion were used \nfor thrombus length measurement. Results of used techniques were compared and \ncorrelated with results of systemic thrombolytic therapy (24 hours recanalization \nand 3-month clinical outcome).\nResults: There was no statistically significant difference in measurement results \nusing conventional CTA and tMIP, but in 23 subjects (36%) measurement of throm-\nbus was not possible using conventional CTA due to unclear peripheral border of \nthrombus. We proved statistically significant correlation of whole extent of thrombus \nand recanalization success (p=0.0241). The involvement of M2 section was main \nnegative factor for recanalization (p=0.0068). The strong significant correlation of \nthrombus length and 3-month clinical outcome was proved (p=0.0079) with cut-off \nvalue of 11 mm.\nConclusion: Our results confirm the benefits of detailed evaluation of cerebral arter-\nies using tMIP datasets, which enable to measure thrombus length in all subjects in \ncomparison to conventional CTA. The thrombus length was established as negative \nfactor for recanalization and clinical outcome after systemic thrombolytic therapy.\nthat with an optimised MR-protocol, mural inflammatory changes of superficial \nextracranial and intradural arteries can be detected in patients with GCA.\nMethods and Materials: 10 patients with suspected GCA underwent 3.0 Tesla MRI, \nincluding fat saturated (fs) T1w scans pre- and post-contrast, optimised for assess-\nment of intradural VWE, and high-resolution fsT1w scans to evaluate superficial \nextracranial vessels. Temporal artery biopsies were available in 4 cases. VWE of \nintradural and extracranial vessels was evaluated by two observers\nResults: In 5 patients, GCA was diagnosed clinically, in 4 biopsy proven. A clear \nVWE of superficial extracranial vessels was detected in 8 cases. Clear VWE of the \nintradural internal carotid artery (ICA) was detected in 6 cases, 5 with correspond-\ning vessel wall thickening. Slight enhancement of the right medial cerebral artery \nwas seen in 1 case. In one patient with GCA, no VWE of intradural or extracranial \nvessels was detected. One patient who did not receive a temporal artery biopsy \npresented with VWE of intradural and extracranial arteries, but the final clinical \ndiagnosis was connective tissue disease.\nConclusion: VWE of extracranial vessels is a frequent finding in GCA. Additionally, \nVWE of intradural arteries, mainly the ICA, can be found. Therefore, high-resolution \nMRI seems to be a feasible technique to visualise vasculitic involvement of the \nextra- and intracranial arteries in GCA.\nB‑0355 11:15\nBOLD fMRI of cerebrovascular reserve in patients with severe \nstenosis of the middle cerebral artery: preliminary results \nA. Krainik, A. Attye, M. Villien, K. Boubagra, K. Garambois, J. Bouvier, \nJ. Warnking, F. Tahon, O. Detante; Grenoble/FR (akrainik@chu-grenoble.fr) \nPurpose: To measure cerebrovascular reserve using fMRI (CVR fMRI) in patients \nwith severe stenosis of the middle cerebral artery (MCA) to identify those at risk \nof haemodynamical stroke.\nMethods and Materials: Among 16 patients with severe intracranial arterial steno-\nsis, 7 patients (4 females; 61.9±18.5years) had a stenosis of the right (n=4) or left \n(n=3) MCA only. CVR fMRI was performed using BOLD contrast with a block-design \nhypercapnic challenge (CO2 7%) at 3 T. Averaged end-tidal CO2 pressure (EtCO2) \nwas used as regressor for statistical analyses. We measured %BOLD/mmHg EtCO2 \non segmented grey matter of MCA territories. We calculated a laterality index with \nLIMCA =(Left_CVR-Right_ CVR)/(Left_ CVR+Right_ CVR). LI were compared \nto those obtained in 100 volunteers that provided a 99% confidence interval for | \nLIMCA |< 0.08. Basal perfusion was measured using dynamic susceptibility contrast.\nResults: Basal perfusion measurements were symmetrical in all patients. No \nadverse reaction to hypercapnia was detected. CVR values ranged from 0.13 to \n0.37 with m±sd=0.25±0.07. Among these 7 patients, three patients had a normal \n|LIMCA|< 0.08 ranging from 0.02 to 0.05 (0.04±0.01), and four patients had an \nabnormal |LIMCA|> 0.08 ranging from 0.13 to 0.17 (0.16±0.02). All abnormal LI \nvalues identified the MCA territory ipsilateral to the stenosis.\nConclusion: These preliminary results show that among patients with severe \nstenosis of MCA, several patients have abnormal |LIMCA| in the territory ipsilateral \nto the stenotic artery, suggesting significant CVR impairment that might be at risk of \nhaemodynamic stroke. CVR fMRI should be considered to better define treatment \nstrategy, including intravascular stenting.\nAuthor Disclosures:\nJ. Bouvier: Research/Grant Support; Philips.\nB‑0356 11:24\nIntracranial artery calcification on CT predicts poor outcome after \nstroke: results from a prospective cohort study \nC. Ovesen, H. Christensen, A.-M. Abild, C. Hansen, I. Havsteen, J. Nielsen, \nA. Christensen; Copenhagen/DK (anderschristensenemail@hotmail.com) \nPurpose: Intracranial atherosclerosis has been reported a significant risk factor \nof recurrent stroke. We investigated if intracranial calcifications (ICC) predicted \nrecurrent vascular events and death in long-term follow-up.\nMethods and Materials: Cerebral CT (CT-C) and CT-angiography (CTA) from \nconsecutive patients admitted to a single centre with acute ischaemic stroke within \n4.5 hours in the period from April 2009 to December 2011 with follow -up until \nAugust 2012 were included in the analysis. ICC was recorded using a four-point \ngrading scale of calcifications in the intracranial segment of the internal carotid \nartery. Recurrence was defined as stroke, transitory ischaemic attack (TIA), or \nmyocardial infarction (MI) documented by a discharge card; poor outcome was \nrecurrence or death.\nResults: First degree calcifications was found in 426/661 patients; 2. degree in \n123/661; 67 had 3. degree, and 45 had 4. degree. Mean follow-up was 701 days \n(range 238-1192 days), 13 patients were lost to follow-up, all visitors to Denmark. \nFifty-three patients died and 42 suffered recurrent ischaemic stroke, of whom 18 \n\nScientific Sessions\nS229\nA\n C D E F G\nB\nFriday\nB‑0362 10:39\nEvaluation of atherosclerosis and endothelial functions in \nnonalcoholic hepatosteatosis patients: comparison with ultrasound \nand biochemical markers \nM.G. Yilmabasar, A. Hayirlioglu, U. Ozdamarlar, I. Kuru; Istanbul/TR \n(yilmabasar@gmail.com) \nPurpose: In this study, we aimed to evaluate the endothelial functions in patients \nwith nonalcoholic fatty liver disease (NAFLD).\nMethods and Materials: In this observational case-control study, a total of 51 pa-\ntients with NAFLD and age and sex-matched 21 healthy controls were enrolled. In \nboth patients and controls, levels of asymmetric dimethylarginine (ADMA), systemic \nendothelial function (brachial artery flow-mediated dilation) (FMD) and carotid artery \nintima-media thickness (C-IMT, mm) were measured. Endothelial functions of the \nbrachial and carotid arteries were evaluated by vascular ultrasound.\nResults: Carotid intima media thickness was significantly higher in patients \nwith NAFLD than controls (0.67±0.09 versus 0.52±0.11 mm, P < 0.001). The \naverage C-IMT measurements were found in groups of control, simple steatosis \nand NAFLD with (borderline and definitive) NASH as 0.52±0.11, 0.63±0.07 and \n0.68±0.1 mm, respectively. The differences between groups were significant (P \n< 0.001). Measurement of brachial artery FMD was significantly lower in patients \nwith NAFLD compared to controls (7.3±4.8 versus 16.5±7.1%, P < 0.001). FMD \nmeasurements in groups of control, the simple steatosis and NAFLD with NASH \nas 16.5±7.1, 9.64±6.63 and 7.03±4.57%, respectively, and the differences were \nstatistically significant (P < 0.001). The increase in C-IMT and decrease in FMD \nwere independent of metabolic syndrome and it was also more evident in patients \nwith simple steatosis and NASH compared to controls.\nConclusion: Our data suggested that NAFLD is associated with endothelial \ndysfunction and increased early atherosclerosis compared to healthy subjects. \nB‑0363 10:48\nCT angiography in renal donors using automated kVp selection \nin combination with sinogram-affirmed iterative reconstruction: \nevaluation of radiation dose and image quality \nM.P.F. Botelho, F.D. Gonzalez-Guindalini, P. Entezari, H. Chalian, V. Yaghmai; \nChicago, IL/US (v-yaghmai@northwestern.edu) \nPurpose: This study aimed to assess image quality and radiation dose of CT \nangiography (CTA) in kidney donors obtained with automated kVp selection and \nsinogram-affirmed iterative reconstruction (SAFIRE), using scans with fixed kVp \nand filtered back projection reconstruction algorithm as the comparison.\nMethods and Materials: Mean attenuation, contrast-to-noise ratio (CNR) and \nsignal-to-noise ratio (SNR) at abdominal aorta, right renal artery (RRA) and left \nrenal artery (LRA) were measured in 24 kidney donors who had undergone CTA \nwith tube current modulation, 120 kVp, filtered back projection reconstruction al-\ngorithm (Group A) and were compared with 24 BMI-matched kidney donors who \nhad undergone CTA with automated kVp selection and SAFIRE (Group B). Mean \nCTDIvol was calculated for the unenhanced and arterial phases. Student’s t-test \nwas used for analysis.\nResults: BMI was comparable between the groups (P=0.38). Lower kVp was au-\ntomatically selected in19/24 of Group B patients (79.1%). Mean attenuation level \nwas significantly different between Groups A and B in abdominal aorta (300 +41.49 \nvs 389.22 +93.89, P=0.0004), RRA (292.56 ±52.15 vs 361.61 ±90.1, P=0.0043) \nand LRA (292.28 ±49.45 vs 359.73 ±78.29, P=0.0017). CNR and SNR at RRA and \nLRA were significantly higher in Group B compared with Group A (P=0.0043 and \nP=0.0061, respectively). Mean CTDIvol was 15.08 ±3.6 mGy and 10.27 ±3.7 mGy \nfor Groups A and B, respectively (P=0.0005).\nConclusion: Both SNR and CNR were improved by automated kVp selection with \nSAFIRE in kidney donors undergoing abdominal CTA while receiving significantly \nlower radiation dose. \nAuthor Disclosures:\nM.P.F. Botelho: Research/Grant Support; Educational Grant Support by \nSiemens Healthcare. F.D. Gonzalez-Guindalini: Research/Grant Support; \nEducational Grant Support by Siemens Healthcare. H. Chalian: Research/Grant \nSupport; Educational Grant Support by Siemens Healthcare.\nB‑0359 11:51\nMRI findings in small vessel disease and their relationship to \ncognitive impairment \nP. Benjamin, A.J. Lawrence, B. Patel, A.W. Chung, T.R. Barrick, \nA.D. Mackinnnon, R. Morris, H.S. Markus; London/UK \n(philipbenjamin@doctors.net.uk) \nPurpose: Cerebral small vessel disease (SVD) is a common cause of cognitive \nimpairment. White matter hyperintensities (WMH) and lacunar infarcts are the \ncommonest magnetic resonance imaging (MRI) parameters observed in clinical \npractice. The relationship between these findings on MRI and cognitive impairment \nremains unclear. The aim of our study was to determine the relationship between \nlacune count, total lacune volume and location of lacunes with cognition.\nMethods and Materials: Patients with lacunar stroke and WMHs were recruited \nto the prospective SCANS study. Baseline data (n=121) was used for this analysis. \nMultimodal MRI and neuropsychological testing were performed. Lacunes were \nidentified and counted by a neuroradiologist on a T1 image, then mapped using \nan automated region growing technique. Lacunar volume was calculated from \nthe resulting masks, and lacunar location automatically determined by projection \nonto standard atlases. T2 WMH volume and brain volume were also measured.\nResults: In multiple regression controlling for WMH volume and brain volume, both \nthe lacune number and the total volume were related to a significant decrease in \nexecutive function (number: Beta=-0.21, p < 0.006; volume: Beta=-0.16, p < 0.04) \nand processing speed (number: Beta=-0.26, p < 0.001; volume: Beta=-0.24, p < \n0.004). Lacunes in the thalamus were associated with impaired processing speed \nperformance (p < 0.002).\nConclusion: One can infer a number of things relating to cognitive impairment \nwhen looking at an MRI scan of a patient with cerebral small vessel disease. 1) The \nnumber of lacunes are a better predictor of cognitive status than diffuse WMH and \n2) thalamic lacunes, in particular, are associated with impaired processing speed.\n10:30 - 12:00 Room N/O \nVascular \nSS 515 \nNovel tools for blood flow evaluation \nModerators: \nJ. Barkhausen; Lübeck/DE \nF. Garaci; Rome/IT \nB‑0361 10:30\nAssessment of blood flow haemodynamics of liver cirrhosis patients \nafter treatment with a TIPS stent-graft using a flowsensitive 4D MRI \nimaging at 3 Tesla \nZ. Stankovic1, M.F. Russe2, B. Jung2, W. Euringer2, Z. Csatari2, \nL. Stehlin2, M. Langer2, M. Markl1; 1Chicago, IL/US, \n2Freiburg/DE (zoran.stankovic@uniklinik-freiburg.de) \nPurpose: To perform qualitative and quantitative analysis of altered haemodynam-\nics of liver cirrhosis patients after TIPS-stent-graft implantation and volunteers using \ntime-resolved flow-sensitive 4D MRI at 3 T.\nMethods and Materials: Our study group consisted of 5 liver cirrhosis patients \nincluding an examination before and after stent-graft implantation as well as 10 \nvolunteers. 3D liver flow characteristics in the arteries and portal vein were evalu-\nated using flow-sensitive 4D MRI at 3 T MRI with a spatial resolution of 1.6x2.1x2.4 \nmm³ and temporal resolution of 62.4 ms. Hepatic flow visualisation was performed \nusing 3D streamlines and time-resolved particle traces. Quantitative evaluation \nincluded retrospective extraction of regional maximum and mean velocities, flow \nvolume, vessel area as well as pulsatility and resistance indices.\nResults: 3D streamlines and particle traces visualisation in the arterial and portal \nvenous system could successfully be performed for almost all patients and volun-\nteers. Quantitative results reveal maximum and mean velocities tend to be lower \nin MRI compared to Doppler Ultrasound, area showed significant lower values \nfor US (p < 0.01). Comparing the changes after TIPS-stent-graft implantation the \ndata results demonstrated an increase of velocities and flow volume in the venous \nsystem as well as hepatic artery.\nConclusion: Flow-sensitive 4D MRI enabled a qualitative and quantitative evalua-\ntion of arterial and portal venous haemodynamics of liver cirrhosis patients before \nand after TIPS-stent-graft implantation including a volunteer group. Flow-sensitive \n4D MRI may be a standardised method with complete volumetric and functional \ncoverage of the blood flow haemodynamics providing additional information in \npatients after TIPS-stent-graft implantation. \n\nScientific Sessions\nS230\n C A D E F\n G\nB\non a 5-point-scale. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) \nwas calculated with ROI measurements.\nResults: SNR of the common carotid artery and middle cerebral artery was \n53.6±22.7 and 43.3±15.3 (group A) versus 54.1±20.5 and 46.2±14.6 (group B). \nCNR was 40.0±19.3 and 29.7±12.0 (group A) compared to 40.7±16.8 and 32.9±10.9 \n(group B). Subjective IQ was excellent in both groups (mean score 4.4±0.7 versus \n4.4±0.6). Differences between the two groups were not significant.\nConclusion: The OSDR algorithm XCare™ does not compromise IQ of head and \nneck CTA. Its application can be recommended for CTA in clinical routine to protect \nthe thyroid gland and ocular lenses from unnecessary high radiation. \nB‑0367 11:24\nPrecision of pulmonary vein diameter measurements assessed by \nCE-MRA and steady-state-free precession imaging \nF. Henes, P. Bannas, M. Regier, J. Buhk, K. Müllerleile, G. Adam, M. Groth; \nHamburg/DE (f.henes@uke.uni-hamburg.de) \nPurpose: To evaluate inter- and intraobserver reliability of pulmonary vein (PV) \ndiameter measurements by contrast-enhanced magnetic resonance angiogra-\nphy (CE-MRA) and ECG-gated 2D unenhanced steady-state-free precession \nsequences (SSFP).\nMethods and Materials: CE-MRA and SSFP of 60 PV in 17 patients were evalu-\nated. PV diameters were measured in transverse and coronal orientation at prede-\nfined levels by two independent readers. Intraclass correlation coefficient (ICC) and \nBland-Altman analysis (BA) were used to assess inter- and intraobserver reliability \nand variances. F-test was performed for comparison of intra- and interobserver \nvariances. Pearson´s correlation coefficient and BA were used to compare CE-\nMRA and SSFP. A t-test was used to determine possible significant differences \nbetween the measurements.\nResults: There was moderate correlation (R = 0.68, transverse; R = 0.66, coronal) \nwithout significant difference in diameter measurements between CE-MRA and \nSSFP (p = 0.15, transverse; p = 0.25, coronal). Intraobserver limits of agreement \n(LAG) ranged between ±0.50 cm (transverse) and ±0.86 cm (coronal) for CE-MRA \nversus ±0.40 cm (transverse) and ±0.67 cm (coronal) for SSFP. Interobserver \nagreement showed LAG ranging between ±0.59 cm (transverse) and ±0.83 cm \n(coronal) for CE-MRA versus ±0.34 cm (transverse) and ± 0.75 cm (coronal) for \nSSFP. Only transverse SSFP measurements revealed ICC > 0.75. Intra- and \ninterobserver variances did not reveal significant differences between CE-MRA \nand SSFP in any orientation (all p-values > 0.05).\nConclusion: SSFP and CE-MRA enable comparable precision of PV diameter \nmeasurements. However both methods revealed a wide range of intra- and inter-\nobserver agreement, which has to be thoroughly considered in the clinical use. \nB‑0368 11:33\nThe application of CT angiography with whole brain perfusion \nimaging in the evaluation of patients with transient ischaemic attack \nH. Shi, F. Yang, X. Ma, W. Guo, S. Dong, M. Qiao; Beijing/CN \n(shihuiping@yahoo.com) \nPurpose: To investigate the 320-row low-dose volume CT perfusion imaging com-\nbined with CT angiography in the evaluation of cerebral microcirculation changes \nof transient ischaemic attack (TIA).\nMethods and Materials: Sixteen cases of TIA patients (male 11, female 5) \nunderwent 320 row of dynamic volume CT perfusion imaging combined with CT \nangiography during 40 ml 370 mgI/ml contrast agent injection and acquired the blood \nflow perfusion parameters such as regional cerebral flow (rCBF), regional cerebral \nvolume (rCBV), mean transit time (MTT), time to peak (TTP) and delay time (DLY) \nand dynamic 4D-CTA images. The measured region including the ischaemia side \nlocal lesions and the corresponding healthy side brain tissue perfusion parameters. \nThe dynamic 4D-CTA images were reconstructed to show vascular stenosis site \nand vascular collateral circulations.\nResults: The stenosis of one side middle cerebral artery in 13 cases, one side \nposterior cerebral artery in 3 cases. The CBF, CBV, MTT, TTP and DLY in stenosis \nand healthy side had statistically significant difference (p < 0.05) and the param-\neters were 33.9 ± 6.4 and 35.7± 6.9 ml/ (100 g •min), 2.03±0.15 and 2.11±0.18 \nml/100 g, 3.88±0.66 and 3.69±0.72s, 14.43±4.20 and 13.68±4.08s, 2.09±0.85s \nand 1.51±0.58s. \nConclusion: The one-stop CTP/CTA imaging technique significantly improves \nthe accuracy and efficiency in the evaluation of cerebral arteries stenosis, infarct \nlocalisation and abnormal blood perfusion and is a perfect imaging tool for the \nTIA diagnosis.\nB‑0364 10:57\nComparison of high pitch (3) and standard pitch (0.6) CT \nangiography using 128-slice dual-source CT in patients with \nperipheral arterial disease \nK. Choo, J. Park, J. Kim, J. Roh; Busan/KR (speedsmile@hanmail.net) \nPurpose: We investigated the effect of high-pitch (3) CT angiography with good \nimage quality on qualitative and quantitative parameters and reduced the radiation \ndose in patients with peripheral arterial disease.\nMethods and Materials: Eighty patients were divided into two groups; the protocol \nwas high pitch in 40 patients group and standard pitch in the other 40 patients \ngroup. For quantitative analysis we calculated the mean arterial attenuation, the \nmean difference between maximum and minimum attenuation values, contrast-to-\nnoise ratio (CNR) and figure of merit (FOM). In addition, visual scores were used \nfor qualitative evaluation.\nResults: There were no significant intergroup differences in mean arterial attenua-\ntion (high pitch vs. standard pitch: 428.6 ± 85.6 vs. 434.3 ± 86.9 HU) and in the mean \ndifference between maximum and minimum attenuation (high pitch vs. standard \npitch: 240.1 ± 90.0 vs. 220.1 ± 98.4 HU). Both the mean CNR and the mean FOM \nwere not significantly different (high pitch vs. standard pitch: 27.0 ± 10.8 vs. 28.0 \n± 8.6, 2.2 ± 1.96 vs. 1.5±0.8, respectively), and there was no significant intergroup \ndifference in visual scores. The mean dose-length product was significantly lower \nat high pitch than at standard pitch (408.4 ± 43.4 vs. 619.8 ± 188.4.7 mGy·cm).\nConclusion: The high-pitch protocol CT angiography with 128-slice dual-source CT \nallows for reduction of the radiation dose by approximately 34% versus standard \npitch protocol CT angiography with 128-slice dual-source CT without deterioration \nof vascular enhancement and image quality. \nB‑0365 11:06\nDifferential diagnosis of cervical artery dissection and intra-arterial \nthrombosis using MRI and MRA \nM. Dreval, M. Krotenkova, L. Kalashnikova, L. Dobryinina, R. Konovalov; \nMoscow/RU \nPurpose: This study aimed at exploring MRI and 3D-TOF MRA in differential di-\nagnosis of intra-arterial thrombosis and cervical artery dissection (internal carotid \nartery and vertebral artery) in different periods of disease using the contrast index.\nMethods and Materials: A total of 40 patients with extracranial artery dissection \nmanifested by ischaemic stroke or isolated headache (20 men, 20 woman, mean \nage 37.3±6.1 years) and 8 patients (5 men, 3 woman, mean age 52.4±8.8) with \nischaemic stroke due to intra-arterial thrombosis were studied. Scanning protocol \nincluded 3D-TOF MRA sequence for extracranial internal and vertebral arteries and \nT1 fat suppression (f/s) sequence for neck in axial plane. MRT/MRA were carried \nin dynamics and obtained data were analysed in 6 time intervals: 1-3 days, 4-7 \ndays, 8-14 days, 15-21 days, 22-60 days and 61-90 days. Intramural haematoma \n(IMH), intra artery thrombus (IAT) and m. sternocleidomastoid signal intensity was \nmeasured and contrast index calculated.\nResults: After statistical analysis of the data with the use of non-parametric sta-\ntistical methods (Mann-Whitney U test) it was revealed that value of the contrast \nindex of IMH was higher than that of IAT within 2-5 time interval (4 to 60 days) (p \n< 0.05). The contrast index did not differ significantly within first 3 days and during \n3 months. The subjective visual analysis showed the same results.\nConclusion: MRI sequences as T1 f/s and 3D-TOF MRA could be useful for \ndifferential diagnosis of IMH and IAT within the interval of 4 days to 2 months of \nthe disease. \nB‑0366 11:15\nImpact of organ-specific dose reduction on image quality of head \nand neck CT-angiography \nR.S. Lanzman, L. Schimmöller, P. Heusch, S. Dietrich, \nF. Miese, J. Aissa, T.A. Heusner, G. Antoch, P. Kröpil; \nDüsseldorf/DE (Patric.Kroepil@med.uni-duesseldorf.de) \nPurpose: Organ-specific dose reduction (OSDR) algorithms can reduce radiation \non radiosensitive organs up to 59%. This study evaluates the influence of a new \nOSDR algorithm on image quality (IQ) of head and neck CT-angiography (CTA) \nin clinical routine.\nMethods and Materials: 62 consecutive patients (68.1±13.2 years) were ran-\ndomised into 2 groups and imaged on a 128-row CT-scanner. Group A (n=31) \nunderwent conventional CTA and group B (n=31) CTA with a novel OSDR algorithm \n(XCare™, Siemens), which lowers the radiation exposure of radiosensitive organs \n(e.g. eye lens, thyroid gland) by reducing the tube current for anterior projections. \nSubjective and objective IQ was statistically compared. Subjective IQ was rated \n\nScientific Sessions\nS231\nA\n C D E F G\nB\nFriday\nConclusion: SnapShot Freeze increases the diagnostic confidence of CCTA scans \nfor patients with high heart rates. \nAuthor Disclosures:\nJ.-L. Sablayrolles: Speaker; General Electric Healthcare. P. Ayestaran: \nEmployee; General Electric Healthcare. A. Sagniez: Employee; General Electric \nHealthcare.\nB‑0371 10:39\nEstimating effective dose for cardiac CT with patient-specific dose \nmaps in comparison with DLP conversion (“k factor”) method \nJ.H. Yanof1, C. Thompson1, J. Wiegert2, K. Yaddanapudi1, S. Halliburton1; \n1Cleveland, OH/US, 2Hamburg/DE \nPurpose: The widely adopted DLP conversion (“k”) factors, developed by Jessen \net. al., used to estimate effective dose are based on a standard reference phantom. \nThe aim of this study was to compare effective doses (ED) estimated from patient-\nspecific CT dose maps with those estimated using k factors.\nMethods and Materials: Nine cardiac CT data sets (mean patient age 56.6 yrs; \n5 F/4 M; BMI 22-42 kg/m 2) were obtained with a 256-slice scanner (iCT, Philips \nHealthcare). These contrast-enhanced coronary scans were performed with \nprospectively ECG triggered axial techniques. A full field of view (500 mm) image \nreconstruction was used with scan lengths ranging from 120 to 600 mm. Each \nimage data set was ‘voxelized’ to create a patient-specific “virtual phantom” with \nattenuation characteristics assigned based on CT numbers per ICRU 44. A Monte \nCarlo dosimetry simulation - using original scan parameters and modelled scan-\nner geometry - was used to compute absorbed dose values for each voxel of the \nvirtual phantoms to create individual dose maps. Dose maps were segmented by \ntwo consulting observers to determine patient-specific organ doses. Average EDs \ncomputed as 1) weighted sum of organ doses (ICRP 60) and 2) k x DLP were \ncompared with linear regression and percent differences.\nResults: ED values differed by an absolute mean percentage of 33.5%. The \nregression line was EDdosemap = 1.41 EDk - 0.98 (R2 = 0.78).\nConclusion: A standard effective dose estimate based on a k-factor can be signifi-\ncantly different from an estimate based on a patient-specific dose map.\nAuthor Disclosures:\nJ.H. Yanof: Employee; Philips Healthcare. C. Thompson: Research/Grant \nSupport; Support from Philips. J. Wiegert: Employee; Philips Research. \nS. Halliburton: Consultant; Philips Healthcare.\nB‑0372 10:48\nImpact of a new detector technology (Stellar, Siemens Healthcare) \non image noise in coronary CTA \nS.D.C. Deseive1, A.-L. Menges1, S. Martinoff1, M. Hadamitzky1, T. Flohr2, \nB. Schmidt2, C. Thierfelder2, T. Allmendinger2, J. Hausleiter1; 1Munich/DE, \n2Erlangen/DE (simon.deseive@gmx.de) \nPurpose: To evaluate the potential of a novel detector technology (Stellar, Siemens \nHealtcare) in combination with iterative image reconstruction (Safire, Siemens \nHealthcare) for the reduction of image noise in coronary CTA.\nMethods and Materials: Twenty (12 male) consecutive non-obese patients (group \nA) were scanned using a 2nd generation Dual Source CT system (Definition Flash, \nSiemens Healthcare) and matched to a control group (group B) of similar age, BMI \nand sex scanned prior to installation of the new Detector. Tube voltage and current \nwere set to 100 kV and 370 mAs in both groups. Image noise, signal intensity, \nsignal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were obtained as \nquantitative image quality parameters for all datasets.\nResults: Mean age and BMI were 58.2 and 24.6 in group A and 57.9 and 24.5 in \ngroup B. Image noise was 30 % lower in group A compared with group B (18.6 vs. \n26.3 HU), while signal intensity was comparable (484.5 vs. 479.7 HU) resulting in \nsignificantly higher SNR (27.4 vs. 19.4) and CNR (21.6 vs. 15.7).\nConclusion: In combination with iterative image reconstruction, image noise can \neffectively be reduced with the novel detector technology. \nAuthor Disclosures:\nT. Flohr: Employee; Siemens Healthcare. B. Schmidt: Employee; Siemens \nHealthcare. C. Thierfelder: Employee; Siemens Healthcare. T. Allmendinger: \nEmployee; Siemens Healthcar. J. Hausleiter: Research/Grant Support; \nSiemens Healthcare. Speaker; Siemens Healthcare.\nB‑0369 11:42\nMulticentre, intra-individual comparison of single dose gadobenate \ndimeglumine and double dose gadopentetate dimeglumine for MR \nangiography of the peripheral arteries \nR. Iezzi1, J. Wang2, F. Yan2, J. Liu3, D. Li4, X. Wang3, Y. Li2, F. De Cobelli5, \nG. Pirovano6; 1Rome/IT, 2Shanghai/CN, 3Peking/CN, 4Hefei/CN, 5Milan/IT, \n6Princeton, NJ/US (miles.kirchin@bracco.com) \nPurpose: To prospectively compare single dose gadobenate dimeglumine with \ndouble dose gadopentetate dimeglumine for CE-MRA in patients with peripheral \narterial occlusive disease (PAOD).\nMethods and Materials: Institutional Review Board approval and informed patient \nconsent was obtained. Sixty-eight patients (53M/15 F; 62.4±15.68 years) with \nsuspected moderate-to-severe PAOD were enrolled for randomised 3-station CE-\nMRA with 0.1 mmol/kg gadobenate dimeglumine and 0.2 mmol/kg gadopentetate \ndimeglumine. Three blinded readers assessed images for vessel anatomical deline-\nation, disease detection/exclusion, and global preference. Diagnostic performance \n(sensitivity, specificity, accuracy, PPV and NPV) for detection of ³51% stenosis was \ndetermined for 53 patients who underwent DSA. The non-inferiority of single dose \ngadobenate dimeglumine was assessed using the Wilcoxon signed rank, McNemar, \nand Wald tests. Quantitative enhancement was compared.\nResults: No differences (p³0.25) were noted for any qualitative parameter at \nany station. Equivalence was reported in at least 62/64 patients (93.8% 3-reader \nagreement) for diagnostic preference. Superiority for gadobenate dimeglumine \nwas reported by all readers for all diagnostic performance indicators (sensitivity: \n80.4-88.0% vs. 75.2-85.8%; specificity: 89.8-96.0% vs. 88.7-94.8%; accuracy: \n87.4-91.7% vs. 84.9-90.6%; PPV: 84.0-92.8% vs. 82.3-90.8%; NPV: 88.5-92.4% \nvs. 85.7-91.1%) with significance (p²0.05) shown by reader 1 for sensitivity, accu-\nracy and NPV. No differences (p> 0.05) were noted by any reader for quantitative \nenhancement in the pelvis although significantly (p < 0.05) greater enhancement \nwith gadobenate dimeglumine was noted by 2 readers in the thigh.\nConclusion: The image quality and diagnostic performance achieved on peripheral \nCE-MRA with 0.1 mmol/kg gadobenate dimeglumine is at least equivalent to that \nachieved with 0.2 mmol/kg gadopentetate dimeglumine.\n10:30 - 12:00 Room P \nCardiac \nSS 503 \nAdvances in coronary CT angiography \nModerators: \nS. Bohata; Brno/CZ \nL. Natale; Sesto Fiorentino/IT \nB‑0370 10:30\nEvaluation of a novel algorithm for coronary motion compensation \nin prospective and retrospective coronary CT angiography (CCTA) \nJ.-L. Sablayrolles1, J. Feignoux1, P. Ayestaran2, A. Sagniez2; 1Saint Denis/FR, \n2Buc/FR (jl.sablayrolles@me.com) \nPurpose: Assessment of coronaries on patients with high heart rate (HR) using \npresent generation CT is challenging due to an increase of vessel motion. The \npurpose of this study was to evaluate the performance of a novel coronary motion \ncompensation algorithm on patients with a HR > 60 bpm.\nMethods and Materials: Prospective or Retrospective CCTA scans on 15 patients \nwith minimum HR of 60 (mean: 72) where acquired using a Discovery CT750 HD \n(GE Healthcare, Waukesha, WI) and reconstructed using conventional CCTA re-\nconstruction algorithm (STD) and novel coronary motion compensation algorithm, \nSnapShot Freeze (SSF). Two senior cardiovascular radiologists evaluated diag-\nnostic image quality of 13 coronary segments in a blinded manner using a 4-grade \nscale (1 non-diagnostic, 4 excellent). 186 coronary segments were assessed.\nResults: Overall number of diagnostic segments was higher using SSF compared \nwith STD (95% vs. 85%). Overall average score of SSF reconstructed segments \nwas significantly higher compared with STD reconstruction (2.7 vs. 2.4, T-Test \np=0.0002). Specifically, average score for right coronary segments (2.8 vs. 2.3, T-\nTest p=0.0001), left coronary segments (2.9 vs. 2.7, T-Test p=0.023) and circumflex \ncoronary segments (2.8 vs. 2.6, T-Test p=0.04) were significantly higher with SSF \ncompared with STD, whereas average score of acute marginal coronary (2.7 vs. \n2.5, T-Test p=0.17) and ramus intermedius coronary (2.6 vs. 2.2, T-Test p=0.09) \nshowed no significant difference between SSF and STD. On 9 patients ramus \nintermedius coronary was missing.\n\nScientific Sessions\nS232\n C A D E F\n G\nB\nB‑0375 11:15\nComputed tomography coronary angiography with a consistent \ndose below 2 mSv using double high-pitch spiral acquisition in \npatients with atrial fibrillation \nQ. Wang, Y. Chen, B. He; Beijing/CN (doctorwq@126.com) \nPurpose: To evaluate the feasibility and imaging quality of double prospectively \nECG-triggered high-pitch spiral acquisition mode for coronary computed tomog-\nraphy angiography (CTCA) in patients with atrial fibrillation (AF).\nMethods and Materials: 47 patients (11 women, 36 men; mean age 64.5±12.1 \nyears) were enrolled for CTCA examinations using a dual-source CT with 2×128 \n× 0.6 mm collimation, 0.28 s rotation time and a pitch of 3.4. Double high-pitch \nmode was prospectively triggered first at 60% and later at 30% of the R-R interval \nwithin two cardiac cycles. Image quality was evaluated using a four-point scale (1 \n= excellent, 4 = non-assessable).\nResults: From 672 coronary artery segments, 77.5% (521/672) was rated as score \nof 1, 20.8% (140/672) as score of 2, 1.2% (8/672) as score of 3 and 0.4% (3/672) \nwas rated as ‘non-assessable’. The average image quality score was 1.25±0.38 \non a per segment basis. Mean dose-length product (DLP) for CTCA was 92.6±28.2 \nmGy·cm, the effective dose was 1.30±0.39 mSv (0.64-1.97 mSv).\nConclusion: In patients with AF, double prospectively ECG-triggered high-pitch \nspiral acquisition could be a feasible and valuable scan mode for CTCA with a \nconsistent dose below 2 mSv as well as diagnostic imaging quality. \nB‑0376 11:24\nCoronary artery calcium scoring from dual-source chest CT: \npotentials for ungated, high-pitch scan technique in routine clinical \npractice \nF. Molinari, A. Hutt, M. Rémy-Jardin, J.-B. Faivre, A. Simeone, E. Algeri, \nJ. Rémy; Lille/FR (martine.remy@chru-lille.fr) \nPurpose: To assess the concordance between ungated, high-pitch (thoracic) and \nECG-gated (cardiac) examinations in the assessment of coronary artery calcium \n(CAC) score.\nMethods and Materials: 185 smokers (mean heart rate: 71.9 bpm) underwent \ndual-source CT examinations with acquisition of two sets of images during the \nsame session: (a) an ungated, high-pitch scan over the entire thorax (pitch: 3.0, \ntemporal resolution: 75 ms) (group 1); (b) a prospectively ECG-gated scan over the \ncardiac cavities (group 2). Two operators independently analysed the CAC load on \nboth examinations and categorised the population according to the Agatston score.\nResults: The interobserver reproducibility was good for both techniques (group 1: \nkappa=0.90, group 2: kappa=0.89). The mean absolute values of the Agatston score \ndid not significantly differ between groups (p=0.18). There was good reproducibility \nbetween the two techniques in classifying the population according to the commonly \nused cutoffs (kappa: 0.90). The ungated technique adequately categorised 172 out \nof the 185 patients (93); in the 13 discordant cases (13/185; 7), the ungated studies \nyielded lower scores than gated studies, with no more than one score category \nmisplaced by the ungated studies. BMI and heart rates did not significantly differ \nbetween concordant and discordant scores (p=0.81, p=0.21, respectively). Differ-\nences in CAC scores between techniques were correlated to differences in the \nCAC scores at the level of the right coronary artery (r=0.98; p=.0001).\nConclusion: Despite the mean heart rate of the studied population, a good con-\ncordance in assessing the CAC scores was found between ungated, high-pitch \nand ECG-gated examinations.\nB‑0377 11:33\nDiagnostic accuracy of free-breathing coronary CTA using dual-\nsource CT high-pitch acquisition: comparison of single and double \nscans with conventional angiography \nM.C. So1, W.L. Chin2, C.M. Wong1, C.W. Tai1, M.W. Leung1; 1Hong Kong/HK, \n2Singapore/SG (ninamc_so@yahoo.com.hk) \nPurpose: To retrospectively investigate whether two subsequent prospectively \nECG-gated high-pitch CT acquisitions can increase the diagnostic accuracy of \ncoronary CT angiography (CCTA) for free-breathing patients compared with a \nsingle acquisition and conventional angiography.\nMethods and Materials: Twenty-one patients (8 male, 13 female, mean age 77.2 \nyears) with heart rates < 60 bpm unable to hold their breath underwent two im-\nmediately subsequent free-breathing CCTA scans in dual-source CT prospectively \nECG-triggered high-pitch mode, followed by conventional angiography within 1 \nmonth. CCTA data and conventional angiograms were evaluated by segment by \ntwo different observers. CCTA image quality was rated on a four-point scale (1 = \nexcellent to 4 = unevaluable) with ³50% diameter stenosis considered significant. \nB‑0373 10:57\nRadiation dose reduction in computed tomography myocardial \nperfusion imaging using iterative reconstruction and patient-tailored \nimaging \nM. Williams1, S. Golay1, N.W. Weir1, S. Mirsadraee1, E.J.R. Van Beek1, J. Reid2, \nG. McKillop1, N. Uren1, D.E. Newby1; 1Edinburgh/UK, 2Melrose/UK \nPurpose: We assessed the application of iterative reconstruction and patient-\ntailored imaging on radiation dose in computed tomography (CT) myocardial \nperfusion imaging (CTP).\nMethods and Materials: Participants underwent rest CT coronary angiography \nand adenosine stress CTP using a 320-multidetector scanner (Aquilion ONE, \nToshiba). Radiation dose reduction techniques included iterative reconstruction \n(AIDR3D), tube current adjustment-based scout attenuation and half-segment \nreconstruction. Dose length product (DLP) and image noise were recorded. Sub-\njective image quality was assessed (1, excellent; 4, uninterpretable) and summed \nfor 17 myocardial segments.\nResults: For 28 patients before and 18 after introduction of the protocol there was \nno difference in gender (68% male vs 72%, p0.754), body mass index (28 kg/m 2 \n(95% CI 27.30) vs 28 (25.30), p0.512), heart rate at rest (56 beats/minute (53.58) \nvs 56 (52.60), p0.970) or stress (73 (69.77) vs 72 (66.78), p0.837), or z-axis collima-\ntion at rest (133 mm (127,138) vs 129 (124,135), p0.956) or stress (115 (108,123) \nvs 120 (112,130), p0.961). There was a significant reduction in tube current (470 \nmA (453,486) vs 371 (290,452), p0.021), tube voltage (96% at 120 kV vs 33%, p \n< 0.001) and DLP at rest (225 mGy.cm (213,238) vs 144 (102,186), p0.001) and \nstress (584 (474,693) vs 242 (171,312), p < 0.001). There was no difference in \nimage noise at rest (30 Hu (26.34) vs 33 (31.36), p0.167) and a small increase at \nstress (26 (22.31) vs 39 (33.45), p0.001). There was no difference in subjective \nimage quality (median 17 [IQR 17.21] vs 17 [17.19], p0.523).\nConclusion: Iterative reconstruction and patient-tailored imaging led to a 60% \nreduction in CTP radiation dose, while maintaining image quality. \nB‑0374 11:06\nRadiation dose reduction in cardiac CTA using a novel iterative \nreconstruction algorithm in 320-row detector CT \nT. Durmus1, R. Luhur1, J. Blobel2, J. Mews2, A. Lembcke1; 1Berlin/DE, \n2Neuss/DE (tahir.durmus@charite.de) \nPurpose: Radiation exposure reduction in cardiac CTA using a novel iterative \nreconstruction algorithm (AIDR3D) with automatic exposure control (AEC).\nMethods and Materials: 60 patients were examined on a 320-row detector CT \n(AquilionONE, Toshiba Medical Systems) using 100 kV, 8-12 cm z-axis, 350 ms \nacquisition time, 0.5 mm slice thickness and 320 mm FoV. Contrast medium injec-\ntion was performed using a standardised protocol with 0.66 mg Iodine per kg body \nweight. Group 1 (G1) consisted of 30 patients (BMI=25.7±3.6 kg/m2, HF=54.9±7.4 \nbpm) examined using BMI adapted tube current (140-580 mA) and a FBP recon-\nstruction algorithm in combination with advanced noise reduction filters. In group \n2 (G2) 30 patients (BMI=25.7±3.7 kg/m2, HF=58.3±7.8 bpm) were examined using \nthe novel reconstruction algorithm AIDR3D. For AEC a target noise of 33 HU was \npredetermined. Analysis was performed using circular regions of interests placed \ninto the descending aorta (DA), left ventricular lumen (LV) and myocardial wall \n(MW). Signal- and contrast-to-noise-ratio (SNR, CNR) were calculated. Dose-\nlength-products (DLP) were recorded and effective doses were estimated. Results \nin G1 and G2 were compared using an unpaired t-test.\nResults: Both SNR and CNR differed significantly in both groups: SNR in G1 and \nG2 were 19.5±6.6 and 23.0±5.3, respectively, in DA (p=0.025) and 12.7±4.4 and \n20.4±4.5, respectively, in LV (p < 0.001). CNR in G1 and G2 were 9.3±3.7 and \n19.3±5.0, respectively (p < 0.001). Effective dose was in G2 (0.88±0.34mSv) 24% \nless than in G1 (1.15±0.46mSv; p < 0.011).\nConclusion: AIDR3D with AEC allows for significant radiation dose reduction \ncompared with advanced FBP reconstruction with BMI-adapted exposure. Image \nquality parameters in the AIDR3D group were superior to the reference group \nindicating further dose reduction potential. \nAuthor Disclosures:\nJ. Blobel: Employee; Toshiba Medical Systems. J. Mews: Employee; Toshiba \nMedical Systems.\n\nScientific Sessions\nS233\nA\n C D E F G\nB\nFriday\n10:30 - 12:00 Room Q \nRadiographers \nSS 514 \nThe radiographer’s role as health care team member \nModerators: \nV. Syrgiamiotis; Athens/GR \nC. Vandulek; Kaposvár/HU \nB‑0380 10:30\nHow do radiographers interact with children in the radiographic \nexamination? \nB. Björkman1, K. Enskär1, M. Golsäter1, R.J. Simeonsson2; 1Jönköping/SE, \n2Chapel Hill, NC/US (bjbe@hhj.hj.se) \nPurpose: The verbal interaction between the child and the radiographer in the \nradiographic examination is an unexplored, but important area of clinical practice. \nThe aim of this study was to investigate the nature of that interaction between child \nand radiographer and the extent to which it varied as a function of the child’s age.\nMethods and Materials: The participants in the study were 20 female radiographers \nand 32 children (3-15 years) examined for acute injuries. The verbal interactions \nof child and radiographer during the examination were videotaped and analysed \nusing the Roter Interaction Analysis System (RIAS). Descriptive and non-parametric \nstatistics were used to analyse the interaction data.\nResults: The results revealed that 80% of the verbal interaction was carried out \nby the radiographer either to the child or to an escorting parent, while 17% was \ncarried out by the child and 3% by the parent. Of the radiographers’ communication \ndirected to children, 78% was categorised as task-focused exchange and 22% as \nsocio-emotional exchange. Of children’s utterances, 34% was categorised as a \ntask-focused exchange and 66% involved socio-emotional exchange. The distribu-\ntion of task-focused and socio-emotional utterances varied with regard to children’s \nage. More frequent utterances and more frequent socio-emotional exchange were \nfound for interactions involving younger children.\nConclusion: These findings reinforce the need for radiographers to be flexible and \nsensitive in their interactions with children and to recognise the child’s individual \nand developmental capabilities when engaging them in radiographic procedures.\nB‑0381 10:39\nRequesting x-rays at the right time to utilise the capacity of the \nradiology department: an everyday challenge \nM. Mowinckel-Nilsen; Os/NO (milh@helse-bergen.no) \nPurpose: Historic data shows that delayed ordering of x-rays makes it difficult to \noptimally utilise the capacity of the Radiology department in a small orthopaedic \nhospital. What could be done to improve this?\nMethods and Materials: A method called patient-focused redesign (developed by \nLeicester Royal Infirmary, adapted to Norwegian conditions by Ringerike Hospital \nHF) was used as a tool to find a better workflow in ordering x-rays. A multidisciplinary \nteam was assembled, and a project outline was made with a process demarcation. \nThe team prepared a communication plan, mapped the current workflow, had a crea-\ntive phase redesigning a new workflow, and measured the situation before the new \nworkflow was tested in the hospital. An analysis of the old and new workflow was \nmade. Evaluation was done after the new workflow had been in place for 1.5 years; \nnew measurements were done to see the effects of the changes in the workflow.\nResults: Numbers of steps in the workflow were halved, saving time for several \nprofessions. X-ray examinations not ordered on time were reduced by 76.5%. \nExaminations ordered a week or more before the images were taken, which is \nwithin the desired timeframe, were increased by 64.1%.\nConclusion: Patient-focused redesign is a good method for finding better and more \nefficient workflows; it can save time, increase the exploitation ratio of the equipment, \nand ultimately increase the quality of the radiographic service. \nDiscrepancies between CT and conventional angiogram results were resolved by \nconsensus together with a third observer. Sensitivity, specificity and accuracy of \nsingle and double high-pitch scans were calculated on a per segment basis. Esti-\nmated effective radiation doses were calculated using dose length product x 0.014.\nResults: CCTA images were diagnostic for 86% (243/283) and 97% (276/283) \nof segments for single and double scans, respectively, and sensitivity, specificity \nand accuracy were 100%, 88%, 90% and 98%, 95%, 95%, respectively. The mean \nestimated effective radiation dose was 1.3mSv and 2.5mSv, respectively.\nConclusion: In patients with heart rates ²60 bpm, free-breathing CCTA using dual \nsource CT double scans in high-pitch acquisition mode was associated with high \ndiagnostic accuracy for the assessment of coronary artery stenosis at a very low \neffective radiation dose.\nAuthor Disclosures:\n W.L. Chin: Employee; Siemens Medical Solutions.\nB‑0378 11:42\nOne beat coronary CT angiography using 640 slices multidetector \nCT scanner in patients with atrial fibrillation \nA. Gennarelli, A. Di Sibio, M. Perri, F. Di Stasio, V. Felli, M. Di Luzio, \nA.V. Giordano, E. Di Cesare, C. Masciocchi; L’Aquila/IT \nPurpose: To evaluate image quality and ionising radiation doses of CT coronary \nangiography using 640-slices multidetector CT in patients with atrial fibrillation (AF).\nMethods and Materials: 28 patients that have persistent AF with median heart \nrate of 75 bpm underwent coronary CT angiography using 640-slices multidetec-\ntor CT with adaptive iterative dose reduction system. All CT examinations were \nperformed using a one-beat prospective gating; in patients, that presented heart \nrate > 65 bpm, was used a broad phase window width (30-85% of R-R). The effec-\ntive dose was assessed for every patient. Coronary arteries were subdivided into \n15 segments using the American Heart Association's (AHA) model. Image quality \nwas evaluated by two expert radiologists on a workstation (Vitrea, Toshiba) using a \n4-score grading system: score 1 (absence of motion artefacts), score 2 (presence \nof mild artefacts), score 3 (presence of moderate artefacts) and score 4 (presence \nof severe artefacts). Median score of both radiologist and inter-rater reliability (k \ncoefficient) were assessed.\nResults: Image quality was judged excellent (score 1) in 65.4% of coronary artery \nsegments (275/420), good (score 2) in 22.7% (95/420), fair (score 3) in 7.1% \n(30/420) and low (grade 4) in 4.8% (20/420). Mean effective dose was 3.35mSv \n(range between 1.3 and 7.9 mSv). Inter-rater reliability was excellent (k=0.85).\nConclusion: High image quality and low ionising radiations effective doses \ndemonstrate that the newest generation of CT scanner overcome the limitation at \ncoronary CT angiography that atrial fibrillation poses so far. \nB‑0379 11:51\nInfluence of AIDR on accuracy of plaque characterisation and lumen \nassessment during CT coronary angiography \nA. Ursani, H. Mehrez, H. Kashani, N. Paul; T oronto, ON/CA (ali.ursani@uhn.ca) \nPurpose: To determine the impact of Adaptive Iterative Dose Reduction (AIDR) on \naccurate lumen assessment in a custom-built arterial plaque phantom.\nMethods and Materials: Custom-built 10 cm coronary artery phantom with 6 x 3.5 \nmm (G1) and 6 x 5 mm (G2) vessels, lumen stenosis 0, 30, 50, 70, 90 and 100% \ndue to 400 HU and 800 HU plaque; and 3 x3.5 mm (G3) and 3 x 5 mm (G4) ves-\nsels with lumen stenosis 30, 50, 70% due to -60 HU and 60 HU plaque. The lumen \nmeasured +400 HU. Volume CT (vCT) was performed; spatial resolution 350 μm \nwith low- and high-resolution kernels (FC04, FC30, FC90), 120 kVp and 150 mA. \n0.5/0.35 mm axial images were reconstructed ± AIDR. In-line histography mapped \naverage plaque CT# (HU) and average lumen CT# (HU) and vessel profile. IN was \nmeasured and image contrast (C) calculated.\nResults: Lumen stenosis contrast data for soft filter kernel FC04 and cal-\ncified plaque 800 HU: Without AIDR: G1:30%=894/705; 50%=910/602; \n70%=784/550;90%=600/400; G2: 30%=919/550; 50%=915/500; \n70%=864/400;90%=413/360. With AIDR:\nG1: 30%=870/602; 50%=890/530; 70%=770/490; 90%=580/345. G2: 30%=900/620; \n50%=898/544; 70%=856/562; 90%=400/330 AIDR improved mean contrast ~10% \nfor calcified plaque and 15% for non-calcified plaque for all reconstructions with \n30-70% luminal stenosis (paired t-test, p²0.001). AIDR improved accurate repre-\nsentation of 90% lumen stenosis in 3.5 mm vessels.\nConclusion: AIDR improves plaque image contrast by 10-15% and visualisation \nof high-grade stenosis in 3.5 mm coronaries. This promises superior performance \nfor accurate coronary plaque characterisation and lumen assessment. \n\nScientific Sessions\nS234\n C A D E F\n G\nB\nResults: Analysis of the results for the area under the curve (AUC) demonstrated \nstatistically significant differences in the accuracy of fracture identification between \ngroups (p value < 0.032), when categorised with respect to post-graduation clinical \nexperience. Radiographers with greater and less than 3 years clinical experience \nscored mean Az scores of 0.737 and 0.716, respectively. A trend in increased \nperformance and increased clinical experience was also demonstrated with a \nmean increase of 9.2% and 8.8% in terms of sensitivity and specificity, respectively.\nConclusion: Radiographers with increased clinical experience performed the \nmost accurately with respect to AUC, sensitivity and specificity findings. Hospital \ncategory did not influence the radiographer’s performance in this investigation: \nuniversity teaching centre versus large regional centre. The acceptable standard \nfollowing post-graduate image interpretation training is 80-95% in terms of accuracy \nof skeletal fracture identification. Graduate training programmes/CPD modules in \nclinical decision making are recommended as is a survey on a national scale to \nincorporate a larger sample size. \nAuthor Disclosures:\nA.P. Tyrrell: Grant Recipient; Alan Tyrrell. Research/Grant Support; Irish \nInstitute of Radiography and Radiation Therapy Student Research Grant Winner \n2012.\nB‑0385 11:15\nWorkloads of reporting radiographers and sonographers: cost-\neffectiveness compared with consultant radiologist \nW.P. Hedges1, S.H. Khan2; 1Lancaster/UK, 2Blackburn/UK \n(will.hedges@doctors.org.uk) \nPurpose: To accurately measure the workload of radiographers and sonographers \nfor the first time in the UK and compare them with that of consultant radiologists \nin a DGH.\nMethods and Materials: Reporting data for sonographers, radiologists and report-\ning radiographers at a large DGH was taken from electronic records. These were \nconverted into an RVU score using an adapted version of the Pitman-Jones RVU \nsystem. Reporting workload was calculated by dividing the total RVU scores by the \nnumber of PA spent reporting images by members of each group.\nResults: There were 9 sonographers working 80.5 PA/week, 2 reporting radiog-\nraphers worked 10 PA/week, and 14 consultant radiologists working 158.21 PA/\nweek during the period April 2010 - March 2011. Sonographer workload amounted \nto 1,955.9 RVU per PA per year (RVU/PA/year). Radiographer workload was to \n4,277 RVU/PA/year. Crude consultant radiologist workload was 4,106 RVU/PA/\nyear, but they spend 42.49% of their time on non-reporting activities, giving a net \nscore of 7,140 RVU/PA/year.\nConclusion: The reporting radiographers and sonographers make a valuable and \nsignificant contribution dealing with the increasing radiology workload. However, \nradiologists are more productive per PA. Differences in pay grades makes cost-\neffectiveness between the groups more equal. \nB‑0386 11:24\nRadiographer’s expectations for role development: a national survey \nin view of radiography students in final year of graduation \nC.M. Mendes, A.F.C.L. Abrantes, R.P.P. Almeida, L.P.V. Ribeiro, S.I. Rodrigues; \nFaro/PT (celinemendes@msn.com) \nPurpose: To investigate the role development expectations of graduate radiog-\nraphers with a view to predicting the potential impact of a misalignment of these \nexpectations on quality of the service delivery and staff retention.\nMethods and Materials: A self-applied questionnaire development by Williamson \nand Mundy (2009) in UK was validated for the Portuguese language by the back-\ntranslation method with permission of the authors and assigned to radiography \nstudents in final year of graduation in the Portuguese health schools. A total of \n84 valid questionnaires, in the Likert scale format, utilised 20 attitude questions \nin relation to main themes of research (expectation, valence and knowledge) \nand were interpreted and statistically analyzed through descriptive statistics and \nSpearman’s rho correlation.\nResults: The radiography students stated an expectation for role development \nopportunities with 66.7% indicating that these expectations would be realized within \n2 (50.0%) and 5 (29.8%) years of graduation. A significant and strong positive \ncorrelation (r=0.791, p=0.000) between job satisfaction and expectation for role \ndevelopment in 5 years after graduation was seen. Farther, there were no significant \ndifferences between the health schools for the expectation, valence and knowledge.\nConclusion: There is an expectation and value assigned for role development \nopportunities. Expectation is seen to be intrinsically linked with job satisfaction \nsuggesting that misalignment of this would have a potentially negative impact on \nmotivation and retention of the future radiography workforce. However, there is \nB‑0382 10:48\nRisk management in computed tomography using an incident \nreporting system \nM. Antoniutti, S. Doratiotto; Treviso/IT (sdoratiotto@alice.it) \nPurpose: Improving the management of patient safety by adopting best manage-\nment practices for the governance of the system and the corporate network.\nMethods and Materials: Analysis of the critical situation in the diagnostic computed \ntomography (CT) performed in 2009-2011 with incident reporting system (IR) using \nthe instrument of audit and definition of improvement actions.\nResults: Improving actions have been taken together with a method of monitoring \nthe most critical issues with greater severity or frequency of occurrence in the CT \nprocess. Critical areas: high number of booking errors from the radiological studies \nof central booking, inappropriate requests by general practitioners (GPs). Improve-\nment action (IA): organization of the audit with GPs, the final shared document \nhas been spread through the Internet site. High number of patients not adequately \nprepared for the examination (non-hydrated, non-fasting, incomplete clinical in-\nformation, and incomplete filling of the informed consent form examination). IA: a \nletter from the chief of radiology was sent to all departments to alert that requests \nfor CT must be sent in. Radiology correctly completed and audit with GPs. Errors \nfound in PACS. IA: correction of PACS errors and permanent organization of audit.\nConclusion: This project helped the development of effective interventions closely \nrelated to the understanding of the organization’s critical work in the CT process \nwith the need to streamline the planning CT scan of the list to avoid an incongruous \nworkload and to give each patient the right welcome. Internal audits and permanent \nworking groups have been proposed to actuate effective remedial actions. \nB‑0383 10:57\nIs a radiographer-led immediate reporting service for emergency \ndepartment referrals a cost-effective initiative? \nM. Hardy1, B. Snaith2; 1Bradford/UK, 2 Wakefield/UK \n(M.L.Hardy1@bradford.ac.uk) \nPurpose: Demand for both Emergency Department (ED) and radiology services \ncontinues to increase across the UK while simultaneously, healthcare organisations \nare being asked to evaluate the quality of care provided and constrain service costs. \nNational guidance on radiograph reporting times recommends ED radiographs are \nreported on day of patient attendance but in practice, delays in reporting persist. \nThis study considers whether a radiographer-led immediate reporting service for \nED referrals could provide a cost-effective service improvement solution.\nMethods and Materials: A pragmatic multi-centre randomised controlled trial was \nundertaken. 1502 patients were recruited and randomly assigned to an immediate \nor delayed reporting arm and treated according to group assignment. Patient health \ngain was measured in terms of change in utilities derived from EQ-5D responses \nat baseline and 8-week follow-up. Resources used and the costs of an immediate \nreporting service were analysed at the patient level and compared to standard \nreporting practices.\nResults: 1688 radiographic examinations were performed (1502 patients). 79 dis-\ncordant radiographic interpretations were identified (n=79/1688; 4.7%). Interpretive \nerrors were significantly reduced within immediate reporting arm. No significant \ndifference was noted in the relative improvement in patient perceived health status \nbetween the 2 arms of the study. The average cost saving per patient in the im-\nmediate reporting arm £23.40.\nConclusion: Radiographer-led immediate reporting of ED radiographs is a \ncost-effective service development and its universal introduction could make a \nsignificant contribution to the current drive to increase service productivity within \ncurrent budget constraints.\nB‑0384 11:06\nAn investigation into the ability of Irish radiographers: in the \nidentification of wrist and scaphoid fractures \nA.P. Tyrrell1, L. Rainford2; 1Kilkenny/IE, 2Dublin/IE (louise.rainford@ucd.ie) \nPurpose: To investigate the ability of Irish radiographers in identifying and locating \nwrist/scaphoid fractures, to add to the evidence base for role expansion.\nMethods and Materials: In total, 25 radiographers across two university teaching \nand two large regional hospitals in Ireland participated. The computer application \nZiltron demonstrated 71 plain film wrist radiographs in a Free-Response Operating \nCharacteristic (FROC) study. The data set contained 35 abnormal images (fracture \n(s) present) and 36 normal (non-fracture). “Truth” was determined by the Radiol-\nogy report. Fracture were categorised: obvious to subtle. Statistical analysis was \nperformed by JAFROC application.\n\nScientific Sessions\nS235\nA\n C D E F G\nB\nFriday\nprovides insight into the influence of technology on the professional development \nand practice in this field.\nMethods and Materials: In August 2011, a postal questionnaire was distributed to \n521 hospital sites across the UK operating both a radiography and trauma service. \nInformation was sought relating to: the type of trauma and radiography service \noperated; details of the RADS operated, including education and audit to support \nradiographer participation; the mandatory/voluntary status of the RADS; and the \nimaging technology operating within the organization.\nResults: A total of 328 (n=328/521; 63.0%) responses were received within the \ndefined timeframe. Analysis of the data is ongoing but will include a descriptive \nsummary of current practice across the UK with regard to “red dot”, commenting \nand reporting by radiographers and assessment of the impact on the implementa-\ntion of digital imaging technology across the UK on service levels compared to an \nearlier survey undertaken in 2007.\nConclusion: Radiographer contribution to the interpretation of trauma images is \nan expectation of UK radiographer practice. Whether the profession has moved \nforward in its readiness to progress beyond “red dot” and embrace commenting is \nyet to be seen and this presentation will provide an insight into practice boundaries \nand variations that exist.\n14:00 - 15:30 Room A \nGenitourinary \nSS 607 \nFemale pelvis imaging \nModerators: \nL.S. Fournier; Paris/FR \nA.G. Rockall; London/UK \nB‑0390 14:00\nDiagnostic and prognostic value of 18F-FDG PET/MR over MR and \nPET/CT in recurrent gynaecologic malignancies prior to pelvic \nexenteration \nI.A. Burger1, H.A. Vargas2, O.F. Donati2, V. Andikyan2, H. Schoder2, D. Chi2, \nE. Sala2, H. Hricak2; 1Zurich/CH, 2New York, NY/US (irene.burger@usz.ch) \nPurpose: To assess the incremental value of fused MRI [18F]-FDG-PET compared \nto MRI or PET/CT for local disease extent prior to pelvic exenteration for recurrent \ngynaecological malignancies, and to determine if FDG uptake metrics [SUVmax, \ntotal lesion glycolysis (TLG) and metabolic tumour volume (MTV)] can be used as \npredictive biomarkers for overall survival.\nMethods and Materials: 31 patients undergoing FDG-PET/CT and pelvic MRI \nalone within 90 days prior to pelvic exenteration were retrospectively selected. \nThe presence of bladder, rectum and pelvic sidewall invasion was determined \non PET/CT, 3 months later on MRI and subsequently on fused MRI/PET images. \nFor each patient SUVmax, TLG and MTV were measured. Areas under the curve \n(AUCs) for detecting pelvic organ or side wall invasion were calculated. Kaplan \nMeier graphs were used to determine associations between SUVmax, TLG, MTV \nand overall survival.\nResults: The AUCs for bladder, rectum and pelvic side wall invasion were 0.90, \n0.92 and 0.77 for PET/CT, 0.86, 0.97 and 0.89 for MRI and 0.94, 0.99 and 0.99, \nrespectively, for fused MRI/PET. There was a significant association between \nTLG/MTV and overall survival (p=0.05/p=0.001), but not for SUVmax (p=0.317).\nConclusion: In patients undergoing pelvic exenteration for recurrent gynaecological \nmalignancies, fused MRI/PET was more accurate than PET/CT or MRI alone for \nassessment of local disease extent. TLG and MTV were predictive biomarkers for \noverall survival, but SUVmax was not associated with overall survival. \nB‑0391 14:09\nDiagnostic value of quantitative measurement of microvascular \nchanges achieved using perfusion MR imaging in the assessment of \ntumour grading in endometrial carcinoma \nO. Minutolo, D. Ippolito, A.C. Cadonici, P.A. Bonaffini, C. Capraro, S. Sironi; \nMonza/IT (orazio.minutolo@yahoo.com) \nPurpose: Diagnostic value of dynamic contrast-enhanced perfusion MRI in detec-\ntion and characterisation of endometrial cancer, correlated with tumour grading, \nbeing the histopathological analysis as the standard of reference.\nMethods and Materials: A total of 80 patients with histologically proven endometrial \ncarcinoma underwent a dedicated pelvic MRI examination (1.5 T system, Achieva, \nPhilips), using high-resolution pelvic phased array multicoil. Each patient scan \na lack of social recognition of the radiographer, suggesting the need to promote \nmeasures to increase the profession recognition.\nB‑0387 11:33\nJob satisfaction among radiographers in Switzerland: a national survey \nN. Richli Meystre, P. Lehmann, N. Mamboury; Lausanne/CH \n(nicole.richli@hesav.ch) \nPurpose: The technological improvements in radiology over the past decade \nhave resulted in an important rise in demands for radiological examinations and \ntreatments. An increasing number of well qualified radiographers are needed and \nhealthcare authorities are worried about the growing shortage of radiographers. Job \n(in)satisfaction has been highlighted as a contributing factor to turnover, respec-\ntively, to long-time retention. The aim of this survey was to appreciate workplace \nconditions and job satisfaction among radiographers.\nMethods and Materials: All radiographers working in Switzerland were invited to \nparticipate with an online questionnaire. Different factors contributing to job satisfac-\ntion were scored from -2 (very unsatisfied) up to +2 (very satisfied).\nResults: 753 radiographers completed the questionnaire. The response rate is \nestimated at 26%. 62% are working in diagnostic, 23 % in nuclear medicine and 15% \nin radiooncology. 37% are working for more than 10 years in the same place. The \noverall job satisfaction level was scored at 0.66. The highest levels were reached \nfor the diversity of job activities (+1.19), the quality of radiology facilities (+ 1.16), \nteamworking (+1.03) and autonomy (+1.03). The lowest levels were reached for \ncollaboration with radiologists (+0.23), salary (+ 0.17) and career opportunities (0).\nConclusion: Radiographers in Switzerland are rather satisfied about their job and \nthe workplace conditions. In order to avoid shortage, efforts should be taken to \nincrease the number of radiographer students and in supporting returnees. Job-\nenrichment measures are seen as a necessity for retention in a profession with \nlow career opportunities. \nB‑0388 11:42\nProgression of quality improvement works in radiography by \nradiographers \nR. Gullien, J.G. Andersen, A.E. Haakull; Oslo/NO (uxraul@ous-hf.no) \nPurpose: To visualise the ongoing progression over years in quality improvement \nwork in radiography by radiographers and share our experiences.\nMethods and Materials: 1) As a basis through the entire improvement work, \nthe National Quality Assurance Manual (QAM) that specifies how to measure \nthe quality assurance work was used. 2) Practiced the method in the department \nas basic measurement individual and overall measurements (static/snapshot). \n3) Individual and overall measurements recorded several times over a period to \nsee changes (dynamics/moving range) (local). 4) Implemented targeted improve-\nments. 5) Measured inter-variability among the quality control (QC) radiographers. \n6) Training the QC radiographers to avoid differences between them. 7) National \nmeeting with representatives from all counties (national). 8) Comparison across \nthe counties and input to the audit of the QAM. 9) Cooperation with hospital outside \nNorway, benchmarking the system, comparison across countries (international).\nResults: Radiographers were trained by self-assessment: their knowledge was \nupdated, their skills were developed, their attitude to regular audit was changed \nand improved, their own performances against international and national standard \nand objectives were reviewed. Targeted initiatives against unacceptable variances \nin performance are necessary. Time set aside to allow radiographic quality assur-\nance work, analysing, evaluating and act accordingly. QC radiographers have the \nresponsibility of ensuring the essential quality improvement and assurance work.\nConclusion: Progression is from snapshot/static to dynamics/moving range, from \ngeneral to focused measures, from local to national, from national to international. \nQuality improvements became more and more complex over time. Advancements \nand developments are important in addition to the continuous implementation of \nbasic training and instructions. \nB‑0389 11:51\nRadiographer contribution to the interpretation of trauma \nradiographs: a survey of UK practice \nB. Snaith1, M. Hardy2, E. Lewis1; 1 Wakefield/UK, 2Bradford/UK \n(bev.snaith@midyorks.nhs.uk) \nPurpose: Radiographer abnormality detection schemes (RADS) were introduced \nin the UK in the mid-1980s with the development of the “red dot scheme”. This \npresentation reports the findings of a new survey and establishes the current posi-\ntion of RADS (including “red dot”, commenting and reporting) across the UK and \n\nScientific Sessions\nS236\n C A D E F\n G\nB\nwas with the obturator in 12 cases and with the internal pudendal in one case. The \nangle of origin of the uterine artery on the right side showed a mean of 53.2° (SD: \n25.23, range: 0°-98°). On the left side the angle showed a mean value of 54.8° \n(SD: 17.72, range: 19°-91°).\nConclusion: The uterine artery arises typically directly from the IIA anterior division. \nAtypical origins like origin from the IIA main stem or from the IIA posterior division \nshould be searched for when the artery could not be found in its typical location. \nB‑0394 14:36\nFibre tracking evaluation of sacral nervous pathways 3D architecture \nin women affected by endometriosis \nM. Sergi, V. Vinci, S. Bernardo, P. Sollazzo, M. Saldari, L. Manganaro; Rome/IT \n(mariaeleonora.sergi@gmail.com) \nPurpose: To evaluate feasibility of tractography to study sacral nerves in women \naffected by pelvic endometriosis.\nMethods and Materials: We enrolled 2 groups of patient: 25 women with US \ndiagnosis of endometriosis and a control-group of 10 women. With 3 T MRI, we \nreconstructed nervous pathway postprocessing DTI images. We analysed 2 main \nparameters: 3D architecture of nervous pathways and fractional anisotropy values \n(FA). We analysed fibres length and branches morphology, thereafter we assigned \nto each a range of values obtaining 3 main classes of pathways: 1st class (normality, \n3-4), 2nd class (mild alteration, 5-6) and 3rd class (severe alteration, 7-8).\nResults: Analysing 3D nervous pathways, we obtained a homogeneous distribution \nof the control group (10pt) in the first class (normal pathways). All cases of en-\ndometriosis of the posterior compartments (18/25 patients) presented an abnormal \npathway (3rd class), while remaining cases with anterior-medial localisation were \nequally distributed in 1st and 2nd class. We obtained low FA values in both groups; \nhowever, in case-control group range values were included between 0.47 and 0.34 \nwhile in patient groups FA values were lower between 0.36 and 0.24.\nConclusion: Fibre tracking allowed a complete evaluation of the female pelvis defin-\ning the global situation of the patient and leastly formulating a potential explanation \nto symptoms. Fibrotic reaction, adhesions and nerves growth stimulation factors \nmay explain both of the altered branch morphology and the lower FA values. We \nsuggest tractography as a complementary tool for the female pelvis study, repre-\nsenting the only non-invasive way to study nervous pathways. \nB‑0395 14:45\nHow to improve magnetic resonance accuracy in detection of deep \ninfiltrating colorectal endometriosis: correlation with laparoscopy \nand histopathology \nM. Miccò, A.L. Valentini, B. Gui, V. Ninivaggi, M. Marino, L. Bonomo; Rome/IT \n(ninivaggi.valeria@hotmail.it) \nPurpose: To verify whether MRI accuracy in diagnosing deep infiltrating colorectal \nendometriosis (DICE) can be improved using an association of two selected find-\nings. Laparoscopy or histopathology was taken as the gold standard.\nMethods and Materials: Imaging database of our Institute was retrospectively \nreviewed. T2-weighted MR images were evaluated by two experienced radiologists \nusing two criteria. First, not thickened or thickened intestinal wall surrounded by \nfat-plane interface represents a normal result; nodules/hypointense plaque-like \nlesions in the adjacent fat-plane joint to thickened intestinal wall are considered an \nabnormal result. Second, not thickened or thickened intestinal wall surrounded or not \nby fat-plane interface represents a normal result; nodules/hypointense plaque-like \nlesions in the adjacent fat-plane joint to thickened intestinal wall showing “radiating \nretracting shape” are considered an abnormal result. A third radiologist looked in \nmedical history for laparoscopy and histopathology. MRI results were compared \nwith laparoscopy or histopathology findings by 2 x 2 tables and were statistically \nanalysed (K statistics).\nResults: 33/50 patients underwent laparoscopy. Intestinal resection was performed \nin 11/33 patients; in 22/33 superficial foci, adhesions or nodules were removed. MRI \nsensitivity, specificity, negative predictive value and positive predictive value were \n100%, 27.2%, 100% and 40.7%, respectively (agreement=51.5%; k value=0.20; \np < 0.055) when using the first, and 100%, 95.4%, 100% and 91.6%, respectively \n(agreement=96.9%; K value=0.93; p < 0.0000) when using the second criterion.\nConclusion: Nodules/hypointense plaque-like lesions joint to thickened intestinal \nwall showing “radiating retracting shape” improve MRI accuracy in DICE diagnosis.\nconsists of multiplanar T2 and T1 sequences and dynamic contrast-enhanced \nTHRIVE. Philips’s workstation was used to generate colour permeability maps \nshowing perfusion of enhancing tumours. After the placing of regions of interests \n(ROIs) on the site of the maps which best corresponded to the enhanced regions of \nlesion, the following parameters were calculated: relative enhancement, maximum \nenhancement, maximum relative enhancement and time to peak.\nResults: Pathological results of all patients were obtained postoperatively and \ncompared with DSCE-MRI perfusion parameters. At histological examination \n21 patients had G1 tumour, 44 had G2, 14 had G3 and 1 had squamous cell \ncarcinoma. Tumour locations visualised on T2w and DSCE-MRI were consistent \nwith histopathological findings and the quantitative analysis showed the following \nvalues for endometrial cancer: RE (%) 61.4±36.4; ME (%) 829.4±418.8; MRE (%) \n69.4±42.2 and TTP (sec) 179.5±27.4. The corresponding values calculated in \nnormal endometrium were: RE (%) 157.1±61.3; ME (%) 1634.5±625.7; MRE (%) \n128.8±51.6 and TTP (sec) 193.6±23.8. A significant (p < 0.001) decrease of each \nevaluated parameters was obtained for tumour lesions in comparison with normal \nmyometrium, furthermore a significant higher values (p < 0.001) for RE, ME, MRE \nwere obtained for G1 tumours (less aggressive) than those with G2 or G3 grading.\nConclusion: Conventional MRI combined with perfusion DSCE represents a \nfeasible technique that provides non-invasive, quantitative parameters of vascu-\nlarization, useful in the assessment of diagnosis of patient with endometrial cancer, \noffering quantitative and qualitative information about biological characteristics of \nendometrial cancer, related to tumour aggressiveness.\nB‑0392 14:18\nInfluence of pathophysiological parameters with kinematic MRI in \nevaluation of female pelvic floor \nM. Palumbo, S. Carbone, L.S. Maltese, D. D’Elia, A. Luceri, V. Ricci, \nL. Volterrani; Siena/IT (palumbomichele81@hotmail.it) \nPurpose: To evaluate the correlation between pelvic floor morphometry obtained \nby Cinematic MR imaging (CineMRI) and physiological and pathophysiological \nparameters.\nMethods and Materials: Two groups of patients were recruited in a period of 6 \nmonths: 18 patients without symptoms (group A, age 41.83 ± 15.05 years), who \nperformed MRI of the pelvis for other indications, 13 patients (group B, age 60.84 ± \n11.30 years) with clear symptoms attributable to pelvic floor dysfunction. All patients \nwere given a questionnaire designed to obtain physiological data (age, gender, \nBMI) and pathological (diabetes, comorbidities, previous pelvic surgery). The MRI \nprovided a morphological study with T2-weighted sequences in the axial sagittal \nand coronal plane and an Cinematic FIESTA (Fast Imaging Employing Steady-\nState Acquisition) in the sagittal plane at rest and during the phase of maximum \nstraining, to measure the line pubo-coccygeal (PCL), the line H (pelvis diastasis) \nand the M (lower pelvis).\nResults: BMI correlated significantly with H (p = 0.037) and PCL (p = 0.026), while \nage correlated with H (p = 0.009) and M (p = 0.004). The parity but not the number \nof children causes a significant increase in pelvic lowering (p = 0.038) as well as \nprevious pelvic surgery (p = 0.038).\nConclusion: The pathophysiological changes are predictive of morphometric pa-\nrameters obtained with MRI. Because of its fast acquisition a cinematic sequence \ncould be advisable in all study protocols of female pelvis. \nB‑0393 14:27\nOrigin of the uterine artery in females using three-dimensional \nreconstructed contrast-enhanced MR angiography before uterine \nartery embolisation: where to look for it \nN.N.N. Naguib, N.-E.A. Nour-Eldin, T. Lehnert, B. Schulz, S. Zangos, T.J. Vogl; \nFrankfurt a. Main/DE (nagy3n@yahoo.com) \nPurpose: To describe the patterns of origin of the uterine artery from the internal \niliac artery (IIA) before uterine artery embolisation (UAE) using three-dimensional \n(3D) reconstructed contrast-enhanced MR angiography (CE-MRA).\nMethods and Materials: The study was retrospectively performed on 84 females \n(mean age 45.5 year). Pre-embolisation CE-MRA was performed before UAE. 3D \nimages were reconstructed using Syngo-VesselView application. For each uterine \nartery the point of origin was identified and the angle which the artery makes with \nits main stem of origin was calculated.\nResults: The uterine artery was detected in 165 (98.2%) of the 168 (84 patients) \narteries. The artery originated directly from the IIA anterior division in 141 arteries \nof the detected arteries (85.5%), from the IIA bifurcation point in 7 arteries (4.2%), \nfrom the IIA main stem in 3 arteries (1.8%) and 1 uterine artery (0.6%) originated \nfrom the IIA posterior division. The uterine artery originated indirectly from the \nanterior division with a common segment in 13 arteries (7.9%). The common origin \n\nScientific Sessions\nS237\nA\n C D E F G\nB\nFriday\nmeasured on the MR console and compared among positions. The obstetric con-\njugate and the sagittal inlet and outlet were both assessed in the midsagittal plane.\nResults: MR pelvimetry in the different positions proved feasible in all subjects, \nyielding diagnostic quality images in every volunteer and pregnant woman, although \nthe hand-to-knee positions were found difficult to maintain. In the hand-to-knee \nposition, pelvic inlet reduced from 13.3 cm to 13.0 cm and obstetric conjugate from \n12.6 cm to 12.3 cm. In contrast, sagittal midpelvic diameter enlarged from 13.3 cm \nto 13.6 cm, pelvic outlet anteroposterior diameter from 11.5 to 12.0 cm and sagittal \npelvic outlet diameter from 8.7 cm to 9.1 cm.\nConclusion: Our results showed that a hand-to-knee birthing position expands \nsagittal midpelvic diameter, pelvic outlet anteroposterior diameter and sagittal pelvic \noutlet diameter, suggesting facilitation of labour and delivery. \nB‑0399 15:21\nRetrospective analysis of elements that can predict short- and long-\nterm outcome in patients affected by uterine leiomyomas and treated \nwith MRgFUS \nF. Ciolina, A. Napoli, F. Zaccagna, F. Boni, L. Bertaccini, V. Noce, \nB. Cavallo Marincola, C. Catalano; Rome/IT (federica.ciolina@gmail.com) \nPurpose: To retrospectively evaluate predictive factors to obtain an optimal \ntreatment of uterine fibroids treated using Magnetic Resonance guided Focused \nUltrasound (MRgFUS).\nMethods and Materials: 68 fibroids (52±18 mm) in 55 symptomatic women (age \naverage 40±5) were treated using MRgFUS (ExAblate 2100) combined with a 3 T \nMR unit (GE). T2 SI and T1 SI of fibroids were measured on pre-treatment exami-\nnation before and after administration of gadolinium (Gd-BOPTA, Bracco); also the \ndistance between centre of myoma and skin, skin thickness, maximum diameter and \nvolume of fibroids were recorded. The day of treatment the non-perfused volume \n(NPV) was recorded at the end of the treatment. It was considered treatment time \nin terms of energy (J) used and duration of single sonication. All parameters were \nrelated to final NPV and volume shrinkage at 12 months to established short- and \nlong-term results of treatment.\nResults: Difference between T1 SI of the fibroids and healthy myometrium signifi-\ncantly correlates with volume shrinkage (45%) and NPV (60%, r=0.85). T2 SI on \npre-treatment studies, distance between skin surface and centre of myoma (53±19 \nmm) and skin thickness (13±7 mm) show a mild correlation with volume reduction at \n12 months (36+18 mm, respectively r=-72.5 p=0.047 and r=69.7 p=0.03).Moreover, \nthere was positive correlation between measured parameters, sonication duration \nand energy necessary to obtain a > 50% NPV (70±15%, r= 62.8, p=0.021).\nConclusion: SI ratio on T1w of uterine fibroids and myometrium on screening MRI \nshould be considered as predictor of positive outcome for MRgFUS treatment. \n14:00 - 15:30 Room B \nNeuro \nSS 611 \nAlzheimer’s and Parkinson’s \nModerators: \nB. Góraj; Nijmegen/NL \nT. Meindl; Landshut/DE \nB‑0400 14:00\nMCI to AD conversion and the role of myoinositol (MI) and \nN-acetylaspertate (NAA) as biomarkers for this process \nJ. Walecki, M. Barcikowska, J.B. Ćwikła, T. Gabrylewicz, T. Bulski; Warsaw/PL \n(jerzy.walecki@cskmswia.pl) \nPurpose: The objective of this study was to evaluate metabolic changes in patients \nsuffering from MCI using MR proton spectroscopy. These metabolic changes \nseem to be biomarkers for clinical conversion from MCI to AD. Among the many \nmodalities which diagnose preclinical and early AD (e.g. PET amyloid imaging) \n1H MRS still remains vital.\nMethods and Materials: MRS was performed on a group of 51 MCI diagnosed \npatients. All of them had clinical and biochemical tests as well as standard neu-\nropsychological examinations. An MCI diagnosis was established following the \ncriteria proposed by the Mayo Clinical Group. 1H MRS was performed with a \nsingle-voxel method using the PRESS sequence. Results were presented in ratios \nand quantitatively (LC model).\nResults: All patients had at least two annual clinical check-ups. In the beginning, \n14 subjects had amnestic MCI and the others had multidomain MCI. During clinical \nB‑0396 14:54\nPreliminary functional study with MR defecography in patients \nsuffering from deep endometriosis \nP. Sollazzo, S. Bernardo, M. Sergi, V. Vinci, M. Saldari, L. Manganaro; Rome/IT \n(valeriavinci87@yahoo.it) \nPurpose: We evaluated feasibility of 3 T system in the detection of endometriosis \nimplants in the Douglas Pouch, in order to offer a precise preoperative diagnosis \nof deep infiltrative endometriosis involving this particular region.\nMethods and Materials: From October 2010 and April 2011, we enrolled 19 women \ncoming with either ultrasound or anamnestic suspect of endometriosis. Pelvic MRI \nexamination was performed on 3 T system. We theoretically divided female pelvis in \nthree compartments and concentrated on the posterior one, evaluating, in particular, \nthe uterosacral ligaments and the specific signs of posterior cul-de-sac obliteration.\nResults: MRI diagnosed posterior cul-de-sac obliteration in 15/19 patients. We \ndetected in 5/15 cases nodular endometriosis implants in PCS; signs of fibrotic \nplaque on the uterine serosal surface were identified in 4/15 cases; 3/15 cases \nshowed a tethered appearance of the rectum, 6/15 cases presented an elevation \nof the posterior vaginal fornix. In 3/15 cases strands between uterus and intestine \nwas clearly depictable, at last, involvement of utero-sacral ligaments (USLs) and \nsigns of utero-sacral ligaments involvement were identified in 6/15 cases. Moreo-\nver, glandular-like collection localised behind uterus was identified in 7/15 cases. \nMRI findings were compared with laparoscopy, thus obtaining a sensitivity value \nof 93%, and specificity value of 75%\nConclusion: Precise preoperative mapping of posterior cul-de-sac region is es-\nsential for a preoperative planning. In our work 3 T MRI revealed excellent in the \nevaluation of posterior cul-de-sac obliteration associated with an optimal evaluation \nof the utero-sacral ligaments, due to the higher contrast spatial resolution. \nB‑0397 15:03\nDiffusion-weighted magnetic resonance imaging of the female \npelvis: do apparent diffusion coefficient values of the fat tissue \nchange over the menstrual phases? \nF. Fornasa, A. Gasparini, F. Pantalone, M. Bellotti, A. Dibenedetto, C. Cicciò; \nSan Bonifacio/IT (francescafornasa@libero.it) \nPurpose: To establish whether the apparent diffusion coefficient (ADC) measured \nwith DWI in the pelvic fat tissue of healthy reproductive-age women significantly \nvaries from the proliferative to the periovulatory phase of the menstrual cycle.\nMethods and Materials: 27 women (18-40 years), not assuming oral contracep-\ntives nor referring any vaginal discharge or abnormalities of their menstrual cycles, \nunderwent pelvic DWI (1.5 T, 8-channel coil, sagittal scans, b values: 0 and 800 \nmm/sec2) both at the 5th day after the beginning of the menstruation and repeat-\nedly every day in the periovulatory phase; among these latter examinations, the \none corresponding to the 14th day before the subsequent cycle was retrospectively \nselected. An ADC value resulting from the average of three measurements obtained \nat slightly different position was calculated for each examination within a circular-\nshaped, 4-mm diameter region of interest totally included in the adipose tissue of \nthe ischiorectal fossa. The statistical significance of the differences between the \nADC values measured in the two menstrual phases was determined using the \nStudent’s t-test per paired data.\nResults: The ADC values measured in the pelvic adipose tissue in the proliferative \nphase of the menstrual cycle (mean: 0.765 mm2/sec, range: 0.26-1.26) were higher \nthan those obtained in the periovulatory phase (mean: 0.558 mm2/sec, range: \n0.24-0.89). The difference was highly significant at statistical analysis (p < 0.001).\nConclusion: The ADC values measured with DWI in the pelvic adipose tissue of \nhealthy reproductive-age women are significantly higher during the proliferative \nthan in the periovulatory phase of the menstrual cycle. \nB‑0398 15:12\nEffect of different birthing positions on pelvic bony dimensions in \nhealthy women and pregnant patients in MR pelvimetry \nS. Zangos, K. Eichler, A. Schollenberger, A. Reitter, F. Louwen, P. Siebenhandl, \nT. Gruber-Rouh, T.J. Vogl; Frankfurt a. Main/DE (zangos@em.uni-frankfurt.de) \nPurpose: The aim of this study was to evaluate whether pelvic dimensions changes \nwith pregnancy or different birthing positions.\nMethods and Materials: MR pelvimetry was performed in 40 nonpregnant female \nvolunteers and in 40 women with a foetus in a breech presentation in a 1.5-T MR \nimaging system (Magnetom Espree; Siemens, Erlangen). Images were taken in the \nsupine and hand-to-knee position. The obstetric conjugate, sagittal inlet, outlet and \nmidpelvic diameter, and interspinous, intertuberous, and transverse diameters were \n\nScientific Sessions\nS238\n C A D E F\n G\nB\nB‑0403 14:27\nMR spectroscopy in mild and moderate cognitive impairment as \nillness outcome predictor: preliminary experience \nJ. Forner Giner1, A. Alberich-Bayarri1, G. Garcia Marti1, A. Pomar-Nadal1, \nJ. Rayón-Aledo2, L. Martí-Bonmatí1; 1Valencia/ES, 2Madrid/ES \n(aalberich.val@quiron.es) \nPurpose: To evaluate Alzheimer’s disease premature diagnosis based on spec-\ntroscopy MRI.\nMethods and Materials: We carried out a prospective study on 178 patients (116 \nwomen and 62 men) whose ages ranged 27 to 68 years (mean age 65 ± 12). Every \npatient presented mild or moderate cognitive impairment according to Reisberg \nscore (3-4 grade). Standard brain MR and spectroscopy brain MR were performed \nusing a 3 T intensity MRI device (Archieva TX, Philips Healthcare, Best, The \nNetherlands). Spectroscopy MR was focused in posterior parietal and frontal lobes \ngray substance using a unique volume (20 x 20 x 15 mm) and two different echo-\ntimes, TE (32 and 136). Morphology and volume of temporal lobes were evaluated \nthrough FLAIR coronal images which were used to quantify temporal horn width \nand so classify patients in four groups. JMRUI (Java Magnetic Resonance User \nInterface) was used to calculate quantitative parameters in MR spectroscopy. MR \nwas used to measure: calculation of NAA (N-acetyl aspartate), Cr (creatinine), Cho \n(choline) and mI (myo-inositol) metabolites ratios. We used analysis of variance to \ncompare metabolite ratios between the different patient groups previously defined.\nResults: We found significant differences (p ² 0.05) between groups in NAA/Cho \nconcentration (p=0.022), both in long and in short eco times and frontal and parietal \nanatomical regions. No other significant differences between groups were found.\nConclusion: MR spectroscopy could increase efficiency in Alzheimer’s disease \npremature diagnosis as well as turning out to be a useful additional tool for the \nclinician next to clinical history.\nB‑0404 14:36\nDifferentiating multiple system atrophy and Parkinson’s disease on \n3 T MRI: a novel use of decision tree \nS. Rajandran Nair, L.K. Tan, N. Ramli, S.Y. Lim, K. Rahmat, H. Mohd Nor; \nKuala Lumpur/MY \nPurpose: Differentiation of multiple system atrophy (MSA) and Parkinson’s dis-\nease (PD) remains a clinical challenge. The purpose of this study was to develop \na decision tree using parameters obtained from standard MRI and diffusion tensor \nimaging (DTI) to distinguish these clinical entities.\nMethods and Materials: We performed standard MRI brain and DTI at 3.0 T on \n26 PD and 13 MSA patients. Linear, volumetry and DTI (fractional anisotropy, FA \nand mean diffusivity, MD) of putamen, substantia nigra, pons, middle cerebellar \npeduncles (MCP) and cerebellum were measured. A three-node decision tree was \ndeveloped, with the aim of 100% specificity at node 1, 100% sensitivity at node 2 \nand highest combined sensitivity and specificity at node 3.\nResults: Mean MCP width, anteroposterior diameter of pons and mean FA MCP \nwith cut-off values of 14.6 mm, 21.8 mm and 0.55 respectively, were selected for the \ndecision tree from nine parameters (mean width, FA and MD of MCP; anteroposterior \ndiameter of pons; cerebellar FA and volume; pons and mean putamen volume; \nmean FA substantia nigra compacta-rostral) that showed statistically significant (P \n< 0.05) differences between MSA and PD. The decision tree accurately classified \n12 out of 13 MSA patients with an overall 92% sensitivity, 96% specificity, 92% \nPPV and 96% NPV.\nConclusion: The decision tree could be used as a diagnostic algorithm in the \ndifferentiation of MSA and PD.\nB‑0405 14:45\nSubthalamic nuclei 3 Tesla T2-relaxometry correlated to UPDRS \nscores in pre-deep brain stimulation (DBS) patients with Parkinson \ndisease with consideration to the laterality of the disease \nT.M.L. Lönnfors-Weitzel, T. Weitzel, J. Slotboom, C. Kiefer, A. Kaelin-Lang, \nC. Pollo, R. Wiest; Berne/CH (tarja.loennfors@insel.ch) \nPurpose: Degeneration within the subthalamic nucleus (STN) in Parkinson’s dis-\nease (PD) is a potential marker for targeting DBS. We aimed to investigate whether \npre- and postoperative Unified Parkinson’s Disease Rating Scale (UPDRS) scores \nare related to T2 relaxation (T2r) of the STN and whether there is a correlation of \nlaterality between clinical assessment and T2r.\nMethods and Materials: 12 patients and 14 controls were examined at 3 Tesla \nby a multicontrast spinecho sequence. STN and control volumes relaxation times \nwere analysed UPDRS scores were determined during “on” and “off” pre- and \npostoperatively.\nfollow-up checks (median 3 years) 15 subjects had stable disease (SD), 20 had \nprogression of disease (PD) and 16 developed AD. Baseline metabolic ratios (1H \nMRS) between the 3 groups of patients indicated significant differences in the left \nfrontal lobe in mI/H20 ratio, between patients with SD (0.27) and DP (0.22) (P = \n0.03). In groups of patients with DP and AD there was a significant difference in \nNAA/Cr (1.77 vs. 1.43), (P = 0.02).\nConclusion: MI and NAA seem to be very sensitive biomarkers for conversion \nfrom MCI to AD. The significance of our metabolic ratio results needs further study. \nB‑0401 14:09\nEvaluation of posterior cingulate region with FDG-PET and MR \nadvanced techniques (MRS, PWI and DTI) in patients with MCI - \ncorrelation of the methods \nA. Zimny, J. Bladowska, A. Macioszek, P. Szewczyk, E. Trypka, R. Wojtynska, \nJ. Leszek, M.J. Sasiadek; Wroclaw/PL (abernac@wp.pl) \nPurpose: Posterior cingulate region (PCR) is an area of the earliest pathologi-\ncal changes in mild cognitive impairment (MCI). PET is the only imaging method \nincluded in diagnostic criteria of dementia. The aim of the study was to compare \nFDG-PET and MR measurements.\nMethods and Materials: Fifty five patients diagnosed with MCI (66.5 yrs) according \nto clinical criteria and PET scan and 20 age-matched controls (69 yrs) underwent \nMR examination including MRS, PWI and DTI. Values of metabolite ratios (NAA/\nCr, Cho/Cr, mI/Cr), cerebral blood volume (rCBV) and fractional anisotropy (FA) \nwere compared to the rates of glucose metabolism within PCR.\nResults: Compared to controls, MCI patients showed significant (p < 0.05) glucose \nhypometabolism and decreased rCBV and FA values. FDG-PET results correlated \nsignificantly only with rCBV values. Compared to FDG-PET, PWI showed similar \nand DTI higher accuracy in distinguishing MCI from controls. According to FDG-PET \nfindings 2 groups of MCI patients were established: with normal (30 subjects) and \nlower (25 subjects) glucose metabolism within PCR. MCI subjects with normal PET \nscan showed normal MRS and PWI results but significantly decreased FA values \nwhile MCI subjects with glucose hypometabolism revealed normal MRS findings \nbut lower rCBV and FA values.\nConclusion: Advanced MR techniques such as PWI and DTI may be regarded \nas competitive techniques to FDG-PET, with PWI showing similar and DTI higher \naccuracy in distinguishing MCI from the control group. DTI was the only method \nto show changes in MCI patients with normal FDG-PET scan and normal PWI \nand MRS findings. \nB‑0402 14:18\nThe relation of uric acid with brain atrophy and cognition: the \nRotterdam scan study \nB.F.J. Verhaaren, M.W. Vernooij, A. Dehghan, H. Vrooman, \nR. de Boer, W.J. Niessen, A. van der Lugt, M.A. Ikram; Rotterdam/NL \n(b.verhaaren@erasmusmc.nl) \nPurpose: Uric acid has been associated with focal vascular brain disease such as \nlacunar infarcts and white matter lesions. However, it is unknown whether uric acid \nalso relates to global brain changes such as brain atrophy. We therefore studied \nthe relation of uric acid with brain atrophy and whether this is coupled with worse \ncognitive function.\nMethods and Materials: In 814 persons of the population-based Rotterdam study \n(mean age 62.0 years), we studied the relation of uric acid levels with brain tissue \natrophy and cognition, using linear regression models, adjusted for age, sex and \nputative confounders. Brain atrophy was assessed using automated processing \nof MRI. Cognition was assessed using a validated neuropsychological test-battery \nand we computed compound scores of cognitive domains.\nResults: Higher uric acid levels were associated with white matter atrophy (differ-\nence in Z-score of white matter volume per standard deviation increase in uric acid: \n-0.07 (95% confidence interval: -0.12; -0.01)). This was particularly marked when \ncomparing hyperuricaemic to normo-uricaemic persons (Z-score difference: -0.27 \n(-0.43; -0.11)). Worse cognition was primarily found in persons with hyperuricaemia \n(-0.28 (-0.48; -0.08)).\nConclusion: Hyperuricaemia is related to white matter atrophy and worse cognition.\n\nScientific Sessions\nS239\nA\n C D E F G\nB\nFriday\nB‑0408 15:12\nThe neural correlates of anomia in the conversion from mild \ncognitive impairment to Alzheimer’s disease \nE. Pravata’1, J. Tavernier1, R. Parker2, H. Vavro3, J.E. Mintzer1, \nM. Spampinato1; 1Charleston, SC/US, 2Gainesville, FL/US, 3Zagreb/HR \n(emanuele.pravata@gmail.com) \nPurpose: Language impairment is frequently observed in patients with Alzheimer’s \ndisease (AD; in this study, we investigated the extent and distribution of brain \natrophy in subjects with conversion from mild cognitive impairment (MCI) to AD \nwith and without naming difficulties.\nMethods and Materials: This study was approved by the Institutional Review Board \nand was HIPAA compliant. All subjects or their legal representatives gave informed \nconsent for participation. Ninety-one subjects from the Alzheimer’s disease neuroim-\naging initiative (ADNI) with (N=51) and without (N=40) naming impairment as per \nthe Boston naming test (BNT) underwent brain magnetic resonance (MR) imaging \n12 months before and at AD diagnosis. Structural MR images were processed using \nvoxel-based morphometry. Longitudinal and cross-sectional comparisons between \ngroups were performed to assess differences in gray matter (GM) loss patterns.\nResults: During the 12-month prior to diagnosis, AD patients with naming difficulties \nshowed distinct areas of greater GM loss in the temporal lobes, cingulate gyri, and \nprecunei than patients without naming difficulties. GM volume in the left fusiform \ngyrus (Brodmann area 20) was greater in patients without naming impairment.\nConclusion: This study provided evidence of distinct patterns and dynamics of \nbrain atrophy in AD patients with naming difficulties when compared with those with \nintact language, as early as 12 months prior to AD diagnosis. Language deficits \nand their neuroanatomical correlates should be taken into account in the design \nof a structural imaging biomarker for the early detection of AD.\nB‑0409 15:21\nGender differences in grey matter atrophy patterns in the mild \ncognitive and early Alzheimer’s disease \nM. Spampinato1, E. Pravata’1, B. Langdon1, K. Patrick1, R. Parker2; \n1Charleston, SC/US, 2Gainesville, FL/US (emanuele.pravata@gmail.com) \nPurpose: To investigate gender-specific differences in grey matter (GM) volume loss \npatterns in amnestic mild cognitive impairment (aMCI) patients with and without pro-\ngression to Alzheimer’s disease (AD) using MR voxel-based morphometry (VBM).\nMethods and Materials: We included 186 aMCI patients (128 males, 58 females; \nage 77±7 years), with (N = 91) and without (N = 95) conversion to AD, from the \nAlzheimer's disease neuroimaging initiative (ADNI) cohort. Three-dimensional \nMPRAGE brain scans obtained one year before conversion from aMCI to AD \nand at AD diagnosis were available. The general linear model was performed to \nevaluate for differences over time in cognitive decline from the clinical dementia \nrating (CDR) scale. Optimised VBM with SPM8 was used to assess GM volume \ndifferences by performing cross-sectional and longitudinal group comparisons with \ntwo-sample and paired t-tests.\nResults: Both male and female AD converters showed significant cognitive decline \nat CDR (p < 0.001). Total GM volumes significantly differed between all groups \nof males and females (p < 0.01). Compared to stable aMCI, male AD convert-\ners showed atrophy progression one year prior to AD diagnosis in the limbic, \ntemporal, parietal, frontal, insular lobes and deep gray nuclei, while female AD \nconverters showed only one area of significant GM loss in the right uncus (p < \n0.05 FWE-corrected).\nConclusion: The extent and distribution of regional GM volume loss in aMCI \nto AD converters is strongly influenced by the gender. This finding has potential \nimplications for therapeutic approaches in AD and should be taken into account \nin clinical trials.\nResults: The preoperative UPDRS motor scale during the off periods correlated \nsignificantly T2r in the STN (Pearson corr.; r=0.72, CI 99 %). Outcome, estimated \nas a difference of preoperative UPDRS motor scale and postoperative UPDRS \nmotor scale correlated with T2r in the STN (Pearson corr. r=0.82, CI 99 %). UPDRS \nimprovement correlated with the laterality between the right to left STN (Pearson \ncorr.; r=0.73, CI 99 %).\nConclusion: T2r values correlated with pre-DBS UPDRS motor scales in the \nSTN. The laterality of right vs. left STN T2r predicts the outcome for UPDRS II. \nT2r reflects the lateralisation of PD that may be further incorporated into planning \nof unilateral DBS. \nB‑0406 14:54\nIncreased regional grey matter volume in Parkinson’s disease \npatients with excessive daytime sleepiness: an MRI study \nM. Chondrogiorgi, L.C. Tzarouchi, A. Zikou, P. Kosta, M.I. Argyropoulou, \nS. Konitsiotis; Ioannina/GR (ltzar@cc.uoi.gr) \nPurpose: Excessive daytime sleepiness (EDS) is an important non-motor symp-\ntom of Parkinson’s disease (PD). The underlying neuropathological mechanism \naccounting for EDS is not well understood. The purpose of the present study was \nto determine regional grey matter (GM) volume changes in PD patients with EDS.\nMethods and Materials: Seventeen PD patients with EDS (Epworth Sleepiness \nScale ESS ³ 12) (EDS-PD), 17 age and disease duration-matched PD patients \n(Epworth Sleepiness Scale ESS ² 6) and 17 age-matched healthy controls were \nenrolled in the study. The χ2 and Student’s t tests were used to test for differences \nin demographic and clinical characteristics between groups. Differences in GM \nvolume between groups were evaluated by applying the voxel-based morphometry \n(VBM) method.\nResults: Total calculated levodopa equivalent dose was higher in EDS-PD when \ncompared to PD patients (p < 0.05). Comparison of EDS-PD with PD patients \nand controls showed increased GM volume bilaterally in the hippocampus, the \nparahippocampal gyrus, the fusiform gyrus and in cortical areas in the temporal, \nfrontal and parietal lobes (p < 0.001).\nConclusion: EDS-PD patients present increased regional GM volume in the \nmesolimbic/mesocortical dopamine pathway, which is activated during sleep. \nDrug-induced GM volume increase through a process of neuronal plasticity may \nrepresent the underlying mechanism.\nB‑0407 15:03\nOlfactory tract evaluation in patients with Parkinson disease (PD) \nand hyposmia: a diffusion tensor imaging (DTI) study \nF. Pitocco, L. Di Biase, A. Giona, L. Scarciolla, C. Mallio, Y. Errante, J. Melgari, \nB. Beomonte Zobel, C. Quattrocchi; Rome/IT (y.errante@unicampus.it) \nPurpose: Olfactory dysfunction is the second most frequent feature of PD, occurring \nin 70-90% of patients. Recent studies suggest that the olfactory system is among \nthe earliest brain regions involved in PD. Diffusion-weighted imaging (DWI) and \ndiffusion tensor imaging (DTI) consent quantitative measures of the microstructural \nintegrity of nuclei and fibre tracts. Our aim was to assess fractional anisotropy (FA) \nchanges of the olfactory tract in early PD patients (Hoehn ed Yahr stage 1-2.5) and \nto correlate FA values with the clinical score of the olfactory deficits\nMethods and Materials: A case control study was conducted on 15 PD patients \nresponding to UK PD Society Brain Bank for probable PD and 13 healthy controls \nthat underwent MRI (1.5T, Avanto, Siemens, Erlangen, Germany). We performed \nT1 weighted MPRAGE, T2 and PD weighted TSE and EPI (on 12 non-collinear \ndirections at b0 and 1000s/mm2 to assess DTI) sequences. FA was computed \nwith standard formulas. All subjects underwent UPSIT (University of Pennsylvania \nSmell Identification Test)\nResults: We found a significant difference between FA values of the gyrum rectum \nsubcortical white matter of PD patients and healthy controls (0.27± vs. 0.39±; p \n< 0.05). A significant difference was also found in UPSIT values between the two \ngroups (p < 0.05).\nConclusion: Our results suggest that early olfactory dysfunction in patients with PD \nmay be a primary consequence of damage to the olfactory tract. Diffusion tensor \nImaging reaches the diagnostic sensitivity to assess early olfactory dysfunction \nin PD patients\n\nScientific Sessions\nS240\n C A D E F\n G\nB\nAuthor Disclosures:\nU.J. Schoepf: Grant Recipient; Bayer-Schering, Bracco, General Electric, \nMedrad, and Siemens. D. Bernhardt: Employee; Siemens.\nB‑0412 14:18\nQuantitative evaluation of myocardial perfusion reserve at 3 and \n1.5 Tesla in comparison to invasive measurement of fractional flow \nreserve for detection of coronary artery disease \nT. Walcher, K. Ikuye, W. Rottbauer, J. Woehrle, P. Bernhardt; \nUlm/DE (peter.bernhardt@uniklinik-ulm.de) \nPurpose: Fractional flow reserve (FFR) is considered as the standard invasive \ndiagnostic tool to determine haemodynamic significance of coronary artery disease \n(CAD). Adenosine-perfusion cardiac magnetic resonance imaging (CMR) at 1.5 \nand 3 Tesla has been proven to be capable to noninvasively determine myocardial \nperfusion reserve, but has not been compared against each other and validated \nagainst FFR as standard reference.\nMethods and Materials: 34 patients (62.0 ± 10.9 years) with suspected CAD \nwere included into the study. All patients were scanned at both field strengths, \n1.5 and 3 Tesla, including adenosine and rest perfusion imaging. Coronary x-ray \nangiography including FFR measurement in the left anterior descending (LAD), \ncircumflex (CX) and right coronary artery (RCA) was then performed in all patients. \nMyocardial perfusion reserve was calculated in 544 myocardial segments for each \nfield strength and compared to the FFR measurement of the supplying coronary \nartery. FFR ²0.8 was regarded as relevantly reduced.\nResults: In 38 coronary arteries (19 LAD, 8 CX, 11 RCA) a FFR ²0.8 was found. \nReceiver operator curve analysis yielded higher area under the curve for 3 T in \ncomparison to 1.5 T CMR (0.963 vs. 0.645, p < 0.001) resulting in higher sensitivity \n(0.91 vs. 0.62) and specificity (1.0 vs. 0.77).\nConclusion: Quantitative evaluation of myocardial perfusion reserve at 3 and 1.5 \nTesla is capable to detect haemodynamic significance of coronary artery stenosis. \nIn our cohort, the diagnostic accuracy at 3 T seems to be superior to 1.5 T.\nB‑0413 14:27\nDynamic stress computed tomography perfusion imaging for the \ndetection of functionally significant coronary lesions \nA. Rossi1, A. Dharampal1, S.E. Petersen2, E. Klotz3, G.P. Krestin1, \nK. Gruszczynska4, E. Capuano2, P.J. de Feyter1, F. Pugliese2; 1Rotterdam/NL, \n2London/UK, 3Forchheim/DE, 4Katowice/PL (a.rossi@erasmusmc.nl) \nPurpose: To evaluate the performance of hyperaemic myocardial blood flow (MBF) \nderived from stress computed tomography perfusion (CTP) imaging in the detection \nof functionally significant coronary lesions defined by fractional flow reserve (FFR) \n²0.75 in a prospective cohort of patients with stable chest pain.\nMethods and Materials: Coronary computed tomography angiography (CTCA) and \nCTP were performed in 50 patients (35 males/15 females; mean age 58±9 years) \nreferred to invasive angiography. A second-generation dual-source CT scanner \n(Somatom Definition Flash, Siemens) with a dynamic ECG-triggered axial shuttle \nmode was used. This technique provides an arterial input function and myocardial \ntime-attenuation curves fitted to a 2-compartment model to give MBF. Hyperaemia \nwas induced by infusion of adenosine (140µg/kg body weight). Three to 4 minutes \ninto the infusion, 60 ml of contrast were injected. Gantry rotation time was 285 \nms, collimation 64x0.6 mm, tube voltage 100 kV and the tube current-time product \nwas 300 mAs/rotation.\nResults: FFR ² 0.75 was found in 22/61 (36%) vessels. MBF was 70 (61-75) ml/100 \nml/min in lesions with FFR ² 0.75 and 99 (82-127) ml/100 ml/min in lesions with FFR \n> 0.75 (p < 0.001). The optimal cut-off value of MBF to discriminate functionally \nsignificant coronary lesions was 79 (61-75) ml/100 ml/min. MBF had 91% sensitiv-\nity and 80% specificity and an area under the receiver operating characteristics \ncurve (AUC) of 0.86 (95% CI, 0.76-0.95, p < 0.001). By comparison, visual CTCA \nanalysis yielded 73% sensitivity, 51% specificity and an AUC of 0.62 (95% CI, \n0.47-0.77, p < 0.001).\nConclusion: MBF performs better than visual CTCA analysis to predict functionally \nsignificant coronary lesions (FFR ²0.75).\nAuthor Disclosures:\n E. Klotz: Employee; Siemens Healthcare.\n14:00 - 15:30 Room C \nCardiac \nSS 603a \nCT and MRI: risk stratification \nModerators: \nE.A. Mershina; Moscow/RU \nM.R. Rees, Gwynedd/UK\nB‑0410 14:00\nUpdated algorithms using “in-office-evaluation” and calcium \nscore may reduce referral of stable angina patients to computed \ntomography coronary angiography \nA.S. Dharampal, A. Rossi, A. Dedic, S.L. Papadopoulou, A. Weustink, \nK. Nieman, E. Boersma, P.J. de Feijter, G.P. Krestin; Rotterdam/NL \n(anoesh_dh@hotmail.com) \nPurpose: The use of CT-scans in assessment of coronary artery disease is rap-\nidly growing. More selective referral of stable angina patients with intermediate \nprobability of coronary artery disease (CAD) to CT coronary angiography (CTCA) \nmay temper the health care spending on cardiac CT-scans. The value of updated \nalgorithms using “in-office-evaluation” and calcium score (CaSc) is investigated.\nMethods and Materials: We evaluated retrospectively 2042 symptomatic stable \nangina patients who underwent “in-office-evaluation”, unenhanced CT-scan for \ncalculation of CaSc and CTCA. Outcome of our study was non-invasive diagnosis \nof obstructive CAD (³50% lumen diameter narrowing) by CTCA. Two algorithms \nwere developed. First algorithm used \"in-office-evaluation\" consisting of chest \npain typicality, sex, age, risk factors and ECG. The second algorithm used both \n\"in-office-evaluation\" and CaSc. Discrimination of both models was tested using \nthe area under the ROC curves (AUC). Patients were classified to low (< 10%), \nintermediate (10-90%) and high pre-test probability (³90%) of obstructive CAD. \nTesting with CaSc or CTCA was deemed appropriate in patients intermediate \nprobability of CAD. Net\nreclassification improvement (NRI) of algorithm 2 was calculated in patients with \nintermediate probability of CAD according to algorithm 1.\nResults: Discrimination of CAD was significantly higher using algorithm 2 com-\npared with algorithm 1 (AUC: 0.90 vs. 0.80, respectively). The “in-office-evaluation” \nalgorithm reduced both unenhanced CT-scan and CTCA by 12%. An additional \n32% of CTCA-scan was reduced using algorithm 2 subsequently with NRI of 66%.\nConclusion: Updated algorithms using both “in-office-evaluation” and CaSc may \nreduce referral of stable angina patients to CTCA by 44%. \nB‑0411 14:09\nDynamic CT perfusion imaging for the detection of myocardial \nischaemia: a first experience with a 3D semi-automated evaluation \nsoftware \nU. Ebersberger1, R.P. Marcus2, U.J. Schoepf1, P. Blanke1, Y. Wang3, L. Geyer1, \nA.D. McQuiston1, D. Bernhardt4, F. Bamberg2; 1Charleston, SC/US, 2Munich/DE, \n3Beijing/CN, 4Forchheim/DE (ebersberger@gmx.net) \nPurpose: To evaluate the performance of a 3D semi-automated evaluation software \nfor its accuracy and time saving potential for CT perfusion myocardial blood flow \n(MBF) and blood volume (MBV) assessments compared to manual evaluation as \nwell as to SPECT.\nMethods and Materials: 37 dynamic, time-resolved myocardial perfusion CT data-\nsets acquired using a dual-source CT system (Somatom Definition Flash, Siemens \nHealthcare, Forchheim, Germany) were assessed both manually and by use of \nthe semi-automated prototype for MBF and MBV, based on the AHA 16-segment \nmodel. Time required for each assessment was recorded. Results were compared \nto SPECT as the standard of reference.\nResults: 592 segments were evaluated. 19 (3.21%) were excluded due to insuf-\nficient coverage. A comparison of MBF and MBV measurements using the prototype \nversus manual assessment showed high correlation (Spearman’s rank correlation \ncoefficient = 0.85/0.83, p < 0.0001). Mean evaluation time for MBF and MBV analysis \nwas 49.1 ±11.2 minutes with manual assessment and 16.5 ± 3.7 minutes with the \nuse of the prototype (p < 0.001).\nConclusion: 3D semi-automated assessment of dynamic myocardial perfusion \nCT highly correlates with manual assessment. Significantly decreased assess-\nment time appears promising for the integration of myocardial perfusion CT in \nclinical workflows. \n\nScientific Sessions\nS241\nA\n C D E F G\nB\nFriday\nprotocol (ADP): clinical examination, MDCT-CA; the positive cases were recovered \nand underwent CA. If MDCT-CA was negative for significant CAD the patient was \ndismissed from the ED and taken under follow-up for 2 years. The costs of every \nprotocol and the amount of costs for individual methods were calculated. Based on \nthe results, the two diagnostic paths were compared about cost/effectiveness ratio.\nResults: At TIMI score only 30% of the patients resulted with high risk, whereas \nMDCT-CA was judged positive in 40% of the cases. MDCT-CA compared to CA \nrevealed an accuracy of 97.8%, PPV and NPV were 99% and 100%. The ADP \nrevealed lower costs than the protocol with only hospitalization (11645€ against \n5322€), and showed better cost/effectiveness ratio. At 2-year follow-up 99.3% of \nthe patients resulted well being.\nConclusion: The ADP can help better than TIMI score to rule out patients with \nundifferentiated chest pain. Moreover, cost analysis demonstrated a better cost \neffectiveness ratio in comparison to the hospitalization, also confirmed with a \nlong-term follow-up.\nB‑0417 15:03\nTransient ischaemic dilation of the left ventricle on SPECT: \ncorrelation with findings at coronary CT angiography \nU. Ebersberger, W.T. Halligan, P.B. Morris, B.T. Mischen, S.A. Chiaramida, \nU.J. Schoepf; Charleston, SC/US (ebersberger@gmx.net) \nPurpose: Transient ischaemic dilation (TID) in the setting of abnormal SPECT \nmyocardial perfusion imaging (MPI) has been linked with increased cardiovascular \nrisk. However, the significance of TID in the setting of an otherwise normal MPI \nstudy has not been clearly established.\nMethods and Materials: Coronary computed tomography angiography (cCTA) \nwas utilised to evaluate the prevalence of atherosclerotic lesions and the severity \nof coronary stenosis in patients with TID with or without associated myocardial \nperfusion defects on SPECT-MPI. The study population consisted of 1553 patients \nwho had undergone both cCTA and stress/rest cardiac SPECT. In patients with TID \ncoronary CTA was used to evaluate each coronary segment for the presence and \ncomposition of atherosclerotic plaque and the degree of coronary stenosis. Findings \nwere compared with a 2:1 matched-pair control cohort without TID.\nResults: TID was identified in a total of 30 patients from a screening population \nof 1553 consecutively imaged patients. Findings demonstrated that compared \nto TID negative risk-factor matched controls (n=60), TID positive patients had \nno significant differences in the presence and extent of atherosclerosis or the \ndegree of coronary artery stenosis as evaluated by cCTA. Similarly, there were no \nsignificant differences in cCTA measures of coronary artery disease (CAD) in TID \npositive patients with normal perfusion compared to TID negative patient with a \nnormal perfusion study (n=48).\nConclusion: These results suggest that the presence of TID with an otherwise \nnormal SPECT study does not reliably predict an increased risk for or the extent \nand severity of coronary artery disease. \nAuthor Disclosures:\nU.J. Schoepf: Grant Recipient; Bayer-Schering, Bracco, General Electric, \nMedrad, and Siemens.\nB‑0418 15:12\nRelationship between myocardial scar and coronary artery plaque \nin diabetes patients: from preliminary results of assessment \nwith cardiac computed tomography angiography and magnetic \nresonance imaging in patients with type 2 diabetes for detection \nof unrecognised myocardial scar in subclinical coronary \natherosclerosis (ACCREDIT) study \nJ.-W. Kang1, S. Choi2, S. Ko1, Y. Choe1, B. Choi1, W. Lee1, T.-H. Lim1; 1Seoul/KR, \n2Seongnam/KR (jwonkang@amc.seoul.kr) \nPurpose: To evaluate the correlation between occult myocardial scar (OMS) on \ndelayed-enhancement MRI (DE-MRI) and coronary atherosclerosis on CT coronary \nangiography (CTCA) in asymptomatic patients with type 2 diabetes.\nMethods and Materials: In this prospective, multicentre, and open-label study, 347 \npatients with type 2 DM were included who had 2 or more risk factors of coronary \nartery disease (CAD). DE-MRI and CTCA were performed on 322 patients. The \nprevalence of OMS and total number of involved myocardial segments on DE-MRI \nwere evaluated. Association of the presence of OMS with clinical parameters and \ncoronary calcium score (CCS) and the association of OMS and the degree of \nstenosis and plaque characteristics of coronary artery on CTCA per patient were \nalso evaluated.\nResults: OMS was detected by CMR in 23 (7.1%) of the 322 patients and the \nnumber of myocardial scar is 49 (median 2, range 1-4 per patient). The prevalence of \nCAD was 74.5%, and more than 50% stenosis was found in 24.9% of the subjects. \nB‑0414 14:36\nIn vivo quantification of total atherosclerotic burden: prognostic \naccuracy of whole body CTA in relation to traditional cardiovascular \nrisk index and 5-year follow-up \nF. Zaccagna, A. Napoli, G. Cartocci, V. Noce, F. Boni, C. Catalano; Rome/IT \n(fulvio.zaccagna@libero.it) \nPurpose: To investigate if mid-term prognostic value of WB-CTA to predict cardio-\nvascular (CV) events in asymptomatic patients with CV risk factors can be superior \nto traditional method of risk stratification.\nMethods and Materials: 341 pts with CV risk factors (mean age 63.39±10.4[34-\n89]) underwent WB-CTA (64x0.6 mm) with an adapted contrast injection protocol \n(Iomeprol-400, 400 mgI/ml; 70+50 ml@4 ml/s). Coronary arteries were divided into \n15 segments and the extra-coronary arteries into 32 segments, detected stenoses \nwere graded using a 5-point scale. An atherosclerosis burden score (ABS) was \ngenerated for each individual and correlated to traditional CV (Framingham risk \nindex; FRI). ABS and FRI were compared using Kaplan-Meier analysis, ROC \nanalysis and stepwise multivariable Cox regression models.\nResults: At baseline mean ABS was 19.5±20.1 and mean FRI was 12±10.7; \n64.5±11.3m after WB-CTA all patients received an interview to determine health \nstatus. According to Kaplan-Meier curves, mean event-free time was of 62.3±2.4m \nfor ABS< 10, 57.6±1.9m for 10 5 mm, distance to neurovascular structures at least 3 mm, \npotential access, absence of articular involvement and planned cryoablation cov-\nering the entire lesion volume. Characteristics of patients eligible for cryoablation \nwere comparing with not selected patients.\nResults: Mean tumour size was 64 mm (10-178). Most frequent histological \nsubtypes were unclassified sarcomas (n=16), liposarcomas (n=15), or myxofibro-\nsarcomas (n=7). Surgical treatment consisted in wide excision (n=16), or combined \ntreatment (n=24). After surgery, the severe complications rate was 47.5%. Since \nrelapse, mean follow-up was 42.8 months with a median overall survival of 57.6 \nmonths and median recurrence-free survival of 39.5 months. A subgroup of 13 \npatients was identified and comparison with other patients showed that trunk, \nshoulder and pelvic girdle locations (p =0.002), locally aggressive (P=0.016) and \ndeep (P=0.002) tumours, ²5 cm (P=0.044), and liposarcoma and myxofibrosarcoma \nsubtypes (P=0.007) were indicative of eligibility for cryoablation.\nConclusion: Eligibility criteria as defined are useful for plan cryoablation as a \ntechnically feasible alternative to surgery for treatment of local relapse of STS. \nB‑0422 14:18\nRobot-assisted radiofrequency ablation of liver tumours: early experience \nB.J.J. Abdullah, C.H. Yeong, K.L. Goh, B.K. Yoong, G.F. Ho, C. Yim; \nKuala Lumpur/MY (basrij@ummc.edu.my) \nPurpose: We report our preliminary experience of RFA of the liver tumours using \na robotic-assisted guidance system.\nMethods and Materials: 6 patients with 8 lesions were treated using the Robio \nEx (Perfint Healthcare, MA, USA) robotic positioning system. All the lesions were \nsmaller than 2.5 cm diameter. All the procedures were performed under general \nanaesthesia. Following baseline CT scans, the lesions were identified. The puncture \nsite and trajectory were then determined on Robio Ex workstation. The angulation \nof the needle, depth of lesion, the fluoroscopic dose as well as the accuracy of \nplacements was determined. The performance level of procedures was documented \nfor each biopsy on a five-point scale (5-1: Excellent-Poor).\nResults: All the tumours were targeted successfully. One lesion in 2 patients \nrequired minor readjustment. 4 patients (5 lesions) had needle placement with \nno cranio-caudal angulation, whereas 2 patients (3 lesions) had cranio-caudal \nangulation of up to 200. The orbital angulation ranged from 60 to 1180. The depth \nof needle ranged from 12.2 to 4.7 cm from skin surface. Performance levels were \nall 5 except in one patient (4). The fluoroscopic (DLP) and total dose (CTDIvol) for \nthe entire procedure were 316±92 mGy.cm and 260.83±70.02 mGy, respectively. \nPost-RFA CT scans showed successful ablation of the targeted lesions. No im-\nmediate complications were noted.\nConclusion: Robotic-assisted planning and needle placement appear to be \ntechnically easier, it requires fewer number of needle passes, fewer check scans \nUsing logistic regression, CCS more than 100 was the predictor of presence of \nOMS (odds ratio 7.484, 2.459-22.776 in 95% confidence interval). The prevalence \nof OMS was significantly higher in patients with more than 50% stenosis and in \npatients with mixed and non-calcified plaques.\nConclusion: The prevalence of OMS on DE-MRI and significant coronary disease \non CTCA are not uncommon even in asymptomatic patients with type 2 diabetes. \nCCS more than 100 is the only predictor of OMS. \nAuthor Disclosures:\nJ. Kang: Research/Grant Support; Guerbet Group, France. S. Choi: Research/\nGrant Support; Guerbet Group. S. Ko: Research/Grant Support; Guerbet Group. \nY. Choe: Research/Grant Support; Guerbet Group. B. Choi: Research/Grant \nSupport; Guerbet Group. W. Lee: Research/Grant Support; Guerbet Group. \nT. Lim: Research/Grant Support; Guerbet Group.\nB‑0419 15:21\nEpicardial fat volume and coronary artery disease at CT: racial \ndifferences in African American and white patients with acute chest pain \nP. Apfaltrer1, A. Schindler2, U.J. Schoepf2, J. Nance2, U. Ebersberger2, \nR. Vliegenthart2; 1Mannheim/DE, 2Charleston, SC/US (paul.apfaltrer@umm.de) \nPurpose: Thoracic adipose tissue likely promotes coronary artery disease (CAD). \nPossibly, differences in CAD risk between races are influenced by racial differences \nin thoracic adipose tissue. We compared CT-derived measures of thoracic fat and \npotential correlations with CAD between African American and white patients.\nMethods and Materials: 372 age-and-gender-matched black and white patients \n(186 black: mean age 54±11 yrs, 50% men; 186 white: mean age 54±11 yrs, 50% \nmen) who underwent thoracic dual-source CT for chest pain evaluation were \nretrospectively included. Epicardial adipose tissue (EAT) volume and mediastinal \nadipose tissue (MAT) volume were quantified using an automated analysis algo-\nrithm. Peri-coronary fat thickness (PFT) was measured on reconstructed sections \northogonal to the right coronary artery centreline. Non-calcified and calcified plaque \nvolume was quantified by applying a threshold-based automated algorithm. CAD \nwas defined as 50% or greater coronary artery stenosis.\nResults: Mean body mass index was 31±7 kg/m 2 for blacks and 30±6 kg/m 2 for \nwhites (p> 0.05). EAT and MAT were significantly lower in blacks than in whites \n(59[25th -75thpercentile, 48-108] versus 97[67-132]cm 3, and 44[27-77] versus \n87[52-157]cm3, for both p < 0.001). Mean PFT in blacks and whites showed no \nsignificant difference (p> 0.05). Patients with CAD showed significantly higher EAT \nthan those without CAD (97.9±52.6 cm3 vs. 77.4±43.5 cm3, p < 0.05). Significant \ncorrelations were observed between EAT measurements and calcium volume \n(r=0.221; p < 0.05). The relationship between race and extent of adipose tissue \nremained significant after adjustment for cardiovascular risk factors.\nConclusion: Measures of thoracic fat were generally higher for symptomatic \nwhite than for black patients suggesting a differential relationship between thoracic \nadipose tissue and CAD pathophysiology by race.\nAuthor Disclosures:\nU.J. Schoepf: Research/Grant Support; Bayer-Schering, Bracco, General \nElectric, Medrad, Siemens.\n14:00 - 15:30 Room D2 \nInterventional Radiology \nSS 609a \nOncologic ablation and guided interventions \nModerators: \nP. Almeida; Coimbra/PT \nA. Basile; Catania/IT \nB‑0420 14:00\nRadiation exposure in CT-guided interventions \nR. Kloeckner, D. Pinto dos Santos, C. Düber, M. Pitton; \nMainz/DE (roman.kloeckner@googlemail.com) \nPurpose: This study aimed at investigating the radiation exposure in CT-guided \ninterventions, to establish reference levels and discuss strategies for dose reduction.\nMethods and Materials: 1576 consecutive CT-guided procedures in 1284 pa-\ntients performed over 4.5 years were analysed including drainage placements, \nbiopsies of different organs, radiofrequency-/ microwave-ablations of liver, bone \nand lung tumours, pain blockages and vertebroplasties. Data were analysed with \nrespect to overall radiation doses and individual doses of planning CT-series, CT-\nintervention and control CT-series. Additionally, the impact of different fluoroscopy \n\nScientific Sessions\nS243\nA\n C D E F G\nB\nFriday\nResults: The sub-capsular lesions at the time of diagnosis of HCC was significantly \nhigher in the left lobe group (38 vs. 11, p=0.02). The percentages of multiple le-\nsions of HCC was significantly high in right lobe group (6 patients had three lesions \nvs. 0, p=0.03). The percentage of patients experiencing major complication was \nsignificantly higher in the RFA left lobe group (p=0.01). There was no difference in \nthe percentage of complete ablation rate in both groups (96% vs. 100%, p=0.11). \nIn multivariate analysis, site and number of lesions were factors associated with \nmajor complication (p=0.04 and 0.03, respectively).\nConclusion: Left lobe location of HCC is an important independent risk factor of \nmajor complication after percutaneous RFA of HCC.\nB‑0426 14:54\nPercutaneous, ultrasound-guided IRE ablations of unresectable \npancreatic cancer \nA. Nilsson, C. Månsson, J. Krause, R. Brahmstaedt, P. Nygren, B.-M. Karlson; \nUppsala/SE (anders.nilsson@radiol.uu.se) \nPurpose: To evaluate if percutaneous, ultrasound-guided irreversible electro-\nporation (IRE) ablations can be performed safely in patients with unresectable \npancreatic cancer.\nMethods and Materials: Between October 2011 and June 2012, 10 patients with \npancreatic cancer were treated with IRE ablation. All patients had undergone \nchemotherapy and radiation treatment without tumour reduction to a point where \nthey became resectable or were not candidates for such treatment. Unresectabil-\nity in all cases was due to tumour growth around the mesenteric vessels. Tumour \nsize was 2-4.5 cm. Ablations were performed under ultrasound guidance with the \npatients under general anaesthesia. 3 needles were placed around the tumour, \nablations performed according to the inbuilt software in the IRE generator and the \nneedles then replaced until the entire tumour area had been covered.\nResults: Contrast-enhanced ultrasound (CEUS) the day after the ablation showed \nablation zones in the tumour area, size 2.5-4 cm in diameter. The average post-\noperative stay was 10 days. 8 of the patients initially had pain at the treatment site \nbut only post-ablation inflammation could be seen on CT. 3 patients developed a \npancreatitis with elevated serum amylase. No other serious complications were \nnoted and check-up with CT and CEUS 1 month after the treatments showed no \nadverse effects.\nConclusion: Percutaneous IRE ablations can be performed safely in patients with \nlocally advanced pancreatic cancer.\nB‑0427 15:03\nHigh-intensity focused ultrasound ablation of pancreatic cancer: a \ntotally non-invasive treatment for tumour control of locally advanced \nlesions (stage III) \nF. Zaccagna, A. Napoli, G. Cartocci, G. Brachetti, L. DI Mare, F. Boni, V. Noce, \nL. Bertaccini, C. Catalano; Rome/IT (napoli.alessandro@gmail.com) \nPurpose: To evaluate safety and effectiveness of non-invasive high-intensity \nMR-guided focused ultrasound (MRgFUS) treatment for tumour control of locally \nadvanced pancreatic cancer.\nMethods and Materials: 5 patients with locally advanced pancreatic cancer under-\nwent MRgFUS treatment using the ExAblate 2100 system (InSightec). Treatments \nwere done in a single session, in an ambulatory setting. To evaluate tumour control, \nperfusion T1w-images after administration of gadobenate dimeglumine (MultiHance; \nBracco, Milan, Italy) were obtained pre- and post-treatment in order to determine \nthe non-perfused sonication-related area. Follow-up examinations were scheduled \nat 1, 3, 6 and 12 months after treatment. After treatment, all patients underwent \nCHT with the same chemotherapy scheme.\nResults: All patients well tolerated the treatment and no heating-related adverse \nevent was recorded during this clinical application. Immediately after treatment \nall patients showed coagulative necrosis with a mean non-perfused volume of \n65.4±16.6 [45 - 90]. All patients showed a significative decrease of pain due to \ncancer infiltration. At follow-up tumour recurrence in treatment site was MRI evident \nbut no local progression were recorded. After MRgFUS 2 patients underwent RT \nmeanwhile one patients required another MRgFUS treatment.\nConclusion: Our preliminary clinical experience indicates that focused ultrasound \nunder MR guidance could be a promising non-invasive treatment modality to \nobtain a reduction of tumour size in patients with pancreatic adenocarcinoma not \nsuitable for surgery.\nand has lower dose. Study with large sample size is needed to confirm these \npreliminary findings.\nB‑0423 14:27\nImage-guided percutaneous thermal ablation of hepatic and renal \ntumours using high-frequency jet ventilation to minimise respiratory \nmotion \nD.M.L. Tse, D.Y.F. Chung, S. Scott, P. Boardman, F.V. Gleeson, E.M. Anderson; \nOxford/UK (donald.tse@gmail.com) \nPurpose: High-frequency jet ventilation minimises respiratory motion during general \nanaesthesia (GA-HFJV). We report our 5-year experience with GA-HFJV in thermal \nablation of hepatic and renal tumours, and evaluate the procedural time, rates of \ntechnical success and complications.\nMethods and Materials: Between November 2007 and September 2012, 76 \npatients (24 females and 52 males, mean 69.6years) underwent 107 sessions of \nradiofrequency (RF) or microwave (MW) ablation. Tumour size, time under anaes-\nthesia, ablation time, technical success and complications were recorded. Proce-\ndural time was calculated by subtracting ablation time from time under anaesthesia.\nResults: 127 hepatic tumours (24 primary, 103 metastasis), 7-80 mm in diameter \n(mean±SD, 34.2±16.0 mm) were treated in 99 sessions and 8 primary renal tumours, \n18-37 mm in diameter (mean±SD, 30.4±5.7 mm) were treated in 8 sessions. Mean \nprocedural time for sessions ablating single hepatic lesions was 77 minutes (range \n32-144), 110 minutes (range 48-157) for sessions ablating multiple hepatic lesions, \nand 94 minutes (range 57-123) for ablations of renal lesions. There is no significant \ndifference in procedural time between CT-guided alone and combined CT and US-\nguided ablations of single hepatic lesions (p=0.27). Technical success was achieved \nin all sessions. No major complications were observed. Minor complications in 15 \nsessions (14%) included 4 cases of immediate peri-hepatic haematoma, 3 cases \nof haemothorax, none requiring further treatment.\nConclusion: GA-HFJV is a safe technique which reliably minimises respiratory \nmotion. This facilitates the procedure directly by producing ideal target immobi-\nlisation, which may reduce procedural time particularly for small or anatomically \nchallenging lesions in the liver or kidney.\nB‑0424 14:36\nRadiofrequency ablation of hepatocellular carcinoma associated \nwith chronic liver disease without cirrhosis: long-term experience \nL. Sottocornola, A. Salmi, A. Rossini, R. Maroldi, P. Cabassa; Brescia/IT \n(lara.sottocornola@gmail.com) \nPurpose: This study aimed at determining the efficacy of radiofrequency ablation \nin the treatment of patients with hepatocellular carcinoma (HCC) in patients with \nchronic liver disease without cirrhosis.\nMethods and Materials: From the database of HCC treated by RF ablation in two \nreferring centres 56 HCCs were found in 49 patients (age range, 62-90 years) with \nchronic liver disease (mainly HCV) without cirrhosis. The mean lesion diameter \nwas 24.6 mm (range, 10-50 mm). Patients were treated percutaneously or by \nlaparoscopic approach. Follow-up was performed by CT at 1, 4, and 6 months and \nevery 6 months after that. Cumulative survival and disease-free survival rates of \npatients were analyzed using the Kaplan-Meier method. Any complications during \nfollow-up were reported.\nResults: Cumulative survival rates were 100%, 82%, and 59% at 1, 3, and 5 years, \nrespectively. Median survival time was 49 months (range, 1-120 months). Maximum \ntumour diameter was associated with the probability of survival. During follow-up 7 \n(14%) out 49 patients developed new nodules. Median disease-free survival rates \nwere 96%, at 1 year and 93% at 2 and 3 years. No major complication occurred.\nConclusion: Radiofrequency ablation of HCCs in patients without cirrhosis shows \nlong-term survival rates and a low recurrence rate. \nB‑0425 14:45\nSafety and efficacy of sonographically guided percutaneous \nradiofrequency ablation of left lobe hepatocellular carcinoma \nM.I.M.A. Ibrahim; Sohag/EG (mandw20022002@hotmail.com) \nPurpose: To assess the safety and effectiveness of percutaneous radiofrequency \nablation (RFA) of left lobe hepatocellular carcinoma (HCC).\nMethods and Materials: We performed a retrospective analysis of 157 patients who \nunderwent percutaneous ultrasound-guided RFA for treatment of HCC. Forty-eight \nHCCs in left lobe were compared with 152 HCCs in right lobe. Patients underwent \nregular computed tomography imaging of the liver during follow-up and the treat-\nment effectiveness and safety were evaluated. Incomplete ablation, recurrence, \ncomplications, and mortality were documented.\n\nScientific Sessions\nS244\n C A D E F\n G\nB\n14:00 - 15:30 Room E1 \nMusculoskeletal \nSS 610a \nMusculoskeletal tumours \nModerators: \nR. Lalam; Oswestry/UK \nE. Quaia; Trieste/IT \nB‑0430 14:00\nMagnetic resonance imaging parameters predictive for malignancy: \na prospective study of 100 consecutive soft-tissue musculoskeletal \nmasses \nV. Vasilevska Nikodinovska, M. Samargiski, V. Janevska, S. K.Kunovska; \nSkopje/MK (v_vasilevska@yahoo.com) \nPurpose: To evaluate magnetic resonance imaging (MRI) parameters that contrib-\nute the most in differentiation of benign vs. malignant soft tissue musculoskeletal \ntumours.\nMethods and Materials: Prospectively, 100 consecutive patients (53 males, 47 \nfemales, median age 51 years) with a musculoskeletal soft-tissue mass underwent \nmagnetic resonance imaging (1.5 T,GE). Fifteen MRI parameters were evaluated \nfor making a radiologic diagnosis. Multivariate logistic regression analysis was used \nfor imaging parameters predictive for malignancy. Histopathology was correlated \nwith radiologic diagnosis in all patients.\nResults: There were 70 benign lesions (53 benign tumours and 17 tumour-like \nlesions) and 30 malignant lesions (26 malignant tumours and 4 metastases). Ra-\ndiological diagnosis for primary malignant tumour was established in a total of 33 \nlesions, of which 24 (72.7%) had histological confirmation for primary malignant \ntumours. Nine cases (9%) were false-positive (4 benign tumours, one tumour-like \nlesion and 4 metastases) and two (2%) were false-negative. Radiological diagno-\nsis for benign and malignant tumours showed identical sensitivity of 92.5% and \n92.3%. High specificity of 95.7% was found in benign tumours. Global accuracy \nin determining the presence of benign tumour was 94% and of primary malignant \ntumour 89%. Multivariate logistic regression analysis identified the following MRI \nparameters to be independent significant predictive for primary malignant tumour: \nextracompartmental location, presence of peritumoural oedema, inhomogeneous \nsignal on T2 WI. After i.v. application of contrast agent, peripheral and inhomogene-\nous enhancement significantly more often pointed to malignant tumour.\nConclusion: A combination of individual MR imaging parameters improved radio-\nlogic imaging diagnosis in differentiation between benign and malignant soft-tissue \nmusculoskeletal lesions. \nB‑0431 14:09\nEvaluation of features and role of ultrasound and MR imaging in \nlarge lipomas and well-differentiated liposarcomas \nH. Gupta1, V. Bhat2, S. Edward1, E. Hensor1, P. Robinson1; 1Leeds/UK, \n2Cardiff/UK (harun.gupta@nhs.net) \nPurpose: To review surgically proven well-differentiated liposarcomas and large \nlipomas for significantly different imaging or clinical features.\nMethods and Materials: Retrospective review of surgically treated extremity/\ntruncal lipomas and well-differentiated liposarcomas. 3 groups identified: lipomas \nimaged by ultrasound and MRI, lipomas imaged by ultrasound only (size ³5 cm), \nwell-differentiated liposarcoma by ultrasound and/or MRI. Imaging was independ-\nently evaluated by 2 radiologists blinded to history and case proportion. Ultrasound \nscored for location, depth, size, shape, echogenicity, homogenicity, septation and \nDoppler flow. MRI scored for location, depth, size, margins, signal characteristics, \nfat suppression, septation, non-adipose areas, nodules and contrast enhancement. \nFischer's exact and Mann-Whitney U tests were performed.\nResults: 114 lipomas (70 ³5 cm US only; 44 US and MRI irrespective of size) and \n27 liposarcomas were evaluated. Majority of lipomas were subcutaneous. Majority \nof liposarcomas were lower limb (sensitivity 88%, specificity 75%). Median lipoma \nvolume was significantly smaller than liposarcoma (58.5 vs 201 mm3). No significant \ndifference in other ultrasound criteria was found. Fat suppression was complete \nin 91% lipomas but only 31% liposarcomas. For liposarcomas nodular areas were \nmoderately specific [65.9%] and sensitive [80.8%] but non-adipose areas specific \n[93.2%] but not sensitive [42.3%].\nConclusion: 1. Lipomas can be large and size criteria (> 5 cm) for specialist refer-\nral is inefficient for those with typical benign imaging appearances. A size > 7 cm \nmay be more effective in such cases. 2. Ultrasound can effectively evaluate large \nB‑0428 15:12\nFusion imaging-guided percutaneous biopsy of focal hepatic lesions \nwith poor conspicuity on conventional ultrasonography \nH. Park, M. Lee, M. Kim, M. Lee, J. Hwang, T. Kang, S. Lim, H. Lim, H. Lim; \nSeoul/KR (mydr.kim@gmail.com) \nPurpose: To evaluate the effectiveness of real-time US and CT/MR image fusion, \nfor percutaneous US-guided biopsy of focal hepatic lesions with poor sonographic \nconspicuity.\nMethods and Materials: This study was conducted as a retrospective analysis \nof a prospective database, and was approved by the Institutional Review Board. \nPatients who had target lesions with poor conspicuity on B-mode US for percuta-\nneous biopsy were enrolled in the study. Lesion conspicuity was assessed using \nconventional B-mode US first, and then using fusion imaging later in the same \nsession. We compared lesion conspicuity and detection rates between B-mode \nUS and fusion imaging and evaluated how many cases of initially invisible lesions \non B-mode US became visible after image fusion. The technical success rate was \nevaluated based on the final diagnoses, which were established by pathological \nexamination of the biopsy specimen as well as through clinical and radiological \nfollow-up examination.\nResults: A total of 22 patients were enrolled in this study. After image fusion, lesion \nconspicuity was increased in 63.6% (14/22) of focal hepatic lesions. Moreover, \n66.7% (6/9) of lesions which were invisible through B-mode US became visible after \nimage fusion. The true positive detection rate was significantly different between \nB-mode US and fusion imaging (9/22 vs. 19/22, p=0.0044). Percutaneous biopsy \nwas performed for all lesions, including 3 target lesions which were invisible even \nafter image fusion. The technical success rate was 95.5% (21/22).\nConclusion: The fusion imaging technique is effective for percutaneous biopsy of \nfocal hepatic lesions with poor sonographic conspicuity.\nB‑0429 15:21\nCTNAV: a prospective randomised clinical trial of a navigation \nsystem for computer assisted CT guided interventions \nP. Durand, A. Moreau-Gaudry, J. Frandon, M. Medici, E. Chipon, C. Sengel, \nI. Bricault; Grenoble/FR (pdurand1@chu-grenoble.fr) \nPurpose: The Imactis Navigation System with electromagnetic needle holder \ntracking was developed to allow interactive display of the needle trajectory in a 3D \nvolumetric CT volume, allowing the radiologist to choose optimal entry point and \ntrack to the target during CT-guided percutaneous interventions. The CTNAV trial \ncompares the accuracy of the needle placement using standard CT procedure (CT \ngroup) and using the navigation system procedure (NAV group).\nMethods and Materials: Prospective, randomised, comparative, open, controlled \nstudy conducted between June 2010 and January 2012 in Grenoble University \nHospital on 120 patients who had to undergo a percutaneous CT procedure. Pa-\ntients were randomised to have normal procedure (CT group) or Navigation System \nassisted procedure (NAV group). The main outcome was the distance between \nthe planned trajectory and the effective needle trajectory after the first placement \nattempt. Significance was set at 0.01\nResults: The comparison between the two groups shows a significant difference \nconcerning the main outcome splitted in distance and angle: distance in mm [95% \nCI]): CT: 9.49[4.92 ;15.18] NAV :3.82 [2.68 ;8.33], (p < 1e-05). Angle in degrees \n[95% CI]):CT :8.19[6.11 ;13.27] NAV: 4.13[2.18 ;7.57] (p < 1e-05). The number of \ncontrol CT series was lower in the NAV group. Operator satisfaction and system \nacceptance were high.\nConclusion: Clinical trial analysis shows that the use of the navigation system \nimproves the accuracy of the procedure when compared with conventional \ninterventions. \n\nScientific Sessions\nS245\nA\n C D E F G\nB\nFriday\ndynamic contrast-enhanced MRI (DCE-MRI) and histology, we assessed the impact \nof this therapeutic approach on the tumour vasculature.\nMethods and Materials: Rats bearing breast cancer bone metastases were im-\naged using VCT and DCE-MRI prior to and 25 days after the onset of therapy; \nuntreated (n=12) and treated (integrin inhibitor monotherapy; n=12) or together \nwith antiresorptive agent (combination therapy; n=11) to assess osteolysis and \nfunctional MRI parameters, respectively. Mean vessel diameter and SMA and \ncollagen-IV-positive vessel area fraction were assessed histologically.\nResults: Compared to the control group, bone defect healing at the osteolytic site \noccurred in rats receiving monotherapy and even more frequent after combination \ntherapy as shown by VCT. In addition, we observed a profound effect of mono- and \ncombination therapy on the tumour vasculature determined by DCE-MRI parameters \namplitude and exchange rate constant. Both therapy regimens induced elevated \nvessel permeability/perfusion in bone metastases, but opposite to monotherapy, \ncombination of agents additionally elevated the blood volume. Immunofluorescence \nanalysis of osteolytic lesions revealed more tumour blood vessels after combination \ntherapy and equally immature vasculature as compared to monotherapy.\nConclusion: Upon treatment with integrin inhibitor monotherapy or in combination \nwith an antiresorptive agent, vessel remodelling could be assessed by DCE-MRI. \nInterestingly, the degree of vessel remodelling could be correlated with bone defect \nhealing, so we conclude the existence of a strong interaction between tumour \nangiogenesis and bone turnover in lytic osseous lesions.\nB‑0435 14:45\nView-angle tilting (VAT) and slice-encoding metal artifact correction \n(SEMAC) for MR imaging of orthopaedic tumor prostheses \nP.M. Jungmann1, C. Ganter1, F. Pohlig1, C. Schaeffeler1, J.S. Bauer1, \nM. Nittka2, E.J. Rummeny1, H. Rechl1, K. Woertler1; 1Munich/DE, \n2Erlangen/DE (pia.jungmann@tum.de) \nPurpose: To evaluate the reduction of metallic artefacts produced by orthopaedic \ntumour prostheses in MR imaging by application of new WARP-sequences (VAT \nand SEMAC).\nMethods and Materials: WARP turbo-spin-echo sequences and standard metal \nsequences were evaluated by scanning tumour-prostheses in an experimental \nmodel at 1.5 T MRI. Three different MR techniques were applied: (i) standard, \n(ii) VAT and (iii) combined VAT and SEMAC sequences (VAT&SEMAC). For each \ntechnique, coronal short-tau-inversion-recovery (STIR), coronal T1-weighted and \naxial T1- and T2-weighted sequences were assessed. Diameters of artefacts \nwere measured quantitatively at n=8 different standardised spots for n=4 different \ntumour prostheses and real diameters of prostheses were compared with artefacts. \nWilcoxon and paired t-test were used for statistical analysis.\nResults: Reduction of artefacts was achieved by application of WARP-techniques. \nFor coronal STIR-sequences, diameters were smaller in the VAT&SEMAC group \n(Mean±standard deviation, 70.1±92.9 mm) compared with standard sequences \n(73.0±92.6 mm; Wilcoxon-test, P < 0.001). The VAT group showed intermediate \ndiameters (72.0±93.1 mm; P=0.002). Compared with standard coronal T1-weighted \nsequences (70.1±91.8 mm), application of VAT (68.3±91.1 mm; P=0.005) and \nVAT&SEMAC (68.2±91.0 mm; P=0.002) showed similar artefact reduction. Ac-\ncordingly, axial VAT also reduced artefacts (T2-weighted, P=0.008; T1-weighted, \nP=0.006). However, real diameters (27.2±18.2 mm) were significantly smaller than \nartefact diameters for all techniques (Standard STIR, 32.5±21.4 mm; VAT, 30.7±21.3 \nmm; VAT&SEMAC, 29.5±20.3 mm; all P < 0.05).\nConclusion: In the experimental model, significant reduction of metallic artefacts \nwas achieved by application of WARP-techniques (VAT and SEMAC) for all pulse \nsequences. Thus, this new technique appears to be applicable to postoperative \nfollow-up of patients with orthopaedic tumour prostheses. \nAuthor Disclosures:\nM. Nittka: Other; Development of the WARP-Sequences, Siemens AG.\nB‑0436 14:54\nAssociation of QCT bone mineral density and bone structure with \nvertebral fractures in patients with multiple myeloma \nJ. Borggrefe1, S. Giravent2, F. Thomsen2, J. Peña2, A. Wulff2, A. Günther1, \nM. Heller2, C.C. Glüer1; 1Cologne/DE, 2Kiel/DE (Jan.Borggrefe@uk-koeln.de) \nPurpose: Computed tomography is widely used for staging osteolyses and \ndetecting fractures in patients with multiple myelioma (MM). We investigated the \nrisk of vertebral fractures for MM patients in dependence of QCT trabecular bone \ndensity (vBMD trab), median trabecular separation (Tb.Sp). and cortical thickness \nof vertebral bodies T11 and T12.\nMethods and Materials: We evaluated CT scans from the OLYMP-CT study with \na cohort of 61 MM patients that underwent CT for clinical staging. A QCT software \nsubcutaneous lesions. 3. Size, depth, heterogenicity, incomplete fat suppression \nand nodular areas are more sensitive for liposarcoma but there is considerable \noverlap with benign lipomas.\nB‑0432 14:18\nComparison of efficacy of surgical-, CT- and PET-CT-guided biopsy \nin musculoskeletal lesions \nJ.L.M.A. Gielen, A.M. De Schepper, S. Ceyssens, D.H. Creytens, \nJ. Somville, P. Van Dyck, P. Pauwels, M. Peeters, P.M. Parizel; Antwerp/BE \n(jan.gielen@uza.be) \nPurpose: To compare the efficacy of surgical-, CT- and PET-CT-guided biopsy of \nmusculoskeletal (pseudo)tumours.\nMethods and Materials: Between January 2011 and July 2012, we biopsied156 \nmusculoskeletal lesions. A new PET-CT guidance technique, targeting the area \nof most intense radio-labelling (AMIR), is introduced. We included 149 lesions, 36 \nsoft tissue lesions (STL) and 113 bone lesions (BL). All patients were randomly \ndistributed over the surgical- or CT-guided biopsy systems: CT (n68), PET-CT (n40), \nsurgical (n41). In each case, appropriate biopsy needles were used.\nResults: Correct characterisation was obtained in 80.5%, 88.2% and 92.5% of \nsurgical-, CT-, and PET-CT-guided techniques, Fisher’s exact test: P=0.2756. Over-\nall efficacy of characterisation was 88% in benign and 86% in malignant lesions, \nChi-squared test X 2 = 0.1367, df=1, P=0.7116. In STL, correct characterisation \nwas obtained in 80% (surgical), 77.8% (CT) and 88.2% (PET-CT). In BL, correct \ncharacterisation was obtained in 80.6% (surgical), 89.8% (CT) and 95.7% (PET-\nCT), Fisher’s exact test, P=0.7329 and 0.2974, respectively.\nConclusion: The diagnostic efficacy of PET-CT was better, compared to surgical- \nand CT-guided biopsy. The efficacy rates for malignant and benign lesions, for the \nthree techniques, were comparable. The best results were obtained in BL with CT \nand PET-CT techniques. Although the differences are not statistically significant, \n(false results are too few to find statistically significant differences), it appears that \nthe information provided by PET for CT-guided biopsy is useful, thereby reducing \nthe false negative rate from 19.4% to 4.3% in BL and from 20% to 11.8% in STL. \nB‑0433 14:27\nCT evaluation of thoracic bone metastasis: comparison of \n3D volume-rendered images and combined axial and coronal \nmultiplanar reconstruction images \nK. Doo1, E.-Y. Kang1, H. Yong1, O. Woo1, K. Lee2, Y.-W. Oh1; 1Seoul/KR, \n2Ansan/KR (kwdoo@korea.ac.kr) \nPurpose: Although a correct assessment of thoracic bone metastasis is important, \nit is time-consuming and insensitive by conventional axial and coronal CT images. \nThe objective of this study was to evaluate the diagnostic benefits of 3D volume-\nrendered (VR) images for the detection of thoracic bone metastasis on CT as com-\npared with combined axial and coronal multiplanar reconstruction (MPR) images.\nMethods and Materials: Among 117 consecutive patients who underwent chest CT \nand PET-CT or bone scan, 21 patients who had thoracic bone metastasis were in-\ncluded. Two radiologists independently reviewed the probability of metastasis of ribs \nand vertebrae on combined axial and coronal MPR, 3D VR, and 3D VR with MPR \nimages. Diagnosis of bone metastasis was determined by PET-CT, bone scan, or \nbiopsy. Diagnostic performance parameters and interpretation time were evaluated.\nResults: For all thoracic metastasis (195/756), the mean sensitivity and accuracy \nof 3D VR with MPR and MPR images were similar (reader 1, 62.1%, 88.6% vs \n52.8%, 91%; reader 2, 50.3%, 86% vs 48.7%, 85.6%, P> 0.05). For rib metastasis, \nthe mean sensitivity and accuracy of 3D VR with MPR were higher than those of \nMPR images (reader 1, 64.1%, 92.7% vs 48.5%, 89.5%.; reader 2, 52.4%, 88.9% \nvs 42.7%, 87.5%, P < 0.05). The mean interpretation time was decreased on 3D \nVR with MPR compared to MPR images (reader 1, 73.6 vs 122.5, reader 2, 103.4 \nvs 182.5 seconds, P < 0.05).\nConclusion: The addition of 3D VR to MPR images performs significantly better \nfeasibility than combined axial and coronal MPR images for rapid evaluation of \nthoracic bone metastasis.\nB‑0434 14:36\nDCE-MRI for assessment of vessel remodelling associated with bone \ndefect healing in experimental lytic bone metastases \nD. Komljenovic, W. Semmler, T. Bäuerle; \nHeidelberg/DE (d.komljenovic@dkfz-heidelberg.de) \nPurpose: Integrin inhibition and antiresorptive therapy decelerate osteolysis in \nexperimental breast cancer bone metastases. Here, using volumetric CT (VCT), \n\nScientific Sessions\nS246\n C A D E F\n G\nB\nB‑0439 15:21\nRole of apparent diffusion coefficient (ADC) maps in the evaluation \nof tumour response in chemotherapy in patients with multiple myeloma \nP.A. Bonaffini, D. Ippolito, V. Besostri, A. Casiraghi, A. Di Lelio, S. Sironi; \nMonza/IT (pa.bonaffini@gmail.com) \nPurpose: To assess the diagnostic value of ADC maps in the evaluation of response \nto chemotherapy in patients with multiple myeloma (MM).\nMethods and Materials: 25 patients with MM underwent a 1.5 T WB-MRI (Achieva, \nPhilips), before and 4-6 months after chemotherapy, with the following protocol: \ncoronal and sagittal short tau inversion recovery (STIR) T2 and T1 TSE and axial \nDWIBS (b values: 0, 500, 1000 mm2/sec). DWIBS were compared with T1 and \nSTIR sequences in five districts (skull, spine, sternum and ribs, pelvis, upper and \nlower limbs) to evaluate response to treatment. On ADC maps ROI were drawn \nalong contours of bone lesions. The absolute values and percentage variation of \nADC (ΔADC) before (MR1) and after (MR2) chemotherapy were calculated and \ncompared between responders and non-responders patients.\nResults: 30 lesions (12 focal, 18 diffuse) were evaluated and correctly detected \non DWIBS as areas with high signal intensity as compared to normal bone mar-\nrow; response to chemotherapy was established as signal intensity decrease after \ntreatment. The mean ADC values were: 0.63 ± 0.24 x 10-3 mm²/sec on MR1 and \n1.04 ± 0.46 x 10-3 mm²/sec on MR2 for responders (18/25); 0.61 ± 0.05 x 10-3 \nmm²/sec on MR1 and 0.69 ± 0.09 x 10-3 mm²/sec on MR2 for non-responders \n(7/25). The mean ΔADC in responders (Δ=66%) was significantly different (p < \n0.05) than that in non-responders (Δ=15%).\nConclusion: WB-MRI is a non-invasive tool able to evaluate response to treatment \nin patients with MM, by determining individual changes of ADC values, related to \nbiological changes in tumour tissue. \n14:00 - 15:30 Room F1 \nAbdominal Viscera \nSS 601 \nLiver steatosis: imaging and quantification \nModerators: \nI. Bargellini; Pisa/IT \nB. Van Beers; Clichy/FR \nB‑0440 14:00\nPresence/absence of hepatic steatosis after percutaneous intraportal \npancreatic islet transplantation in 108 allo- and auto-transplanted \npatients: can ultrasound predict the clinical outcome? \nG. Agostini, M. Venturini, G. Querques, P. Maffi, C. Gremizzi, A. Palmisano, \nF. De Cobelli, A. Secchi, A. Del Maschio; Milan/IT (venturini.massimo@hsr.it) \nPurpose: Islet transplantation is a less invasive/safer/repeatable option than \nsurgical pancreas transplantation for type 1 diabetic patients; it can be performed \nafter kidney transplantation (IAK), alone (ITA) in patients without chronic renal \ninsufficiency, or as an autotransplantation (IAT) after pancreatectomy (immu-\nnosuppression unnecessary). Steatosis is a consequence of islet engraftment: \nits meaning is controversial. Our longitudinal study aimed to assess steatosis \nincidence at ultrasound after islet auto- and allo-transplantation, and to identify \nany relationship with graft function.\nMethods and Materials: Ultrasound was performed at baseline/6/12/24 months \nin 108 islet-transplanted patients (33 IAK/50 ITA/25 IAT). Steatosis first detection/\nprevalence/duration/distribution were recorded. Steatosic (S) and non-steatosic \npatients (NS) were compared for the following parameters at baseline/6/12/24 \nmonths: insulin independence rate, ß-score, C-peptide, glycated-haemoglobin, \nexogenous insulin requirement, fasting plasma glucose, infused islet mass.\nResults: Steatosis was found in 21/108 patients, 24% (20/83) allo-transplanted, \n4% (1/25) auto-transplanted (better outcome), with first detection at 6 months, high-\nest prevalence at 1 year (18 cases). S-patients had a significantly higher infused \nislet mass (IE/kg: S=10.822; NS=6.138) and worse basal metabolic conditions \n(ß-score: S=1.7±1.6; NS=2.8±2.8), but better islet function at the time of steatosis \nfirst detection (ß-score: S=3.9±2.0; NS=2.9±2.3), after which a progressive islet \nexhaustion, along with steatosis disappearance, was observed. Conversely, in NS \npatients these parameters remained more stable in time.\nConclusion: Steatosis at ultrasound is significantly less detectable in auto-trans-\nplanted-patients with better clinical outcome. It seems to be related to stressed \nislets’ overworking activity (higher ß-score values when steatosis appears), and a \nhigher infused islet mass. Steatosis presence precedes metabolic alterations and \n(Structural Insight) was adapted in order to allow calibrated bone density and bone \nstructure analyses of the vertebral bodies, using an underlying light weight calibra-\ntion phantom with design for coronary calcium scoring (Image Analysis Phantom®).\nResults: The prevalence of vertebral fractures was 48%. Patients with fractures \nwere not significantly older than patients without fractures (65 vs 62 years of av-\nerage, p> 0.25). The trabecular vBMD in patients with fractures was significantly \nreduced from 200 mg/cc (SEM ± 9.3) to 166 mg/cc (SEM ± 9.6) (p < 0.05). In the \nage-adjusted logistic regression, the OR per SD for vBMD trab. was 1.9 (1.1-3.6). \nThe OR for Tb.Sp. was 2.3 (1.3-4.0) per SD. In a model combining both parameters, \nTb.Sp. remained significant without additional predictive value. Cortical parameters \ndid not provide significant predictive value for fracture events.\nConclusion: In MM patients, the loss of trabecular density is associated with the \nrisk of vertebral fractures. The detection of increased trabecular separation as \ncaused by plasmacell-infiltration appears to be of value for fracture risk assessment. \nB‑0437 15:03\nImaging patterns in multiple myeloma: observations at whole body MRI \nN.M. Long, O.M. Drumm, P. O’ Gorman, S.J. Eustace; Dublin/IE \n(nevelong@gmail.com) \nPurpose: To categorise imaging patterns in multiple myeloma and correlate with \npatient demographics and outcome.\nMethods and Materials: 200 consecutive whole body MRI studies of patients with \na proven diagnosis of multiple myeloma were included for review. Images were \nreviewed by 2 experienced radiologists with discrepancies resolved by consensus. \nIn each case an attempt was made to characterise patterns of marrow infiltration. \nCorrelation was subsequently performed with markers of disease activity including \npercentage plasma cells, LDH, immunological markers and Bence-Jones protein.\nResults: Four distinct patterns of marrow infiltration were identified in multiple \nmyeloma. Pattern A: Normal marrow with superimposed plasmacytoma. Pattern \nB: Normal marrow with multiple superimposed plasmacytomata. Pattern C: Diffuse \nmarrow infiltration/marrow packing. Pattern D: Diffuse marrow infiltration/marrow \npacking with superimposed plasmacytomata. Type A patients showed optimum \noutcome with improved treatment response and reduced early mortality. Marrow \npatterns type B, C and D correlated with progressively increasing disease severity \nwith type D patients demonstrating the poorest treatment response and outcome.\nConclusion: Four distinct patterns of marrow disease can be identified in patients \nwith multiple myeloma and these should be evaluated at diagnosis as they ultimately \ndictate outcome and correlate with treatment response. \nB‑0438 15:12\nEfficacy of whole body low-dose CT (WBLDCT) in the staging of \npatients with early multiple myeloma: comparison with whole body \nmagnetic resonance imaging (WBMRI) \nV. Besostri, D. Ippolito, P.A. Bonaffini, A. Masetto, A. Cuccia, S. Sironi; Milan/IT \n(valeriabesostri@gmail.com) \nPurpose: To compare WBLDCT (whole body low dose CT) study with WBMRI \n(whole body magnetic resonance imaging) in the identification of bone marrow \ninvolvement for the detection of bone lesions and for risk evaluation of pathologi-\ncal fractures.\nMethods and Materials: A total of 25 patients with histologically confirmed my-\neloma underwent WBLDCT and WBMRI. Entire skeleton was divided into five \ndistricts (skull, spine, sternum and ribs, pelvis, upper and lower limbs) in terms of \npattern, size and distribution of disease. Unenhanced WBLDCT was performed \non 256-slice scanner (Philips, ICT, 256): voltage 120 KV, tube current time product \n40 mAs, collimation 128x0.65. MRI protocol was performed on a 1.5 T (Achieva \nPhilips) and consisted of T1 TSE and T2 STIR on coronal and sagittal plane and \nDWIBS on axial plane. WBLDCT findings were compared with those of WBMRI. \nThe disease was staged according to Salmon and Durie System.\nResults: On WBMRI 9 patients showed no involvement; in 16 patients, 65 regions \nwere affected by a total of 400 focal lesions: 14 patients were stage I, 4 were \nstage II and 6 were stage III. On WBLDCT 8 patients showed no involvement; \nin 17 patients, 49 regions were affected by a total of 396 focal bone lesions: 14 \npatients were stage I, 2 were stage II and 8 were stage III. WBLDCT overstaged \n5 patients compared with MRI. The infiltration patterns were concordant in both \ntechniques: focal in 9 patients, diffuse in 5 patients and combined in 10 patients; \n1 patient showed no disease.\nConclusion: WBLDCT is a fast and feasible technique for detecting small osteo-\nlytic lesions, but presents poor sensitivity for evaluation of abnormalities in early \nfocal marrow infiltrations. Conversely, MRI protocol is more specific to assess low \ndegrees of diffuse bone marrow infiltration.\n\nScientific Sessions\nS247\nA\n C D E F G\nB\nFriday\nB‑0443 14:27\nLiver fat volume fraction quantification in patients with chronic liver \ndiseases with separated estimation of fat and water relaxation times \nat 1.5 and 3.0 T \nB. Leporq, F. Pilleul, O. Beuf; Villeurbanne/FR \n(benjamin.leporq@creatis.insa-lyon.fr) \nPurpose: To validate a magnitude-based method, transposable on any imaging \nsystem and for all current clinical fields (1.5 and 3.0 T) for liver fat volume fraction \n(FVF) quantification without dominant component ambiguity problems.\nMethods and Materials: MR imaging was performed at 1.5 and 3.0 T using a \nmultiple-angle multiple-gradient echo acquisition. A quantification algorithm cor-\nrecting for relaxation time effects using a disjointed estimation of T1 and T2* of fat \nand water and accounting for the NMR spectrum of fat was developed. Validations \nwere performed in a prospective comparative study with histology on 28 patients \nwith chronic liver diseases.\nResults: MR-estimated FVF and histological results were strongly correlated \n(ρ=0.96). ROC analysis showed that FVF allowed the diagnosis of a mild (cut-off \n= 5.5%) and a moderate steatosis (cut-off=15.2%) with a sensitivity/specificity of \n100%. Water relaxation times (T1 and T2*) were found significantly reduced in \npatients with iron deposition (p < 0.01), whereas water T1 was found significantly \nincreased in patients with cirrhosis (p < 0.01).\nConclusion: This method that can be performed at 1.5 and 3.0 T on all imaging \nsystems provide an accurate quantification of the FVF in patients with chronic liver \ndisease. FVF could be a relevant biomarker for the clinical follow -up of patients \nwith NAFLD as well as to quantify steatosis in the full spectrum of chronic liver \ndiseases. Interestingly, thanks to the separated estimation of fat and water relaxa-\ntion times, detection of cofactors such as iron deposition or cirrhosis in patients \nwith NAFLD could be achieved.\nB‑0444 14:36\nCombination of liver intravoxel incoherent motion imaging with MR \nfat quantification at 3.0 T to distinguish between pure steatosis and NASH \nB. Leporq1, F. Pilleul1, J. Dumortier2, O. Guillaud2, T. Lefort2, O. Beuf1; \n1Villeurbanne/FR, 2Lyon/FR (benjamin.leporq@creatis.insa-lyon.fr) \nPurpose: To evaluate the combination of liver intra-voxel incoherent motion imaging \n(IVIM) and a MRI fat quantification method at 3.0 T to make the distinction between \nNASH and pure steatosis.\nMethods and Materials: A multi-angle multi-gradient echo acquisition combined \nwith a dedicated algorithm was used to quantify liver fat volume fraction (FVF), \ncorrected for water and fat relaxation times and accounting for the NMR spectrum \nof fat. IVIM was performed using a single-shot SE-EPI sequence, in free breathing, \nwith 11 b-values (0-20-40-60-80-100-200-300-400-600-800s.mm-2) and a weighted \nsignal averaging procedure. Three orthogonal diffusion gradients were sequentially \napplied. A 2000 ms TR, 54 ms minimum TE; 21 axial slices of 8 mm thick; 400×300 \nmm² FOV; 128×96 matrix were used. IVIM parameters (pure molecular diffusion \ncoefficient (DSlow), perfusion-related diffusion coefficient (DFast) and perfusion \nfraction (f)) were estimated. MR imaging was performed on a healthy volunteers \ngroup (n=33), and on patients with histologically confirmed pure steatosis (n=16) \nor NASH (n=4).\nResults: Wilcoxon test showed that DSlow was significantly lower when fat is \npresent (FVF > 5.5%) (p < 0.01). DSlow and DFast were found significantly reduced \nbetween subjects with pure steatosis (Brunt=0) and NASH (Brunt> 0) (p < 0.05).\nConclusion: Fat vesicles in pure steatosis restrict molecular diffusion without \nmodification of micro-perfusion. In NASH, fibrosis still increase the restriction of mo-\nlecular diffusion compared to patients with pure steatosis and decrease the micro-\nperfusion as illustrated by the decrease of perfusion-related diffusion coefficient. \nThese preliminary results suggest that combining MRI fat quantification and IVIM \ncould be a none invasive mean to distinguish between pure steatosis and NASH.\nB‑0445 14:45\nQuantification of steatosis hepatitis and liver iron overload in a \npopulation-based study using magnetic resonance imaging \nJ.P. Kühn1, D. Hernando2, H. Völzke1, S.B. Reeder2, N. Hosten1, B. Mensel1, \nK. Hegenscheid1, M. Evert1, S. Baumeister1; 1Greifswald/DE, 2Madison, WI/US \n(kuehn@uni-greifswald.de) \nPurpose: To determine the proton-density fat fraction (PDFF), and the apparent \nR2* (=1/T2*) of the liver and to explore its relationship with metabolic parameters \nin a large-scale epidemiological study.\nMethods and Materials: Between 2009 and 2012, 3,198 volunteers, 1,586 men \nand 1,612 women, aged 52.6±13.7 years were participated in a population-based \ntherefore could predict graft dysfunction addressing therapeutic decisions before \nislet exhaustion. Steatosis absence does not allow any conclusion.\nB‑0441 14:09\nPhosphorus magnetic resonance spectroscopy (31P-MRS) in non-\nalcoholic fatty liver disease (NAFLD) \nJ.M. Abrigo, V.-S. Wong, D.-W. Yeung, G.-H. Wong, A.-h. Chan, H.-Y. Chan, \nW.-W. Chu; Shatin/HK (jillabrigo@cuhk.edu.hk) \nPurpose: To describe hepatic biochemistry in biopsy-proven NAFLD states using \n31P-MRS and to evaluate its diagnostic performance for distinguishing non-alcoholic \nsteatohepatitis (NASH).\nMethods and Materials: The cohort consisted of healthy controls (n=19), and \n132 NAFLD patients with liver biopsy, as follows: simple steatosis (SS, n=37), \nNASH with non-significant fibrosis (NASH-NSF, n=49) and NASH with significant \nfibrosis (NASH-SF, n=46). 31P-MRS was performed on a 3 T MRI to obtain signal \nintensities for phosphomonoesters (PME), phosphodiesters (PDE) and component \nglycerophosphocholine (GPC), total adenosine triphosphate (ATP) and component \nα-ATP , and inorganic phosphate (Pi). These were expressed as percentages relative \nto total phosphate and compared using one-way ANOVA with post hoc Bonferroni \ntest. Receiver operating curve (ROC) analysis was performed to determine cut-off \nvalues with highest Youden index. Statistical significance was declared at α< 0.05.\nResults: Compared with controls, all NAFLD groups had higher PDE (p < 0.049). SS \nand NASH-NSF had decreased PME (p=0.001-0.015), increased GPC (p < 0.001), \nnormal total ATP (p=0.067-1.000) and decreased Pi (p=0.018-0.021). NASH-SF \nhad normal PME (p=0.764) normal GPC (p=0.727), decreased total ATP (p=0.035) \nand normal Pi (p=0.443). α-ATP was significantly decreased in both NASH groups \nand identified as a potential diagnostic marker. The computed area under the ROC \nwas 0.705, and an α-ATP threshold of < 13.13% gave a 65% sensitivity and 73% \nspecificity for the identification of NASH.\nConclusion: 31P-MRS shows observable spectroscopic patterns within the NAFLD \nspectrum. α-ATP is a potential diagnostic marker for distinguishing NASH from SS.\nAuthor Disclosures:\nV. Wong: Research/Grant Support; Health and Health Services Research Fund \nsponsored by the Government of Hong Kong SAR and Research Grants Council \nof Hong Kong SAR. W. Chu: Research/Grant Support; Health and Health \nServices Research Fund sponsored by the Government of Hong Kong SAR and \nResearch Grants Council of Hong Kong SAR.\nB‑0442 14:18\nClinical implications of fatty liver on hepatic diffusion-weighted \nimaging studied in healthy subjects \nH. Dijkstra, A. Handayani, P. Kappert, M. Oudkerk, P.E. Sijens; Groningen/NL \n(h.dijkstra01@umcg.nl) \nPurpose: To evaluate the diagnostic implications of fatty liver on DWI by assessing \nthe hepatic fat fraction (HFF) and T2* of healthy subjects in eight liver segments in \norder to eliminate patient-related confounding factors such as cirrhosis and fibrosis.\nMethods and Materials: Eleven healthy volunteers were examined with DWI \n(seven b-values) and two series of in- and out-of-phase dual-echo spoiled gradi-\nent echo sequences (SPGR) to obtain the HFF (Dixon’s method). A third SPGR \nseries was acquired to calculate T2* relaxation. DWI data were analyzed using the \nIVIM model: molecular diffusion (Dslow), microperfusion (Dfast) and the respective \nfractions (fslow/fast). For each subject, four circular regions-of-interest (ø22.3 mm) \nwere drawn in each segment according to the Couinaud-Bismuth classification. \nData with low SNR< 5 were excluded. IVIM parameters were compared between \ngroups of low (²2.5%), intermediate (2.5²HHF< 10%) and high HHF (> 10%). Linear \ncorrelations between HHF, DWI parameters, and T2* were assessed.\nResults: In each segment, Dslow decreased with increasing HFF. Dslow averaged \nover all segments differed significantly (p < 0.001) between low (0.99×10-3 mm2/s), \nintermediate (0.74×10-3 mm2/s) and high HFF (0.32×10-3 mm2/s). Both Dslow and \nT2* decreased with HFF (R 2=0.89; R2=0.72). Dfast and fslow/fast showed small \nintergroup differences (p < 0.04).\nConclusion: Increasing hepatic fat fractions caused significant reduction of the \nmolecular diffusion and shortening of T2*. This implies that hepatic DWI hindered \nby fat leads to apparent fluctuations of the molecular diffusion and hypointensity \non DWI images; this may induce false diagnoses such as fibrosis or cirrhosis.\n\nScientific Sessions\nS248\n C A D E F\n G\nB\n(p < 0.001/p < 0.001), whereas there was no significant correlation between BAT \nvolume and the amount of subcutaneous adipose tissue (p=0.70). BAT activity \nwas an independent, negatively influencing variable for liver fat content (p=0.027).\nConclusion: BAT significantly correlates with body fat composition, especially \nvisceral fat mass considered relevant for the development of metabolic syndrome, \nand seems to be an independent regulator of hepatic steatosis.\nB‑0448 15:12\nIn-phase/opposed-phase MRI and MR spectroscopic measurements \nfor the quantification of liver fat content in morbidly obese patients \nH.H. Bertram1, G. Thörmer2, N. Garnov2, T. Schütz2, V. Peter2, T. Kahn2, \nH. Busse2; 1Munich/DE, 2Leipzig/DE (henriette.bertram@tum.de) \nPurpose: Different MR techniques have been explored to quantify the liver fat \ncontent (LFC). The goal of this study is to compare the LFC values between MRS \nand in-phase/opposed-phase MRI in extremely obese patients.\nMethods and Materials: 30 obese patients (mean BMI 48 kg/m2) were imaged \nat 1.5 T. MR spectra were acquired in liver segments II, IV and VII. In-phase/\nopposed-phase (IP/OP) MRI data were corrected for T1 and T2* effects and used \nto calculate LFC maps. To compare IP/OP MRI and MRS, regions of interests of \nthe size of the MRS voxels were placed in the fat parameter map at positions that \nmatched the location of the spectroscopic voxel. Tissue samples were taken for \nhistopathological analysis.\nResults: Mean overall intrahepatic fat content from IP/OP imaging was 14.3 ± \n2.0%. Lipid content ranged from 0.2 to 35.7% with the IP/OP technique and from \n0.0 to 71.2% with MRS. MRI and MRS values were characterised by an insignifi-\ncant (p=0.36) bias of -3.6% and upper/lower limits of agreement of 3.8/-11.0%. \nAgreement for the three individual liver segments (II, IV and VII) had upper/lower \nlimits of +5.0/-11.9%, +1.9/-9.6% and +4.8/ -12.0% and insignificant biases of 3.4% \n(p=0.14), -3.9% (p=0.25) and -3.6% (p= 0.27), respectively.\nConclusion: IP/OP imaging and MRS are reliable methods for the assessment of \nLFC. IP/OP imaging is superior in terms of processing time and liver coverage and \nprovides information for cases with larger regional fat differences and is helpful for \nlipid assessment in the left liver lobe where MRS is impractical.\nB‑0449 15:21\nDynamic contrast enhanced-MRI (DCE-MRI) functional assessment \nof vascular events occurring during the intra-hepatic engraftment of \npancreatic islets may predict long-term outcome of islets transplantation \nA. Palmisano, A. Esposito, G. Ironi, P. Maffi, F. De Cobelli, T. Canu, A. Secchi, \nA. Del Maschio; Milan/IT (a.palmisano@live.it) \nPurpose: Pancreatic islets transplantation (islets-tx) is a promising treatment for \npatients with type-1 diabetes. Neoangiogenesis of transplanted islets is a crucial \nphenomenon for engraftment and was investigated with DCE-MRI in mice. The \naim was to use DCE-MRI in clinical islets-tx to evaluate the relationship between \nearly vascular changes, islets loss and long-term clinical outcome.\nMethods and Materials: 6 diabetic pts were enrolled. DCE-MRI was performed at \nbaseline and 7 days after islet-tx with a 3D-T1w-TFE dynamic sequence (temporal \nresolution: 4sec; 45 dynamics) acquired during gadolinium bolus injection. K-trans \nwas assessed by DCE-MRI datasets. Three patients received Ferucarbotran \nlabelled islets and were monitored with T2*sequences (before islets-tx, 7 days \nand each month after). Unlabelled islets were infused in the remaining three pa-\ntients. Glycated haemoglobin, blood glucose, daily insulin request and stimulated \nC-peptide were monthly assessed in order to calculate beta-score (0-8) as index \nof graft function.\nResults: Variation of liver perfusion from pre-transplantation to 7 days after islet-tx \nwere evaluated by k-trans changes at DCE-MRI ([[Unable to Display Character: \n∆]]k-trans0-7days). [[Unable to Display Character: ∆]]k-trans0-7days \nwas strongly correlated to mean beta-score achieved during the subsequent clini-\ncal monitoring (R=0.835;p < 0.05); in particular, a [[Unable to Display Character: \n∆]]k-trans0-7days decrease was observed in case of early graft impairment \n(Pt#6: Δktrans0-7days=-11%, meanβ-score:2) or complete graft failure after 1 \n(Pt#2: Δktrans0-7days=-32%, meanβ-score:1) and 6 months (Pt#4: Δktrans0-\n7days=-28%; meanβ-score:1). Moreover, in pts with labelled islets, a k-trans \ndecrease ([[Unable to Display Character: ∆]]k-trans0-7days: -28%) was \nassociated with a faster rate of labelled islets disappearance at T2* follow-up.\nConclusion: DCE-MRI assessment of the vascular events occurring in the earliest \nphases of islets engraftment may predict graft outcome. \nstudy. MRI was performed in a 1.5 T system using a pre-clinical T2* corrected \nthree-echo chemical shift-encoded sequence. Offline reconstruction of the PDFF \n(corrected for T1, T2* relaxation, noise bias, and multi-peak spectrum of fat) and \nthe apparent R2* (fat corrected) were performed. PDFF and R2* were previously \ncalibrated by histopathologically determined fat and hepatocellular iron content, \nrespectively. PDFF and R2* were graduated in a 4-point scale system: no-, mild-, \nmoderate-, and high content.\nResults: 2,762 MRIs were successfully performed. Median PDFF was 4.0%, range \n0-41.7%. Liver steatosis was observed in 40.0%, composed of mild: 27.6% (762 \nsubjects), moderate: 10.7% (295 subjects), high fat content: 1.7% (48 subjects). \nMedian apparent R2* was 34.4s -1, range 14.0-331.4s -1. Subjects were grouped \nin no iron overload: 82.4% (2,276 subjects), and with iron overload in 17.6%, \ncomposed of mild: 14.9% (412 subjects), moderate: 0.6% (19 subjects), high iron \ncontent: 1.9% (55 subjects).\nConclusion: In North-East Germany the frequency of steatosis hepatitis assessed \nby MRI is 40.0% (median PDFF of 4.0%), and hepatocellular iron overload of 17.6% \n(apparent R2* of 34.4s-1), respectively.\nB‑0446 14:54\nEffect of Gd-EOB-DTPA on hepatic fat quantification using high-\nspeed T2-corrected multiecho acquisition (HISTO) at 1H MR spectroscopy \nY. Park1, C. Lee1, I. Kim1, B. Kiefer2, K. Kim1, J. Choi1, J. Lee1, C. Park1; \n1Seoul/KR, 2Erlangen/DE (pys797979@naver.com) \nPurpose: To determine whether administration of Gd-EOB-DTPA affects hepatic fat \nquantification in a fast breath-hold high-speed T2-corrected multiecho acquisition \n(HISTO) MR spectroscopy.\nMethods and Materials: Sixty-two patients underwent 15-second breath-hold \nHISTO MR spectroscopy, which enables quantification of water and fat T2, and \nsubsequently to provide corrected measure of hepatic fat fraction (FF). All patients \nperformed HISTO twice before and after administration of Gd-EOB-DTPA, respec-\ntively. Post-contrast HISTO was performed between 2-minute equilibrium phase and \n20-minute hepatobiliary phase. We evaluated variability of FF calculation during pre-\ncontrast HISTO and post-contrast HISTO and effect of contrast material on mean \nFF calculation, using paired t test and intraclass correlation coefficient (ICC). We \nalso evaluated whether effect of contrast material on mean FF calculation depends \non FF level (FF< 5%, 5%²FF< 10%, 10%²FF), by comparing ICC using the z-test.\nResults: High reproducibility of FF calculation before and after contrast administra-\ntion was observed (ICC=0.888 vs 0.885, respectively). Mean FF on pre-contrast \nHISTO was 5.06%±2.90 and mean FF on post-contrast HISTO was 5.20%±3.02. \nMean FFs were not significantly different before and after administration of contrast \nagent (P=0.50). ICC for assessment of effect of administration of contrast agent \nwas 0.848 ( P  < 0.001). ICC did not significantly change according to FF level \n(ICC=0.353, 0.450, and 0.730, respectively; P=0.44).\nConclusion: HISTO is known as a simple, accurate MR spectroscopic sequence of \nquantifying hepatic fat noninvasively. Gd-EOB-DTPA administration did not change \nthe FF calculation of HISTO. HISTO after Gd-EOB-DTPA administration can be used \nfor hepatic fat quantification, without spending time for additional MR sequence.\nAuthor Disclosures:\nI. Kim: Employee; Seimens. B. Kiefer: Employee; Siemens.\nB‑0447 15:03\nBrown adipose tissue influences body fat composition and hepatic \nsteatosis \nM.K. Werner, S. Ripkens, M. Schmadl, I. Stef, A. Deckert, \nC.D. Claussen, C. Würslin, N. Stefan, C. Pfannenberg; \nTübingen/DE (Matthias.Werner@med.uni-tuebingen.de) \nPurpose: Brown adipose tissue (BAT) mass and activity is considered a significant \nfactor for the development of adiposity and metabolic syndrome in humans, and \nrepresents a natural target for the modulation of energy expenditure. We evaluated \nthe correlation of BAT activity and active volume as detectable on FDG-PET/CT \nscans with abdominal body fat composition and liver fat estimation.\nMethods and Materials: 4852 FDG-PET/CT examinations in 3680 individual \npatients were screened for BAT, resulting in 601 patients and controls for subse-\nquent analysis, matched for exam date and therefore ambient temperature, age, \nand gender. In addition to BAT volume and activity, an automated segmentation \nwas used to determine visceral fat and subcutaneous fat as well as lean tissue in \nthe abdomen. Liver fat was estimated in 430 patients with non-contrast-enhanced \nCT. Spearman rank correlation between parameters and a multi-variate model for \nliver fat excluding influencing parameters was calculated.\nResults: BAT volume and activity showed a significant inverse correlation with \ntotal adipose tissue (activity p < 0.001/volume p=0.022) and visceral adipose tissue \n\nScientific Sessions\nS249\nA\n C D E F G\nB\nFriday\nB‑0452 14:18\nRadiological evaluation of complete pathological response after \nneoadjuvant chemotherapy treatment of breast carcinoma \nN.M.A. Abdel Razek, H.A. El Ghazaly, O.Z. Yousef; Cairo/EG \n(naglaabdelrazek@yahoo.com) \nPurpose: Neoadjuvant chemotherapy followed by locoregional therapy and post-\noperative systemic chemotherapy is now an accepted strategy. More than 70% of \npatients achieve an objective response (including pathological complete remission \nin 10%-25% of cases), and many patients experience downstaging through primary \nchemotherapy. This study aimed to assess the complete pathological response by \ndifferent imaging modalities including digital mammography, sonography, dynamic \nMRI, MRS and PET-CT.\nMethods and Materials: 125 female patients were enrolled in the study; all were \nhistopathologically proven breast carcinoma and underwent full-course neoadju-\nvant chemotherapy. 25/125 showed complete pathological response indicated by \nhistopathological examination of the surgical specimen.The pathological complete \nresponse was retrospectively evaluated by different imaging modalities done prior \nsurgery including digital mammography, high-resolution breast sonography, dynamic \nMR mammography and MR spectroscopy as well as PET CT. In all patients, metallic \nclips werer lodged in the tumour prior neoadjuvant treatment and preoperative wire \nlocalisation was done to all the 25 cases showing complete pathological response.\nResults: Of 25 of 125 patients who showed complete pathological response, 14/25 \nhas residual asymmetric density with or without microcalcifications by mammogra-\nphy. 17/25 patients showed complete disappearance of the lesion by sonography. \nDynamic MRM showed complete change in the kinetics of the lesions from type \n3 to type 1 and type 2a curves in 24/25 cases and MRS showed complete disap-\npearance of the choline peak in 23/25 cases. PET CT shows absence of FDGB \nuptake in 21/25 cases.\nConclusion: Dynamic MRM and MR proton spectroscopy offered good tools to \nmonitor the response to chemotherapy and are the most sensitive indicators of \ncomplete pathological response even more sensitive than the PET CT. \nB‑0453 14:27\nBreast MRI at 3 T: a pilot study estimating the role of unenhanced \nMRI (DWI combined with T2 IDEAL sequence) vs CE-MRI in the \nassessment of response to neo-adjuvant chemotherapy \nF. Vasselli, F. Pediconi, M. Telesca, M. Luciani, V. Casali, E. Miglio, \nA. Castrignanò, C. Catalano; Rome/IT (federica.vasselli@gmail.com) \nPurpose: To assess the role of contrast-agent-free diagnostic approach combin-\ning DWI with ueMRI and compare the results with CE-MRM in the assessment of \nresponse to NAC using a 3 T Magnet.\nMethods and Materials: Consecutive patients undergoing neo-adjuvant chemo-\ntherapy for biopsy-proved breast cancer > 2 cm underwent MR at 3 T prior to \nchemotherapy and before surgical excision.MR protocol comprised an FSE-T2-\nIDEAL and DWI sequences and a Vibrant-3D-T1W sequence acquired before and \nafter contrast media. Two blinded observers rated ueMRI and then CE-MRI for \nevaluation of tumour response. Lesion size, ADC values and FSE-IDEAL descrip-\ntors were assessed. Tumour size measurements on UE-MR were compared with \nthose of CE-MR with statistic T-test. Response at MRI after chemotherapy were \ncompared to histological specimen after surgery.\nResults: 31 patients were enrolled. Sensitivity of ueMRI was 92% (observer1) \nand 84% (observer2). Sensitivity of CE-MRI was 100% for both observers. Spe-\ncificity was 82% (ueMRI) and 86% (CE-MRI) for both observers. The differences \nbetween methods and observers were not statistically significant (P³0.09). Lesion \nsize measurements did not differ significantly between all sequences. Lesion \nconspicuity was assessed quantitatively by measuring lesion Contrast/Noise Ratio \n(CNR). No statistically significant difference was observed between CNR of CE-\nMRI and DWI (p < 0.009) while CNR on T2 IDEAL was significantly lower respect \nto CE-MRI and DWI (> 0.009).\nConclusion: Combination of DWI and T2 IDEAL have similar values of sensitivity \nand specificity of CE-MRI in the evaluation of tumour response to neo-adjuvant \nchemotherapy. ADC values could be useful for differentiating responders from \nnon-responders earlier during the treatment. \n14:00 - 15:30 Room F2 \nBreast \nSS 602 \nBreast imaging after neoadjuvant therapy and \nsurgery \nModerators:\nG. Gennaro; Padua/IT \nP. Martinez-Miravete; Logroño/ES \nB‑0450 14:00\nEarly response monitoring of neoadjuvant chemotherapy in breast \ncancer patients using magnetic resonance imaging: a systematic review \nM. Lobbes1, R. Prevos1, M. Smidt1, V. Tjan-Heijnen1, M. van Goethem2, \nR.G.H. Beets-Tan1, J. Wildberger1; 1Maastricht/NL, 2Antwerp/BE \n(marc.lobbes@mumc.nl) \nPurpose: To assess whether MRI can identify pretreatment differences or monitor \nearly response in breast cancer patients receiving neoadjuvant chemotherapy.\nMethods and Materials: Pubmed, Cochrane library, Medline, and Embase data-\nbases were searched for publications until January 1, 2012. After primary selec-\ntion, studies were selected based on predefined inclusion/exclusion criteria. Two \nreviewers assessed study contents using an extraction form.\nResults: In 15 studies, which were mainly underpowered and of heterogeneous \nstudy design, 31 different parameters were studied. Most frequently studied pa-\nrameters were tumour diameter or volume, Ktrans, Kep, Ve, and apparent diffusion \ncoefficient (ADC). Other parameters were analysed in only two or less studies. \nTumour diameter, volume, and kinetic parameters did not show any pretreatment \ndifferences between responders and non-responders. In two studies, pretreatment \ndifferences in ADC were observed between study groups. At early response moni-\ntoring significant and non-significant changes for all parameters were observed for \nmost of the imaging parameters.\nConclusion: Evidence on distinguishing responders and non-responders to \nneoadjuvant chemotherapy using pretreatment MRI, as well as using MRI for \nearly response monitoring, is weak and based on underpowered study results and \nheterogeneous study design. Thus, the value of breast MRI for response evaluation \nhas not yet been established.\nB‑0451 14:09\nThe role of magnetic resonance imaging in assessing residual \ndisease and pathologic complete response in breast cancer patients \nreceiving neoadjuvant chemotherapy: a systematic review \nR. Prevos1, M. Smidt1, V. Tjan-Heijnen1, M. van Goethem2, R.-J. Schipper1, \nR.G.H. Beets-Tan1, J. Wildberger1, M. Lobbes1; 1Maastricht/NL, 2Antwerp/BE \n(marc.lobbes@mumc.nl) \nPurpose: This systematic review aimed to assess the role of magnetic resonance \nimaging (MRI) in the evaluation of residual disease extent and the ability to detect \npathologic complete response (pCR) after neoadjuvant chemotherapy for invasive \nbreast cancer.\nMethods and Materials: Pubmed, Cochrane library, Medline, and Embase data-\nbases were searched for relevant studies published until July 1, 2012. After primary \nselection, two reviewers independently assessed content of each eligible study us-\ning a standardised extraction form and pre-defined inclusion and exclusion criteria.\nResults: 35 eligible studies were selected. Correlation coefficients of residual \ntumour size assessed by MRI and pathology were good, with a median value \nof 0.698. Reported sensitivity, specificity, positive predictive value, and negative \npredictive value for predicting pCR with MRI ranged from 25 to 100%, 50 to 97%, \n47 to 90%, and 44 to 100%, respectively. Both overestimation and underestimation \nwere observed. MRI proved more accurate in determining residual disease than \nphysical examination, mammography, and ultrasound. Recent studies suggest that \ndiagnostic accuracy of MRI after neoadjuvant chemotherapy might be influenced \nby treatment regimen and breast cancer subtype.\nConclusion: Breast MRI accuracy for assessing residual disease after neoad-\njuvant chemotherapy is good and probably surpasses other diagnostic means. \nHowever, both overestimation and underestimation of residual disease extent \ncan be observed.\n\nScientific Sessions\nS250\n C A D E F\n G\nB\ngadobutrol (Gadovist®) was injected intravenously at a dose of 0.1 mmol/kg BW \nand six dynamic T1w GRE sequences (VIBE) were collected. The contrast kinet-\nics of all malignant lesions were analysed quantitatively on a pixel by pixel basis \nusing a computer-aided detection system (iCAD). The signal enhancement pattern \nwas coded by three colour intensities and three colour hues. Pharmacokinetic \nchanges were analysed based on the Tofts model including vascular permeability \nand extracellular volume fraction.\nResults: In comparison to the baseline MRI, follow -up examinations showed a \nsignificant tumour size reduction of 57% on average. A decrease of colour hues \nand colour intensities demonstrated significant changes in contrast kinetics. \nVascular permeability revealed a statistically significant decrease (p < 0.05). \nHowever, extracellular volume fraction changes revealed only a slight decrease \nunder chemotherapy (mean decline of 16%).\nConclusion: The CAD analysis provides a reliable evaluation of tumour size, \ncontrast kinetics, vascular permeability and extracellular volume fraction within \na reasonable time. This form of CAD analysis provides a fast and reliable as-\nsessment of early treatment response, enabling a fast modulation of therapy for \nnon-responders. \nB‑0457 15:03\nBreast MRI for assessment of primary systemic chemotherapy \n(PSC): computer assisted diagnosis (CAD) predicts degree of tissue \nresponse and residual tumour mass \nP.A.T. Baltzer1, M. Dietzel2, W.A. Kaiser3; 1Vienna/AT, 2Erlangen/DE, 3Jena/DE \nPurpose: Dynamic contrast-enhanced breast MRI (bMRI) is used for assessment \nof primary systemic chemotherapy (PSC), revealing functional information about \ntumour vasculature. Application of CAD systems to bMRI allows for volumetric \nenhancement pattern assessment. This study investigates the performance of \nCAD-assisted bMRI to assess the degree of tissue response to PSC and to identify \nresidual tumour mass prior to surgery.\nMethods and Materials: bMRI examinations (1.5 T, according to EUSOMA recom-\nmendations) of 67 patients with biopsy proven invasive breast cancer lesions were \nexamined before and after PSC. Maximum diameter reduction (D), lesion volume \nreduction (V) and most suspect enhancement curve (C) were obtained using a \ncommercial available CAD system (CADstream). Histopathologic assessment of \nresidual tumour mass (RT) and tumour tissue vitality (TV) was performed on open \nsurgery specimen. Prediction of RT and TV by bMRI was analysed.\nResults: Before PSC, 108 malignant lesions were identified. After PSC 85 lesions \nremained. CAD revealed 108 lesions before and 48 lesions after PSC. Pathology \nshowed no RT:44, reduced TV:53, TV not reduced: 11 cases. ROC-based ac-\ncuracy for RT was highest for C and D (76.5% and 76.7%, respectively) whereas \nV showed lower diagnostic performance (70.7%). Regarding TV, accuracy was \nhighest for V (85.7%), whereas C and D showed equal diagnostic use (80.9% \nand 81.7%, respectively).\nConclusion: Our investigation shows that functional information both of curve \ntype and size of enhancement are predictors of breast cancer response to PSC. \nAlthough bMRI is specific in the described setting, it shows only moderate sensitivity. \nB‑0458 15:12\nEvaluation of residual breast tissue post-mastectomy using breast MRI \nV. Tsehmaister Abitbol, A. Rundstein, A. Shalmon, E. Konen, M. Sklair-Levy; \nT el Hashomer/IL \nPurpose: To measure the residual breast tissue in patients who underwent mas-\ntectomy with implant reconstruction using breast MRI. \nMethods and Materials: Retrospective review of the breast MRI examinations \nperformed at our institute between January and November 2011, in 45 women \nwho had mastectomy with implant reconstruction. Residual breast thickness was \nevaluated at 4 points (3, 6, 9, 12 o’clock). Breast MRI was performed on 1.5 Tesla \nwith a dedicated breast coil and a standard dynamic implant bilateral breast MRI \nprotocol. Statistics included average, standard deviation, t-test and Kendall’s Tau \nand Spearman’s rank correlation coefficient.\nResults: 45 women were evaluated, the number of breasts evaluated was 88. \nMean age was 43.6 (range 26-61years). We compared residual breast tissue \npost-mastectomy due to carcinoma (n= 45) vs. preventive mastectomy (n=43). The \naverage width of residual breast tissue at 3, 6, 9, 12 o’clock was 8.8 mm,13.3 mm, \n9.3 mm, and 13.3 mm, respectively. The mean width of residual breast tissue was \nsmaller in the mastectomy due to carcinoma (10.63 mm) compared to preventive \nmastectomy (11.86 mm), the difference was not statistically significant (p=0.09).\nConclusion: In women undergoing mastectomy either for breast carcinoma or \nprevention we have shown residual breast tissue measuring between 0 and 53.4 \nmm, with the maximum thickness at 12 o’clock. As far as we know this is the first \nB‑0454 14:36\nRadiological findings in breast autologous fat injection: a \nretrospective review in 12-year follow-up \nL. Camera, I. Baglio, G. Barbazeni, A. Bianchin, M. Valdo, S. Montemezzi; \nVerona/IT (camera.lfmad@gmail.com) \nPurpose: To describe the radiological appearance of normal and pathological \nfindings resulting from mammary autologous fat injection (lipofilling).\nMethods and Materials: We retrospectively reviewed all the patients who under-\ngone breast lipofilling at our Institution from January 2000 to June 2012. All patients \nperformed mammography and ultrasound examination; 1/3 of those completed \nthe follow-up with MRI (until February 2011 with 1.5 T scanner, from March 2011 \nwith 3.0 T scanner).\nResults: 320 Patients (range 25 - 82 years) were included. 280 underwent lipofilling \nafter mastectomy, 40 after wide local excision. 83/320 patients had MRI to complete \nstandard senological examination in cases of prothesis, suspicious recurrence \nor uncertain fat necrosis; after MRI, the patients underwent US - second look. \nNo severe complications were observed after treatment. 232/320 were negative \nfor all the follow -up including in this group “oil cysts” like normal findings due to \nlipofilling. Liponecrosis (64/88 cases), the most frequently observed complication, \nwas detected in 43/64 using US and 21/64 with MRI. In 8/88 cases mammography \nshowed calcifications, which underwent biopsy with diagnosis of fat necrosis. 16/88 \npatients developed homolateral recurrence (7/16 discovered with mammography \nand US, 9/16 confirmed with MRI).\nConclusion: Lipofilling is an important reconstructive surgical application in onco-\nlogic patients. This long follow-up demonstrates that this method is safe because \nin our experience the majority of patients remained negative after surgery. The \neventual complications are easily observed with radiological examinations and do \nnot interfere with breast cancer recurrence early diagnosis. \nB‑0455 14:45\nInvasive ductal carcinoma with marked necrosis on neoadjuvant \nchemotherapy: RECIST or mRECIST in MRI assessment of tumour \nresponse? \nM.M. Nadrljanski, Z.C. Milosevic; Belgrade/RS (dr.m.nadrljanski@gmail.com) \nPurpose: To assess the use of RECIST, mRECIST and volumetric measurements \nin patients with Invasive ductal carcinoma (IDC) with initially marked necrosis on \nneoadjuvant chemotherapy (NACT).\nMethods and Materials: In prospective analysis of 71 patients, 14 patients were \nselected based on marked intralesional necrosis and examined 3 times on MRI: \nbefore the beginning, after the 2nd cycle and upon completion of NACT (anthracy-\ncline/taxane-based regimen). The lesions were measured in axial plane according \nto RECIST and mRECIST. The volumes of the entire lesion and of the viable tissue \nwere computed.\nResults: The longest diameters measured according to RECIST and mRECIST \nand the appropriate volumes were significantly different initially, after the 2nd cycle \nand upon the completion of NACT (p < 0.001 for all). The size of the lesions was \nsignificantly different with/without the necrotic areas. Differences in tumour diameter \nand volume change (delta; %) between RECIST and mRECIST were not significant \nafter the 2nd cycle and upon completion of NACT (p> 0.01 for both). According to \neither RECIST or mRECIST, including the volume measurements, the same number \nof patients were classified in the same response category, i.e., early response - PR \n(21.4%); late response - PR (50.0%).\nConclusion: To our knowledge, this is the first trial testing the use of mRECIST \nin extrahepatic setting. There was no significant difference in changes of diam-\neters or the corresponding volumes according to RECIST Vs. mRECIST. Further \nresearch in larger groups needs to assess the use of the tools in the follow -up of \nnew NACT protocols. \nB‑0456 14:54\nCAD-based assessment of therapy monitoring in neoadjuvant \nchemotherapy of breast cancer \nJ.S. Grueneisen1, S. Maderwald1, T. Heusner2, S. Kuemmel1, \nE.A. Hauth1, M. Forsting1, T.C. Lauenstein1, L. Umutlu1; 1Essen/DE, \n2Düsseldorf/DE (johannes.grueneisen@uk-essen.de) \nPurpose: To evaluate computer-aided detection analysis in dynamic breast MRI for \n(a) volume determination and analysis of (b) contrast kinetic and (c) pharmacokinetic \nchanges of malignant lesions under neoadjuvant chemotherapy.\nMethods and Materials: 85 patients with histopathologically proven breast cancer \nwere studied. Breast MRI was performed on a 1.5 T scanner (Magnetom Espree) \n(a) before and (b) after the third cycle of chemotherapy. For dynamic imaging \n\nScientific Sessions\nS251\nA\n C D E F G\nB\nFriday\nB‑0461 14:09\nPotential value of fibrosis quantification in hypertrophic cardiomyopathy \nA. Jacquier, A. Kallifatidis, B. Maurel, A. Flavian, J. Gaubert, J. Bartoli, \nG. Moulin; Marseille/FR (alexis.jacquier@ap-hm.fr) \nPurpose: To assess the potential value of fibrosis quantification using T1 mapping \nin hypertrophic cardiomyopathy (HCM) in comparison to late contrast enhancement \nimaging, circumferential strain and LV thickness.\nMethods and Materials: Seventeen patients with HCM, and 11 controls subjects \nwere prospectively included. All patients underwent cardiac MR with the following \nsequences: 1) cine sequence, 2) tagging sequence CSPAMM TR/TE=37.1 ms/1.4 \nms; matrix 256, FOV 340, temporal resolution 37.1 ms, distance between tag: 6 mm, \nshort axis. 3) Molli sequence (TR/TE=3.0 ms/1.5 ms; matrix 144-150, thickness:7 \nmm) acquired before and 5, 7, 9 min after gadolinium injection (DOTAREM, 0.2 \nmmol/kg). 4) Late gadolinium enhanced sequence 10 min after injection. T1 values \nwere assessed in blood and in the 6 segments of the mid-LV slice. Statistical analy-\nsis were performed for patients and for segments with (+) and without (-) enhance-\nment on LGE. R1, ΔR1, ΔR1 ratio were calculated (partition coefficient of Gd, λ).\nResults: In HCM, λ was significantly different between patient with (0.54±0.08) \nand without (0.45±0.05) enhancement on LGE (p < 0.0001). No significant dif-\nference was measured in λ value between control and HCM without delayed \nenhancement (p=0.1). We did not found any correlation between lambda and \ncircumferential strain (r=0.11; CI (-0.12;0.34); p=0.3). On the other hand, we found \na significant correlation between LV wall thickness and circumferential strain (0.40; \nCI (0.20;0.56); p < 0.0001).\nConclusion: In HCM, fibrosis is a focal process. In our study, there were no cor-\nrelation between the presence of fibrosis and circumferential strain, but we found \na significant correlation between LV wall thickness and circumferential strain. \nB‑0462 14:18\nExtent of myocardial scar detected by late Gadolinium enhancement-\ncardiac magnetic resonance (LGE-CMR) as a predictor of major \nadverse cardiac events (MACE) in HCM patients \nS. Bertugno, G. Ligabue, F. Fiocchi, L. Nocetti, S. Vasaturo, V. Morini, \nA. Barbieri, R. Lugli; Modena/IT \nPurpose: To investigate the prognostic value of LGE-CMR, throughout the as-\nsociation between LGE extension and the occurrence of MACE in HCM patients.\nMethods and Materials: 90 consecutive HCM patients (60 males and 30 females), \naged between 14 and 79 years, underwent 1.5T CMR. Indexed end-diastolic left \nventricular mass (IEDLV mass) was assessed at end-diastole. LGE-MR images \nwere performed 15 min after injection of 0.2 mmol/kg of Gadolinium. A threshold \nof 6 SD exceeding the mean signal intensity from normal myocardium was used \nto define areas of fibrosis and LGE extent was expressed as percentage to the \ntotal IEDLV myocardial mass. Clinical adverse events were prospectively assessed \nduring a follow-up period of 40.2±11.1 months. MACE included were atrial fibril-\nlation, non-sustained and sustained ventricular tachyarrhythmias, implantable \ncardioverter defibrillator implant and shock, progression of NYHA functional classes \nIII or IV, surgery for obstructive HCM (myomectomy and mitral valve replacement), \nunscheduled hospitalisation, death from heart failure and sudden cardiac death.\nResults: The mean LGE% was 8.11±6.63 g/m2. During the follow-up one or more \nMACE were recorded in 35 (38.9%) patients; 23 (25.5%) patients experienced two \nor more MACE. We found a significant association between LGE% and overall \nMACE (86). Patients who experienced one or more MACE had significantly higher \nLGE% compared with those without: [7.8±7.6] vs. [4.8±5.7], P=0.016. Moreover \nLGE% was significantly higher in patients who presented two or more MACE than \nin patients with only one or without MACE: [10.1±7.6] vs. [4.6±5.7], P=0.0002.\nConclusion: Extension of LGE is a significant predictor for the occurrence of \nMACE in HCM patients. \nB‑0463 14:27\nMyocardial scar extension detected by late Gadolinium \nenhancement-cardiovascular magnetic resonance (LGE-CMR) for \narrhythmic risk stratification of HCM patients \nS. Bertugno, G. Ligabue, F. Fiocchi, L. Nocetti, S. Vasaturo, V. Morini, \nA. Barbieri, R. Lugli, P. Torricelli; Modena/IT \nPurpose: To investigate the role of myocardial fibrosis detected by LGE-CMR as \na potential arrhythmogenic substrate in HCM, throughout the association between \nLGE extension and the occurrence of ventricular tachyarrhythmias (VT) and im-\nplantable cardioverter defibrillator shock (ICDs).\nMethods and Materials: LGE-CMR was performed in 90 consecutive HCM patients \n(mean age: 58.4±15.3; 66.6% males) using a 1.5T scanner. LGE-MR images were \nattempt to evaluate residual breast tissue in patients following mastectomy and \nreconstruction. This study emphasizes the need for follow -up after mastectomy \ndue to the possible risk of recurrence in the residual tissue.\nB‑0459 15:21\nBreast cancer recurrence in DIEP flap reconstructed breasts: a 12-\nyear retrospective study \nJ.A. Farras Roca, A. Luciani, R. Bosc, E. Meyblum, P. Beaussart, \nF. Pigneur, Y. Belkacemi, A. Rahmouni, T.-H. Dao; Créteil/FR \n(josep.farras@etu.parisdescartes.fr) \nPurpose: There is no consensus on surveillance strategies of reconstructed breasts \nafter breast cancer, and it is routinely based on clinical examination alone. This \nstudy aims to assess the incidence and radiological presentation of breast cancer \nrecurrences after deep inferior epigastric perforator (DIEP) flap reconstruction for \nwomen with a history of breast cancer.\nMethods and Materials: 265 consecutive women who underwent DIEP flap \nreconstruction after breast cancer from 1997 to 2009 were included in this ret-\nrospective study. All had annual screening for recurrence and we reviewed their \nfollow-up records in our institution. The date and site of recurrences - ipsilateral or \ncontrolateral to the reconstructed breast, regional and metastatic disease - were \nretrieved. Clinical and radiological presentations - on mammography, ultrasound, \nand MRI - were further analysed.\nResults: 31 of 265 patients presented 34 relapses, with a mean delay of 4.7 years \n(SD=2.9) after DIEP reconstruction; 14 (41%) were ipsilateral, while 6 (18%) were \ncontrolateral and 14 (41%) metastatic. Ipsilateral recurrences had a tendency to oc-\ncur earlier (3.8 years, SD=2.4, p=0.11) and 12 presented at a clinically patent stage.\nConclusion: Cancer recurrence rate after DIEP flap reconstruction was 12% \nin our cohort, 41% of them occurring in the reconstructed breast. Standardised \nradiological screening of DIEP flap reconstructed breasts should be encouraged.\n14:00 - 15:30 Room G/H \nCardiac \nSS 603b \nCardiomyopathy and fibrosis \nModerators: \nP. Donato; Coimbra/PT \nR. Maksimović; Belgrade/RS \nB‑0460 14:00\nPotential value of fibrosis quantification in dilated cardiomyopathy \nA. Jacquier, A. Kallifatidis, B. Maurel, A. Flavian, J. Gaubert, J. Bartoli, \nG. Moulin; Marseille/FR (alexis.jacquier@ap-hm.fr) \nPurpose: To assess the potential value of segmental quantification of myocardial \nfibrosis using T1 mapping in dilated cardiomyopathy (DCM) in comparison to late \ncontrast enhancement imaging and circumferential strain.\nMethods and Materials: Seventeen patients with DCM, and 11 controls subjects \nwere prospectively included. All patients underwent cardiac MR with the following \nsequences (parameters set according to recommendation of the SCMR): 1) cine \nsequence, 2) tagging sequence CSPAMM TR/TE=37.1 ms/1.4 ms; matrix 256, \nFOV 340, temporal resolution 37.1 ms, distance between tag: 6 mm, short axis. 3) \nMolli sequence (TR/TE=3.0 ms/1.5 ms; matrix 144-150, thickness: 7 mm) acquired \nbefore and 5, 7, 9 min after gadolinium injection (DOTAREM, 0.2 mmol/kg). 4) Late \ngadolinium enhanced sequence 10 min after injection. T1 values were assessed in \nblood and in the 6 segments of the mid-LV slice. Statistical analysis were performed \nfor patients and for segments with (+) and without (-) enhancement on LGE. R1, \nΔR1, ΔR1 ratio were calculated (partition coefficient of Gd, λ).\nResults: In DCM, λ was not significantly different between patient without \n(0.50±0.05) and with at least one segment showing enhancement on LGE \n(0.52±0.06; p=0.06). In all DCM, λ was significantly higher compared with the \nvalue obtained in control subject (p < 0.0001). We found a significant correlation \nλ and circumferential strain in each segment (r=0.55; CI (0.39;0.68); p < 0.0001), \nand between λ and LVEF (r= -0.56; CI (-0.82;-0.11); p < 0.01).\nConclusion: In DCM, fibrosis was a diffuse process involving all the myocardium. \nThere was a correlation between the quantity of fibrosis, circumferential strain \nand LVEF. \n\nScientific Sessions\nS252\n C A D E F\n G\nB\nrepresent a physiological behaviour of RV. The lack of LGE further indicate the \nabsence of myocardial structural damage. Our results indicate that BrS seems to \noccur in individuals with structurally and functionally normal heart. \nB‑0466 14:54\nSensitivity of cardiac magnetic resonance varies with clinical \npresentation of biopsy-proven acute myocarditis: correlation with \nnecrosis/apoptosis patterns of viral aetiology \nG. Cannavale, M. Francone, R. Rosati, P. David, A. Frustaci, C. Catalano; \nRome/IT (giuseppe_cannavale@hotmail.it) \nPurpose: Our aim was to evaluate CMR sensitivity in patients presenting with \nacute myocarditis with various clinical presentations and correlate results with \nhistological, immunohistochemical and ultrastructural analysis.\nMethods and Materials: We retrospectively evaluated CMR sensitivity in com-\nparison with clinical presentation in 57 patients who had in the last two years \nan endomyocardial biopsy diagnosis of active myocarditis and clinical history ²3 \nmonths. All subjects underwent at time of diagnosis a CMR and invasive cardiac \nexamination. Immunohistochemistry and viral genomes detection by PCR were \nalso performed.\nResults: Three types of clinical patterns of myocarditis were recognised: 1) \nInfarct-like (fever, chest pain, ST segment deflection at ECG and serum Troponin \nI elevation). 2) Cardiomyopathic (left ventricular dysfunction in absence of ECG \nor systemic abnormalities). 3) Arrhythmic (sudden occurrence of arrhythmias in \nabsence of systemic evidence of inflammation). Delayed enhancement suggest-\ning a myocarditis was documented in 71% of patients (n=15/21) of pattern 1, 57% \n(n=12/21) of pattern 2 and 47% (n=7/15) of pattern 3. Tissue oedema was observed \nin 81% (n=17/21) of pattern 1, 28% (n=6/21) in pattern 2 and 27% (n=4/15)in pattern \n3. Early enhancement was positive in 71% (15/21) of the cases with pattern 1, 67% \n(14/21) with pattern 2 and 40% (6/15) with pattern 3. Myocardial damage due to \ndifferent viral agents detected for each pattern was correlated with CMR findings.\nConclusion: Sensitivity of CMR is high for infarct-like myocarditis, low for cardio-\nmyopathic and very low for arrhythmic pattern. These variations are likely due to \nthe different viral agents involved reflecting different histological patterns, causing \na more extensive vascular disease in pattern 1 compared with focal myocyte and \nconduction tissue damage of patterns 2 and 3. \nB‑0467 15:03\nCardiac magnetic resonance vs echocardiography for the \nassessment of cardiac volumes and function in thalassemia \nintermedia patients \nC. Tudisca1, A. Meloni2, C. Ascioti3, S. Renne3, V. Santamaria4; 1Palermo/IT, \n2Pisa/IT, 3Lamezia T erme/IT, 4Vibo Valentia/IT \nPurpose: We aimed to compare the agreement of left ventricular (LV) volumes and \nejection fraction (EF) by Cardiac Magnetic Resonance (CMR) and Echocardiog-\nraphy (US) in a moderately large cohort of Thalassaemia Intermedia (TI) patients.\nMethods and Materials: 74 TI patients (38 M; 36.7±10.9 years) enrolled in the \nMIOT (Myocardial Iron Overload in Thalassaemia) network were studied by both \necho and CMR (1.5 T) within 3 months of each other. CMR cine images were \nacquired to assess LV parameters in a standard way. LV parameters were meas-\nured by two-dimensional echocardiography using the biplane Simpson’s formula. \nPaired-samples t-test or Wilcoxon test, correlation coefficient, intraclass correlation \n(ICC) and Bland & Altman plot were used to compare CMR and US parameters.\nResults: All US volumes were significantly underestimated, especially the LV end-\ndiastolic volume index (69.9±18.1 ml/m2 vs 96.3±17.9 ml/m2, P < 0.0001), while \nthe US LV EF was significantly higher than the CMR EF (63.7±6.6% vs 62.0±7.4%, \nP=0.051). The correlation between US and CMR end-dyastolic and stroke volume \nindexes was significant but with a very low coefficient, while the correlation for the \nejection fraction was acceptable. The ICC was unsatisfactory for all volumes and \ngood for the ejection fraction. The widest Bland Altman plot range was found for \nthe end-diastolic volume index.\nConclusion: In conclusion, metrics of LV volume index and function showed sig-\nnificant systematic inter-modality differences. In particular, the US volumes were \nsystematically underestimated. This suggests that serial measurements of volumes \nand function in TI should be performed using the same method and, if available, \nthe more reproducible CMR technique. \nAuthor Disclosures:\nC. Tudisca: Research/Grant Support; The MIOT project receives “no-profit \nsupport” from industrial sponsorships (Chiesi Farmaceutici S.p.A., ApoPharma \nInc. and Bayer-Shering). This study was also supported by: “Ministero della \nSalute”. .\nobtained 15 min after injection of 0.2 mmol/kg of Gadolinium. LGE was quantified \nautomatically and defined as area of myocardium with signal intensity 6SD above \nthe mean signal of remote myocardium. Indexed end-diastolic left ventricular mass \n(IEDLV mass) was assessed and LGE extension was defined as percentage of \ntotal IEDLV myocardium mass. Patients were followed prospectively for a mean of \n40.2±11.1 months, during which period occurrence of VT and ICDs were recorded.\nResults: The mean IEDLV mass was 89.5±28.4 g/m 2. On LGE-CMR, 70 (80%) \npatients showed myocardial scar (mean LGE%: 8.11±6.63 of IEDLV mass). During \nthe follow-up period 18 (20%) NSVT and 10 (11.1%) SVT were recorded. 9 (10%) \npatients underwent ICD implantation and 4 of them experienced one or more \nappropriate ICDs. LGE% was significantly higher in patients who exhibited NSVT \nand SVT than in patients who did not: [11.6±7.5] vs. [4.6±5.6], P=0.00001 and \n[13.9±7] vs. [5.9±5.1], P=0.00001. There was no significant relationship between \nLGE extension and ICDs: P=0.075.\nConclusion: Extension of fibrosis on LGE-CMR predicts the occurrence of NSVT \nand SVT in HCM patients. \nB‑0464 14:36\nPrognostic value of RV remodelling in pulmonary hypertension: \ncardiac magnetic resonance study \nN. Galea, M. Francone, I. Carbone, I. Iacucci, P. David, C. Vizza, C. Catalano; \nRome/IT (nicogale2000@yahoo.it) \nPurpose: In Pulmonary arterial hypertension (PH),increase of pulmonary vascular \nresistances results in severe right ventricular (RV) dysfunction due to increased \nafterload and myocardial remodelling.\nThe aim of our study was to investigate how the morphological adaptive changes \nin myocardium (concentric vs eccentric hypertrophy,myocardial fibrosis at late \nenhancement) and RV ejection fraction (RVEF) impact survival in PH.\nMethods and Materials: Our study population included 83 consecutive patients \nwith PH (56 idiopathic,9 CHD-related,16 secondary) who underwent to clinical set-\nting, right heart catheterisation, CMR, and 6-min walk testing at the baseline. CMR \nprotocol included cine imaging and LE acquisitions after contrast-administration (0.1 \nmmol/kg Gd-BOPTA) in order to measure volumes and detect fibrosis. Population \nwas divided in groups on the basis of median value of RV mass/diastolic volume \nratio (RV M/V=Gr1< 0.60,Gr2> 0.60),RVEF (GrA< 34%,GrB> 34%) and LE pres-\nence (y/n) and followed up for deaths (average:4.3±1.6 yrs).\nResults: Increase of RV M/V ratio (> 0.60) was related to lower RV systolic and \ndiastolic volume (respectively p=0.006 and < 0.005), but similar RV mass (p=ns). In \nspite of significant differences in clinical status, effort capacity and haemodynamics \nbetween the two groups,Gr2 patients have a lower mortality according to Kaplan-\nMayer curve (mean survivor time Gr1:925dys,Gr2:1339dys,p=0.008). Baseline \nRVEF was predictor of mortality (p=0.002). DE was demonstrated in 74/85 pts \nand predominantly confined to RV insertion points (70/74). Multivariate analysis \nexcluded negative impact of LE as prognostic indicators of death.\nConclusion: In PH,RV hypertrophy and mild diastolic volume increase (high M/\nVratio and high RVEF) is associated with low rate of deaths, suggesting a favour-\nable prognostic role of this parameter. \nB‑0465 14:45\nEvaluation of Brugada syndrome by cardiac magnetic resonance \nL. Salvatori1, C. Tessa1, i. Del Meglio1, S. Diciotti2, C. Vignali1, G. Casolo1; \n1Lido di Camaiore/IT, 2Firenze/IT (l.salvatori71@gmail.com) \nPurpose: Brugada syndrome (BrS) has been originally considered to occur in \nstructural normal hearts. However, recent pathological and imaging data suggest \nthat structural and functional changes may be present in this syndrome. This study \nwas designed to elucidate whether any macroscopic heart abnormality is detectable \nin patients with BrS. For this purpose we used cardiac magnetic resonance (CMR).\nMethods and Materials: Twenty-nine patients displaying the BrS type-1 ECG \npattern and 29 healthy controls underwent CMR (1.5 Tesla). Left (LV) and right \nventricular (RV) dimensions, function and regional contractility were evaluated. \nLate-gadolinium-enhancement (LGE) imaging was obtained in 24 patients.\nResults: We found no difference between BrS patients and controls regarding LV \nand RV dimensions and ejection fraction. RV wall motion abnormalities (WMA) were \ndetected in 19 patients (65.5%) and in 22 control subjects (75.9%). The majority of \nthese WMA were attributable to areas of hypokinesia and found in the RV inferior \nwall. None of the patients showed LGE. No differences were detected between \ncontrols and the different subgroups of BrS patients according to symptoms, family \nhistory and spontaneous type-1 ECG pattern.\nConclusion: BrS patients do not differ from normal subjects with regard to dimen-\nsions and global function of both LV and RV. BrS patients may show RV-WMA; \nhowever, similar changes are also present in healthy subjects and may therefore \n\nScientific Sessions\nS253\nA\n C D E F G\nB\nFriday\n14:00 - 15:30 Room L/M \nHead and Neck \nSS 608 \nTechnical innovations, TMJ disease and rare entities \nModerators: \nJ. Frühwald-Pallamar; Vienna/AT \nJ. Widelec; Brussels/BE \nB‑0470 14:00\nCT numbers of CBCT regarding position dependence on different \nsize of field-of-view \nM. Imura1, T. Todoroki2; 1Kyoto/JP, 2Osaka/JP (minori.imura@gmail.com) \nPurpose: Quality-controlled x-ray beam CBCT (QX-CBCT) is equipped with cali-\nbration function for HU measurements in cone beam CT for the first time. In this \nstudy, we examined its characteristics of CT numbers in terms of cone angle effect \nrepresented as different field-of-view.\nMethods and Materials: 1) Reproducibility and possible variation of CT numbers \nof QX-CBCT within exposure area on three different FOV were examined. Water \nphantom attached to QX-CBCT for calibration was scanned four times. Mean CT \nnumbers of region of interest (ROI) at the centre and twenty peripherals in each axial \nimage were measured. 2) Varying concentrations of iodinated solution phantoms \n(0-4700 HU) were scanned at 100 kV for QX-CBCT and 80 to 140 kV for MDCT \non all FOV. ROIs were placed at the centre of each phantom on the basis of water \nphantom study. Correlation of CT numbers between QX-CBCT and MDCT were \nexamined by the Pearson’s correlations analysis.\nResults: 1) Mean CT numbers of QX-CBCT at each independent ROI were repro-\nducible for all FOV (R=0.86-0.95, P < 0.0001). CT numbers at the centre region \nwere consistent regardless of the size of FOV, whereas the values tended to be \nhigher and heterogeneous at the outer edge of exposure area. The consistent \narea was sphere like shape within exposure area. 2) CT numbers of QX-CBCT \nexhibited significant correlation to those of MDCT under 2500 HU (R=0.98, P < \n0.0001) for all FOV.\nConclusion: When handing the CT numbers of QX-CBCT, region-dependence \nwithin exposure area due to the effect of cone angle should carefully be considered.\nB‑0471 14:09\nDual-source 128-slice MDCT neck: radiation dose and image quality \nestimation of a clinically relevant dual-energy, high-pitch, standard \nsingle-energy protocol \nJ. Paul, E. Mbalisike, T.J. Vogl; Frankfurt a. Main/DE (jijopaul1980@gmail.com) \nPurpose: To estimate the radiation dose and image quality of a clinically relevant \nsingle-source (SSCT), high-pitch (HPCT), and dual-energy (DECT) protocols of an \ninnovative dual-source (DSCT) system for the examination of neck.\nMethods and Materials: 180 patients were randomised to one of the three \nprotocols: 60 patients (age: 55.4±12 years; range: 44-84 years) were examined \nwith a SSCT, other 60 (59.5±16.4 years; R: 40-85) with HPCT, and the last 60 \n(61.1±14.9 years; R: 47-84) were examined with a DECT protocol. All examina-\ntions were performed using a DSCT system. The used protocols: group-1 (SSCT: \n120 kV; effective mAs: 185.4±17.7), group-2 (HPCT: 120 kV; eff.mAs: 97.7±11.8), \nand group-3 (DECT: 80 kV/140 kV with tin-filter; eff.mAs: 248.5±25.7; 187±21.2). \nA 100-ml Iomeprol non-ionic contrast material was injected in to the patients dur-\ning examination.\nResults: Insignificant results were yielded regarding SNR and CNR between the \ngroups (group-1 vs. 2: 0.3125, group-1 vs. 0.6 W: 0.6875, group-2 vs.0.6 W: 0.3125), \nexcept DECT-80 (group-1 vs. 80 kV: 0.04289, group-2 vs. 80 kV: 0.025, group-0.6 \nW vs.80 kV: 0.04567) and 140 kV data; moreover, qualitative analysis yielded the \nsame results. Mean effective-dose was significantly lower (p < 0.05) in group-2 \n(1.06±0.16mSv) compared to group-1 (2.05±0.22mSv) or group-3 (1.76±0.2mSv). \nSingle- and dual-energy comparison showed a significant difference (group-1 vs.3: \np=0.00001 and group-2 vs. 3: p=0.00001) for CTDIvol (percent difference: 16%, \n64%) or DLP (PD: 15.5%, 50.5%).\nConclusion: Quantitative and qualitative analyses showed similar results for SSCT, \nHPCT, and DECT-0.6 W datasets regarding quality. HPCT yielded lower dose \ncompared to other groups; however, the DECT achieved a lower and significant \ndose difference from the SSCT protocol. HPCT and DECT can be used with similar \nimage quality and lower radiation dose compared to SSCT for the scans and can \nbe utilised various clinical advantages.\nB‑0468 15:12\nRight heart involvement in thalassaemia major (TM) patients: a \ncardiac MR (CMR) assessment \nF. Pitocco, I. Di Giampietro, A. De Vivo, P. Cianciulli, C. Liguori, \nB. Beomonte Zobel; Rome/IT (f.pitocco@unicampus.it) \nPurpose: TM patients should develop right heart failure caused by right ventricle \n(RV) impairment related to chronic anaemia. It is still unknown if iron myocardial \ndeposition and iron overload can influence the RV functional/volumetric parameters. \nOur aim was to define normal ranges for RV volumes and RV ejection fraction in \nTM with and without myocardial iron overload.\nMethods and Materials: We performed CMR examination (Scanner 1.5T, Avanto, \nSiemens-Germany) in a setting of 220 patients with TM under iron chelation therapy \nand without clinical or instrumental signs of right heart failure (mean age 37.8 ± \n12.8 ys; mean body surface area kg/m2 1.64±0.24;13%). Myocardial iron overload \nwas considered T2*< 20 ms. RV-EF, volumes and mass index were evaluated.\nResults: Myocardial iron overload in 13% of population was noted. A significant \ndifference was found between mean RVEF in patients with iron overload and RVEF \nin patients without iron overload (60±6.7% vs 60±11%, p < 0.01), with no differences \nbetween sex. A significant difference was found in RV stroke, end-diastolic and \nend-systolic volume indices between the two groups (45, 30.75 vs 49, 31, 76 ml/\nm2, p < 0.01). No significant difference was found in right ventricle mass values \n(19 ± 5 vs 15 ± 13 g/m2).\nConclusion: Iron overload can damage right heart myocardium in the same way \nof left heart myocardium, showing similar functional impairment and volumetric \nenlargement. CMR is an useful technique for a correct evaluation of heart function \nand iron myocardial deposition in these kinds of patients.\nB‑0469 15:21\nβ-thalassaemia as a new potential risk factor for left ventricular \nnoncompaction (LVNC): a cardiac MRI evaluation \nC. Liguori, I. Di Giampietro, F. Pitocco, P. Cianciulli, B. Beomonte Zobel; \nRome/IT (c.liguori@unicampus.it) \nPurpose: Noncompaction of the left ventricle myocardium (LVNC) is a rare \ncardiomyopathy characterised by multiple and excessive trabeculations, deep \nintertrabecular recesses and thickened ventricular myocardium. This condition is \nconsidered mostly congenital but acquired forms have also been described. Aim \nof the present study is to assess LVNC prevalence in β-thalassaemia patients and \nits potential association with cardiac siderosis\nMethods and Materials: 229 transfusion-dependent patients with β-thalassaemia \n(160 major and 69 intermedia, mean age 37.8 ± 12.8 years, mean BSA 1.64 ± \n0.24 Kg/m2) presenting for cardiac and abdominal iron assessment by MRI (1.5T \nScanner, Avanto, Siemens-Germany) were studied. Cardiac iron overload was \nassessed by T2* Black-Blood gradient-multiecho sequences; cardiac functional \nand morphological characteristics were evaluated using SSFP acquisitions. Risk \nfactors for LVNC were noted and none of the patients had neuromuscular or \ncongenital heart disease.\nResults: 69 patients (30%) fulfilled the preassigned strict criteria for LVNC on car-\ndiac MRI. There were no statistically significant differences between patients with \nand without LVNC with respect to demographics, haemoglobin levels, splenectomy \nstatus, systemic, hepatic, and cardiac iron overload indices, iron chelation therapy. \nPatients with LVNC showed a significant lower cardiac functional performance \n(Ejection Fraction; volumes impairment).\nConclusion: Patients with β-thalassaemia have a higher prevalence of LVNC \nthan normal individuals suggesting an underlying iron deposition mechanism to \nexplain this condition in absence of conventional risk factors. These data seem to \nbe crucial regarding an entity with adverse cardiac outcomes, especially in patients \nwith β-thalassaemia where cardiac disease remains a primary cause of mortality. \n\nScientific Sessions\nS254\n C A D E F\n G\nB\nranged from 2.3 mm to 34.3 mm (mean = 11.3 mm). Involvement of internal carotid \nartery (n = 9, 64%) was more common than external carotid artery (n = 5, 36%). \nPetrous segment of ICA was the most commonly involved segment (n = 5, 36%), \nfollowed by cervical segment of ICA (n = 4, 29%) and maxillary artery (n = 3, 21%).\nConclusion: Carotid blowout syndrome following RT were more common in our \nstudy subjects with advanced T and N stage of NPC, local recurrence and repeated \nRTs. Pseudoaneurysms were identified in most patients. ICA involvement was more \ncommon and petrous segment of ICA was the most commonly involved segment.\nB‑0475 14:45\nNasal-type NK/T-cell lymphoma of the nasal cavity and PNS: CT and \nMR imaging findings \nK. Kang1, S. Suh1, K. Kim1, K. Son1, Y. Lee2, H. Seo2, N. Lee1, H. Seol1; \n1Seoul/KR, 2Ansan/KR (slothgw@hotmail.com) \nPurpose: To describe the computed tomography (CT) and magnetic resonance \n(MR) imaging findings of nasal-type NK/T-cell lymphoma of the nasal cavity and \nPNS.\nMethods and Materials: During the period between July 2007 and June 2012, \nthe CT (n = 25) and MR (n = 14) images of 26 patients with biopsy-proven nasal-\ntype NK/T-cell lymphoma of the nasal cavity and paranasal sinus (PNS) were \nretrospectively reviewed.\nResults: The cases of nasal-type NK/T-cell lymphoma consisted of primary \ntumours arising from the nasal cavity in 20 patients (77%), PNS in 1 patient (4%) \nand simultaneous involvement in the nasal cavity and PNS in 5 patients (19%). \nOf the 6 patients with involvement of PNS, one presented with orbital extension. \nNasopharyngeal and oropharyngeal involvement was seen in two cases. In 20 \ncases (77%), the primary tumours seen as diffuse enhancing mucosal thickening. \nIn five cases (19%), the primary tumours seen as an enhancing mass lesion. In \none case (4%), the primary tumour was undetectable. Bone destruction was noted \nonly in 3 cases (12%).\nConclusion: Nasal-type NK/T-cell lymphomas of the sinonasal regions often \npresents with diffuse mucosal thickening rather than mass lesion. And they can \nmimic inflammatory disease such as sinusitis. Radiologists should be familiar \nwith these findings indicative of the possibility of NKTL, and should perform a \nhistopathologic confirmation to establish a diagnosis.\nB‑0476 14:54\nTemporomandibular joint internal derangement: correlation of MRI \nfindings with clinical symptoms \nK. Šurlan Popovič, U. Lamot, M. Vrabec, R. Klavžar; Ljubljana/SI \n(katarina.surlan@gmail.com) \nPurpose: To determine whether the morphological manifestations detected by MRI \ncorrelate with the signs and symptoms of TMJ dysfunction according to gender \nand age of the patients.\nMethods and Materials: 144 subjects with at least unilateral TMJ dysfunction \nunderwent a MRI investigation of both TMJ to establish the presence of various \ndegrees of disk displacement, osteoarthritis and effusion. Chi-square or Fisher’s \nexact test to analyse the relationship between descriptive variables and logistic \nregression analysis was preformed. For the comparison of mean values between \nsamples we used T-test. For describing the strength of association between two \nbinary values we used odds ratios (OR).\nResults: A significant relationship between symptoms and morphological mani-\nfestations was found (disk displacement (p < 0.001), osteoarthritis (p < 0.001) and \neffusion (p = 0.001)). In the group without reduction there were significant increases \nin the risk of experiencing symptoms (p = 0.002) in the group with reduction the risk \nwas marginal (p = 0.071). Significant correlation between age and osteoarthritis \n(p = 0.001) and age and effusion (p = 0.022) was found. There was no correlation \nbetween sex and morphological manifestations. Significant increases in the risk of \nexperiencing symptoms were found in the group with morphological manifestations \n(disk displacement (p = 0.006), osteoarthritis (p < 0.001) and effusion (p < 0.001)). \nStatistically marginal results were verified with multivariate analysis.\nConclusion: MRI morphological manifestations of the TMJ correlate with the pres-\nence of symptoms, therefore MRI has a crucial role in the diagnosis of treatment \nof TMJ dysfunction.\nB‑0472 14:18\nPerformance of filtered back-projection (FBP), statistical (ASIR) \nand model-based (VEO) iterative reconstruction of neck CT staging \nexaminations \nF.G. Mück, L. Geyer, J. Grimm, Z. Deak, M.F. Reiser, S. Wirth; \nMunich/DE (fgmueck@gmail.com) \nPurpose: To compare image quality of FBP, ASIR and VEO reconstructed CT im-\nages of the neck in tumour patients with a contrast-enhanced scan.\nMethods and Materials: Consecutive regular contrast-enhanced tumour staging \nCT-scans (Discovery HD750, GE; helical, 0.8s, 120 kV, 50-400 mA mod., NI 33) \nof the neck were reconstructed using FBP, ASIR and VEO; n=27. Image quality at \nthree defined heights (lymph node levels=LNL 2, 3, 7) were independently rated \nby 2 radiologists blinded to the reconstruction algorithm. Readers rated image \nquality including artefacts, contrast and noise using a semi-quantitative scale of 0 \nto 10 (lower than 5 was defined as non-diagnostic) yielding a summary score for \neach height. Wilcoxon´s test was used for statistical testing. ICC was calculated.\nResults: Patient weight was 78.2±11.3 kg, BMI was 25.7±4.7 and CDTI was 9.7±2.8 \nmGy. Reconstruction-time was 58±12s for ASIR and FBP and 3780s±180s for VEO \n(p < 0.01). Image rating at LNL 2 was 7.9±0.5 (VEO), 6.2±0.6 (ASIR) and 5.6±0.5 \nfor FBP (p < 0.01, respectively). Rating at LNL 3 was 8.5±0.3 (VEO), 7.4±0.4 (ASIR) \nand 6.8±0.8 for FBP (p < 0.01). LNL 7 score was 7.9±0.4 (VEO), 5.5±0.4 (ASIR) \nand 5.1±0.4 for FBP (p < 0.01). ICC was 0.81.\nConclusion: Contrast-enhanced CT investigations of the neck VEO generally \nperformed better then ASIR and FBP. Especially, at levels where artefacts (e.g. \nteeth) or high overlay of image noise (e.g. shoulder) have a strong impact on image \nquality, Veo clearly outperformed the other algorithms. As VEO requires 75 times \nhigher data reconstruction-time, the process has to be sped up to allow integration \ninto normal clinical routine work.\nB‑0473 14:27\nMaxillary sinus pyocele: a new radiological entity \nA. Lacan-Melki, S. Espinoza-Boireau, I. Khettab, P. Halimi; Paris/FR \n(alacanmelki@hotmail.fr) \nPurpose: Maxillary sinus pyocele is a true chronic abscess found in drug-\nrefractory sinusitis. The purpose of this study is to define this new entity and its \nMRI-characteristics.\nMethods and Materials: We retrospectively reviewed MRI datasets for 23 \npatients with “pseudotumoral sinusitis” on CT (including 2 bilateral cases). The \nMRI datasets were scored by two radiologists for morphological features, T1 and \nT2-weighted signal intensities, contrast enhancement and the degree of impact \non the sinus mucosa and the retromaxillary fat. These features were compared \nwith per-operative findings.\nResults: We observed a content presenting T1 low signal (92%), heterogeneous \nT2 low signal (92%), a capsule with contrast enhancement (100%) containing \nmicroabscesses (52%), a mass effect on the lateral nasal wall (100%) and retro-\nmaxillary fat stranding (88%). Eighteen pyoceles were treated endoscopically, with \nconfirmation of a maxillary sinus abscess in all cases. Furthermore, we suggest a \nstaging system for maxillary sinus pyocele.\nConclusion: Maxillary sinus pyocele presents specific MRI characteristics. This \nentity must be suspected on sinus CT scan and recognised on MRI. Surgical endo-\nscopic sinus surgery is needed. These findings therefore merit further investigation.\nB‑0474 14:36\nCarotid blowout syndrome in patients with nasopharyngeal \ncarcinoma treated with radiotherapy: a review of 12-year experience \nV.K. Fung, J.S. Shum, B.M. Lai, C. Chu, W.K. Kan; Hong Kong/HK \n(vincentkpfung@hotmail.com) \nPurpose: To describe the clinical and angiographic features of carotid blowout \nsyndrome (CBS) in patients with nasopharyngeal carcinoma (NPC) treated with \nradiotherapy (RT).\nMethods and Materials: 14 patients with RT-treated NPC who underwent digital \nsubtraction angiography (DSA) from 2000 to 2012 for management of CBS were \nretrospectively reviewed. The initial T and N staging of NPC, duration between \ndiagnosis of NPC to CBS, number of radiotherapies (RT) received for recurrence \nwere studied. Distributions and sizes of pseudoaneurysms were analysed.\nResults: 9 patients (64%) with CBS had initial T3 disease or above while 11 pa-\ntients (79%) presented with N1 stage or above. Time interval between diagnosis \nof NPC and presentation of CBS varied from 4 months to 468 months (mean = \n181months). Most patients (n = 8, 57%) had recurrence and all received further RTs. \nPseudoaneurysms were identified in 11 patients (79%) with the maximum diameter \n\nScientific Sessions\nS255\nA\n C D E F G\nB\nFriday\ncontained within a continuous or incomplete lamella (81% and 19%, respectively). \n31% of AEA canals was classified as dehiscent.\nPEA was identifiable in 98/106 on the axial plane, 104/106 on coronal and 101/106 \non sagittal. Most of PEAs (98%) were located within the skull base; only 2% of PEAs \nwas separated from the skull base by a posterior ethmoid cell or sphenoid sinus.\nConclusion: CBCT allows a precise evaluation of ethmoidal arteries anatomy. This \ninformation could be valuable for treatment planning in paranasal sinus surgery \nand for intraoperative 3D navigation.\n14:00 - 15:30 Room N/O \nMusculoskeletal \nSS 610b \nCartilage: advanced imaging \nModerators: \nA. Karpenko; St. Petersburg/RU \nP. Omoumi; Brussels/BE \nB‑0480 14:00\nDirect comparison of MR imaging at 1.5- and 3.0-T for evaluating the \narticular cartilage of the knee \nP. Van Dyck1, C. Kenis1, V. Lambrecht2, K. Wouters1, F.M.H.M. Vanhoenacker1, \nJ.L. Gielen1, P.M. Parizel1; 1Antwerp/BE, 2Gent/BE (pieter.van.dyck@uza.be) \nPurpose: To compare MR imaging at 1.5- and 3.0-T in the same individuals for \nperformance in the diagnosis of cartilage lesions of the knee.\nMethods and Materials: This prospective study was approved by our Institu-\ntional Review Board, and informed consent was obtained from all patients. From \nDecember 2010 to February 2012, MR examinations of the knee at both 1.5- and \n3.0-T were performed in 100 symptomatic patients (71 men, mean age 45y, range \n17-75y) who underwent subsequent knee arthroscopy. Three blinded independent \nreaders graded all articular surfaces seen at MR using the Noyes classification \nsystem. With arthroscopy as the reference standard, the sensitivity and specificity \nof the 1.5- and 3.0-T MR protocols for detecting cartilage lesions were calculated. \nDifferences between the 1.5- and 3.0-T exams were compared using bootstrap-\nping statistics (p < 0.05).\nResults: For all readers and grades of cartilage lesions combined, the respective \nsensitivity, specificity, and accuracy of MR for detecting cartilage lesions (n=144) \nwere 60%, 96%, and 87%, respectively, at 1.5- T and 69%, 96%, and 90%, respec-\ntively, at 3.0- T. For detecting and correct grading of cartilage lesions, the readers \nperformed significantly better with 3.0-T than with 1.5-T (p=0.001).\nConclusion: A comprehensive MR protocol at 3.0-T significantly improves diag-\nnostic performance for evaluating the articular cartilage of the knee in symptomatic \npatients, when compared with a similar protocol performed at 1.5-T.\nB‑0481 14:09\nBiochemical imaging of the knee’s cartilage: comparison of three \ntechniques at 3 Tesla \nC. Rehnitz1, J. Kupfer1, N. Streich1, I. Burkholder2, B. Schmitt3, L. Lauer3, \nH.-U. Kauczor1, M.-A. Weber1; 1Heidelberg/DE, 2Zweibrücken/DE, \n3Erlangen/DE (Christoph.Rehnitz@med.uni-heidelberg.de) \nPurpose: To prospectively compare dGEMRIC (delayed gadolinium-enhanced MRI \nof cartilage), T2-mapping and gagCEST (glycosoaminoglycan chemical-exchange \nsaturation-transfer) to assess the biochemical knee’s cartilage composition.\nMethods and Materials: Sixty-nine subjects were prospectively included (median \nage, 42 years; male/female=32/37) in three cohorts: 10 healthy volunteers, 40 \npatients with clinically suspected cartilage lesions, and 19 patients about one year \nafter microfracture therapy. T2-mapping, dGEMRIC, and CEST were performed at \na 3 Tesla scanner with an 15-channel knee coil. Parameter maps were evaluated \nusing region-of-interest analysis of healthy cartilage, areas of chondromalacia and \nrepair tissue. Differentiation of damaged from healthy cartilage was assessed using \nreceiver-operating characteristic (ROC) analysis.\nResults: Chondromalacia grade 2-3 had significantly lower dGEMRIC-values (p \n< 0.001), higher T2-values (p < 0.001) and higher CEST-values (p=0.001) when \ncompared to the normal appearing cartilage. dGEMRIC and T2-mapping correlated \nnegatively (Spearman coefficient r=-0.56, p=0.0018) and T2-mapping and CEST \npositively (r=0.5, p=0.007), while dGEMRIC and CEST did not correlate (r=-0.311, \np=0.07). Areas of repair tissue had significantly lower T1-values (p < 0.001) and \nhigher CEST-values (p < 0.001) with a significant negative correlation (r=-0.589, \np=0.01), whereas T2-values were not different (p=0.54). In healthy volunteers' \nB‑0477 15:03\nAn investigation of relative signal intensity of MR images in \nretrodiscal tissue and lateral pterygoid muscle in patients with \ntemporomandibular joint disorder and its relation with MRI findings \nZ. Ghoncheh, M. Panjnosh, H. Banihashemi; T ehran/IR \n(m_ghoncheh@hotmail.com) \nPurpose: The purpose of this study is evaluation of correlation between relative \nsignal intensity of MR images in retrodiscal tissue, superior and inferior heads of \npterygoid muscle in TMD patients with types of anterior disc displacement and \ncondylar flattening.\nMethods and Materials: In this cross-sectional study, 31 MR images of patients \nwho had anterior disc displacement were evaluated. After relative signal intensity \nmeasurement for retrodiscal tissue, superior and inferior head of lateral pterygoid \nmuscle, the correlation between relative signal intensity and types of anterior disc \ndisplacement and also condylar flattening was evaluated.\nResults: The correlation between relative signal intensity of MR images and type \nof anterior disc displacement in retrodiscal tissue (p-value=0.10), superior head of \nlateral pterygoid muscle (p-value=0.68) and inferior head of lateral pterygoid muscle \n(p-value=0.40) was not significant. There was also no statistically significant cor-\nrelation between relative signal intensity of MR images and flattening of condylar \nhead in retrodiscal tissue (p-value=0.75), superior head of lateral pterygoid muscle \n(p-value=0.49) and inferior head of lateral pterygoid muscle (p-value=0.60).\nConclusion: We found that although MRI is a non-invasive procedure in the \ndiagnosis of TMD, probably relative signal intensity of MR images in retrodiscal \ntissue, superior and inferior head of pterygoid muscle is not a good predictor for \ntype of anterior disc displacement and flattening of condylar head. It seems that \nthis cannot be used as a diagnostic marker for TMD progression.\nB‑0478 15:12\nHigh resolution 3D MR imaging of the temporomandibular joint: \nfeasibility and comparison with 2D sequences \nU. Navarro, M. Ravanelli, D. Farina, E. Botturi, R. Maroldi; Brescia/IT \n(navarrougo@gmail.com) \nPurpose: To assess the feasibility of high-resolution 3D MR imaging of the \ntemporomandibular joint (TMJ) and to compare 3D and standard 2D techniques.\nMethods and Materials: Ten volunteers underwent a TMJ MR study with surface \ncoils including a proton density (PD) fat-saturated 3D sequence “SPACE” and 2D \nPD fat-saturated sequences acquired on parasagittal and paracoronal planes. \nTwenty TMJ were imaged and analysed. The contrast between articular disk (AD) \nand bilaminar zone signals was measured on parasagittal images and normalised \nby the AD signal. Capability of 3D sequences to depict eight small anatomical \nstructures of the TMJ (4 on parasagittal and 4 on paracoronal plane) was assessed \nand compared to that of standard 2D sequences.\nResults: Contrast between bilaminar zone and AD in 3D and 2D sequences was \n2.93 and 2.61, respectively (p 0.34). Fifty-eight out of 80 structures assessed in \nparasagittal plane were detectable on 2D sequences, 67/80 on 3D sequences (p \n0.03). Among the 80 structures assessed on paracoronal images, 40 were recog-\nnised on 2D sequences, 67 on 3D sequences (p 0.0001).\nConclusion: High resolution 3D MR imaging of TMJ is feasible with 3D PD fat-\nsaturated SPACE sequences. The detectability of anatomical structures, potentially \nkey for joint functionality (ligaments) is enhanced in comparison to standard 2D \nsequences, especially on paracoronal plane. \nB‑0479 15:21\nRadiological anatomy of the ethmoidal arteries: a cone beam CT study \nL. Sottocornola, M. Dal Corso, M. Ravanelli, L. Pianta, R. Maroldi; Brescia/IT \n(lara.sottocornola@gmail.com) \nPurpose: To assess the use of high-resolution Cone Beam computed tomography \n(CBCT) to evaluate the radiological anatomy of the anterior and posterior ethmoidal \narteries (AEA, PEA).\nMethods and Materials: Retrospective review of 53 Cone Beam CT (CBCT) of \nparanasal sinuses acquired from December 2011 to August 2012. Image analysis \nwas performed on 200-m-thick multiplanar reconstructions (orthogonal planes).\nResults: AEA was identifiable in 106/106 on the axial plane, 106/106 on coronal \nand 105/106 on sagittal. In 43% of patients, the AEA canal run inside the skull \nbase (condition #1), in 57% of cases a pneumatised cell was interposed between \nthe canal and the skull base (condition#2), 52% of the pneumatised cells above \nthe AEA canal were supraorbital cells, 35% supra-bullar recesses and 13% frontal \nsinuses. In these cases, the average distance between the AEA canal and the \nskull base was 2.2 mm (range 1.5-2.8 mm). In condition #2, the AEA canal was \n\nScientific Sessions\nS256\n C A D E F\n G\nB\nConclusion: Progression cohort subjects showed the greatest baseline femorotibial \ncartilage T2, but demonstrated less increase than the other 2 cohorts over time, \nindicating a potential ceiling effect. High baseline cartilage volume and elevated \nT2 measurements were associated with the presence of cartilage degeneration.\nB‑0484 14:36\nLongitudinal increase of T2 relaxation time in normal subjects \nindicating physiological aging of the collagen network and cartilage \nmatrix: data from the osteoarthritis initiative (OAI) \nU.R. Heilmeier, P. Beringer, L. Nardo, H. Liebl, S. Lee, G. Joseph, \nC.E. McCulloch, M.C. Nevitt, T.M. Link; San Francisco, CA/US \nPurpose: To analyse physiological changes of cartilage matrix in healthy subjects \nusing T2 relaxation time measurements over a period of 48 months.\nMethods and Materials: Right knee 3 Tesla MRI studies of 55 subjects (17 male, \n38 female, aged 45 - 60, BMI 23.9 ± 5.7) without risk factors, symptoms or radio-\ngraphic signs of osteoarthritis (OA) of the osteoarthritis initiative control cohort were \nstudied at baseline, 2- and 4-year follow -up. Knee cartilage was segmented and \nT2 maps were generated in five compartments (patella, medial and lateral femur, \nmedial and lateral tibia). Mean T2 relaxation time values and changes over time \nwere measured for each compartment. Statistical analysis was performed using a \nmixed random effects model adjusted for age, sex and BMI.\nResults: All subjects showed significant increases in mean T2 over time (baseline- \n24 -48 months) in each compartment. The yearly rate of T2 change was highest \nin the patella (0.78 ms, p < 0.001) and lateral femur (0.71 ms, p < 0.001). It was \nlower in the lateral tibia (0.45 ms, p < 0.001), medial femur (0.36 ms, p < 0.001) \nand medial tibia (0.50 ms, p < 0.001).\nConclusion: Using T2 relaxation time as a sensitive biomarker for cartilage col-\nlagen network integrity, this is the first study that radiologically demonstrates over 48 \nmonths, that healthy subjects undergo age-related changes in cartilage composition \nresulting in continuously increasing T2 values over time. These findings need to \nbe considered when evaluating pathologic changes of knee cartilage such as OA. \nB‑0485 14:45\n3D delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) at 3 T \nused to evaluate the effect of hyaluronic acid on cartilage quality in \nknee osteoarthritis patients \nJ. van Tiel, M. Reijman, K. Bos, J. Verhaar, G.P. Krestin, S. Bierma - Zeinstra, \nH. Weinans, G. Kotek, E. Oei; Rotterdam/NL (j.vantiel@erasmusmc.nl) \nPurpose: Intra-articular hyaluronic acid (HA) injections are frequently used as \ntreatment for knee osteoarthritis (OA). It was suggested that HA injections might \nimprove cartilage sulphated glycosaminoglycan (sGAG) content of cartilage. The \ncartilage sGAG content can be determined using delayed gadolinium-enhanced \nMRI of cartilage (dGEMRIC). This study assessed if improvement in cartilage \nquality can be detected with dGEMRIC in OA knees 3 months after HA injections.\nMethods and Materials: In 20 patients with KL grade 1-2 knee OA, dGEMRIC \nwas acquired at 3 T using a 3D-SPGR sequence before and 3 months after HA \ntreatment. To evaluate patient symptoms, the knee injury and osteoarthritis outcome \nscore (KOOS) questionnaire was recorded at baseline and follow-up. We analysed \n8 matching anatomical ROIs in the medial and lateral knee compartment in both \nexaminations, using the T1 relaxation times as a measure of cartilage quality. \nOutcomes of dGEMRIC and KOOS at baseline and follow-up were compared using \npaired testing to evaluate the symptomatic and potential structural effects of HA.\nResults: Outcomes of dGEMRIC at follow-up (pooled median T1 504 ms) did not \nimprove significantly compared to baseline (pooled median T1 490 ms) in any of \nthe analysed anatomical cartilage ROIs. Patient complaints improved significantly \nin KOOS subscales: pain, daily-, and sports activities.\nConclusion: Using dGEMRIC, no improvement in articular cartilage quality can be \ndetected 3 months after HA. However, patient complaints decreased significantly \nafter HA. Therefore, the results of this study suggest that the working mechanism \nof HA is not acting through an improvement of sGAG content in the cartilage.\nAuthor Disclosures:\nG.P. Krestin: Consultant; to GE Healthcare. Grant Recipient; from GE \nHealthcare, from Bayer.\ncartilage, CEST and dGEMRIC correlated moderately positively (r=0.56, p=0.09). \nROC analysis demonstrated non-significant differences of T2-mapping vs. CEST \n(p=0.14), CEST vs. dGEMRIC (p=0.89), and T2-mapping vs. dGEMRIC (p=0.12).\nConclusion: All techniques can distinguish normal from damaged cartilage with \nnon-superiority of either technique. T2-mapping may be recommended to detect \nor exclude early chondromalacia, while dGEMRIC might be principally useful to \nassess cartilage repair tissue. CEST might have a role in both issues.\nAuthor Disclosures:\nB. Schmitt: Employee; Siemens Healthcare, Erlangen, Germany. L. Lauer: \nEmployee; Siemens Healthcare, Erlangen, Germany.\nB‑0482 14:18\nHigh-resolution flat-panel CT arthrography for cartilage defect \ndetection: comparison to multi-detector CT \nR. Guggenberger1, S. Winklhofer1, T. Redel2, J. Korporaal2, \nA. Meier2, J. von Spiczak1, G. Andreisek1, H. Alkadhi1; 1Zurich/CH, \n2Forchheim/DE (romanguggenberger@yahoo.de) \nPurpose: To analyse the spatial resolution of different reconstruction kernels and \nacquisition protocols including a prototypic high-resolution protocol in flat-panel (FP) \nand multi-detector (MD) CT to evaluate contrast and cartilage depiction quality of \nFPCT and MDCT arthrography.\nMethods and Materials: A cone-beam image quality phantom was used to compare \nresolution and different reconstruction kernels of standard MDCT (120 and 80 kV), \nstandard binned (2x2) and prototype high-resolution unbinned (1x1) FPCT protocols \n(5s and 20s runs each). With the resulting FPCT kernel best matching the standard \nMDCT kernel (U90u), joint phantoms with differently sized cartilage defects were \nscanned. CT numbers and noise in iodine contrast and phantom cartilage tissue \nwere measured, and contrast-to-noise ratios (CNR) were calculated. Depiction \nquality of cartilage defects was qualitatively rated by two independent radiologists.\nResults: A sharp reconstruction kernel for all FPCT protocols best matched the \nresolution of the standard MDCT kernel. High-resolution 20s 1x1 binning FPCT \nshowed superior resolution in higher frequencies than 1.6 lp/mm. The CNR were \nhighest in 20s FPCT, followed by 5s FPCT binned and MDCT protocols. Inter-\nreader agreement for depiction quality of cartilage defects was substantial and \nhigh in joint phantoms (0.74 and 0.8, respectively; p < 0.001). The best ratings of \ncartilage defect depiction quality were seen in FPCT 20s, followed by FPCT 5s \nand MDCT acquisitions.\nConclusion: FPCT arthrography offers superior CNR and cartilage defect depiction \nquality to MDCT, and spatial resolution for small structures is higher when applying \nhigh-resolution acquisition protocols. \nAuthor Disclosures:\nT. Redel: Employee; Siemens. J. Korporaal: Employee; Siemens. A. Meier: \nEmployee; Siemens.\nB‑0483 14:27\nLongitudinal evaluation of T2 relaxation time in relation to baseline \nvolume of femorotibial cartilage - data from the osteoarthritis initiative \nP. Beringer1, L. Nardo1, H. Liebl1, U.R. Heilmeier1, A. Lai1, F. Liu1, \nG.B. Joseph1, F. Eckstein2, T.M. Link1; 1San Francisco, CA/US, 2Salzburg/AT \n(paula.beringer@pmu.ac.at) \nPurpose: To relate longitudinal changes in femorotibial cartilage T2 relaxation \ntimes to baseline cartilage volume in subjects with OA, at risk for OA and controls \nfrom the osteoarthritis initiative (OAI).\nMethods and Materials: One-hundred-thirty subjects (85 females, 45 males; age \n45-70; BMI 19-27; KL ²2) were selected from the OAI database, 45 subjects with \npain and radiographic evidence of osteoarthritis (OA) (progression cohort), 45 \nsubjects with risk factors for OA (incidence cohort) and 40 subjects from the control \ncohort. Right knee 3 T MRIs were analysed at baseline and 48 months. Coronal \nFLASH sequence was used to measure cartilage volume at baseline, multi-echo \nspinecho sequence to generate T2 maps at baseline and 48 months. Regression \nmodels were adjusted for age, gender and BMI and were applied to 4 compartments \n(medial femur, lateral femur, medial tibia and lateral tibia).\nResults: Global T2 measurements increased in all cohorts over 48 months. Base-\nline T2 were significantly greater in the progression cohort compared to incidence \nand control cohort (P < 0.001), whereas 48-month follow-up data showed signifi-\ncantly greater measurements in the Incidence cohort (P < 0.003). Most pronounced \nT2 changes over time were observed in the incidence cohort (P < 0.023), changes \nin the progression cohort were not significant. Mean volume did not significantly \ndiffer between the cohorts, but progression cohort subjects showed the highest \nvolumes in all compartments.\n\nScientific Sessions\nS257\nA\n C D E F G\nB\nFriday\nB‑0488 15:12\nIn-vivo sodium magnetic resonance (MR) imaging of healthy \nintervertebral discs during unloading \nK.M. Friedrich, J. Wimmer, V. Juras, S. Zbyn, I. Nöbauer-Huhmann, S. Trattnig; \nVienna/AT \nPurpose: To assess changes in sodium MR imaging values of the intervertebral \ndiscs during unloading in healthy volunteers.\nMethods and Materials: This study was approved by the Institutional Review \nBoard. All subjects provided written informed consent. Sodium MR imaging values \nof the intervertebral discs were measured at 7T in 7 female healthy volunteers \n(mean age, 24.20±1.79years) at the time point zero, and 20, 40, 60, 80, 100, 120, \n160, and 180 minutes later. P values less than.05 were considered to indicate a \nstatistically significant difference. Paired t-tests were used for statistical analysis.\nResults: Mean sodium signal intensity values of the intervertebral discs were as \nfollows (time point, mean sodium signal intensity values): 0, 1983.92; 20, 2040.14; \n40, 2178.19; 60, 2267.63; 80, 2450.02; 100, 2433.31; 120, 2473.86; 160, 2438.56; \n180, 2554.13. The values increased significantly until time point 40 (time point \n0 versus 20, p=0.0002; time point 20 versus 40, p=0.0001); later no significant \nincrease was observed.\nConclusion: Sodium MR imaging provided insight into the biochemical processes \ntaking place in the intervertebral discs during unloading of the spine. The results \nof this study indicate that a 40-min rest before starting the sodium measurements \nmight be beneficial for the planning of future studies.\nB‑0489 15:21\nT2 mapping for assessment of lumbar disc repair after autologous \ndisc-derived chondrocyte transplantation (ADCT) \nM. Glowacki, M. Ostrowska, W. Gradkowski, J. Walecki; Warsaw/PL \n(mostrowska@yahoo.com) \nPurpose: The goal of the study was to demonstrate the benefits of T2 mapping to \nthe assessment of lumbar disc repair after the ADCT.\nMethods and Materials: 50 patients, male and female, age range 18-40, with \na single-level degenerative disc disease (DDD) were studied. All patients had a \nstandard lumbar microdiscetomy performed and 4-6 weeks after the surgery un-\nderwent the ADCT. Prior to the surgery, one month later and 3, 6 and 12 months \nafter the ADCT each patient had a MR examination on the 1.5 T MR scanner. 20 \npatients completed a 12-month long follow-up protocol. T2 mapping revealed the \nlevel of DDD and the adjacent levels. The evaluation of signal intensity was carried \nout using pixel value software.\nResults: Each patient during the 12-month long follow -up reported a significant \nrelief of pain: VAS score ranged 0-3, ODI score 0-20%. In the MR examination \nheld after the ADCT, changes in signal intensity seen on T2-weighted MR images \nwere reported. T2 mapping showed signs of the disc repair regardless of the lack of \nchanges in disc dimensions. Mild increase of T2 with improved homogeneity of the \nstructural morphology of the nucleus pulposus was observed on T2 after the ADCT.\nConclusion: T2 mapping may be used for evaluating the changes of the molecular \ncomposition and structural integrity of the intervertebral disc after the ADCT and \nother novel restorative therapies. It has also the potential to be valuable in the \ndetection of the early degeneration in the intervertebral disc.\n14:00 - 15:30 Room P \nInterventional Radiology \nSS 609b \nGynaecological and obstetric interventions \nModerators: \nP. Andersen; Odense/DK \nR. Nijenhuis;  Maastricht/NL\nB‑0490 14:00\nNon-invasive treatment of uterine fibroids using MR-guided high-\nintensity focused ultrasound: results on quality of life, non-perfused \nvolume ratio and size reduction over 12 months \nF. Ciolina, A. Napoli, B. Cavallo Marincola, F. Boni, F. Zaccagna, V. Noce, \nL. Bertaccini, C. Catalano; Rome/IT (federica.ciolina@gmail.com) \nPurpose: To evaluate the efficacy of MR-guided acoustic ablation in symptoms \nrelief and volume reduction over time.\nB‑0486 14:54\nT2* mapping and delayed gadolinium-enhanced magnetic resonance \nimaging in cartilage (dGEMRIC) of glenohumeral cartilage in \nasymptomatic volunteers at 3 T \nB. Bittersohl1, F.R. Miese1, C. Dekkers1, H. Senyurt1, J. Kircher2, \nH.-J. Wittsack1, G. Antoch1, R. Krauspe1, C. Zilkens1; 1Düsseldorf/DE, \n2Cologne/DE (bbittersohl@partners.org) \nPurpose: To evaluate the feasibility of T2* and T1Gd mapping to assess gleno-\nhumeral cartilage, and to establish baseline values of healthy glenohumeral \ncartilage at 3 T.\nMethods and Materials: Forty asymptomatic volunteers (mean age: 24.8 ± 2.2 \nyears) without shoulder abnormality were included. The MRI protocol comprised \na three-dimensional (3D) double-echo steady-state (DESS) sequence for mor-\nphological cartilage evaluation, a 3D gradient-echo (GRE) multiecho sequence \nfor T2* assessment, and a dual-flip-angle 3D GRE sequence for T1Gd mapping. \nStatistical assessment involved descriptive statistics establishing mean T2* and \nT1Gd values ± standard deviation and the one-way analysis of variance (ANOVA) \nto identify any significant differences between the T2* and T1Gd values of various \nregions of the glenohumeral joint. Intra-class correlation (ICC) analysis comparing \nrepetitive T2* and T1Gd measures of ten randomly selected individuals was used \nto assess intra- and inter-observer reliability.\nResults: Total mean values of T2* = 24.7 ms ± 3.7 ms and T1Gd = 735.3 ± 106.2 \nms were assessed. Both techniques revealed significant differences between \nsuperior and inferior glenohumeral cartilage demonstrating higher T2* (26.2 ms \nvs. 23.2 ms, p-value < 0.001) and T1Gd (750.1 ms vs. 720.2 ms, p-value = 0.014) \nvalues in the superior regions. High intra- and inter-observer agreement (ICC value \nrange: 0.895-0.983) was noted for both T2* and T1Gd mapping.\nConclusion: T2* and T1Gd mapping is reliable in the assessment of glenohumeral \ncartilage. The values of this study can be used as reference for comparison to \nidentify cartilage degeneration in patients suffering from shoulder joint pathology. \nB‑0487 15:03\nValidity of gradient-echo three-dimensional delayed gadolinium-\nenhanced magnetic resonance imaging of hip joint cartilage: a \nhistologically controlled study \nC. Zilkens1, F.R. Miese1, M. Herten1, S. Kurzidem1, M. Jäger2, D. König3, \nG. Antoch1, R. Krauspe1, B. Bittersohl1; 1Düsseldorf/DE, 2Essen/DE, \n3Viersen/DE (christoph.zilkens@med.uni-duesseldorf.de) \nPurpose: To validate gradient-echo 3D delayed gadolinium-enhanced magnetic \nresonance imaging of cartilage (dGEMRIC) by means of histological analyses in \nthe assessment of hip joint cartilage.\nMethods and Materials: Twenty-one femoral head specimens collected from \n21 patients (7 males, 14 females, mean age: 60.9 ± 9.6 years; range: 37.6-77.3 \nyears), who underwent total hip replacement for symptomatic hip joint osteoarthritis, \nunderwent MRI and histological assessment. A region of 2 cm2 with morphologically \nintact cartilage was marked with four pins to enable multi-planar MRI reformatting \nto be matched with histological sections. MRI was performed at 3 T with a 3D \ndouble-echo steady-state (DESS) sequence for morphological cartilage assessment \nand 3D volumetric interpolated breathhold examination (VIBE) for T1Gd mapping. \nHistological sections were evaluated according to the Mankin score system. Total \nMankin score, grade of toluidine staining and a modified Mankin score classification \nsystem with four sub-groups of cartilage damage were correlated with MRI data.\nResults: Spearman’s rho correlation analyses revealed a significant correlation \nbetween T1Gd mapping and histological analyses in all categories including total \nMankin score (r = -0.658, p-value = < 0.001), toluidine staining (r = -0.802, p-value \n< 0.001) and modified Mankin score (r = -0.716, p-value < 0.001). Correlation be-\ntween morphological MRI and histological cartilage assessment was statistically \nsignificant but inferior to biochemical cartilage MRI (r-values ranging from -0.411 \nto 0.525, p-values < 0.001).\nConclusion: Gradient-echo dGEMRIC is reliable while offering the unique features \nof high image resolution and 3D biochemically sensitive MRI for the assessment \nof early cartilage degeneration. \nAuthor Disclosures:\nC. Zilkens: Grant Recipient; Deutsche Arthrosehilfe. . B. Bittersohl: Grant \nRecipient; Deutsche Arthrosehilfe.\n\nScientific Sessions\nS258\n C A D E F\n G\nB\ntreatment were used to determine fibroids shrinkage. The Symptom Severity Score \n(SSS) and Quality of Life Score (QOLS) were examined before treatment and after \n6 months. Post-treatment NPV and 6 months fibroids shrinkage were correlated \nand compared with SSS and QOLS results.\nResults: The average NPV was 62%±19% after treatment. Six months after treat-\nment the treated fibroids average volume decreased from 136±142 cm³ to 98±116 \ncm³ (n=49) (p < 0.00005) with an average volume reduction of 36%±22%. A linear \nregression model showed highly significant correlation between post-treatment \nNPV and fibroid shrinkage at 6 months (p=0.001). The mean SSS value before \nMRgFUS was 53±17 and after 6 months it significantly decreased to a mean value \nof 22±13 (p < 0.001). Similarly the mean QOLS value before treatment was 48±22 \nand it significantly increased to 76±19 (p < 0.001).\nConclusion: MRgFUS is a non-invasive, efficacy treatment for uterine fibroids. The \nNPV after treatment resulted predictive of uterine fibroid shrinkage after 6 months.\nB‑0493 14:27\nUterine adenomyosis treated by MRgFUS: technical approach and \nclinical results \nF. Ferrari, A. Miccoli, F. Arrigoni, A.V. Giordano, E. Fascetti, G. Mascaretti, \nC. Masciocchi; L’Aquila/IT (fabianaferrari@hotmail.it) \nPurpose: To evaluate the efficacy of the treatment of uterine adenomyosis using \nmagnetic resonance imaging-guided focused ultrasounds (MRgFUS) with a new \nspecific technical plan.\nMethods and Materials: Twenty-four patients aged between 28 and 47 years \n(mean age 37.5), with symptomatic adenomyosis and uterine fibroids were treated \nwith MRgFUS in our department, from October 2011 to July 2012. This study evalu-\nates the findings on 6 patients affected by adenomyosis alone. Symptomatology \nwas assessed through the symptom severity score questionnaire. One single \ntreatment was performed with an average energy delivered to each patient equal \nto 2840 J (with a minimum value of 1300 J and maximum of 4800 J). The longest \ntreatment duration was 120 minutes. The plan employed was characterised by \nhigh density and reduced size of the spot length (ranging from 4 to 6 mm) with the \nshortest cooling time between the sonifications.\nResults: The evaluation of the non-perfused volume on the c.e. T1-weighed se-\nquences performed 6 weeks after treatment, measuring each single slice, showed \na maximum retraction of the necrotic area of 73% and a minimum of 52% with a \nmean value of 66.5%. After six weeks, the symptomatic score showed a reduction \nof about 80% if compared to the pre-treatment one.\nConclusion: The treatment with MRgFUS allows a resolution of the symptoms \nand a reduction of the treated area, maintaining the integrity of the uterus, in a \npathology which, up to now, has limited therapeutic perspectives.\nB‑0494 14:36\nIs uterine artery embolisation in large sized myoma as efficient as in \nnormal sized myoma: a retrospective comparative study in 263 patients \nH. Choi1, G. Jeon1, M. Kim2, J. Lee1, J. Yoon1, S. Hwang1; 1Seongnam/KR, \n2Seoul/KR (piscean84@hanmail.net) \nPurpose: The purpose of this study was to evaluate the effectiveness, safety and \ncomplications of uterine fibroid embolisation (UFE) when applied to myomas of \nlarge volume.\nMethods and Materials: A total of retrospectively collected 323 patients who under-\nwent UFE for symptomatic uterine fibroids without adenomyosis between January \n2005 and February 2011 were included in this study. Patients were divided into \ntwo groups: 63 patients were selected with large fibroid burden group, defined as \na dominant fibroid with a longest axis ³10 cm or a uterine volume of ³700 cm3 and \nremaining 260 patients with control group. Fibroid infarction and volume reduction \nwith MRI, complications and patients’ satisfaction score were evaluated.\nResults: The large fibroid group consisted of 63 (mean age 37.10 ± 5.62) women \nand 260 (mean age 37.33 ± 5.62) women included in control group. There were no \nstatistical difference in average % volume reductions of dominant fibroid as 46% in \nlarge group and 41.19% in control group, the mean satisfaction score at immediate \nfollow-up (average 2.94 months) and mid-term follow-up (average 32.63 months) \nand procedure related complications or major surgery following UFE.\nConclusion: Uterine fibroid embolisation is a safe and effective treatment method \nwhich can be utilised in the treatment of myomas of large volume. The size of \nmyoma is not a definite contraindication or poor prognosis factor for embolisation.\nMethods and Materials: 76 leiomyomas in 60 women (average age 39.3 years) \nwere treated with MRI-guided focused ultrasound (MRgFUS). The treatment is \ncarried out using the ablative properties of the HIFU system under 3 T MRI guide. \nSymptoms were scored using Severity Score (SS) and quality of life was determined \nusing the UFS-QOL score. Pre-treatment measurements of leiomyoma volume \nwere obtained by MR images. After treatment, Non-perfused Volume (NPV) was \ncalculated from T1-w contrast-enhanced MR sequences. The average volume of \ntreated fibroids was 90.27 ± 90.4 mm3. Follow-up images were obtained 3, 6 and \n12 months after treatment and served to determine leiomyoma shrinkage. Qualita-\ntive and quantitative relations between fibroid volume, NPV ratio at treatment, and \n12-month shrinkage were measured.\nResults: MRgFUS treated patients demonstrated a significant change in USF-QoL \nscore: mean SS score values were 48.6 ± 13.4 (pre-treatment), 25.1 ± 8.9 (three-\nmonths follow-up), 22.1± 7.5 (six-months follow-up) and 19.3± 6.8 (twelve-months \nfollow-up). Fibroids volume changed from 90.27±90.4 mm3 (before treatment) to \n54 ± 66.1 mm3 (at 12 months follow-up). We encountered a statistically significant \ndifference between the two values (p = 0.001). Mean post-treatment VNP was \n57.65±52.9 mm3, about 63% of total fibroid volume (p=0.001).\nConclusion: MRgFUS therapy of leyomioma results in a significant relief of symp-\ntoms and greater than 50% total fibroid ablation. The procedure is carried out in a \ntotally non-invasive manner and features a high-safety profile. \nB‑0491 14:09\nMRI-guided focused ultrasound treatment of symptomatic uterine \nfibroids: impact of technology advancement on ablation volumes in \n115 patients \nC.G. Trumm1, R. Stahl1, D.-A. Clevert1, P. Herzog2, I. Mindjuk2, S. Kornprobst2, \nR.-T. Hoffmann3, M.F. Reiser1, M. Matzko2; 1Munich/DE, 2Dachau/DE, \n3Dresden/DE (christoph.trumm@med.uni-muenchen.de) \nPurpose: To assess the impact of the advancement of MRI-guided focused ul-\ntrasound technology on treatment outcomes in patients with symptomatic uterine \nfibroids, as measured by the non-perfused volume ratio.\nMethods and Materials: This is a retrospective analysis of 115 women (average \nage, 42 years; range 27 to 54 years) with symptomatic fibroids who consecutively \nunderwent MRI-guided focused ultrasound treatment in a single centre with the new \ngeneration ExAblate system 2100 (Insightec Ltd., Haifa, Israel) from November 2010 \nto June 2011. Average total volume and number of the treated fibroids (per patient) \nwere 89±94 (SD) cm3 and 2.2±1.7, respectively. Patient baseline characteristics \nwere analysed regarding their impact on the resulting non-perfused volume ratio.\nResults: MRI-guided focused ultrasound treatment was technically successful in \n115 of 123 patients (93.5%). In 8 patients treatment was not possible due to bowel \nloops in the beam pathway that could not be mitigated (n=6), patient movement \n(n=1) and system malfunction (n=1). Average non-perfused volume ratio was \n88±15% (range, 38 to 100). Mean applied energy level was 5400±1200J, and \nmean number of sonications was 74±27. No major complications occurred. Two \ncases of first degree skin burn resolved within one week after the intervention. Of \nthe baseline characteristics analysed, only the planned treatment volume had a \nstatistically significant impact on the non-perfused volume ratio.\nConclusion: With technological advancement, outcome of MRI-guided focused ul-\ntrasound treatment in terms of the non-perfused volume ratio can be enhanced with \na high safety profile, markedly exceeding results reported in previous clinical trials.\nAuthor Disclosures:\nD. Clevert: Speaker; Siemens Healthcare, Philips Healthcare, Bracco Imaging. \nR. Hoffmann: Speaker; Sirtex Medical Limited, Boston Scientific Corporation. \nM. Matzko: Speaker; GE Healthcare / Insightec Limited.\nB‑0492 14:18\nEfficacy of MRI-guided focused ultrasound (MRgFUS) treatment of \nuterine fibroids: evaluation of non-perfused volume (NPV), fibroid \nshrinkage and clinical improvement at 6-month follow-up \nI. Invernizzi1, M. Vaiani1, P. Colombo1, F. Zucconi1, S. Sironi2, C. Ticca1; 1Milan/IT, \n2Monza/IT (fibromauterino.niguarda@gmail.com) \nPurpose: To determine the efficacy of MRgFUS treatment of uterine fibroids evalu-\nating fibroid shrinkage and clinical improvement after 6 months and to assess the \npredictive role of non-perfused volume (NPV).\nMethods and Materials: A total of 74 symptomatic uterine fibroids in 60 women \n(range 39-51 years) underwent MRgFUS between September 2010 and July \n2012 using the ExAblate 2000 system (InSightec). Before treatment T2-weighted \nmultiplanar MRI images were obtained to measure uterine fibroids volume. Imme-\ndiately after treatment T1-weighted contrast-enhanced fat-suppressed multiplanar \nMR images were used to measure NPV. Similar images obtained 6±1 months after \n\nScientific Sessions\nS259\nA\n C D E F G\nB\nFriday\nResults: All patients underwent embolisation of bilateral uterine arteries. The me-\ndian time between delivery and UAE was 11 days (range 3-76 days). The technical \nsuccess rate of embolisation was 100%. Bleeding was controlled in all patients \nduring follow-up (11.3±6.9 months, range 3-24months), and no further bleeding \noccurred. One patient developed lower extremity deep venous thrombosis after \nUAE and no other major complications occurred. Placenta left inside the uterus \ngradually decreased in size except one during follow-up. 14 patients resumed nor-\nmal menstruation. One patient subsequently became pregnant and had uneventful \nintrauterine pregnancies carried to term.\nConclusion: UAE is safe and effective for the management of secondary post-\npartum haemorrhage associated with PA.\nB‑0498 15:12\nPlacenta percreta: role of bilateral occlusion balloons insertion in to \ninternal iliac arteries to prevent haemorrhage and hysterectomy \nM. Teixidor Viñas, A.-M. Belli, E. Chandraharan; London/UK \n(mireia.teixidor@hotmail.com) \nPurpose: Placenta percreta (PP) is a recognised cause of severe postpartum \nhaemorrhage, with high risk of blood transfusions and emergency hysterectomy \nwith maternal morbility and mortality. Our purpose is to evaluate the role of bilateral \nocclusion balloon catheter insertion in to both internal iliac arteries (IIA) before \nelective caesarean to prevent haemorrhage and to preserve the uterus. This is \none of the longest cohort of women treated with prophylactic balloon occlusion and \nprevents caesarean hysterectomy in abnormal placentation.\nMethods and Materials: Twenty-two pregnant women who were identified as \nhaving a PP by US were treated prophylactically with bilateral occlusion balloon \ncatheters placed in the anterior trunk of both IIA prior to elective caesarean. The \nballoons were inflated immediately after the baby delivery and deflated four hours \nlater. Patients with peri-operative bleeding were treated with uterine artery embolisa-\ntion (UAE), blood transfusion or hysterectomy. For each patient, estimated volume \nof blood lost and transfusion required was recorded.\nResults: Abnormal placentation was confirmed histologically as percreta (13), \nacreta (7) and increta (2). Estimated median blood lost during the delivery was \nnoted 1.8L (range 0.5-12L). Postpartum haemorrhage occurred in nine patients, \nsix had successful embolisation and three required hysterectomy. No foetal or \nmother death occurred.\nConclusion: Prophylactic occlusion balloon catheter insertion in both IIA prior \nto elective caesarean deliveries in patients with abnormal placenta contributes \nto successful treatment, reduced blood lost and preserved the uterus in this high \nrisk group of women. \nAuthor Disclosures:\nM. Teixidor Viñas: Research/Grant Support; Fundacion Alfonso Martin \nEscudero.\nB‑0499 15:21\nEfficacy of bilateral uterine artery embolisation as a first-line \ntherapeutic option for acquired uterine arteriovenous malformations \nJ. Shin, H.-K. Yoon, G.-Y. Ko, D.-I. Gwon; Seoul/KR (jhshin@amc.seoul.kr) \nPurpose: To evaluate the efficacy of bilateral uterine artery embolisation (UAE) \nas a first-line therapeutic option for the treatment of uterine bleeding associated \nwith acquired uterine arteriovenous malformations (AVMs).\nMethods and Materials: Ten patients were diagnosed with acquired uterine AVMs. \nThe clinical characteristics, embolisation details, technical and clinical success, \nprocedure-related complications, and follow-up data were assessed. Clinical suc-\ncess was defined as immediate resolution of vaginal bleeding without recurrence \nof symptoms and resolution of AVM seen on subsequent imaging studies.\nResults: A total of 11 transcatheter embolisation procedures of bilateral uterine \narteries with or without extra-uterine feeding arteries were performed as the first-\nline treatment, and with a technical success rate of 82% (9/11). Embolisation was \nincomplete in two patients who had an extra-uterine blood supply or a dominant \ndraining vein; the former recovered from menorrhagia during our close observation, \nwhile the latter underwent a successful second embolisation procedure. Clinical \nsuccess was achieved in the remaining eight patients after a single procedure \nand there was no recurrence of bleeding. Only one minor complication occurred: \nrupture of the proximal UA. Recovery to their normal menstrual cycle was seen \nin all eight of the clinically successful patients, one of whom subsequently had an \nuneventful intrauterine pregnancy carried to term.\nConclusion: Bilateral UAE is safe and effective for the treatment of acquired uterine \nAVMs while it preserves uterine function. However, the presence of an extra-uterine \nblood supply or a dominant draining vein may result in incomplete embolisation \nand, consequently, less successful clinical outcome.\nB‑0495 14:45\nUsefulness of pelvic artery embolisation: a comparison between \ncaesarean section and vaginal delivery in 176 patients \nH. Lee, G. Jeon; Seongnam-si/KR (hyunjoo17@naver.com) \nPurpose: To evaluate the efficacy and safety of transcatheter arterial embolisation \n(TAE) of the pelvic arteries for the treatment of postpartum haemorrhage (PPH) \nassociated with caesarean section as compared with vaginal delivery.\nMethods and Materials: A retrospective analysis of all 176 patients undergoing \nTAE of the pelvic arteries for PPH from January 2006 through August 2011 was \nconducted at two institutions. The mean patient age was 33.9 years, with a range \nfrom 24 to 46 years. Delivery details, haematology and coagulation results, em-\nbolisation details, and clinical outcomes were collected. Technical success was \ndefined as the cessation of bleeding upon angiography and/or the angiographically \nsuccessful embolisation of the bleeding artery. Clinical success was defined as the \nobviation of repeated embolisation or surgical intervention\nResults: The technical success rate was 98.8% (n=174), and the clinical success \nrate was 89.7% (n=158). Among the 176 patients, 71 had caesarean sections, \nand 105 underwent normal vaginal deliveries. Of the 105 patients who underwent \nnormal vaginal deliveries, 11 (10.5%) required re-embolisation or surgical inter-\nvention. Of the 71 patients who had caesarean sections, seven (9.8%) required \nre-embolisation or surgical intervention. The clinical success and complication rate \nwas not related to the mode of delivery. All women resumed menses after TAE, \nand the majority of them (n=125) described their menses as unchanged. Thirteen \nwomen had spontaneous pregnancies.\nConclusion: The caesarean mode of delivery is not a predictor of poorer outcomes \nof TAE; however, further study is needed to clarify this relationship.\nB‑0496 14:54\nTransarterial embolisation in the treatment of postpartum haemorrhage \nZ. Wang, X. Li, Z. Jin; Beijing/CN (zhiweiwang1981@sina.com) \nPurpose: To evaluate the effectiveness and safety of transarterial embolisation in \nthe treatment of postpartum haemorrhage (PPH).\nMethods and Materials: All patients who underwent embolisation for PPH in our \nhospital between January 2005 and March 2012 were included. Primary PPH \nwas defined as haemorrhage occurred within the first 24 hours after delivery, and \nsecondary PPH was defined as haemorrhage occurring more than 24 hours after \ndelivery. The complications, control of haemorrhage and outcome of subsequent \npregnancies were assessed.\nResults: A total of 143 patients (mean age, 31.2±5.9 years) underwent embolisa-\ntions for PPH. Of these patients, 109 (76%) underwent embolisations for primary \nPPH and 34 (24%) for secondary PPH. Uterine arteriovenous malformations and \nretaining products of conception were associated with secondary PPH (P < 0.05). \n112 (78%) patients underwent bilateral uterine arteries embolisations and 31 (22%) \npatients underwent bilateral uterine arteries and other collateral arteries (including \nbranches of internal iliac artery, branches of external iliac artery and ovarian arteries) \nembolisations. Embolisation was performed using gelatin sponge. The technical \nsuccess rate was 100%. Bleeding was controlled in 137 patients (95.8%) after \nembolisation. Six patients experienced recurrent bleeding. Two patients underwent \nrepeated embolisations and angiography revealed uterine collaterals arising from \nbranches of internal iliac artery. One patient with placenta percreta and three pa-\ntients with persistent coagulation disorders required emergency hysterectomies. \nSeventeen patients became pregnant and eight uneventful intrauterine pregnancies \ncarried to term at a median follow-up of 28 months.\nConclusion: Transarterial embolisation is a safe and effective treatment for patients \nwith PPH allowing uterine conservation.\nB‑0497 15:03\nUterine artery embolisation for management of secondary \npostpartum haemorrhage associated with placenta accreta \nZ. Wang, Z. Jin, X. Li; Beijing/CN (zhiweiwang1981@sina.com) \nPurpose: To retrospectively evaluate the efficacy and safety of uterine artery \nembolisation (UAE) for the management of secondary postpartum haemorrhage \nassociated with placenta accrete (PA).\nMethods and Materials: 55 women with PA which was found during delivery were \nconservatively managed in our hospital between January 2005 and May 2012. They \ndid not experience severe bleeding during delivery. 15 patients (mean age, 31.4±6.1 \nyears) developed secondary postpartum haemorrhage and they underwent UAE. \nThe complications, control of haemorrhage and outcome of the placenta left inside \nthe uterus were retrospectively reviewed.\n\nScientific Sessions\nS260\n C A D E F\n G\nB\nfor whole body staging, as it provides redundant information and does not aid the \ndetection of PET positive malignancies. \nB‑0502 14:18\nMolecular imaging of the prostate using multiparametric functional \n[11C]-acetate PET/MRI: proof of concept \nS. Polanec, T. Helbich, K. Pinker-Domenig, S. Leitner, B. Füger, G. Karanikas, \nM. Margreiter, S. Kommata, P. Brader; Vienna/AT \nPurpose: The potentials of multiparametric functional PET/MRI (mfPET/MRI) \nare not yet explored. We hypothesise that mfPET/MRI, which assesses multiple \npathophysiologic, enables an improved diagnosis prostate cancer (PCa). Therefore, \nthe purpose of this study was to demonstrate the feasibility of multiparametric \nfunctional MRI and [11C]-Acetate PET/CT for molecular imaging of the prostate.\nMethods and Materials: 21 patients (mean age of 68.1 years range from 54 to \n79 years; mean PSA level: 8.1 ng/ml range 0.9-23.4 ng/ml) were included in this \nIRB-approved prospective study. [11C]-Acetate PET/CT as well as 3 T MRI of the \nprostate using T2-weighted, dynamic contrast-enhanced and diffusion-weighted \nMR imaging was performed. mfPET/MRI data were coregistered, fused and colour-\ncoded images were generated. mfPET/MRI was assessed for lesion morphology, \nacetate-avidity and nodal status. Lesions within the prostate gland were classified \nas positive when [ 11C]-Acetate uptake was greater than blood-pool activity. The \nlesions were classified in the MRI with the PIRADS classification system and in \n21 patients histopathologically verified.\nResults: 21 lesions were detected by both MRI and mfPET/MRI. MRI classified \n5 lesions as benign and 16 lesions as probably malignant. PET/MRI upgraded \nthe 16 suspect lesions to definite malignant, which were all histopathologically \nproved to be malignant. Sensitivity and specificity of PET/MRI was 100 and 95%, \nrespectively. In one patient mfPET/MRI revealed a lymph node metastasis and in \ntwo patients an additional skeletal metastasis, which was missed by MRI alone.\nConclusion: Molecular imaging of the prostate with mfPET/MRI is feasible and \nimproves diagnostic accuracy. Additionally, an improved assessment of nodal status \nand bone metastasis is enabled. \nB‑0503 14:27\nPET/CT guided therapy planning in prostate cancer patients eligible \nfor radiotherapy: results from a bicentric clinical study \nE. Lopci1, B.A. Jereczek-Fossa2, M. Rodari1, G. Pepe1, C. Fodor2, \nD. Zerini2, O. De Cobelli2, R. Orecchia2, A. Chiti1; 1Rozzano/IT, 2Milan/IT \n(egesta.lopci@gmail.com) \nPurpose: To analyse the role of 11C-Choline PET/CT (Cho-PET) in the manage-\nment of prostate cancer (PC) patients eligible for radiotherapy (RT).\nMethods and Materials: We analysed data from 82 Cho-PET scans, out of 74 PC \npatients (median age 67.7years; range 50-83), referred to our Institutions for RT \nplanning in case of biochemical relapse after previous treatment (26 surgery; 39 \nsurgery±systemic), or at initial diagnosis (9 patients). All Cho-PET were reviewed \nand the outcome was classified as positive in prostate/prostatic bed (T), pelvic \nlymph nodes (N), distant metastases (M) or negative (neg). Median PSA at Cho-PET \nwas 1.6 ng/mL (range 0.1-150 mg/mL). In 23 cases, PET was performed during \nandrogen deprivation therapy (ADT). Cho-PET findings were confirmed with other \ndiagnostic techniques, clinical data and/or follow-up.\nResults: Cho-PET was positive in 45 exams (55%), of which 22T (49%), 4N (9%), \nand 19M in combination with T and/or N (42%). The median pre-PET PSA in T-pos \nand N/M-pos cases were 7.4 ng/mL (range 2.7-150) and 13.7 ng/mL (range 5.3-139), \nrespectively. According to Cho-PET findings, in 28 cases patients proceeded with \nRT± systemic therapy, whereas in the remaining 17 (48%) the therapeutic approach \nchanged. In 6 cases patients underwent surgery followed ±RT, in 4 cases patients \nreceived systemic therapy only, or other treatment in 7 cases. When considering \nall scans, PET impact on treatment planning reaches 21% (17/82).\nConclusion: Despite the suboptimal detection rate, Cho-PET comes out an im-\nportant imaging modality for treatment planning in PC patients. The method results \ncapable of influencing more than 1/5 of all patients and almost half of those with \na PET-pos result. \n14:00 - 15:30 Room Z \nMolecular Imaging \nSS 606 \nMR/PET and PET/CT \nModerators: \nP.R. Ros; Cleveland, OH/US \nN. Belcari; Pisa/IT\nB‑0500 14:00\nSimultaneous 68Ga-DOTATOC PET/MRI for whole body staging in \npatients with neuroendocrine tumours: preliminary results \nK.J. Beiderwellen1, T.D. Poeppel1, V. Hartung-Knemeyer1, \nC. Buchbender2, H. Kuehl1, A. Bockisch1, T.C. Lauenstein1; 1Essen/DE, \n2Düsseldorf/DE (karsten.beiderwellen@uk-essen.de) \nPurpose: Comparison of diagnostic efficiency of simultaneously acquired 68Ga-\nDOTATOC PET/MRI with a triple phase contrast-enhanced 68Ga-DOTATOC PET/\nCT in patients with neuroendocrine tumours (NET).\nMethods and Materials: 25 patients (12 women, 13 men; aged 53±15 years) \nwith histologically confirmed NET underwent a triple phase contrast-enhanced \nPET/CT with 68Ga-DOTATOC (Biograph mCT 128, Siemens, Erlangen, Germany). \nThe patients subsequently underwent a whole body contrast-enhanced PET/MRI \n(Biograph mMR, Siemens, Erlangen, Germany). The resulting datasets were rated \nseparately by two radiologists. The criteria comprised lesion count, lesion localisa-\ntion and characterisation using a 4-point ordinal scale (0: not visible, I: benign, II: \nindeterminate, III: malignant). All available data (PET/CT, PET/MRI, history) and a \nclinical follow-up (mean: 95 days) served as standard of reference. Additionally, a \ncase-based descriptive data analysis of PET/CT, PET/MRI and the submodalities \nwas performed.\nResults: In 15 of the 25 patients malignant NET lesions were present. While PET/\nCT allowed for identification of 13 patients, PET/MRI offered correct identification \nof all 15 patients. All lesions classified as malignant in PET/CT (74 lesions) could \nequally be visualised in PET/MRI. With PET/MRI 12 additional liver metastases \ncould be detected.\nConclusion: This is the first study showing the feasibility of whole body staging \nwith 68Ga-DOTATOC PET/MRI in patients with NET. Our results demonstrate the \nsuperiority of PET/MRI in detecting malignant liver lesions compared to PET/CT. \nWhole body PET/MRI with 68Ga-DOTATOC bears the potential of replacing PET/\nCT as the current gold standard in the staging of NETs. \nB‑0501 14:09\nDiffusion-weighted imaging as part of hybrid FDG-PET/MRI protocols \nfor whole body cancer staging: does it benefit lesion detection? \nT.A. Heusner1, P. Heusch1, V. Hartung-Knemeyer2, K. Beiderwellen2, \nT. Lauenstein2, M. Forsting2, G. Antoch1, C. Buchbender1; 1Düsseldorf/DE, \n2Essen/DE (heusner@med.uni-duesseldorf.de) \nPurpose: To evaluate if diffusion-weighted imaging (DWI) results in a diagnostic \nbenefit for lesion detection in oncologic patients if added to a whole body [18 F]-\nFDG PET/MRI protocol.\nMethods and Materials: 25 patients (mean age: 57 ± 12 years) with [18 F]-FDG \nPET positive tumours prospectively underwent whole body [18 F]-FDG-PET/MRI \nincluding DWI on a hybrid PET/MRI scanner. Two readers assessed [18 F]-FDG \nPET/MRI without DWI for primary tumours and metastases in consensus. In a \nsecond session, now considering DWI, readers reassessed [18 F]-FDG PET/MRI \naccordingly. Additionally, the lesion-to-background contrast on [18 F]-FDG PET and \nDWI was rated qualitatively on a 4-point scale. McNemar´s test and Wilcoxon´s \nsigned-rank test were performed to test for differences in the number of detected \nlesions and the lesion-to-background contrast.\nResults: 54 lesions were detected (5 primaries, 49 metastases). 51 of 54 lesions \nwere concordantly detected by [18 F]-FDG PET/MRI alone and [18 F]-FDG PET/\nMRI with DWI. [18 F]-FDG PET/MRI with DWI detected 3 additional lymph node \nmetastases. There was no significant difference between the number of lesions \ndetected by [18 F]-FDG PET/MRI alone and [18 F]-FDG PET/MRI with DWI (p= \n0.25). The lesion-to-background was significantly higher on [18 F]-FDG PET \ncompared to DWI (p= 0.001).\nConclusion: DWI does not increase the number of detected lesions when added \nto a whole body [18 F]-FDG PET/MRI protocol. Compared to [18 F]-FDG PET it \nprovides a lower lesion-to-background contrast. In order to optimise PET/MRI \nprotocols with regard to patient comfort and scan duration, DWI seems dispensable \n\nScientific Sessions\nS261\nA\n C D E F G\nB\nFriday\nB‑0506 14:54\nFDG-PET/CT for the early prediction of histopathological complete \nresponse to neoadjuvant chemotherapy in breast cancer patients \nT.A. Heusner1, C. Riegger1, S. Kuemmel2, M. Forsting2, \nV. Hartung-Knemeyer2, G. Antoch1, C. Buchbender1; 1Düsseldorf/DE, \n2Essen/DE (heusner@med.uni-duesseldorf.de) \nPurpose: To test if FDG-PET/CT can early differentiate between breast cancer \nlesions with and without pathological complete response (pCR/npCR) after two \ncycles of neoadjuvant chemotherapy (NACT).\nMethods and Materials: 26 breast cancer patients (mean age, 46.9 years ± 9.9 \nyears) underwent a pre-therapeutic FDG-PET/CT scan and a FDG-PET/CT after \nthe second cycle of NACT. Histopathology served as the reference standard. SUV-\nmax of cancer lesions before and after the second cycle of NACT were measured. \nTwo evaluation algorithms were used: (a) pCR: Sinn Score 3 and 4, npCR: Sinn \nScore 0-2; (b) pCR: Sinn Score 4, npCR: Sinn Score 0-3. The absolute and relative \ndecline of the SUVmax (ΔSUVmax, ΔSUVmax (%))was calculated. Differences \nof the SUVmax and of the SUVmax decline between pCR and npCR lesions were \ntested for statistical significance (p <.05). To identify the optimal cut-off value of \nΔSUVmax (%) to differentiate between pCR lesions and npCR lesions a receiver \noperating curve (ROC) analysis was performed.\nResults: Using evaluation algorithm A the ΔSUVmax was 13.5 (pCR group) and \n3.9 (npCR group) (P = 0.006); the ΔSUVmax (%) was 79% and 47%, respectively \n(P = 0.001). On ROC analysis an optimal cut-off ΔSUVmax (%) of 66% was found. \nUsing evaluation algorithm B the ΔSUVmax was 17.5 (pCR group) and 4.9 (npCR \ngroup) (P = 0.013); the ΔSUVmax (%) was 89% and 51%, respectively (P = 0.003). \nOn ROC analysis an optimal cut-off ΔSUVmax (%) of 88% was found.\nConclusion: FDG-PET/CT early differentiates between pCR and npCR after two \ncycles of NACT. \nB‑0507 15:03\nDiagnostic accuracy of 11C-choline PET (CHO-PET) in patient \naffected by hepatocellular carcinoma (HCC): comparison with CT/MRI \nE. Lopci, G. Torzilli, A. Palmisano, M. Scorsetti, A. Chiti; Rozzano/IT \n(egesta.lopci@gmail.com) \nPurpose: To assess the diagnostic role of 11C-choline PET/CT (CHO-PET), com-\npared to conventional imaging with CT/MRI, in patients affected by hepatocellular \ncarcinoma (HCC).\nMethods and Materials: In our study we prospectively enrolled 23 consecutive \npatients (M:F=20:3, mean age 70years) affected by HCC: 6 patients at presenta-\ntion and 17 at restaging. In all cases we performed a whole body CHO-PET and \ncompared findings with referring CT (n=20) and/or MRI scanning (n=11), for a \ntotal of 25 paired scans. The reference standard for validating imaging results was \neither histology (5 patients), or a multidisciplinary work-up. For every modality we \ndetermined diagnostic accuracy on a scan-based and on a site-based analysis.\nResults: On a scan-based analysis CHO-PET and CT/MRI demonstrated an ac-\ncuracy of 86.4% and 88%, respectively, whereas on a site-based analysis the two \nmodalities demonstrated a sensitivity and accuracy, respectively, of 67.6% and \n65.9% for PET, and 71.7% and 69% for CT/MRI. In both analyses, no statistically \nsignificant difference was found on T-test. In 7/23 patients, HCC showed either \nloco-regional involvement (n=3) or distant metastases (n=6). All extra-hepatic \nlesions were properly detected by CHO-PET (accuracy 100%), whereas CT/MRI \nmissed a large part of them (accuracy 58.8%) and this most likely due to the limited \nfield of view during acquisition. In 7 cases (30.4%), PET information determined a \nchange in treatment planning.\nConclusion: According to our findings, CHO-PET has a comparable accuracy \nwith CT/MRI in HCC. The principle advantage of the modality appears its ability to \ndetect extra-hepatic lesions, which can lead to treatment modification.\nB‑0508 15:12\nPIB-PET as a pathological and functional marker in Alzheimer’s disease \nV. Abreu1, A. Nordberg2; 1Lorenskog/NO, 2Stockholm/SE \nPurpose: Amyloid imaging using positron emission tomography (PET) with the \ntracer PIB is widely used in Alzheimer’s disease (AD) research. FDG-PET is a \nwell-established method for measuring cerebral glucose metabolism (CMRglc), \nassessing functional status. We investigated the possibility to use early frames \n(ePIB) of PIB scans as a rough index of CBF comparing the normalised early PIB \nvalues with rCMRglc in AD patients, mild cognitive impairment (MCI) subjects and \nhealthy controls.\nMethods and Materials: PIB-PET and FDG-PET was performed in 37 AD patients, \n21 MCI subjects and 6 healthy controls. Patients were divided based on their PIB \nB‑0504 14:36\nDetection of lung nodules in an integrated whole body MR/PET \nscanner: comparison to PET/CT \nN.F. Schwenzer, C. Schraml, S. Gatidis, C. Brendle, \nH. Schmidt, C. Pfannenberg, C.D. Claussen; \nTübingen/DE (nina.schwenzer@med.uni-tuebingen.de) \nPurpose: To investigate the diagnostic performance of a whole body 3 T MR/PET \nin the detection of lung nodules.\nMethods and Materials: Lung imaging of PET/CT and MR/PET in 20 patients \nwith oncologic diseases was evaluated. PET/CT comprised whole body scans in \nexpiration (CTex) and inspiration (CTin). In MR/PET, axial T1 3D-VIBE sequences \nof the lung were performed both in inspiration (VIBEin) and in expiration (VIBEex). \nFurthermore, in-/opposed-phase sequence (Dixon) used for attenuation correction \nin MR/PET were evaluated. In all images, the diagnostic confidence in identifica-\ntion of nodules was rated on a 4-point scale (1=certain; 4=uncertain). Additionally, \nthe involvement of each lung lobe (primary/metastatic) was assessed. CT scan \nin inspiration served as reference. The diagnostic performance of each modality \nwas compared in a lesion- and lobe-based analysis. The diagnostic confidence \nwas compared using Wilcoxon test.\nResults: 48 lung nodules were evaluated. In the lesion-based analysis, sensitivity \n(false negative rate) of CTex, VIBEin, VIBEex and Dixon was 77% (23%), 52% \n(48%), 48% (52%) and 25% (75%). In the lobe-based analysis reflecting the clini-\ncal assessment, sensitivity (false negative rate) was 94% (6%), 89% (11%), 89% \n(11%) and 53% (47%), respectively. In CT and MRI diagnostic confidence was \nrated higher in inspiration (mean score CTin/CTex 1.1/1.3; VIBEin/VIBEex 1.2/1.5) \nalthough no statistical significance was reached.\nConclusion: Results suggest that for reliable detection of lung nodules a CT scan \nof the lung is still recommended. Concerning clinical assessment of lung lobe \ninvolvement, VIBE sequences offered fair results especially. Lesion detection and \ndiagnostic confidence of MRI can be improved if an inspirational examination is \nperformed. \nAuthor Disclosures:\nN.F. Schwenzer: Other; Research contract Siemens Healthcare.\nB‑0505 14:45\nAssessment of tumour aggressiveness with quantitative perfusion \nimaging and tumour volume in patients with lung cancer: correlation \nwith metabolic parameters of 18 FDG-PET/CT \nD. Fior, D. Ippolito, P.A. Bonaffini, C. Capraro, C. Messa, S. Sironi; Monza/IT \n(davidefior85@gmail.com) \nPurpose: To evaluate the relationship between quantitative CT-perfusion param-\neters and tumour volume with glucose metabolism parameters, in staging of lung \ncancer patients with 18 FDG PET/CT whole body study.\nMethods and Materials: Thirty-one patients with biopsy-proven lung cancer, \nreferred for cePET/CT staging, were prospectively enrolled in our study. CTp was \nperformed with following parameters: 120 Kv; 80 mAs; scan 30, during intravenous \ninjection of 50 ml of contrast-agent, flow rate: 5 ml/sec. CTp and cePET/CT data \nwere used to calculate a range of tumour vascularity parameters (blood flow, blood \nvolume and mean transit time) and tumour glucose uptake (SUVmax), and finally \ncorrelated with tumour volume using a commercially available software. Four \npatients were excluded due to the advanced stage of the tumour. CT perfusion \nparameters were then statistically analysed and compared with those of FDG-PET.\nResults: Perfusion parameters were calculated with a dedicated software \n(Perfusion 3.0; Advantage; GE) and a quantitative map of arterial perfusion was \ngenerated. Patients were divided into two groups according to tumour volume, \nwith a cut-off of 14 cm3. Linear regression was performed among two groups and \nstatistically significant correlations (P < 0.05) were found between BF and SUVmax \n(negative correlation) and between MTT and SUVmax (positive correlation) for \ntumours with volume > 14 cm3. These findings may be due to the inadequate blood \ninflow typical of larger tumours, with a significant increase of anaerobic metabolism \nand glucose consumption.\nConclusion: CePET/CT perfusion is a feasible technique that offers informations \nrelated to the biological tumour behaviour that can be used for planning treatment \nand for an accurate evaluation of tumour response after therapy.\n\nScientific Sessions\nS262\n C A D E F\n G\nB\nretention as PIB positive (PIB+) or PIB negative (PIB-). Data of the unidirectional \ninflux K_1 from a subset of 7 AD patients and 3 controls were used for correlative \nanalysis. Data were analysed using regions of interest (ROI) analysis.\nResults: We found a strong, positive correlation across brain regions between \nK_1 and ePIB (r=0.70; p < 0.001). ePIB values were significantly lower in posterior \ncingulate (p < 0.001) and parietal cortices (p=0.002) in PIB+ subjects compared \nwith PIB- although the group difference were stronger for rCMRglc in cortical \nareas (p < 0.001). Strong positive correlations between ePIB and rCMRglc were \nobserved in all cortical regions analysed, especially posterior cingulate and parietal \ncortices (p < 0.001).\nConclusion: This study suggests that a single dynamic PIB-PET scan may provide \nclinical estimates of pathological (amyloidosis) and functional changes (impaired \nblood flow) in AD. This dual information might be valuable both in early diagnosis \nof AD and evaluation of treatment strategies, but our results emphasise the need \nfor further research. \n\nScientific Sessions\nS263\nA\n C D E F G\nB\nSaturday, March 9\n\nScientific Sessions\nS264\n C A D E F\n G\nB\nB‑0511 10:48\nDynamic contrast-enhanced (DCE) MRI of cerebral gliomas: \nassessment of tumoral angiogenesis with low gadolinium-based \ncontrast agent dose \nD. Gadda, L. Mazzoni, M. Moretti, S. Chiti, G. Giordano; Firenze/IT \n(davgadda@tin.it) \nPurpose: DCE-MRI biomarkers are related to angiogenesis, a crucial process for \nthe neoplastic growth of high-grade gliomas (HGG). A dose of 0.1-0.2 mmol/kg \nbody weight gadolinium-based contrast agent (GBCA) is generally administered \nfor DCE imaging. We hypothesized that DCE-MRI parameters obtained with the \nlower dose of 0.05 mmol/kg of a high-relaxivity GBCA (gadobenate dimeglubine) \nused as preload for rCBV quantification with dynamic-susceptibility contrast (DSC) \nMRI, may differentiate HGG from low-grade gliomas (LGG).\nMethods and Materials: The GBCA low-dose DCE-MRI studies of 11 HGG and \n6 LGG were retrospectively evaluated. DCE-MRI had been followed by DSC-MRI \nfor quantification of rCBV. Tofts model was utilised for DCE quantitative analysis. \nKtrans, Kep, Ve, iAUC and rCBV estimates of HGG were compared to LGG with \nStudent’s t-test. ROC analyses were also done for each parameter.\nResults: Significant differences were found for Ve (HGG 0.140±0.12, LGG \n0.010±0.009, p0.005, AUC 0.924), iAUC (HGG 3.15±2.01, LGG 0.43±0.4, p0.0012, \nAUC 0.939) and rCBV (HGG 3.67±2.42, LGG 1.27±0.33, p0.011, AUC 0.860), \nwhereas no significant differences were found for Kep (HGG 3.91±5.9, LGG \n9.31±6.55, p0.1, AUC 0.803) and Ktrans (HGG 0.096±0.05, LGG 0.054±0.036, \np0.11, AUC 0.742).\nConclusion: DCE-MRI with the dose of 0.05 mmol/kg of gadobenate dimeglubine \ncan differentiate HGG, a tumour with generally high angiogenic activity, from the \nslow-growing LGG. The diagnostic performance of DCE parameters Ve and iAUC \nwas higher than rCBV. The preload dose of gadolinium for DSC-MRI may be utilised \nfor DCE-MRI, making feasible the estimation of blood volume and permeability in \na single examination.\nB‑0512 10:57\nCorrection of CBV perfusion maps from T1 leakage effect allows a \nbetter correlation of perfusion DSC MR imaging with histopathologic \nglioma grading and an estimation of vascular permeability \nF. Viry1, D. Galanaud1, A. Mitulescu2, Y. Chaibi2, V. Reina1, D. Leclercq1, \nD. Dormont1; 1Paris/FR, 2La Ciotat/FR (viryflore@yahoo.fr) \nPurpose: Capillary proliferation is a major histopathological criterion in glioma \ngrade determination, known to correlate with CBV. However, in case of blood brain \nbarrier (BBB) disruption, contrast agent extravascular leakage increases the signal \nin voxels inducing under-estimation of CBV. Sophisticated mathematical models \ntaking into account BBB disruption and arterial input function (AIF) can be used \nto correct this misestimation and enable permeability constant K2 calculation. We \nhypothesized that CBV corrected from vascular leakage can better differentiate \nglioma grade than uncorrected_CBV and that K2 increases with glioma grade.\nMethods and Materials: Fifty-four patients with steretotaxic biopsy-confirmed \ngliomas (20 WHO grade II, 13 grade III and 21 grade IV) explored by multimodal MR \nimaging including DSC gradient-echo perfusion-MR (1.5 T-3 T) were retrospectively \nincluded. Preprocessing included motion correction, automatic AIF determination \nand leakage correction (Perfscape/Neuroscape-Olea Medical). Perfusion maps \nincluding relative CBV (corrected/uncorrected), relative CBF and K2 were calcu-\nlated. Regions-of-interest were delineated within the tumour (biopsy site), and in \nthe symmetrical contralateral normal-appearing region.\nResults: Differences in corrected_rCBV were statistically significant (p < 0.05) be-\ntween grades II-IV, III-IV, II-III (non-parametric Steel-Dwass test). Uncorrected_rCBV \ndoes not statistically differentiate grade II-III. K2 could only differentiate grade II-IV. \nCorrected_rCBV had a stronger correlation to glioma grade than uncorrected_rCBV \n(Spearman r=0.73 and r=0.6, respectively, p < 0.01). K2 was weakly correlated to \nglioma grade (r=0.34, p < 0.01).\nConclusion: Taking into account BBB disruption in DSC perfusion imaging im-\nproves glioma grades differentiation with rCBV. K2 has a weak correlation with \nglioma grade, which could partly be explained by the heterogenous parameters of \nDSC sequences in this study.\nAuthor Disclosures:\nF. Viry: Equipment Support Recipient; Using Perfscape/Neuroscape software \n(Olea Medical). D. Galanaud: Equipment Support Recipient; Using Perfscape/\nNeuroscape software (Olea Medical). A. Mitulescu: Employee; VP Clinical \nAffairs at Olea Medical. Y. Chaibi: Employee; Clinical & Scientific Research \nEngineer at Olea Medical. V. Reina: Equipment Support Recipient; Using \nPerfscape/Neuroscape software (Olea Medical). D. Leclercq: Equipment \nSupport Recipient; Using Perfscape/Neuroscape software (Olea Medical). \n10:30 - 12:00 Room C \nNeuro \nSS 911 \nNew insights into brain gliomas \nModerators: \nL.C. Tzarouchi; Ioannina/GR   \nP. Vilela; Almada/PT \nB‑0509 10:30\nData-driven grading of brain gliomas: a multiparametric MRI study \nV. Panara, D. Tortora, P. Mattei, S. Salice, C. Briganti, A. Cotroneo, A. Tartaro, \nM. Caulo; Chieti/IT (valepana@libero.it) \nPurpose: To grade brain gliomas using data-driven analysis of multiparametric MRI \nand to compare these results with qualitative and semi-quantitative evaluations.\nMethods and Materials: 110 patients with histologically confirmed brain gliomas \nwere retrospectively evaluated. Conventional and advanced MR sequences (DWI, \nPWI, MRS, DTI) were performed. Three evaluations were done: semiquantitative \n(radiological report), qualitative (conventional MRI) and quantitative. For the latter \nregions of interest (ROI) placed in 4 areas: with contrast enhancement (CE), high-\nest T2 signal intensity (T2+), lowest T2 signal intensity (T2-), and most restricted \ndiffusion (RD). rCBV, rMTT, Cho/Cr, Cho/NAA, Lip/Cr, Lac/Cr, ADC and FA were \nmeasured. Statistical analysis included t-test (p < 0.05), ROC analysis, discriminant \nanalysis, and Kendall coefficient of concordance, where appropriate.\nResults: Significant differences between grades were noted in age, rCBV in CE \n(cut off> 2.59, sensitivity 80%, specificity 91%, AUC= 0.937, p=0.0001), T2- (cut \noff > 2.45, sensitivity 57%, specificity 97%, AUC=0.852, p=0.0001), RD (cut off > \n2.61, sensitivity 54%, specificity 97%, AUC=0.808, p=0.0001), Cho/Cr in T2- (cut \noff > 2.07, sensitivity 49%, specificity 88%, AUC=0.685, p=0.0007). Discriminant \nanalysis including age, rCBV in CE, in T2- and in RD and Cho/Cr in T2- correctly \nclassified 95% of patients. Quantitative analysis showed a higher concordance with \nhistologic examination than qualitative and semiquantitative methods (p < 0.0001).\nConclusion: The integration of multiple biomarkers with a quantitative approach \nsignificantly increased the diagnostic accuracy in discriminate between high and \nlow grade gliomas. \nB‑0510 10:39\nCombining diffusion kurtosis imaging, dynamic susceptibility-\nweighted MR imaging and short echo time chemical shift imaging for \ngrading gliomas \nS. Van Cauter1, F. De Keyzer1, D. Sima1, J. Veraart2, F. D’Arco1, R. Peeters1, \nS. Van Gool1, S. Sunaert1, U. Himmelreich1; 1Leuven/BE, 2Antwerp/BE \n(sofie.vancauter@uz.kuleuven.be) \nPurpose: To assess the diagnostic accuracy of diffusion kurtosis imaging (DKI), \ndynamic susceptibility-weighted imaging (DSC) and short echo time chemical shift \nimaging (CSI) for grading gliomas, as separate techniques and in a multimodal \napproach in order to determine the best discriminative parameter (s).\nMethods and Materials: 35 patients with cerebral gliomas (12 F/23M; age range: \n22-78, median age: 55) underwent DKI, DSC and CSI on a 3 T MR scanner. Diffusion \nparameters: mean diffusivity (MD), fractional anisotropy (FA), mean kurtosis (MK); \nperfusion parameters: mean relative regional cerebral blood volume (mean rrCBV), \nmean relative regional cerebral blood flow (mean rrCBF), mean transit time (MTT) \nand relative decrease ratio (rDR), and twelve CSI metabolite ratios were compared \nbetween 22 high-grade gliomas and 14 low-grade gliomas (Mann-Whitey-U, p < 0.05 \nsignificance, Bonferroni corrected). Sensitivity, specificity, diagnostic accuracy and \noptimal thresholds were determined for the techniques separately and combined.\nResults: MK, MD, mean rrCBV, mean rrCBF, rDR, Lips/Cho, Lips/Cre, Myo/sum \nand Cre/sum showed statistically significant differences among tumour grades, \nwith mean rrCBF as the best discriminative parameter. The combination of mean \nrrCBF, MK and Myo/sum to grade gliomas showed diagnostic accuracy, sensitivity \nand specificity of 100%, whereas combining mean rrCBV, MD and Lips/Cho gave a \ndiagnostic accuracy, sensitivity and specificity of 91%, 93% and 82%, respectively.\nConclusion: Combining the parameters mean rrCBF, MK and Myo/sum to de-\ntermine the glioma grade was pathognomonic in this study. The best performing \nparameters, when used individually, were found to be MK and mean rrCBF.\n\nScientific Sessions\nS265\nA\n C D E F G\nB\nSaturday\nB‑0515 11:24\nAdditive value of arterial spin labeling in differentiating primary \ncentral nervous system lymphoma from glioblastoma multiforme: an \nobserver performance study \nK. Yamashita, T. Yoshiura, A. Hiwatashi, O. Togao, K. Kikuchi, K. Yoshimoto, \nH. Honda; Fukuoka/JP (yamakou@radiol.med.kyushu-u.ac.jp) \nPurpose: To determine whether ASL has an additive diagnostic value to the con-\nventional MR images in differentiating primary central nervous system lymphomas \n(PCNSLs) from glioblastoma multiformes (GBMs).\nMethods and Materials: MR images of 48 patients including 12 with PCNSL and \n36 with GBM were retrospectively studied. Two independent neuroradiologists took \npart in 2 reading sessions. In the first session, the observers read only conventional \nMR images (T1-weighted image, T2-weighted images, post-contrast images, and \nDWI with apparent diffusion coefficient maps). In the second session, they read \nASL cerebral blood flow (CBF) maps along with the conventional images. The \nconfidence level for the diagnosis (PCNSL versus GBM) was graded on a 5-point \nscale. Interobserver agreement as well as sensitivity, specificity, accuracy, posi-\ntive predictive value (PPV), and negative predictive value (NPV) were assessed \nfor the two readers.\nResults: Substantial interobserver agreement was shown for both sessions (κ=0.62 \nand 0.60, respectively). For both observers, reading with ASL was associated with \nhigher sensitivity (92.3-100%), specificity (100-100%), accuracy (94.1-100%), PPV \n(100-100%), and NPV (80.0-100%) than those without ASL (sensitivity, 92.3-100%; \nspecificity, 87.5-87.5%; accuracy 91.2-97.1%; PPV 96.0-96.3%; NPV 77.8-100%).\nConclusion: ASL has an additive diagnostic value to the conventional MR images \nin differentiating PCNSLs from GBMs. \nB‑0516 11:33\nGlioma grading using pharmacokinetic parameters in T1-weighted \ndynamic contrast-enhanced perfusion MR \nS.C. Jung, S. Choi, S. Kim, H. Shin, J. Yeom, I. Ryoo; Seoul/KR \n(dynamics79@gmail.com) \nPurpose: To investigate the feasibility of pharmacokinetic parameters (Ktras, Ve, Vp) \nderived from T1-weighted dynamic contrast-enhanced (DCE) perfusion magnetic \nresonance (MR) imaging in terms of glioma grading.\nMethods and Materials: Thirty-two patients (16 males, 16 females; mean age, 48.6 \nyears; age range, 25-72 years; 32 tumours) with histologically confirmed gliomas \n(WHO grade II, 6; grade III, 9; grade IV, 17) were examined with conventional MR \nimaging and T1-weighted dynamic contrast-enhanced imaging at 3 T before surgery \nor biopsy. Ktras, Ve, and Vp were calculated and correlated with glioma grading \n(high grade versus low grade) on a pixel-by-pixel basis. Various percentile values \nof cumulative histogram were compared and assessed with receiver operating \ncharacteristic (ROC) curve according to glioma grading. We rated the percentile \nwith highest area under the ROC curve.\nResults: There were significant differences between high- and low-grade gliomas \nin Ktras, Ve, and Vp (p < 0.05). Ktras showed highest association according to glioma \ngrading (p < 0.01). The 95 percentile in K tras presented highest area under the \nROC curve (sensitivity of 80.95%, specificity of 66.67%, positive predictive value \nof 89.49%, negative predictive value of 49.97%, accuracy of 77.79%).\nConclusion: The parameters derived from DCE perfusion MR imaging were useful \nvalues for differentiating between low- and high-grade gliomas. Ktras showed best \nresults in grading gliomas. \nB‑0517 11:42\nIntravoxel incoherent motion MR imaging with biexponential and \nstretched-exponential model in grading cerebral gliomas \nY. Bai1, D. Shi1, S. Dou1, F. Sun2, M. Wang1; 1Zhengzhou/CN, 2Beijing/CN \n(resonance2010@126.com) \nPurpose: To evaluate the diagnostic accuracy of intravoxel incoherent motion \n(IVIM) MR imaging with biexponential and stretched-exponential models in grad-\ning cerebral gliomas.\nMethods and Materials: IVIM MR imaging using biexponential and stretched-\nexponential models with 15 different b values range from 0 to 5000 sec/mm2 at 3 \nT MRI was performed on 17 high-grade gliomas and 14 low-grade gliomas proved \nby histopathology after MR examination. The derived parameters of diffusion \ncoef[[Unable to Display Character: fi]]cient (ADCslow), and pseudo-\ndiffusion coef[[Unable to Display Character: fi]]cient (ADCfast) were \ncalculated by biexponential analysis. Water diffusion heterogeneity index α and \ndistributed diffusion coef[[Unable to Display Character: fi]]cient (DDC) were \nobtained from stretched-exponential model. All the parameters were measured in \nD. Dormont: Equipment Support Recipient; Using Perfscape/Neuroscape \nsoftware (Olea Medical).\nB‑0513 11:06\nParadoxical imaging features of high-grade gliomas with \noligodendroglial component: quantitative analysis on diffusion and \nDSC perfusion MR imaging \nL. Sunwoo, S. Choi, T. Kim, S.-H. Lee, C.-K. Park, J.-H. Kim, C.-H. Sohn, \nS.-H. Park, I. Kim; Seoul/KR (leonard.sunwoo@gmail.com) \nPurpose: The aim of this study is to retrospectively investigate characteristic imag-\ning features of high-grade gliomas with oligodendroglial component, which was \ncompared with pure astrocytic high-grade gliomas on diffusion and DSC perfusion \nMR imaging using quantitative analysis.\nMethods and Materials: The study was approved by the Institutional Review \nBoard and was HIPAA compliant. Newly diagnosed high-grade glioma patients \nwere enrolled (n=52; 21 pure astrocytic glioblastomas (GBMs), 10 glioblastomas \nwith oligodendroglial component (GBMOs), 9 anaplastic astrocytomas (AAs), 8 \nanaplastic oligodendrogliomas (AOs), and 4 anaplastic oligoastrocytomas (AOAs)). \nAll participants underwent standard b-value (b=0, 1000 s/mm2) diffusion and DSC \nperfusion MR imaging within 2 weeks before surgery. All tumours were manually \nsegmented based on T2 hyperintense portion. Apparent diffusion coefficient (ADC) \nand relative CBV (rCBV) values were analysed using histogram approach. The \n5th, 10th percentile values of ADC and 90th, 95th percentile values of rCBV, as well \nas mean values were derived, and their mean values according to each tumour \nsubtypes and grades were analysed.\nResults: For grade III tumours, AOs showed significantly higher rCBV compared to \nAAs (P < 0.01). Derivatives of rCBV values of AOAs were not significantly different \nfrom those of AAs or AOs. For grade IV tumours, GBMOs showed significantly lower \nrCBV than GBMs (P < 0.01). Also, the 5 th percentile ADC values of the GBMOs \nwere significant higher than those of GBMs (P=0.046).\nConclusion: We have firstly demonstrated paradoxical lower rCBV and higher \nADC values in GBMOs compared to GBMs, which was a contrary finding to grade \nIII tumours.\nB‑0514 11:15\nSurvival predictive value of perfusion-weighted MRI relative cerebral \nblood volume (rCBV) in glioblastoma multiforme adjusted by \nmultiple biomarkers including MGMT promoter methylation \nG. Viteri, P. Slon, J. Etxano, G. Aldave, R. García-Eulate, J.L. Zubieta, S. Tejada, \nR. Díez-Valle, P.D. Dominguez; Pamplona/ES (pslon@unav.es) \nPurpose: The survival predictive value of perfusion MRI in glioblastoma multiforme \nhas been investigated with contradictory results. Several biomarkers have been \nisolated that may confound or interact with the predictive value of perfusion MRI as \nthey imply significant therapeutical response changes. The purpose of this study is \nto evaluate retrospectively whether the tumoral maximum rCBV on pretreatment \nperfusion MRI has prognostic value in patients with glioblastoma multiforme, \nconsidering several biomarkers including the presence or the absence of MGMT \npromoter methylation.\nMethods and Materials: Between December 2007 and July 2012, 42 patients \n(24 men, 18 women; age range, 34-78 years) with newly diagnosed supratentorial \nglioblastoma multiforme underwent MRI before treatment. The patient age, sex, \nKarnofsky Performance Scale (KPS), preoperative/postoperative tumoral volume, \nMGMT methylation and maximum rCBV were assessed. A multivariate Cox pro-\nportional hazards model was used to evaluate prognostic factors.\nResults: Maximum rCBV (0.984; 95% CI, 0.825-1.173), MGMT promoter methyla-\ntion (1.658; 95% CI, 0.627-5.529) and the other factors (age, KPS, preoperative \nvolume, postoperative volume and MGMT methylation) did not significantly predict \nsurvival (p> 0.05). The only independent prognostic factor that was statistically \nsignificant was sex (HR = 3.672; 95% CI 1.184-11.395).\nConclusion: In this series, the maximum rCBV at pretreatment perfusion MRI in \npatients with glioblastoma multiforme did not predict survival, adjusted by MGMT \npromoter methylation and other biomarkers. \n\nScientific Sessions\nS266\n C A D E F\n G\nB\nsignificant increase in CNR at T1 (T1: 11.5 ± 3.5 HU; T0: 10.9 ± 3.7 HU; p=0.03). \nThe increase in objective image noise at T1 (25.4±4.7 HU vs 17.9 ± 3.4 HU) did \nnot alter the diagnostic value of lung and mediastinal images with a mean score of \nimage quality of 1.73 ± 0.39 in a 4-point scale ranging from 1 (excellent) to 4 (poor).\nConclusion: The automatic tube voltage selection reduced by 38.5% the radiation \ndose delivered during chest CT angiograms while improving the contrast-to-noise \nratio of the examinations.\nB‑0520 10:39\nOrgan-based tube-current modulation: impact of breast position in \nclinical practice \nS. Taylor1, D. Tack2, V. De Maertelaer3, P. Gevenois3; 1Montigny-le-Tilleul/BE, \n2Baudour/BE, 3Brussels/BE (stephengtaylor@gmail.com) \nPurpose: Organ-based tube-current modulation (OBTCM) is a technique developed \nto lower CT radiation dose to anterior dose-sensitive organs. This IRB-approved \nobservational study aimed to establish the location of breast tissue in a female \npatient in supine position with arms raised over their shoulders. A secondary \npurpose was to look for possible thresholds of chest diameter and woman’s age \nbelow or above which the breasts lie in a central location with subsequent possible \nbenefit from OBTCM.\nMethods and Materials: Informed consent was obtained in 200 consecutive \nwomen included. From standard chest CT acquisitions, one 5/5 mm image set \nwith FOV of 500 mm and X and Y coordinates at 0 were obtained. From the gantry \nrotation centre (x=y=0), the outer and inner angles limiting the breast tissue were \nmeasured and compared to the angles (60°), where OBTCM delivers lowered and \nincreased dose to the organs.\nResults: Outer angles of breast tissue were < 60° for one breast in only two pa-\ntients. Inner breast angles were > 60° in 14/200 patients for at least one breast. No \nthreshold of chest diameter or age was found to predict a central enough location \nof the breast for OBTCM to be beneficial.\nConclusion: Our data show that the angular position of breast tissue is higher than \nthe limit where reduced versus increased radiation dose is delivered in OBTCM. \nThis system should therefore not be applied to CT chest examinations in adult \nwomen lying supine.\nAuthor Disclosures:\n D. Tack: Board Member; ESR SP Committee.\nB‑0521 10:48\nReduced radiation exposure of the female breast during low-dose \nchest CT using an organ-based tube-current modulation and \nbismuth shield: comparison of image quality and radiation dose \nY. Kim, Y. Sung, E. Kim, H. Kim, J. Choi; Incheon/KR (skyhi95@naver.com) \nPurpose: To evaluate the effect of an organ-based tube-current modulation \n(OBTCM) and bismuth shielding on image quality and breast radiation dose in \nwomen undergoing low-dose chest CT.\nMethods and Materials: Low-dose chest CT was obtained from 80 women, who \nwere randomly assigned to a control, OBTCM, breast shield, or breast shield plus \nOBTCM group. Axial slice images from aortic arch, carina, and inferior pulmonary \nvein were used to analyse image quality. Three radiologists scored the image quality \nin terms of artefact and noise, and then designated the overall image quality as \noptimal (does not affect the diagnostic accuracy) or suboptimal (affects the diag-\nnostic accuracy). Noise levels were measured in the anterior and posterior lung in \neach image. A phantom dose study was conducted to measure the radiation dose.\nResults: Images with artefacts or noise were more frequently obtained in the \nbreast shielded groups. The overall image quality was not significantly different \namong the four groups. Measured noise levels in the anterior lung were significantly \nhigher in the breast shielded groups than the control group; however, no statistical \nsignificance was found among the four groups in the posterior lung. In the phantom \ndose study, a 16-37.5% dose reduction in the breast was achieved using the breast \nshield and/or OBTCM protocol.\nConclusion: The radiation dose in the female breast may be reduced using the \nbreast shield or OBTCM during low-dose chest CT with acceptable image qual-\nity. The OBTCM reduced the radiation dose in the breast without inducing image \nquality deterioration. \nthe solid parts of gliomas and compared between high- and low-grade gliomas. All \nthe parameters were also normalised to the corresponding values in contralateral \nnormal appearing white matter (NAWM) and compared between high- and low-\ngrade gliomas. A receiver operating characteristic (ROC) analysis was performed \nfor statistical analysis.\nResults: There were significant differences in ADCfast and ADCslow values \nbetween high- and low-grade gliomas (P < 0.05). The α value was significantly \nlower in high-grade gliomas than that in low-grade gliomas (P < 0.001). In addi-\ntion, the ADCfast, ADCslow and α values that were normalised to the values in \nthe contralateral NAWM were all significantly different between high-grade and \nlow-grade gliomas (P < 0.05).\nConclusion: IVIM imaging with biexponential and stretched-exponential model is \na useful tool in grading cerebral gliomas. The α value may be the best parameter \nfor distinguishing high- from low-grade cerebral gliomas. \nB‑0518 11:51\nApparent diffusion coefficient obtained by magnetic resonance \nimaging as a prognostic marker in glioblastomas: correlation with \nMGMT promoter methylation status \nL. Calabria1, M. Rossi Espagnet1, F. Tavanti1, A. Boellis1, V. Coppola2, \nM. Federici1, A. Romano1, L. Fantozzi1, A. Bozzao1; 1Rome/IT, 2Ronciglione/IT \nPurpose: To evaluate whether apparent diffusion coefficient (ADC) values can \npredict the status of MGMT of glioblastoma multiforme (GBM) and correlate with \noverall survival (OS) and progression-free survival (PFS).\nMethods and Materials: This retrospective study included 47 patients with patho-\nlogically proven glioblastoma. All of them underwent MR DWI study before surgery \n(mean time 1 week) and the status of methylguanine-DNA-methyltransferase \n(MGMT) promoter methylation was searched for. Minimum apparent diffusion coef-\nficient (ADC) values were evaluated. OS and PSF parameters were calculated, and \nStudent’s t-test, Kaplan-Meier curves, linear and Cox regression were performed.\nResults: Twenty-five patients showed positive methylation of the MGMT promoter. \nPatients showing MGMT promoter methylation had higher minimum ADC values, \nand they survived longer than those without MGMT promoter methylation. The \nmedian ADCmin value of 0.80 represents the cut off value able to distinguish \nbetween methylated and un-methylated patients. Patients showing minimum ADC \nvalues higher than 0.80 survived longer than patients with minimum ADC values \nlower than 0.80. A linear correlation between minimum ADC values vs. the OS \nand PFS was observed.\nConclusion: Minimum ADC values in glioblastoma multiforme could be used as \na preoperative parameter to estimate the status of MGMT promoter methylation \nand the survival of patients. \n10:30 - 12:00 Room D1 \nChest \nSS 904 \nImage quality and dose reduction \nModerators: \nP.A. Grenier; Paris/FR \nJ. Vlahos; London/UK\nB‑0519 10:30\nClinical evaluation of an automatic tube voltage selection in chest \nCT angiography \nT. Niemann, S. Henry, F. Pontana, K. Yasunaga, J.-B. Faivre, J. Rémy, \nM. Rémy-Jardin; Lille/FR (martine.remy@chru-lille.fr) \nPurpose: To evaluate the clinical impact of automatic tube voltage selection in \nchest CT angiography (CTA).\nMethods and Materials: 93 consecutive patients (mean BMI 25.1 kg/m2), referred \nfor a follow-up chest CTA examination, were prospectively evaluated with a scanning \nprotocol aimed at comparing two successive CTAs acquired in similar technical \nconditions except for the kV selection: (a) the initial examination (i.e., T0 scan) was \nsystematically obtained at 120 kVp and 90 ref mAs, (b) the follow-up examination \n(i.e., T1 scan) was obtained with an automatic selection of the kilovoltage that \nproposes optimised kV and mA settings according to the planned examination type \n(Care KV; Siemens Healthcare) which was preset for optimised CTA in this study.\nResults: At T1, 90 patients (97%) were scanned with reduced tube voltage: 100 \nkV (n=26; 28%), 80 kV (n=64; 69%) resulting in a significant DLP reduction at T1 \n(T1: 87.27; T0: 141.88 mGy.cm; p < 0.0001) (mean dose reduction: 38.5%) and a \n\nScientific Sessions\nS267\nA\n C D E F G\nB\nSaturday\nB‑0524 11:15\nEffect of acquisition parameters and reconstruction algorithm on \nlesion conspicuity in low-dose MDCT of the thorax \nV. Yaghmai, H.G. Töre, M.P.F. Botelho, F.D. Gonzalez-Guindalini, S.K. Patel, \nK. Dill, C.B. Harmath; Chicago, IL/US (v-yaghmai@northwestern.edu) \nPurpose: To evaluate lesion conspicuity in chest CT obtained with different tube \nvoltage and current settings and reconstructed with iterative reconstruction (IR) \nand filtered back projection (FBP).\nMethods and Materials: Torso phantom was scanned with 64-slice CT, 80 and \n120 kVp and a range of tube currents (110, 75, 40, 20 and 10 mAs). Images were \nreconstructed with FBP and IR. Two blinded thoracic radiologists evaluated overall \nimage quality: 1=excellent, 2=good, 3=adequate, 4=suboptimal, and 5=unaccept-\nable. Conspicuity of ground glass opacity, ground glass nodule, soft tissue nodule, \ntree-in-bud nodules and emphysema was evaluated: 1=excellent, 2=good, 3=subtle \nlesion, 4=probably an artefact mimicking a lesion, 5=no discrimination from arte-\nfact. The lowest score was accepted as the consensus score. Image noise was \nmeasured with circular ROI. Effective dose (ED) for each acquisition was recorded.\nResults: Radiologists found 80 kVp/40 mAs with IR as the lowest dose acquisition \nsetting with adequate overall image quality (ED: 0.4mSv). Objective noise was lower \nwith IR (p < 0.0001). The lowest dose acquisition settings with lesion conspicu-\nity score of at least 4: 120 kVp/20 mAs (ED:0.74mSv) with both FBP and IR for \nground-glass opacity; 120 kVp/20 mAs (ED: 0.74mSv) with FBP vs 80 kVp/40 mAs \n(ED:0.40mSv) with IR for ground-glass nodule; 80 kVp/20 mAs (ED:0.21mSv) with \nFBP vs 80 kVp/10 mAs (ED:0.09mSv) with IR for soft tissue nodule; 80 kVp/110 \nmAs (ED:1.13mSv) with FBP vs 120 kVp/40 mAs (ED:1.49mSv) with IR for tree-in-\nbud nodule; 80 kVp/110 mAs (ED:1.13mSv) with both FBP and IR for emphysema.\nConclusion: Lesion conspicuity is affected by CT acquisition settings. Iterative \nreconstruction may allow further dose reduction in implementation of low-dose \nCT protocols. \nAuthor Disclosures:\n H.G. Töre: Grant Recipient; Educational Grant Support by Siemens Healthcare. \nM.P.F. Botelho: Grant Recipient; Educational grant Support by Siemens \nHealthcare. F.D. Gonzalez-Guindalini: Grant Recipient; Educational Grant \nSupport by Siemens Healthcare.\nB‑0525 11:24\nEvaluation of an iterative reconstruction algorithm (iDose) to reduce \nimage noise and improve image quality in submillisievert CT scans \nof the thorax \nM. Henninger, A.A. Fingerle, C. Markus, T. Zahel, P.B. Noël, E.J. Rummeny, \nM. Dobritz; Munich/DE \nPurpose: To evaluate objective and subjective image quality of submillisievert \nCT scans of the thorax reconstructed with an iterative reconstruction algorithm \ntermed iDose.\nMethods and Materials: 15 patients were prospectively included in this IRB ap-\nproved study. Native CT scans were performed on a 256-MSCT (Brilliance iCT, \nPhilips, Cleveland, OH) with a tube voltage of 120 kV and a tube current of 20 \nmAs. The images were reconstructed with a sharp filter (YB, Philips) using standard \nfiltered backprojection (FBP) and the iterative reconstruction algorithm iDose at a \nLevel of 4 and 7 with a slice thickness of 0.6 mm. Three thorax radiologists assessed \nimages for overall image quality (1=excellent to 5=unacceptable), delineation of \nsmall anatomic details and abnormal findings (1=excellent demarcation - 6=not \napplicable), image noise (1=unacceptable image noise - 5=none) and artefacts \n(1=substantial artifacts - 4=none).\nResults: Overall image quality was rated 4.5 for FBP, 3.3 for iDose Level 4 and \n2.3 for iDose Level 7, anatomic details 4.6 for FBP, 3.3 for iDose Level 4 and 2.3 \nfor iDose Level 7, abnormal findings 4.5 for FBP, 3.3 for iDose Level 4 and 2.2 for \niDose Level 7, image noise 1.7 for FBP, 2.7 for iDose Level 4 and 3.7 for iDose \nLevel 7 and artefacts 1.8 for FBP, 2.8 for iDose Level 4 and 3.3 for iDose Level 7. \nAverage radiation dose was 0.78 ± 0.07 mSv.\nConclusion: The iDose reconstruction algorithm significantly improves image qual-\nity and reduces image noise and artefacts in submillisievert CT-scans of the thorax. \nIn the future this may allow a further dose reduction in clinical day-to-day routine. \nB‑0522 10:57\nEvaluation of automated attenuation-based tube potential selection \nin combination with organ-specific dose reduction for clinical chest CT \nP. Kröpil, L. Schimmöller, S. Dietrich, P. Heusch, J. Aissa, G. Antoch, \nR.S. Lanzman; Düsseldorf/DE \nPurpose: To evaluate the influence of attenuation-based tube potential selection \n(TPS) combined with organ-specific dose reduction (ODSR) on radiation dose and \nimage quality (IQ) of contrast-enhanced chest-CT examinations in clinical routine.\nMethods and Materials: 68 consecutive patients (mean age 58.3±12.7 years) \nundergoing clinical contrast-enhanced (100 ml) chest CT on a 128-row scanner \nwere included in this study. 34 chest CTs were performed using the novel dose \nsaving algorithms TPS and ODSR (CareKV, XCare; Siemens). ODSR protects \nradiosensitive tissues such as breast parenchyma by lowering the tube current for \nanterior projections. TPS adapts semiautomatically the tube potential depending \non attenuation of the subject and type of examination. Objective and subjective IQ \nand radiation dose (CTDIvol) were compared with 34 standard protocol chest CTs \n(120 kVp). Subjective IQ (lesion detectability, diagnostic confidence) was rated on \na 4-point scale (1_non diagnostic, 4_excellent). Signal-to-noise ratios (SNR) were \ndetermined from ROIs placed in the contrast-enhanced lumen of the aorta and the \nsurrounding air outside the body.\nResults: CTDIvol of chest CTs using TPS and ODSR was significantly lower than \nat standard protocol (3.1±1.0 mGy versus 6.2±2.3 mGy; p < 0.001). Although noise \nlevel was slightly elevated when using dose saving algorithms (14.7±5.7 vs. 11.4±3.8 \nHU; p < 0.01), no significant differences in SNR (17.0±4.6 vs. 16.5±4.5) or subjec-\ntive IQ (mean score 3.88 versus 3.93) were observed between the two protocols.\nConclusion: Attenuation-based TPS in combination with OSDR essentially low-\ners the dose of chest CT in clinical routine while maintaining high subjective and \nobjective image quality.\nB‑0523 11:06\nThoracic imaging with low-dose MDCT at low tube voltages using \niterative image reconstruction: where is the limit of diagnostic \nconfidence compared to the clinical standard? \nW. Stiller1, G. Pahn1, J.L. Mayer1, M. Dadrich1, J. Hirsch2, S. Böhme3, \nK. Markstaller3, G. Szabó1, H.-U. Kauczor1; 1Heidelberg/DE, 2 Witten/DE, \n3Vienna/AT (wolfram.stiller@med.uni-heidelberg.de) \nPurpose: This study aimed to determine which combination of acquisition and \niterative reconstruction parameters for low-dose MDCT at low tube voltages yields \nimage quality and diagnostic confidence equivalent to current clinical standards \nin thoracic imaging.\nMethods and Materials: Thoracic images of eight sedated and mechanically \nventilated pigs were acquired with MDCT during mid-inspiratory breath hold using \nstandard (120 kVp, 180 mAs) and low-dose protocols at low tube voltages (100/80 \nkVp) and current-time products (120/60/30 mAs). Using lung and soft-tissue kernels, \nimages of all acquisitions were reconstructed with filtered backprojection (FBP); \nlow-dose acquisitions were also reconstructed iteratively (levels 2 and 5, iDose, \nPhilips Healthcare). Three independent blinded readers sorted the resulting 19 im-\nage data sets per animal according to diagnostic image quality (best to worst), and \nsorted images were statistically clustered. Additionally, CT numbers and noise have \nbeen determined in lung parenchyma, liver, muscle and aorta of all image data sets.\nResults: Interreader-agreement was moderate-high (κ=0.56-0.66). For any fixed \nset of acquisition parameters FBP-images were ranked lowest while those recon-\nstructed iteratively (iDose5) were ranked highest independent of reconstruction \nkernel. The 19 image series could be clustered into 3 homogeneous clusters of \nequivalent diagnostic quality: Iteratively reconstructed images acquired at 100 \nkVp/120 mAs (iDose2/5), 100 kVp/60 mAs (iDose5) or 80 kVp/120 mAs (iDose5) \nwere ranked equivalent to FBP-images acquired using standard protocol. Iterative \nreconstruction did only affect CT numbers at very low dose (80 kVp/30 mAs) while \nimage noise could be reduced by up to ~60%.\nConclusion: Using low-kVp and low-mAs protocols combined with iterative image \nreconstruction, radiation exposure of thoracic MDCT could be reduced by 50-75%. \nAuthor Disclosures:\nW. Stiller: Equipment Support Recipient; Philips Healthcare. Research/Grant \nSupport; Philips Healthcare. H.-U. Kauczor: Advisory Board; Siemens Medical \nSolutions. Investigator; Boehringer Ingelheim. Speaker; Siemens Medical \nSolutions, Boehringer Ingelheim, Bayer, Bracco.\n\nScientific Sessions\nS268\n C A D E F\n G\nB\nMethods and Materials: Ten artificial spherical nodules (diameter: 3, 5, 8, 10 and \n12 mm; CT densities: -630 and +100 HU) were randomly placed inside a thoracic \nphantom. The phantom was scanned with low (50 mAs) and ultra-low dose (10 \nmAs). They were reconstructed with FBP and AIDR 3D. Nodule volumes were \nestimated by a semi-automated software, which were compared with a reference \nstandard by calculating the absolute percentage error (APE).\nResults: There was no significant difference between FBP and AIDR for all nodules \nin low dose and for nodules of ²5 mm in ultra-low dose. Under ultra-low dose for \nnodules of ³8 mm, AIDR showed significantly lower APE than FBP (10.9±5.3% vs \n16±7.8%, P < 0.05) in non-solid (-630 HU) nodules. However, in solid (+100 HU) \nnodules, AIDR showed higher APE than FBP (4.2±1.8% vs 3.3±1.5%, P < 0.05). APE \non ultra-low dose with AIDR was comparable with low dose with FBP (6.4±3.1%) \nfor non-solid nodules of ³8 mm.\nConclusion: AIDR 3D reconstruction improves the accuracy of volumetry for \nnon-solid nodules in ultra-low dose CT, but not for solid nodules and nodules of ²5 \nmm. For accurate volumetry of a lung nodule, it is critical to apply reconstruction \nalgorithm and tube current appropriate for the size and density. \n10:30 - 12:00 Room D2 \nInterventional Radiology \nSS 909 \nThoracic interventions \nModerators: \nJ. Tacke; Passau/DE \nK. Zelenak; Martin/SK \nB‑0529 10:30\nCT-guided lung biopsy: core needle coaxial technique with \nautologous blood needle tract embolisation compared with fine \nneedle aspiration in diagnostic yield and post-biopsy pneumothorax rate \nS. Lee1, A. Montaser2, L. Nardo1, U.R. Heilmeier1, B.A. Aronson2; \n1San Francisco, CA/US, 2Canton, OH/US (Sonia.Lee@ucsf.edu) \nPurpose: To compare two different lung biopsy techniques in diagnostic yield and \npost-biopsy pneumothorax rate: CT-guided 18-gauge core needle coaxial technique \n(CNCT) with autologous blood needle tract embolisation (ABNTE) versus fine \nneedle aspiration (FNA).\nMethod and Materials: CT-guided lung biopsies using 18-gauge CNCT with AB-\nNTE were performed on 147 patients (79 male and 68 female, age ranging from \n31 to 87. The diagnostic yield was compared with 22-gauge fine needle aspiration \nlung biopsy performed on 145 patients by reviewing cytology and pathology report \nresults. Hypocelluar specimen or non-diagnostic cell morphology was considered \nnon-diagnostic results. Presence of pneumothorax was determined on CT or \nfollow-up radiograph for CNCT with ABNTE group and compared with FNA pneu-\nmothorax rate statistics based on 140 cases. Pearson’s chi-square test, Spearman \nrank correlation test (SRC) and Kendall’s tau (KT) were used to compare the two \nbiopsy techniques. Differences of pneumothorax rate were compared using one-\nway analysis of variance (ANOVA) and t tests.\nResults: Non-diagnostic result was seen in 3.9 % of CNCT with ABNTE group \ncompared with 20.7 % of FNA (p < 0.001). 72.8 % of CNCT and 69.3 % of FNA \ngroups were diagnosed with malignancy. No significant difference was seen in \npneumothorax rate. 20.4 % of the CNCT with ABNTE developed pneumothorax, \n7.4 % of which needed chest tube. For FNA biopsies, 18.6 % had pneumothorax \nand 8.6 % needed chest tube.\nConclusion: CT-guided lung 18-gauge CNCT with ABNTE is comparable to FNA \nmethod in post-procedure pneumothorax rate and superior in diagnostic yield. \nB‑0530 10:39\nComputed tomography-guided lung biopsy with the patient in lateral \nposition and the biopsy side down: effect on pneumothorax rate and \nclinical significance \nG. Velonakis, D. Filippiadis, A. Mazioti, S.I. Argentos, K. Malagari, A. Kelekis, \nN. Kelekis; Athens/GR \nPurpose: The purpose of the study was to assess pneumothorax rate and clinical \nsignificance in CT-guided lung biopsies with the patient in lateral position and the \nbiopsy side down.\nMethods and Materials: We retrospectively reviewed 214 percutaneous lung \nbiopsies performed under CT guidance during the past 40 months. In 173 biopsies, \npatients were placed in prone or supine position (Group A). In 41 biopsies, patients \nB‑0526 11:33\nPhantom study for adaptive iterative dose reduction 3D (AIDR \n3D) for low-dose chest CT examination: utility for identification of \npulmonary ground glass opacity and nodule on 320-detector row CT \nusing different scanning methods \nS. Seki1, H. Koyama1, Y. Ohno1, M. Nishio1, T. Yoshikawa1, S. Matsumoto1, \nN. Sugihara2, H. Inokawa2, K. Sugimura1; 1Kobe/JP, 2Ohtawara/JP \n(klfsiena@yahoo.co.jp) \nPurpose: To determine utility of adaptive iterative dose reduction using three-\ndimensional processing (AIDR 3D) for pulmonary nodule identification on low-dose \n320-detector-row CT using different scanning methods in phantom study.\nMethods and Materials: A chest CT phantom including simulated pulmonary nodule \nwas scanned on a 320-detector-row CT using non-helical wide volume scan (WVS) \nand helical scans as 64-detector-row CT (64HS) and 160-detector-row CT (160HS) \nat nine different tube currents. All data sets were reconstructed using AIDR 3D and \nfilter back projection (FBP). To determine the capability of overall identification, \ntwo chest radiologists independently evaluated lesion conspicuities by five-point \nscoring system. At the each scanning method, gold standard was defined as the \ndata set of standard tube current (270 mA) reconstructed by FBP. Interobserver \nagreements of detection and the capability for radiation dose reduction on each \nscan method were assessed by kappa statistics and ROC analyses.\nResults: Interobserver agreements were almost perfect or substantial at all data \nsets (κ> 0.60). When applied AIDR 3D, area under the curves of data sets equal \nto or higher than 30 mA on WVS, 40 mA on 64HS, and 40 mA on 160HS had no \nsignificant difference with standard data sets (p> 0.05). On the other hand, when \napplied FBP, radiation dose reduction was limited in comparison with the data sets \napplied AIDR 3D at all scanning methods.\nConclusion: AIDR 3D was more useful for low-dose chest CT examination for \nnodule screening than FBP, and WVS can reduce more radiation dose than 64HS \nand 160HS on 320-detector-row CT.\nAuthor Disclosures:\nN. Sugihara: Employee; Toshiba Medical Systems Corporations. H. Inokawa: \nEmployee; Toshiba Medical Systems Corporations.\nB‑0527 11:42\nThe lateral scan projection radiograph (topogram) in CT pulmonary \nangiography: the effect on scan length and radiation dose \nJ.C.L. Rodrigues, I. Negus, N.E. Manghat, M.C.K. Hamilton; Bristol/UK \nPurpose: To investigate the effect of a lateral topogram on excess scan length in \nCTPA and to quantify the impact on effective dose.\nMethods and Materials: 50 CTPA studies planned with frontal topogram only (Pro-\ntocol 1) were compared with 50 CTPA studies planned with frontal and lateral topo-\ngrams (Protocol 2).Optimal scan length was defined from lung apex to lung base. \nExcess scan length beyond these landmarks was measured. Mean organ doses \nto thyroid, liver and stomach were estimated using standard conversion factors.\nResults: The mean excess scan length was significantly lower in Protocol 2 com-\npared with Protocol 1 (19.5 ± 5.3 mm Vs 39.1 ± 5.3 mm,P < 0.0001). The mean \nexcess scan length below lung bases was significantly lower in Protocol 2 cohort \ncompared with Protocol 1 (7.5 ± 4.2 mm Vs 23.0 ± 4.2 mm,P < 0.0001), as were \nthe mean organ doses to stomach (4.24 ± 0.26 mGy Vs 5.22 ± 0.26 mGy,P < \n0.0001) and liver (5.60 ± 0.21 mGy Vs 6.38 ± 0.21 mGy,P < 0.0001).A trend towards \nreduced over-scanning above the apices in Protocol 2 was observed compared \nwith Protocol 1 (12.0 ± 3.2 mm Vs 16.2 ± 3.2 mm,P= 0.07), with a trend towards \nlower mean thyroid organ dose in (3.28 ± 0.71 mGy Vs 4.11 ± 0.71 mGy,P= 0.104).\nConclusion: Incorporation of a lateral topogram into scan protocol in CTPA reduces \nexcess scan length, significantly reducing dose to liver, stomach and lowers thyroid \ndose, without compromising image quality. This simple dose saving technique can \nbe applied to all CT investigations of the chest on all scanners with immediate effect. \nB‑0528 11:51\nAccuracy of lung nodule volumetry using adaptive iterative dose \nreduction 3D for ultra-low dose of 320-detector row CT: a phantom study \nK. Doo1, E.-Y. Kang1, H. Yong1, O. Woo1, K. Lee2, Y.-W. Oh1; 1Seoul/KR, \n2Ansan/KR (kwdoo@korea.ac.kr) \nPurpose: Volumetric measurement of a nodule is more sensitive in the detection \nof tumour growth than axial diameter measurement. The purpose of this study \nwas to assess the accuracy of lung nodule volumetry using adaptive iterative \ndose reduction (AIDR) 3D in comparison with filtered back-projection (FBP) in an \nanthropomorphic thoracic phantom on 320-detector row CT.\n\nScientific Sessions\nS269\nA\n C D E F G\nB\nSaturday\nConclusion: Pulmonary haemorrhage during fine-needle lung biopsy is a frequent \nevent. It protects against pneumothorax in patients with pre-existing comorbidities, \nespecially for long needle trajectory, for bleeding greater than 6 mm developing \nalong the needle track. \nB‑0533 11:06\nFeasibility and safety of CT-guided percutaneous radiofrequency, \nmicrowave or cryoablation of the pulmonary and mediastinal \nunresectable tumours adjacent to the heart and large vessels \nC. Pusceddu, L. Melis, G. Meloni; Cagliari/IT (clapusceddu@gmail.com) \nPurpose: To verify the feasibility and safety of radiofrequency ablation (RFA), \nmicrowave ablation (MWA) and cryoablation (CRA) under CT guidance in the \ntreatment of cancer adjacent to the heart and large vessels.\nMethods and Materials: 27 patients (mean age of 64 years) with unresectable \nprimary and secondary pulmonary and mediastinal tumours (12 NSCLC, 1 invasive \nthymoma, 1 mesothelial sarcoma and 13 metastases) were treated by CT-guided \nRFA (14 cases), MWA (7 cases) and CRA (6 cases). All the tumours were in contact \nor distant from the large vessel wall or the pericardium less than 1 cm. All ablations \nwere performed under conscious sedation and local anaesthesia. Vital signs of the \npatients were non-invasively monitored continuously. The therapeutic outcomes \nwere evaluated by contrast-enhanced CT after 1 month. In two patients, an electrode \nis penetrated in the pericardium without any consequences.\nResults: In all cases, the procedure was technically successful. No intraprocedural \narrhythmia occurred. Morbidity consisted of 7 cases of pneumothorax, 3 cases of \npleural effusion and 1 case of asymptomatic thickening of the pericardium. In the \nCT control after 1 month, there was a complete necrosis in 22 cases and a partial \n(from 70 to 90%) necrosis in the remaining 5 cases.\nConclusion: Indifferently from the energy source used to obtain the tumour \nnecrosis, the treatment of the pulmonary and mediastinal unresectable tumours \nadjacent to the heart and large vessels is feasible and safe because the blood \nflow cause a “heat-sink” effect adjacent to such structures that prevent undesired \nthermal damage. \nB‑0534 11:15\nFactors influencing local tumour control in patients with neoplastic \npulmonary nodules treated with microwave ablation (MWA): a risk \nfactor analysis \nT.J. Vogl, T.S. Worst, N.N.N. Naguib, N.-E.A. Nour-Eldin; \nFrankfurt a. Main/DE (t.vogl@em.uni-frankfurt.de) \nPurpose: To evaluate risk factors predicting local tumour control after microwave \nablation (MWA) of primary and secondary lung malignancies ²3 cm in maximum \ndiameter.\nMethods and Materials: In this retrospective study, 91 index tumours (ITs) in 57 \npatients were treated with single antenna MWA. Time-to-local-tumour progression \nwas monitored using CT over a median follow -up of 10.2 months±6.2 (6.0-29.2 \nmonths). An overall estimated time-to-local-tumour progression was performed via \nCox regression model. Factors hypothesized to correlate with ablation response \nincluded: tumour diameter ( 15.5 mm), tumour shape (round/oval vs. irregular), \nclear vs. ill-defined tumour margin, adjacency to the pleura, adjacency to bronchi, \nvessels of ³3 mm in diameter located at a maximum of 5 mm from the IT, energy \napplied to IT ( 26.7 J/mm3) and occurrence of cavernous formations after abla-\ntion. A logistic regression model was used to correlate the data.\nResults: Local tumour progression occurred in 30/91 (33%) ITs, seen in 21/57 \n(36.8%) patients. Mean time-to-local tumor progression was 8.3 months (±5.5, \nrange 2.1-25.2) (median: 22.6 months±12.4 months). Risk factors significantly \ncorrelating with local tumour progression were > 15.5 mm (p < 0.01) in diameter, \nirregular IT shape (p < 0.01), pleural contact (p=0.02) and < 26.7J/mm3 applied to \nthe IT (p < 0.001). IT shape (p=0.03) and energy deployed per IT volume (p=0.001) \nwere found to be independent risk factors after regression analysis. Tumour margin \ndefinition (p=0.06), cavernous formations (p=0.19), juxtatumoral vessels (p=0.08) \nand bronchi (p=0.89) did not impact upon tumour progression post-ablation.\nConclusion: Independent predicting factors for local tumour progression in primary \nand secondary lung neoplasms ²3 cm in diameter were irregular IT shape and < \n26.7J/mm3 per IT volume. \nwere placed in lateral position with the biopsy side down (Group B). Statistical \nanalysis was performed comparing pneumothorax rate between the two groups. \nThe rate of pneumothorax requiring intervention was also assessed. The effect \nof other variables (patients demographic characteristics, lesion characteristics, \nlesion distance from the skin and biopsy technique) was evaluated in both groups.\nResults: 27 pneumothorax occurred in Group A (15.61%) versus 1 (2.44%) in group \nB (p= 0.025). Pneumothorax requiring treatment was noticed in 10 cases (5.78%) in \nGroup A, versus 0 (0%) in Group B. Emphysema and lesion size were independent \nrisk factors for pneumothorax in Group A. Emphysema was also independent risk \nfactor for pneumothorax necessitating a drainage catheter insertion in Group A. \nNo independent risk factor was recognised for pneumothorax or pneumothorax \nrequiring intervention in Group.\nConclusion: CT-guided percutaneous lung biopsies in lateral position with the \nbiopsy side down are associated with reduced rate of pneumothorax and pneu-\nmothorax requiring treatment comparing to biopsies in other positions. Lateral \nposition with the biopsy side down reduces also the impact of known risk factors \nfor pneumothorax. \nB‑0531 10:48\nC-arm cone-beam computed tomography (CBCT) needle path \noverlay for percutaneous biopsy of pulmonary nodules \nC. Floridi, F. Fontana, A. Ierardi, G. DeMarchi, L. Nocchi-Cardim, C. Pellegrino, \nG. Carrafiello, C. Fugazzola; Varese/IT (chiarafloridi@libero.it) \nPurpose: The aim of this study was to evaluate the feasibility of percutaneous \ntransthoracic needle biopsy of pulmonary nodules under XperGuide CBCT navi-\ngation guidance.\nMethods and Materials: Between February 2010 to July 2011, we evaluated 70 \npatients with a pulmonary lesion. All patients had a diagnostic conventional chest \nCT and after underwent percutaneous transthoracic needle biopsies of pulmonary \nnodules under XperGuide CBCT navigation guidance.The mean size of the lesion \nwas on average 5.5 cm. Immediately after FNAB an additional CBCT was performed \nto evaluate any complications; moreover, a follow-up expiratory chest radiograph \nwas obtained. Calculation of radiation dose of the procedure and statistical analysis \nwere performed.\nResults: Technical success rate was achieved in 100% of cases. Forty-six lesions \nwere diagnosed as malignant, 20 were benign, and 4 were indeterminate. All ma-\nlignancies diagnosed by FNAB were confirmed by history and imaging. The overall \naccuracy, sensitivity, specificity, positive predictive value and negative predictive \nvalue were 94.2%, 92%, 100%, 100% and 92%, respectively. In the 34 patients \nwith a lesion equal or less to 3 cm undergoing XperCT-guided lung biopsy the \naverage effective dose was 11.14 mSV (range 1.39-27.29 mSv), while in the 36 \npatients with lesions larger than 3 cm the average effective dose was 12.10 mSv \n(range 2.89-49.46 mSv).The pneumothoraces rate in our study was 22.8% (16/70).\nConclusion: Our study reports the diagnostic accuracy, safety of CBCT-navigation \nfor percutaneous trans-thoracic lung biopsy which combines CT-like images for \ntarget and path location and fluoroscopy for real-time needle navigation. \nB‑0532 10:57\nComputed tomography guided trans-thoracic fine needle aspiration \nbiopsy of pulmonary nodule: pulmonary haemorrhage, complication \nor advantage? \nM. De Filippo, L. Saba, G. Concari, C. Rossi; Parma/IT \nPurpose: Evaluation of the incidence and the clinical significance of pulmonary \nhaemorrhage that may occur during the computed tomography (CT)-guided trans-\nthoracic fine needle aspiration (TTFNA).\nMethods and Materials: From January 2007 to September 2011 we retrospectively \nreviewed the CT images without contrast of 538 patients of both sexes (364 M and \n174 F, average age 70 years, age range 36-90) used for the guidance of CT-guided \nTTFNA of pulmonary nodules with suspected primitive and/or secondary neoplasm. \nThe variables analysed were: distance between the nodule and the pleural surface, \npresence of emphysema, pulmonary haemorrhage (Type 1: along the needle track; \nType 2: perilesional, Grade 1: < 6 mm, Grade2: 6 12 mm), \npresence of pneumothorax.\nResults: For lesions distant more than 3 cm from the pleural surface, in the pres-\nence of type 1 and high Grade (> 6 mm) of pulmonary haemorrhage, pneumothorax \noccurred in 12 out of 62 cases (26%); in the absence of pulmonary haemorrhage, \npneumothorax occurred in 30 out of 42 cases (71.4%). For lesions distant less than \n3 cm from the pleural surface, in the presence of type 1 and high Grade (> 6 mm) \nof pulmonary haemorrhage, pneumothorax has never occurred (0%). Emphysema \nwas present in 192 cases (35.7%), pulmonary haemorrhage in 144 cases (26.8%), \npneumothorax in 154 cases (28.6%).\n\nScientific Sessions\nS270\n C A D E F\n G\nB\n(9.24%), other primaries: n=48 (40.34%)) and primary lung tumours (n=25 (21.01%)) \nwere treated with repetitive (3-19) TPCE or TPCP. Response since initial treatment \nwith TPCE and TPCP are evaluated according to the RECIST and WHO criteria.\nResults: The therapy was well tolerated without severe complications. The overall \ntumour response according to RECIST was partial response (PR) in 3.4 % (n=4), \nstable disease (SD) in 54.6% (n=65) and progressive disease (PD) in 42.0% (n=50). \nAfter WHO the overall tumour response was PR in 3.36% (n=4), SD in 51.26% \n(n=61) and PD in 45.38% (n=54). Overall survival rate since initial intervention was \n517 days (median), 590.4 days (mean) (range, 80-1742 days), the survival rate of \nthe patients with palliative indication was 556 days (median), 614.3 days (mean) \n(range, 122-1742 days), of those with symptomatic indication 202 days (median), \n206.5 days (mean) (range, 80-397 days) and of those with neoadjuvant indication \n595 days (median), 717.4 days (mean) (273-1647 days).\nConclusion: TPCE and TPCP are effective therapy options for treatment of unre-\nsectable lung tumours. TPCE proved superior in lung metastases, TPCP superior \nin primary lung cancer. \nB‑0538 11:51\nEndovascular treatment of haemoptysis of pulmonary artery origin: \na single-centre experience \nA. Khalil, S. Haddad, M. Tassart, A. Parrot, M.-F. Carette; Paris/FR \n(antoine_khalil@yahoo.fr) \nPurpose: This study aimed at reviewing the results and the safety of embolisation \nin patients affected by haemoptysis of pulmonary arterial (PA) origin.\nMethods and Materials: All consecutively patients treated for haemoptysis of PA \norigin during 12 years (1999 to 2011) were reviewed. Age, underlying disease, \nand haemoptysis volume were recorded. CT-scan and pulmonary angiography of \neach patient were reviewed for the description of the PA lesion (aneurysm, false \naneurysm, irregularity of the PA or abrupt interruption) and the material of emboli-\nsation used for the treatment.\nResults: Forty-three patients (10 women, 33 men; mean age: 53 years) were \ntreated during this period. Aetiologies were tuberculosis (n=13), lung cancer \n(n=8), necrotizing pneumonitis (n=8), aspergillosis (n=5), Behcet disease (n=5) \nand others (n= 4). Five abnormalities of PA were found: pseudo aneurysm of the \nPA (PAPA) (n=28), aneurysm of the PA (APA) (n=5), irregularity of PA (n=4), early \ninterruption of PA (n=3), one PAVM, and no abnormalities in 2 patients. Materials \nused for embolisation were coils (n=25), Onyx (n=14) and covered stent (n=2). Two \nearly recurrences, 5 short-term recurrences, and one long term recurrence after \nembolisation were recorded. They were treated by surgery (n=4) or by embolisa-\ntion (n=4).[[Unable to Display Character: 
]]Three patients died during the \nhospitalisation, one of them by haemoptysis recurrence.\nConclusion: Embolisation is a safe and an effective method for the treatment of \nsevere haemoptysis of PA origin. \n10:30 - 12:00 Room E1 \nMusculoskeletal \nSS 910 \nSpine: advancing the use of CT and MRI \nModerators: \nP.M. Cunningham;  Navan/IE \nJ. Labuscagne; Bunbury, WA/AU \nB‑0539 10:30\nCervical nerve root infiltration under CT and MRI guidance: a cost \ncomparison \nM.H. Maurer, M. deBucourt, T. Hartwig, B. Hamm, F. Streitparth; \nBerlin/DE (martin.maurer@charite.de) \nPurpose: To compare the costs of CT-guided and MR-guided cervical nerve root \ninfiltration for minimally invasive treatment of cervical radicular pain.\nMethods and Materials: From September 2009 until April 2012, twenty-two pa-\ntients (9 men, 13 women; mean age: 48 years) underwent MR-guided single-site \nperiradicular cervical nerve root infiltration with 40 mg triamcinolon acetonide. A \nfurther 64 patients (34 men, 30 women; mean age: 50 years) were treated under \nCT-fluoroscopic guidance. Prorated costs of equipment use (purchase, depreciation, \nand maintenance) and expenditure for disposables were identified for MR- and CT-\nguided procedures. For CT-guided interventions the effective dose (in millisievert, \nmSV) was calculated based on the dose length product.\nB‑0535 11:24\nPercutaneous microwave ablation of lung tumours \nC. Pusceddu, L. Melis, G. Meloni; Cagliari/IT (clapusceddu@gmail.com) \nPurpose: To assess the feasibility and safety of percutaneous CT-guided lung \ntumour microwave ablation.\nMethods and Materials: 28 consecutive patients (18 men, 10 women, mean \nage 62 years) underwent CT-guided percutaneous microwave ablation (MWA) \nof unresectable lung tumours (11 primary NSCLC and 17 metastases) mean \nsize 3.2 cm (2.5-8 cm). The study cohort was selected according to the follow-\ning criteria: 1) maximum tumour size less than 9 cm in diameter, 2) less than 5 \nmetastatic tumors, 3) patients with a normal coagulation status and 4) provision of \nwritten informed consent. All procedures were performed with CT guidance under \nconscious sedation and local anesthesia. One or two straight microwave antenna \n(14 or 16-gauge) were placed directly into the tumour for 8-12 minutes. Follow-up \nincluded contrast-enhanced CT at 1, 3, 6 months and then at 6-month intervals; \nstable or reduction size and the absence of tumour enhancement CT images were \nconsidered indicative of complete tumour necrosis.\nResults: In all cases, the procedural was technically successful. Morbidity consisted \nof 8 cases of partial pneumothorax (28.6%) which were resolved spontaneously \nwithin 7 days. At a mean follow-up of 8 months (range 2-15), we recorded a 67.8% \nof complete response (tumour necrosis = 100%) and a 32.2% of partial response \n(tumour necrosis range 65%-92%).\nConclusion: Our preliminary results show that percutaneous CT-guided micro-\nwave ablation is feasible and safe for the treatment of primary and secondary \nlung tumour. Further follow -up and a prospective controlled trial is necessary to \nvalidate the procedure. \nB‑0536 11:33\nMRI chest parameters used in the assessment of tumour response \npost microwave ablation of pulmonary metastases \nN.-E.A. Nour-Eldin, N.N.N. Naguib, T. Gruber-Rouh, T. Lehnert, M. Sadegi, \nT.J. Vogl; Frankfurt a. Main/DE (nour410@hotmail.com) \nPurpose: To determine the value contrast enhanced (CE-MRI) follow-up in the as-\nsessment of tumour response of microwave (MW) ablated pulmonary metastases \nby correlating the results with CE-CT.\nMethods and Materials: This prospective study included 130 ablation sessions \nfor pulmonary metastases in 80 patients. CE-MRI Chest scanning was performed \n1week before the ablation and at 24hours, 3, 6, 9 and 12 months post ablation. \nThin section CT Volumetric measurement of the lesions was performed at the same \ntime periods as a second parameter for comparison. The lesion MRI enhancement \nintensity in each study was estimated, and the ratio to the paraspinal muscle en-\nhancement intensity at the same level was measured (Lesion Muscle Signal (LMS \nratio). The correlations between post ablation follow-up CT volume of tumours and \nCE-MRI LMS ratio at the follow-up periods were assessed.\nResults: The preablation tumour volumes ranged between 0.30 and 6.1 cm (mean: \n1.5 cm³, SD:1.3). LMS ratio 1 was noted in preablation due to high contrast enhance-\nment of the tumour and in 24-h post ablation due to the inflammatory response \nassociated with the thermal ablation and due to tumour residue or progress. Weak \ncorrelation was detected between the LMS-ratios and CT-volumetric changes in \n24-h post ablation. Strong correlation between the LMS ratios was estimated be-\ntween the follow-up periods of 3 months (SpearmanR:0.62,p=0.0021), 6 months \n(SpearmanR:0.66,p=0.001), 9 months (SpearmanR:0.61,p < 0.001) and 12 months \n(Spearman R:0.7, p < 0.00001).\nConclusion: CE-MRI follow-up of the MW ablated lung tumours can be used ef-\nfectively to assess the tumour response to ablation using LMS ratio as a parameter \nof assessment. \nB‑0537 11:42\nTranspulmonary chemoembolisation (TPCE) and transpulmonary \nchemoperfusion (TPCP) as a treatment for unresectable primary and \nsecondary lung tumours: local tumour control and survival \nT.J. Vogl, A. Müller, S. Zangos, T. Lehnert; \nFrankfurt a. Main/DE (t.vogl@em.uni-frankfurt.de) \nPurpose: To evaluate the effect of transpulmonary chemoembolisation (TPCE) \nand transpulmonary chemoperfusion (TPCP) in unresectable primary lung tumours \nand lung metastases on progression-free survival and overall survival depending \non the indication (palliative, symptomatic, neoadjuvant).\nMethods and Materials: In a retrospective study from 12/2006 to 10/2011, 119 \npatients (51 men (43%), 68 women (57%)) mean age 57 years with unresectable \nlung metastases (colorectal carcinoma: n=35 (29.41%), breast cancer: n=11 \n\nScientific Sessions\nS271\nA\n C D E F G\nB\nSaturday\nB‑0542 10:57\nComputed tomography of the cervical spine: comparison of image \nquality between standard-dose filtered back-projection and low-dose \niterative reconstruction protocols \nF. Becce1, Y. Ben Salah2, F.R. Verdun1, B.C. Vande Berg2, F.E. Lecouvet2, \nR. Meuli1, P. Omoumi2; 1Lausanne/CH, 2Brussels/BE (fabio.becce@chuv.ch) \nPurpose: To compare image quality between standard-dose filtered back-projection \n(FBP) and low-dose iterative reconstruction (IR) protocols in computed tomography \n(CT) of the cervical spine.\nMethods and Materials: Forty patients investigated by CT of the cervical spine \nfor chronic neck pain and/or cervical radiculopathy were prospectively randomised \ninto two groups: standard-dose CT (120 kVp, 275 mAs) with FBP, or low-dose CT \n(120 kVp, 150 mAs) with IR. Image noise, signal-to-noise (SNR) and contrast-to-\nnoise (CNR) ratios were measured. Two radiologists, blinded to CT parameters, \nindependently assessed the following anatomical structures at C3-C4 and C6-C7 \nlevels, using a four-point scale: intervertebral disc, content of neural foramina and \ndural sac, ligaments, soft tissues and vertebra. They subsequently rated overall \nimage quality using a ten-point scale. Volume CT dose index (CTDIvol) and dose-\nlength product (DLP) were recorded.\nResults: No significant difference in noise (Δ=0 HU), SNR (Δ=0.1) and CNR \n(Δ=-0.5) was noted between standard-dose FBP and low-dose IR protocols (all \np³0.39). With low-dose IR, semi-quantitative scores were significantly higher for the \nintervertebral discs, neural foramina and ligaments (all p²0.05), comparable for the \ndural sac (all p³0.24), and significantly lower for the soft tissues and vertebrae (all \np²0.02), at both disc levels. Overall image quality scores were significantly higher \nwith low-dose IR (all p < 0.01). Radiation exposure (Δ=8.1 mGy and 99.2 mGy•cm) \nwas significantly lower with low-dose IR (all p < 0.01).\nConclusion: Low-dose CT of the cervical spine with IR provides better image quality \nfor the intervertebral discs, neural foramina and ligaments compared to standard-\ndose CT with FBP, while reducing radiation exposure by approximately 40%.\nB‑0543 11:06\nImaging quality of reduced radiation dose lumbar spine CT with \niterative reconstruction \nC.-J. Lin, S. Hung, W. Guo, T. Wu; T aipei/TW (bcjlin@gmail.com) \nPurpose: The purpose of our study was to investigate the diagnostic accuracy \nof CT scans of the lumbar spine (CTLS) acquired with lower mAs and kilovoltage \nreconstructed with an IR algorithm.\nMethods and Materials: We prospectively recruited 120 patients for CTLS. Pa-\ntients were classified into three groups. The radiation dose reduction was set to \n50% of the original estimated dose with alternative tube currents and 120 KV in \ngroup A, and 100 KV in group B. Images were reconstructed with iDOSE4 level 4 \nreconstruction algorithm. For group C, the standard mAs and 120KV with filtered \nback projection (FBP) algorithm was employed. The SNR of the intervertebral disc \n(IVD), dural sac (DS) and psoas muscle (PM), and the CNR of the IVD and DS \nwere compared across groups. Two radiologists independently rated the quality \nof each reduced-dose image as either equivalent (‘1’) or inferior (‘0’) to the rater’s \nsubjective ‘standard’ CTLS.\nResults: There were decreased SNRs of all ROIs in group A but only DS showed \nstatistical significance. There were significant decreased SNRs in IVD, DS, and PS \nin group B. There was a weak correlation between SNR and BMI in all 3 groups. \nThe CNRs for groups A, B and C were 0.08+0.05, 0.15+0.09 and 0.12+0.06, \nrespectively. The mean image quality scores for groups A, B and C were 0.63, \n0.83, and 0.87, respectively.\nConclusion: With the aid of the IR algorithm, it is feasible to provide diagnostic \nCTSL imaging with a 50% radiation reduction using lower mAs.\nB‑0544 11:15\nMultidetector computed tomography of the cervical spine: \noptimisation of iterative reconstruction strength levels \nP. Omoumi1, F.R. Verdun2, Y. Ben Salah1, B.C. Vande Berg1, \nF.E. Lecouvet1, R. Meuli2, F. Becce2; 1Brussels/BE, 2Lausanne/CH \n(patrick.omoumi@uclouvain.be) \nPurpose: To determine the optimal strength level of iterative reconstructions (IRs) \nin multidetector computed tomography (MDCT) of the cervical spine.\nMethods and Materials: Twenty patients (14 women, mean age 54.5 years) inves-\ntigated by cervical spine MDCT for refractory cervical pain and/or cervicobrachial \nneuralgia were prospectively studied. MDCT raw data were reconstructed using \nboth filtered back-projection and IR (sinogram-affirmed iterative reconstruction; \nstrength levels 1 to 5) techniques. The image noise, signal-to-noise (SNR) and \nResults: Mean intervention time was 24.9 min (range, 12-36 min) for MR-guided \nand 19.6 min (range, 5-54 min) for CT-guided treatment. The average total costs \nper patient were EUR 197 for MR-guided and EUR 98 for CT-guided interventions. \nThese were (MR/CT guidance) EUR 98/32 for equipment use, EUR 47/41 for staff, \nand EUR 52/25 for disposables. The mean effective dose for CT-guided interven-\ntions was 0.48 ± 0.51 mSv.\nConclusion: Cervical nerve root infiltration using MRI guidance is still about twice \nas expensive as infiltration using CT guidance. However, not involving radiation \nexposure for patients and personnel, MR-guided nerve root infiltration may become \na promising alternative to the CT-guided procedure, especially as a further decrease \nin prices is expected for MRI devices and MR-compatible disposables. \nB‑0540 10:39\nFast inner volume imaging of the lumbar spine with a zoomed \nSPACE sequence using parallel transmit \nP. Riffel1, S. Kannengiesser2, D. Paul2, S. O. Schönberg1, H. Michaely1; \n1Mannheim/DE, 2Erlangen/DE (philipp.riffel@umm.de) \nPurpose: Inner volume parallel transmit imaging (Zoom) allows reduction of scan \ntime while maintaining spatial resolution in the targeted ROI. Aliasing artefacts from \nbody regions outside the reduced FOV can be suppressed via local excitation with \nthe use of multidimensional RF pulses. The purpose of this study was to evaluate \nthe feasibility and technical quality of a zoomed SPACE (Sampling Perfection with \nApplication optimised Contrasts using different flip-angle Evolutions) sequence of \nthe lumbar spine.\nMethods and Materials: In this IRB-approved study 9 volunteers underwent an \nMRI exam of the lumbar spine including a conventional 3D T2w SPACE sequence \nwith Generalized Autocalibrating Partially Parallel Acquisitions parallel imaging \n(GRAPPA) (acceleration factor: 2) and zoomed 3D T2w SPACE sequence with a \nreduced FOV (reduction factor: 2). Images were evaluated with regard to image \nsharpness, homogeneity and artefacts. For qualitative analysis SNR values were \ndetected.\nResults: Image sharpness of anatomical structures was significantly better with \nzoomed SPACE (p < 0.0001). Image homogeneity was significantly better with \nconventional SPACE (p = 0.0003). There was no significant difference regarding \nartefacts. Acquisition times were 8.19s for conventional SPACE and 6.3s for zoomed \nSPACE, respectively. In 9 of 18 cases (9 volunteers/2 readers), zoomed SPACE \nwas selected as the preferred sequence. In 5 of 18 cases conventional SPACE was \nselected as the preferred sequence. SNR values showed no significant difference.\nConclusion: Using parallel transmit zoomed SPACE images of the lumbar spine \ncan be acquired about 25% faster with an increased sharpness and comparable \nSNR values.\nB‑0541 10:48\nThe importance of ispection of true FISP sequences during MRI of \nthe lumbar spine \nM. Papavasilopoulou, M. Raissaki, C. Voulgaris, A. Karantanas; Iraklion/GR \n(mariapapavasilopoulou@gmail.com) \nPurpose: True FISP sequence is routinely applied as scout during lumbar spine \nMRI (LS MRI) in our institution. We investigated whether this sequence contributes \nin the diagnostic performance of LS MRI or in depicting other incidental disorders.\nMethods and Materials: 272 consecutive patients, 79% of whom aged between \n40 and 85 years old, underwent LS MRI accordingly: true FISP fat saturation in \ncoronal plane, T1w, T2w, STIR in sagittal plane and T2 sequences in axial plane. \nTwo readers by consensus recorded abnormalities exclusively or better depicted \nat True FISP images and characterised them as potentially important, either clini-\ncally and /or radiologically.\nResults: True Fisp images showed abnormalities in 240 patients (88%) and pathol-\nogy not visualised elsewhere in 98 (36%). True FISP increased conspicuity of or \nrevealed spinal, sacroiliac or paravertebral lesions including scoliosis assessment \nin 72 patients (26.5%). Scoliosis was noted in 62 patients (22.8%), was more \naccurately characterised and/or was depicted only on coronal views in 52. Other \nabnormalities included 111 renal lesions in 110 patients (36.7%), solid abdominal \norgan lesions/organomegaly in 37 (13.6%), chest abnormalities in 13 (4.8%) and \ngenital in 14 (5.15%). Out of the above, there were 27 lesions (9.9%) with direct \nimpact on patient management, 113 lesions (41%) that could potentially affect pa-\ntient health in the future if reported and 106 incidentalomas (38.9% of True FISP), \nwith equivocal clinical importance.\nConclusion: Careful inspection of TRUE FISP sequence during LS MRI may result \nin depiction of additional abnormalities that can potentially alter patient management \nand may increase diagnostic confidence. \n\nScientific Sessions\nS272\n C A D E F\n G\nB\nB‑0547 11:42\nDifferentiation of benign and malignant vertebral body fractures with \ndynamic contrast-enhanced MRI \nT. Geith1, A. Biffar1, G. Schmidt1, S. Sourbron2, H.R. Duerr1, M.F. Reiser1, \nA. Baur-Melnyk1; 1Munich/DE, 2Leeds/UK (tobias.geith@med.uni-muenchen.de) \nPurpose: Evaluating the ability of dynamic contrast-enhanced MRI (DCE-MRI) \nin differentiating between acute benign and malignant vertebral body fractures.\nMethods and Materials: 46 patients with acute vertebral body fractures (20 \nmalignant, 26 osteoporotic) were included. STIR, T1w, T2w and DCE-MRI (SR-\nTurbo-Flash 2D) were acquired at 1.5 T. Parameter maps for mean-transit-time \n(MTT) and plasma flow (PF) were created. 2-compartment tracer kinetic modelling \nwas applied to provide quantitative perfusion data in selected regions of interest.\nResults: 44 fractures were evaluated. Spots of increased PF showed significant \ndifferences (p=0.0003) between osteoporotic (mean 28.62) and malignant (mean \n11.73) fractures (sensitivity 63.2%, specificity 96.0%), extracellular volume (ECV) \nwas significantly different (p=0.002, osteoporotic mean 52.68, malignant mean \n36.71, sensitivity 63.2%, specificity 92.0%), extraction flow (EF) was significantly \ndifferent (p =0.03, osteoporotic mean 15.19, malignant mean 23.67, sensitivity \n57.9%, specificity 92.0%). K-trans, PF and plasma volume (PV) in spots of increased \nPF, and all quantitative perfusion parameters in regions of increased MTT did not \nshow any significant differences between benign and malignant fractures.\nConclusion: Measurement of IV, ECV and EF in spots of increased PF with DCE-\nMRI can help to differentiate between benign and malignant vertebral body fractures.\nAuthor Disclosures:\nT. Geith: Research/Grant Support; Deutsche Forschungsgemeinschaft \n(DFG), grant no. DI 1413/1-1. A. Biffar: Research/Grant Support; Deutsche \nForschungsgemeinschaft (DFG), grant no. DI 1413/1-1. G. Schmidt: Research/\nGrant Support; Deutsche Forschungsgemeinschaft (DFG), grant no. DI 1413/1-\n1.M.F. Reiser: Research/Grant Support; Deutsche Forschungsgemeinschaft \n(DFG), grant no. DI 1413/1-1. A. Baur-Melnyk: Research/Grant Support; \nDeutsche Forschungsgemeinschaft (DFG), grant no. DI 1413/1-1.\nB‑0548 11:51\nTrabecular bone structure analysis of the spine using clinical MDCT: \ncan it predict vertebral bone strength? \nT. Baum1, M. Gräbeldinger1, E. Grande Garcia1, R. Burgkart1, J. Patsch2, \nE.J. Rummeny1, T.M. Link3, J.S. Bauer1; 1Munich/DE, 2Vienna/AT, \n3San Francisco, CA/US (thbaum@gmx.de) \nPurpose: It was reported previously that trabecular bone structure parameters \ncould add significant information for predicting bone strength beyond bone mineral \ndensity. In the past, trabecular bone structure analysis was limited by the spatial \nresolution of clinically available MDCT scanners. Recent technical improvements \nhave made it possible to determine trabecular bone structure parameters of the \nspine using clinical MDCT. Therefore, the purpose of this study was to assess \ntrabecular bone structure parameters obtained from clinical MDCT as well as \nXtreme-CT (hr-pQCT) as standard of reference and to investigate whether clinical \nMDCT can predict vertebral bone strength.\nMethods and Materials: Fourteen thoracic vertebral bodies were harvested from \nformalin-fixed human cadavers (11 women and 3 men; age: 84±10 years). All \nspecimens were examined using Xtreme-CT (isotropic voxel size of 41 μm³) and \na clinical whole body MDCT (interpolated voxel size: 146x146x300 μm³, spatial \nresolution: 250x250x600 μm³). Trabecular bone structure analyses (histomorpho-\nmetric and texture measures) were performed in the Xtreme-CT as well as MDCT \nimages. Vertebral failure load was determined in an uniaxial biomechanical test.\nResults: Xtreme-CT and MDCT-derived trabecular bone structure parameters \nshowed correlations ranging from r=0.60 to r=0.90 (p < 0.001). Correlations between \ntrabecular bone structure parameters and failure load amounted up to r=0.86 (p < \n0.001) using the Xtreme-CT images, and up to r=0.79 (p < 0.001) using the MDCT \nimages. Correlation coefficients obtained with Xtreme-CT and MDCT were not \nsignificantly different (p> 0.05).\nConclusion: The spatial resolution of clinically available whole body MDCT scan-\nners is suitable for trabecular bone structure analysis of the spine and to predict \nvertebral bone strength.\ncontrast-to-noise (CNR) ratios were measured. Two radiologists independently and \nblindly evaluated the following anatomical structures at both C3-C4 and C6-C7 \nlevels, using a four-point scale: intervertebral discs, content of neural foramina and \ndural sac, ligaments, soft tissues and vertebrae. They ultimately rated the overall \ndiagnostic image quality using a ten-point scale.\nResults: As the strength level of IRs increased, the image noise decreased linearly, \nwhile the SNR and CNR both increased linearly (all p²0.001). For the intervertebral \ndiscs, the content of neural foramina and dural sac, and for the ligaments, the \nsubjective image quality scores increased linearly with increasing IR strength levels \n(all p²0.03). In contrast, for the soft tissues and vertebrae, the image quality scores \ndecreased linearly with increasing strength level of IRs (all p < 0.001). Finally, \nthe overall diagnostic image quality scores increased linearly with increasing IR \nstrength levels (both p < 0.001).\nConclusion: The optimal strength level of IRs in cervical spine MDCT depends \non the anatomical structure to be analysed. For the intervertebral discs and the \ncontent of neural foramina, high IR strength levels are recommended.\nB‑0545 11:24\nRelationship among facet joint fluid (FJF) at MRI, age, and disk \ndegeneration in patients affected with low back pain \nC. Ottonello1, A. Giardino2, G.D.E. Papini3, A. Sharipova3, G. Di Leo3, \nF. Sardanelli3; 1Pomezia/IT, 2Milan/IT, 3San Donato Milanese/IT \nPurpose: To estimate the relationship among FJF at MRI, age, and disk degenera-\ntion in patients affected with low back pain.\nMethods and Materials: Ninety-six consecutive patients (M/F 48/48, aged 49±15 \nyears) affected with low back pain underwent MRI of lumbar spine using sagittal \nT1- and T2-weighted fast spin-echo and axial T2*-weighted gradient-echo se-\nquences. For each level from L3 to S1, disk degeneration was graded using the \nThompson scale (1-5), while the FJF was graded as 0 (absent), 1 (monolateral), \nor 2 (bilateral): per-patient disk degeneration and FJF were calculated summing \nthe scores of the 3 spine levels. Spearman correlation coefficient, multivariate \nregression analysis, Friedman McNemar tests were used. Data were reported as \nmedian and interquartile interval (II).\nResults: The degeneration of L3/L4 (median 3; II 2-3) was lower than that of both \nL4/L5 (median 3; II 2-3; p=0.017) and L5/S1 (median 3; II 3-4; p=0.002). The FJF \nof L5/S1 (median 0; II 0-1) was lower than that of both L3/L4 (median 1; II 0-2; \np=0.002) and L4/L5 (median 1; II 0-2; p=0.019). At bivariate per patient analysis, \nage was correlated negatively with FJF (r= -0.199; p=0.052) and positively with \ndisk degeneration (r=0.582; p0.142).\nConclusion: This preliminary study suggests that, differently from what expected, \nyoung patients undergoing MRI for low back pain show higher FJF than older \npatients, regardless of the disk degeneration. Further prospective studies should \ninvestigate the role of FJF on the low back pain.\nB‑0546 11:33\nTypification of posterior instability in patients with spondylolysis or \nisthmic spondylolisthesis \nP. Niggemann1, J. Kuchta2, H. Urbach2, H.H. Schild2; 1Mannheim/DE, \n2Bonn/DE (pniggemann@hotmail.com) \nPurpose: To characterise different pathologic movements (posterior instability) \nencountered in the spondylolytic cleft in patients with spondylolysis using positional \nMRI. The findings are discussed with regard to possible mechanisms leading to \nthe development of instability.\nMethods and Materials: 178 segments of the lumbar spine with spondylolysis and \nisthmic spondylolisthesis were examined using positional MRI. Scans were obtained \nin neutral sitting, flexion and extension position. No visible movement in the cleft \nwas defined as type A, fluid displaced into the cleft as type BI, displacement of \nthe flava ligaments at the level of the cleft as type BII, and intraspinal cysts arising \nfrom the spondylolytic cleft as type BIII. The movements were characterised by a \nradiologist and a neurosurgeon experienced in positional MRI.\nResults: A high agreement was found between the two observers. 133 segments \nwere characterised as type A, six as type BI, twenty-four as type BII and ten as \ntype BIII. In five segments, the type differed between the right and the left side. In \ntwo patients a mixed type BI/II, in another two patients a mixed type BII/III and in \none patient a mixed type BI/III were found.\nConclusion: Imaging findings in the spondylolytic cleft are similar to findings in \nfacet joint degeneration suggesting a similar pathomechanism. Fluid displaced in \nthe spondylolytic cleft may lead to bulging of the flava ligament or the develop-\nment of intraspinal cysts, thus explaining nerve root compression. The reported \nimaging findings might help understanding the connection of posterior instability \nand unstable slips.\n\nScientific Sessions\nS273\nA\n C D E F G\nB\nSaturday\nB‑0551 10:48\nCombination of continuously moving table MRI and PET including \nimage fusion: improved lesion detection in local and distant \nrecurrence of rectal cancer \nT. Baumann, A.-O. Schäfer, M. Langer; \nFreiburg/DE (tobias.baumann@uniklinik-freiburg.de) \nPurpose: Comprehensive and accurate staging of recurrent rectal cancer is a \nprerequisite to correctly assign patients to potentially curative treatment options. \nTherefore, it was the aim of this study to investigate the incremental utility of high-\nresolution pelvic MRI with continuously moving table MRI (CMT-MRI) of the chest \nand abdomen and 18 F-FDG-PET using image fusion.\nMethods and Materials: Thirty-one patients with suspected recurrence of rectal \ncancer received MRI and PET within a maximum interval of 30 days. MRI alone, \nPET alone and MRI and PET combined including fusion images were separately \nanalysed by two observers. All detectable lesions were noted and the likelihood \nof malignancy was rated on a 5-point scale (1=definitely benign to 5=definitely \nmalignant). The standard of reference consisted of all available follow-up imaging \nand histopathology. Confidence ratings were subjected to JAFROC analysis and \nsensitivities were computed with ratings of 4 and 5 being considered as positive \ntest results.\nResults: The reference standard comprised 150 malignant lesions with 48 being \nconsidered local and 102 considered distant (35 lung, 17 liver, 40 lymph nodes, \n10 other). JAFROC analysis revealed overall figures-of-merit of 0.73 for MRI, 0.63 \nfor PET, and 0.83 for the combined approach (all differences significant). The \nsensitivities of MRI, PET and the combined approach were 85.4, 52.1, and 95.8% \nfor local recurrence and 61.8, 47.1, and 81.4% for distant recurrence, respectively.\nConclusion: The combination of local high-resolution MRI, thoracoabdominal \nCMT-MRI and FDG-PET by means of image fusion improves lesion detection in \nrecurrent rectal cancer. \nB‑0552 10:57\nDoes positron emission tomography data acquisition impact \nsimultaneous diffusion-weighted imaging in a whole body PET/MRI \nsystem? \nR.S. Lanzman1, C. Buchbender1, P. Heusch1, V. Hartung-Knemeyer2, \nT. Lauenstein2, M. Forsting2, G. Antoch1, T. Heusner1; 1Düsseldorf/DE, \n2Essen/DE (Rotem.Lanzman@med.uni-duesseldorf.de) \nPurpose: To investigate whether the acquisition of PET has an impact on simul-\ntaneous diffusion-weighted imaging (DWI) on an integrated PET/MRI system.\nMethods and Materials: Fourteen oncological patients (9 men, 5 women; age \n54 ±13 years) underwent DWI (EPI; b = 0-500-1000 s/mm²) on a whole body 3 T \nPET/MRI system twice in one session; first with simultaneous PET acquisition and \nsecond with the PET component switched off. The apparent diffusion coefficient \n(ADC) and the SNR at b = 1000 s/mm² of the myocardium, paraspinal muscle, \nliver, spleen, renal cortex and tumour tissue (if present) were measured. Student's \nt-test was performed to test for differences between the two DWI acquisitions.\nResults: ADC did not differ significantly between DWI acquisitions with and without \nsimultaneous PET for the myocardium (2572 ± 441 10-6 * mm2/s and 2586 ± 376 \n10-6 * mm2/s, respectively) (P = 0.817), liver (1245 ± 158 10 -6 * mm2/s vs. 1254 ± \n171 10-6 * mm2/s) (P = 0.848), spleen (980 ± 122 10-6 * mm2/s vs. 1000 ± 187 10-6 \n* mm2/s) (P = 0.676), renal cortex (1951 ± 226 10-6 * mm2/s vs. 1930 ± 273 10-6 * \nmm2/s) (P = 0.730) and lymph node metastases (n = 6) (853 ± 174 10-6 * mm2/s vs. \n865 ± 170 10-6 * mm2/s) (P = 0.675). There was no significant difference regarding \nthe SNR between the two DWI acquisitions.\nConclusion: Our results indicate that simultaneous acquisition of DWI and PET \non an integrated PET/MRI system does not impact ADC quantification of normal \nand tumour tissue.\nB‑0553 11:06\nStandardised uptake values for [18 F]-FDG in normal organ tissues: \ncomparison of whole body PET/CT and PET/MRI \nC. Buchbender1, P. Heusch1, V. Hartung-Knemeyer2, H. Kühl2, \nT. Lauenstein2, M. Forsting2, G. Antoch1, T.A. Heusner1; 1Düsseldorf/DE, \n2Essen/DE (philipp.heusch@med.uni-duesseldorf.de) \nPurpose: To compare standardised uptake values (SUVmax/mean) of normal \norgan tissues derived from PET/MRI using MR attenuation correction (MRAC) \n(DIXON-based 4-segment µ-map) with PET/CT using CT-based attenuation cor-\nrection (CTAC).\nMethods and Materials: In 25 oncologic patients (15 men, 10 women; age 57 \n±13 years) after PET/CT (60 minutes after injection of 292 ± 40 MBq [18 F]-FDG), \n10:30 - 12:00 Room F1 \nOncologic Imaging \nSS 916 \nWhole-body imaging: how to do it \nModerators: \nT.F. Hany; Zurich/CH\nD.M.J. Lambregts; Maastricht/NL \nB‑0549 10:30\nCross over PET/MRI vs PET/CT study in oncological patients: does it \nchange management? \nJ. Al-Kalbani, A. Afaq, K. Alnabhani, R. Syed, C. O’Meara, A. Barnes, \nJ. Boumanji; London/UK (jalkalbani@yahoo.com) \nPurpose: To evaluate the feasibility of using whole body 18 F-FDG PET/MRI in \nassessing patients with a proven primary tumour.\nMethods and Materials: 42 consecutive patients with different tumour types \nunderwent PET/CT (GE) with low-dose CT for attenuation correction followed by \nPET/MRI (Siemens Biograph mMR) using 2-point Dixon technique for attenuation \ncorrection. Three radiologists reviewed all studies and recorded the number of \nprimary and non-primary lesions on PET CT and PET MRI. The location of each \nlesion was then using recorded using a confidence on a scale of 1 to 3 (1= uncertain, \n2= probable, 3= definite). The degree of confidence for anatomical localisation of \nthe lesions and degree of inter-observer agreement were measured.\nResults: A total of 182 18 F-FDG avid lesions were identified on PET/MRI and PET/\nCT. MRI helped in accurate identification of FDG activity in 11 lesions that were \nmissed on CT component of PET/CT (2 rectal, 1 bladder, 2 prostate, 2 vagina, 2 \ncervix, 1 liver, 1 nerve). 22% of the patients had a change in management following \nPET/MRI. The overall inter-observer agreement for both the modalities was 98% \nfor primary and 95% for non-primary lesions. There was overall improvement in \nthe confidence in anatomical localisation on PET/MRI (6% primary lesions and \n12% non-primary lesions).\nConclusion: Whole body PET/MRI improves the confidence in anatomical localisa-\ntion of sites of disease and also provides additional value to patient management \ncompared with PET/CT. \nB‑0550 10:39\nWhole body magnetic resonance imaging, including diffusion-\nweighted imaging, for staging malignant lymphoma: comparison to \ncomputed tomography in 135 patients \nT.C. Kwee1, M.A. Vermoolen1, E.A. Akkerman2, M. Kersten2, R. Fijnheer3, \nF.J. Beek1, M.S. van Leeuwen1, M.B. Bierings1, R.A.J. Nievelstein1; 1Utrecht/NL, \n2Amsterdam/NL, 3Amersfoort/NL (thomaskwee@gmail.com) \nPurpose: To compare whole body magnetic resonance imaging (MRI), including \ndiffusion-weighted imaging (DWI), to computed tomography (CT) for staging newly \ndiagnosed lymphoma.\nMethods and Materials: One hundred and thirty-five consecutive patients with \nnewly diagnosed lymphoma prospectively underwent whole body MRI (T1-weighted \nand T2-weighted short inversion time inversion recovery [n=135], and DWI [n=130]) \nand CT. Ann Arbor stages were assigned according to whole body MRI and CT \nfindings. Disagreements in staging between whole body MRI (without and with \nDWI) and CT were resolved using bone marrow biopsy, 18 F-fluoro-2-deoxyglucose \npositron emission tomography (FDG-PET), and follow-up FDG-PET, CT, and whole \nbody MRI studies as reference standard.\nResults: Staging results of whole body MRI without DWI were equal to those of \nCT in 66.7% (90/135), higher in 25.2% (34/135), and lower in 8.1% (11/135) of \npatients, with correct/incorrect/unresolved overstaging and incorrect/unresolved \nunderstaging relative to CT in 18/10/6 and 10/1 patient (s), respectively. Staging \nresults of whole body MRI with DWI were equal to those of CT in 65.4% (85/130), \nhigher in 29.2% (38/130), and lower in 6.2% (8/130) of patients, with correct/incor-\nrect/unresolved overstaging and incorrect/unresolved understaging relative to CT \nin 22/10/6 and 7/1 patient (s), respectively.\nConclusion: Staging of newly diagnosed lymphoma using whole body MRI (without \nand with DWI) equals staging using CT in the majority of patients. Disagreements \nbetween whole body MRI and CT are mostly caused by overstaging of the former \nrelative to the latter, with the number of correctly and incorrectly overstaged cases \nbeing approximately equal. The potential advantage of DWI is still unproven. \n\nScientific Sessions\nS274\n C A D E F\n G\nB\nrate (p=0.0001), independently from surgical/non-surgical approach. For SUV > \n2.5 and < 2.5, the survival rates 1 year after PET imaging were 72.5% and 94.0%, \nwhile survival expectancies after 2 years were 56.5% and 86.3%, respectively.\nConclusion: In conclusion, prognostic value of SUVmax was proved, independ-\nently from nature of lesions; a cut-off value of 2.5 seems to offer good reliability \nand accuracy. \nB‑0556 11:33\nDetection of underlying malignancy in patients with paraneoplastic \nneurological syndromes: comparison of 18 F-FDG-PET/CT and \ncontrast-enhanced CT \nN. Schramm, A. Rominger, C. Schmidt, C. Schmid-Tannwald, F.G. Meinel, \nM.F. Reiser, C. Rist; Munich/DE (nicolai.schramm@med.uni-muenchen.de) \nPurpose: To determine the value of 18 F-FDG-PET/CT with contrast-enhanced \nCT (CECT) in detecting malignancies in patients with paraneoplastic neurological \nsyndromes (PNS) in comparison with CECT alone.\nMethods and Materials: PET/CTs of 66 patients with PNS were retrospectively \nevaluated. Two blinded readers initially reviewed the CECT. In a second session, \nthey analysed the combined PET/CT examinations. Findings were assessed us-\ning a 4-point-scale (1= normal; 2= inconclusive; 3= malignant; 4= inflammatory). \nSensitivity and specificity for malignant findings were calculated. Data from clinical \nfollow-up (including histopathology, follow-up imaging; mean follow-up: 25.6 months) \nserved as standard of truth.\nResults: Both readers classified 12 findings in 10 patients (15%) as malignant on \nPET/CT (two patients with two primary tumours). One imaging finding was false \npositive. The most common tumours were bronchial carcinoma (n=3), lymph-\nnode metastases of gynaecological tumours (n=3) and tonsillar carcinoma (n=2). \n3/12 findings were not detected by CECT alone (cervical and tonsillar carcinoma, \nlymph-node metastasis). Sensitivity and specificity for malignant findings were 100 \nand 90% (PET/CT) and 78 and 88% (CECT). In 24% of the patients inconclusive \nPET/CT findings were identified. 57% of these findings were only diagnosed with \nPET (e.g. focal uptake of the GI tract). On follow -up none of these findings cor-\nresponded to malignancy.\nConclusion: In this cohort of patients with PNS, PET/CT exhibited improved \ndetection of underlying malignancy versus CECT alone. While hybrid imaging \nproduces a greater number of inconclusive findings, sensitivity is increased for the \ndetection of head and neck and gynaecological malignancies as well as metastatic \nlymph-node involvement. \nB‑0557 11:42\nFDG-avid duodenal lesions: a retrospective analysis of their \nsignificance in oncology practice \nS. Puri, L. Jones, J. Strang; Rochester, NY/US \n(savita_puri@urmc.rochester.edu) \nPurpose: To determine the significance of focal or segmental 18 F-FDG uptake \nwithin the duodenum on PET/CT.\nMethods and Materials: Computerized text search for the word duodenum appear-\ning anywhere within the PET/CT report was conducted on all patients undergoing \nF-18 fluorodeoxyglucose (FDG) PET/CT at the University of Rochester Medical \nCenter from January 1, 2009 to July 30, 2012. Three expert radiologists reviewed \nthose cases and classified duodenal uptake as focal, multifocal, segmental or dif-\nfuse. Results were correlated with histopathology, other imaging studies and clinical \nfollow-up. Exclusion criteria included use of the word duodenum unassociated with \nFDG uptake, extra-duodenal tumors invading the duodenum, duplicated follow-up \nstudies, lack of histopathology or adequate clinical follow-up.\nResults: Of 8725 PET/CT reports, 95 contained the word duodenum on 83 patients. \nTwenty-seven of 83 patients (33%) had duodenal FDG uptake (19 focal, 1 multifo-\ncal, 6 segmental and 1 diffuse). Eighteen of 20 with focal or multifocal pattern were \nmalignant (90%): 11 known biopsy-proven primary or metastatic malignancy and 7 \nnewly identified by PET and subsequently proven malignant either by biopsy or by \nresponse to targeted chemotherapy. Of the 9 non-malignant lesions, 2 had focal \nuptake (1 biopsy-proven duodenitis, 2nd nonspecific), 6 had segmental pattern, 1 \nof which was biopsy-proven Crohn’s disease, the remaining 5 segmental and 1 \ndiffuse uptake were presumed physiologic.\nConclusion: Focal duodenal FDG uptake is highly predictive of an underlying \nmalignancy with a positive predictive value of 90% (P-value < 0.01). \nwhole body PET/MRI was additionally performed (Magnetom Biograph mMR™, \nSiemens Healthcare, Erlangen, Germany). 3 cm3 regions of interest were drawn \nin seven organ sites in MRAC-PET and the corresponding CTAC-PET images. \nPearson correlation coefficients were calculated to compare MRAC- and CTAC-\nbased SUV values; Student´s T-test for paired samples was performed to test for \npotential differences.\nResults: The mean delay between PET/CT and PET/MRI was 152 ± 42 minutes. \nNear-perfect correlations of SUV values were found for the myocardium (SUVmax/\nmean: R = 0.98/0.98); good correlations were found for the liver (R = 0.6/0.7), \nsubcutaneous fat (R = 0.6/0.8), bone marrow (R = 0.6/0.5), psoas muscle (R = \n0.6/0.5) and the SUVmax of the blood-pool (R = 0.6). Correlations between MRAC \nand CTAC were non-significant for SUVmax and SUVmean of the lung and the \nSUVmean of the blood-pool. The mean SUVmax and SUVmean in MRAC-PET \ncompared to the respective CTAC values was significantly lower in all organs (p < \n0.05) but in the myocardium (SUVmax) and the psoas muscle (SUVmax/mean).\nConclusion: Although SUVmax and SUVmean values of normal organ tissues \nin PET/MRI and PET/CT are generally well correlated, the absolute values differ \nsignificantly and, for a quantitative comparison, have to be adjusted. \nB‑0554 11:15\nImpact of FDG PET-CT on patient management and radiotherapy \ntreatment planning in locally advanced cervical carcinoma \nS. Fleming, R. Cooper, S. Swift, F. Chowdhury, A. Scarsbrook, C. Patel; \nLeeds/UK \nPurpose: Evaluation of the clinical impact of FDG PET-CT on management of \npatients with locally advanced cervical carcinoma initially staged with pelvic MRI.\nMethods and Materials: Retrospective analysis of consecutive patients undergo-\ning FDG PET-CT for cervical carcinoma, between April 2008 and August 2011 in a \nsingle tertiary referral centre. Comparison was made between findings on PET-CT \nand pelvic MRI. Clinical impact of PET-CT was divided into major (detection of \noccult disease or characterisation of indeterminate lesions on MRI, as benign or \nmalignant), minor (confirmation of suspicious MRI findings or additional findings \nnot altering management), or no impact (concordance between PET-CT and MRI \nwith no additional findings).\nResults: Sixty-three patients were referred for a pre-treatment FDG PET-CT; age \nrange was 21-78 years (mean age 47 years). PET-CT had a major impact on patient \nmanagement in 32%, a minor impact in 8% and no impact in 60%. In patients with \na major impact; 12 had unsuspected nodal involvement, 5 had occult metastases, \n2 had synchronous tumours and 1 had negative nodes on PET-CT. These find-\nings either altered radiotherapy treatment planning or treatment intent. During the \nfollow-up period until August 2012, 25% developed disease recurrence following \ncompletion of therapy (11% isolated local relapse and 14% distant (± local) disease).\nConclusion: FDG PET-CT can have a major impact on patient management in \nlocally advanced cervical carcinoma, by detecting occult disease or characterising \nindeterminate findings on MRI, resulting in an alteration in radiotherapy treatment \nplanning and/or treatment intent in up to one-third of patients.\nB‑0555 11:24\nIs there a role for standard uptake value in the prognostic evaluation \nof lung nodules? \nA. Bazzocchi, S. Brocchi, G. Facchini, V. Ambrosini, S. Ascanio, G. Battista, \nS. Fanti; Bologna/IT (giancarlo.facchini@gmail.com) \nPurpose: Criticisms and limits about the measurement and use of standard uptake \nvalue (SUV) in PET imaging are well known. Our aim was to investigate the aid \nof SUV in the detection of malignancy of solitary lung nodules and to study its \nprognostic value.\nMethods and Materials: We retrospectively analysed the clinical history of 136 \npatients (81 males, 55 females, 70.3±11.2 year old) undergoing PET/CT for lung \nnodules, in a single-centre experience. The analysis included images evaluation \nand physicians' reports of PET/CT exams, anamnesis of patients and subse-\nquent diagnostic examinations in their follow -up (imaging, biopsy specimen and/\nor pathological analysis after surgical resection). Patient's follow -up ended with \nsurvival control in September 2012. Receiver-operating-characteristic curves and \nKaplan-Meier method were used for statistical analysis.\nResults: Mean follow -up was 26.3±18.0 months. In 58/136 (42.6%) subjects, a \nnon-small cell lung cancer was diagnosed (35/58-adenoCa, 23/58-squamousCa); \n30/136 (22.1%) patients underwent surgery. In all other patients (78/136-57.4%), \nlesions were classified as non-oncologic diseases or benign. The best combination \nto properly characterise the neoplastic nature of nodules found a SUVmax cut-off \nvalue of 2.5, resulting in 93.1% and 71.8%, sensitivity and specificity, respectively. \nNodules with higher SUVmax value (> 2.5) were associated with lower survival \n\nScientific Sessions\nS275 \nA\n C D E F G\nB\nSaturday\nB‑0560 10:39\nWhich screenings program should be offered to women with BRCA1 \nor BRCA2 mutations? A simulation of comparative cost-effectiveness \nG.H. De Bock1, K.M. Vermeulen1, L. Jansen1, J.C. Oosterwijk1, S. Siesling1, \nT. Feenstra1, N. Houssami2, M.J.W. Greuter1; 1Groningen/NL, 2Syndey/AU \n(g.h.de.bock@umcg.nl) \nPurpose: There is no consensus on the most effective strategy for screening \nwomen with BRCA1 or BRCA2 mutations and women with a strong family history \nof breast cancer but unknown mutation status (BRCAu). The Dutch strategy uses \nannual MRI for age 25-30 years, annual mammography and MRI for age 30-60, \nand biennial mammography-only for age 60-75. The UK strategy uses annual \nmammography and MRI from age 30, and mammography-only from age 50 every \nthree years. The US strategy includes annual mammography and MRI from age \n25. The effectiveness and cost-effectiveness of these screening strategies were \nmodelled in high-risk women.\nMethods and Materials: To compare various screening strategies, we integrated \noutcomes and cost parameters, from published data and cancer registry data into \na validated simulation screening model. Model main outcomes were life-years \ngained and incremental cost-effectiveness rate (ICER). Analyses were performed \naccording to the US and European guidelines with a discount-rate of 3%.\nResults: For BRCA1 as well for BRCA2 women, the Dutch strategy was preferred \nas this strategy was equally effective and cheaper than the US strategy. The three \nscreening strategies were relatively less effective for the BRCAu group: the life-\nyears gained were approximately twice in BRCA mutation carriers. For women in \nthe BRCAu group, UK strategy was cheapest, but about 6% less effective.\nConclusion: From a cost-effectiveness perspective, the Dutch strategy for screen-\ning is preferred in women with BRCA1 or BRCA2 mutations. \nB‑0561 10:48\nMRI of hereditary breast cancer: can hyper T2 signal intensity be \nconsidered as a new semeiotic parameter of higher aggressiveness? \nG. Trecate, R. Agresti, S. Viganò, L. Suman, D. Vergnaghi, \nC. Ferranti, M. Marchesini, G. Scaperotta, P. Panizza; Milan/IT \n(giovanna.trecate@istitutotumori.mi.it) \nPurpose: To compare MRI of 43 hereditary and 40 sporadic breast cancers, observe \nthe differences and evaluate the pathological reports to investigate the differences.\nMethods and Materials: We positioned a ROI on the hyperT2STIR carcinomas \nto quantify the optical impression of signal intensity, evaluated the presence of \nnecrosis, grading and triple negative status. Cox model was applied for statistical \nevaluation.\nResults: The surprising main difference was the high signal intensity on T2 weight-\ned-images (T2SI) that we registered for hereditary cancer. We found 79%(34/43) \nhigh T2SI in hereditary cancers and only 8%(3/40) hyperT2 lesions in sporadic \ncancers (p < 0.01). Over the highT2 hereditary neoplasm 53% were BRCA1 and \n85%were Invasive carcinoma. The triple negative status was confirmed in 34%, \nwhile not calculated for 5. Interestingly, none of the hiperT2 lesions was G1, while \n58.8%were G3 and 29% G2. Necrosis was registered in 30% and not calculated \nin 6. Medullary aspect were present in 3. All hyperT2 sporadic lesions were G3, \nwhile necrosis and triple-negative were found in 2/3 with no mucinous variants.\nConclusion: Several authors investigated the reason of hyperT2SI in breast \ncancers. Some described the presence of necrosis also as index of rapid growth \nrate and unfavourable prognosis. Some evaluated the combination with triple-\nnegative status while some others discovered a relationship between high-grade \nand BRCA1 germline. Nowadays only necrosis can reliably explain the raise of \nT2SI, but if further investigations should confirm that triple-negative status and \nhigh-grade are mostly combined with hyperT2SI, then we can point-at hyperT2SI \nas an MR marker of higher aggressiveness. \nB‑0562 10:57\nFully automated MRI breast density (BD) measurement: comparison \nto standard mammographic density estimation \nG.J. Wengert, W.-D. Vogl, T.H. Helbich, H. Bickel, W. Bogner, \nK. Pinker-Domenig; Vienna/AT (georg.wengert@meduniwien.ac.at) \nPurpose: To develop a fully automated quantitative BD measurement system with \nMRI based on the Dixon sequence and to compare it with qualitative and quantita-\ntive mammographic BD estimation.\nMethods and Materials: 35 healthy women were included in this prospective \nIRB-approved study. Breast density was measured qualitatively using the ACR \nBIRADS categories, quantitatively from digitized mammograms using Cumu-\nlus, a user-assisted interactive thresholding technique and with radiation- and \nB‑0558 11:51\nFeasibility and first clinical experiences with simultaneous PET/MR \nimaging of cervical cancer: comparison of image quality with MRI \nand PET/CT \nP. Brandmaier, S. Purz, M. Reinhardt, M. Gawlitza, H. Barthel, O. Sabri, T. Kahn, \nR. Kluge, P. Stumpp; Leipzig/DE (philipp.brandmaier@medizin.uni-leipzig.de) \nPurpose: We report about our approach in imaging patients with cervical cancer \nusing an integrated simultaneous PET/MRI device. Goals were the introduction of \na stable and effective protocol for whole body and dedicated pelvic examination \nand rating of image quality.\nMethods and Materials: Ten patients with primary (n=4) cervical carcinoma or \ntumour recurrence (n=6) were included. Patients underwent a simultaneous PET/\nMR, PET/CT and conventional MR examination. MR and PET image quality were \nrated on a Likert score system (0-4) by three radiologists and a nuclear physician. \nPET data were simultaneously visually compared by two nuclear physicians and \na radiologist.\nResults: Conventionally acquired images showed adequate to good image quality \nfor T2w-TSE and T1w-TSE (mean values 2.5±0.58 and 2.7±0.49). PET/MR images \nof the pelvis were rated slightly better (p> 0.05) with a mean value of 2.8±0.71 \n(T2w-TSE) and 2.8±0.73 (T1w-TSE). Superior results (p < 0.05) were seen in fused \nT2w-PET images (mean 3.4±0.62). For whole body PET/MR imaging quality was \ngood to excellent in head, pelvis and thigh. DWI showed the highest variations \nof values ranging from 3.32±0.67 to 0.43±0.88. Visual comparison of the PET \ncomponent revealed adequate image quality with a tendency towards improved \ndelineation of small foci in PET/MRI.\nConclusion: This work shows the feasibility of a combined protocol with a whole \nbody simultaneous PET/MR examination plus a dedicated simultaneous PET/MR \nof the pelvis. This examination can be done within approximately one hour and \nprovides good image quality for both, the PET and the MRI. \n10:30 - 12:00 Room F2 \nBreast \nSS 902 \nIncreased risk of breast cancer \nModerators: \nL.A. Carbonaro; San Donato Milanese/IT \nL. Ollivier; Paris/FR \nB‑0559 10:30\nIndividual radiosensitivity: a key-issue to reconsider high breast \ncancer risk patient screening modalities \nC. Colin1, N. Foray2, F. De Vathaire3, M. Bourguignon4, \nP.-J. Valette1; 1Pierre-Bénite/FR, 2Lyon/FR, 3Villejuif/FR, 4Paris/FR \n(catherine.colin01@chu-lyon.fr) \nPurpose: BRCA1 and BRA2 mutation carriers may be more susceptible to radiation-\ninduced cancer because of their role of tumour suppressor genes in radio-induced \nDNA damage repair and signalling. Heterozygous mutations of ATM, a major kinase \ninitiating the response to radio-induced DNA double-strand breaks, is likely to be \ninvolved in lymphoma as well as in breast cancer in high-risk patient (HRP) treated \nfor a Hodgkin disease. Thus the standard two-view mammographic screening an-\nnually recommended with MRI in HRP must be adapted.\nMethods and Materials: Recent literature data were analysed. Individual radio-\nsensitivity was assessed by radiobiological effects and epidemiological studies. \nRadiophysical and radiological mammographic data about calcifications detection \nand reduction of exposures were also taken into account.\nResults: Radio-induced DNA damage in breast epithelial cells were demonstrated \nex vivo with a Low and Repeated Dose effect reflecting an increase of unrepaired \nDSB after 2-views mammography, exacerbated in high family risk women. Recent \nepidemiological data highlighted mammographic radio-induced breast cancer in \nBRCA1-BRCA2 mutation carriers. Compared with other technologies, Full-Field \nDigital Mammography is the most accurate technology to detect calcifications and/\nor ductal carcinoma in situ, while delivering the lowest doses.\nConclusion: Mammographic modalities in HRP must be up-dated since patho-\ngenic alleles in DNA repair and signalling genes carriers have an increased risk \nof radio-induced breast cancer. A drastic limitation of the number of systematic \nmammographic views to one single view (oblique) in addition to MRI may be a \ngood compromise to detect both infiltrative and carcinoma in situ, using Full-Field \nDigital Mammography. \n\nScientific Sessions\nS276\n C A D E F\n G\nB\nB‑0565 11:24\nThe diagnostic value of 3 Tesla breast MRI in the diagnosis of in situ \nand invasive breast cancer \nL.G. Merckel1, H.M. Verkooijen1, N.H.G.M. Peters1, R.M. Mann2, W.B. Veldhuis1, \nT. van Dalen1, W.P.T.M. Mali1, P.H.M. Peeters1, M.A.A.J. van den Bosch1; \n1Utrecht/NL, 2Nijmegen/NL (L.G.Merckel-2@umcutrecht.nl) \nPurpose: To investigate the added diagnostic value of 3 T breast MRI over con-\nventional breast imaging in the diagnosis of in situ and invasive breast cancer and \nto explore the role of routine versus expert reading.\nMethods and Materials: Between January 2006 and May 2009, 207 patients with \nnonpalpable BI-RADS 3-5 lesions underwent contrast-enhanced 3 T breast MRI \nin a multicentre randomised trial (MONET trial). Initially, MRI scans were read by \nradiologists in a routine clinical setting. All histologically confirmed index lesions \nwere re-evaluated by an expert breast radiologist according to the BI-RADS ® \nlexicon. Added diagnostic value of breast MRI was assessed using ROC analysis.\nResults: Overall 78/207 (38%) patients had malignant lesions, 31 (15%) patients \nhad pure DCIS and 47 (23%) had mixed or pure invasive breast cancer. After \nroutine MRI reading, 48% of BI-RADS 3, 66% of BI-RADS 4, and 95% of BI-RADS \n5 lesions were proven malignant. After expert reading, positive predictive values \nwere 35%, 63%, and 100% for BI-RADS 3, 4, and 5 lesions, respectively. In the \nroutine setting, MRI was of added diagnostic value over baseline characteristics \nand conventional imaging, as the AUC increased from 0.78 (95% CI 0.71-0.86) to \n0.81 (95% CI 0.74-0.89). Expert MRI reading led to a strong improvement in AUC \nfrom 0.78 (95% CI 0.71-0.86) to 0.89 (95% CI 0.83-0.95).\nConclusion: 3 T breast MRI of nonpalpable breast lesions is of added diagnostic \nvalue in the diagnosis of in situ and invasive breast cancer, in particular when \nperformed by expert radiologists. \nB‑0566 11:33\nPositive enhancement integral values in diagnostic magnetic \nresonance imaging of breast carcinoma: ductal carcinoma in situ \n(DCIS) vs invasive ductal carcinoma (IDC) \nM.M. Nadrljanski, O.S. Radulovic, Z.C. Milosevic; Belgrade/RS \n(dr.m.nadrljanski@gmail.com) \nPurpose: Positive enhancement integral (PEI) of the area under the curve after \nthe contrast injection on breast MRI, presented as the time-intensity graph and \nmaps, provides insight into tumour perfusion. The purpose of this paper was \nto contribute to the standardisation of the PEI values in IDC, DCIS and breast \nparenchyma and to compare the PEI values: IDC Vs. parenchyma, DCIS Vs. \nparenchyma and IDC Vs. DCIS.\nMethods and Materials: In the prospective analysis of the 60 consecutive pa-\ntients (performed between March 2010 and September 2012), with histologically \nconfirmed DCIS (n=30) or IDC (n=30) (DCE-MRI, DWI, 1.5 T, gadoxetic acid), we \nanalysed the intralesional and the parenchymal PEI values and calculated the \ntumour-to-parenchyma ratio. Range values, graphs and maps are provided by the \nsoftware-package for diagnostic use.\nResults: In our series, the PEI values in the IDC group (748.7±32.2) were sig-\nnificantly different than those in the DCIS group (428.0±25.0), (p < 0.0001). The \ndifferences were also significant between the IDC and the parenchyma (748.7±32.2 \nVs. 74.6±17; p < 0.0001) and between the DCIS and the parenchyma (428.0±25.0 \nVs. 66.0±10.6; p < 0.0001). Average breast parenchyma PEI value in both groups \n(n=60), was 70.3+-/15.2. The tumour-to-parenchyma ratio was also significantly \ndifferent between the groups IDC Vs. DCIS: 10.1±2.4 Vs. 6.6±1.4 (p < 0.0001).\nConclusion: As the quantitative parameter, PEI and tumour-to-parenchyma ratio \nmay be helpful in differential diagnosis of DCIS Vs. IDC, with the standard DCE-\nMRI exam and other parameters of fMRI. To our knowledge, this is the first paper \ntesting the PEI values in the differential diagnosis: DCIS Vs. IDC. \nB‑0567 11:42\nDCIS at image-guided needle biopsy: can breast MRI pre-operatory \npredict invasivity? \nM. Marcon, V. Bertani, P. Clauser, E. Di Gaetano, V. Londero, A. Linda, \nR. Girometti, C. Zuiani, M. Bazzocchi; Udine/IT (magda.marcon@gmail.com) \nPurpose: To assess MRI features predictive of IDC in patients with a diagnosis of \nDCIS at percutaneous biopsy.\nMethods and Materials: We enrolled 72 patients (72 lesions) with biopsy-proven \nDCIS who underwent dynamic-MRI and subsequent surgical excision between \n2009 and 2012. Two experienced readers in consensus retrospectively evaluated \nMRI images considering lesion morphology (mass-like vs non mass-like), size (²10 \nmm vs > 10 mm), enhancement-rate (²100% vs > 100%) and dynamic curves (I, \ncompression-free MRI using the Dixon sequence at 3 T Tesla, which acquired \ntwo datasets one representing fatty and the other fibroglandular tissue. The fully \nautomated MRI breast density measurement system calculated the percentage of \nfatty and fibroglandular tissue (%) and the total volume (cm3) of the breast. Mean \nvalues were compared using student’s T-test, and descriptive statistics using the \n25-75% percentile were used to define the typical range of MRI density readings \ncorresponding to the 4-BIRADS categories.\nResults: Percentage MRI breast density correlated with percentage mammographic \nbreast density (r=0.83; P < 0.0001). MRI measurements ranged from 1.70% to \n61.9% (29.05%) and mammographic measurements from 5.42% to 74.33% (40.23). \nCompared with the BIRADS categories, 25-75% percentile assessment demon-\nstrated an interquartile range of 2.4-9.4% for BIRADS-1, 7.27-26.88% for BIRADS-2, \n26.1-48.43% for BIRADS-3 and 39.7-53.9% for BIRADS-4. Quantitative MRI breast \ndensity readings were consistently lower than qualitative BIRADS assessment.\nConclusion: Fully automated quantitative MRI BD measurement correlates well \nwith mammography-based breast density readings; it is fast, user-independent and \nradiation- and compression-free and a reliable way of breast density estimation.\nB‑0563 11:06\nFully automated quantitative MRI breast density (BD) measurement \nconfirms higher breast density in breast cancer patients \nK.J. Pinker-Domenig, G.J. Wengert, H. Bickel, H.F. Magomatschnigg, M. Curda, \nT.H. Helbich; Vienna/AT (katja.pinker-domenig@meduniwien.ac.at) \nPurpose: To measure and compare BD in breast cancer patients and age-matched \nhealthy controls using a fully automated MRI BD measurement system.\nMethods and Materials: 19 breast cancer cases and 19 age-matched healthy \ncontrols (age range of 34 to 68; mean 50 years) were included in this IRB-approved \nprospective study. BD was measured separately in all participants. The fully au-\ntomated MRI BD measurement system calculated the total volume of the breast \n(cm3), the percentage of fatty tissue (%) and the percentage of fibroglandular tissue \n(%). In each group normal distribution (Kolmogorov-Smirnov test; P = 0.12) and \nvariance homogeneity (Levene’s test, P = 0.69) was determined to accomplish \nindependent t-test (P = 0.316).\nResults: Fully automated quantitative MRI BD measurements were successfully \nperformed in both groups. Breast density ranged from 1.7% to 58.4%, mean density \nfor all women was 21.24%. Mean percentage density was higher in breast cancer \npatients as compared with healthy controls with an average of 24% (SD 16.9%) vs. \n18.4% (16.6). Breast density decreased gradually with age in both cancer patients \n(r2=0.237) and healthy controls (r2=0.259).\nConclusion: Fully automated quantitative MRI BD measurements confirm higher \nbreast density in cancer patients as compared to healthy controls. Although not \nstatistically significant due to the small sample size, these results are entirely \nconsistent with the fact that breast density is a strong risk factor for breast cancer.\nB‑0564 11:15\nTo excise or not to excise? Management of high-risk breast lesions \nin a symptomatic population \nJ.D. Cunningham, A. Corr, E. Kelliher, A. O’Shea, J. Kerr, D. Duke, N. Hambly; \nDublin/IE (janecunningham0708@gmail.com) \nPurpose: Management of high-risk breast lesions detected by image-guided \nbiopsy is controversial. We aim to determine the upgrade rate of high-risk lesions \nin a symptomatic population where surgical excision is currently the standard \npractice in all cases.\nMethods and Materials: All ultrasound, stereotactic and MR-guided biopsies \nperformed in our symptomatic breast unit between 01/01/2009 and 30/06/2012 \nwere reviewed. High-risk lesions were identified from our pathology database. \nCurrently, standard practice is surgical excision of all high-risk lesions following \nmultidisciplinary discussion. For all lesions, post-operative histopathology was \ndetermined and malignancy upgrade rates were calculated. Correlation was made \nwith lesion morphology, R imaging category and biopsy modality.\nResults: 3157 image-guided biopsies were performed. Of these, 103 (3.3%) were \nhigh-risk lesions, excluding fibroepithelial lesions. The distribution was as follows: 47 \n(45.6%) papillary lesions, 22 (21.4%) atypical ductal hyperplasia, 17 (16.5%) radial \nscars, 14 (13.6%) lobular neoplasia, 3 (2.9%) flat epithelial lesions. The upgrade \nrate at surgical excision was 11% for papillary lesions, 18% for radial scars, 50% \nfor atypical ductal hyperplasia, 36% for lobular neoplasia and 33% for flat epithelial \nneoplasia. The overall upgrade rate was 23%.\nConclusion: The distribution of high-risk lesions in a symptomatic breast unit is \ndifferent to a screening population. Diagnosis of a high-risk breast lesion at image-\nguided core biopsy in a symptomatic woman warrants surgical excision given the \nupgrade rate of 23%. \n\nScientific Sessions\nS277\nA\n C D E F G\nB\nSaturday\n10:30 - 12:00 Room I/K \nAbdominal Viscera \nSS 901 \nCross-sectional pancreatic imaging and biomarkers \nModerators: \nB. Marincek; Cleveland, OH/US \nG.A. Zamboni; Verona/IT \nB‑0570 10:30\nDynamic contrast MR imaging of the pancreas under free breathing \nin combination with navigator technique \nT. Masui1, M. Katayama1, K. Sato1, K. Terauchi1, K. Tsukamoto1, K. Mizuki1, \nY. Iwadate2, H. Sakahara1, H. Kabasawa2; 1Hamamatsu/JP, 2Hino/JP \n(masui@sis.seirei.or.jp) \nPurpose: In aged patients who cannot hold breaths, image quality of dynamic \ncontrast MR might not be acceptable. The purpose was to evaluate feasibility of free \nbreathing dynamic contrast MR imaging using navigator technique for pancreas.\nMethods and Materials: Twenty-six patients (age 73 years, pancreatic cystic \nlesions: 19 cases 40 lesions, solid 2 cases 2 lesions, none 5) underwent Gd-\ncontrast-enhanced MR imaging for pancreas at 3 T (Discovery750, GEHC). Pre \nand 5 phases of postcontrast images (Gd-chelate, 0.1 mmol/kg, injection 3 ml/sec) \nwere obtained using 3D fatsat FSPGR (LAVA) under free breathing with navigator \ntechnique. Image quality, blurring, recognition of each organ, and lesions were \nevaluated using five-point scale (5 good-1 poor). Imaging time for each phase, signal \nintensities (SIs) of aorta, portal vein, pancreas, and spleen, and sizes of lesions \nwere measured. Contrast ratios were defined as SI on postcontrast/precontrast \nimage. Existence of septa and nodules in lesions was evaluated.\nResults: All images with navigator were diagnostic (image quality 4.4-4.7, blurring \n4.3-4.7, lesion recognition 4.5-4.6). Imaging time was 38 to 46sec. The enhance-\nment was observed initially in aorta followed by spleen, pancreas. All cystic (19 \ncases, 40 lesions), and solid lesions (2 cases, 2 lesions) were identified (diameter \n13.7 mm, 1 mm to 52 mm). Septa in cysts were recognised in 10 of 19 cases. \nThere was no nodule in cystic lesions.\nConclusion: With navigator technique, dynamic contrast MR imaging of pancreas \ncan be successfully obtained with acceptable image quality and lesion recognitions \nunder free breathing. Shorter acquisition times may be required.\nAuthor Disclosures:\n Y. Iwadate: Employee; GE Healthcare. . H. Kabasawa: Employee; GE \nHealthcare.\nB‑0571 10:39\nDiffusion-weighted magnetic resonance imaging of healthy \npancreas: a study to investigate the effect of age on apparent \ndiffusion coefficient values \nC. Ma, C. Pan, H. Zhang, H. Wang, J. Wang, S. Chen, J. Lu; Shanghai/CN \n(mengqihi@gmail.com) \nPurpose: To investigate and characterise the effect of age on apparent diffusion \ncoefficient (ADC) values in healthy pancreas.\nMethods and Materials: A total of 559 patients with healthy pancreas, ranging \nfrom 20 to 81 years of age, were included in this study. Breath-hold single-shot \necho-planar diffusion weighted imaging (DWI; b-value = 0, 500 s/mm2) was em-\nployed to determine the ADCs across all patients. Dependency of ADCs on age \nwas characterised using a Spearman rank-order correlation test.\nResults: Across the age spectrum, it is shown that there is no significant correla-\ntion between the mean ADCs with age (correlation values = 0.03706, P = 0.3818 \n> 0.05) or with age groups (correlation values = 0.03048, P = 0.4721 > 0.05).\nConclusion: Our findings suggest that the effect of age can be excluded from \nthe clinical diagnosis of pancreatic diseases, and that changes in ADCs are likely \nindicative of pancreatic pathology.\nII and III). We compared the association of the above features in two groups of \npatients: those with pure DCIS and those with DCIS and an invasive component \n(DCIS+IDC) at surgical specimens. Analysis was performed using Chi-square test.\nResults: Patients underwent MRI after and before percutaneous biopsy in 51 \n(70.8%) and 21 (29.2%), respectively. Final diagnoses were pure DCIS in 47 \npatients (65.0%) and DCIS+IDC in 25 patients (35.0%). The presence of IDC \nwas significantly (p < 0.05) associated with a contrast-enhancement rate > 100% \n(65.2% in IDC vs 27.0% in DCIS). Invasion was higher in mass-like (52.0% in IDC \nvs 29.7% in DCIS) than in non-mass-like lesions (48.0% in IDC versus 70.3% in \nDCIS), although the difference was not significant (p> 0.05). No further significant \ndifferences were found between the two groups (p> 0.05).Of note, 12/72 lesions \n(8.0% of DCIS+IDC and 21.3% of pure DCIS) were excluded from the analysis \nbecause of the absence of contrast-enhancement.\nConclusion: IDC in patients with a bioptic diagnosis of DCIS is associated with \nan enhancement rate > 100%. \nB‑0568 11:51\nBreast dynamic MRI in patient with DCIS percutaneous biopsy \ndiagnosis: are different grades associated with specific features? \nV. Bertani, M. Marcon, P. Clauser, A. Linda, V. Londero, R. Girometti, C. Zuiani, \nM. Bazzocchi; Udine/IT (valeriabert@hotmail.it) \nPurpose: To assess MRI features predictive of low and intermediate grade versus \nhigh grade and microinvasive DCIS.\nMethods and Materials: We enrolled 47 patients (47 lesions) with biopsy-proven \nDCIS who underwent dynamic-MRI and subsequent surgical excision between \n2009 and 2012. Two experienced readers in consensus retrospectively evaluated \nMRI images for the presence/absence of contrast-enhancement, lesion morphology \n(mass-like vs non mass-like), size (²10 mm vs > 10 mm), enhancement rate (²100% \nvs > 100%) and dynamic curves (I, II and III). We compared the association of the \nabove features in two groups of patients: those with low and intermediate grade \nDCIS (set-1) and those with high grade and microinvasive DCIS (set-2) at surgical \nspecimens. Analysis was performed using Chi-square test.\nResults: Final diagnoses were 3 low grade (6.4%), 17 intermediate grade (36.2%), \n18 high grade (38.3%) and 9 microinvasive (19.1%) DCIS. Although no significant \ndifferences in the above features were found in the two groups, a tendency to an \nenhancement rate > 100% and lesions size > 10 mm was observed in set-2 (31.8% \nin set-2 vs 20.0% in set-1 for enhancement rate; 86.4% in set-2 vs 73.3% in set-1 \nfor size lesions). Of note, 10/47 lesions (25.0% in set-1 and 18.5% in set-2) were \nexcluded from the analysis because of the absence of contrast enhancement.\nConclusion: We observed no MRI features predictive of low and intermediate \ngrade vs high and microinvasive DCIS. \nB‑0569 12:00\nTriple negative breast cancers (TNBCs) versus non-triple negative \nbreast cancers (non-TNBCs) diagnosed during a high-risk screening \nprogram: sensitivity of imaging modalities and patient outcome \nR.M. Trimboli1, F. Podo2, F. Santoro2, F. Sardanelli3; 1San Donato Milanese/IT, \n2Rome/IT, 3Milan/IT (trimboli.rm@gmail.com) \nPurpose: To compare TNBCs with non-TNBCs diagnosed during a high-risk \nscreening program\nMethods and Materials: Forty-four patients were diagnosed with invasive cancers, \n14 (32%) TNBCs and 30 (68%) non-TNBCs. Sensitivities of modalities, age at \ndiagnosis, grade, size, nodal status, loco-regional relapse, disease-free survival \n(DFS), and breast cancer related death (BCRD) were evaluated. Statistics: Mann-\nWhitney, Fisher exact, χ2.\nResults: While of 14 TNBCs, 13 (93%) were invasive ductal carcinomas (IDCs), \nof 30 non-TNBCs, 15 (50%) included lobular subtype and/or DCIS component \n(p=0.005). All 3 interval cancers were TNBCs. Sensitivity for mammography was \n43% for TNBCs and 59% for non-TNBCs (p=n.s)., for ultrasound 57% and 62% \n(p=n.s)., for MRI 75% and 96% (p=0.043). MRI was always more sensitive than \nmammography or ultrasound. Of 14 TNBCs, 10 (71%) were observed in BRCA1+, \nof 30 non-TNBCs, only 9 (30%) (p=0.028). Median age at diagnosis was 49 and 53 \nyears, mean tumor size was 1.6 and 1.2 cm, respectively. Eleven TNBCs (79%) and \n8 non-TNBCs (27%) were grade 3 (p=0.002). Nodal status was negative for 12/14 \nTNBCs (86%) and 16/30 non-TNBCs (53%) (p=0.038). Loco-regional relapses \nwere observed for 1/13 TNBCs (8%) and 5/27 non-TNBCs (19%), 7 years DFS in \n8/13 (62%) and 17/27 (63%), BCRD for 2/13 (15%) and 3/27 (11%), respectively. \nDistant recurrence was reported for 2 non-TNBCs only.\nConclusion: MRI outperformed mammography/ultrasound in both TNBCs and \nnon-TNBCs. TNBCs were associated with BRCA1 + and grade 3. Loco-regional \nrelapse, DFS and BCRD were similar. These data support entering women at high \nrisk of TNBC (BRCA1+) in screening programs including MRI. \n\nScientific Sessions\nS278\n C A D E F\n G\nB\nMethods and Materials: 133 patients with pathological diagnosis of pancreatic \nadenocarcinoma, studied with CEUS and MDCT, have been enrolled. Two radiolo-\ngists evaluated tumour size, site and imaging appearance. Sensitivity of the two \nmethods was compared using McNemar test.\nResults: In 9/133 patients neither MDCT nor US/CEUS could identify the lesion; in \n9/133 patients only MDCT and in 13/133 only US/CEUS could identify the lesion. \nIn the remaining 102 patients, both MDCT and US/CEUS were positive. US/CEUS \nsensitivity was 86.47%, while MDCT was 83.58%, with no statistically significant \ndifference (p=0.523). For lesions smaller than 2 cm US/CEUS sensitivity was 100%, \nwhile MDCT sensitivity was 73.33% with no significant difference (p=0.125). For \nlesions between 2.1 and 3 cm US/CEUS had a sensitivity of 95.35%, while MDCT \nhad a sensitivity of 83.72% with no significant difference, p=0.180). For lesions \nbetween 3.1 and 4 cm, US/CEUS had a sensitivity of 87.88%, while MDCT had \na sensitivity of 93.94% with no significant difference (p=0.688). For lesions larger \nthan 4 cm, US/CEUS had a sensitivity of 90.91%, while MDCT had a sensitivity of \n100% with no statistically significant difference (p=0.250).\nConclusion: US/CEUS sensitivity in diagnosing pancreatic adenocarcinoma does \nnot statistically differ from that of MDCT. US/CEUS sensitivity seems to be higher \nfor small lesions, while MDCT sensitivity is higher for large lesions. By combining \nboth the imaging methods a higher accuracy in diagnosing pancreatic carcinoma \ncan be expected. \nB‑0575 11:15\nHigh-resolution diffusion-weighted imaging of pancreatic ductal \nadenocarcinoma using 2D reduced field of view single-shot echo \nplanar imaging at 3.0 Tesla \nC. Ma, Y. Li, H. Wang, S. Chen, J. Lu; Shanghai/CN (mengqihi@gmail.com)\nPurpose: To demonstrate the feasibility of high-resolution DWI of pancreas using \n2D reduced field of view (RFOV) single-shot echo-planar sequence in the evalu-\nation of pancreatic ductal adenocarcinoma.\nMethods and Materials: 50 normal volunteers and 50 patients with histopatho-\nlogically proven pancreatic ductal adenocarcinoma by surgery were included in \nthe study. High -resolution DWI of pancreas was obtained using a multi -section \n2D RFOV single-shot echo-planar sequence on the axial plane (FOV 16×8 cm 2, \nmatrix 128×64). ADC of the normal pancreas in control group and pancreatic ductal \nadenocarcinoma group were measured. Mann -Whitney U-test has been used to \ncompare ADC values between tumoral tissues and normal pancreatic tissues of \nthe volunteers.\nResults: On the high-resolution DW images, all pancreatic ductal adenocarcinoma \ndemonstrated high signal intensity relative to the surrounding pancreatic paren-\nchyma. The mean and standard deviations of the ADC values (×10-3 mm2/s) were \nas follows: pancreatic ductal adenocarcinoma (n = 50), 1.53 ± 0.26 (1.02 - 2.23), \nand normal pancreas in normal volunteers (n = 50), 1.98 ± 0.25 (1.60 - 2.73). ADC \nof the pancreatic ductal adenocarcinoma were significantly higher compared with \nthose of normal pancreas (U = 230.000, P = 0.000).\nConclusion: RFOV DWI shows advantages in higher resolution (1.25×1.25 mm2) \nand blurring reduction compared to full FOV DWI of the pancreas. It makes a sta-\ntistically significant difference on the ADC measurements of the pancreatic ductal \nadenocarcinoma when comparing to the control group. This approach is promising \nto benefit the early diagnosis of pancreatic cancers.\nB‑0576 11:24\nImaging features of acinar cell cystadenoma: can we differentiate \nthem from branch duct IPMNs? \nC. Delavaud1, G. D’Assignies1, J. Cros1, P. Ruszniewski1, P. Hammel1, \nA. Couvelard2, V. Vilgrain1, M.-P. Vullierme1; 1Clichy sur Seine/FR, 2Paris/FR \n(christophe.delavaud@hotmail.fr) \nPurpose: Acinar cystic cystadenoma (ACC) of the pancreas is a rare benign entity \nfirst described in 2002, defined by histological criteria. Radiographic appearance had \nalmost not been described so far. Most of the patients underwent surgical resection \nunder the preoperative diagnosis of intraductal papillary mucinous neoplasms. \nThe aims of this study are to define imaging diagnostic criteria of ACC based on \nradiopathological confrontation and to compare clinical, biological and imaging \ndata between patients with ACC and with branch ducts IPMN.\nMethods and Materials: All patients with ACC who underwent pancreatic surgery \nfor suspicion of IPMN and the 20 last patients with histologically proven branch \nducts IPMN were retrospectively included. Clinical and biological information were \ncollected from the medical reports. Radiological and histological documents were \nreviewed in order to define imaging diagnostic criteria of ACC. Data were compared \nusing the Chi-square test or Fisher’s exact test.\nB‑0572 10:48\nPancreatic cystic lesion fluid content virtual analysis by means of \nacoustic radiation force impulse (ARFI) ultrasound imaging: fact or \nfiction? \nS. Canestrini, M. D’Onofrio, R. De Robertis, S. Crosara, E. Demozzi, G. Puntel, \nR. Pozzi Mucelli; Verona/IT (mirko.donofrio@univr.it) \nPurpose: To prospectively evaluate the application of ARFI implemented with \nvirtual touch tissue quantification in the study of pancreatic cystic lesions, using \ndifferent analysis methods, compared with the final diagnosis (pathological or by \nMRI/EUS findings).\nMethods and Materials: 38 patients with pancreatic cystic focal lesion (diameter \n> 3 cm and located at a depth < 5.5 cm) were included in the study and underwent \nconventional US. For every patient 5 measurements with virtual touch quantification \nROI were performed. In order to distinguish mucinous (potentially malignant) from \nserous cystic lesions (mainly benign) the result \"XXXX/0\" was considered mean-\ning simple liquids (reportable to water), and the accuracy of virtual touch tissue \nquantification in differentiating cystic-pancreatic lesions was calculated. To consider \nthe lesion as containing complex fluids (potentially mucinous), two different read-\ning methods have been applied: at least two numerical values when performing \nfive measurements; prevalence of numerical values irrespective of the number of \nmeasurements. Sensitivity, specificity, positive and negative predictive values and \naccuracy were calculated for the differential diagnosis between mucinous versus \nnon-mucinous cystic lesions.\nResults: Sensitivity, specificity, PPV, NPV and accuracy in the group of cystic \nlesions using the first reading method were, respectively, 68.8%, 77.3%, 68.8%, \n77.3%, 73.7%. Sensitivity, specificity, PPV, NPV and accuracy in the group of \ncystic lesions using the second reading method were, respectively, 37.5%, 100%, \n100%, 68.8%, 73.3%.\nConclusion: ARFI with virtual tissue touch quantification can have a role in non-\ninvasive characterisation of pancreatic cystic lesion during the conventional US \nexamination. \nB‑0573 10:57\nRole of perfusion CT in the evaluation of pancreatic masses \nR. Vasudevan, M. Kang, R. Gupta, D. Bhasin, S. Rana, N. Khandelwal; \nChandigarh/IN (ravisankarv85@gmail.com) \nPurpose: To evaluate the efficacy of CT perfusion for detection of malignancy in \npancreatic masses.\nMethods and Materials: 27 patients (pts) who presented with a mass in the \npancreas were enrolled in this Institute Review Board-approved prospective study \nafter informed consent and underwent biphasic CECT with perfusion CT of the \npancreas. Pts were followed up and results of cytopathological diagnosis obtained. \nFinal diagnosis consisted of malignancy (adenocarcinoma) in 11, various benign \nmasses in 13 and neuroendocrine tumour in 3 pts. Control group consisted of 15 \npts who were referred for CT for an indication other than pancreatic pathology. 11 \nperfusion parameters were calculated using software MIStar 3.2 (Apollo imaging \nsoftware). CT perfusion parameters were compared between the control and study \ngroups as well as results of cytopathological diagnosis using ANOVA and Dunnett \n2-sided t-test for statistical analysis.\nResults: All perfusion parameters except extraction (E) were significantly different \nbetween adenocarcinoma and benign groups. All perfusion parameters except per-\nmeability (PS) were also statistically significantly different between adenocarcinoma \ngroup and controls. Blood flow (BF), blood volume (BV), extraction fraction product \n(EFP), PS and peak enhancement intensity (PEI) showed decreasing trend in \nvalues, whereas rest of the parameters showed an increasing trend from normal to \nbenign to adenocarcinoma. Neuroendocrine tumours had different perfusion values \nwith significantly elevated BF, BV, PEI and earlier time to peak (TTP). One patient \nwith pancreatic tuberculosis had perfusion values paralleling adenocarcinoma but \nwith relatively earlier TTP.\nConclusion: Perfusion CT seems to be a useful tool for differentiating between \nmalignant and benign pancreatic masses.\nB‑0574 11:06\nComparison between CT and CEUS in the diagnosis of pancreatic \nadenocarcinoma \nS. Crosara, M. D’Onofrio, R. De Robertis, S. Canestrini, R. Pozzi Mucelli; \nVerona/IT (mirko.donofrio@univr.it) \nPurpose: To compare CEUS and CT features of pancreatic ductal adenocarcinoma \nin relation to tumour size.\n\nScientific Sessions\nS279\nA\n C D E F G\nB\nSaturday\nof each other. Pancreatic imaging may help to detect early signs of FIP in children \nwith CF, although it is unclear if this would help to prevent IDDM. \nB‑0579 11:51\nPancreatic atrophy in β-thalassaemia population: morphological MR \nevaluation and correlation with pancreatic functional parameters \nC. Liguori, F. Pitocco, I. Di Giampietro, P. Cianciulli, B. Beomonte Zobel; \nRome/IT (c.liguori@unicampus.it) \nPurpose: To assess correlation between MRI iron deposition of the pancreas with \nthose of the heart, liver and adrenals in patients with β-thalassaemia. To assess \npancreas parenchyma atrophy prevalence coupling results with pancreatic endo-\ncrine and exocrine functional levels and ferritin levels.\nMethods and Materials: We retrospectively evaluated 113 β-thalassaemia patients \n(83 major and 30 intermedia, mean age 37.8 ± 12.8 years, mean BSA 1.64 ± 0.24 \nKg/m2) using T2* MRI to assess iron content in the heart (T2*< 20 ms), liver (< \n6.3 ms), pancreas and adrenals (< 26 ms). MRI results were compared with one \nanother and with endocrine and exocrine pancreatic serum enzyme levels and \nwith Ferritin levels. Moreover pancreatic atrophy (TrueFISP sequences; qualitative \ngrading) was evaluated.\nResults: T2* measurements were possible in all patients regarding heart, liver and \nadrenals; pancreas T2* evaluation was impossible in case of moderate-severe \natrophy. Cardiac and pancreatic values were very poorly correlated (r=0.3, p < \n0.001). Stronger correlation between pancreas and liver (r=0.6, p < 0.001) and \nadrenals (r=0.6, p < 0.001) was found. High prevalence of pancreas atrophy was \nnoted (29 pts, 25%) with a majority of severe pancreatic atrophy (70%) in young \nsubjects. Pancreatic T2* was weakly correlated to ferritin levels. Good correlation \nbetween pancreatic T2* and pancreatic enzyme levels was noted. All patients with \npancreatic atrophy showed an impaired pancreatic function.\nConclusion: Pancreatic iron overload do not correlate significantly with cardiac \nsiderosis whether shows a better correlation with abdominal organs iron deposi-\ntion. β-thalassaemia patients show higher prevalence of pancreatic atrophy with \nconsequential pancreatic functional impairment. \n10:30 - 12:00 Room N/O \nCardiac \nSS 903 \nMyocardial perfusion and coronary artery disease \nModerators: \nF. Cademartiri;  Monastier  di Treviso/IT \nG.I. Kirova-Nedialkova; Sofia/BG\nB‑0580 10:30\nDual bolus dynamic contrast-enhanced cardiac perfusion imaging: \ncomparison of eight reported analysis methods \nB.M. Müller-Bierl, K. Tanaka, N. Buls, Y. Fierens, T. van Cauteren, I. Willekens, \nR. Luypaert, J. De Mey; Brussels/BE (bernd.mueller-bierl@uzbrussel.be) \nPurpose: To compare eight reported methods for the analysis of cardiac perfusion \nflow data from 3 Tesla MRI on a porcine model.\nMethods and Materials: An anaesthetized healthy minipig was repeatedly scanned \n(x 5) with a 14-day interval with Turbo FLASH. Voxel size was 2.00 x 2.47 x 8 mm³ \nand prepulse delay time was TI=110 ms. Total scan time for 120 scans was 2:00 \nmin. Prebolus and bolus CA were 1.2 ml and 6 ml 0.5 mmol/ml GdDTPA (Magnev-\nist) with an injection speed of 4 ml/sec. Perfusion was assessed in 6 segments of \nthe mid-ventricle short axis view from the heart with eight reported methods: (1) \nfermi, (2) model-free deconvolution, (3) modified tofts, (4) exchange, (5) uptake, \n(6) tofts, (7) patlak, and (8) upslope. We assessed the concordance of the methods \nby regression analysis and by comparing medians and distribution of the data.\nResults: The highest correlation (R2 > 0.9) can be observed for methods 1-3, 5, 6. \nThose were considered as a reference. Method 7 underestimates the flow (slope \n0.34). The median values of the methods 1-3, 5 match within an interval of ±2 SD \nthe median of the reference (56.0 ml/100 ml/min). The SD (3.05 ml/100 ml/min) \nwas computed from the 5 methods. Perfusion flow assessed by the methods 1-3, 8 \nwas observed to be not significantly different from the reference (p < 0.01, related \nsamples Wilcoxon rank test).\nConclusion: Perfusion analysis methods can yield different results. Our data \nsuggest that the methods 1-3 are most concordant.\nResults: ACC was symptomatic in all but one patient. There were no statistical \ndifference between ACC and IPMN group with regard to clinical and biological data. \nCombination of four radiological criteria allowed differentiating ACC from IPMN: cyst \ncalcification, presence of more than 5 cysts, clustered peripheral small cyst, and \nabsence of communication with main pancreatic duct. Sensibility and specificity \nwere, respectively, 75 and 100% with combination of at least three of these criteria.\nConclusion: ACC is a rare benign pancreatic tumour with specific imaging fea-\ntures despite some similarities with IPMN. Recognition of this entity may help us \nto propose the diagnosis and prevent extensive surgery.\nB‑0577 11:33\nDiffusion-weighted 3 T MR imaging with b-multiple SE-EPI in the \ndifferential diagnosis of cystic pancreatic lesions \nP. Boraschi, F. Donati, R. Gigoni, G. Gherarducci, U. Boggi, F. Falaschi, \nC. Bartolozzi; Pisa/IT (p.boraschi@do.med.unipi.it) \nPurpose: To evaluate the usefulness of diffusion-weighted 3 T MR imaging with \nb-multiple SE-EPI in providing an objective value for the differentiation of cystic \npancreatic lesions.\nMethods and Materials: A series of eighty-six patients with cystic pancreatic le-\nsions of at least 1 cm in size identified at US and/or CT and twenty normal subjects \nunderwent MR imaging at 3 T device (GE DISCOVERY MR750; GE Healthcare). \nAfter the acquisition of axial T1w and T2w sequences and coronal MRCP , diffusion-\nweighted MR imaging was performed using an axial respiratory-triggered spin-echo \necho-planar sequence with multiple b values (150, 500, 1000, 1500 sec/mm²) in \nall diffusion directions. ADC value was calculated by using a dedicated software \nfitting the curve obtained from the corresponding ADC for each b value. Fitted ADC \nvalues were calculated by two observers in conference for each cystic pancreatic \nlesion and for normal pancreatic parenchyma. Imaging results were correlated with \nsurgery, ERCP, and/or imaging follow-up.\nResults: Final diagnoses included intraductal papillary mucinous tumour (IPMT) \n(n=58), serous cystoadenoma (n=18), and mucinous cystoadenoma (n=10). Fitted \nADC value was 1.33x10-3 mm2/sec for normal pancreatic parenchyma, 3.10x10-3 \nmm2/sec for IPMT, 2.57x10-3 mm2/sec for serous cystoadenoma, 2.93x10-3 mm2/\nsec for mucinous cystoadenoma. Fitted ADC values were significantly higher in \nmucinous neoplasms than in serous cystoadenomas (p < 0.05).\nConclusion: Our results suggest that diffusion-weighted 3 T MR imaging with \nb-multiple SE-EPI may be helpful to differentiate mucinous from serous cystic \npancreatic lesions. Further investigations in larger series of patients are necessary \nto confirm our data. \nB‑0578 11:42\nCystic fibrosis in juveniles and adults: association of fatty involution \nof the pancreas at MDCT with CFTR genetic mutation and insulin-\ndependent diabetes mellitus \nU.G. Mueller-Lisse, N. Ashoori, H.A. Strube, M. Schmitz, R. Fischer, R.M. Huber, \nM.F. Reiser, E.M. Coppenrath; Munich/DE \nPurpose: Fatty involution of the pancreas (FIP) and insulin-dependent diabetes \nmellitus (IDDM) are characteristic features of cystic fibrosis (CF). We hypothesised \nthat there was no association of FIP or IDDM with particular mutations at the \nCFTR gene locus.\nMethods and Materials: MDCTs of the chest (4-64 rows, 120 KVp, 10-150 mAs/\nslice, CTDIw appr. 1.0-10.0 mGy, effective dose appr. 0.5-5.0 mSv) of 111 con-\nsecutive juvenile and adult CF-patients (52 females, 59 males, age, 14-51 years, \nmean±sd, 33±8 years) were retrospectively reviewed for complete FIP versus \nremnant (RP) or normal pancreas (NP). Association with different CFTR-gene-\nlocus-mutations, IDDM state and patient age was statistically evaluated with \nFisher's-exact-test, chi-square-test, McNemar's-chi-square-test, or Student's-t-test \n(two-tailed, p < 0.05).\nResults: FIP was found in 88 CF-patients, RP in 10, and NP in 13, respectively. \nFIP was significantly associated with homozygous (61/66) rather than heterozygous \n(17/34) dF508-CFTR-mutation (chi-square, 21.1287, p < 0.001). RP and NP were \nsimilarly frequent in homozygous dF508-CFTR-mutation and other CFTR-gene \nconstellations (3 and 2 versus 10 and 8, respectively, p=0.3825). RP and NP were \nsignificantly associated with heterozygous R347P-CFTR-mutation (4/4) versus \nhomozygous dF508-CFTR-mutation (5/66, p=0.00014). FIP and IDDM were not \nindependent of each other (McNemar's-chi-square, 0.0167, p> 0.5). FIP was not \nage-dependent (p=0.1239).\nConclusion: In juvenile and adult CF-patients, FIP is frequently found, particularly \nalong with homozygous dF508-CFTR-mutation. Heterozygous R347P-CFTR-mu-\ntation may be pancreas-protective. FIP and IDDM are statistically not independent \n\nScientific Sessions\nS280\n C A D E F\n G\nB\nB‑0583 10:57\nAdenosine perfusion and late gadolinium enhancement at 3 Tesla in \ncomparison to 1.5 Tesla for the detection of coronary artery stenosis \nT. Walcher, K. Ikuye, W. Rottbauer, J. Woehrle, P. Bernhardt; \nUlm/DE (peter.bernhardt@uniklinik-ulm.de) \nPurpose: Cardiac magnetic resonance imaging (CMR) using a comprehensive \napproach consisting of adenosine perfusion and late gadolinium enhancement \n(LGE) at 1.5 Tesla has established for detection of relevant coronary artery disease \n(CAD). Little is known about the potential advantages of 3 Tesla CMR to detect \nrelevant CAD. Aim of our prospective study was to compare a clinical routine \nCMR protocol performed at both 1.5 and 3 Tesla in patients with suspected CAD \nundergoing coronary x-ray angiography.\nMethods and Materials: 52 patients (62.3±10.2 years) with suspected CAD were \nincluded into the study. All patients were scanned at both 1.5 and 3 Tesla including \nfunctional imaging, adenosine stress and rest perfusion, and LGE. CMR images \nwere analysed by two blinded readers in consensus. X-ray angiography served \nas the reference method.\nResults: Diagnostic accuracy of the combined analysis of perfusion and LGE imag-\ning yielded better values at 1.5 and 3 Tesla than the analysis of perfusion images \nalone. Sensitivity and specificity at 3 Tesla were superior to 1.5 Tesla in detection \nof coronary stenoses ³50% (0.90 vs. 0.75 and 0.84 vs. 0.75) and in detection of \ncoronary stenoses ³70% (0.88 vs. 0.80 and 0.96 vs. 0.89).\nConclusion: 3 Tesla CMR seems to be superior to 1.5 Tesla in detection of \nsignificant CAD, as shown in our routine clinical setting in a prospective study. \nHence, 3 Tesla might become the preferred CMR field strength for evaluation of \nCAD in clinical practice.\nB‑0584 11:06\nMyocardial perfusion defects and late gadolinium enhancement in \nasymptomatic subjects with subclinical atherosclerosis and mild \ncoronary calcifications - results of the Heinz Nixdorf recall MRI substudy \nT. Schlosser, K. Nassenstein, P. Hunold, K.-H. Joeckel, J. Barkhausen, R. Erbel, \nB. Sievers; Essen/DE (thomas.schlosser@uni-due.de) \nPurpose: The purpose of this study was to evaluate the prevalence of pathological \ncardiac MRI findings in subjects with mild coronary calcifications.\nMethods and Materials: 101 asymptomatic volunteers were selected from a large \npopulation-based screening study in accordance with their Agatston calcium score \n(group 1: Agatston score: 0, n = 51, age 60.10 +- 6.41; group 2: Agatston score: \n1 - 100, n = 50, age 63.9 +- 6.33). All subjects underwent cardiac MRI at 1.5 T. \nThe MRI protocol included a) functional assessment of the left ventricle, b) assess-\nment of adenosine stress-/rest perfusion and c) quantification of late gadolinium \nenhancement (LGE).\nResults: A stress-induced perfusion deficit was present in 1/101 subjects (1.0%), \nwhereas LGE was seen in 17/101 subjects (16.8%). Group 1 (Agatston score: 0): \nIn this group none of the subjects showed a perfusion deficit, whereas in seven \nsubjects LGE was observed (13.7%). Two of the seven subjects showed an \nischaemic-type pattern of LGE (3.9%) indicating chronic infarction. Group 2: median \nAgatston score of group 2 was 19 (Q1, 11; Q3, 43). In this group a perfusion deficit \ncould be observed in one subject (2.0%), whereas LGE was observed in ten subjects \n(20.0%). However, all of these LGE patterns were assessed as non-ischaemic.\nConclusion: The prevalence of stress-induced myocardial ischaemia in subjects \nwith mild coronary calcifications score is low, whereas the frequency of non-ischae-\nmic LGE is relatively high. Long-term follow -up will clarify whether these cardiac \nMRI findings contribute to cardiovascular risk stratification in asymptomatic subjects.\nB‑0585 11:15\nLate enhancement multidetector computed tomography (LE-MDCT) \nassessment of scar substrate in recurrent ventricular tachycardia (VT) \nC. Colantoni, A. Esposito, A. Palmisano, F. De Cobelli, F. Baratto, G. Maccabelli, \nP. Della Bella, A. Del Maschio; Milan/IT (colantoni.caterina@hsr.it) \nPurpose: Radiofrequency ablation (RFa) guided by electroanatomic-mapping \n(EAM) is a useful therapy in patients with recurrent-VT. Pre-treatment scar substrate \nassessment with cardiac-MR is important for EAM/RFa planning (subendocardial/\nsubepicardial), but most of these patients have ICD, contraindicating MR imaging. \nThis study aimed to evaluate the effectiveness of LE-MDCT in the assessment of \nscar substrate in patients with recurrent-VT, comparing imaging findings with EAM.\nMethods and Materials: 26 patients with recurrent-VT underwent 64-slice-MDCT \nbefore EAM/RFa, including angiographic-scan and low-energy (80 kV) delayed-\nscan (10 minutes after high-concentration iodine). MDCT scans were merged with \nEAMs and scar distribution at imaging was compared with scars at EAM. EAM/RFa \nB‑0581 10:39\nImage quality and radiation exposure of low-dose dual-source \ndynamic CT stress myocardial perfusion Imaging: a randomised \nstudy comparing 80-kVp/370-mAs and 100-kVp/300-mAs protocols \nM. Fujita, K. Kitagawa, T. Ito, Y. Shiraishi, Y. Kurobe, M. Nagata, M. Ishida, \nH. Sakuma, K. Dohi; T su/JP (fujitam@clin.medic.mie-u.ac.jp) \nPurpose: We determined the effect of reduced 80 kVp tube voltage with increased \n370 mAs tube current on the radiation dose, image quality and estimated myocar-\ndial blood flow (MBF) of dynamic CT stress myocardial perfusion imaging (CTP) \nin patients with a normal body mass index (BMI).\nMethods and Materials: Thirty consecutive patients with a normal BMI (< 25 kg/\nm2) with known or suspected coronary artery disease underwent adenosine-stress \ndynamic CTP using a dual-source CT scanner with alternating table positions \n(shuttle mode). Patients were randomised to 100-kVp/300-mAs imaging (n=15) or \n80-kVp/370-mAs imaging (n=15). CT-estimated MBF map was generated using a \nmodel-based parametric deconvolution method. Two blinded readers graded im-\nage quality of the MBF map using a 4-point scale. Peak signal and noise of the left \nventricular (LV) cavity and MBF of non-ischaemic myocardium were also compared.\nResults: Imaging with 80-kVp/370-mAs instead of 100-kVp/300-mAs was associ-\nated with 40% lower radiation dose (mean dose length product, 359±66 [range, \n287-482] vs 628±112 [493-830] mGy[[Unable to Display Character: ⋅]]cm; p \n< 0.001) with no significant difference in image quality of the MBF map (3.3±0.6 vs \n3.4±0.9, p=0.627) or MBF of non-ischaemic myocardium (0.93±0.27 vs 1.01±0.32 \nml/min/g; p=0.543). Studies obtained using 80-kVp/370-mAs were associated with \n33% higher peak LV enhancement (803±203 vs 603±104 HU; p=0.002), and 23% \ngreater noise (22.3±3.5 vs 18.1±3.6; p=0.001).\nConclusion: Dynamic CTP using 80-kVp/370-mA instead of 100-kVp/300-mAs al-\nlowed 40% reduction in radiation dose with no significant difference in image quality \nor MBF. The use of 80 kVp tube voltage should be considered in dose-reduction \nstrategies for dynamic CTP of individuals with a normal BMI.\nAuthor Disclosures:\nH. Sakuma: Research/Grant Support; Siemens Japan.\nB‑0582 10:48\nFeasibility of CT-based dynamic stress perfusion imaging to \ndifferentiate ischaemic and infarcted myocardium as compared with \nmagnetic resonance imaging \nF. Bamberg, R. Marcus, K. Hildebrandt, F. Schwarz, \nD. Theisen, K. Bauner, A. Becker, T. Johnson, K. Nikolaou; \nMunich/DE (fabian.bamberg@med.uni-muenchen.de) \nPurpose: To determine the feasibility of CT-based myocardial perfusion imaging \nto differentiate ischaemic and infarcted myocardium as compared to magnetic \nresonance imaging (MRI).\nMethods and Materials: We prospectively enrolled subjects with suspected \ncoronary artery disease, who underwent adenosine-mediated stress myocardial \nperfusion imaging by dynamic dual-source CT (100 kV, 320 mAs/rot) and 3 T-MRI. \nMyocardial blood flow and volume (MBF and MBV, respectively) were derived \nfrom CT images, using a model-based parametric deconvolution method for 16 \nmyocardial segments. These were related to perfusion defects visually assessed \nduring rest/stress and delayed MRI acquisitions. Conventional measures of diag-\nnostic accuracy and differences in MBF/MBV were determined in a blinded fashion.\nResults: Among 41 enrolled subjects, 31 (mean age 70 ± 9 years, 74% men) \ncompleted the protocol. The prevalence of ischaemic and infarcted segments \ndetected by MRI was moderately high (11.6% and 12.4%, respectively). Applying \na MBF cut-point (88 ml/100 ml/min), the diagnostic accuracy of CT-MPI in detecting \nsegmental ischaemic perfusion defects and infarcted segments, as defined by MRI, \nwas good (sensitivity: 88.89% [0.76-0.96], NPV: 80.77% [0.6-0.93] and sensitivity: \n85.25% [0.74-0.93], NPV: 97.05% [0.94-0.99], respectively), both showing moderate \nPPV (42% and 29%, respectively). While in segment with excellent image quality \nthere was no difference in MBF between ischaemic and infarcted myocardium \n(p=0.8635), MBV was significantly lower in infarcted than in ischaemic segments (p \n< 0.0001). Adding MBV as a co-indicator to pathological MBV (cut-point 16 ml/100 \nml) detected 23/31 transmural infarcted segments (sensitivity: 74.19% [0.55-0.88]).\nConclusion: MBV derived from dynamic CT perfusion imaging may help to dif-\nferentiate infarcted from ischaemic myocardium. \nAuthor Disclosures:\nF. Bamberg: Research/Grant Support; Siemens Healthcare, Bayer Healthcare. \nSpeaker; Siemens Healthcare, Bayer Healthcare. . K. Nikolaou: Research/\nGrant Support; Siemens Healthcare, Bayer Healthcare. Speaker; Siemens \nHealthcare, Bayer Healthcare.\n\nScientific Sessions\nS281\nA\n C D E F G\nB\nSaturday\nB‑0588 11:42\nPrevalence of severe subclinical coronary artery disease on cardiac \nCT and MRI in patients with extra-cardiac arterial disease \nM.A.M. den Dekker1, J.J.A.M. van den Dungen1, I.F.J. Tielliu1, R.A. Tio1, \nR.M.J.J. Jaspers2, M. Oudkerk1, R. Vliegenthart1; 1Groningen/NL, 2Deventer/NL \n(m.a.m.Dekker@rad.umcg.nl) \nPurpose: Patients with extra-cardiac arterial disease (ECAD) are at high risk of \ncoronary heart disease. We examined the prevalence of silent, significant coronary \nartery disease in patients with stenotic or aneurysmatic ECAD.\nMethods and Materials: Cardiac asymptomatic ECAD patients without contra-\nindications for computed tomography (CT) and magnetic resonance imaging (MRI) \nunderwent coronary CT angiography (cCTA) and adenosine perfusion MRI (APMR). \nCalcium scoring was performed based on non-contrast CT. CCTA was positive \nwhen ³50% lumen diameter stenosis in a coronary artery was found. Patients were \nreferred to a cardiologist when cCTA showed a stenosis in the left main coronary \nartery (or equivalent), or when APMR showed inducible myocardial ischaemia.\nResults: In total, 115 patients (mean age 65 yrs; 76% male) were included. \nPatients were divided into 2 categories: stenotic (N=87) and aneurysmatic ECAD \n(N=28). CCTA was positive in 38% in stenotic and 29% in aneurysmatic ECAD. \nNo cCTA was performed in 20% due to excessive calcium. Two patients, 1 stenotic \nand 1 aneurysmatic ECAD had left main stenosis. APMR was positive in 12% in \nstenotic and 11% in aneurysmatic ECAD. Eighteen percent of stenotic and 21% in \naneurysmatic ECAD have been referred to the cardiologist. A cardiac intervention \nwas performed in 43% of stenotic and 33% in aneurysmatic ECAD. Significant \nstenosis or high calcium score was found in 58% in stenotic, compared to 50% in \naneurysmatic ECAD. None of these outcomes were statistically significant.\nConclusion: Silent, significant coronary artery disease is highly prevalent in patients \nwith ECAD, either stenotic or aneurysmatic.\nB‑0589 11:51\nDual-energy CT with non-linear image blending improves \nvisualisation of delayed myocardial contrast enhancement in acute \nmyocardial infarction \nA.H. Mahnken1, P. Bruners2, K. Kartje2, B. Schmidt3; 1Marburg/DE, 2Aachen/DE, \n3Forchheim/DE (mahnken@med.uni-marburg.de) \nPurpose: To evaluate non-linear image blending in comparison with linear image \nblending in late phase dual-energy computed tomography (DECT) for the visualisa-\ntion of delayed myocardial contrast enhancement in acute myocardial infarction \n(MI) and to identify optimal parameters for non-linear image blending.\nMethods and Materials: Acute reperfused MI was induced in seven pigs by \ntemporary occlusion of the left anterior descending or left circumflex artery. Two \nhours after reperfusion contrast-enhanced late phase DECT (80 kV/140 kV) was \nperformed. DECT data were post-processed with linear and non-linear image blend-\ning techniques. Contrast and percentage signal difference between healthy and \ninfarcted myocardium as well as the blood pool of the left ventricle were computed \nfor the linear and non-linear techniques including the low and high kV images. Data \nwere compared using repeated measures ANOVA and post hoc t-tests.\nResults: Non-linear blending showed the highest signal differences for all contrasts \nand analyses. Repeated measure ANOVAs confirmed these differences to be \nstatistically significant for the different post-processing techniques (p-value ranging \nfrom < 0.001 to 0.003). Paired-samples post hoc t-tests proved the significance of \nthese results (p-value ranging from < 0.001 to 0.037). The ideal settings for non-\nlinear image blending can be deduced from the CT values of the regions of interest \nin the linearly blended images with the weighting factor 0.3.\nConclusion: Non-linear image blending improves the visualisation of acute MI in \nDECT. Non-linear image blending in late phase DECT of acute MI is superior to \nlinearly blended images as well as source images obtained at 80 kV or 140 kV.\nAuthor Disclosures:\nA.H. Mahnken: Research/Grant Support; Siemens Healthcare. Speaker; Bayer \nPharma.B. Schmidt: Employee; Siemens Healthcare.\napproach (endocardial/epicardial) was chosen based on the prevalent distribution \nof scars at LE-MDCT.\nResults: MDCT scans were prospectively ECG-triggered in 18 patients and \nretrospectively gated in 8. 10 patients showed subepicardial LE suggestive for \npost-myocarditis scars; 14 patients had LE suggestive of post-ischaemic scars \nwith subendocardial (4 patients) or transmural (10 patients) involvement; 1 patient \nhad a large transmural area of LE in myocardial dystrophy; 1 did not show any \nscar at imaging. EAM (voltage < 0.5mV) confirmed scars identified at LE- MDCT \nin 22/26 pts (85%): in 10 cases (45%) there was perfect match between LE areas \nand low-voltage areas in EAM, in 12 (55%) there was partial match and in 4 (15%) \nthere was no match. In all 22 patients with scars at imaging, RFa was always \nperformed within LE areas.\nConclusion: LE-MDCT may represent an effective alternative for scar substrate \nassessment in patients with recurrent-TV, especially when ICD was previously \nimplanted to prevent sudden death. \nB‑0586 11:24\nDynamic CT perfusion imaging of the myocardium using a wide \ndetector CT scanner: stress/rest or stress only \nA.M. Huber1, V. Leber1, B. Gramer1, M. Vembar2, A. Leber1, E. Hoffmann1, \nE.J. Rummeny1; 1Munich/DE, 2Cleveland, OH/US (armin.huber@tum.de) \nPurpose: To determine the diagnostic accuracy of dynamic CT perfusion imaging \nof the myocardium in comparison to coronary angiography (CA) and fractional \nflow reserve (FFR).\nMethods and Materials: 32 consecutive patients were examined by dynamic CT \nperfusion imaging (14 consecutive data sets) using a 256-slice scanner with 8-cm \ndetector without table movement under adenosine stress (80 kV, 250 mAs per data \nset). The semiquantitative parameters time-to-peak (TTP), area-under-the-curve \n(AUC), upslope and peak-enhancement (PE) were determined after calculation of \ntime-density curves. In addition, myocardial blood flow (MBF) was quantitatively \ndetermined. Results were compared with CA and FFR.\nResults: The area under the ROC curve, sensitivity and specificity were 0.73, \n41.7% and 90.0% for TTP, 0.67, 58.3% and 83.3% for AUC, 0.90, 83.3% and \n93.1% for US, 0.85, 83.3% and 93.3% for PE and 0.88, 75.0% and 100% for MBF, \nrespectively. The thresholds, determined by Youden´s index, were 148.5 HU*s, 12 \ns, 2.5 HU/s, 34 HU and 1.64 ml/g/min, respectively.\nConclusion: The semiquantitative parameters PE, US and the quantitative pa-\nrameter MBF showed a similar, high diagnostic accuracy. Therefore, currently it is \nunclear, if a dynamic examination can be considered as superior compared to a \nsingle shot examination at a potentially lower radiation dose. \nB‑0587 11:33\nAdvanced age and apnoea-hypopnoea index predict subclinical \natherosclerosis in patients with obstructive sleep apnoea syndrome \nB. Arık1, C. Gümüş1, M. İnci2, M. Ege3, A. Zorlu4, K. Varol1, Ö. Doğan1; 1Sivas/TR, \n2Kahramanmaraş/TR, 3Ankara/TR, 4Malatya/TR (drfatihinci@gmail.com) \nPurpose: Both obstructive sleep apnea syndrome (OSAS) and coronary artery \ncalcification (CAC) are considered to be related with the presence of coronary artery \ndisease. In this present study, we evaluate the association between OSAS and the \npresence of subclinical atherosclerosis assessed by tomographic coronary calcium \nscore in patients who had OSAS but no history of known coronary artery disease.\nMethods and Materials: Seventy-three patients who were asymptomatic for \ncoronary artery disease and had suspected OSAS were referred to overnight at-\ntended polysomnography. Patients were classified into 4 groups according to the \nApnoea-Hypopnoea Index (AHI). All patients underwent computed tomographic \nexamination for tomographic coronary calcification scoring. Physical examina-\ntion, sleep study recordings, complete blood count and serum biochemistry were \nobtained from all patients.\nResults: There were mild to moderate, moderate to severe and severe correla-\ntion between the coronary calcium score and AHI, basal oxygen saturation and \noxygen desaturation index respectively. In univariate analysis, age, AHI, basal \noxygen saturation, oxygen desaturation index and diabetes mellitus were found to \nbe univariate predictors of coronary artery calcification in patients with OSAS. In \nmultivariate logistic regression model, age (p=0.007, OR=1.082) and AHI (p=0.013, \nOR=1.034) were only independent predictors of coronary artery calcification in \npatients with OSAS with a sensitivity of 88.9% and 77.8% and a specificity of \n54.3% and 56.5%, respectively.\nConclusion: Our findings suggest that in patients with moderate or severe OSAS \nand advanced age, physicians should be alert for the presence of subclinical \natherosclerosis.\n\nScientific Sessions\nS282\n C A D E F\n G\nB\nB‑0593 10:48\nEarly-stage disease activity of the wrist in juvenile idiopathic \narthritis: assessment with MRI in a pilot study \nC.M. Nusman, R. Hemke, D. Schonenberg, J.M. van den Berg, \nK.M. Dolman, T.W. Kuijpers, M.A.J. van Rossum, M. Maas; Amsterdam/NL \n(c.m.nusman@amc.uva.nl) \nPurpose: To assess feasibility and reliability of the Juvenile arthritis MRI scoring \nsystem (JAMRIS) for the wrist to evaluate early-stage disease activity, and to \ncompare reliability of JAMRIS for the wrist for early-stage disease with the vali-\ndated paediatric-targeted MRI scoring system (PTMRIS) for children with more \nprogressive stage of disease.\nMethods and Materials: MRI datasets from 20 juvenile idiopathic arthritis (JIA) \npatients with wrist involvement were evaluated independently by three readers \nusing JAMRIS and PTMRIS. Assessment of early-stage disease activity in JAMRIS \nwas achieved through extending soft tissue scoring items (synovial hypertrophy, \ntenosynovitis) and specifying the grading of bone scoring items affecting < 25% of \nthe bone (bone marrow changes, bone erosions). Intraclass correlation coefficient \n(ICC) or Cohen's kappa was used to assess inter- and intrareader reliability. ICC of \neach JAMRIS scoring item was compared with the ICC of its equivalent in PTMRIS.\nResults: Three JAMRIS scoring items (synovial hypertrophy, bone marrow changes \nand bone erosions) showed moderate to good reliability: ICC varied from 0.62 to \n0.89 for interreader reliability and 0.28-0.95 (reader 1) and 0.88-0.97 (reader 2) for \nintrareader reliability. Reliability of tenosynovitis was moderate to poor with Cohen’s \nkappa varying from 0.24 to 0.48 (interreader) and 0.41 to 0.64 (intrareader). JAMRIS \nand PTMRIS showed similar results of interreader reliability.\nConclusion: Early JIA disease activity in the wrist can be reliably evaluated with \nthree-out-of-four features of the simple and accurate JAMRIS scoring system. Cor-\nrelating clinical disease assessment and responsiveness to change will be needed \nto validate JAMRIS for the wrist as outcome measure and disease monitoring tool. \nB‑0594 10:57\nClavicle radiographs in children: a waste of time and radiation? \nM.R. Jackson, M.-P. Lirette, P. Leonard; Edinburgh/UK \n(m.jackson@doctors.org.uk) \nPurpose: Fractured clavicles are a common childhood injury but, in our experience, \nrarely require operative intervention. The purpose of this study was to evaluate if \nclavicle radiographs make any tangible difference to clinical management in the \ncontext of possible traumatic injury.\nMethods and Materials: Retrospective analysis of all clavicle radiographs per-\nformed in our institution over the 4.5-year period since the introduction of PACS was \nundertaken. Radiographs performed for traumatic injury were reviewed to ascertain \nif a fracture was demonstrated, if follow -up radiographs were performed and if \northopaedic fixation was performed. Prospective subgroup analysis to correlate \nclinician confidence of the likelihood of fracture is ongoing at the time of submission.\nResults: Between Feb 2008 and August 2012, 995 clavicle radiographs were \nperformed, of which 934 were taken in the context of possible acute traumatic \ninjury. 625 demonstrated an identifiable clavicle fracture (67%), with 22 radiographs \nshowing equivocal findings or a bone injury outwith the clavicle. In those found to \nhave clavicle fractures, 32 follow -up radiographs were performed in 26 individu-\nals (4%). Orthopaedic fixation was not performed in any of the identified cases.\nConclusion: Despite a high pick-up rate of fractures, clavicle radiographs do not \nappear to substantially alter clinical management. In our centre, immobilization \nis the usual management for suspected traumatic clavicle injury, regardless of \nradiographic appearance. We suggest that, in the context of an experienced pae-\ndiatric Emergency Department team, radiographs are reserved for patients causing \nconcern at follow-up and are not required routinely at presentation. \nB‑0595 11:06\nA follow-up study of a delayed approach to managing developmental \nhip dysplasia (DDH) \nL. Woods, M. Khalil, A. Witwit, S. Manickam, M. Churchill, V. Cook; London/UK \n(liamwoods@doctors.org.uk) \nPurpose: To assess the results of a delayed approach to managing DDH, a local \nsystem of 23 years duration.\nMethods and Materials: 262 patients over 4 years with at least 3 ultrasound \nexaminations of the hips were included, to identify follow -up patients. DDH type \nwas recorded and treatment determined by patient records. The treatment group \nunderwent follow-up radiography for up to 5 years.\nResults: There were 12,840 live births, of which between 28 and 32% each year \nunderwent ultrasonography of the hips based on inclusion criteria. Less than 0.06% \n10:30 - 12:00 Room P \nPaediatric \nSS 912 \nPaediatric body and bones \nModerators: \nK.J. Johnson; Birmingham/UK \nL.-S. Ording-Müller; Tromsø/NO \nB‑0590 10:30\nAccuracy of ultrasound using a computerised technique to evaluate \nnonalcoholic fatty liver disease in obese and eutrophic adolescents \nas compared with MRI \nJ.H.R.N. Nascimento, R.B.S. Soder, M.E. Epifanio, M.B. Baldisserotto; \nPorto Alegre/BR (josehermesnascimento@gmail.com) \nPurpose: To compare the accuracy of ultrasound (US) with computerised analysis of \nthe hepatorenal gradient (HRG) to MRI for the evaluation of NAFLD in adolescents.\nMethods and Materials: This prospective transversal study evaluated 50 ado-\nlescents (aged 11-17 years), including 24 obese and 26 eutrophic individuals. All \nadolescents underwent computer-based US, MRI, laboratory exams, and anthro-\npometric evaluation. Posterior generation of the receiver operating characteristic \n(ROC) curve was performed, and the area under the ROC curve was calculated \nto determine the cutoff point for the HRG and to predict levels of steatosis. The \nsensitivity, specificity, positive and negative predictive values and accuracy of US \nwith computerised analysis were compared with those of NMRI as the gold standard.\nResults: The obese group Included 29.2% girls and 70.8% boys, and the eutrophic \ngroup included 69.2% girls and 30.8% boys. The prevalence of NAFLD was 19.2% \nfor the eutrophic group and 83% for the obese group. The ROC generated for the \nHRG, with a cutoff point of 13, had 100% sensitivity and 100% specificity. Use of \nthis same cutoff point for the eutrophic group led to a false-positive rate of 9.5% \n(90.5% specificity) and false-negative rate of 0% (100% sensitivity).\nConclusion: Ultrasound with computerised analysis of the HRG is a simple and \nnoninvasive technique for the quantitative evaluation of hepatic ecogenicity that \ncould be used to help identify obese and eutrophic adolescents with NAFLD. This \nmethod could be used in population tracking for NAFLD and for by clinical issues. \nB‑0591 10:39\nCan ultrasonography reliably differentiate between ileo-colic and \nsmall bowel intussusception? \nN. Simanovsky1, N. Lioubashevsky2, K. Rozovsky2, N. Hiller2; 1Beth Horon/IL, \n2Jerusalem/IL (natalias@hadassah.org.il) \nPurpose: Sonographic findings for ileo-colic intussusception (ICI) and small bowel \nintussusception (SBI) are similar. We sought clinical and sonographic criteria that \ncan be used to confidently differentiate these lesions.\nMethods and Materials: We retrospectively evaluated ultrasound and clinical \ndata for children diagnosed with intussusception in 2007-2011. Diameter of the \nintussusception, fat core diameter, outer bowel wall thickness, and the presence/\nabsence of lymph nodes inside the intussusception and mesentery were noted. \nThe ratio of inner fat core (IFC) diameter to outer wall thickness (core-to-wall index \n[CWI]) was calculated. Characteristics for ICI and SBI were compared using the \nT-test, and Mann-Whitney, Levene, Chi-square, and Fisher’s exact tests.\nResults: There were 200 cases of intussusception in 174 consecutive patients \n(126 males/48 females; mean age 17.2 months; 57 SBI [28.5%] 143 ICI [71.5%]). \nMean ICI lesion diameter was 2.63 cm (1.4-4) vs 1.42 cm (0.8-3) for SBI. Mean ICI \nfat core diameter measured 1.32 cm (0.6-2.2) vs 0.1 cm (0-0.75) for SBI. The CWI \nwas ³1 in all ICI, and [[Unable to Display Character: ˂]]1 in all SBI (p[[Unable \nto Display Character: ˂]]0.0001). Lymph nodes inside the lesion were seen \nin 90.7% of ICI vs 14.4% of SBI (p[[Unable to Display Character: ˂]]0.0001). \nChildren with ICI had a more severe clinical picture with more vomiting (p=0.003), \nleucocytosis (p=0.003), and blood in the stool (p=0.0005).\nConclusion: The presence of a central fatty core in the intussusception, its diameter \nand wall thickness, the ratio of fatty core thickness to outer wall thickness, and the \npresence of lymph nodes may reliably differentiate between ileo-colic and small \nbowel intussusceptions.\n\nScientific Sessions\nS283\nA\n C D E F G\nB\nSaturday\nB‑0598 11:33\nDXA as a key instrument for the evaluation and the follow-up of \nadolescents affected by anorexia nervosa \nF. Ciccarese, G. Facchini, E. Di Pietro, F. Moscano, L. Iero, E. Franzoni, \nG. Battista, A. Bazzocchi; Bologna/IT \nPurpose: Anorexia nervosa (AN) is an eating disorder characterised by alteration \nof bone metabolism (osteopenia) and of body composition (reduction and abnormal \ndistribution of fat mass-FM and lean mass-LM), due to oestrogen deficiency and self \nstarvation. The aim of our study was to address bone metabolism and body changes \nin a cohort of patients with AN by using Dual-energy x-ray-Absorptiometry (DXA).\nMethods and Materials: Prospective study on 75 patients with AN, submitted to \nDXA at baseline-T0 and after 12months-T12. We evaluated total and regional FM \nand LM percentages, as well as lumbar bone mineral density-BMD and Z-score, \nlinking them to clinical variables: menarche/amenorrhea/hormonal therapy and \nphysical activity.\nResults: Among the 46/79-58.2% patients that completed the study the T0 clini-\ncal condition was as follows: BMI=16.4±1.4 kg/m2, low levels of FM percentage \n(21.7±5.7%), osteopenia (Z-score:-1.21±1.27SD, with higher values related to \nphysical activity-p=0.001). At T12: significant increase in BMI-p=0.001, with LM \nreduction and FM increase (more evident in the trunk-p < 0.001); regarding bone, \nno significant changes were observed, though a tendency in terms of improvement \nassociated with resumption of menses was manifested.\nConclusion: After one year, significant conclusions on bone metabolic condition \ncould not be reached. By contrast, weight recovery was associated with the increase \nof FM and a distortion of its distribution, more evident in trunk region (potential and \nadjunctive risk factor for the relapse of the psychiatric condition). The complexity \nof these clinical findings suggested that DXA, a low-dose and low-cost technique, \ncould have a key role in long-term monitoring of AN patients. \nB‑0599 11:42\nReplacing conventional spine radiographs with dual-energy x-ray \nabsorptiometry (DXA) in children with suspected reduction in bone density \nE. Adiotomre, L. Summers, P. Broadley, I. Lang, G. Morrison, A. Offiah; \nSheffield/UK (eseadio@googlemail.com) \nPurpose: Children have greater lifetime risks of radiation-induced complications \ncompared to adults. In children with osteogenesis imperfecta conventional radio-\ngraphs are obtained to assess spine morphometry, while DXA assesses bone \ndensity. In adults DXA is used for both. We aim to establish whether iDXA can \nreplace spine radiographs in assessment of paediatric vertebral morphometry.\nMethods and Materials: An 18-month prospective study of 200 consented chil-\ndren (5 to 15 years old) with and 50 without suspected reduction in bone density, \nwho had lateral spine radiographs and lateral DXA scans on the same day, was \nconducted. Three observers will independently assess all images (blinded to cor-\nresponding results of radiographs and DXA) using a modified ABQ technique. 100 \nrandom images will be interpreted twice. Diagnostic accuracy and inter- and intra-\nobserver reliability of DXA will be compared to the gold standard of radiography. \nPatient/carer experience, DXA radiation dose compared to radiographs and health \neconomics will be assessed.\nResults: Interim analysis of the first 50 recruited patients showed 26 had 1 or \nmore vertebral fractures. The fracture detection sensitivity for DXA was 62.7% and \nspecificity 87.8%. The overall accuracy for vertebral fracture detection with DXA \nwas 83.5%. The overall agreement between radiographs and DXA was 68.7%.\nConclusion: The modified ABQ technique has limitations in children and a more \nreliable scoring system is required. Compared to radiography DXA does not ap-\npear to be worse for morphometry and given the reduced dose and comparable \nimage quality, DXA should be recommended for morphometry in children pending \nmore robust analyses. \n(n=221) had DDH necessitating 3 or more ultrasound examinations, of which 23% \n(n=50) required treatment. There was one case of missed hip dislocation, represent-\ning 0.0001% of unexamined patients. No patients with IIC hips at presentation with \nconservative management represented with a dislocated hip. Radiographs in the \ntreated group demonstrated a satisfactory outcome in 94%. One patient represented \nwith a dislocated hip following erroneous cessation of harness treatment and went \non to develop early avascular necrosis. Two patients were lost to follow-up.\nConclusion: A delayed approach to managing DDH in infancy allows those patients \nwith ultrasonographically immature hips the opportunity to develop normally without \ninvasive treatment and identifies patients which would most benefit from treatment. \nThis reduces the demand on resources that a DDH screening programme which \ntreated patients more promptly would incur. Within the same financial constraints, \nthis allows more patients to be selected for screening. A delayed approach results \nin a satisfactory outcome with no subsequent late dislocation in those treated \nappropriately. \nB‑0596 11:15\nValue of lower-limb MRI in the staging and re-staging of \npost-treatment osteonecrosis in paediatric patients with \nlymphoproliferative disease \nA. Masetto, D. Ippolito, P.A. Bonaffini, L. Longoni, A. Sala, A. Rovelli, S. Sironi; \nMonza/IT (dr.masetto@gmail.com) \nPurpose: To assess the diagnostic value of MRI in detecting and monitoring \npost-treatment osteonecrotic lesions in paediatric patients with lymphoprolifera-\ntive disease.\nMethods and Materials: 109 patients (60 males, mean age 12 years) with lym-\nphoproliferative disease treated with chemotherapy (71) or bone marrow transplant \n(38), and with clinical suspicion of lower limbs osteonecrosis, underwent a lower-\nlimb MRI examination between November 2006 and August 2012. The study was \nperformed on a 1.5 T scanner (Philips, Achieva), acquiring short tau inversion \nrecovery (STIR) long TE and T1-weighted sequences in the coronal plane from \nthe hips to the ankles, with an average acquisition time of 18 minutes. Additional \nsequences were performed in selected cases (e.g. restaging known osteonecrosis \nof the hip with articular deformity).\nResults: On the baseline or follow-up MRI, 72/109 patients showed osteonecrosis, \nwith a total of 424 lesions (5 hips, 195 femurs, 19 patellae, 159 tibiae, 7 fibulae, \n39 ankle and foot bones). 151/424 involved articular surface and 33 lesions had \narticular deformity. 58/109 patients had osteonecrosis on the baseline study: 35/58 \nunderwent follow-up and 7 of them developed articular deformity. 51/109 patients \ndid not show osteonecrosis at baseline examination and 15 of them developed at \nfollow-up examination osteonecrotic lesions (4 with articular deformity). Moreover, \n8 patients showed concomitant neoplastic lesions.\nConclusion: Our MRI protocol proved to be quick and feasible in detecting and \nmonitoring osteonecrosis in haematologic paediatric patients, impacting both their \nprognosis and their management in terms of treatment and follow-up.\nB‑0597 11:24\nPainful paediatric hip: frog-leg lateral view only! \nJ. Bomer, F. Klerx, H.C. Holscher; Den Haag/NL (j.bomer@hagaziekenhuis.nl) \nPurpose: In cases of hip complaints in the paediatric population it is common \npractice to acquire both AP and frog-leg lateral (FL) radiographs. The combination \nof these views has a diagnostic yield, but also doubles the radiation exposure. In \nour observation, the FL view alone is often diagnostic. We therefore investigated \nthe diagnostic accuracy of obtaining a solitary FL view as compared to a combina-\ntion of the AP and FL views.\nMethods and Materials: Children aged 2-15 years who were sent in for hip radio-\ngraphs between September 2007 and January 2011 were included in the study. \nCases of related trauma or a history of hip pathology were excluded. Radiographs \nwere retrospectively assessed by two independent radiologists. Radiologists were \nblinded for the AP radiograph while assessing the FL radiograph and vice versa \nand radiographs were presented in a random order. We used the Kappa test to \ncalculate interobserver agreement and agreement between the assessment of \nboth views and the solitary FL view.\nResults: 524 children (mean age 8.1 yrs) met the study criteria and were included \nfor analysis. 477 children had a normal exam and 47 were considered abnormal. \nCalculated interobserver agreement using the Kappa test was 0.96. Agreement \nbetween the solitary FL view and the combination of the AP/FL view was 0.989.\nConclusion: The diagnostic accuracy of the FL radiograph in case of hip complaints \nin children is as high as the current standard of both AP and FL views.\n\nScientific Sessions\nS284\n C A D E F\n G\nB\nand healthcare centres. Statistical analysis was made using descriptive statistics, \nMann-Whitney and Kruskal-Wallis tests in order to verify correlation between items.\nResults: Radiographers consider that it is essential the implementation of a qual-\nity control program in the radiology department, but there is lack of information \nin this field, and 53.2% do not know what a quality control program is. 96% of \nradiographers claim their institutions do not have quality control programmes or \naccreditation. However, 25.5% had received education on quality and 85% make \nregular personnel radiation measures. Also, despite there is no lack of radiological \nprotection equipment in most departments, 77.4% claim they are in poor condition. \nConclusion: Quality control programs are essential to the radiology department \nand radiation safety guidelines must be implemented. Despite that some radiology \ndepartments have radiological protection equipment often applied by radiographers, \ntheir effectiveness and condition must be checked regularly. \nB‑0603 10:57\nAssessment of radiological imaging conformities based in quality \ncontrol charts \nS. Cândido, A.M. Ribeiro, L.P.V. Ribeiro, A.F.C.L. Abrantes, J. Pinheiro, \nK.B. Azevedo, R.P.P. Almeida; Faro/PT (susanacandido@msn.com) \nPurpose: Applying control charts to demonstrate the importance of implementing \na radiological imaging quality control system.\nMethods and Materials: Research conducted in a public hospital comprising a \ntotal of 1110 randomly selected exams (640 chest studies, 340 abdominal stud-\nies and 130 foot studies) grouped in 37 samples, each one with 30 exams. The \nconformities and non-conformities found were used to establish three types of \nquality control charts based on the evidence collected, namely the proportion of \nconformities and non-conformities (p), the total number of non-conformity exams \n(np) and the total number of non-conformities in each sample (c) in order to suggest \ncorrective actions for improvement.\nResults: Considering all exams, 57% are non-conformities and 43% are within \nconformities. Of 640 chest studies, 40% were within conformities and 60% were \nnon-conformities; of 340 abdominal studies, 46% were within conformities and 54% \nwere non-conformities. Foot studies had an almost even distribution of conformities \nand non-conformities with 51 and 49%, respectively.\nConclusion: This research allowed the identification of different types of non-\nconformities found in radiological images which have impact on imaging quality. \nTherefore, the existence of adequate quality control of radiographic imaging is \nessential. \nB‑0604 11:06\nA review of diagnostic imaging frequency to aid research exploring \nthe issue of consent for higher dose paediatric examinations \nJ.L. Portelli1, J. McNulty2, S. Mohan2, P. Bezzina1, L. Rainford2; 1Msida/MT, \n2Dublin/IE (jonathan.portelli@um.edu.mt) \nPurpose: Concerns have grown in recent years in relation to potential radiation-\nrelated risks associated with diagnostic imaging examinations performed on \npaediatrics (< 18 years). This retrospective cohort study aims to provide an insight \ninto the use of potentially higher dose computed tomography (CT) and fluoroscopy-\nguided examinations in paediatrics, in two national clinical centres of comparable \ncatchment areas in Malta and Ireland.\nMethods and Materials: Retrospective data, of higher dose diagnostic imaging \nexaminations performed in paediatrics in 2011, was collected from departmental \nlogbooks and radiology information system (RIS) databases of the participating \ncentres. This data included details pertaining to patient’s age, type of examination \nand relevant examination kV, mAs, DAP, fluoroscopy time, CTDI and DLP (if avail-\nable). Data were categorised according to age and examination type, and effective \ndose estimates for CT were calculated.\nResults: In 2011 alone, at least 2,093 CT examinations, 1,532 fluoroscopy-guided \nprocedures and 438 cardiac catheterisation interventions were performed on paedi-\natrics across both centres. Particular complex fluoroscopy-guided interventions had \nan associated DAP exceeding 10,000cGy.cm2, while effective dose estimates for \nCT examinations indicated that some paediatric patients may receive a moderate \n(> 3-20mSv) or high radiation dose (> 20-50mSv).\nConclusion: Paediatric patients may undergo examinations that potentially involve \na high dose of ionising radiation. Further research to explore the debated issue \nof benefit-risk communication and consent in paediatric imaging is therefore justi-\nfied and encouraged, particularly as the study’s findings also indicate that repeat \nor multiple imaging examinations of different anatomical areas are commonly \nperformed in CT. \n10:30 - 12:00 Room Q \nRadiographers \nSS 914 \nDose optimisation as daily challenge \nModerators: \nP. Blackburn Andersen;  Kolding/DK \nA. Petakovic; Novo Mesto/SI \nB‑0600 10:30\nEstimating organs cancer incidence related to patient radiation \nexposure following PCI for acute and chronic coronary total occlusion \nD. Maccagni; Milan/IT (maccagni.davide@gmail.com) \nPurpose: To estimate the lifetime attributable risk (LAR) of cancer incidence for \nindividual organs following radiation exposure during PCI in the context of two op-\nposite sides of angiographic spectrum of coronary occlusive disease: ST-elevation \nmyocardial infarction (STEMI) and chronic coronary total occlusion (CTO).\nMethods and Materials: We identified all consecutive patients treated with PCI for \nSTEMI (n=555) and for CTO (n=543) in a tertiary care centre in 6 years. The LARs \nof cancer incidence for six organs (colon, liver, lung, red bone marrow, stomach \nand thyroid) were estimated using the Biological Effects of Ionising Radiation \n(BEIR) VII model.\nResults: The estimated LARs of cancer incidence for individual organs was found \nto markedly increase as the age of the patient decreases and was significantly \nhigher for the lung (additional risk up to 18/100.000 person’s lifetime exposure in \nCTO and 9/100.000 in STEMI patients, respectively, p < 0.0001) and for the red \nbone marrow (up to 3.5/100.000 and 1.5/100.000, respectively, p < 0.0001). In \nboth the groups, the estimated LAR of cancer incidence for stomach, colon, liver \nand thyroid was similar and very low.\nConclusion: In PCI procedures, the lung was the organ with the highest radiation \nabsorbed. According to BEIR-VII model, the number of additional cancer cases for \nindividual organs was on average two times higher in patients treated with PCI for \nCTO and the highest LARs were for lung and red bone marrow cancers. \nB‑0601 10:39\nProject retake: quality assurance of radiation hygiene by maintaining \nimage quality \nS.M. Khan; Oslo/NO (SAHIRA.M.KHAN@HOTMAIL.COM) \nPurpose: To reduce the extent of retake while maintaining image quality.\nMethods and Materials: The research was conducted in two digital x-ray labs, data \nfor six months were analysed by quantitative method. Patient data: id, information of \nretakes was stored at modality, post-examination. 750 random patients, undergoing \nstandard x-ray examinations, were selected each month. A standard examination \ncontains two or three exposures, front oblique and/or lateral. Radiographers were \nencouraged to choose a cause for retake. Analysis contained: type of examination, \nnumber of projections, number of exposures and retake reason per patient. The \ncauses are systemised in the modality, ready to select if there is a retake. Reject \noptions were radiographer, patient or student failure.\nResults: There was an average of 234 retaken images out of 750 examinations. \nThat is to say, 30% margin of error. 28% of the standard examinations were retakes; \nthe reject option was radiographer failure. Rest 2% was patient or student failure. \nAs a result of this a PGMI test is established for the digital labs to test quality as-\nsurance. Results after this quality assurance give a reduction of 110 retakes per \nmonth. A reduction of 50% retakes due to radiographer failure.\nConclusion: Environment, method, monitoring and feedback, influence radiogra-\npher result and radiation dose to patients. Radiographers using digital x-ray need \nquality assurance as in mammography. PGMI usage will give feedback to maintain \nimage quality and reduce radiation dose. \nB‑0602 10:48\nImplementation of a quality control program in a radiology department \nM. Leão, L.P.V. Ribeiro, A.F.C.L. Abrantes, J. Pinheiro, R.P.P. Almeida, \nK.B. Azevedo, S.I. Rodrigues; Faro/PT (rui_ppa@hotmail.com) \nPurpose: To evaluate the importance that radiographers give to quality control pro-\ngrams, radiological protection and the verification of radiological protection criteria.\nMethods and Materials: A 30-item quality control assessment and radiological \nprotection questionnaire was applied to radiographers working on public hospitals \n\nScientific Sessions\nS285\nA\n C D E F G\nB\nSaturday\nviability was tested by performing two tests on the lateral position of the lumbar \nspine, with a phantom.\nResults: The results obtained using the aluminum filter resulted in a reduced vari-\nation in relative dose rate (9%) compared to not using the filter as well as a 32% \nreduction in dose to the entrance surface of the skin.\nConclusion: Regarding the image quality, it has been found that the use of filter \npresents significant reasons the optimisation of this parameter. These results \nindicate that the use of the filter should be considered as a good practice in the \nlumbar spine radiography to achieve dose reductions. \nB‑0608 11:42\nAntero-posterior (AP) pelvic radiography: collimator errors and their \neffects on radiation dose \nH. Brookfield1, A.S. Manning-Stanley2, A. England1; 1Liverpool/UK, 2Salford/UK \n(aengland@liverpool.ac.uk) \nPurpose: To investigate the range of collimator errors in x-ray rooms and to \ncalculate their possible effects on the radiation dose for AP pelvis examinations.\nMethods and Materials: A collimator test tool was suspended at three heights (14, \n21 and 28 cm) above the table bucky in nine x-ray rooms. Heights corresponded to \nthe patient thickness (mean, ±2SD) in 100 patients. The x-ray beam was visually \ncollimated to the inner boundary of the test tool and exposed to radiation. Differ-\nences between the visualised field size and the resultant x-ray field size (corrected \nfor magnification) would indicate any collimator errors. On the pelvic phantom \nminimum textbook collimation was set and then changed in order to simulate a \nrange of possible collimator errors. Phantom examinations used a standard tech-\nnique with exposure termination using outer AEC chambers. Dose-area-product \n(DAP) was recorded.\nResults: Out of nine x-ray rooms all but one produced a smaller irradiated area \nthan was visually set. Errors ranged from a 16% reduction in irradiated field size to a \nslight over irradiation by 0.4%. With the possibility that these errors could be larger \nin other institutions a range of (-27% to +18%) errors were simulated. Increasing \nthe field size by 1 cm (superior/inferiorly) increased the DAP by 5%. Laterally, a 1 \ncm increase caused a 4% rise. Increases of 1 cm in both planes raised DAP by 4%.\nConclusion: In this study collimator errors were minimal and favoured under \nirradiation. Small errors can affect DAP and are more dose significant in the \nsuperior/inferior plane. \nB‑0609 11:51\nBreast shielding significantly reduces breast dose during lumbar \nspine radiography \nN. Mekiš, D. Žontar, D. Škrk; Ljubljana/SI (nejc.mekis@zf.uni-lj.si) \nPurpose: As use of protective shielding for the patient in conventional radiography \nvaries widely in practice, the study aimed at providing objective answer about the \neffect of lead rubber sheet shielding for a specific case of breast dose during the \nlumbar spine radiography. Influence of the body mass index on the breast dose \nwas also investigated.\nMethods and Materials: The study was conducted both on an anthropomorphic \nphantom and on a cohort of 100 female patients, randomly divided into two equal \ngroups. In both cases lumbar spine imaging was conducted in AP and lateral \nprojection with and without the lead shield (in case of the patient study the shield-\ning was used in one group only). The dose was measured by thermoluminescent \ndosimeters (TLD) placed at the centre of the breast.\nResults: Using the lead shielding dose to the right breast was reduced from \n0.45±0.25 mGy to 0.09±0.07 mGy (p < 0.001) and the dose to the left breast from \n0.26±0.14 mGy to 0.06±0.04 mGy (p < 0.001), compared to the unshielded breast. \nOn average, the breast dose was reduced by approximately 80%. No correlation \nbetween the body mass index (BMI) and the breast dose was found.\nConclusion: Based on the results, we can conclude that the use of breast shield-\ning is recommended in lumbar spine radiography. Despite the low-dose exposure \neven without shielding, the dose can be further reduced. Moreover, the quality of \nthe x-ray image is not affected by the use of the lead shield. \nB‑0605 11:15\nAn approach for Portuguese diagnostic reference levels for bedside \nchest radiography \nA. Sousa, S. Serém, J. Santos, G. Paulo; Coimbra/PT \n(sarajoanacs@hotmail.com) \nPurpose: Bedside chest radiography represents the most commonly performed \nexamination. Taking into account the different protocols and equipments it is im-\nportant to develop diagnostic reference levels, in order to promote a patient safety \nculture and consequently health care best practice.\nMethods and Materials: This research was carried out in two imaging department \ncentres from the same geographic region (Hospital A and Hospital B). In phase \none, the exposure parameters and entrance skin dose (ESD) value of 40 bedside \nstandard patients’ chest radiography were collected. To optimise the obtained dose \nvalues in Hospital B more 15 bedside standard patients’ chest radiography were \ncollected on phase two, using parameters of Hospital A, that had already went \nthrough an optimisation process.\nResults: In phase one Hospital A ESD value was statistically lower (16.45 μSv) \nin comparison to Hospital B (21.94 μSv). In phase two Hospital B decreased sig-\nnificantly the ESD value (17 μSv) in comparison with the phase one, but with no \nsignificant differences with Hospital A.\nConclusion: Patients in Hospital B at phase one were 25% more exposed to \nionising radiation than patients from Hospital A for the same procedure. The imple-\nmentation of optimised protocols at phase two reduced the dose levels in 29.1% in \nthe Hospital B. The regional DRL for bedside chest radiography was set at 17 μSv.\nB‑0606 11:24\nAn investigation into the relationship between the exposure index \nvalue and image quality \nM.-L. Butler, L. Rainford; Dublin/IE (marielouise.butler@ucd.ie) \nPurpose: ‘Exposure creep’ is a documented phenomenon in computed radiog-\nraphy (CR) where radiation dose is given unnecessarily to patients due to CR’s \nprocessing capabilities. Manufacturers have responded by developing an exposure \nindex (EI), which is a measurement of detector dose and hence relates to noise in \nthe image. This study aimed to identify how the EI value relates to image quality \nin clinical practice.\nMethods and Materials: Three imaging suites and five radiographic examinations \nwere included: ankle and wrist series (antero-posterior (AP) and lateral); AP and \nlateral lumbar spine; AP pelvis and postero-anterior (PA) chest projections. In \ntotal, 306 examinations were documented with a minimum of 10 patients for each \nprojection. Twelve patient images representative of each projection were selected \naccording to their Agfa lgM value; 3 low, median and high lgM values and images \nrecording 3 lgM values closest to the manufacturers’ guidelines. Three observers, \nexperienced radiographers (minimum of 6 years working clinically), reviewed the \nimages for noise and overall exposure of the image. In addition the observers \nindicated what EI value they judged appropriate to image presentation.\nResults: No significant difference in image quality was noted across the categories \nof lgM when considering noise (Chi-Square (12)=19.265, p=0.082) or exposure \n(Chi-Square (12)=18.012, p=0.115). lgM values judged by observers as representa-\ntive of image quality were lower than those recorded clinically.\nConclusion: No correlation with lgM and clinical image quality was identified in \nthis study. Further research is recommended to include additional manufacturers \nand radiographic examinations. \nB‑0607 11:33\nAttenuation of anode heel effect with an aluminum filter and their \ninfluence on patient dose in lumbar spine radiography \nJ. Soares, R. Dores, P. Sousa, S.I. Rodrigues, L.P.V. Ribeiro, A.F.C.L. Abrantes, \nR.P.P. Almeida; Faro/PT (joana.soares.8@hotmail.com) \nPurpose: Study the attenuation of anode heel effect with an aluminum filter, \nthereby optimising the image quality, without increasing the patient dose exposure.\nMethods and Materials: This study was performed in a radiology department \nwith a conventional radiology equipment. The filter construction was based on the \nradiographic study of the lumbar spine in a lateral position, and used the following \ntechnical parameters: 80 kV, 10 mA, 100 ms and 90.2 cm of SID. Experiments were \nperformed to study the behaviour of anode effect along the longitudinal anode-\ncathode axis. Measurements of dose rate using the Detetor Unfors Xi RF was \ncarried out. This detector also allowed performing the equipment quality control. \nIn order to standardise the variation in beam intensity of x-ray filters were used \nwith different thicknesses of aluminum to reduce the value of the dose rate and \nto determine the thickness of the filter construction. After construction of the filter, \n\nScientific Sessions\nS286\n C A D E F\n G\nB\nConclusion: The stereological approach enables the quick estimation of RV \nparameters with high accuracy and reproducibility from MR images.\nB‑0612 10:48\nAutomated computerized software for diameter and volume \nmeasurements of pulmonary metastatic disease: preliminary evaluation \nE. Lotan, D. Aharoni, S. Raskin, B. Boursi, R. Berger, E. Konen; Ramamt Gan/IL \nPurpose: Serial CT scans of metastatic tumours are vital in assessing the efficacy \nof cancer treatment. We evaluated the performance of a novel automated com-\nputerized software system that integrates registration, segmentation and tumour \nmeasurement into a single process to expedite RECIST measurement with the \naddition of volume measurement.\nMethods and Materials: Measurements of long and short-axis of 50 lung meta-\nstatic lesions in 18 sequential patients with metastatic renal cell carcinoma were \nmanually obtained twice by 3 radiologists. Those measurements were compared \nwith automated software measurements (Carestream Health, Rochester, NY). In \naddition, the software automatically identified the lesions’ contours and volumes; \nthe readers could accept the automated measurement or correct it manually. \nIntraobserver correlation was assessed by intraclass correlation coefficient (ICC), \nand interobserver reliability by the concordance correlation coefficient (CCC) and \nBland-Altman limits of agreement.\nResults: The intraobserver agreements (ICC) for long/short axis and volume were in \nrange of 0.878-0.943/0.905-0.948 and 0.984-0.995, respectively. The interobserver \nagreement (CCC) between radiologists’ and software measurements for the long \naxis ranged from 0.836 to 0.947 vs 0.820 to 0.989 between different radiologists, \nfor the short axis 0.923-0.974 vs 0.839 0.955, and for volume 0.911-0.941 vs \n0.968-0.991. The mean relative difference of software vs radiologists’ measure-\nments corresponds to 2.5% overestimated volume (95% CI=98.4%, 106.8%) of \nthe software compared to radiologists’ evaluation.\nConclusion: Automated computerized software might have an important and reli-\nable role in current RECIST evaluations, expanding its availability and efficiency, \nas well as providing potential additional benefit of automated volume determination \nfor other future response criteria.\nB‑0613 10:57\nComputerised morphological estimation of sex and age - from \nsubjective investigation to computer-assisted analysis \nA. Vlcek, F. Kanz, W. Weninger, J. Streicher, D. Risser, F. Kainberger; Vienna/AT \n(alexander.vlcek@meduniwien.ac.at) \nPurpose: The aim of this feasibility-study was to develop a computerised method \nfor sex estimation with its age-associated changes to the skeleton on macerated \nskulls for comparison with subjective assessments applying the osteoscopic \nKnußmann scheme.\nMethods and Materials: 24 skulls of Europeans, 12 males (aged 23 to 77 years, \nmean 45.58 years) and 12 females (aged 22 to 75 years, mean 46.17 years) from \nlocal historical collections, were scanned with a 64-row multidetector CT (pitch=0.64) \nand modelled with AMIRA 5.4. to calculate the percentual deviation of the local \nconcavity or convexity of 5 sex specific traits (frontal bone zygomatic bone, mastoid \nprocess, planum nuchale and mentum) as measured with the shape index. Based \non that different surface shapes and two indices were defined and sex differentiat-\ning formulas were developed with the regression analysis. This computer-assisted \ntechnique was compared with the Knußmann scheme and the documented sex \nwith the two-sided Fisher’s exact test.\nResults: Performing the regression analysis an accuracy of 100% was reached at \nthe frontal bone, the mentum, the planum nuchale and the right zygomatic bone, \nbut it ranged between 75 and 100% at the left zygomatic bone and the mastoid \nprocess bilateral. The application of the Knußmann scheme ranged between 4.2 \nand 100%. Besides that changes to the surface could be demonstrated partly as \na feature during adultery.\nConclusion: Results show, that the computerised technique may be superior to \nsubjective definitions. The lower accuracies may be reasoned by the variability of \nexisting sutures and age.\nB‑0614 11:06\nSemiautomatic evaluation of quantitative pharmacokinetic \nparameters - systematic evaluation of a new CAD-tool and evaluation \nof clinical performance at high field 3 T MRI \nM. Dietzel, A. Dörfler; Erlangen/DE \nPurpose: Widespread use of quantitative perfusion-MRI is still hampered by sophis-\nticated post-processing and lack of commercially available semi-automatic software \n10:30 - 12:00 Room Z \nComputer Applications \nSS 905 \nComputer-aided diagnosis \nModerators: \nT. Mang; Vienna/AT \nD. Regge; Turin/IT \nB‑0610 10:30\nAutomated characterisation of pulmonary nodules in thoracic CT \nimages using a segmentation-based classification system \nC. Jacobs1, E.M. van Rikxoort2, J.-M. Kuhnigk1, E.T. Scholten3, P.A. de Jong4, \nC. Schaefer-Prokop5, M. Prokop2, B. van Ginneken2; 1Bremen/NL, 2Nijmegen/NL, \n3Haarlem/NL, 4Utrecht/NL, 5Amersfoort/NL (colin.jacobs@mevis.fraunhofer.de) \nPurpose: Clinical guidelines for follow-up of pulmonary nodules depend on nod-\nule type and therefore accurate characterisation of nodules is important. A novel \ncomputer-aided diagnosis (CAD) system to distinguish solid, part-solid and non-\nsolid nodules is presented and evaluated on a large data set from a lung cancer \nscreening trial.\nMethods and Materials: The automated characterisation system is based on a \npreviously published nodule segmentation algorithm. Four different parameter set-\ntings were used to extract the solid part, non-solid part and solid core of the lesion. \nFor each segmentation, volume, mass, average density, 5 th percentile and 95 th \npercentile of densities inside the segmentation were used as features. A k-nearest-\nneighbour classifier was used to classify nodules. The accuracy of the system to \ndifferentiate between solid and subsolid nodules, between solid, part-solid and \nnon-solid nodules and between part-solid and non-solid nodules was evaluated.\nA data set consisting of 137 low-dose chest CT scans (16x0.75 mm, 120-140 kVp, \n30 mAs) with 52 solid, 50 part-solid and 50 non-solid nodules was collected from \na screening trial. The nodule type recorded in the screening database was used \nas the reference standard. Experiments were performed in leave-one-nodule-out \ncross-validation.\nResults: The accuracy of CAD to differentiate between solid and subsolid nod-\nules was 0.88. Differentiation into solid, part-solid and non-solid nodules gave an \naccuracy of 0.72. CAD had an accuracy of 0.71 in differentiating part-solid from \nnon-solid nodules.\nConclusion: Automated characterisation of pulmonary nodules shows good \nperformance. This can aid radiologists to decide on appropriate workup in clinical \npractice. \nAuthor Disclosures:\nC. Jacobs: Research/Grant Support; MeVis Medical Solutions AG.\nB‑0611 10:39\nSemiautomatic estimation of right ventricular parameters from MR \nimages: a new stereological approach \nM. Mazonakis, K. Pagonidis, C. Varveris, J. Damilakis; Iraklion/GR \n(mazonak@med.uoc.gr) \nPurpose: Right ventricular (RV) volume and ejection fraction (EF) assessment is \nof clinical value. This procedure, based on manual delineation of the endocardial \ncontours on MR images, is time-consuming due to ventricle’s complex shape. We \nintroduce a stereological method for estimating RV parameters from MRI data \nwithout the need for image segmentation.\nMethods and Materials: Twenty-two consecutive patients with coronary artery \ndisease underwent cardiac MRI. Stereological estimations involved the automatic \nplacement of a systematic grid of test points with random orientation over short-\naxis images. All points hitting the RV were counted using the semiautomatic point \nselection process. The optimum point spacing of the grid was defined. The software \nautomatically provided the RV volumes and EF. Two independent observers evalu-\nated the measurement reproducibility. Stereological estimations were compared \nwith those determined by manually tracing RV contours.\nResults: Acceptable estimations of RV parameters with a mean coefficient of error \nof 6.9±1.3% were obtained by counting an average of only 12 points per image. The \nmean time of stereological analysis was 3.7±0.4 min, whereas the intraobserver \nand interobserver variability was 3.2-5.2% and 4.6-7.8%, respectively. The mean \ndifferences between stereology and manual tracing for estimating the end-diastolic \nvolume, end-systolic volume and EF were small and equal to 4.1±8.0 ml, 2.1±4.6 \nml and -0.4±3.5%, respectively. The parameters obtained by the two methods were \nnot significantly different (p> 0.05), and they were strongly correlated (r> 0.88).\n\nScientific Sessions\nS287\nA\n C D E F G\nB\nSaturday\nperformed after standardised preparation. 2D-motility-acquisitions (dynamic-2D-\nT2-FIESTA; TR 247.07/TE 1.23/FOV500/15 mm) covering the entire small bowel \nwere performed in free breathing over 75sec. Image analysis for the assessment \nof small bowel motility was performed both manually and with the software. The \ntime consumption and reproducibility were compared using coefficient of variance \nand paired Student`s t-test.\nResults: 25 single regions of interest were analysed two times by hand and two \ntimes using Motasso with a dedicated displacement provider. Mean small bowel \ncontraction frequency was 5.25 contractions per minute (SD+-2.74) for manual and \n4.86 (SD+-2.48) for Motasso analyses; the mean luminal diameter was 17.88 mm \n(manual, SD+-9.31) and 18.00 mm (Motasso, SD+-9.13), respectively. The vari-\nability of repetitive measurements (coefficient of variation) was 9.77% (SD+-11.08) \nfor manual and significantly lower (p < 0.01) for Motasso-assisted measurements \n(3.90%, SD+-5.69). The mean duration needed for a single small-bowel motility \nassessment was 17.48 min for manual (SD+-1.75 min, range 14-22 min) and \nhigh significant lower (p < 0.001) for Motasso-assisted measurements (4.52 min, \nSD+-1.58, range 2-8 min).\nConclusion: The use of Motasso proves highly reliable and fast measurements of \nsmall bowel motility in free breathing MRI. Reproducibility was significantly higher \nfor Motasso-assisted than for manual measurements, while the time needed for the \nsingle measurement could be tremendously reduced using Motasso.\nAuthor Disclosures:\nH. Bouquet: Employee; Former employee of SOHARD AG. U. Bill: Employee; \nFromer Employee of SOHARD AG.\nB‑0617 11:33\nAutomated system for CT carotid plaque characterisation into \nsymptomatic and asymptomatic classes \nL. Saba1, U. Acharia2, M. Anzidei3, M. Piga1, J.S. Suri4; 1Cagliari/IT, \n2Singapore/SG, 3Rome/IT, 4Pocatello, ID/US (lucasaba@tiscali.it) \nPurpose: Plaque treatments carry considerable risk, and hence, adjunct techniques \nare necessary to help doctors in making a confident decision about the necessity of \nsuch procedures for a patient. Mostly, symptomatic patients face a greater risk of \ncardiovascular diseases, and hence, classification of the plaque into symptomatic \nand asymptomatic is necessary. Therefore, we have developed a non-invasive \ncomputer-aided diagnostic technique for the same.\nMethods and Materials: Carotid artery images were acquired using multi-detector \nrow CT angiography (MDCTA). The region of interest (ROI) was segmented \nmanually from the images, and the ROIs were used to extract texture-based and \ndiscrete wavelet transform-based features. Significant features were used to train \nand test support vector machine (SVM) classifiers of various kernel configurations.\nResults: The SVM classifier with a polynomial kernel of order 3 presented the \nhighest accuracy of 90%, sensitivity of 95.6%, and specificity of 84.4%. We for-\nmulated a RiskScore, which is a combination of all the features, in order to monitor \nthe variations in features, and also to more objectively classify the two classes.\nConclusion: A technique that uses the CT images to identify symptomatic and \nasymptomatic plaques would add more value to this modality in the area of athero-\nsclerosis management. We have proposed and demonstrated the efficiency of one \nsuch technique in this work. The classification accuracy is high, and the technique \nis non-invasive, fast, highly objective, cost-effective and user-friendly. Therefore, \nit can serve as a valuable adjunct tool that can be used by clinicians in deciding \ntreatment options for patients.\nB‑0618 11:42\nAutomated labelling framework applied on full and partial spine CT scans \nD. Major, J. Hladuvka, F. Schulze, K. Bühler; Vienna/AT (david.major@vrvis.at) \nPurpose: The spine is often a frame of reference for diagnosis. For this purpose \nits parts have to be labelled in upper body CT scans which is a time-consuming \ntask. An automated framework is introduced for detecting intervertebral disk and \nvertebra centre points and its labels in CT data containing the spine fully or partly \nconsidering clinical resource constraints.\nMethods and Materials: The framework uses a machine learning-based classifi-\ncation approach for detecting spinal canal centre point candidates as a first step. \nIntervertebral disk-, rib- and sacrum centre point candidates are extracted next to \nthe spinal canal by the same classification approach. Intevertebral disk centre point \nlabelling is started relative to either ribs or sacrum depending on detection certainty. \nThe labelling run is done iteratively along the spine by obtaining best matches of \ntrained local appearance models to detected three intervertebral disk and spinal \ncanal centre point candidate clusters. Vertebra centres/labels are derived from the \nintervertebral disk ones. The framework has been trained on 16 and tested on 36 \nsolutions. Accordingly, dedicated software was developed. We evaluated its clinical \nperformance in a series of brain tumours imaged with state-of-the-art 3 T-MRI.\nMethods and Materials: Seventeen enhancing brain tumours were investigated \n(Magnetom Trio/3 T; dynamic T1-weighted-sequence/TWIST: temporal-resolution: \n1.77s, in-plane-resolution: 1.2*1.1*1.1 mm 3, 10 ml Dotarem@2 ml/s; anatomic-\nsequence/MPRAGE: in-plane-resolution: 1.0 mm3). Post-processing was performed \nto test a dedicated commercially available CAD-tool. Amongst other pre-processing \nfeatures it implements [1] Elastic 3D-Motion-correction (dynamic-contrast-\nenhanced scans), [2] co-registration of DCE- and anatomic-scans (3D and 4D), \n[3] identification of regions-of-interest (3D-ROI), [4] identification of appropriate \narterial-input-function (AIF). Output data include quantitative pharmacokinetic-\nparameters (two-compartment Tofts-model: ktrans, kep, Ve, etc). and fitted/unfitted \nenhancement-curves ([mmolGd/l]). All 4 pre-preprocessing features and the quality \nof fitted curve-data were evaluated by an experienced neuroradiologist and scored \non confidence-scales (0=not appropriate to 10=excellent). Pharmacokinetic-\nparameters were correlated with final diagnosis (benign/malignant: ROC-analysis).\nResults: Motion-correction was technically successful in all cases. Co-registration \nin 3D (mean-score[ms]:9.4) and 4D (ms=9.3) as well as identification of the AIF (ms: \n9.6) reached excellent ratings. Placement of 3D-ROIs was difficult in one lesion \n(score=6). Yet, in total it was performed appropriately (ms=9.0). Overall quality of \nfitted curve-data reached good scores (ms=9), resulting into a high diagnostic-\naccuracy for the differentiation of benign vs. malignant tumors (AUC=89% [kep]).\nConclusion: The software showed an excellent clinical performance. This should \nhelp to further promote quantitative pharmacokinetic-analyses and might broaden \nits application in clinical practice in the future. \nB‑0615 11:15\nRapid semi-automated volumetry of pleural effusion in MDCT \nM.P.F. Botelho, F.D. Gonzalez-Guindalini, H. Chalian, V. Yaghmai; \nChicago, IL/US (v-yaghmai@northwestern.edu) \nPurpose: To evaluate precision and reproducibility of volumetric semi-automated \nquantification of pleural effusions in MDCT.\nMethods and Materials: This study was IRB approved. We evaluated 29 consecu-\ntive pleural effusions in 20 adult patients undergoing contrast-enhanced MDCT of \nthe chest. Two independent blinded readers used a semi-automated segmentation \nsoftware for estimation of volume and recorded quantification time. Manual vol-\numetry was obtained as the reference. We evaluated the volumetry for precision, \ntime for assessment and inter-rater agreement, as well as percentage of over- and \nunder-segmentation. Statistical analysis encompassed paired t-test, Bland-Altman \nplot and Lin’s concordance correlation coefficient.\nResults: The mean semi-automated and manual volumes were 1040.3 mL (SD \n964.6 mL) and 1033.1 mL (SD 979.0 mL), respectively (P=0.379). Semi-automated \nvolumetry showed significant inter-rater agreement, with Bland-Altman precision \nof 8.2% (upper and lower limits of 18.5% and -13.7%, respectively). The mean \nsemi-automated volumetry was accurate when compared to manual volumetry, \nwith Bland-Altman precision of 5.0% (upper and lower limits of 12.1% and -7.7%, \nrespectively), and Lin’s concordance correlation coefficient (ρc) = 0.998. There \nwas a mean of 2.3% over-segmentation using the semi-automated software. The \naverage user time for semi-automated volumetry was 105.3 sec/case, whereas \nthose for manual volumetry were 336 sec/case (P < 0.001).\nConclusion: Rapid and accurate semi-automated volumetry of pleural effusions \nin MDCT is feasible and reproducible. \nAuthor Disclosures:\nM.P.F. Botelho: Grant Recipient; Educational Grant Support by Siemens \nHealthcare. F.D. Gonzalez-Guindalini: Grant Recipient; Educational Grant \nSupport by Siemens Healthcare. H. Chalian: Grant Recipient; Educational \nGrant Support by Siemens Healthcare.\nB‑0616 11:24\nSoftware-supported evaluation of small-bowel motility using free-\nbreathing cine MRI \nS. Bickelhaupt1, R. Cattin2, S. Raible2, J.M. Froehlich1, H. Bouquet3, U. Bill3, \nM.A. Patak1; 1Zurich/CH, 2Biel/CH, 3Berne/CH \nPurpose: MRI acquisitions for analyses of small bowel motility are commonly \nperformed in breath-hold resulting in relatively short cine sequences that limit reli-\nable quantitative analyses. A new dedicated motility software (Motasso) permits \nautomatic measurement of small bowel motility in free-breathing MRI allowing \nacquisition of long motility sequences. The aim was to validate the software pro-\ntotype by comparing it to manual measurements.\nMethods and Materials: 25 patients (15m/10f; mean 39 years) were included \nin this IRB-approved, retrospective study. MRI (1.5-T, Siemens-Sonata) was \n\nScientific Sessions\nS288\n C A D E F\n G\nB\nCT scans from different vendors constructed from 102 up to 5966 axial 512x512 \nslices containing spine-related diseases (scoliosis, fractures and osteoporosis).\nResults: A correct labelling was achieved within 2 minutes on average in 35 out \nof 36 test cases with 99% precision and 95.5% recall of intervertebral disk centre \npoint placements.\nConclusion: A high-throughput, memory-efficient and robust framework for auto-\nmated spine labelling was developed which copes with both full and partial spine \nCT scans in a clinically reasonable time. \nAuthor Disclosures:\nD. Major: Research/Grant Support; This work has been supported by the \nAustrian Funding Agency (FFG) and AGFA Healthcare within the scope of the \nCOMET K1 program. J. Hladuvka: Research/Grant Support; This work has \nbeen supported by the Austrian Funding Agency (FFG) and AGFA Healthcare \nwithin the scope of the COMET K1 program. F. Schulze: Research/Grant \nSupport; This work has been supported by the Austrian Funding Agency (FFG) \nand AGFA Healthcare within the scope of the COMET K1 program. K. Bühler: \nResearch/Grant Support; This work has been supported by the Austrian Funding \nAgency (FFG) and AGFA Healthcare within the scope of the COMET K1 \nprogram.\nB‑0619 11:51\nSegmentation-free scheme for computer-assisted image \ninterpretation: application to CT colonography \nF. Chandelier1, T. Cabrera2, P. Kocsis1, L. Stein2, V. Demers2; 1Granby, QC/CA, \n2Montreal, QC/CA (virginie.demers@mail.mcgill.ca) \nPurpose: To present a paradigm shift in computer-assisted image interpretation \nand to assess its application in CT colonography. A novel segmentation-free \nscheme has been developed with the hypothesis that accurate colon segmentation \nis neither necessary nor an end clinical objective for delivering efficient support \nsuch as colon centreline, electronic colon cleansing (ECC) and computer-aided \ndetection of lesions (CAD).\nMethods and Materials: Thick regions are expanded until they encompass statisti-\ncally significant representations of the colon wall and its surroundings (Air, Tag, \nSoft/Hard tissue). From these regions, a coarse colon centreline is inferred through \ntopological analysis guided by anatomic constraints; ECC is obtained by determin-\ning a transposing function depicting the distribution of voxels in a given Air-region, \nand applying said function to Tag-regions depicting statistically similar colon wall \nsurroundings; unlike surface shape analysis, a CAD identifies local hyper-density \nconcentrations from implicit surfaces flux, at a given depth related to the targeted \nlesion size. The complete schemes were retrospectively tested on 111 and 135 \npatients datasets for {centreline; electronic cleansing} and CAD, respectively.\nResults: Colon centreline extraction was accurate in 85% of combined cathartic \nand tagged datasets. CAD performance was similar to that in the literature, specifi-\ncally a sensitivity of 80% [70-85] for lesions at least 7 mm featuring a false-positive \nrate less than 5 per-patient.\nConclusion: The presented novel paradigm in computer-assisted image interpreta-\ntion prevents traditional limitations arising from “accurately segmenting” a specific \norgan for further processing. To our best knowledge, this is the first attempt to \ndesign and validate such a paradigm shift in CT colonography. \nAuthor Disclosures:\nF. Chandelier: Employee; Cadens Imaging. Patent Holder; Canada Patent \n2727736. P. Kocsis: Employee; Cadens Imaging.\n\nScientific Sessions\nS289\nA\n C D E F G\nB\nSunday, March 10\n\nScientific Sessions\nS290\n C A D E F\n G\nB\nConclusion: Using DCE-MRI-based kinetic parameters, we showed a decreasing \ntumour vascular function from the luminal towards extramural tumour invasion. This \nspatial vascular heterogeneity brings new insights into rectal cancer pathophysiol-\nogy and may have important implications for treatment-strategies. \nB‑0622 10:48\nEnhanced vascular structure and function in the tumour-\nsurrounding mesorectum: potential risk factors for patients with \nrectal cancer \nM.H. Martens, E. Kluza, J.-P.J.E. Kleijnen, M. Maas, C.R.L.P. Jeukens, \nW.H. Backes, G.L. Beets, R.G.H. Beets-Tan; Maastricht/NL \n(milou.martens@mumc.nl) \nPurpose: The role of mesorectal vasculature in rectal cancer is poorly understood. \nAim of our study was to determine impact of tumour growth as well as neoadjuvant \nchemoradiotherapy on mesorectal vasculature.\nMethods and Materials: Ten patients with locally advanced rectal cancer under-\nwent (re)staging MRI. Dynamic contrast-enhanced MRI with blood pool contrast \nagent (gadofosveset) was performed. Maximal intensity projections (MIPs) were \nused to assess macrovascular structure. Number, diameter and length of vascular \nbranches were determined in mesorectum surrounding tumour and normal rectal \nwall. Same parameters were used to compare pre- and post-chemoradiotherapy \nMIPs. The mesorectal microvascular function was studied using relative en-\nhancement-time curves, and expressed as area under the initial 2 minutes of the \nenhancement curve (AUC).\nResults: A significantly higher number of vessel branches was found in tumour-\nneighbouring mesorectum compared to mesorectum around normal rectal wall \n(p=0.001). Furthermore, vessel diameter in tumour surroundings was 0.2 mm larger \n(p=0.025). The average AUC in tumour-neighbouring mesorectum was also higher \n(6.35 and 0.58, respectively (p=0.01)). Comparison of pre- and post-CRT MIPs \nrevealed 40% lower vessel branching after CRT (p=0.002). Moreover, the vascular \ndiameter of 1.7 ± 0.2 mm at the primary staging was significantly decreased to 1.3 \n± 0.2 mm after CRT (p=0.007). In contrast, CRT resulted in significantly increased \nAUC values.\nConclusion: There is a significantly enhanced vascular structure and function in the \ntumour-surrounding mesorectum, which may have an important prognostic value \nfor rectal cancer patients. Furthermore, chemoradiotherapy induces remodelling \nof the mesorectal vasculature. \nB‑0623 10:57\nValue of 3D FSE Cube sequence at 3 T MRI in preoperative local \nstaging of rectal cancer \nR. Scandiffio, P. Vagli, P. Bemi, A. Mantarro, L. Faggioni, R. Balestri, \nP. Buccianti, E. Neri, C. Bartolozzi; Pisa/IT (rossellascandiffio@libero.it) \nPurpose: To compare a standard T2w imaging, based on 2D acquisitions, with 3D \nFSE Cube sequence in the local staging of rectal cancer at 3 T MRI.\nMethods and Materials: 32 patients with rectal cancer were prospectively evalu-\nated at 3 T MRI before and after neoadjuvant chemotherapy. Sagittal, coronal, axial \nand oblique 2D T2w FSE images and an additional 3D T2 FSE Cube sequence \nwere obtained. Each 3D dataset was processed with multiplanar and curved planar \nreconstructions along the rectal centreline. Two experienced radiologists, using, \nrespectively, 2D or 3D sequences evaluated T and N parameters, with specific at-\ntention to measurement of the distance lesion-puborectal muscle and mesorectal \nfascia, and lesion extension. All T and N parameters were evaluated independently \nand grouped for statistical analysis. Linear Cohen k values were calculated to \nquantify agreement between MRI and histopathological data. Image quality was \nevaluated using a linear qualitative scale.\nResults: Global sensitivities for T parameters were 67% and 62% for 2D and 3D \nimages, while N category lesion accuracy values were 70% and 68%, respectively. \nAccuracy in measuring the distance from pubo-rectal muscle to lesion border was \n60% and 98% for 2D and 3D, respectively. Image quality was considered very \ngood on 2D images, and good on 3D images.\nConclusion: No significant differences between 2D and 3D images were observed \nfor T and N staging. T2w FSE Cube demonstrated higher accuracy than 2D in \ndetermining the distance between lesion and pubo-rectal muscle, which represents \na key factor in planning surgical resection.\n10:30 - 12:00 Room A \nOncologic Imaging \nSS 1316 \nRectal cancer imaging: the next step \nModerators: \nL. Curvo-Semedo; Coimbra/PT \nC. Hoeffel; Reims/FR \nB‑0620 10:30\nPredictive value of combined quantitative parameters obtained \nwith ADC map and 18-FDG/PET study in assessment of treatment \nresponse of patients with advanced rectal cancer: histopathologic \ncorrelation \nD. Ippolito, A. Cadonici, C. Trattenero, L. Monguzzi, C. Capraro, S. Sironi; \nMonza/IT (davide.atena@tiscalinet.it) \nPurpose: To investigate the combined role of quantitative parameters of functional \nimaging by analysing ADC and SUVmax values before and after chemo-radiation \ntherapy (CRT) in prediction of tumour response of patients with LARC, correlating \nwith histologic examination (tumour regression grade/TRG).\nMethods and Materials: 40 patients, with biopsy-proven rectal carcinoma, under-\nwent a whole body 18 FDG PET/CT scan and pelvic MR examination including DWI \nfor staging (PET 1,RM1) and after CRT (PET 2,RM 2). Subsequently, all patients \nunderwent total mesorectal excision and the histological results were compared \nwith imaging findings. MR scanning, performed on 1.5 T magnet (Philips, Achieva), \ncomprised T2-weighted multiplanar imaging and DW images with b-value 0 and \n1000 mm²/sec. On PET/CT, the SUVmax of rectal lesion was calculated on PET1 \nand PET2. Percentage decrease of SUVmax (ΔSUV) and ADC (ΔADC) values \nfrom baseline to pre-surgical scan were assessed and correlated with pathologic \nresponse (Mandard’s criteria:TRG 1=complete regression, TRG5=no regression).\nResults: 27 tumours (68%) showed complete (TRG1) or subtotal histological \nregression (TRG2) and were classified as responders; 13 tumours (32%) were \nclassified as non-responders (TRG3-5). Considering all patients mean values of \nSUVmax on PET 1 was higher (p < 0.001) than those on PET 2, whereas mean \nADC values was lower (p < 0.001) on RM 1 than RM 2, with a ΔSUV and ΔADC \nof 67% and 69%, respectively. The most sensitive and specific predictors for TRG \nresponse were SUV2 (threshold 4.4) and ADC2 (1.29x10-3 mm2/s). Combining in \na single analysis both the obtained values, positive predictive value (PPV) in differ-\nent group category response related to TRG system, presented an AUC of 97%.\nConclusion: Combination of DWI and PET/CT may be the most feasible method \nto evaluate LARC patients, with accuracy values higher than those reported for \nother conventional imaging techniques. \nB‑0621 10:39\nIntrinsic gradient of the vascular function in rectal tumours \nM.H. Martens, E. Kluza, S. Subhani, M. Maas, C. Jeukens, G.L. Beets, \nR.G.H. Beets-Tan; Maastricht/NL (milou.martens@mumc.nl) \nPurpose: Spatial vascular heterogeneity decreases from periphery towards tumour \ncore in solid tumours and is related to cancer viability. This pattern is not present \nin rectal tumours. The aim of this study was to determine whether rectal tumour \nspread into layers of rectum, affects tumour vascular function compared to that \nof normal rectal wall.\nMethods and Materials: Seven patients with cT3- tumours received DCE-MRI. \nTumours were segmented into luminal, mural and extramural regions. Normal tis-\nsue counterparts were defined (mucosa, muscularis propria and mesorectal fat). \nInitial slope (slopei) and area under the first 120s of enhancement curve (AUC120) \nwere determined from relative signal enhancement-time curves. Pixel parameter \nvalues and mean parameter values were compared per patient and for entire \npatient group. The correlation between kinetic parameters of tumour segments \nand of corresponding normal tissues was determined.\nResults: For each patient, both the slopei and AUC120 were significantly higher \nfor luminal tumour pixels compared to mural and extramural tumour pixels (p < \n0.05). Mural pixel parameter values were significantly higher than the extramural \npixels (p < 0.05). For the patient group the mean AUC120 for the luminal, mural \nand extramural tumour region was 240±46, 178±20 and 129±18, respectively. \nThere was a strong and significant correlation between the parameters of tumour \nsegments and those of corresponding normal tissues (Pearson's correlation coef-\nficient=0.84, p=0.0001).\n\nScientific Sessions\nS291\nA\n C D E F G\nB\nSunday\njuvant chemoradiotherapy with oxaliplatin and 5-fluorouracile. Ktrans, Kep, Ve and \nIAUGC90 were calculated. Tumoral dimension and apparent diffusion coefficient \n(ADC) were analysed. Surgical specimens were the gold standard. For variable \ncomparison, Spearman’s rank correlation and Kruskal-Wallis test were used. P < \n0.05 was considered significant.\nResults: Six patients showed cPR. Baseline Ktrans, IAUGC90 and Ve were sig-\nnificantly higher in non-responder (NR) patients (1.22±1.03 min-1, 1.36±1.07mM/s, \n0.7±0.4) in comparison to cPR (0.92±0.91 min-1, 0.69±0.6mM/s, 0.37±0.15); Kep \nwas significantly lower in NR (1.6±0.65 min-1 vs 2.93±2.71 min-1). A significant \nreduction in Ktrans, IAUGC90 and Ve was observed in NR during (0.68±0.58, \n0.62±0.33, 0.52±0.1) and after treatment (0.047±0.016, 0.052±0.025, 0.19±0.28); \ninstead in cPR patient a significant increase in perfusional values was reported \n(1.24±1.15, 1.21±0.96, 0.63±0.26 and 1.13±1.36, 1.24±1.34, 0.59±0.34). No differ-\nence in baseline ADC value was observed between cPR (0.88 x10-3 mm2/sec±0.22) \nand NR (0.85x10-3 mm2/sec±0.09). In cPR mean tumour ADC significantly increase \nduring treatment comparing to NR (1.22 x10-3 mm2/sec ± 0.6 vs 0.98 10-3 mm2/\nsec ±0.12). No correlation was found between ADC values and pMRI parameters.\nConclusion: pMRI and ADC values are two independent parameters to predict \nrectal tumour response to chemoradiotherapy.\nB‑0627 11:33\nAdditional value of diffusion-weighted (DWI) MRI for predicting \ncomplete tumour response (T0N0) in rectal cancer treated with neo-\nadjuvant chemoradiation therapy (CRT) \nS. Sassen1, M. de Booij1, M.N. Sosef1, G. Lammering2, C.M.M. Bakker1, \nR. Clarijs1, R.C.M. Berendsen1, J. Wals1, R.F.A. Vliegen1; 1Heerlen/NL, \n2Maastricht/NL (sandersassen@yahoo.com) \nPurpose: Patients with complete response (CR) after CRT might be considered for \nless aggressive treatment like a wait-and-see strategy. Few studies investigated \nthe value of DWI-MRI for predicting CR after CRT, but none included lymph nodes \nin the analysis (ypT0N0). The aim of the present study was to retrospectively \ndetermine the additional value of DWI-MRI to conventional (T2-weighted) MRI for \npredicting CR after CRT.\nMethods and Materials: Eighty locally advanced rectal cancer patients underwent \nCRT followed by restaging MRI and operation. MRI consisted of conventional se-\nquences and DWI. Two readers with different levels of experience independently \nscored conventional images for CR and, in a second reading, combined conven-\ntional and DWI-MRI images. A 5-point confidence level score was used to generate \nROC curves. Differences in performance were calculated by comparing areas under \nthe ROC curves (AUC). Interobserver agreement, sensitivity, specificity and positive \npredictive values (PPV) were calculated. Histology served as reference standard.\nResults: Ten of 80 patients (13%) had a pathologic complete response (ypT0N0). \nComparison of the ROC curves showed significant improvement of the AUC only \nfor the experienced reader 1 from 0.77 to 0.88 (p=0.009). Sensitivity improved \nfrom 20-30% to 40-70%. Specificity and PPV improved only for reader 1 from 87 \nto 93%, resp., 25 to 58%. Interobserver agreement improved from 0.14 to 0.27.\nConclusion: Adding DWI to conventional MRI improves diagnostic performance \nof experienced readers and increases interobserver agreement for identification \nof CR. Sensitivity and PPV remain low, with a considerable risk of over- and \nundertreatment.\nB‑0628 11:42\nAdvanced characterisation of rectal cancer prior surgery: \npreliminary results on the evaluation of multimodality functional MRI \ntechniques in correlation to histopathology \nD. Hausmann, D. Dinter, P. Kienle, F. Doyan, S.O. Schönberg, U.I. Attenberger; \nMannheim/DE \nPurpose: High-resolution MRI has evolved to the leading imaging method for \nlocoregional staging in rectal cancer prior treatment. Besides, functional param-\neters such as perfusion and diffusion-weighted imaging (DWI) could be valuable \nparameters for tumour characterisation. The aim of this preliminary data analysis \nwas to compare reader variability of quantitative parameters for different stages \nof primary rectal cancer.\nMethods and Materials: 54 patients (mean age 63 yrs) with biopsy proven rectal \ncancer (RC) underwent a multi-parametric examination protocol on a 3 T MR-system \nprior treatment, consisting of high-resolution T2 sequences as well as functional \nimaging techniques including DWI with calculation of ADC (b-Werte angeben) and \nperfusion (turboFLASH). Perfusion values (plasma flow, PF; mean transit time, \nMTT) in the tumour were calculated.\nResults: N=45 RCs with complete data sets were included in this preliminary analy-\nsis. Distribution of the histopathologically proven tumour stages were as follows: \nB‑0624 11:06\nPrediction of subsequent metastatic disease by dynamic contrast \nMRI in locally advanced rectal cancer \nE.M. Anderson, J.M. Franklin, L. Tanner, M. Brady, F.V. Gleeson; Oxford/UK \n(ewan.anderson@ouh.nhs.uk) \nPurpose: To predict development of metastatic disease in patients with rectal \ncancer by dynamic contrast-enhanced (DCE) MRI.\nMethods and Materials: Twenty-three patients with locally advanced rectal cancer \nwere treated with long course chemotherapy on an IRB-approved clinical trial. For \n20/23 patients, analysable DCE MRI was acquired on a 1.5 T magnet. Images \nincluded repeated T1-weighted, gradient-echo, fat suppressed sequences (LAVA, \nTR 4.5 ms, TE 2.2 ms, 4.0/-2.0 mm thickness/gap, matrix, mm FoV) repeated \nevery 12-15 seconds for six minutes. After 4 initial acquisitions, gadobenate \ndimeglumine was injected, at a dose of 0.1 mg/kg at 3 ml/sec, followed by a 10-ml \nnormal-saline chaser. Ktrans, Kep, Ve were calculated from Toft’s two-compartment \nkinetics model. Patients were followed for three years, or death, and the presence \nof metastases was assessed with contrast-enhanced CT. ROC curve analysis as-\nsessed the performance of DCE-MRI to predict development of metastases. For \ncategorical variable comparison, the Kruskal-Wallis test was used.\nResults: 17 of 23 patients had adequate follow-up, one died during chemoradio-\ntherapy, one died post-operatively and one patient was diagnosed as metastatic \nduring neo-adjuvant treatment. All patients were treated with adjuvant chemo-\ntherapy post-surgery. Six patients developed metastases. The median Ktrans \nand median Ve for all patients that developed metastases were greater than 0.6 \nand 0.5, respectively. Area under ROC curve was 0.848 (p=0.021) for Ktrans and \n0.864 (p=0.016) for Ve.\nConclusion: DCE MRI (Ktrans and Ve) values can categorise patients as likely \nor unlikely to develop subsequent metastatic disease, independent of the disease \nat presentation and the use of adjuvant therapy. \nB‑0625 11:15\nFeatures on MRI after transanal endoscopic microsurgery in patients \nwith rectal cancer \nL.A. Heijnen1, M. Maas1, M.H. Martens1, D.M.J. Lambregts1, J.W.A. Leijtens2, \nW. Deserno2, G.L. Beets1, R.G.H. Beets-Tan1; 1Maastricht/NL, 2Roermond/NL \n(luc.heijnen@mumc.nl) \nPurpose: Transanal endoscopic microsurgery (TEM) is a minimal invasive tech-\nnique for local resection of T1 and selected T2 tumours and is also an emerging \noption for good-responders after chemoradiation. In most centres follow-up includes \nregular MRI. This study aimed to describe the MR morphology of the rectal wall \nduring follow-up in patients that received TEM.\nMethods and Materials: Forty-nine patients underwent a post-TEM MRI in our \ncentre. For 21 patients only one post-operative MRI was available. For 28 patients \n> 1 MRIs were available. The MR morphology of the TEM-site was studied on the \nconsecutive MR examinations. 32 patients were primary treated with TEM, 17 \npatients underwent chemoradiation followed by TEM.\nResults: We identified three morphological patterns: (1) rectal wall thickening with \nor without fibrosis, (2) a notch at the TEM-location, and (3) irregular delineation of \nthe rectal wall. Multiple patterns could occur within one patient. 32 patients (65%) \nhad rectal wall thickening, 17 patients (35%) a notch, and 28 patients (57%) ir-\nregular delineation of the rectal wall. In addition to these patterns, oedema (due \nto chemoradiation) persisted in post-chemoradiation TEM-patients. Ten patients \nhad dehiscence after TEM post-chemoradiation (n=58%). Six luminal recurrences \noccurred; 3 had rectal wall thickening, 3 a notch, and 5 an irregular rectal wall.\nConclusion: Three patterns were identified on MRI after TEM. This enables radi-\nologists to monitor this group of patients more accurately. Since minimal invasive \ntechniques are gaining, it is very important for radiologists and surgeons to have \nknowledge about the normal follow-up findings after TEM. \nB‑0626 11:24\nRole of perfusional MRI and DWI to predict pathological complete \nresponse to neoadjuvant chemoradiotherapy in rectal cancer \nC.N. De Cecco, M. Ciolina, M.M. Maceroni, G. Muscogiuri, F. Iafrate, A. Laghi; \nRome/IT (mciolina@yahoo.com) \nPurpose: To determine the ability of perfusional MRI (pMRI) and diffusion-weighted \nimaging (DWI) to predict pathological complete response (pCR) in patient treated \nwith chemoradiotherapy.\nMethods and Materials: Eleven consecutive patients underwent pre-, during and \npost-treatment dynamic contrast-enhanced MRI performed at 3 T. Gadolinium 0.1 \nmmol/kg was injected at a rate of 3 mL/s. Treatment protocol consisted of neoad-\n\nScientific Sessions\nS292\n C A D E F\n G\nB\n1, there was: (a) no significant difference in objective noise (p=0.9131) and (b) \nsimilar depiction of acute PE (p=1).\nConclusion: Reconstruction of low-dose images with SAFIRE provided similar \ndiagnostic information compared to full-dose FBP images. \nB‑0631 10:39\nComparison of image quality and radiation dose between 64-MDCT \nand high pitch 128-DSCT protocols in triple rule-out studies \nA. Fernandez del Valle, C. Delgado, R. Oca, N. Silva, G. Tardáguila; Vigo/ES \n(anafdelvalle84@hotmail.com) \nPurpose: To compare the image quality and radiation dose between 64-MDCT \nretrospective-ECG and 128-DSCT high pitch acquisition in triple rule-out protocol \nin acute chest pain.\nMethods and Materials: An homogeneous group of 60 patients with triple rule-out \nprotocol was retrospectively revised. 30 underwent retrospective acquisition with \n64-MDCT (120kv, pitch 0.2) and 30 high pitch acquisition in a 128-DSCT (2x120kv, \npitch 3.4). All patients had heart rates below 65 bpm during acquisition. A triple \ncontrast injection protocol was used in all patients. Vessel enhancement and image \nnoise were quantified; signal to-noise ratio (SNR) and contrast-to-noise ratio (CNR) \nwere calculated. Artefacts in superior cava vein, aortic root and coronary arteries \nwere assessed by two radiologists in consensus. Effective dose was calculated \non the basis of dose length product and volume CT dose index. Results were \ncompared using the Chi-quadrate and Student’s t tests.\nResults: High pitch protocol had significantly lower image noise (11.8±2.2 vs \n16.5±3.6 HU), SNR (19.5±4.9 vs 26.2±8.6) and CNR (16.2±4.8 vs 21.7±7.6); p < \n0.01. Vessel attenuation was similar in both protocols (296.3±63.1 vs 308.9±58.1 \nUH; p=0.42). No significant differences were found in artefacts measurements. In \nhigh pitch protocol only 3 coronary artery segments were non-diagnostic versus 34 \nin 64-MDCT protocol. Mean effective dose for high pitch protocol was significantly \nlower than 64-MDCT protocol (2.77±0.6 vs 13.77±4mSv; p < 0.001).\nConclusion: 128-DSCT high pitch acquisition compared to 64-MDCT reduces \nradiation dose drastically and also improves image quality in triple rule-out studies. \nB‑0632 10:48\nSinogram-affirmed iterative reconstructed simulated ECG-gated ultra \nhigh pitch CT pulmonary angiography in the acute setting: effect on \ndose and image quality \nS.J. Co1, S. Nicolaou1, J. Mayo1, T. Liang1, D. Hou1, K. Krzymyk2; \n1Vancouver, BC/CA, 2T opanga, CA/US (co.steve@gmail.com) \nPurpose: To evaluate the effect of a simulated ECG-gated computed tomographic \npulmonary angiography (CTPA) at 100 kV on image quality and radiation dose.\nMethods and Materials: Retrospective study includes 100 patients referred for \nCTPA with pitch 3.2. 50 patients were scanned with a standard 100 kV protocol \nand 50 patients were scanned with a simulated ECG-gated 100 kV protocol that \nintroduces a specialized cardiac bowtie filter. All other scanning parameters were \nkept constant. Images were reconstructed with filtered back projection and itera-\ntive reconstruction (SAFIRE, Siemens). Central pulmonary vessel attenuation and \nbackground noise were quantitatively measured and signal-to-noise (SNR) and \ncontrast-to-noise (CNR) were calculated. Two radiologists performed qualitative \nassessment grading visualisation of the pulmonary vasculature and noise level \n(Likert scale). Volume CT dose index and dose length product were recorded and \neffective dose was calculated.\nResults: CTDIvol, DLP and effective dose were significantly (p < 0.0001) lower in \nthe simulated ECG-gated protocol (2.3±0.5 mGy, 78.4±16.5 mGycm, 1.4±0.3 mSy, \nrespectively) compared to standard protocol (4.3±0.5 mGy, 152.0±19.6 mGycm, \n2.7±0.3 mSy, respectively). Simulated ECG-gated protocol had significantly (p < \n0.0001) higher noise than the standard protocol (23.8±6.9 HU vs 36.8±7.3 HU) and \nresulted in lower SNR (11.8±3.7 HU vs 19.2±8.1 HU) and CNR (10.3±3.7 HU vs \n24.9±13.4 HU) but there was no significant difference in the subjective diagnostic \naccuracy. Post-processing with iterative reconstruction significantly (p < 0.0001) \nimproved noise (29.4±5.5 HU from 36.8±7.3 HU).\nConclusion: The simulated ECG-gated CTPA resulted in 48% dose reduction \nwithout significantly affecting diagnostic image quality. Furthermore, the use of \niterative reconstruction improves image quality by reducing noise permitting the \npossibility for further dose reduction strategies.\nAuthor Disclosures:\nK. Krzymyk: Employee; Siemens.\nstage I n=8, stage II n=16, stage III n=18. Depending upon tumour stage, ADCmean \n(10-3 mm2/s) ranged from 0.86-0.9 (I), 0.9-0.99 (II) and 0.84-0.88 (III). PFmean \n(ml/100 ml/min) ranged from 257-295 (I), 222-454 (II) to 80-195 (III). MTTmean \n(s) ranged from 56-57 (I), 55-57 (II) to 45-49 (III). No significant difference was \nfound for the functional parameters between both readers (p> 0.11). Interreader \ncorrelation was good (rADC=0.8, rPF=0.9, rMTT=0.8; p < 0.0001).\nConclusion: Functional tumour characterisation is feasible with a good interob-\nserver correlation, allowing for an objective tumour evaluation prior to treatment. \nThese parameters can be used for functional response evaluation in neoadjuvant \nradiochemotherapy. \nB‑0629 11:51\nColoCare: compartmental quantification of obesity on CT as risk \nfactor for colorectal cancer \nJ. Welzel, H. Hogenauer, J. Staffa, D. Scherer, L. Grenacher, C. Ulrich, \nH.-U. Kauczor; Heidelberg/DE (johannawelzel@gmx.de) \nPurpose: Obesity is associated with an increased incidence and mortality in color-\nectal cancer (CRC). The ColoCare study has been set up in order to determine \nprognostic factors following CRC diagnosis. Within this study we analysed the \nimpact of total adipose tissue (TAT), visceral adipose tissue (VAT) and subcutaneous \nadipose tissue (SAT) on mortality as alternative measures to BMI.\nMethods and Materials: In 77 patients with CRC (21 females, 45 males; stage 1-4; \ngrade 1-4; mean BMI male 26.6 and female 25.8 kg/m2; mean age male 59y and \nfemale 61y), who underwent multi-detector-CT, quantification of TAT, VAT, SAT and \nratio VAT/SAT was performed on the levels of L3/4 and L4/5 using a compartimental \ndensitometric technique (Syngo Volume, Siemens). Reproducibility was tested by \ninterreadership analysis. Correlation with gender, age, tumour stage and grade, \nlocalisation, CRP and fat distribution was performed.\nResults: Interreadership analysis showed high correlation of 0.95 to 1.0. VAT and \nVAT/SAT were significantly higher in men than in women and increased with age. \nBMI had significance predictive value for TAT and SAT, but not for VAT. No mean-\ningful correlation with tumour stage and grade, localisation and CRP was found.\nConclusion: Regional densitometric quantification of fat compartments on CT is \nhighly reproducible and indispensable to obtain accurate data on visceral fat not \nprovided by BMI. Men with CRC have a larger volume of visceral than women. \n10:30 - 12:00 Room D1 \nChest \nSS 1304 \nCTPA techniques in lung perfusion and pulmonary \nhypertension \nModerators: \nI. Hartmann; Rotterdam/NL \nE.J. Stern; Seattle, WA/US \nB‑0630 10:30\nImpact of iterative reconstructions on the diagnosis of acute \npulmonary embolism (PE) on low-dose CT angiograms: clinical \nexperience in 53 patients \nF. Pontana, S. Henry, J.-B. Faivre, N. Tacelli, S. Bendaoud, M. Rémy-Jardin, \nJ. Rémy; Lille/FR (martine.remy@chru-lille.fr) \nPurpose: To evaluate the impact of iterative reconstructions on the diagnosis of \nacute PE on low-dose CT angiograms.\nMethods and Materials: 53 patients were prospectively enrolled in a study de-\nsigned to compare low-dose and full-dose images simultaneously available from \nthe same dataset. The examinations were acquired with (a) both tubes set at \nsimilar energy (120 kVp) and (b) the total reference mAs (i.e., 110 mAs) split up \nin a way that 40% was applied to tube A while 60% was applied to tube B. Three \nseries of images were generated: (a) full-dose images (generated from both tubes), \nreconstructed with FBP (group 1), used as the standard of reference, (b) low-dose \nimages (generated from tube A; 60% dose reduction) reconstructed with FBP (group \n2), then with an iterative reconstruction algorithm (SAFIRE) (group 3).\nResults: In group 1: (a) acute PE was diagnosed in 8 patients (15%) with 82 clots \nidentified within central (n=5), segmental (n=39) and subsegmental (n=38) arter-\nies, (b) the mean level of objective noise was 41.41 HU. In group 2, the significant \nincrease in objective noise compared to group 1 (48.37 HU; p < 0.0001): (a) ham-\npered detection of acute PE in one patient and (b) altered detection of peripheral \nclots (12 false-negative and 2 false-positive results). Comparing group 3 to group \n\nScientific Sessions\nS293\nA\n C D E F G\nB\nSunday\nMethods and Materials: This retrospective study included 100 consecutive \npatients (63 females, 28 to 97 years) who underwent CT-PA and DS-CT-P of the \nlung (Somatom Definition, Siemens, Forchheim, DE, 140 kV and 80 kV, collimation \n64x1.2 mm; 100 ml Jopamiro 370, Bracco, IT, flow rate 5 ml/s, 50 ml NaCl) for the \ndiagnosis of suspected PE. Two radiologists (A, B) blinded to patient information \n(except suspicious PE) independently analysed the CT-PA-data in random order \ntwice, with and without DS-CT-P images. Both radiologists assessed CT-PA and \nDS-CT-P for image quality, presence of pulmonary emboli at main, lobar, segmental \nand sub-segmental arterial levels and perfusion defects, respectively. Confidence \nin PE diagnosis was scored on a 10-point scale.\nResults: PE was diagnosed in 21 and 22 patients by readers A and B, respectively, \nin concordance in 20 patients. There was no significant change in diagnostic \nconfidence with additional DS-CT-P data analysis (A: 9.4 to 9.4; B: 9.0 to 9.6), B \nscored one study neg. for PE on CT-PE + DS-CT-P , which was pos. by CT-PA alone. \nInterobserver variability with kappa=0.882 (CT-PA) and 0.910 (CT-PA+DS-CT-P) \nfor diagnosis of PE was excellent.\nConclusion: DS-CT-P data do not improve diagnostic confidence in CT-PA \ndiagnosis of acute PE, because low image quality in CT-PA parallels low image \nquality in DS-CT-P.\nB‑0636 11:24\nCT-pulmonary angiography follow-up in acute pulmonary embolism: \nresolution of emboli and change of CT signs of right heart dilatation \nand pulmonary hypertension \nC. Neumann, H. Prosch, K. Osinger, D. Vedrilla, M. Weber, G. Mostbeck; \nVienna/AT (christian.neumann.nch@wienkav.at) \nPurpose: To determine the resolution of pulmonary emboli (PE) by CT-pulmonary \nangiography (CT-PA) in correlation with CT parameters of right heart load and \npulmonary hypertension.\nMethods and Materials: Two independent radiologists analysed initial and \nfollow-up (F/U) CT-PA data (time interval 1-6 weeks, clinical indication for F/U) \nfrom 81 consecutive patients (37m/44f, 54±36 years) with PE in a retrospective \nstudy between 12/2008 and 4/2012. Clot load was assessed by Qanadli-score \n(QS), right (RV) and left ventricular (LV) short axis and diameters of pulmonary \ntrunk and ascending aorta were measured to calculate the RV/LV-ratio (RLR) and \nvessel diameter ratio (AOPA).\nResults: All 81 patients showed significant decrease of QS (mean 17.4 to 9.8, p \n<.001), RLR and AOPA between initial and F/U CT-PA. In 10/81 patients complete \nPE lysis was found. There was good correlation between reduction of QS and \nregression of RLR (r=-.506; p <.001) and AOPA (r=-.458; p <.001), respectively. \nRLR and AOPA changes (r=.330; p=.003) correlated poorly. Patients with initial \nQS > 20 showed higher reduction of QS at F/U, but no significant difference was \nfound concerning the reduction of RLR between patients with initial QS > 20 and \n²20 (p=.921). The time interval between initial and F/U CT-PA differed between \npatients with and without complete lysis (3.5 vs. 2.14 weeks, p=.016).\nConclusion: Clot resolution is associated with improvements of RLR and AOPA, \nbut the time to complete resolution is variable and not predictable. RLV and AOPA \nare independent markers of right heart burden in patients with PE, but they cor-\nrelate poorly with each other.\nB‑0637 11:33\nClinical significance of high density thrombi on non-enhanced CT \nscan in patients with pulmonary thromboembolism \nK.S. Beck, B. Lee, H. Kim, D. Han; Seoul/KR (sallahbar@gmail.com) \nPurpose: To evaluate the incidence and significance of occasionally detected high \ndensity thrombi of pulmonary embolism (PE) on non-enhanced chest CT scans.\nMethods and Materials: We retrospectively evaluated the non-enhanced and \nenhanced CT findings of 76 patients with pulmonary embolism, and the incidence \nof high density thrombi was calculated. Then in both iso-density thrombi (group 1) \nand high-density thrombi (group 2) groups, embolic burden score, ventricular septal \nbowing, and diameter of right ventricle (RV) and left ventricle (LV) were evaluated \nand compared using independent sample T tests.\nResults: 19 patients (25%) showed high density thrombi in pulmonary arteries on \nMDCT. Embolic burden score was significantly different between group 1 and 2 \n(7.3±5.4 & 12.3±6.6) (p=0.007). Ventricular septal bowing was also significantly \nmore frequent in group 2. Diameter of RV (44.0±9.6 & 45.8±8.8) (p=0.433) or \ndiameter of LV (41.3±6.9 & 40.9±5.8) (p=0.821) did not show significant difference \nbetween group 1 and 2.\nConclusion: High density thrombi detected on non-enhanced scan in patients \nwith PE are relatively frequent and suggest more dangerous condition. Radiolo-\ngists should be aware of the possibility of thrombi on non-enhanced CT scans.\nB‑0633 10:57\n70 kV CT pulmonary angiography in clinical routine: initial \nexperience, radiation dose and image quality \nR.W. Bauer, F. Al-Butmeh, C. Frellesen, J.A. Wichmann, T. Lehnert, T.J. Vogl, \nM. Kerl; Frankfurt a. Main/DE (ralfwbauer@aol.com) \nPurpose: To investigate the general applicability of a 70 kV protocol for routine CT \npulmonary angiography (CTPA) in unselected patients.\nMethods and Materials: Thirteen patients suspected of having pulmonary embo-\nlism underwent CTPA with a novel 70 kV protocol (208 mAs, pitch 1.2) on a 64-slice \nCT device. Ten patients who were investigated with the standard protocol (100 \nkV, 120 mAs, pitch 1.2) served as the control group. Images were reconstructed \nwith sinogram affirmed iterative reconstruction with medium regulation strength \nin both groups. 75 ml of contrast material (350 mgI/ml) was injected at 4 ml/s. \nCTDIvol, DLP, signal intensity in the pulmonary trunk and segmental arteries and \ncorresponding SNR values were compared. Images were assessed for diagnostic \nquality and artefacts.\nResults: Chest diameter was not significantly (p> 0.05) different between the \ngroups. CTDIvol (2.3 vs. 6.6 mGy) and DLP (71 vs. 193 mGycm) were by 65% \nand 63% lower at 70 kV (p < 0.05); iodine attenuation was significantly higher \n(e.g. segmental arteries 554 vs. 313 HU), but so was image noise, resulting in no \nsignificant differences in SNR. Photon starvation artefacts from dense contrast \nmaterial in the venous system and high image noise in bigger patients were the \nmain drawbacks at 70 kV.\nConclusion: 70 kV CTPA seems feasible in clinical routine and results in a dose \nreduction of more than 60% compared to a 100 kV protocol at equal SNR; however, \npatient selection is advisable. Artefacts from inflowing contrast material will require \ndedicated injection protocols or the use of low-iodine contrast material.\nB‑0634 11:06\nAutomated quantification of pulmonary perfused blood volume in \nacute pulmonary embolism using dual-energy CTPA \nF.G. Meinel, A. Graef, F. Bamberg, S.F. Thieme, C. Neurohr, C. Kupatt, \nM.F. Reiser, T.R.C. Johnson; Munich/DE (felix.meinel@med.uni-muenchen.de) \nPurpose: To determine whether automated quantification of pulmonary perfused \nblood volume (PBV) in dual-energy computed tomography pulmonary angiography \n(DE-CTPA) is of diagnostic value in assessing the severity of acute pulmonary \nembolism (PE).\nMethods and Materials: Ethical approval and informed consent were waived by \nthe responsible Institutional Review Board for this retrospective study. Automated \nquantification of PBV was performed in 71 consecutive patients (mean age 62 ± 16 \nyears) with DE-CTPA positive for acute PE and no cardiopulmonary co-morbidities. \nPBV values adjusted for age and gender were correlated with the Qanadli obstruc-\ntion score, morphological CT signs of right heart dysfunction, serum levels of \ntroponin as well as the necessity for ICU admission.\nResults: DE-CTPA-derived PBV values inversely correlated with Qanadli score \n(r=-0.46, p < 0.001), RV/LV ratio (r=-0.52, p < 0.001) and troponin I (r=-0.45, \np=0.001). Patients with global PBV values < 60% were significantly more likely to \nrequire admission to an ICU than patients with global pulmonary PBV³60% (47% \nvs. 11%, p=0.003, PPV 47%, NPV 89%). The area under the receiver operat-\ning characteristic curve (AUC) for the prediction of ICU admission was 0.75 for \npulmonary PBV, 0.83 for the Qanadli obstruction score, 0.68 for CT signs of right \nheart dysfunction (interventricular septal bowing and/or contrast reflux) and 0.76 \nfor the RV/LV diameter ratio.\nConclusion: DE-CTPA can be used for an immediate, reader-independent estima-\ntion of global pulmonary PBV in acute PE, which inversely correlates with thrombus \nload and laboratory parameters of PE severity and can be used to predict the \nnecessity for ICU admission.\nAuthor Disclosures:\nT.R.C. Johnson: Equipment Support Recipient; Siemens Healthcare. Research/\nGrant Support; Bayer Healthcare.\nB‑0635 11:15\nDual-source CT perfusion maps: do they increase the diagnostic \nconfidence in the diagnosis of pulmonary embolism by CT? \nE. Stiefsohn, S. Scharer, H. Prosch, C. Neumann, K. Osinger, M. Weber, \nG. Mostbeck; Vienna/AT (elisabeth.stiefsohn@wienkav.at) \nPurpose: The aim of this study was to assess the image quality and the diagnostic \nvalue of dual-source CT perfusion maps (DS-CT-P) compared to pulmonary dual-\nsource CT pulmonary angiography (CT-PA) with regard to the confidence of the \ndiagnosis of acute pulmonary embolism (PE).\n\nScientific Sessions\nS294\n C A D E F\n G\nB\n10:30 - 12:00 Room D2 \nInterventional Radiology \nSS 1309 \nSkeletal and endocrinologic interventions \nModerators: \nL. Crocetti; Pisa/IT \nD.K. Tsetis; Iraklion/GR \nB‑0640 10:30\nSelective arterial embolisation for bone tumours \nG. Rossi1, E. Rimondi1, A.F. Mavrogenis2, A. Andreone1, P. Spinnato1, \nG. Garzillo1, P. Ruggieri1, D. Vanel1, A. Bazzocchi1; 1Bologna/IT, 2Athens/GR \n(andreanselmo99@yahoo.it) \nPurpose: To present the experience of a single institution on selective arterial \nembolisation for primary and metastatic bone tumours.\nMethods and Materials: 365 patients were treated by 454 embolisations as \nprimary treatment for benign tumors (81 tumors), adjuvant treatment to surgery \nfor bening and malignant bone tumours (41 tumors), and palliative treatment for \nbone sarcomas and metastases (243 metastatic carcinomas). The indications for \nrepeat embolisation included pain or imaging evidence of progressive disease; \n105 patients had repeat embolisation at the same location, at an interval of 1-3 \nmonths; 260 patients had one embolisation, 78 patients had two embolisations, \nand 29 patients had three or more embolisations.\nResults: 419 of the 454 embolisations (93%) were technically successful. In 35 \ncases, embolisation was not feasible because of poor vascularisation of the lesions, \norigin of Adamkiewicz artery in the embolisation field, atheromatosis-arteriosclero-\nsis, and anatomical and technical problems such as small caliber vessels, many \nbrenches, and acute angles of the vessels. A clinical response was achieved in 406 \nof the 419 procedures (97%). Complications included post-embolisation syndrome \nin 81 patients (22%), transient paresthesias in 41 patients (11%), sink breakdown \nand subcutaneous necrosis in five patients (1.4%), and paresis of the sciatic nerve \nin one patient (0.3%).\nConclusion: Embolisation can be recommended as primary or palliative treat-\nment, or adjunct to surgery of bone tumours. Arteries feeding the tumor and col-\nlaterals must be evaluated carefully and catheterised superselectively to protect \nthe normal tissues.\nB‑0641 10:39\nRadiofrequency ablation of osteoid osteoma: technique with special \ntricks for difficult anatomical locations and atypical nidus \nA.K. Janu, B. Jankharia, K. Pilania, P. Thakrar; Mumbai/IN \n(amiteasy10@gmail.com) \nPurpose: 1. To identify osteoid osteoma, on the basis of clinical features and \nradiological findings. 2. To describe the technique for performing radiofrequency \nablation (RFA), with special considerations in difficult anatomical locations and \natypical nidus. 3. To evaluate the efficacy and complications of ablation.\nMethods and Materials: In this prospective study, RF ablation of 50 osteiod os-\nteoma was carried out under CT guidance using a RITA uni-ablate electrosurgical \ndevice. Special approach planning, to minimize to complications and morbidity, was \nrequired for large lesions and lesions in difficult locations like in spine, superficial \nlesions and lesions adjacent to joint and growth plates (15 patients).\nResults: Intranidal localisation of the needle and complete ablation was achieved in \nevery patient accounting for a technical success rate of 100%. Most of the patients \nwere pain free within the first week and almost all had complete pain relief within a \nmonth after RFA, accounting for a primary clinical success rate of 95% and second-\nary clinical success rate of 100%. Recurrent lesions were treated successfully with \na second ablation. Mild to moderate pain, within first 48 hours, was controlled by \noral analgesics. Complications seen were mild local swelling (1), transient weak-\nness of leg (1), chip fracture (1), superficial skin infection (2) and osteomyelitis (1).\nConclusion: Percutaneous CT-guided radiofrequency ablation is a safe, quick and \nminimally invasive method for treatment of osteoid osteoma with a high technical \nand clinical success rate, and minimal complications and morbidity, even in patient \nwith atypical nidus and difficult locations. \nB‑0638 11:42\nAutomated quantification of pulmonary perfused blood volume by \ndual-energy CTPA in chronic thromboembolic pulmonary hypertension \nF.G. Meinel, A. Graef, M. Armbruster, C. Neurohr, M.F. Reiser, T.R.C. Johnson; \nMunich/DE (felix.meinel@med.uni-muenchen.de) \nPurpose: To determine whether automated quantification of pulmonary perfused \nblood volume (PBV) in dual-energy computed tomography pulmonary angiography \n(DE-CTPA) is of diagnostic value in assessing the severity of chronic thromboem-\nbolic pulmonary hypertension (CTEPH).\nMethods and Materials: Ethical approval and informed consent were waived by \nthe responsible Institutional Review Board for this retrospective study. Automated \nquantification of PBV was performed in 25 consecutive CTEPH patients undergoing \nDE-CTPA. PBV values were correlated with cardiac index and pulmonary vascular \nresistance quantified by right heart catheterization and walking distance in the \n6-minute walk test using Pearson’s correlation coefficient and multivariate linear \nregression analysis to control for age and gender.\nResults: DE-CTPA-derived PBV values inversely correlated with systolic (r=-0.64, \np=0.001) and mean (r=-0.57, p=0.004) pulmonary arterial pressure. There was a \ntrend for PBV values to inversely correlate with pulmonary vascular resistance \n(r= -0.20, p=0.35). No significant correlation was found between PBV values and \ncardiac index or 6-minute walking distance. These correlations were confirmed \nto be independent of age and gender on multivariate linear regression analysis.\nConclusion: DE-CTPA can be used for an immediate, reader-independent estima-\ntion of global pulmonary PBV in chronic thromboembolic pulmonary hypertension, \nwhich inversely correlates with systolic and mean pulmonary arterial pressure.\nAuthor Disclosures:\nT.R.C. Johnson: Equipment Support Recipient; Siemens Healthcare. Research/\nGrant Support; Bayer Healthcare.\nB‑0639 11:51\nNon-invasive diagnosis of pulmonary hypertension with dynamic \ncontrast-enhanced computed tomography \nM. Pienn1, G. Kovacs1, M. Tscherner1, T.R.C. Johnson2, P. Kullnig1, \nR. Stollberger1, A. Olschewski1, H. Olschewski1, Z. Bálint1; 1Graz/AT, \n2Munich/DE (michael.pienn@lvr.lbg.ac.at) \nPurpose: Pulmonary hypertension (PH) is a disease characterised by an elevated \npulmonary arterial pressure (PAP) and is diagnosed invasively via right heart \ncatheterization (RHC). We explored whether timing measures from dynamic \ncontrast-enhanced computed tomography (CT) can be used as a non-invasive \nmethod to determine PH.\nMethods and Materials: 20 patients (15 with and 5 without PH) were examined \nwith a novel dynamic contrast-enhanced CT sequence following their diagnostic \nor follow-up RHC. X-ray attenuation over time curves were recorded for several \nregions of interest (ROIs) in the main pulmonary artery and in the ascending aorta \nand subsequently fitted with a spline fit. Time differences between the contrast-\nmaterial bolus peaks were measured. Distances between the ROIs were measured \nin a simultaneously acquired thorax CT to calculate the bolus propagation speeds. \nWe compared our results to haemodynamic parameters acquired during RHC.\nResults: Time differences between peaks showed good correlation (Spearman \ncorrelation coefficients ³ 0.65) with mean PAP, pulmonary vascular resistance and \ngas exchange parameters. Discrimination between patients with and without PH \nwas achieved by evaluating time differences (sensitivity/specificity 100%/80%, \n95% confidence intervals: 72-100% and 28-99%, respectively) and bolus speeds \n(sensitivity/specificity 100%, 95% confidence intervals: 72-100% and 48-100%, \nrespectively).\nConclusion: Time differences between bolus peaks and bolus speeds in the \npulmonary artery can be utilised to identify PH patients with only little additional \ndose, contrast material and post-processing. This method can reduce the number \nof invasive right heart catheterizations.\n\nScientific Sessions\nS295\nA\n C D E F G\nB\nSunday\ntion (ve) with a dedicated analysis software. Every subject was monitored over the \nfollowing three months assessing clinical outcome by means of pain relief with VAS.\nResults: Eight of eleven subjects clinically demonstrated a complete treatment \nresponse (CR), with a VAS score mean reduction of 4.3 (47.8%. p < 0.001), whereas \nthree patients showed a partial clinical response (PR) with fractional relief according \nto VAS scale. Compared perfusional analysis of metastatic lesions in CR patients \nshowed a significant reduction of gadolinium extraction with a 2.14/min Ktrans \nmean reduction (-ΔKt=52.65%. p0.01), while PR patients showed no substantial \nmodification in Ktrans value (ΔKt=+0.042/min, +11.39%. p < 0.01) or increase in \nextravascular volume. Spearman test revealed a significant relationship between \nKtrans quantitative parameters and clinical evaluation by VAS scale (p < 0.001) \nin both CR and PR patients.\nConclusion: Perfusional quantitative MRI is a sensitive predictor of MRgFUS \nbone metastases treatment response if compared with clinical outcome datas. \nKtrans negative modifications (-ΔKt) may reflect effectiveness of ultrasound abla-\ntion procedure, as direct expression of decreased tumoural cell metabolism, and \npositively correlate to clinical response. \nB‑0645 11:15\nPalliative treatment of bone metastases: analysis of biological \neffects of MR-guided focused ultrasound (MRgFUS) versus external \nbeam radiation therapy (EBRT). A randomised comparative trial \nusing functional diffusion maps as molecular activity indicator \nA. Napoli, G. Brachetti, D.S. De Oliveira, G. Cartocci, F. Boni, \nV. Noce, C. Marsecano, V. Tombolini, C. Catalano; Rome/IT \n(alessandro.napoli@uniroma1.it) \nPurpose: This study aimed to investigate and compare the response to MRgFUS \nand EBRT treatments of painful bone metastases by using diffusion-weighted \n(DW) magnetic resonance (MR) imaging with apparent diffusion coefficient (ADC).\nMethods and Materials: This prospective, double arm, randomised study with \nEBRT serving as control arm, received IRB approval. 36 consecutive patients (fe-\nmale:15 male:21 mean age:60.3) with painful bone metastases were enrolled. 18 \npatients underwent MRgFUS treatment, using ExAblate 2100 system (InSightec), \nand 18 patients underwent EBRT. Pain palliation was evaluated by visual analog \nscale (VAS), pain questionnaires and changes in the patients’ medication. All \npatients underwent 3 T ce-MRI (Discovery 750, GE; gd-BOPTA, Bracco) before \ntreatment and at 1, 2, and 3 months afterwards. MRI protocol included DWI \nsequences with five b factors (0-800 sec/mm2) and ADC maps were obtained. \nThe average ADC values for each lesion were analyzed in comparison between \npre- and post-treatment.\nResults: No treatment-related adverse events were recorded for both arms. \nStatistically significant difference between baseline and follow -up VAS values \nand medication intake for both MRgFUS and EBRT patients (p0.5) was observed. \nProgressive decrease in VAS values positively correlated to an increase in mean \nADC values (p> 0.01) for both treatment modalities.\nConclusion: MRgFUS is a promising non-invasive treatment modality for suc-\ncessful palliation of bone metastasis and has potential for tumour control as \ncompared with ERBT. \nB‑0646 11:24\nPercutaneous laser ablation of metastatic lymph nodes in the neck \nfrom papillary thyroid carcinoma: 1-year results \nG. Mauri1, T. Tondolo1, L. Cova1, T. Ierace1, N.S. Goldberg2, L. Solbiati1; \n1Busto Arsizio/IT, 2Jerusalem/IL (vanni.mauri@gmail.com) \nPurpose: To assess the feasibility, safety and effectiveness of PLA in the treat-\nment of metachronous lymph node metastases from papillary thyroid carcinoma \nin the neck.\nMethods and Materials: 24 lymph nodes (mean size 1.2 cm, range 0.6-2.6 cm) \nin 15 patients were treated. A 1,064 nm Nd:YAG laser was used. All cases were \nnegative at 131I whole body scan, had positive 18 F-FDG PET and CEUS and \nelevated serum levels of thyroglobulin (Tg) or anti-thyroglobulin antibodies (TgAb). \nNodes were treated with 3 W power for 400-600 sec (total energy 1,200-1,800 \njoules). Follow-up was performed at 6 and 12 months with CEUS, 18 FDG-PET/\nCT and assessment of serum levels of Tg and of TgAb.\nResults: Laser ablation was technically feasible and well tolerated in all patients, \nwith no complications. At 6-month follow-up complete ablation was demonstrated \nin 19/24 (79.1%) lymph nodes in 10/15 (66.6%) patients. 6/15 (40.0%) patients also \nhad negative Tg and TgAb serum levels. One patient with four treated lymph nodes \ndeveloped distant metastases and did not undergo the 12-month 18 FDG-PET. \nAt 12 months complete ablation was demonstrated in 16/20 (80%) lymph nodes \nB‑0642 10:48\nOsteoid osteomas of the elbow: a challenging location \nA. Bazzocchi, G. Facchini, G. Bettelli, E. Castiello, M. Cavaciocchi, R. Rotini, \nU. Albisinni; Bologna/IT (giancarlo.facchini@gmail.com) \nPurpose: The elbow joint is a site deserving special consideration in the radi-\nofrequency thermal ablation (RFA) of osteoid osteomas (OO). OO affecting the \nintracapsular space often involve articular ends; moreover, the proximity to the \nskin as well as the presence of vascular and nervous structures call for technical \nskills and caution. The purpose of this study was to report our experience in the \ntreatment of OO of the elbow (e-OO).\nMethods and Materials: Between 2002 and 2010, 27 patients with e-OO were \ncandidate to RFA as first choice treatment at our Institution. Extra-articular and \njuxta-articular OOs were not included. We retrospectively analysed outcomes of the \nprocedure in terms of ablation efficacy, incidence of complications and functional \nresults measured by Mayo-Elbow-Performance-Score (MEPS), with a minimum \nfollow-up of 24 months.\nResults: Twenty males and 7 females with age ranging from 13 to 45 years (av-\nerage 26.4) showed the onset of symptoms 5 months to 6 years (average 28.0 \nmonths) before diagnosis. All patients complained about pain, while joint function \nwas impaired in 24/27-88.9% cases. The average improvement of MEPS after RFA \nwas 39.8 (±15.8) points, with 25/27-92.6% patients scoring 90 to 100 (/100) points \nat the end of follow -up. No complications were recorded. One (the first treated) \npatient presented with recurrence of the disease 9 months after the procedure, and \nthis was successfully healed by a second RFA. All patients were free from disease \nat an average follow-up of 49 months (range 2-8 years).\nConclusion: RFA of e-OO is a safe and an effective procedure, allowing excellent \nfunctional recovery. \nB‑0643 10:57\nMR-guided high-intensity focused ultrasound for non-invasive \ntreatment of osteoid osteoma \nM. Anzidei, A. Napoli, G. Brachetti, B. Cavallo Marincola, G. Cartocci, F. Boni, \nV. Noce, L. Bertaccini, C. Catalano; Rome/IT (michele.anzidei@gmail.com) \nPurpose: To determine the feasibility and initial clinical efficacy of MR-guided \nFocused Ultrasound (MRgFUS) for treatment of patients with osteoid osteoma.\nMethods and Materials: This prospective, IRB approved study involved 7 consecu-\ntive patients (6 m; 1f; mean age, 21) with clinical and imaging diagnosis of Osteoid \nOsteoma; all patients underwent MRgFUS ablation (ExAblate, InSightec). Lesions \nlocated in the vertebral body were excluded, while lesions in proximity to joints \nor neurovascular bundles were included. Treatment success was determined at \nclinical and imaging follow-up at 1, 3, and 6 months post-treatment. A visual Analog \nPain Score (VAS) was used to assess changes in symptoms.\nResults: Treatment was carried out using a variable number of sonications (mean \n4±1.8) with a mean energy deposition of 866±211 J. There were no treatment- or \nanaesthesia-related complications. A statistically significant (p=0.001) difference \nwas noted between the overall pre- and post-treatment mean VAS scores (8.3±1.6 \nand 0.6±1.5, respectively). Six of the 7 treatments were conducted on patients with \ntypical osteoid osteoma and all were completely clinically successful. The patient \nwith giant osteoma had pain recurrence after 2 weeks, requiring surgery. At imaging, \noedema and hyperemia associated with typical osteoid osteoma gradually disap-\npeared in all lesions. No apparent relationship between nidus vascular extinction \nand successful outcome was found.\nConclusion: MRgFUS ablation represents an effective and totally non-invasive \ntherapeutic option for osteoid osteoma management, without treatment-related \nadverse events. \nB‑0644 11:06\nMR-guided focused ultrasound ablation on bone metastases: role of \ndynamic contrast-enhanced MRI in the evaluation of treatment response \nA. Napoli, V. Noce, M. Anzidei, F. Boni, G. Brachetti, G. Cartocci, L. Bertaccini, \nC. Catalano, F. Ciolina; Rome/IT (alessandro.napoli@uniroma1.it) \nPurpose: To quantitatively evaluate perfusional MRI findings in skeletal metastases \ntreated with MR-guided Focused Ultrasound (MRgFUS) ablation and compare \nimaging parameters with clinical pain assessment by visual analogue scale (VAS).\nMethods and Materials: Eleven patients treated with MRgFUS ablation of bone \nmetastases were examined with a Dynamic Contrast-Enhanced 3 T MR-scan \n(DCE-MRI; Discovery 750, GE; gd-BOPTA, Bracco) before and 3 months after \nthe sonication procedure. Quantitative perfusional parameters were obtained by \nmeans of DCE-MR transfer rate constant (Ktrans) and extravascular volume frac-\n\nScientific Sessions\nS296\n C A D E F\n G\nB\n10:30 - 12:00 Room E1 \nMusculoskeletal \nSS 1310 \nArthritis and metabolic bone disease \nModerators: \nA.J. Grainger; Leeds/UK \nA. Plagou; Athens/GR \nB‑0650 10:30\nRadiological peripheral involvement in a cohort of polyarticular \njuvenile idiopathic arthritis at adulthood \nA. Feydy, R. Bazeli, V. Freire, M. Elhai, J. Wipff, C. Job-Deslandre, A. Kahan, \nJ.-L. Drapé; Paris/FR (antoine.feydy@cch.aphp.fr) \nPurpose: Radiographic damage was recently identified as a feature of poor prog-\nnosis in polyarticular juvenile idiopathic arthritis (pJIA). However, most radiographic \nstudies did not differentiate pJIA from other subtypes of JIA and little is known \nin pJIA persisting into adulthood. We set out, therefore, to describe radiological \nperipheral involvement in young adults with pJIA as compared to rheumatoid \narthritis (RA) patients.\nMethods and Materials: All consecutive pJIA patients followed in a transition \nprogram were included. Age, sex, disease duration, and treatment information \nwere collected. Laboratory tests and standard radiographs of the hands and \nwrists, feet and hips were then analysed by two independent radiologists blinded \nto the diagnosis. A RA control group (< 55years), matched for sex and disease \nduration, was recruited.\nResults: Fifty-eight pJIA and 59 RA patients were included. Radiographs showed \nhand lesions in 78% of pJIA and 86% of RA patients, feet lesions in 67% of pJIA \nand 79% of RA patients and coxitis in 30% of pJIA and 17% of RA patients (p=NS). \nSpecificities to juvenile forms were a lower frequency of proximal interphalangeal \njoints involvement and a higher risk of bilateral coxitis (81% vs. 25% (p=0.007, \nOR=13 [1.701-99.375]) than adult RA. Peripheral damage correlated with a more \nsevere disease.\nConclusion: Structural peripheral damage is as common and as severe in young \nadults with pJIA as in adult RA. The main specific feature of pJIA seems to be a \nhigh risk of bilateral coxitis. This requires a particular monitoring of pJIA patients \nwith unilateral hip involvement to prevent bilateralization.\nB‑0651 10:39\nMonitoring of initial methotrexate therapy effect on cartilage \ncomposition in early rheumatoid arthritis with biochemical MRI of \nfinger cartilage \nC. Schleich, B. Ostendorf, C. Buchbender, C. Nowak, P. Sewerin, M. Schneider, \nG. Antoch, A. Scherer, F. Miese; Düsseldorf/DE (schleich2003@gmx.de) \nPurpose: To test for improvement in cartilage glycosaminoglycan content of \nmetacarpophalangeal joints (MCP) in patients with early rheumatoid arthritis (eRA) \nundergoing initial methotrexate therapy using delayed Gd (DTPA) 2-enhanced MRI \nof the cartilage (dGEMRIC).\nMethods and Materials: MCP II/III in 19 patients with eRA and 13 healthy volun-\nteers were examined (eRA patients: 13 females, six males, mean age 51 years; \neRA six-month follow -up patients: 7 females, one male, mean age 48 years; \nhealthy volunteers: ten females, three males, mean age 51 years). dGEMRIC \nwas measured with manually drawn region-of-interest evaluation. Cartilage thick-\nness was determined as a conventional measure of cartilage integrity. CRP was \nrecorded, remission was assessed according to EULAR 2011 criteria. Statistical \nanalysis used non-parametric Mann-Whitney-U-test to test for significant differ-\nences between the groups.\nResults: dGEMRIC was significantly decreased in eRA patients compared to \nhealthy subjects (healthy volunteers: MCP II 488 ms ± 90 ms, MCP III 523 ms ± \n100 ms; eRA patients: MCP II 414 ms ± 119 ms (p < 0.05) MCP III 415 ms ± 132 \nms (p < 0.05)). There was no significant difference in cartilage thickness. Follow-\ning six-month of methotrexate therapy, remission was achieved in six out of eight \npatients. Mean improvement of dGEMRIC index was 12 ms ± 180 ms (n.s). There \nwas no significant association of dGEMRIC with remission or change in CRP.\nConclusion: Decreased glycosaminoglycan content of normal appearing finger \ncartilage in eRA did not significantly improve with methotrexate therapy despite \nclinical remission. dGEMRIC may be a possible tool for studies on cartilage pro-\ntection in RA therapy.\nin 10/14 (71.4%) patients. 4/15 (26.6%) patients also had negative Tg and TgAb \nserum levels. 3/15 (20%) developed distant metastases.\nConclusion: Percutaneous US-guided interstitial laser ablation is potentially safe \nand effective in the treatment of metachronous nodal metastases from papillary \nthyroid carcinoma in the neck. With further study this may help reducing or delaying \na large number of highly invasive radical neck dissection.\nB‑0648 11:33\nArterial spin labelling (ASL) MRI for monitoring kidney perfusion \nbefore and after renal denervation: initial results \nC. Schleich, D. Blondin, P. Kröpil, O. Vonend, \nP. Heusch, H.-J. Wittsack, G. Antoch, R.S. Lanzman; \nDüsseldorf/DE (Rotem.Lanzman@med.uni-duesseldorf.de) \nPurpose: The purpose of our study was to investigate changes in kidney perfusion \nfollowing renal denervation using arterial spin labelling (ASL) MRI at 1.5 T.\nMethods and Materials: 7 patients (mean age 58 ± 13 years) undergoing interven-\ntional renal denervation were included in this study. In each patient, between 6 and \n8 ablations were performed per renal artery. ASL MRI was performed at 1.5 T using \na single-slice FAIR TrueFisp sequence in the coronal plane (30 averages of label \nand control pairs, inversion time 1200 ms, slice thickness 8 mm, matrix 128x128) \nprior to and within 24 hours following renal denervation. Patients refrained from \nfluid intake for at least 2 hours prior to the examination. Following post-processing, \nROIs were drawn by a single reviewer on ASL parameter maps for quantification of \ncortical perfusion. Both kidneys of each patient were used for statistical analysis.\nResults: Image acquisition was completed successfully in all patients and perfusion \nwas determined for 14 kidneys in 7 patients. In 6 patients, ASL perfusion increased \nby at least 10% following denervation, while in one patient ASL perfusion decreased \nfollowing intervention. Mean ASL perfusion following renal denervation (245.8 ± \n43.3 ml/100 g/min) was significantly higher than prior to denervation (273.4 ± 56.4 \nml/100 g/min)(p < 0.01).\nConclusion: Renal denervation leads to a significant increase in kidney perfusion \nas assessed with ASL MRI. Further studies are required to determine the predictive \nvalue of perfusion changes in patients undergoing renal denervation.\nB‑0649 11:42\nReliable and reproducible sampling of adrenal veins in the \nmanagement of hyperaldosteronism, a technically demanding yet \nfeasible procedure: an institutional experience \nC.H. Lam, H.L. Chow, S.H. Chiu, H.Y. Cho, S. Lau; Hong Kong/HK \n(sunnylamsjc@yahoo.com.hk) \nPurpose: To analyse the feasibility and accuracy of adrenal venous sampling \n(AVS) in predicting and lateralizing a surgically remedial adrenal adenoma, and to \ncompare its findings with CT.\nMethods and Materials: We compared results of AVS and computed tomography \n(CT) from January 2009 to May 2012. Biochemical evidence of adrenal vein can-\nnulization was analysed with adrenal-peripheral cortisol ratios. Pathology was then \nreviewed in patients undergoing adrenalectomy.\nResults: A total of 37 patients underwent 43 AVS during the period. The success \nrate was 100% (37 out of 37) and 91.9% (34 out of 37) for left and right-sided \nsamples, respectively. A second AVS was performed on three patients who failed \nthe first attempt (8.1%). There were 23 (62.2%) unilateral APA and 14 (37.8%) \nbilateral hyperplasia. All patients had a prior CT scan: 25 patients had unilateral \nnodules, 8 had bilateral disease, and 4 were normal scan. Concordance between \nCT and AVS was observed only in 21 (56.8%) of the 37 patients. In the 26 patients \nwith APA (AVS proven), 17 (65.4%) had concordant CT findings, 7 had discordant \nfindings, and 2 had normal scan. In the 14 patients with BAH (AVS proven), 4 \n(28.6%) had concordant CT findings, 8 had discordant findings, and 2 were normal \nscan. The 23 patients with unilateral disease underwent adrenalectomy. Pathology \nall confirmed cortical adenoma.\nConclusion: We conclude that reliable and reproducible AVS result is feasible. \nAVS is also superior to CT in differentiation of primary aldosteronism and in lat-\neralization of APA.\n\nScientific Sessions\nS297\nA\n C D E F G\nB\nSunday\nof Gd-DTPA (Omniscan, Schering, Berlin). Starting from injection, 20 acquisitions \nwere acquired of 3 slabs of the wrist, the first of which positioned tangentially to the \nradio. A ROI was placed on the most enhancing region of the synovial membrane. \nThe dynamic curve was quantified in terms of rate of early enhancement (REE) and \nrelative enhancement (RE). Patients were classified as remitting or not-remitting. \nMann-Whitney test was used for comparisons.\nResults: The mean duration of follow-up was 38 months (range 4-84 months). The \nfinal diagnosis was: 12 rheumatoid arthritis, 3 psoriatic arthritis, 3 connectivitis, and \n12 other pathologies (2 carcinomas, 1 palindromic rheumatism, 2 fibromyalgia, \n3 seronegative arthritis, 3 oligoarthritis, 1 reactive arthritis). Nine patients were \ncompletely remitting. Mean REE in remitting patients (0.85±0.62) was not signifi-\ncantly different (p=0.300) from that of non-remitting patients (1.12±0.80); instead, a \nsignificant difference was observed in the RE (53±37% versus 92±53%; p=0.020). \nREE was negatively correlated to the follow-up duration (p=0.026).\nConclusion: Dynamic MRI is highly predictive in outcomes of early arthritis \ninvolving the wrist. \nB‑0655 11:15\nAssociation of trochlear dysplasia with degenerative abnormalities \nin the knee: data from the osteoarthritis initiative \nP.M. Jungmann1, S.-C. Tham2, H. Liebl3, M. Nevitt3, C.E. McCulloch3, \nJ. Lynch3, T.M. Link3; 1Munich/DE, 2Singapore/SG, 3San Francisco, CA/US \n(pia.jungmann@tum.de) \nPurpose: To evaluate trochlear morphology as a potential risk factor for patellofemo-\nral osteoarthritis, determined by morphological and quantitative measurements of \ncartilage degeneration using 3 T magnetic resonance imaging (MRI) of the knee.\nMethods and Materials: MR images of right knees of 304 randomly selected sub-\njects, aged 45-60 years, from the osteoarthritis initiative (OAI) progression cohort \nwere screened for trochlear dysplasia, defined by a pathological trochlear depth. \nOut of 304 subjects, n=85 demonstrated a shallow trochlea (depth ²3 mm; 28%). In \nthese, and also in a random sample of controls with normal trochlear depth (n=50), \nwe calculated the facetal ratio and assessed knee structural abnormalities using \na modified Whole-Organ-MR-Imaging Score (WORMS). Cartilage segmentation \nwas also performed and T2 relaxation times and patellar cartilage volume were \ndetermined. ANOVA and multivariate regression models were used for statistical \nanalysis of the association of MRI structural measures and trochlear morphology.\nResults: Knees with a shallow trochlea showed higher patellofemoral degenera-\ntion (WORMS mean ± standard deviation, 11.2±4.6 versus 5.7±4.2; multivariate \nregression, P < 0.001) and lower patellar cartilage volume than controls (900±664 \nmm3 versus 1671±671 mm3, P < 0.001). Knees with a pathological facetal ratio \nshowed increased patellofemoral WORMS scores (8.3±4.6 versus 2.3±6.3, P < \n0.001). T2 values at the patella were significantly lower in the dysplasia group. \nHowever, significance was lost after adjustment for cartilage volume (multivariate \nregression, P=0.673).\nConclusion: Trochlear dysplasia, defined by a shallow trochlea, is associated \nwith higher WORMS scores and lower cartilage volume, indicating more advanced \nosteoarthritis at the patellofemoral joint.\nB‑0656 11:24\nReliability of tomosynthesis for semiquantitative assessment of \nknee osteoarthritis features by radiologists with different levels of \nexpertise \nD. Hayashi1, L. Xu1, J. Gusenburg1, F.W. Roemer1, D.J. Hunter2, L. Li1, \nA. Guermazi1; 1Boston, MA/US, 2Sydney/AU (guermazi@bu.edu) \nPurpose: To assess intra-reader reliability for semiquantitative (SQ) scoring of \nosteophytes (OPs) and subchondral cysts (SCs) using tomosynthesis among \nradiologists with various levels of expertise.\nMethods and Materials: 40 subjects (aged 40 or above) had both knees imaged \nby tomsynthesis. Three readers individually assessed these 80 knees: A, expert \nmusculoskeletal radiologist with 13 years of experience in radiographic SQ scoring \nof osteoarthritis features; B, board-certified musculoskeletal radiologist with 5 years \nof clinical experience and 1 year of research experience involving SQ scoring of \nosteoarthritis features; and C, 1st-year radiology resident with no prior experience. \nOPs were scored based on the OARSI atlas from 0 to 3, and presence of SCs \nin medial/lateral femur and tibia was noted. 20 knees were randomly chosen and \nre-read 1 month later. Intra-reader reliability was assessed across the knee by \ncalculating the overall exact % agreement and the weighted κ.\nResults: Readers A, B and C detected 178, 167 and 127 OPs, and 31, 28, and 37 \nSCs, respectively. Reader A had substantial to perfect intra-reader agreement for \nOPs (100% agreement, κ=1.00 [95%CI 1.00-1.00]) and SCs (90%, κ=0.86 [0.65-\n1.00]). Reader B also showed substantial intra-reader agreement for OPs (90%, \nAuthor Disclosures:\nG. Antoch: Speaker; Siemens AG, Bayer AG, MDS Nordion. F. Miese: Speaker; \nServier.\nB‑0652 10:48\nQuantification of synovitis in the cranio-cervical region in early \nrheumatoid arthritis using dynamic contrast-enhanced (DCEI) and \ndiffusion-weighted (DWI) magnetic resonance imaging (MRI) \nM. Jeromel1, V. Jevtič1, M. Tomšič1, I. Pisanec2, J. Markota1, I. Serša,1, \nA. Ambrožič1; 1Ljubljana/SI, 2Celje/SI (miran.jeromel@gmail.com) \nPurpose: Early diagnosis of synovitis in the cranio-cervical region (CCR) of pa-\ntients with rheumatoid arthritis (RA) is of utmost clinical importance. Quantitative \nevaluation of early synovitis using DCEI and DWI is introduced.\nMethods and Materials: 27 patients with early RA ([[Unable to Display Character: \n˂]] 24 months) and neck pain were studied at baseline and after 6 months. \nStandard qualitative MRI evaluation of atlantoaxial joints was coupled with two \nquantitative MRI methods (DCEI and DWI). Rate of early enhancement (REE), en-\nhancement gradient (Genh) and apparent diffusion coefficient (ADC) were extracted.\nResults: Qualitative MRI proved synovitis around the odontoid process in 16 \n(59%) patients at baseline and 14 (54 %) patients at follow-up. Quantitative DCEI \nand DWI confirmed active synovitis in 25 (93%) patients at baseline and 24 (92%) \npatients at follow-up. Average ± standard error REE value was 0.72 ± 0.05%/s at \nthe beginning and 0.66 ± 0.06%/s at the follow-up, mean Genh value was 1.42%/s \n(95% CI 1.06 - 1.88%/s) and 1.41%/s (95% CI 1.04 - 1.90%/s), respectively. Aver-\nage ± standard error ADC value at the beginning was 1.79 ± 0.07 x 10-3 mm2/s \nand 1.74 ± 0.06 x 10-3 mm2/s at the follow-up.\nConclusion: DCEI and DWI enable quantification of synovitis in the CCR of patients \nwith early RA. Qualitative and quantitative MRI demonstrated very high incidence of \nsynovitis and confirmed active inflammatory disease in the CCR following therapy \nalthough all clinical criteria showed signs of improvement of the peripheral disease.\nB‑0653 10:57\nSlow radiographic progression of bone destruction in the hands in \nearly psoriatic arthritis without correlation to clinical disease activity \nM. Geijer1, U. Lindqvist2, T. Husmark3, G.-M. Alenius4, P.T. Larsson5, A. Teleman6, \nE. Theander7; 1Lund/SE, 2Uppsala/SE, 3Falun/SE, 4Umeå/SE, 5Stockholm/SE, \n6Oskarström/SE, 7Malmö/SE (ecr2012@geijer.info) \nPurpose: To describe early x-ray findings in the hands and evaluate progression \nof destruction after five years correlated to clinical parameters in early psoriatic \narthritis (PsA).\nMethods and Materials: In 31 men and 46 women with PsA fulfilling the CASPAR \ncriteria hand x-rays were available from the 5-year follow-up and either inclusion or \nthe 2-year visit. X-rays were scored by the Wassenberg scoring system.\nResults: Median symptom duration at inclusion was 12 months. 58% had polyarticu-\nlar and 38% mono/oligoarticular PsA. At the first evaluation 60% had Wassenberg \nscore zero. At the 5-year visit median score was 2. In 34 patients (44%) the score \nwas still 0, in 28 between 1 and 5, in 5 between 6 and 10, in 6 between 11 and \n15, and 1 patient each had a score of 19, 22, 39, and 42. At baseline women had \nsignificantly higher disease activity than men, but similar x-ray score. At 5 years \nmen had improved considerably in function and disease activity score, but had \ngreater x-ray progression (58% vs 28%, p=0.009). Male gender was a significant \npredictor of x-ray progression. Longer symptom duration at entry predicted x-ray \nprogression (p=0.038) and prevented minimal disease activity (p < 0.001).\nConclusion: After 5 years of PsA, most patients still have no or very little hand \njoint destruction. Symptom duration at inclusion and male gender were the main \npredictors of x-ray progression,\npreserved function at baseline was protective. Despite worse clinical outcome \nwith higher disease activity scores, women had less x-ray progression than men. \nB‑0654 11:06\nRole of dynamic MRI in predicting outcome of patients affected with \nearly stage arthritis \nC.A. Mattiuz1, L.M. Sconfienza1, M. Cimmino2, G. Garlaschi2, G. Di Leo1, \nF. Sardanelli1; 1Milan/IT, 2Genoa/IT (chiara.mattiuz@gmail.com) \nPurpose: To estimate the association between curve parameters of dynamic MRI \nof the wrist and outcome of patients affected with arthritis.\nMethods and Materials: Thirty-nine patients (M/F 10/29; age range 25-79 years) \naffected with early stage arthritis (< 9 months) in at least one wrist were prospec-\ntively enrolled. Each patient underwent MRI using a dedicated unit (Artoscan 0.2 T). \nImaging protocol included spin-echo sequences before/after injection of 0.2 ml/kg \n\nScientific Sessions\nS298\n C A D E F\n G\nB\nB‑0659 11:51\nMultifocal endosteal thickening of the femur in patients on long-term \nbisphosphonate therapy presenting with atypical femoral fractures \nM.A. Png, P.C. Mohan, J.S.B. Koh, T.S. Howe; Singapore/SG \n(gdrpma@gmail.com) \nPurpose: To describe the incidence and radiological characteristics of multifocal \nendosteal thickening in patients on bisphosphonate therapy.\nMethods and Materials: A retrospective study of 68 patients with atypical femoral \nfractures (AFF) whilst on bisphosphonate therapy was performed. Available femoral \nradiographs were assessed for: focal endosteal thickening (at least 1 mm in length \nand width), number of lesions, lesion location, femoral bowing, periosteal beak and \nblack line. Multifocal endosteal thickening was defined as multiple foci of discrete \nendosteal thickening. Medical records were reviewed to obtain relevant clinical data.\nResults: Forty-eight lesions with multifocal endosteal thickening were detected in \nseven patients (2 unilateral, 5 bilateral), affecting 11.8% of femora. Location was \nmainly diaphyseal (95.8%), upper (10.4%), middle (58.3%) and lower femur (31.3%), \ninvolving the lateral (85.4%), anterior (6.3%), anterolateral (2.1%) and posterior \ncortices (6.3%). Femoral bowing was present in 85.7%. Associated findings of a \nperiosteal beak and/or a black line, seen in 14.6%, were associated with increased \nfracture risk (100.0% sensitivity, 93.2% specificity).\nConclusion: Multifocal endosteal thickening is a new finding seen in patients with \nlow bone mineral density on bisphosphonate therapy. In our cohort of patients, who \npresented with AFF, it was present in 11.8% of femora. It was frequently bilateral, \npredominantly diaphyseal in location involving the lateral cortex and often associ-\nated with bowing. Caution is advised when seen in association with periosteal \nbeak and/or black line because of a high rate of progression to complete fracture.\n10:30 - 12:00 Room E2 \nCardiac \nSS 1303 \nTowards improved image quality and detection \nModerators: \nG. Feuchtner; Innsbruck/AT \nC. Herzog; Munich/DE \nB‑0660 10:30\nStenosis quantification in coronary CT angiography: impact of an \nintegrated circuit detector with iterative reconstruction \nF. Morsbach1, L. Desbiolles2, A. Plass1, S. Leschka2, B. Schmidt3, V. Falk1, \nH. Alkadhi1, P. Stolzmann1; 1Zurich/CH, 2St. Gallen/CH, 3Forchheim/DE \nPurpose: To assess an integrated circuit (IC) detector, improving spatial resolu-\ntion by means of reduced cross-talk between detector channels, in coronary CT \nangiography regarding image quality and stenosis quantification.\nMethods and Materials: In the ex vivo part of the study, a coronary phantom \nincluding 63 defined stenoses were scanned with 128-section dual-source CT \nequipped with IC and with conventional detector technology. Data were recon-\nstructed with filtered-back projection (FBP) and with iterative reconstruction (IR) \nat a slice-thickness of 0.6 mm and for data acquired with the IC detector with a \nslice-thickness of 0.5 mm. Phantom observations were validated in 30 consecutive \npatients (11female;mean age 62) undergoing coronary CT angiography with IC. \nThe patient images were reconstructed with FBP (slice-thickness:0.6 mm) and \nwith IR (slice-thickness:0.5 mm). All images were assessed for image quality and \ndegree of stenosis.\nResults: Image quality was significantly (P < 0.001) higher with the IC detector \nas compared with the conventional detector. The IC detector yielded significantly \nmore accurate results regarding stenosis grading: FBP:12.1±7.6%vs.13.7±7.6% \n(P=0.043) and IR:10.5±6.6vs.13.0±6.9%(P < 0.001). Images with a slice thickness \nof 0.5 mm reconstructed with IR (8.8±5.9%) obtained by the IC detector significantly \n(P < 0.001) improved measurement accuracy in the phantom as compared with \nFBP with a slice thickness of 0.6 mm (12.1±7.6%). We found a significantly (P < \n0.001) higher image quality in patients and stenoses were quantified significantly \n(P=0.009), more severe with FBP (47.6%) as compared with IR (42.1%).\nConclusion: Our study indicates more accurate stenosis quantification in coronary \nCT angiography when acquiring data using an IC detector and combining IR with \nhigh-resolution images as compared with conventional detector technology and \nFBP reconstructions. \nAuthor Disclosures:\nB. Schmidt: Employee; Siemens Healthcare, Germany.\nκ=0.93 [0.83-1.00]) and SCs (95%, κ=0.83 [0.50-1.00]). Reader C showed perfect \nagreement for SCs (100%, κ=1.00 [1.00-1.00]) but agreement for OPs was notably \nlower than two experienced readers (75%, κ=0.79 [0.61-0.96]).\nConclusion: TS seems to offer excellent intra-reader reliability regardless of the \nreader experience for SCs. However, reader experience seems important for reli-\nable SQ assessment of OPs using tomosynthesis. \nAuthor Disclosures:\n F.W. Roemer: Consultant; Merck Serono, NIH. Shareholder; Boston Imaging \nCore Lab, LLC. D.J. Hunter: Grant Recipient; ARC Future Fellowship; DonJoy; \nNIH; NHMRC. A. Guermazi: Consultant; Merck Serono, Novartis, Stryker, \nGenzyme; AstraZeneca. Shareholder; Boston Imaging Core Lab, LLC.\nB‑0657 11:33\nScoring hip abnormalities using MR images (SHAMRI): a novel hip \nwhole joint osteoarthritis evaluation system \nS. Lee1, L. Nardo1, A. Lai1, D. Kumar1, C.R. Wyatt1, R.B. Souza1, N.E. Lane2, \nS. Majumdar1, T.M. Link1; 1San Francisco, CA/US, 2Sacramento, CA/US \n(Sonia.Lee@ucsf.edu) \nPurpose: To develop a semi-quantitative osteoarthritis evaluation scoring system \nfor degenerative hip abnormalities using MR images and to test its reproducibility \nand validity.\nMethods and Materials: Radiographs and non-contrast 3 T MR images were ac-\nquired from hips of forty patients (20 males and 20 females; aged 25 to 61 years). \nIntermediate weighted fast spin echo images were acquired in 3 planes. Radio-\ngraphs were classified using the Kellgren-Lawrence (KL) grading and MR studies \nwere analysed using a new whole-joint MRI scoring system evaluating cartilage, \nlabrum, bone, synovial structures and tendons of the hip. Reproducibility was de-\ntermined using weighted-kappa statistics. Cochran-Armitage test was used to test \nassociations between new MRI classification scores and radiographic KL scores.\nResults: Radiographic KL grading distribution was: KL 0=10, KL 1=10, KL 2=10, \nKL 3=10. Intra- and inter-observer reproducibilities per single feature had K values \nbetween 0.68 to 0.82 and 0.60 to 0.95, respectively. Kappa values were lower for \nsubregional cartilage evaluation (between 0.60 and 0.70), and higher for labral, \nbone marrow, synovial abnormalities and greater trochanter insertion tendinopa-\nthy (greater than 0.80). The overall percent agreement was above 0.80 for both \nintra- and interobserver reproducibilities. Amongst the abnormalities, full thickness \ncartilage defects had the highest association with KL scores (p < 0.001).\nConclusion: The novel MRI evaluation system of hip osteoarthritis evaluated a \nwide range of pathology and showed high intra- and inter-observer reproducibilities. \nB‑0658 11:42\nCortical thickness mapping reveals effects of age, weight and \nosteophytes in the proximal femur \nT.D. Turmezei, G.M. Treece, A.H. Gee, C.J. Tonkin, K.E.S. Poole; Cambridge/UK \n(tom@diagnosticradiology.eu) \nPurpose: Cortical thickness mapping is a technique that uses clinical computed \ntomography (CT) imaging to plot the distribution of cortical bone thickness in \n3D. Given our understanding of their relationships with bone mineral density, we \nperformed a study to investigate the effects of age, weight, and osteophytes on \ncortical bone distribution in the proximal femur.\nMethods and Materials: We analysed CT imaging data from a cohort of 230 \nwomen aged 66±17 years, selecting one hip from each randomly according to side. \nA DICOM analysis tool (Stradwin) was used to contour each hip semi-automatically \nand create a 3D surface mapped with individual cortical thickness values. Statisti-\ncal parametric mapping was then performed to investigate model effects of age, \nweight and osteophytes on cortical thickness.\nResults: Cortical thickness was generally thinner with advancing age, but was \npreserved in characteristic load-bearing regions at the medial femoral neck and \nlateral subtrochanteric cortex. Greater weight was also associated with significantly \nthicker cortex per kilogram at these same sites. Including osteophytes in the model \nshowed that increasing severity was detected as increasingly thick cortical bone \naround the articular margin at the femoral head-neck junction.\nConclusion: These results demonstrate, for the first time, the effects of age, \nweight and osteophytes on cortical bone thickness in the proximal femur. It will be \nessential for future analysis of bone in this region to take these effects into account.\nAuthor Disclosures:\n G.M. Treece: Patent Holder; Co‐inventor on a related GB patent application “A \nmethod of determining the cortical thickness of a patients bone”.K.E.S. Poole: \nPatent Holder; Co‐inventor on a related GB patent application “A method of \ndetermining the cortical thickness of a patients bone”.\n\nScientific Sessions\nS299\nA\n C D E F G\nB\nSunday\nCTCA-derived parameters were determined and their diagnostic performance for the \ndetection of flow-limiting coronary lesions (FFR²0.80) was compared to visual CTCA.\nResults: Optimal cut-off values to predict flow-limiting coronary lesion were 1.8 \nmm2 for MLA, 71% for %AS and 76% for plaque burden. Significantly higher \nspecificity for MLA (68%; 95%CI: 58-78; p=0.001), %AS (68%, 95%CI: 58-77; p < \n0.001) and plaque burden (63%; 95%CI: 53-73; p=0.004) were found compared to \nvisual CTCA (42%; 95% CI: 32 to 52). No significant difference in sensitivity was \nfound between visual CTCA and quantitative CTCA cross-sectional parameters.\nConclusion: Quantitative CTCA cross-sectional parameters improve the prediction \nof functionally significant coronary lesions compared to visual CTCA assessment \nbut remain insufficient. Functional assessment is still needed in lesions of moderate \nseverity to guide patient’s management.\nAuthor Disclosures:\nP.H. Kitslaar: Employee; Medis medical imaging systems B.V.\nB‑0664 11:06\nImpact of iterative CT image reconstruction on calcium score \nmeasurements \nJ.A.C. van Osch1, M. Mouden1, J.A. van Dalen1, J.R. Timmer1, S. Reiffers1, \nM.J.W. Greuter2, J.P. Ottervanger1, S. Knollema1, P.L. Jager1; 1Zwolle/NL, \n2Groningen/NL (j.a.c.van.osch@isala.nl) \nPurpose: To investigate the effect of iterative reconstruction (IR) on the coronary \ncalcium score in cardiac computed tomography (CT).\nMethods and Materials: In 111 patients with suspected coronary artery disease \nand a low to intermediate pre-test likelihood the total Agatston calcium scores (TAS) \nwere assessed using a 64-slice CT (Lightspeed VCT XT, GE). The IR algorithm \nused was adaptive statistical iterative reconstruction (ASIR). Comparisons were \nperformed between scores, obtained with full-dose scans, using traditional filtered \nback projection (FBP) and use of 100% IR. Also, the resulting shift of patients into \ndifferent risk categories was evaluated.\nResults: Comparison of the FBP and IR images showed a significant reduction of \nthe TAS (411 ± 39 versus 327 ± 31, P < 0.001). For all patients, the TAS calculated \non the IR images was consistently lower than the TAS calculated on the FBP images \n(reduction ranging from 3% to 100%). As a result, almost 30% of patients classified \nin a lower risk category when using IR, compared to FBP . Significantly more patients \nhad a TAS of zero when using 100% IR (26 vs. 11, P < 0.01).\nConclusion: The TAS decreased significantly using IR compared to FBP. This \nunderestimation, compared to FBP, is present over the entire range of the calcium \nscore, but most pronounced in the lower range of calcium scores. Subsequently, \nmore patients were classified in the zero calcium score category. This effect may \nhave a significant impact on clinical decision making and should be taken into \naccount when using IR.\nB‑0665 11:15\nAccuracy of prospectively ECG-triggered ultra low-dose coronary \ndual-source CT angiography using iterative reconstruction \nM. Lell, C. Layritz, T. Pflederer, W. Wuest, S. Achenbach, M. Uder; \nErlangen/DE (michael.lell@uk-erlangen.de) \nPurpose: To evaluate the image quality and diagnostic accuracy of very-low-dose \nCT angiography (CTA) for evaluation of coronary artery stenosis.\nMethods and Materials: 50 symptomatic patients with an intermediate likelihood \nfor coronary artery disease underwent coronary CTA prior to invasive coronary \nangiography. CTA images were reconstructed both using standard filtered back \nprojection (FBP) and a raw-data based IR algorithm. Subjective image quality, \nimage noise, signal-to-noise ratio, contrast-to-noise ratio as well as the presence \nof coronary stenosis > 50% were independently determined by two observers.\nResults: Mean estimated effective dose was 0.66 mSv. IR led to significantly \nimproved objective image quality compared to FBP (image noise: 41±12 vs. 49±11 \nHU, CNR: 16±8 vs. 12±4, SNR: 13±7 vs. 10±3; all p < 0.001). Four coronary seg-\nments were not evaluable on FBP data, where as all segments showed diagnostic \nimage quality with IR. To detect significant coronary stenosis, sensitivity, specificity, \nPPV and NPV were 69%, 97%, 69%, 97% per vessel with FBP, the corresponding \nvalues with IR were 81%, 97%, 68%, 98% (p=0.617).\nConclusion: Raw-data-based iterative reconstruction significantly improved image \nquality in very-low-dose prospectively ECG-triggered coronary DSCT angiography \nwhen compared to standard reconstruction using FBP. Along with substantial re-\nduction of radiation exposure, iterative reconstruction also shows a trend towards \nhigher accuracy in coronary stenosis detection compared to FBP. \nAuthor Disclosures:\nM. Lell: Grant Recipient; Bayer, Siemens. Speaker; Bayer, Siemens. \nS. Achenbach: Grant Recipient; Bayer, Siemens. Speaker; Siemens. M. Uder: \nGrant Recipient; Siemens.\nB‑0661 10:39\nCT coronary angiography: effect of iodine CONcentration on \nvascular attenuation. The CT-CON multicentric study preliminary results \nM. Rengo1, A.S. Dharampal2, D. Caruso1, K. Nieman2, A. Laghi1, G.P. Krestin2; \n1Latina/IT, 2Rotterdam/NL (marco.rengo@gmail.com) \nPurpose: To explore the relative impacts of iodine concentration versus iodine \ndelivery rate on intra-coronary attenuation. To describe the effect of iodine con-\ncentration on contrast bolus characteristics.\nMethods and Materials: Two hundred fifty patients were prospectively randomised \nin 4 groups and all underwent CT Coronary Angiography (CTCA). Four CM with \ndifferent iodine concentrations (300, 350, 370, 400 mgI/ml) were delivered at a fix \niodine delivery rate (2.0 mgI/s). Intracoronary attenuation values were measured \nand grouped on a per-vessel and per-segment bases. Time-to-peak, and pressure \ncurves during CM injection were evaluated and compared.\nResults: Injection fluxes were 6.7 ml/sec, 5.7 ml/sec, 5.4 ml/sec and 5 ml/sec for \ngroup A, B, C and D, respectively. Group A [300] and C [370] provided significantly \nhigher intravascular attenuation values compared with group B [350] and D [400] (P \n< 0.05) in both per segment and per vessel analysis. Time-to-peak was significantly \nearlier in group A (15.3 sec) than in the other three groups. The injection peak \npressure was significantly lower in group A (185.16 psi) and C (189.05 psi) than in \ngroup B (215.89 psi) and D (243.33 psi). No extravasations were noted in all groups.\nConclusion: Despite that the four CM were injected at the same IDR, intravascular \nattenuation values were not equal. The influence of chemico-physical characteristics \ninfluenced also the other injection parameters. In particular a non correspondence \nbetween the injection flux and the injection pressure was observed among groups. \nB‑0662 10:48\nMDCT coronary angiography evolution of phasic critical stenosis in \nmyocardial bridges \nR. Malago, M. Tezza, G. Sala, A. Pezzato, C. Barbiani, R. Pozzi Mucelli; \nVerona/IT (robertomalago@gmail.com) \nPurpose: MDCT-CA can detect the presence of myocardial bridges, through \nqualitative evaluation of coronary diameter, measured from the end-diastolic to \nthe end-systolic phase; an objective evaluation can also be performed through \nquantitative coronary CT (QCTA). The aim is to evaluate the significance of stenosis \nin case of myocardial bridge.\nMethods and Materials: Sixty-nine cases (mean age 62.3 YO, 48 M) with MB \nidentified at MDCT-CA in the period from 04/2008 to 02/2012 were retrospectively \nevaluated. All patients underwent CA that was performed to treat critical coronary \nartery stenosis. Bridges were evaluated and divided into 3 categories according to \nMohlenkamp classification. Through curved MPR and axial reconstruction of the \nbridge the diameter of the vessel was measured before the intramyocardial stretch \n(a), at the middle portion (b) and at the end (c) of the bridge, using the data from \nthe 10% of the RR interval in all datasets. Measurements were performed manually \nand using QCTA and compared with QCA at end-systolic and end-diastolic phase. \nCorrelation between the results obtained by manual measurements, QCTA and \nQCA were calculated according to Spearman test.\nResults: Type I was retrieved in 34/69 patients and type 3 in 2/69 patients. Minimum \ndiameter in the middle of the bridge recorded was 2 mm. Significant stenosis was \nrecorded in 8/69 patients and confirmed with QCA in 6/69 of them. Correlation \nbetween manual score and QCA resulted r=0.84, p> 0.001.\nConclusion: Both manual and QCTA measurements can evaluate the presence \nand the type of bridges and discriminate the phasic stenosis.\nB‑0663 10:57\nQuantitative CT coronary angiography: does it predict functionally \nsignificant coronary stenoses? \nA. Rossi1, S. Papadopoulou1, F. Pugliese2, B. Russo1, A. Dharampal1, \nP.H. Kitslaar3, S.E. Petersen2, P. de Feyter1, G.P. Krestin1; 1Rotterdam/NL, \n2London/UK, 3Leiden/NL (a.rossi@erasmusmc.nl) \nPurpose: CT coronary angiography (CTCA) interpreted visually is often inaccurate \nin identifying functionally significant coronary lesions in patients with stable angina. \nSeveral quantitative cross-sectional parameters can be derived from CTCA. The \naim of this study was to compare the diagnostic performance of quantitative CTCA \nwith visual CTCA in the detection of functionally significant coronary lesions using \nfractional flow reserve (FFR) as the reference standard.\nMethods and Materials: CTCA and FFR measurements were obtained in 99 \nsymptomatic patients. In total, 144 coronary lesions detected on CTCA were visu-\nally graded for stenosis severity. Quantitative CTCA cross-sectional parameters \nincluded minimal area diameter (MLA), percentage area stenosis (%AS) and plaque \nburden [(vessel area - lumen area)/vessel area*100]. Optimal cut-off values of \n\nScientific Sessions\nS300\n C A D E F\n G\nB\nMethods and Materials: 12 patients underwent evaluation of the RV function on \n1.5 T employing a 32-element coil. Acquisition was performed using a real-time \nradial SSFP sequence (16 projections) in a multislice breath-hold and free-breathing \nsetting with a spatial resolution of 2x2 mm2 (matrix 128; slice 6 mm) and a temporal \nresolution of 46 ms (TR 2.9 ms). Through-time radial GRAPPA reconstruction was \nperformed off-line (MATLAB) incorporating fully sampled (128 projections) calibra-\ntion data acquired prior to the undersampled datasets. Segmented Cartesian cine \nSSFP was acquired at identical slice positions in multiple consecutive breath-holds \nwith a spatial resolution of 1.3-1.5x1.3-1.5 mm, 6 mm slices and 35 ms temporal \nresolution (TR 3 ms). Free-breathing and breath-hold real-time datasets were \nevaluated for RV size and function and compared with segmented cine SSFP.\nResults: Breath-hold real-time imaging with through-time radial GRAPPA did not \nshow significant difference in EDV (285.3±102.2 ml vs. 292.8±107.2 ml;P 0.12), ESV \n(161.3±85.0 ml vs.163.2±78.7 ml;P=0.6) and EF (45.2±9.6% vs.45.5±6.6%;P=0.73) \nwith low systematic and random errors as compared with respective segmented \ncine SSFP data. Free-breathing real-time imaging demonstrates a significant offset \nfor ESV (177.6±89.2 ml vs.163.2±78.7 ml;P=0.02) resulting in lower EF results \n(42.3±9.6% vs.45.5±6.6%;P=0.05) and higher scatter for random error.\nConclusion: Real-time imaging using through-time radial GRAPPA allows for \nadequate temporal and spatial resolution to ensure adequate volumetric analysis \nof the RV. Although it enables artefact-free free-breathing cine data acquisition, \ninconsistency of slice location in transverse orientation may affect accuracy of \nvolumetric results. \nAuthor Disclosures:\nB.J. Wintersperger: Research/Grant Support; Siemens Healthcare. Speaker; \nBayer Pharma, Siemens Healthcare.M.A. Griswold: Equipment Support \nRecipient; Siemens Healthcare. Patent Holder; ThroughTime GRAPPA. \nResearch/Grant Support; Siemens Healthcare. N. Seiberlich: Patent Holder; \nThroughTime GRAPPA.\nB‑0669 11:51\nDiagnostic accuracy of delayed phase dual-energy CT for the \ndetection of chronic myocardial infarction compared to 3-T MRI late \ngadolinium enhancement \nJ.L. Wichmann, J.M. Kerl, T. Lehnert, M. Doss, T.J. Vogl, R.W. Bauer; \nFrankfurt a. Main/DE (docwichmann@gmail.com) \nPurpose: To compare the performance of delayed phase cardiac dual-energy CT \n(DECT) with different grayscale image contrasts and selective myocardial iodine \nmapping for the detection of chronic myocardial infarction compared to 3 T MRI.\nMethods and Materials: This HIPAA-compliant study was approved by the Insti-\ntutional Review Board and patients gave informed consent. 20 patients underwent \ndelayed phase cardiac CT on a second-generation DECT scanner. Late iodine \nenhancement data were compared with late gadolinium enhancement images from \n3 T cardiac MRI. DECT greyscale images were reconstructed as 100 kV, 140 kV \nand weighted-average (WA; linear blending) images from low and high kV data \nincorporating 80%, 60% or 30% of 100 kV data. In addition, a colour-coded map \nof myocardial iodine distribution was calculated from DECT data. Two independent \nblinded radiologists reviewed all images for late enhancement areas in standard \ncardiac views and rated subjective image quality.\nResults: DECT data from 100 kV, WA-80% and WA-60% showed identical results \nfor the correct identification of myocardial scarring (89% sensitivity, 98% specificity \nand 96% accuracy). However, WA-60% received the best subjective image quality \nrating and average measured infarct size correlated best with MRI. Colour-coded \niodine distribution maps were prone to artefacts (52% sensitivity, 88% specificity, \n81% accuracy), overestimating quantity of scars while underestimating lesion size \nby 55% compared to MRI.\nConclusion: Linear blending of delayed phase cardiac DECT data improves image \nquality for the detection of myocardial scar tissue compared to MRI. Colour-coded \nmyocardial iodine distribution maps were prone to artefacts and showed inferior \ndiagnostic performance. \nAuthor Disclosures:\n J.M. Kerl: Consultant; Research Consultant, Siemens AG Speakers Bureau, \nSiemens AG. R.W. Bauer: Consultant; Research Consultant, Siemens AG \nSpeakers Bureau, Siemens AG.\nB‑0666 11:24\nInfluence of iterative reconstruction on coronary calcium score in \ncardiac computed tomography \nK. Jaspers1, J.A.C. Van Osch2, J.M. Groen1, M.J.W. Greuter1; 1Groningen/NL, \n2Zwolle/NL (m.j.w.greuter@umcg.nl) \nPurpose: To investigate the relation between the percentage of iterative recon-\nstruction (IR) and coronary calcium score in cardiac computed tomography (CT).\nMethods and Materials: A phantom containing 100 cylindrical calcifications with \nvarying size and density was inserted into a thorax phantom (QRM Thorax, QRM, \nGermany) with artificial lungs and spine. The phantom was scanned with a clinical \nacquisition protocol on a 64-slice CT (Lightspeed VCT XT, GE). Each scan was \nrepeated five times. The images were reconstructed with filtered backprojection \n(FBP) and increasing percentages of IR of 20-100%. The amount of calcium was \ndetermined as an Agatston score. The influence of percentage IR on both total \nAgatston score (TAS) of the phantom as well as the individual calcium score (IAS) \nfor each calcification was investigated.\nResults: The average TAS decreased with increasing percentage of IR (p < 0.001). \nTAS was 124±22 at 0% IR and 76±16 at 100 % IR. IAS were underestimated when \nIR was used compared to pure FBP. The underestimation was relatively larger for \ncalcifications with a low calcium score and increased for increasing percentage \nIR. Increasing numbers of calcifications were missed at increasing percentages \nof IR. At 20% IR, 4% of the calcifications were missed, whereas at 100% IR, 26% \nof the calcifications could not be detected.\nConclusion: Iterative reconstruction in CT results in an underestimation of coronary \ncalcium scores compared to pure filtered backprojection. With increasing iterative \nreconstruction more calcifications yield a zero calcium score. \nB‑0667 11:33\nMagnetic resonance velocity mapping-based evaluation of elevated \nmean pulmonary arterial pressure: the impact of visualisation techniques \nU. Reiter1, G. Reiter1, G. Kovacs1, A. Stalder2, M.A. Gulsun3, A. Greiser2, \nH. Olschewski1, M.H. Fuchsjäger1; 1Graz/AT, 2Erlangen/DE, 3Princeton, NJ/US \n(ursula.reiter@klinikum-graz.at) \nPurpose: Elevated mean pulmonary arterial pressure (mPAP) correlates linearly \nwith the relative period of existence of vortical blood flow in the main pulmonary ar-\ntery (PA), which can be investigated by time-resolved 3-dimensional (3D) magnetic \nresonance phase-contrast imaging (MRPCI). Ability of different visualisation tools \nto estimate elevated mPAP from complex flow patterns in the PA was analysed.\nMethods and Materials: 28 patients with elevated mPAP (11 male, mean age \n60±14 years) underwent right heart catheterization and time-resolved 3D-MRPCI \nof the PA. 4D-Flow software (Siemens) was used to visualise 3D velocity vector \nfields on 2-dimensional anatomical images (3D-vectors), vector fields projected on \n2-dimensional cut-planes by multiplanar reconstruction (MPR) and 3D streamline \nrepresentation. Relative period of existence of vortical blood flow within the cardiac \ncycle (tvortex) was evaluated with all visualisation techniques and compared with \nBland-Altman and linear regression analysis.\nResults: tvortex derived from different visualisations strongly correlated (r=0.97, \n0.96 and 0.94 for 3D-vectors versus MPR, 3D-vectors versus streamlines and MPR \nversus streamlines, respectively). No bias was observed for tvortex determined \nfrom different techniques, 95%-limits-of-agreement were ±0.11 between tvortex \ndetermined from 3D-vectors versus MPR, and ±0.12 in both other comparisons. \nIn all techniques tvortex showed strong correlation with mPAP with small standard \nerrors from regression lines (r=0.97, SE=3.2 mmHg for 3D-vectors, r=0.96, SE=3.6 \nmmHg for streamlines, and r=0.92, SE=4.8 mmHg for MPR).\nConclusion: Relative periods of existence of vortical blood flow in the main pul-\nmonary artery can be determined from vector field and streamline visualisations. \n3D-vectors, however, yield best estimates for elevated mPAP. \nAuthor Disclosures:\n G. Reiter: Employee; Siemens. A. Stalder: Employee; Siemens. M.A. Gulsun: \nEmployee; Siemens. A. Greiser: Employee; Siemens.\nB‑0668 11:42\nUndersampled real time cine SSFP with through-time radial \nGRAPPA: evaluation of RV function in breath-hold and free breathing \nB.J. Wintersperger1, A. Pellow1, G. Bastarrika1, M.A. Griswold2, \nN. Seiberlich2, M. Sussman1; 1T oronto, ON/CA, 2Cleveland, OH/US \n(Bernd.Wintersperger@uhn.ca) \nPurpose: To evaluate real-time imaging using the Through-time Radial GRAPPA \nreconstruction in free-breathing and breath-hold evaluation of right ventricular \n(RV) function.\n\nScientific Sessions\nS30\nA\n C D E F G\nB\nSunday\nB‑0672 10:48\nSurveillance neuroimaging in patients with medulloblastoma should \ninclude diffusion-weighted imaging \nL. van den Hauwe, C. Gidding, E. van Lindert, P. Wesseling, B. Goraj; \nNijmegen/NL (lucvdhauwe@mac.com) \nPurpose: To demonstrate that diffusion-weighted imaging (DWI) is able to pick \nup intracranial recurrences of medulloblastoma (MB) with higher sensitivity than \ncontrast-enhanced (CE) series.\nMethods and Materials: All MRI examinations of 22 children with histologically \nproven MB were retrospectively evaluated. Routine follow-up examinations were \nperformed initially 3 months after operation and thereafter, every 6 months for the \nnext 2 years. Then, controls were done yearly. Concomitant cranial and spinal MRI \nincluded T1, T2, and FLAIR in the axial plane, followed by T1 after gadolinium (Gd) \nin 3 orthogonal planes for the brain. Additional DWI was performed. Subsequent \nspinal imaging included sagittal T1- en T2-weighted images.\nResults: Eleven recurrences were observed in 10 patients. In 5 patients recurrent \ndisease was observed at the resection site in 2 of which subarachnoid spread \nwas also observed, with recurrence in loco only in 3 patients. Five patients had \nrecurrent disease away from the resection cavity, 2 of them in the frontal areas and \n4 intraventricular recurrences at the supratentorial level. In 2 patients CE-series \nscored better than DWI; in 3 patients results on DWI and CE-series were equivocal. \nIn 5 patients, recurrences were better demonstrated on DWI; some of them were \nonly observed in retrospect.\nConclusion: The results of our retrospective study demonstrate that DWI is a \npowerful technique allowing for early diagnosis of recurrent disease in MB patients. \nDWI especially demonstrates non-enhancing metastatic lesions earlier than CE-\nlesions. DWI should therefore be included in surveillance imaging protocols of MB \npatients, especially in the group of high-risk patients. \nB‑0673 10:57\nPreoperative evaluation of consistency of meningiomas: diagnostic \nefficacy of MRI \nA. Hiwatashi, T. Yoshiura, O. Togao, K. Yamashita, K. Kikuchi, K. Yoshimoto, \nM. Mizoguchi, S.O. Suzuki, H. Honda; Fukuoka/JP \nPurpose: To evaluate the value of conventional magnetic resonance imaging \n(MRI), diffusion-weighted imaging (DWI) and perfusion imaging (PI) in predicting \nthe consistency of intracranial meningiomas.\nMethods and Materials: This study included 44 patients (30 females and 14 males, \nage range; 20-83 years, median 60) with pathologically proven meningiomas. All \npatients underwent preoperative T2-weighted imaging (T2WI), DWI, PI including \narterial spin labelling (ASL), and dynamic contrast enhancement imaging and \npostcontrast 3D T1-weighted imaging on 3 T-MRI. The ratio of signal intensity of \nT2WI (T2R) to adjacent normal cortex that of minimum ADC (ADCR) to normal \nappearing white matter, tumour blood flow (TBF), K trans, and tumour volume were \ncalculated. These were compared with the consistency of meningiomas reported \nby neurosurgeons. Statistical analysis was performed with Mann-Whitney U test \nand logistic regression analysis.\nResults: Twenty-five meningiomas were soft and the other 19 were hard (including \nmixed consistency). Compared to hard meningiomas, the soft meningiomas had \nhigher T2R (1.39±0.24 vs. 1.15±0.33, P < 0.05) and higher ADCR (1.05±0.18 vs. \n0.97±0.19, P < 0.05). There were no statistically significant differences in TBF, K trans \nor tumour volume between soft and hard meningiomas (P> 0.05). Logistic regression \nanalysis resulted in T2R as a causative factor to predict consistency (P < 0.01).\nConclusion: Among various imaging techniques, T2WI is the most feasible in \npredicting the consistency of meningiomas. \nB‑0674 11:06\nRadiation-induced telangiectasia in the long-term survivors of \nintracranial germ cell tumours: whole-ventricle vs whole-brain radiation \nL. Li, S. Mugikura, T. Murata, T. Kumabe, K. Jingu, T. Fujii, E. Mori, S. Takahashi; \nSendai/JP (liliyanzhen05@gmail.com) \nPurpose: Telangiectasia on MR images were reported to be seen in patients who \nreceived intracranial radiation. To determine the relationship between the radia-\ntion field/dose and the prevalence of telangiectasia on MR images, we compared \nwhole-ventricle alone (WV) and whole-ventricle plus whole-brain (WB) radiation \ngroups in the long term survivors (more than 10 years) of intracranial germ cell \ntumours (GCT).\nMethods and Materials: We compared the number of telangiectasia on T2*-\nweighted MR images (T2*WI) between WV (n=12) and WB (n=11) groups. Total \ndose of radiation between two groups was not significantly different (54.1 Gy in WV \n10:30 - 12:00 Room F1 \nNeuro \nSS 1311 \nBrain tumours: imaging and therapy \nModerators: \nX. Golay; London/UK \nA. Zimny; Wroclaw/PL\nB‑0670 10:30\nIntra-arterial ophthalmic artery chemotherapy for group D \nretinoblastoma in children: 4-years Lausanne experience \nS. Binaghi, J.-B. Zerlauth, M. Beck-Popovic, F. Munier, R. Meuli; Lausanne/CH \n(stefano.binaghi@chuv.ch) \nPurpose: To evaluate prospectively the efficacy of supra-selective ophthalmic artery \nchemotherapy with Melphalan as a tumoricidal agent in children with advanced \nretinoblastoma to avoid surgical enucleation and/or secondary radiotherapy.\nMethods and Materials: From November 2008 to August 2012, 27 children (mean \nage 25 months) affected by group D retinoblastoma underwent intraarterial superse-\nlective chemotherapy using Melphalan (0.35 mg/kg) into the ophthalmic artery. This \nprocedure was performed under general anesthesia and repeated for a maximum \nof 3 sessions separated by an interval of 3-4 weeks in between sessions. A total \nof 72 procedures were performed. Every endovascular treatment was coupled with \nlocal intravitreal Melphalan injection, thermotherapy and/or cryotherapy.\nResults: Technical success was achieved in all but two patients without major \nsystemic or thromboembolic complications. 25 patients showed dramatic regres-\nsion of tumor volume, vitreous and subretinal seeds. In the other 2 cases, severe \nvasospasm of the femoral artery in one case and of the ophthalmic artery in the \nother case prevented the successful technical realization of the procedure. Enu-\ncleation and external beam radiotherapy could be avoided in all but two treated \npatients, with a mean follow-up of one year. Local complications consisted of retinal \ndetachment (2), transient ptosis (18), conjunctival and lid edema (6), local skin \npigmentation (1), transient carotid artery vasospasm (1) and sectoral choroidal \nocclusive vasculopathy (2).\nConclusion: Transarterial ophthalmic artery chemotherapy using Melphalan has an \nimportant tumoricidal action in advanced retinoblastoma, and can avoid secondary \nenucleation and/or external beam radiotherapy. \nB‑0671 10:39\nNeurocutaneous melanosis in children with giant congenital \nmelanocytic nevi \nO. Szczygielski, M. Boczar, E. Sawicka, M. Bekiesinska-Figatowska, J. Madzik, \nA. Romaniuk-Doroszewska, M. Uliasz, T. Klepacka, E. Michalak; Warsaw/PL \n(m.figatowska@mp.pl) \nPurpose: To assess the incidence of neurocutaneous melanosis (NCM) in children \nwith giant congenital melanocytic nevi.\nMethods and Materials: Material consists of 21 children with giant melanocytic \nnevi. Brain MRI was performed at a 1.5 T scanner with 16-channel head coil. All the \nchildren were operated on, the nevi were excised and histopathologically assessed.\nResults: Melanin deposits in the brain were found in 7 children (33.3%). Six patients \nwere asymptomatic and one suffered from epileptic seizures. The lesions were \nlocated in the temporal and frontal lobes, thalamus, cerebellum and pons. Two \npatients showed leptomeningeal spread of the disease. In one patient multilevel \nnerve roots neurofibromas were found on MRI and neurofibromatosis type 1 was \ndiagnosed. No statistically significant difference of the localisation of skin nevi was \nfound between children with and without NCM. In all the patients with NCM the ex-\ncised nevi showed the picture of compound nevus with neurofibromatic component. \nAdditionally in one patient superficial spreading melanoma was diagnosed. In the \nremaining 14 children various histological types of nevi were found with predomi-\nnance of compound nevus with neurofibromatic component (8/14 cases=57.1%).\nConclusion: In every case of giant melanocytic nevus brain MRI should be \nperformed to confirm or rule out the co-existence of CNS lesions typical of NCM. \nEvery child with NCM requires neurological and ophthalmological follow -up for \nmonitoring the lesions. NCM seems to be correlated with histopathological type of \ncompound nevus with neurofibromatic component. Localisation of skin nevi is not \ncorrelated with presence of NCM. \n1\n\nScientific Sessions\nS30\n C A D E F\n G\nB\nand CBV proved to have 100% specificity and 100% positive predictive value, \nidentifying preoperatively all the histopathologically proven high-grade gliomas.\nConclusion: All the three perfusion parameters play an important role in the \npreoperative classification of cerebral tumour entities with high rate of histopatho-\nlogic correlation.\nAuthor Disclosures:\n E. Klotz: Investigator; Principal Scientist of the CT Division in Siemens \nHealthcare Sector. U. Haberland: Employee; CT division, Siemens Healthcare \nSector.\nB‑0677 11:33\nApparent diffusion coefficient in determination of histological \nsubtype of meningioma \nD.A. Stojanov; Nis/RS (drstojanov@gmail.com) \nPurpose: The aim of our study was to verify the reliability of apparent diffusion \ncoefficient (ADC) measurements to differentiate benign from atypical/malignant \nmeningiomas and among different sub-types.\nMethods and Materials: Thirty patients (20 women and 10 men, average age \n53 ±15 years) with meningiomas were prospectively studied using routine MR \nimaging and diffusion-weighted imaging. All MR examinations were performed on \n1.5 T MR (Avanto, Siemens, Erlangen, Germany). ADC values of the neoplastic \ntissue (avoiding calcifications and cystic or necrotic areas) were obtained as the \nmean of measurements from three regions of interests within the mass. MRI find-\nings were compared with the histopathologic findings after resection using World \nHealth Organization criteria.\nResults: Meningiomas were histologically graded as benign and malignant. The \nmeningothelial subtype was found in 15 (50%) patients, fibroblastic in 10 (33.33%) \npatients and cystic 5 (16.67%) patients. There was no statistical difference between \nmeningothelial, fibroblastic and cystic meningiomas when considering mean ADC \nvalues (0.000411 ± 0.000066 mm2/s vs. 0.000750 ± 0.001045 mm2/s vs. 0.000688 \n± 0.000063 mm2/s) (p[[Unable to Display Character: ˃]]0.05).\nConclusion: ADC measurement does not seem reliable in grading meningiomas \nor identifying histological sub-types.\nB‑0678 11:42\nEvaluation of diffusivity in pituitary adenoma in the Sella Turcica \nwith 3D turbo field echo with diffusion-sensitized driven-equilibrium \npreparation: initial experience \nA. Hiwatashi1, T. Yoshiura1, O. Togao1, K. Yamashita1, K. Kikuchi1, H. Honda1, \nM. Obara2; 1Fukuoka/JP, 2T okyo/JP \nPurpose: To evaluate the feasibility of 3D turbo field echo (TFE) with diffusion-\nsensitized driven-equilibrium (DSDE) preparation, which is a novel non-EPI \ntechnique for diffusion-weighted imaging, for pituitary adenoma in sella turcica.\nMethods and Materials: This prospective study included thirteen patients (9 \nfemales and 4 males, age 19-82 years) with pituitary adenomas were imaged \nwith 3D TFE with DSDE preparation. Among them four were prolactin-producing \n(PRL), three were growth hormone-producing (GH) and six were non-functioning \ntumours (NON). Motion probing gradients were conducted at one direction (A-P) \nwith b values of 0 and 500 s/mm2. The imaging voxel size was 1.5x1.5x1.5 mm3. \nThe apparent diffusion coefficients (ADCs) were measured in the pituitary adenoma \nand the normal pituitary gland.\nResults: In each patient, a pituitary adenoma was clearly visualised on 3D TFE \nwith DSDE preparation and ADC maps without obvious geometrical distortion. \nADC of the pituitary adenoma ranged from 0.57 to 2.90 x10 -3 mm2/s (mean ± \nstandard deviation, 1.37±0.72 x 10-3 mm2/s), and was higher than that of the normal \npituitary gland (1.34±0.23 x 10 -3 mm2/s) without statistically significant difference \n(P > 0.05). ADC in PRL (2.07±0.92 x 10-3 mm2/s) was significantly higher than that \nin GH (0.86±0.31 x 10-3 mm2/s) and in NON (1.17±0.32 x 10-3 mm2/s) (P < 0.05).\nConclusion: With its insensitivity to field inhomogeneity and high spatial resolu-\ntion, 3D TFE with DSDE preparation was feasible to evaluate the diffusivity in the \npituitary gland. ADC measurement using this new technique may help characterise \nhormone activity of pituitary adenomas. \nAuthor Disclosures:\n M. Obara: Employee; Makoto Obara.\nand 51.3 Gy in WB groups). In the WB group, axial sections of the ventricular level \nwere considered to have received significantly higher dose of radiation (51.3 Gy, \nhigh-dose field) than the other upper and lower levels (24.0 Gy, low-dose fields). \nIn the WB group, we compared the number of telangiectasia on T2*WI between \nventricular level and the other upper and lower levels.\nResults: Telangiectasias were observed in 22 (96%) patients. The number of tel-\nangiectasia in the WB group was significantly higher than the WV group (average \n8.5 in WB and 3.6 in WV, P = 0.019). In WB group, the number of telangiectasia \nwas significantly higher in the ventricular level than the other upper and lower \nlevels (P < 0.01).\nConclusion: Radiation-induced telangiectasia appears to occur in at least 96% \nof patients who undergo cranial irradiation. Larger radiation exposure and higher \nradiation dose were associated with higher number of telangiectasia lesions. \nB‑0675 11:15\nDynamic sequences in Intraoperative MRI during transsphenoidal \nresection of pituitary adenomas: quantitative analysis \nM. Rossi Espagnet1, A. Boellis1, V. Coppola2, A. Romano1, S. Pugliese1, \nF. Tavanti1, L. Calabria1, L. Fantozzi1, A. Bozzao1; 1Rome/IT, 2Ronciglione/IT \nPurpose: During transsphenoidal pituitary removal of macroadenomas, Intraop-\nerative Magnetic Resonance Imaging (iMRI) can assess the presence of residual \ntumour. The purpose of this prospective study was to demonstrate the efficacy \nof intraoperative dynamic contrast-enhanced (DCE) sequences compared with \nconventional CE in evaluating tumour removal.\nMethods and Materials: Inclusion criteria were complete tumour removal at iMRI \nas subsequently demonstrated by normal 12-month MRI follow-up or-demonstration \nof residual tumour at iMRI as assessed by DCE and CE images subsequently \nconfirmed by immediate second look surgery. 19 patients were thus selected. \nThey all underwent iMRI (1.5T) acquisitions during transsphenoidal resection of \nmacroadenomas. For each patient, DCE and CE images were acquired directly \nin the operating room when neurosurgeon indicated complete tumour removal. \nThese sequences were evaluated by measuring the volume of the surgical cavity. \nThe mean values of these volumes were statistically compared through Student \nt-test analysis (p value was set < 0.05).\nResults: No patient showed recurrence at follow-up indicating complete removal \nof the tumour, 2 showed tumour residual. Intraoperative analysis demonstrated \nthat the mean value of the surgical cavities was significantly bigger in DCE than in \nCE images (2955 mm3 vs 1963 mm3, respectively, p=0.022).\nConclusion: This study demonstrated underestimation of surgical cavity by \nconventional iMRI, simulating possible residual tumour and potentially leading \nto unnecessary surgical revision. This may be related to post-operative changes \nwith subsequent delayed enhancement. Because of this, DCE sequences are \nmandatory in the intraoperative evaluation of surgical cavity during transsphenoidal \npituitary resection. \nB‑0676 11:24\nPreoperative classification of cerebral tumours by applying whole \nbrain VPCT: which parameter to use in order to achieve the highest \nprognostic value? \nA. Xyda1, E. Klotz2, U. Haberland2, R. Schramm3, M. Knauth3, P. Schramm3; \n1Iraklion/GR, 2Forchheim/DE, 3Göttingen/DE (iroxida@yahoo.com) \nPurpose: To evaluate the preoperative diagnostic power and classification accuracy \nof perfusion parameters derived from whole brain volume perfusion CT (VPCT) in \npatients with cerebral tumours.\nMethods and Materials: Sixty-three patients (31 males, 32 females; mean age \n55.6 ± 13.9 years), with MRI findings suggestive of cerebral lesions, underwent \nVPCT. Two readers independently evaluated VPCT data. Volumes of interest (VOIs) \nwere delineated around the tumour according to maximum intensity projection \nvolumes, and then mapped automatically onto the cerebral blood volume (CBV), \nflow (CBF) and permeability (Ktrans) perfusion datasets. A second VOI, cortically \npronounced, was placed in the contra lateral hemisphere, as control. Correlations \namong perfusion values, tumour grade, cerebral hemisphere and VOIs were evalu-\nated. Moreover, the diagnostic power of VPCT parameters, by means of positive \nand negative predictive value, was analysed.\nResults: Our cohort included 32 high-grade gliomas WHO III/IV, 18 low-grade I/\nII, 6 primary cerebral lymphomas, 4 metastases and 3 tumour-like lesions. Ktrans \ndemonstrated the highest sensitivity, specificity and positive predictive value, with a \ncut-off point of 2.21 mL/100 mL/min, for both the comparisons between high-grade \nversus low-grade and low-grade versus primary cerebral lymphomas. However, \nfor the differentiation between high-grade and primary cerebral lymphomas, CBF \n2\n\nScientific Sessions\nS30\nA\n C D E F G\nB\nSunday\nconjunction with a k-nearest neighbour classifier, based on the combination of the \n10 TF with the highest Fisher coefficients. Classification accuracy was used as \nthe primary outcome measure.\nResults: The accuracy of texture-based lesion classification was 84.33% (70 of \n83 lesions) for IDC vs. ILC, 81.1% (30 of 37 lesions) for ILC vs. DCIS, but only of \n70% (70 of 100 lesions) for IDC vs. DCIS.\nConclusion: TF derived from FFDM may be of value for differentiating between \nILC and IDC, and ILC and DCIS, but of limited value for differentiating between \nIDC and DCIS.\nB‑0681 10:48\nVariation of apparent diffusion coefficients (ADC) measured in the \nnormal breast using diffusion-weighted MR mammography: effects \nof menopausal status, anthropometric measures and hormone intake \nK. Hegenscheid, R. Seipel, R. Laqua, C.O. Schmidt, H. Völzke, N. Hosten, \nB. Mensel; Greifswald/DE (katrin.hegenscheid@uni-greifswald.de) \nPurpose: To assess variations of ADC values of normal breast parenchyma and \neffects of menopausal status, menstrual cycle phase, age, body mass index (BMI), \noral contraceptives (OC), and postmenopausal hormone therapy (HT).\nMethods an Materials: A total of 705 women from a population-based study \n(49.2±13.0 years) underwent diffusion-weighted imaging (DWI) of the breast at \n1.5-T using a four-channel breast coil with five b values [50, 200, 500, 800, 1000 \nmm2/s (7900 ms/ 91 ms (repetition time/echo time); 340 mm field of view; 1.8*1.8*4 \nmm voxels)]. Quantitative analysis was performed in normal fibroglandular tissue \nby manually tracing regions of interest and calculating ADC. The effects of meno-\npausal status, BMI, OC, and HT were studied using univariate analysis. Difference \nin mean ADC values between the proliferative (day 1-14) and secretory menstrual \ncycle phase (day 15-31) was evaluated by unpaired T-test.\nResults: Mean ADC values were significantly higher in the secretory (1.56±0.29*10-\n3 mm2/s) than in the proliferative menstrual cycle phase (1.42±0.28*10-3 mm2/s) \n(P=0.012). No significant difference was seen in ADC values in relation to \nmenopausal status (P=0.744). Age significantly affected mean ADC values only \nin postmenopausal women (P=0.013), while BMI had no effects (P=0.400). Mean \nADC values were significantly higher in OC users (1.57±0.29*10-3 mm2/s) than \nin non-OC users (1.47±0.28*10-3 mm2/s) regardless of menstrual cycle phase \n(P=0.044) but were similar between HT users and non-HT users (P=0.814).\nConclusion: ADC measurements for breast lesion differentiation and evaluation of \ntreatment response should be interpreted with consideration of normal variability, \nmenstrual cycle phase and hormone intake. \nB‑0682 10:57\nSecond-look US with MR volume navigation (V Nav) of breast \nlesions: a way to make it objective \nA. Fausto, P. Mercuri, L. Mantovani, L. Volterrani; Siena/IT (alfofa@yahoo.it) \nPurpose: To investigate the clinical impact of second-looK US with and without \nMR volume navigation (V Nav) as reference.\nMethods and Materials: Forty-one patients (59±22 years, range 27-91) with \nadditional lesions at conventional MR underwent bilateral contrast-enhanced \n(0.1 mmol/Kgbw Gd-BOPTA, Bracco Diagnostics) breast MR in supine position \n(1.5 T, Achieva, Philips Healthcare and 1.5 T Signa HDxt, GE Healthcare) using \nT1-weighted high-resolution isotropic examination volume and spectral fat sup-\npression with body coil. Three fiducial pills of vitamin E on the corresponding \nskin markers were used. US and MR co-registration was obtained by means of a \nmagnetic transmitter positioned close to the patient and two small magnetic receiv-\ners positioned on a linear probe's bracket (LOGIQ E9, GE Healthcare). The same \nradiologist performed second look US without and thereafter with VNav. Images \nwere reviewed by consensus by two radiologists. Pathologic examination was the \nstandard of reference. McNemar test was used.\nResults: Forty-seven additional lesions were detected in both MR exams. Patho-\nlogic examination showed 29 malignant and 18 benign lesions. Lesions diameter \nwas 2.2±1.3 cm (mean±SD, range 0.6-6.2 cm). Finally, 62% (18/29) of malignant \nand 44% (8/18) of benign lesions were detected only using VNav (p=0.0015). \nMR-guided biopsy was performed in three cases. Pathology demonstrated a 9-mm \nDCIS, an 8-mm sclerosing adenosis and a 12-mm atypical ductal hyperplasia.\nConclusion: Second-look US with VNav showed a significant higher detection rate \nthus suggesting the efficacy of this new technique in reviewing additional lesion \ndetected after MR imaging. \n10:30 - 12:00 Room F2 \nBreast \nSS 1302 \nHow to get more from breast imaging modalities \nModerators: \nN. Houssami; Sydney/AU \nM. Nadrljanski; Belgrade/RS \nB‑0679 10:30\nMagnetic resonance imaging of fibroadenomas in the female breast: \nnew insights on dynamic and morphologic profiles and differential \ndiagnosis from malignant breast lesions \nM. Dietzel1, P.A.T. Baltzer2, W.A. Kaiser3; 1Erlangen, Jena/DE, \n2Jena/DE, Vienna/AT, 3Jena/DE (dietzelmatthias2@hotmail.com) \nPurpose: Fibroadenomas are amongst the most common benign breast tumours. \nSurprisingly, there is still little systematic data on their typical MRI characteristics. \nAccordingly, this breast MRI study investigates morphologic and dynamic profiles \nof fibroadenomas in detail and aims to identify overall accuracy regarding the dif-\nferentiation from breast cancer.\nMethods and Materials: Consecutive patients receiving breast MRI (standardised \nprotocols: dynamic-T1w-GRE before/after Gd-DTPA [0.1 mmol/kgBW]; T2w-TSE) \nwith subsequent surgico-pathological verification were enrolled. For the detailed \nassessment of morphologic and dynamic profiles two experienced radiologists (> \n500 MRM examinations; blinded to surgico-pathological verification) performed \nprospective evaluation of breast MRI in consensus applying 17 predefined breast \nMRI descriptors.\nOut of this database all patients showing fibroadenomas (n=103) or breast cancer \n(n=647) were further evaluated statistically: univariate (association of single-\ndescriptors with fibroadenomas/breast cancer: contingency table statistics) as well \nas multivariate analyses were performed to identify accurate descriptor combina-\ntions and overall accuracy of breast MRI for differential diagnosis of fibroadenomas \nvs. breast-cancer (Chi-squared automatic interaction detection [CHAID], 10-fold \ncross-validation, receiver operating characteristics [ROC], area under the ROC \ncurve [AUC], Bonferroni correction).\nResults: Typical features of fibroadenomas were “lobulated shape” (OR=8.6), \n“sharp margin” (OR=14.0), “internal septations” (OR=17.1), “hyperintense signal in \nT2w” (OR=17.6) and “persistent curve-type” (OR=16.2; all: P < 0.001). Diagnostic \naccuracy increased significantly (P < 0.001), if features were assessed in combi-\nnation. Highest values were then observed, if the following feature combinations \nwere present: \"sharp margin and persistent curve type\" (OR=140.3), \"plateau and \ninternal septations\" (OR=18.1). Overall accuracy of breast MRI for the differential \ndiagnosis of fibroadenomas vs. breast cancers revealed excellent AUC (0.95, \ncross-validated sample).\nConclusion: In breast MRI fibroadenomas show typical morphologic and dynamic \ncharacteristics. Particularly, if multiple breast MRI characteristics are assessed \nin combination, differential diagnosis vs. breast cancer is possible with excellent \naccuracy. \nB‑0680 10:39\nTexture analysis of malignant breast tumours: is a differentiation of \nductal carcinoma in situ, invasive ductal and invasive lobular breast \ncancer possible? \nT. Knogler1, K. Pinker-Domenig1, N. Perry2, S. Milner2, \nK. Mokbel2, M.E. Mayerhoefer1; 1Vienna/AT, 2London/UK \n(thomas.knogler@meduniwien.ac.at) \nPurpose: To evaluate the ability of texture features (TF), to differentiate between \nductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC) and invasive \nlobular carcinoma (ILC) of the breast on full-field digital mammograms (FFDM).\nMethods and Materials: 110 screen detected and histopathologically verified \nbreast cancers (27 DCIS, 73 IDC, 10 ILC) imaged with FFDM in standard views \nwere included in this study. For each lesion, a region of interest (ROI) was manually \ndefined, which covered the lesion as well as a rim (1 cm width) of normal-appearing \nbreast tissue around the lesion in the view, where the lesion was depicted in largest \ndiameter. TF derived from the grey-level histogram, co-occurrence matrix (COC), \nrun-length matrix (RLM), absolute gradient (AG), autoregressive model (ARM) and \nwavelet transform were calculated for the ROIs. Fisher coefficients were calculated \nto determine which TF were best-suited for distinguishing between DCIS, IDC \nand ILC. Lesion classification was performed using linear discriminant analysis in \n3\n\nScientific Sessions\nS30\n C A D E F\n G\nB\nFinally, 2214 patients with normal or benign mammograms (BI-RADS categories \n1 to 3) were included in this study. Statistical analysis was performed to compare \nthe rate of additional cancers detected on US and TS, calculating a McNemar’s \ntest (SPSS 15.0).\nResults: 41 breast tumours were detected on mammography (detection rate \n1.79%). US detected 15 additional cancers (additional detection rate 0.65%) after \nnormal digital mammograms. TS detected 12 additional cancers (0.40%). No \nstatistical differences were found (p=0.51).\nConclusion: Both, TS and US, increased the detection rate, without significant \ndifference between them. \nB‑0686 11:33\nLesion detection and characterisation of one-view digital breast \ntomosynthesis combined with one-view mammography compared to \ntwo-view mammography \nG. Gennaro1, E.R. Hendrick2, A. Toledano3, R. Chersevani4, C. di Maggio1, \nM. La Grassa5, L. Pescarini1, I. Polico1, A. Proietti1; 1Padua/IT, 2Denver, CO/US, \n3 Washington, DC/US, 4Gorizia/IT, 5Aviano/IT (gisella.gennaro@ioveneto.it) \nPurpose: To compare lesion detection and characterisation by the combination \nof one-view breast tomosynthesis (DBT) and one-view digital mammography with \ntwo-view digital mammography (MX).\nMethods and Materials: The study included 250 consenting women with breast \nlesions classified as suspicious at mammography and/or ultrasound. A clinical \nperformance study comparing two-view (CC, MLO) mammography, and the com-\nbination of DBT in MLO view and MX in CC-view (DBT+MXCC) was conducted \nwith six breast radiologists. Data were analysed per-lesion, using lesion localisa-\ntion fraction - LLF (the percentage of lesions correctly localised). Lesion detection \nwas determined by calculating the total number of lesions rated above BI-RADS \n1. Lesion characterisation was evaluated by counting malignant lesions rated \nabove BI-RADS 3 and benign lesions scored BI-RADS 2 or 3. Lesion detection \nand characterisation for all lesions, and stratified for malignant and benign lesions, \nwere compared between DBT+MXCC and MX using analysis of variance (ANOVA). \nP-values < 0.05 were considered statistically significant. The non-inferiority margin \nwas set at 5%.\nResults: Overall, DBT+MXCC was superior to MX alone in terms of number of \nlesions correctly detected and characterised (LLF difference: +6.85%, -95% CI: \n+4.02%; p-value = 0.0007). DBT+MXCC superiority was confirmed for benign \nlesions (LLF difference: +7.93%, -95% CI: +5.71%; p-value < 0.0001), while non-\ninferiority was achieved for malignant lesions (LLF difference: +3.03%, -95% CI: \n-4.59%; p-value < 0.369).\nConclusion: The combination of DBT+MXCC significantly improved lesion detec-\ntion and characterisation, reducing the number of false positives, while keeping \nthe number of false negatives unchanged.\nAuthor Disclosures:\nE.R. Hendrick: Consultant; GE Healthcare. A. Toledano: Consultant; GE \nHealthcare.\nB‑0687 11:42\nDoes the adjunct of digital breast tomosynthesis (DBT) increase \ninter-reader reproducibility of two-dimensional digital mammography \n(2D-DM)? \nG. Di Leo1, L.A. Carbonaro1, M. Bazzocchi2, V. Londero2, A. Dal Col2, \nR.M. Trimboli1, F. Sardanelli1; 1San Donato Milanese/IT, 2Udine/IT \n(gianni.dileo77@gmail.com) \nPurpose: To estimate the inter-reader reproducibility of DBT added to 2D-DM in \ncomparison to that of 2D-DM alone.\nMethods and Materials: A series of 65 breasts (65 women, aged 58±9 years) \nunderwent DBT (Giotto, IMS, Italy) as an adjunct to 2D-DM. After an agreement \non how to report 2D-DM and DBT, 3 independent readers (R1, R2, R3) with > \n6 years of experience in 2D-DM and > 1 year of experience in DBT evaluated \nall studies. Each reader evaluated the breast density and assigned a BI-RADS \nscore using only 2D-DM. After 30 days, they repeated the evaluation adding DBT \nto 2D-DM. The inter-reader reproducibility was estimated using the quadratically \nweighted Cohen's kappa.\nResults: The breast density reported at 2D-DM by the most experienced reader \nwas: 75% in 1 (1%). Considering the B1, B2, B3, B4, and B5 BI-RADS scores, the \nsame reader assigned the followings: 25, 0, 10, 20, and 10 using 2D-DM; 31, 1, \n7, 13, and 13 using 2D-DM plus DBT. For each pair of readers, 2D-DM plus DBT \nresulted in a higher inter-reader reproducibility than that of 2D-DM alone: kappa \nvalue for 2D-DM ranged from 0.418 to 0.566 while that for 2D-DM plus DBT ranged \nfrom 0.656 to 0.758.\nB‑0683 11:06\nDense breasts as a new standard indication for MR mammography: \nprospective analysis of 1488 consecutive patients \nC.G. Kaiser1, C. Reich2, K. Wasser1, S.O. Schönberg1, W.A. Kaiser2; \n1Mannheim/DE, 2Jena/DE (clemens.kaiser@umm.de) \nPurpose: To evaluate the role of MRM in patients with “extended indications”, i.e. \ndense breasts, in which under standard circumstances either biopsy or further \ndiagnostic efforts would have been the next step.\nMethods and Materials: Between 04/2006 and 12/2011 a consecutive total of \n1492 were examined resulting in a study population of 1488 patients after dropout.\nResults: 124 patients were diagnosed with suspicious findings by MRM, resulting \nin 76 true positive findings, 48 false positive cases, 971 true negative cases and 0 \nfalse negative cases. True negative cases were either confirmed by histology upon \nrecommendation of external physicians (18 patients), follow-up by MRM or patient \nquestionnaires over the next 5 years by mail (1737 cases). 393 patients were lost \nto follow-up. This resulted in a sensitivity of 100%, specificity of 95.2%, positive \npredictive value of 61.3%, a negative predictive value of 100% and an accuracy \nof 95.5%. For the calculation of invasive cancers only (without DCIS cases), the \nresults were 63 true positives, 27 false positives for malignant findings, 971 true \npositives and 0 false positives for benign findings.\nConclusion: The results for “dense breasts” as an extension to the standard \nindications for MRM are encouraging, as an excellent negative predictive value \nalong with a satisfactory positive predictive value can be achieved. However, \nthese results are strongly dependent on reader experience and adequate technical \nstandards as prerequisites for optimal diagnoses. In this setting, “dense breasts” \nare an indication for MRM in case of unclear findings. \nB‑0684 11:15\nIs 2D central projection obtained with digital breast tomosynthesis \nqualitatively equivalent to digital mammmography? \nP. Clauser1, V. Londero1, C. Molinari1, R. Girometti1, A. Taibi2, S. Vecchio3, \nC. Zuiani1, M. Bazzocchi1; 1Udine/IT, 2Ferrara/IT, 3Bologna/IT \n(clauser.p@hotmail.it) \nPurpose: Based on a novel approach, digital breast tomosynthesis (DBT) may \nsimultaneously acquire 2D and 3D images of the breast. Variable dose geometry is \nused to give a sufficient dose in the central projection for that image to be a 2D mam-\nmogram (2D-CP). We investigated whether 2D central projection (2D-CP) obtained \nwith DBT is equivalent to digital mammography (DM) in terms of image quality.\nMethods and Materials: We retrospectively evaluated 45 asymptomatic patients \nwho underwent DM and DBT with 2D-CP for screening. Two experienced radiolo-\ngists in consensus reviewed the DM and 2D-CP images in separate sessions. \nReaders were asked to subjectively score image quality on a 1-5 scale in terms of \na) artefacts (1=absent to 5=significant artefacts), b) noise (1=absent to 5=very high \nnoise) and c) fibro-glandular-breast-tissue-to-fat-contrast (1=poor to 5=excellent). \nThe comparison between 2D-CP and DM scores was performed with a Wilcoxon \nsigned-rank-test on a per-breast basis.\nResults: There was no significant difference between DM and 2D-CP in terms of \nartefacts, with median scores of 2.0 for both techniques (p> 0.05). A significant \ndifference (p < 0.05) was found between DM and 2D-CP concerning noise and \ncontrast (median were 2 vs 4 and 5 vs 4, respectively).\nConclusion: Although DM is superior to 2D-CP in terms of image noise and \ncontrast, both techniques showed a reduced incidence of artefacts. Clinical stud-\nies should be performed to assess whether this qualitative difference has clinical \nrelevance. \nB‑0685 11:24\nThe role of additional ultrasound and tomosynthesis after normal \ndigital mammography: comparison between both techniques \nP. Slon, J. Etxano, I. Simon-Yarza, G. Viteri, A. Elizalde, L.J. Pina Insausti; \nPamplona/ES (ljpina@unav.es) \nPurpose: To assess and compare the detection rate of additional cancers by means \nof ultrasound (US) or tomosynthesis (TS).\nMethods and Materials: From October 2011 to September 2012 we conducted \na prospective study at our reference centre. During this time, 3615 consecutive \nwomen and one man (mean age 52.3, range 29-88) underwent digital mammogra-\nphy (Inspiration, Siemens, Erlangen, Germany). After the evaluation of the breast \ndensity by a radiologist, routine US and tomosynthesis (oblique mediolateral view) \nwere performed in all patients with ACR density patterns 2 (901), 3 (1165) and 4 \n(224). Out of these 2290 patients, 76 had suspicious lesions on conventional mam-\nmography (BI-RADS categories 4 and 5) and among them 41 had breast cancer. \n4\n\nScientific Sessions\nS30\nA\n C D E F G\nB\nSunday\nany of the other tumour features and overall survival were identified. Inter-reader \nagreement for was fair to moderate (k=0.34-0.78).\nConclusion: In patients with intradiverticular bladder tumours, the length of contact \nbetween the tumour and diverticular wall and the tumour width are significantly \nassociated with overall survival. \nB‑0690 10:39\nUsefulness of diffusion-weighted magnetic resonance imaging in \npatients with muscle-invasive bladder cancer selected for radical \ncystectomy: lymph node staging prospective study and comparison \nwith CT scan \nJ. Borrego Gómez, J. Martel Villagrán, E. De la Peña, J. Culebras, C. Llorente; \nMadrid/ES (jesusborregoes@yahoo.es) \nPurpose: To evaluate the feasibility and accuracy of preoperative DW-MRI for the \ndetection of metastatic lymph nodes in patients with muscle-invasive bladder cancer \n(MIBC) who were selected for radical cystectomy with extended lymphadenectomy \nas well as to compare with CT.\nMethods and Materials: Prospective study opened in January 2010 including \n28 patients to date with MIBC selected for radical cystectomy with extended \nlymphadenectomy. Before surgery, DW-MRI and CT scan were performed. Two \nindependent radiologists with experience in urogenital radiology interpreted the \nDW-MRI and CT images. MR images were read at the time of patient inclusion \nwith the DW image findings. The measurement of the ADC value was calculated \nfor selected studies and in nodes > 5 mm. Diagnostic accuracy of DW-MRI was \ncompared with CT and with histopathological findings. The sensitivity, specificity, \npositive and negative predictive values of diagnostic tests were analysed.\nResults: 26 patients were male. The median rate of age was 69.8 years. Eight \nof 28 patients had lymph node metastasis. The average number of nodes in the \nlymphadenectomy was 12.1. The sensitivity of DW-MRI was higher than CT: 62.5% \nvs 25%. CT alone is not considered suitable for nodal metastasis staging because \nof its high false negative rate. The specificity, PPV and NPV values were similar \nfor both DW-MRI and CT.\nConclusion: The diagnostic methods for tumour staging in MBIC should be im-\nproved to select the appropriate treatment. DW-MRI can contribute effectively in \nthe nodal staging of patients with MIBC, but it is necessary to continue evaluation.\nB‑0691 10:48\nUse of FLAIR sequences for detection and local staging of bladder \ntumours with MRI \nM. Di Girolamo, G. Muscogiuri, M. Cappucci, V. Catena, R. Persechino, \nV. David; Rome/IT (digirolamomarco@hotmail.com) \nPurpose: To increase the diagnostic accuracy of MRI in the detection and local \nstaging of bladder tumours by using Fluid-attenuated Inversion Recovery (FLAIR) \nsequences.\nMethods and Materials: 32 patients with bladder tumours detected by US under-\nwent MRI using 1.5 T superconductive magnet. We performed TSE T1-weighted \nand T2-weighted and FLAIR sequences on axial scans. The contrast to lesion ratio \nwas always evaluated. All the patients underwent cystoscopy with transurethral \nbiopsy and 14 had subsequent cystectomy.\nResults: In comparison with other sequences, FLAIR sequence was more sen-\nsitive in the detection of bladder neoplasms. This sequence demonstrates the \nhyperintense signal of bladder neoplasms from the filled bladder lumen with no \nsignal. The sensitivity in the identification of bladder neoplasms was 100% with \nFLAIR sequences, 89.6% with TSE T2-weighted sequences and 86.2% with \nTSE T1-weighted sequences. That was due to the higher signal-to-lesion ratio \nof FLAIR sequences in comparison with the others. In fact, on FLAIR sequences \nthe mean value of contrast to lesion ratio of bladder neoplasm was 33.1 while on \nSE T1-weighted sequences and TSE T2-weighted sequences was, respectively, \n15.2 and 29.2. FLAIR sequences allowed the detection of small papillomas (< 2 \nmm). TSE T2-weighted sequences were more sensitive than other sequences in \nthe study of bladder wall infiltration.\nConclusion: FLAIR sequences were more sensitive in the detection of bladder \nneoplasms, thanks to their higher contrast-to-lesion ratio and were helpful in the \nvisualisation of small papillomas, especially when multifocal. \nConclusion: While the inter-reader reproducibility of 2D-DM resulted only moder-\nate, the adjunction of DBT allowed to reach a substantial reproducibility. The use of \nDBT added to 2D-DM can reduce inter-reader variability and allow for more reliable \nreadings from different radiologists.\nAuthor Disclosures:\nG. Di Leo: Consultant; IMS.\nB‑0688 11:51\nOne-to-one comparison between digital mammography and digital \nbreast tomosynthesis using a fully automated software: breast \ndensity underestimation on digital breast tomosynthesis varies in \ndifferent BI-RADS classes \nA. Tagliafico, S. Airaldi, F. Cavagnetto, B. Bingotti, S. Tosto, D. Astengo, \nM. Calabrese; Genoa/IT (albertotagliafico@gmail.com) \nPurpose: To compare breast density on digital mammography (FFDM) and tomo-\nsynthesis (DBT) according to different BI-RADS classes (four classes from 1 to 4) \nwith an automated software.\nMethods and Materials: IRB approval and written informed consent were obtained. \nDigital breast tomosynthesis and digital mammography were obtained in the same \npatient. A total of 160 consecutive patients (mean age years: 50±14; mean BMI: 22 ± \n3) were included. One-to-one comparison between FFDM and DBT was made with \na fully automated software previously validated. Statistical analysis was performed \nwith two-tailed t-test for paired data using statistical software.\nResults: In BI-RADS class 1, digital mammography overestimated breast density \nof a 16%. In BI-RADS class 2, digital mammography overestimated breast density \nof a 11.9%. In BI-RADS class 3, digital mammography overestimated breast density \nof a 3.5%. In BI-RADS class 4, digital mammography overestimated breast density \nof a 18.1%. The differences resulted highly statistically significant (p < 0.0001). \nThere was a good correlation between BI-RADS categories and the density evalu-\nated with digital mammography and digital breast tomosynthesis (r=0.56, p < 0.01 \nand r=0.48 p < 0.01).\nConclusion: Breast density values were underestimated by DBT in comparison \nto FFDM with a non-linear relationship in the different BI-RADS classes. This data \nshould influence clinical and research studies dealing with breast density as a \nqualitative biomarker. \n10:30 - 12:00 Room G/H \nGenitourinary \nSS 1307 \nThe bladder and below \nModerators: \nM. Baramia; Tbilisi/GE \nR.H. Oyen; Leuven/BE \nB‑0689 10:30\nThe role of CT as a staging tool and prognostic biomarker in the \npretreatment evaluation of intra-diverticular bladder tumours \nP.L. Di Paolo, H.A. Vargas, H. Hricak; New York, NY/US (dipaolop@mskcc.org) \nPurpose: To evaluate the use of CT for staging intradiverticular bladder tumours, \nand to determine the associations between CT tumour features, pathology and \noverall survival.\nMethods and Materials: Between 2001 and 2010, we retrospectively identified \n34 patients (32 men; median age=65y) with intra-diverticular bladder tumours who \nunderwent pre-treatment CT. In addition to CT stage (dichotomised as ²T1 and \n³T2), the following CT features were evaluated by 2 independent readers: length \nof contact between the tumour and diverticular wall, tumour width (measured \nperpendicular to the diverticular wall), tumour morphology (flat vs polypoid) and \ndiverticular neck involvement. Pathology findings constituted the standard of refer-\nence. Spearman correlation coefficients and hazard ratios (HRs) were calculated \nto determine the association between CT features, pathology and overall survival. \nInter-reader agreement was evaluated with weighted-kappa statistics.\nResults: All patients had cystoscopy-guided biopsy/resection, and underwent CT \nbefore treatment. On pathology, 30/34 patients had high-grade lesions. There was \na significant association between CT stage and pathology stage for both readers \n(p < 0.001). However, neither CT nor pathology stage was associated with overall \nsurvival (p=0.20-0.55). Both the length of contact between the tumour and diverticu-\nlar wall and the tumour width were significantly associated with overall survival for \nboth readers (HRs 1.31-1.62, p < 0.001-0.04). No significant associations between \n5\n\nScientific Sessions\nS30\n C A D E F\n G\nB\n190.24 mL and PVR = 94.45 ± 167.99 mL). Micturition MRI mean results were not \nas good as reference standard with 13 patients who could not void. MRI sagittal \nsurface-derived Qmax results were biased in the full population with MRI systemati-\ncally inferior to reference standard (-39.3%, 95% confidence interval was -60.2 to \n-18.5). Urinated volume was calibrated between two different techniques; however, \nboth methods disagreed on measurements (mean = 142.41 ± 146.2 mL, intraclass \ncorrelation was 0.18 (-0.05, 0.41), PValue = 0.07). Qmax performance depended \non the threshold value, AUC from 0.64 (0.28, 1.00) to 1.00 in conclusive results.\nConclusion: Micturition MRI allowed continent ileal urinary reservoir functional \nassessment. Micturition MRI was biased, agreed with reference standard on Qmax \nand PVR measurement but disagreed on urinated volume. Functional evaluation \nof micturition with MRI is complete with non-invasive outlet anomaly detection and \nurine flow assessment. \nB‑0695 11:24\nClinical relevance of magnetic resonance dynamic \nspongiourethrotomography of male urethral stricture detection \nE. Banchik, V. Dombrovsky, M. Kogan, V. Mitusov; Rostov-on-Don/RU \n(emma.mail@mail.ru) \nPurpose: To evaluate clinical relevance of urethral stricture detection and stag-\ning using magnetic resonance dynamic spongiourethrotomography (MRDSUT).\nMethods and Materials: The series of 65 patients, aged 19-71 years (mean, \n39.6) with urethral stricture different localisations were included. Retrograde \nurethrography (RUG) and voiding cystourethrography (VCUG) were also done. \nAll patients were undergone to urethroplasty. Radiological results were compared \nwith morphological data. MRDSUT using 2D Fast Imaging Employing Steady-State \nAcquisition pulse sequence in sagittal plane were done. This technique is usually \nused for evaluation of coronary and other vessels. This method was conducted \nunder retrograde injection of normal saline (0.1-0.3 ml/sec) into the urethra and \nduring micturition. Penis was taped midline to the abdominal wall. Urethral caliber, \nurethral elasticity, the presence of stricture, its length and spongiofibrosis extent \nwere assessed.\nResults: In all cases (n=65) MRDSUT provided exact delineation of the urethral \nstricture and its length. The sensitivity, specificity and overall accuracy were 100%, \n92.6% and 96.6%, respectively, compared to 90%, 92.2% and 90.9%, respectively, \nfor RUG and VCUG. MRDSUT sensitivity, specificity and overall accuracy in the \nspongiofibrosis detection were 97.4%, 94.5% and 96.2%, respectively. RUG and \nVCUG cannot detect the spongiofibrosis.\nConclusion: MRDSUT can define the length of urethral stricture and its locali-\nsation more accurately than RUG in combination with VCUG, but in contrast to \nthem it allows to detect a cause of urethral stricture, spongiofibrosis. In our clinic, \nMRDSUT became crucial study for diagnostic of urethral stricture disease and in \nthe preoperative determining of a surgery type.\nB‑0696 11:33\nUrinary bladder neck dysfunction in male patients: evaluation with \nMRI and with voiding MR-cystourethrography \nM. Di Girolamo, A. Trucchi, S. Mariani, G. Muscogiuri, I. Casazza, V. David; \nRome/IT (digirolamomarco@hotmail.com) \nPurpose: This study aimed to evaluate with MRI male patients with urinary bladder \nneck dysfunction, studying the anatomy of bladder neck and performing voiding \nMR-cystourethrography.\nMethods and Materials: We have evaluated with MRI 21 male patients with urinary \nbladder neck dysfunction diagnosed with pressure-flow study. All patients had \nundergone US in the month preceding MRI, excluding patients with BPH. The MR \nexaminations were performed with an 1.5 T magnet. The patients had urine-filled \nbladders and sagittal and oblique coronal TSE T2-weighted scans were performed. \nThe oblique coronal scans were parallel to the plane of the bladder neck. 15 pa-\ntients underwent also voiding MR-cystourethrography performed with T1-weighted \nspoiled 3D gradient-echo acquisitions on sagittal plane performed after the filling \nof bladder lumen with contrast-material-enhanced urine. \nResults: The entire MR examination lasted no longer than 10 minutes. We detected \n18patients with abnormality of smooth muscular structures of the bladder neck \nand 3 with bladder neck cyst. MRI allowed a perfect evaluation of the different \nsmooth detrusor muscles of the bladder neck. In patients with urinary bladder neck \ndysfunction, we detected hypertrophy of posterior smooth muscular structures of \nbladder neck and kyphosis of prostatic urethra. 6 patients were able to perform \nvoiding MR-cystourethrography that showed the characteristic radiological features.\nConclusion: MRI with voiding MR-cystourethrography could be performed in \nmale patients with bladder outlet obstruction in order to visualise the aspect of the \nB‑0692 10:57\nMagnetic resonance virtual cystoscopy versus conventional \ncystoscopy in the detection of urinary bladder cancer \nS. Elangovan; Puducherry/IN (elangovansundar@hotmail.com) \nPurpose: The non-invasive investigation of urinary bladder carcinoma by mag-\nnetic resonance (MR) virtual cystoscopy was evaluated by us and compared with \nconventional cystoscopy.\nMethods and Materials: Thirty consecutive patients, presenting with gross hae-\nmaturia and trans abdominal ultrasound suggestive of mass in the bladder were \ntaken up for study. All patients underwent conventional cystoscopy and CISS 3D \nMR imaging and the images reconstructed for virtual cystoscopy using volume \nrendering technique. Lesions were detected and the number, size, location and \nmorphologic features of lesions were noted. Subsequently, patients underwent \nconventional cystoscopy, and the findings were noted. The final diagnosis of the \ncases was established by histopathology.\nResults: Sixty-five lesions were seen in MR virtual cystoscopy and 69 in conven-\ntional cystoscopy. The smallest lesion identified on MR virtual cystoscopy was 3 \nmm. Overall sensitivity and specificity of MR virtual cystoscopy for lesion detection \nwere 94.2 and 100%, respectively. For lesions greater than 5 mm, the detection \nrate was 98%.Pearsons correlation test showed a good between virtual and con-\nventional cystoscopy for maximum and minimum diameters of the lesion (0.98 and \n0.92, respectively). Location of the lesions and their morphological characteristics \nwere found to correspond by both methods.\nConclusion: MR virtual cystoscopy is an effective tool in the detection of urinary \nbladder tumours, especially those larger than 5 mm. When bladder lesion is less \nthan 5 mm a sessile conventional cystoscopy is better than MR virtual cystoscopy. \nB‑0693 11:06\nVoiding MR cystourethrography: a new diagnostic imaging \ntechnique for the evaluation of male lower urinary tract \nM. Di Girolamo, C. Cantone, E.M. Pandolfi, R. Persechino, F. Caporilli Razza, \nV. David; Rome/IT (digirolamomarco@hotmail.com) \nPurpose: To evaluate the diagnostic accuracy of a diagnostic imaging technique \ncalled voiding MR cystourethrography.\nMethods and Materials: 10 normal volunteers and 86 male patients with blad-\nder outlet obstruction (evaluated with urine-flow velocity recording) underwent \nvoiding MR cystourethrography. The MR examination was performed with 1.5 \nT superconductive magnet. The filling of the urinary bladder with paramagnetic \ncontrast agent was obtained by the i.v. administration of furosemide followed by \n¾ of the normal dose of a paramagnetic contrast agent. During the micturition two \nconsecutive T1-weighted spoiled 3D gradient-echo acquisitions on sagittal plane \nwere performed. 3D row images were post-processed with MIP algorithm. 25 \npatients performed retrograde and micturating conventional cystourethrography \nin the month preceding MRI.\nResults: Homogeneous opacification of the bladder lumen was always obtained. \n10 patients were unable to perform the MR examination. In all the volunteers and \nin all the patients studied (76 pts), a perfect evaluation of the male urethra with \nMRI was obtained and its visualisation with MIP reconstructed images was con-\nsidered comparable to that obtained with conventional cystourethrography. Site, \nlength and number of urethral strictures were accurately determined. The analysis \nof 3D sagittal scans allowed a better evaluation of the morphology of the urethral \nstrictures in comparison with conventional cystourethrography.\nConclusion: Voiding MR cystourethrography demonstrates the morphology of \nthe bladder neck and urethra during the micturition and can substitute stand-\nard cystourethrogram, avoiding radiation exposure to the gonads and urinary \ncatheterization.\nB‑0694 11:15\nMicturition MRI: voiding assessment in continent ileal urinary reservoir \nJ. Lopater1, A. Scherrer1, V. Delmas2, S. Gey2, Y. Neuzillet1, T. Lebret1; \n1Suresnes/FR, 2Paris/FR (a.scherrer@hopital-foch.org) \nPurpose: The aim of this study was to assess micturition MRI voiding characteristics \nin continent ileal urinary reservoir performed after cystectomy for bladder cancer.\nMethods and Materials: A total of 51 patients with continent ileal urinary reservoir \nwere included prospectively. Reference standard micturition evaluation with maxi-\nmum urine flow rate (Qmax), urinated volume and ultrasound post-void-residual \n(PVR) measurements were performed before or after micturition MRI. Qmax results \nwere conclusive when urinated volume was superior to 150 mL.\nResults: Reference standard evaluations voiding mean results in the full popula-\ntion were satisfying (Qmax = 20.59 ± 15.91 mL/sec, urinated volume = 286.98 ± \n6\n\nScientific Sessions\nS30\nA\n C D E F G\nB\nSunday\n10:30 - 12:00 Room I/K \nAbdominal Viscera \nSS 1301 \nAbdominal CT: dose reduction and technical \nimprovements \nModerators: \nD. Tack; Baudour/BE \nA. Taibbi; Palermo/IT \nB‑0699 10:30\nHybrid iterative reconstruction for abdominal CT: can the radiation \ndose be decreased while preserving the low-contrast detectability? \nS.T. Schindera1, D. Odedra2, S. Arsalan Raza2, T.K. Kim2, H.-J. Jang2, \nZ. Szucs-Farkas3, P. Rogalla2; 1Basle/CH, 2T oronto, ON/CA, 3Biel/CH \n(sschindera@aol.com) \nPurpose: To compare the low-contrast detectability and image quality of abdominal \nCT at different radiation dose levels reconstructed with iterative reconstruction (IR) \nand filtered back projection (FBP).\nMethods and Materials: A liver phantom with 12 simulated tumours (diameters \nof 5, 10, 15 and 20 mm; tumour-to-liver contrast of -10, -20, and -40 HU) was \ndesigned. The phantom was scanned with a standard abdominal CT protocol \n(equivalent 100% dose) and four low-dose protocols (20%, 40%, 60%, and 80% of \nthe standard protocol dose). CT datasets were reconstructed with hybrid IR (AIDR \n3D, Toshiba) and FBP. Image noise was measured, and the tumours’ CNRs were \ncalculated. Tumour detection was assessed by three blinded radiologists. A total \nof 840 tumours were presented to the radiologists.\nResults: IR yielded image noise reduction of 44-64% and a CNR increase of 74-\n180% compared to FBP at the same dose level (P < 0.001). The overall sensitivity \nfor tumour detection was 64.7-85.3% for IR and 66.3-85.7% for FBP at the 20% \nto 100% doses, respectively. There was no significant difference in the sensitivity \nbetween IR and FBP at the same dose level (P=1.0). The sensitivity of the protocol \nat the 20% dose using FBP and IR was significantly lower compared to the protocol \nat the 100% dose using FBP and IR (P < 0.05).\nConclusion: Although hybrid IR at a reduced radiation dose provides the same \nor better quantitative image quality compared with FBP at standard protocol dose, \nthe low-contrast detectability is decreased which presents a risk of missing subtle \npathologies.\nB‑0700 10:39\nImage quality on liver CT based on sinogram-affirmed iterative \nreconstruction algorithm \nB. Schulz, B. Bodelle, P. Siebenhandl, M. Beeres, F. Al-Butmeh, C. Frellesen, \nT.J. Vogl; Frankfurt a. Main/DE (mail@borisschulz.com) \nPurpose: To evaluate efficiency of sinogram-affirmed iterative reconstruction \ntechnique, regarding noise and image quality on contrast-enhanced computed \ntomography (CT) of the liver.\nMethods and Materials: CT examinations were performed upon 32 patients (128 \nslice CT, 120 kV, 180 mAs, activated tube current modulation, 0.6 mm collimation). \nEach examination was reconstructed at standard filtered back projection (FBP) \nand 5 different SAFIRE strengths in 5 mm images in transversal direction with soft \ntissue kernel. Image noise was defined as standard deviation (SD) of Hounsfield \nunits (HU) in air, and signal-to-noise ratio (SNR) of the liver was defined as mean \nliver HU per liver SD. Subjective image quality was evaluated by three raters us-\ning a 5-point scale (1=non-diagnostic image quality, 5=excellent image quality).\nResults: Average image noise was 6.2 HU (FBP), vs. 5.7 HU (SAFIRE 1), vs. 5.0 \n(SAFIRE 2) 4.4 HU (SAFIRE 3), 3.8 HU (SAFIRE 4), 3.1 HU (SAFIRE 5). SNR of \nthe liver consecutively increased when using the iterative reconstruction algorithms \nfrom 8.4 (FBP) to 9.3 (SAFIRE 1) to 10.4 (SAFIRE 2) to 12.2 (SAFIRE 3) to 15.1 \n(SAFIRE 4) to 17.5 (SAFIRE 5). The differences in image noise and SNR of each \nSAFIRE-strength to FBP was statistically significant (p < 0.05). Subjective image \nquality was voted 3.9 (FBP) vs. 4.3 (SAFIRE 1) vs. 3.7 (SAFIRE 2) vs. 2.8 (SAFIRE \n3) vs. 1.8 (SAFIRE 2) vs. 1.2 (SAFIRE 5).\nConclusion: Sinogram-affirmed-based iterative reconstruction technique sig-\nnificantly reduces image noise and increases SNR for examinations of the liver. \nHowever, subjective image quality decreases with strong iterative strengths.\nbladder neck. These anatomical information are useful to determine the causes of \nvoiding obstruction and diagnose urinary bladder dysfunction. \nB‑0697 11:42\nMRI findings of radiation-induced changes in the urethra and \nperiurethral tissues in patients with prostate cancer \nC. Marigliano1, O.F. Donati2, O. Akin2, D. Goldman2, J. Eastham2; 1Rome/IT, \n2New York, NY/US \nPurpose: The aim of this study was to assess radiotherapy (RT)-induced changes \nin the urethra and periurethral tissues in patients with prostate cancer (PCa).\nMethods and Materials: This retrospective study included 108 men (median age, \n65y; range, 43-87y) who underwent external-beam radiotherapy (EBRT) and/or \nbrachytherapy for PCa. On endorectal-coil MRIs of the prostate obtained within \n180d before RT and 2-63 months (median, 20 months) after RT, two readers in-\ndependently measured the urethral length (UL) and graded the margin definition \n(MD) and signal intensities (SIs) of the urethral wall, the levator ani and obturator \ninternus muscles and the muscles of the genitourinary diaphragm on 4-point scales.\nResults: Mean UL decreased significantly from pre- to post-RT MRI for both read-\ners (from 15.2 to 12.6 mm and 14.4 to 12.9 mm, [p < 0.0001, both]). Inter-reader \nagreement for UL was excellent for pre- and post-RT MRI (ICC= 0.89 and 0.90, \nrespectively). Both readers found significantly decreased MD and increased SI \nin the urethral wall and pelvic muscles on post-RT MRI (p?0.008). Inter-reader \nagreement was fair for MD (?=0.31, pre- and post-RT) and SI of the urethral wall \n(?=0.33, pre- and post-RT) and ranged from slight to moderate for SI of the pelvic \nmuscles (?=0.11-0.56, pre-RT and?=0.11-0.46, post-RT). SI changes in the obtura-\ntor internus muscle were greater after EBRT (p=0.0003-0.01), while SI changes in \nthe levator ani muscle were greater after brachytherapy (p=0.03).\nConclusion: After RT of the prostate, MRI shows urethral shortening, decreased \nurethral margin definition and increased SI of the urethral wall and pelvic muscles. \nB‑0698 11:51\nMRI anatomic evaluation in patients with persistent urinary \nincontinence after advance male sling: a work in progress study with \na 3 T system \nV. Zampa, D. Pistolesi, S. Ortori, L. Faggioni, M. Marletta, C. Bartolozzi; Pisa/IT \n(virnazampa@hotmail.com) \nPurpose: Retrourethral transobturator sling is a new functional treatment of stress \nurinary incontinence after prostatectomy consisting in repositioning the urethral \nsphincter into the pelvis. Overall success rate is 54-80%; however, a failure rate \nof 20-45% is reported. The aim of this study was to retrospectively analyse mor-\nphologic changes visible on MRI after sling procedure in incontinent patients and \ncompare with the continent ones, in order to detect possible factors explaining the \ndifferent clinical outcome.\nMethods and Materials: 16 patients treated with advance sling were enrolled: 8/16 \nhad clinical recovery while 8/16 had persistent incontinence. MR protocol performed \nwith a 3 T system included 3D T2w sequence (cube) and a high temporal resolution \nFiesta for dynamic MRI. On the T2w sequence, the length of the bulbus posterior \nto the sling and the distance of the sling from a line parallel to the symphysis \npubis (LSP), were measured. Mann-Whitney test was used to analyse the results.\nResults: In the 8 incontinent patients the length of the bulbus posterior to the sling \nwas < 8 mm (range 4-8 mm) while in the continent ones was > 12 mm (12-23 mm) \n(p < 0.001). The sling position was located posterior to the LSP in 7/8 incontinent \npatients (4-12 mm) and almost coincident in 6/8 continent patients (p=0.04).\nConclusion: Based on our results, the length of the bulbus posterior to the sling \nseems to strongly correlate with continence. Although our results must be confirmed \nin a larger series, surgeons should consider this element in planning the proper \nposition of the device. \n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nof the patient and type of examination semiautomatically. In addition, 40 abdominal \nCT examinations were performed with a standard tube potential of 120 kVp. Radia-\ntion doses (CTDIvol) were noted for all examinations. Signal-to-noise ratio (SNR) \nwas determined in the contrast-enhanced lumen of the abdominal aorta (A), liver \n(L) and spleen (S). Subjective IQ (lesion detectability, diagnostic confidence) was \nrated on a 4-point scale (1_non diagnostic; 4_excellent) by two readers. \nResults: Whereas noise level was slightly elevated when using TPS algorithm \ncompared to the standard protocol (10.2 vs. 8.0 HU, p < 0.01), no significant dif-\nferences in SNR (15.2±5.4 vs. 16.5±5.2 [A], 10.5±3.3 vs. 11.7± 3.9 [L], 10.8±3.8 \nvs. 12.0±3.9 [S]) were observed between the two protocols. Subjective IQ (mean \nscore of 3.9 versus 3.8, respectively) was good to excellent in all examinations. \nTPS lowered the CTDIvol significantly as compared to standard abdominal CT \n(6.1±1.7 mGy vs. 11.0±3.9 mGy, p < 0.01).\nConclusion: Attenuation-based TPS lowers the dose of abdominal CT in clinical \nroutine by up to 45% while maintaining high subjective and objective image quality.\nB‑0704 11:15\nSecond generation dual-energy CT of the abdomen: radiation dose \ncomparison with 64- and 128-row single energy acquisition \nC.N. De Cecco, A. Darnell, N. Macias, G. Muscogiuri, C. Ayuso, A. Laghi; \nRome/IT (g.muscogiuri@gmail.com) \nPurpose: This study was designed to compare the radiation dose in abdominal \ndual-energy (DE) and single energy (SE) acquisitions obtained with a dual-energy \nCT (DECT) and a 64-row CT (SECT).\nMethods and Materials: A total of 130 patients divided into two groups underwent \nprecontrast and portal abdominal 128-row CT examination. In group A, DE portal \nacquisition was performed; group B underwent SE portal acquisition. Group C was \ncompound of 32 subjects from group A studied with 64-row SECT. In each group, the \nportal phase dose length product (DLP) and radiation dose (mSv) were calculated.\nResults: A significant radiation dose increment (p < 0.05) was observed in group \nA 10.2±2.3 mSv in comparison to group B 8.9±2.4 and group C 8.8±1.9 mSv. \nNo significant difference (p> 0.05) was reported between SE 64- and 128-row \nacquisitions. A significant positive correlation between radiation dose and BMI \nwas observed in each group (group A, r2=0.59, p < 0.0001; group B, r2=0.35 p < \n0.0001; group C, r2=0.20, p=0.0098).\nConclusion: In clinical practice, abdominal DE modality delivers a significant \nhigher radiation dose to the patient compared to 64- and 128-row SE acquisition. \nThe radiation increment can be justified if a real advantage in patient diagnosis is \nobtained using DE information.\nB‑0705 11:24\nCan iterative reconstructions improve the detection of small \nhypervascular liver nodules with dual-energy CT? \nL. Facchetti1, L. Berta2, L. Mascaro1, F. Pittiani1, L. Romanini1, R. Maroldi1; \n1Brescia/IT, 2Milan/IT (facchettil@gmail.com) \nPurpose: To optimise Dual-Energy CT (DECT) protocols with Sinogram Iterative \nREconstruction (SAFIRE) algorithms for improving small hepatocellular carcinoma \n(HCC) detection.\nMethods and Materials: A DECT arterial acquisition of a cirrhotic patient was \nreconstructed using the standard filtered back projection (FBP-B20f) and 3 iterative \nreconstructions both for the whole dose protocol (DE composition 0.5) and for 80-\nkV acquisitions. Each one of the iterative medium-smooth filter (I26-I30-I31) was \nreconstructed at 3 different strengths (S3-S4-S5) for a total of 20 image series. For \neach series, 8 virtual spherical lesions were simulated in random positions on the \nliver. A lesion-to-liver contrast (LLC) of +20 HU was selected for DE-composition \n0.5 and +30 HU for 80 kV, according to a preliminary study on 20 HCCs acquired \nwith DECT. Four expert radiologists performed a detectability test and rated the \noverall quality, noise and sharpness (5-point scale) in all images.\nResults: 2/32 lesions were detected with FBP-B20f. In all the iterative reconstruc-\ntions, the strength-5 kernels led to detect 23±1.2/32 lesions. The highest image \nquality ratings were 3.3±1.3 (B20f), 3.5±0.7 (I30-S3 DE-composition 0.5) and \n3.1±1.2 for I30-S5 DE-composition 0.5, without a statistical difference (ANOVA \ntest). All subjective ratings in the 80 kV series were defined as suboptimal (2.3±0.3).\nConclusion: Iterative reconstructions increase the sensitivity of the detection \nof sub-centimetric low-contrast lesions, even in the 80-kV series delivering half \ndose. The I30-S5 reconstruction was considered the best for the routine protocol. \nB‑0701 10:48\nEfficacy of a liver detection algorithm for noise reduction in abdominal CT \nN. Ardley1, K. Buchan2, K. Lau1; 1Clayton/AU, 2Melbourne/AU \n(Nicholas.Ardley@southernhealth.org.au) \nPurpose: The liver, an inherently low contrast structure, appears ‘noisy’ on routine \nCT of abdomen. This may impede liver lesion detection. The development of a \nspecific CT liver detection algorithm delivers higher radiation exposure to the liver \nwith the aim of improving quantum noise, and correspondingly less radiation to \nthe remaining abdomen. The aim of this study was to assess the efficacy of this \nalgorithm on reducing noise in the liver.\nMethods and Materials: 80 consecutive patients for abdominal CT with same \nlevel of iterative reconstruction were included. There was no exclusion. The CT \nliver detection algorithm was enabled in the last 40 of these patients. Region of \ninterest in Hounsfield units and standard deviation (SD) were measured in the left \nand right lobes of liver, spleen, psoas and bladder for all patients. Radiation doses \nwere also recorded. The results of the two groups were compared.\nResults: SD reflected noise. In the liver detection algorithm group, there was a SD \nreduction by 10.1% in the right liver, 15.61% in the left liver and 15.83% in spleen. \nNo significant change of SD was seen in psoas and bladder. A 5.6% overall radia-\ntion dose reduction was noted in this group.\nConclusion: The application of this newly developed CT liver detection algorithm \ndemonstrated a reduction in noise in the liver and spleen with no significant noise \nchanges in the remaining abdomen. There was an added benefit of overall radia-\ntion dose reduction. \nAuthor Disclosures:\nK. Buchan: Employee; Philips Healthcare.\nB‑0702 10:57\nImpact of modified abdominal CT protocols for obese patients with \nfiltered back projection and hybrid iterative reconstruction technique \non image quality, radiation dose and low-contrast detectability: a \nphantom study \nS.T. Schindera1, D. Odedra2, D. Mercer2, S. Thipphavong2, P. Chou2, \nZ. Szucs-Farkas3, P. Rogalla2; 1Basle/CH, 2T oronto, ON/CA, 3Biel/CH \n(sschindera@aol.com) \nPurpose: To assess the impact of modified CT protocols for obese patients, using \nfiltered back projection (FBP) and hybrid iterative reconstruction (IR), on image \nquality, radiation dose and low-contrast detectability.\nMethods and Materials: A liver phantom with 12 different tumours was designed, \nand two fat rings were added to mimic intermediate-sized and large-sized patients. \nThe intermediate and large phantoms were scanned with our standard abdomi-\nnal CT protocol (standard deviation [SD] 15) (Aquilion ONE, Toshiba) and were \nreconstructed with FBP. The large phantom was also scanned with four modified \nprotocols using different SD values (10, 12.5, 17.5 and 20) and was reconstructed \nwith FBP and IR technique. The image noise and the CNR were assessed. Tumour \ndetection was independently performed by three radiologists.\nResults: The IR algorithm in the large phantom decreased the image noise (range \n-14.5 to -37.0%) and increased the CNR (range 26.7 to 70.6%) compared to the \nFBP algorithm at the same targeted SD value (P < 0.001). Applying a targeted \nSD of 15, the overall sensitivity for tumour detection in the intermediate and large \nphantom with FBP measured 87.7% and 75.5%, and the radiation dose 42.0 mGy \nand 23.7 mGy, respectively. IR did not improve the sensitivity in the large phantom \ncompared to FBP at the same SD value (P> 0.05).\nConclusion: The same quantitative image quality yields decreased low-contrast \ndetectability in large-sized compared to intermediate-sized patients. Compared to \nFBP , IR significantly improves the quantitative image quality in large-sized patients, \nbut no improvement is observed for the low-contrast detectability.\nB‑0703 11:06\nAutomated attenuation-based tube potential selection for abdominal \nCT examinations: impact on image quality and dose reduction \nP. Kröpil, P. Heusch, L. Schimmöller, F. Miese, S. Dietrich, G. Antoch, \nR.S. Lanzman; Düsseldorf/DE \nPurpose: To evaluate the impact of attenuation-based tube potential selection \n(TPS) on radiation dose and image quality (IQ) of contrast-enhanced abdominal \nCT examinations.\nMethods and Materials: 80 consecutive patients undergoing clinical contrast-\nenhanced (120 ml) abdominal CT examinations on a 128-row scanner were included \nin this study. 40 CT scans were performed using the novel attenuation-based TPS \nfor dose saving (CARE KV, Siemens), which adapts the tube potential to attenuation \n08\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nSunday\ndata were collected in a time period of 5-40 minutes for the T1w sequences. \nVolunteers underwent subsequent T2w respiratory-gated MRC on a 3 T MRI. For \nqualitative analysis a 5-point scale was used. Contrast ratios were calculated for \nquantitative assessment.\nResults: Contrast-enhanced T1w MRC at 7T showed a homogeneous depiction of \nthe intra- and extrahepatic biliary tract with a maximum enhancement 20 minutes \npost-contrast. VIBE and FLASH IR provided a good image quality for the intra- (VIBE \n3.60, FLASH IR 3.67) and extrahepatic bile ducts (VIBE 3.50, FLASH IR 3.72). \nQuantitative analysis revealed high CR values for FLASH IR (CR 0.41 intrahepatic \nand 0.45 extrahepatic) due to a strong signal decrease of hepatic tissue and ves-\nsels. T2w TSE at 7T revealed a poor image quality without diagnostic potential \n(2.22 intrahepatic, 1.93 extrahepatic). 7T VIBE and FLASH provided superiority \nin the depiction of the intrahepatic bile ducts, while 3 T MRC was superior in the \ndelineation of the extrahepatic biliary tract.\nConclusion: Our results demonstrate the feasibility of contrast-enhanced imaging \nof the biliary ducts at 7T, particularly T1w FLASH with inversion recovery enables \nhigh-quality assessment of the biliary tract. \n10:30 - 12:00 Room L/M \nHead and Neck \nSS 1308 \nAdvanced imaging of the ear, orbit and glands \nModerators: \nR. Elias; Rotterdam/NL \nB.F. Schuknecht;  Zurich/CH \nB‑0709 10:30\nVolume-rendering 3D-MRI for detection of auditory pathways in \nchildren under evaluation for cochlear implantation \nI. Burck, N.N. Nagy, M. Harth, T. Stöver, T.J. Vogl, S. Strieth; \nFrankfurt a. Main/DE (iris.burck@gmx.de) \nPurpose: Volume rendering 3D-magnetic resonance imaging (MRI) is able to \nshow auditory pathways between the cochlea and the cerebellopontine angle in \nchildren with negative auditory brainstem responses and cochlear nerve structures \nundetectable by conventional high-resolution (HR) MRI.\nMethods and Materials: Twelve children (mean age ± 43.8 mo) with confirmed \nsevere hearing loss by ABR (auditory evoked brainstem responses) underwent HR-\nCT and HR-MRI of the petrous bone. In addition, three-dimensional T2-weighted \nturbo spin-echo axial slices were obtained at 1.5 T and maximum intensity pro-\njections and 3D volume reconstructions were performed for visualisation of the \ncochlear anatomy.\nResults: Abnormal cochleovestibular anatomic findings such as incomplete \npartition type I (n=1), incomplete partition type II (n=1), narrow internal auditory \ncanal (n=3), splitting of the internal auditory canal and concomitant anomalies of \nthe posterior labyrinth (n=2) were detected by HR-CT and HR-MRI. Interestingly, \nvolume-rendered 3D inner ear reconstructions detected varying but communicating \nstructures of the cochlea and the brainstem in all 12 cases. After cochlear implanta-\ntion all twelve children showed obvious hearing reactions.\nConclusion: In contrast to conventional HR-MRI, 3D-MRI volume-rendering re-\nconstructions are useful to detect aberrant and even tiny auditory path structures \nderived from the cochlea. Children with severe hearing loss and HR-MRI-based \nfindings of missing cochlear nerve structures should be further screened with volume \nrendering 3D-MRI during cochlear implantation evaluation. \nB‑0710 10:39\nCongenital sensorineural hearing loss and ABI surgery: pre-\noperative radiological protocol and considerations after 12 years of \nexperience \nM. Barillari, R. Cerini, F. Spagnolli, N. Cardobi, M. Carner, L. Colletti, V. Colletti, \nR. Pozzi Mucelli; Verona/IT (marco-barillari@hotmail.it) \nPurpose: Cochlear nerves aplasia represents a rare but possible congenital cause \nof Sensori Neural Hearing Loss (SNHL) in children. Early identification and accu-\nrate diagnosis are mandatory to correctly select auditory brainstem implantation \n(ABI) candidates. The purpose of the study was to evaluate the contribution of a \ncomplete pre-operative radiological assessment based on CT and MRI to prevent \nmisdiagnosis and erroneous treatments.\nMethods and Materials: Since 2000, 38 SNHL patients have been treated with \nan ABI in our ENT Department. Six patients had already been operated elsewhere \nB‑0706 11:33\nLow-voltage CT of the abdomen: correlation between patient \ndiameters and subjective image quality, toward identifying cutoff \npatient diameters for patient selection. \nG.A. Zamboni, M. Ambrosetti, R. Pozzi Mucelli; Verona/IT \n(gzamboni@hotmail.com) \nPurpose: To correlate patient diameters and subjective image quality in low-voltage \nand standard-voltage CT of the upper abdomen in the same patient population, \nwith the goal of identifying cutoff patient diameters for selecting patients for low-\nvoltage scans.\nMethods and Materials: 32 patients underwent MDCT of the abdomen with arterial \nphase at 80 kV with angular dose modulation on 64-row MDCT (test group). This was \ncompared to a previous 120-kV scan on the same scanner. Mean interval between \nscans was 139 days. Patient transverse and sagittal diameters were measured \nat celiac axis level, and the mean was calculated. Two radiologists by consensus \ngraded image quality on a 5-point scale (5=excellent; 4=good; 3=moderate; 2=poor; \n1=non-diagnostic; 3 was the chosen cutoff quality). Image quality was correlated to \nthe transverse, sagittal and mean diameter by means of an ANOVA test.\nResults: Patient diameters were unchanged across exams (all p=ns). In 80-kV \nscans, image quality was significantly correlated to sagittal (p=0.034) and mean \ndiameters (p=0.025), while a trend to significance was observed for transverse \ndiameter (p=0.053). In 120-kV scans, image quality was not significantly correlated \nto patient diameters (all p=ns), and all patients received grade 4 or 5. In 80-kV \nscans, a subjective grade 3 corresponded to a transverse diameter of 329 mm and \na sagittal diameter of 267 mm.\nConclusion: Subjective image quality in low-voltage scans appears to be more \ninfluenced by patient size than at standard voltage scans. For our protocol, cutoff \ndiameters for adequate image quality are transverse 329 mm and sagittal 267 mm.\nAuthor Disclosures:\nG.A. Zamboni: Speaker; Guerbet.\nB‑0707 11:42\nPreliminary application of spectral CT imaging in the differentiation \nof hepatic tumours \nW. Chen, X. Ye, C. Zhou; Beijing/CN (wenchen0629@yahoo.com.cn) \nPurpose: To investigate the value of spectral CT imaging in differential diagnosis \nof hepatic tumours.\nMethods and Materials: This prospective study was Institutional Review Board \napproved with patient consent. Thirty-eight patients with hepatic tumours (22 men, \n16 women, 63 lesions), including 11 patients with hepatocellular carcinoma (HCC), \n17 with hemangioma (HH) and 10 with metastatic tumour (MT), underwent plain \nscan of spectral CT imaging and conventional contrast CT scan. Contrast-to-noise \nratio (CNR) of different energy levels and homologous keV of optimal CNR were \ncalculated by the spectral analysis software. The authors also chose three regions \n(60-80keV, 50-90keV and 40-100keV) and calculated the slope rates of spectral \ncurves. One-way ANOVA followed by LSD post hoc tests were performed to com-\npare parameters among HCC, HH and MT groups.\nResults: The homologous keV of optimal CNR of HCC, HH and MT groups were \n68.71±1.72, 67.23±1.93 and 67.16±2.79, respectively. The slope rate of 60-80-\nkeV region in HCC group (0.446±0.201) was significantly higher than that in HH \ngroup (0.205±0.209). There were significant differences between HCC, HH and \nMT groups in the slope rates of 50-90-keV and 40-100-keV regions (p < 0.05). \nThe slope rates were 0.481±0.199, 0.202±0.213 and 0.344±0.229, respectively, in \n50-90-keV region and 0.565±0.231, 0.222±0.289 and 0.396±0.260, respectively, \nin 40-100-keV region.\nConclusion: The 65-70-keV monochromatic imaging of spectral CT imaging is \nthe best for detection of hepatic tumours and slope rates of spectral curves may \nbe useful in differentiation of hepatic tumours.\nB‑0708 11:51\nUltra-high-field imaging of the biliary tract at 7 Tesla: initial results of \nGd-EOB-DTPA-enhanced magnetic resonance cholangiography \nA. Fischer, O. Kraff, S. Orzada, F. Nensa, L.C. Schäfer, M.E. Ladd, L. Umutlu, \nT.C. Lauenstein; Essen/DE (anja.fischer@uk-essen.de) \nPurpose: To assess the feasibility of magnetic resonance cholangiography (MRC) \nusing biliary secreted gadoxetic acid at 7 Tesla (T) and to compare it to T2-weighted \n(w) MRC at 3 T.\nMethods and Materials: 10 healthy volunteers were examined on a 7T MR-system. \nT2w TSE, T1w VIBE and FLASH with inversion recovery (IR) were acquired in \ncoronal orientation. For dynamic imaging gadoxetic acid was administrated and \n09\n\nScientific Sessions\nS31\n C A D E F\n G\nB\n6-GKR=2*10 5a.u. (p < 0.05); WiPI values were: b-GKR=8*10 7 cm3/sec, \n3-GKR=2*108 cm3/sec (p> 0.05), 6-GKR=6*10 6 cm3/sec (p < 0.05). 6-GKR mean \ndiameters decreased in 8/10 patients, 6-GKR CEUS parameters (PE, WiR, WiPI) \ndecreased in all patients.\nConclusion: A reduction in PE, WiR and WiPI at 6 months after GKR suggested \na depletion in tumour vascularization due to radiotherapy-induced necrosis. Our \npreliminary results showed the feasibility of CEUS perfusion analysis for UM, which \ncould provide reproducible, reliable and earlier parameters for the assessment of \ntumour response to GKR.\nB‑0713 11:06\nEvaluation of lacrimal drainage system obstruction using combined \nmultidetector CT and instillation dacryocystography \nM. Shweel, A. ElShafaey, M. Nasar, R. MohyElDien; ElMinia/EG \n(mohshweel@yahoo.com) \nPurpose: To assess the use of combined multidetector computed tomography \nand instillation dacryocystography (CTDCG) in detection of the level of lacrimal \ndrainage system (LDS) obstruction.\nMethods and Materials: Twenty-one patients with one-sided epiphora were our \ncandidates for CTDCG. Axial source and post-processing images were assessed \nfor clear viewing and the ability to detect the level of LDS obstruction. To our \nknowledge, no previous studies used this combination in the assessment of the \nLDS obstruction.\nResults: All patients tolerated the examination well. Various levels of LDS obstruc-\ntion were detected, common canaliculus in 4 (19%) patients, lacrimal sac in 3 \n(14.2%), junction between lacrimal sac and NLD in 9 (42.8%) and NLD obstruction \nin 5 (23.8%) patients. The most common CTDCG findings were dilated opacified \nlacrimal sac with no opacification of the nasolacrimal duct (NLD) in 9/21 (42.8%) \npatients. Curved planner reformation (CPR) was excellent to detect the nasolacrimal \nduct (NLD) obstruction.\nConclusion: CTDCG is a non-invasive patient friendly procedure that adds benefit \nin documentation and preoperative planning.\nB‑0714 11:15\nParotid gland tumours shear wave elastography: a preliminary study \nS. Espinoza-Boireau, I. Khettab, A. Lacan Melki, P. Halimi; Paris/FR \n(sophie.espinoza@gmail.com) \nPurpose: To assess the feasibility of parotid gland tumours shear wave elastogra-\nphy. To establish normal parotid gland elasticity. To evaluate elasticity for the most \ncommon benign parotidian tumours (pleomorphic adenoma, Warthin’s tumour) \nand malignant tumours.\nMethods and Materials: Prospective study including 30 consecutive patients with \nparotid gland tumour. They all underwent share wave elastography to measure \ntumour elasticity and contralateral normal parotid gland elasticity. The results were \nconfronted with histological analysis or fine-needle aspiration cytology.\nResults: Elasticity measure was feasible in all cases. Mean normal parotid gland \nelasticity was 7 kPa (n=25; 3-15). Benign tumours elasticity was 17.8±8 kPa (n=18). \nMalignant tumours elasticity was 37±18 kPa (n=3). Pleomorphic adenomas elastic-\nity was 15.3±8 kPa (n=12). Warthin's tumours elasticity was 21.8±7.4kPa (n=6).\nConclusion: Benign and malignant tumours seem to behave differently under \nshear wave elastography. Complementary studies are required to establish relevant \nthreshold values allowing proper elastography lesions discrimination. \nB‑0715 11:24\nDoes heterogeneous echogenicity of the thyroid parenchyma \ninfluence the detection of multifocality and bilaterality for papillary \nthyroid carcinoma on preoperative ultrasound staging? \nS. Herh, E.-K. Kim, H. Moon, J. Kwak; Seoul/KR (jinnyhs@hanmail.net) \nPurpose: This study was to evaluate whether heterogeneous echogenicity of the \nthyroid parenchyma can influence the diagnostic performances of ultrasonography \n(US) in detection of multifocality and bilaterality of papillary thyroid carcinoma (PTC).\nMethods and Materials: Between December 2010 and January 2011, 240 patients \nhad preoperative staging US for PTC, and underwent total or near-total thyroid-\nectomy. Seven experienced radiologists performed preoperative US for T and N \nstaging. Underlying parenchymal echogenicity of the thyroid gland, multifocality, \nand bilaterality of the thyroid nodules were also evaluated. Patients were divided \ninto two groups according to the underlying echogenicity of thyroid parenchyma on \nUS. To evaluate the diagnostic accuracy of preoperative staging US according to \nthe underlying thyroid echogenicity, diagnostic performances including sensitivity, \nwith cochlear implantation without benefits. All the children performed pre-operative \nfunctional tests, temporal bone CT and brain/cerebellum-pontine angle (CPA) MRI.\nResults: MRI showed in all cases the absence of the cochlear branch of the eighth \nnerve bilaterally (38/38). Unilateral facial nerve aplasia was present in one patient. \nAssociated inner ear malformations were present in 21/38 patients, in particular \ncommon cavity in 8/21, incomplete partition type 1 in 6/21 and semicircular canals \nmalformations in 3/21. No brain anomalies were showed. CT scans better depicted \nthe labyrinthine malformations, adding information about facial nerve canal and \ninternal auditory canal (IAC) size. 2/38 CT showed normal inner ear structures \nand IAC size.\nConclusion: Providing accurate information about cochlear nerve and brain \nanomalies is crucial in the pre-operative assessment of SNHL patients. MRI is the \nonly radiological technique that is able to directly demonstrate the presence or the \nabsence of cochlear nerves. CT is not fundamental and provides complementary \ninformation; a negative CT pattern cannot exclude a cochlear nerve malformation.\nB‑0711 10:48\nThree dimensional and multiplanar reconstruction of the internal \nauditory canal using high-resolution MR imaging before cochlear \nimplantation: does the size of the cochlear nerve affect the results of \nspeech recognition outcome after implantation? \nN.N.N. Naguib, N.-E.A. Nour-Eldin, T. Lehnert, T. Lehnert, M. Harth, T.J. Vogl, \nC. Hey; Frankfurt a. Main/DE (nagy3n@yahoo.com) \nPurpose: To test whether the size of the cochlear nerve measured in the internal \nauditory canal using three dimensional (3D) and multiplanar reconstruction (MPR) \nhigh-resolution MRI affects the speech recognition outcome following cochlear \nimplantation.\nMethods and Materials: The study was retrospectively performed on 51 patients \nwith longstanding hearing loss (mean age of 54.5 years). MRI was performed using \na T2-weighted SPACE sequence. MPR and 3D reconstructions were performed \nusing 3D and InSpace Applications, respectively. The preoperative cross-sectional \nsurface area of the cochlear nerve was measured by drawing a region-of-interest \naround the circumference of the nerve. Speech recognition (SR) was tested using \nthe Freiburger-Monosyllabic-Words (MSWT) and Numbers-tests (NT) preopera-\ntively, postoperatively, at 3-, 6- and 12-month follow-up. SR and size assessment \nwere performed in a double-blinded fashion. The correlation between the SR and \nnerve size were tested using Spearman’s rank correlation test.\nResults: The mean cross-sectional surface area of cochlear nerve in MPR and \n3D was 1.27 mm2 (SD: 0.41, range: 0.38-2.1) and 0.6 mm2 (SD: 0.197, range: \n0.25-1.3). The mean percentages of the SR-MSWT were 5.6, 27.16, 41.25, 51.84 \nand 57.1, while the mean percentages of SR-NT were 37.35, 65.88, 81.4, 85.1 \nand 88.47 in the preoperative, postoperative, at 3-, 6- and 12-month follow -up, \nrespectively. There was no statistically significant correlation (p> 0.05) between \nthe preoperative size of the cochlear nerve (both at MPR and 3D) and the results \nof the SR assessment at any time point of the study.\nConclusion: The preoperative size of the cochlear nerve does not correlate \nsignificantly with the outcome of the speech recognition tests following cochlear \nimplantation.\nB‑0712 10:57\nLocal tumour control in uveal melanoma (UM) after gamma knife \nradiosurgery (GKR): quantitative assessment of tumour response \nwith contrast-enhanced ultrasound (CEUS) \nC. Colantoni, M. Venturini, G. Modorati, A. Colucci, M. Di Nicola, G. Agostini, \nF. De Cobelli, F. Bandello, A. Del Maschio; Milan/IT (colantoni.caterina@hsr.it) \nPurpose: GKR efficacy in the treatment of UM, a hypervascular tumour, is con-\nventionally assessed by clinical and ultrasound findings. Previous reports showed \nthat, in case of hypervascular lesions (HCC, melanoma metastasis, etc). changes \nin vascularization precede diameters reduction after treatment. Hence, our aim \nwas to evaluate CEUS in the quantitative assessment of tumour response to GKR.\nMethods and Materials: Ten patients, who underwent GKR, were enrolled. CEUS \nwas performed (SonoVue Bracco) with iU-22 ATL (Philips) and 5-9 MHz linear probe \nat baseline, at 3 and 6 months after GKR (bGKR, 3-GKR, 6-GKR). Two main tumour \ndiameters and different quantitative parameters related to blood volume (area under \nthe curve in the wash-in phase; wash-in perfusion index - WiPI; peak enhance-\nment - PE) and blood flow (mean transit time; wash-in rate - WiR; rise time - RT; \ntime to peak) were evaluated using a dedicated software (SonoTumor Bracco).\nResults: Mean diameters were: bGKR=10x8 mm, 3-GKR=9x9 mm (Wilcoxon \nbGKR/3-GKR p> 0.05), 6-GKR=7x6 mm (Wilcoxon b-GKR/6-GKR=p < 0.05). PE \nvalues were: b-GKR=2*10 7a.u., 3-GKR=5*10 7a.u. (p> 0.05), 6-GKR=2*10 6a.u \n(p < 0.05); WiR values were: b-GKR=5*10 6a.u., 3-GKR=9*10 6a.u. (p> 0.05), \n0\n\nScientific Sessions\nS31\nA\n C D E F G\nB\nSunday\n476437 of Ministry of Science Poland. J. Bierca: Research/Grant Support; \nGrant Nr N N402 476437 of Ministry of Science Poland.\nB‑0718 11:51\nSemiquantitative strain elastography for the evaluation of chronic \nthyroiditis \nF. Ozkan, M. Sahin, K. Gul, M.F. Inci, M. Yuksel; Kahramanmaras/TR \n(drfozkan@yahoo.com) \nPurpose: To determine the value of semiquantitative strain elastography for the \nevaluation of chronic thyroiditis.\nMethods and Materials: The study was conducted on 48 consecutive patients \nwith chronic autoimmune thyroiditis and 53 healthy controls. Semiquantitative \nstrain elastography was performed to calculate the strain index value (strain ratio \nof the strap muscles to the thyroid parenchyma) to assess thyroid stiffness. For \neach lobe, measurements were obtained from upper, middle and lower part of the \nthyroid parenchyma. Mean strain ratio values of patients and healthy controls were \ncompared by the Mann-Whitney U-test. Validity was analysed by receiver operating \ncharacteristic (ROC) curves.\nResults: The median strain ratio value of patients with chronic autoimmune thy-\nroiditis (2.22) was significantly higher than that of healthy controls (1.22; p < 0.001). \nThe optimal cut-off value for the prediction of diffuse thyroid pathology was 1.41. \nFor this cut-off value, thyroid stiffness had 90% sensitivity, 71.7% specificity, 75% \npositive predictive value (PPV) and 88.4% negative predictive value (NPV) for the \npresence of diffuse thyroid pathology. This cut-off point was exceeded by 89.6% of \nthe patients with and 28.3% of the subjects in control group. SI values showed mild \npositive correlation with the TSH levels (Spearman r coefficient = 0.265). However, \nthis difference did not reach statistical significance (p=0.069).\nConclusion: Semiquantitative Strain Elastography seems to be a useful method \nfor the assessment of Chronic Thyroiditis. Further studies are warranted in larger \npatient groups to determine the reliability of sonoelastography in patients with \nchronic thyroiditis. \n10:30 - 12:00 Room N/O \nEmergency Radiology \nSS 1317 \nTechnical issues and clinical results \nModerators: \nM. Brink; Nijmegen/NL \nG. Schueller; Bülach/CH \nB‑0719 10:30\nAdvanced visualisation of intracranial hematomas of cranial \ncomputed tomography \nH. Ringl, F. Stiassny, W. Schima, M. Toepker, C. Czerny, \nG. Schueller, U. Asenbaum, J. Furtner, C.J. Herold; Vienna/AT \n(helmut.ringl@meduniwien.ac.at) \nPurpose: To retrospectively assess the detection rate of intracranial hematomas \nachieved with the use of curved MIPs of the meningeal spaces, compared to read-\ning transverse CT sections only.\nMethods and Materials: This retrospective study was approved by the Institutional \nReview Board of our institution, which waived informed consent. 314 consecutive \npatients who underwent CT imaging for cranial trauma (n = 314; 155 men and 159 \nwomen; mean age, 58 ± 24 y; range, 2 - 98 y) were included. Four curved MIPs of \nthe meningeal spaces with different thicknesses were rendered for each patient. \nFour radiologists independently evaluated all cases. Hematomas of less than 3 \nmm thickness were considered 'thin' throughout this study. The radiologists were \nblinded to patient names, and patient and group order was randomised. The results \nwere compared to a standard of reference built by two experts. Logistic regression \nwith repeated measurements was used for statistical analysis.\nResults: 121 intracranial hematomas were confirmed in 39 patients. For all readers, \nthe reading time for hematoma detection was significantly shorter (3 - 5 times, P \n<.001)) for curved MIPs. The mean lesion-based detection rate of all readers was \n80% (193/242) for transverse sections and 83% (200/242) for curved MIPs. For \nthin hematomas, the mean detection rate rose from 20% (8/40) with transverse \nsections to 83% (33/40) with curved MIPs.\nspecificity, positive predictive value (PPV), negative predictive value (NPV), and \naccuracy were calculated and compared among the two groups.\nResults: Of the 240 patients, underlying echogenicity of thyroid was heterogeneous \nin 55 patients (22.9%), and homogenous in 185 patients (77.1%). Forty-four (18.3%) \nof the 240 patients had multifocal lesions in one lobe, and 77 (32.1%) had bilateral \nlesions on pathologic examination. Diagnostic performances of preoperative stag-\ning US did not show significant differences in detecting multifocality and bilaterality \nbetween patients with homogenous and heterogeneous parenchymal echogenicity.\nConclusion: Heterogeneous echogenicity of underlying thyroid parenchyma does \nnot significantly influence the detection of multifocality and bilaterality for PTC on \npreoperative US staging.\nB‑0716 11:33\nRole of elastography in the characterisation of thyroid nodules \nF. Sogaro, P. Tessitore, A. Scrimieri, F. Pittiani, A. Borghesi, R. Maroldi; \nBrescia/IT (fsogaro@alice.it) \nPurpose: This study aimed at evaluating the reliability of elastography in predicting \nmalignancy of thyroid nodules.\nMethods and Materials: 59 patients with thyroid nodules, who underwent to \ngrey-scale ultrasonography (US), elastography and FNC (Fine-Needle Cytology), \nwere prospectively enrolled from February to August 2012. For each nodule, \ngrey-scale US parameters (hypoechogenicity, absence of halo sign, absence of \ncolloid) were examined. Findings at elastography were classified according to Rago \ncriteria (2010). Cytological diagnosis were classified according to the SIAPEC-IAP \ncriteria in Tir1, Tir2, Tir3, Tir4 and Tir5. The diagnostic performance of grey-scale \nUS and elastography were compared with cytological findings. Tir1 and Tir3 with \nindeterminate cytology were excluded from the study.\nResults: 48 nodules were included: 41 Tir2, 3 Tir4 and 4 Tir5. According to Rago \ncriteria 32 nodules were score 1, 2 nodules score 2 and 14 nodules score 3. The \nsensitivity, specificity, positive predictive value (PPV), negative predictive value \n(NPV) of elastography were 71%, 78%, 35%, 94%, respectively. The combination \nof grey-scale US parameters (hypoechogenicity with absence of halo sign and \ncolloid) showed 57% sensitivity, 76% specificity, 28% PPV and 91% NPV.\nConclusion: Elastography is not useful in the differentiation of malignant and \nbenign thyroid nodules. However, elastography had a high probability in predicting \ncytological benign diagnosis (high VPN). Moreover, elastography demonstrated a \nsuperior performance than the combination of grey-scale US parameters. \nB‑0717 11:42\nThe new approach to thyroid elastosonography - time-strain curves - \nmay aid the differentiation of nodules \nR.Z. Slapa, B. Migda, W.S. Jakubowski, J. Bierca, J. Slowinska-Srzednicka; \nWarsaw/PL (rz.slapa@gmail.com) \nPurpose: To evaluate a new linear/non-linear approach to strain elastosonography \nof thyroid nodules, based on the analysis of time-strain curves and to compare it \nwith classical elasticity score and thyroid strain ratio methods.\nMethods and Materials: During 2009-2011, 67 patients scheduled for thyroidec-\ntomy (62 with multinodular goitre and 5 with single thyroid nodule) were evaluated \nwith B-mode and power Doppler ultrasound of the whole thyroid. During ultrasound \nexamination, 96 dominant nodules were examined with strain elastosonography \nwith Aplio XG with linear 5-17 MHz transducer. The stiffness of each thyroid nodule \nwas evaluated with classical features of strain elastosonography qualitatively (with \nelasticity scores) and semi-quantitatively with thyroid tissue strain/nodule strain \nratios with application of elasto Q. Moreover, a novel, original approach to elasticity \ndata based on evaluation of time-strain curves was applied.\nResults: 7 papillary carcinomas, 89 benign nodules. Classical elastosonographic \nanalysis with elasticity score and elasticity ratio on statistical analysis did not show \nsignificant difference between cancer and benign nodules (p-value, respectively, \n0.431 and 0.156). On linear/non-linear analysis of time-strain curves excellent \ndifferentiation (p=5.6x10-9) was possible with new parameter: the Relative Length \nof Non-Linear Relaxation. With threshold 0.5: sensitivity 100%, specificity 85.4%, \narea under ROC=0.975.\nConclusion: The analysis of linear and non-linear elastosonography data may \ngreatly improve differential diagnosis of thyroid nodules. Further large-scale stud-\nies evaluating the usefulness of linear/non-linear elastosonography phenomena \n(involving evaluation of vioscoelasticity, e.g. shear wave spectroscopy) in differential \ndiagnostics of thyroid cancer are warranted. \nAuthor Disclosures:\nR.Z. Slapa: Research/Grant Support; Grant Nr N N402 476437 of Ministry of \nScience Poland. W.S. Jakubowski: Research/Grant Support; Grant Nr N N402 \n1\n\nScientific Sessions\nS31\n C A D E F\n G\nB\nB‑0722 10:57\nPatient-tailored automatic kVp selection with sinogram-affirmed \niterative reconstruction (SAFIRE) to reduce dose in patients \nundergoing emergent CT imaging of abdomen and pelvis: an intra-\npatient comparison \nF.D. Gonzalez-Guindalini, M.P.F. Botelho, H. Chalian, V. Yaghmai; \nChicago, IL/US (v-yaghmai@northwestern.edu) \nPurpose: To assess the combined effect of automated kVp selection and Sinogram \nAffirmed Iterative Reconstruction (SAFIRE) on patient radiation dose and image \nquality in abdomen and pelvis CT.\nMethods and Materials: This HIPAA compliant retrospective study was IRB ap-\nproved. We included 52 patients who had undergone emergent CT scans of the \nabdomen and pelvis for abdominal pain with tube current modulation, automated \nkVp selection and SAFIRE (Scan A) and compared their abdomen and pelvis CT \nscans with tube current modulation, 120 kVp, filtered back projection reconstruc-\ntion algorithm (Scan B). CTDIvol, DLP, effective dose (DLP x k) and image noise \nvalues were compared between two protocols. Paired samples Wilcoxon test was \nused for analysis and P < 0.05 was considered significant.\nResults: The median CTDIvol were 12.73 mGy and 18.26 mGy for Scans A and \nB, respectively (P=0.0002); the median DLPs for Scans A and B were 583.00 \nmGycm and 888.50 mGycm (P < 0.0001), respectively. The median effective dose \nwas 34.38% lower with Scan A compared with Scan B (8.74 mSv vs. 13.32 mSv, \nP < 0.0001). The median image noise was significantly lower with Scan A using \nSAFIRE (11.05 vs. 14.15, P < 0.0001).\nConclusion: Automated kVp selection with SAFIRE results in significantly lower \ndose and image noise in patients undergoing emergent CT examinations of the \nabdomen and pelvis. \nAuthor Disclosures:\nF.D. Gonzalez-Guindalini: Research/Grant Support; Educational Grant Support \nby Siemens Healthcare. M.P.F. Botelho: Research/Grant Support; Educational \nGrant Support by Siemens Healthcare. H. Chalian: Research/Grant Support; \nEducational Grant Support by Siemens Healthcare.\nB‑0723 11:06\nAutomated selection of tube potential in thoraco-abdominal trauma \nCT results in significant dose savings \nC. Frellesen, J. Kerl, T. Lehnert, M. Harth, B. Schulz, B. Bodelle, M. Beeres, \nT.J. Vogl, R.W. Bauer; Frankfurt/DE (c.frellesen@gmail.com) \nPurpose: To investigate the impact of automated attenuation-based tube potential \nselection on image quality and radiation dose in polytrauma patients undergoing \nthoraco-abdominal trauma CT.\nMethods and Materials: 2x100 age- and sex-matched polytrauma patients under-\nwent whole body CT. The first group was examined on a 16-slice device at fixed 120 \nkV with 190 ref.mAs and automated exposure control (AEC) modulating only mA \noutput. The second group underwent 128-slice CT with AEC and topogram-based \nautomated tube potential selection (autokV) by the scanner software with either \n100 kV/248 ref.mAs, 120 kV/180 ref.mAs or 140 kV/145 ref.mAs. CTDIvol, DLP, \nbody diameters, organ enhancement and image noise were compared between \nthe groups and sub-groups.\nResults: 100 kV were automatically selected in 82 patients, 120 kV in 12 patients \nand 140 kV in 6 patients of the autokV group. Patient diameters increased with \nhigher kV settings. The average CTDIvol (9.4 vs. 12.9 mGy) and DLP (669 vs. \n925 mGycm; p < 0.05) in the entire autokV group were 27%/28% lower than in the \ngroup with fixed 120 kV. This effect was even more pronounced in the patients in \nwhom 100 kV were selected (CTDIvol 8.1 mGy, -37%; DLP 571 mGycm, -38%). \nEnhancement of parenchymal organs gradually increased with lower kV, while \nimage noise was at a stable level.\nConclusion: Software-based automated selection of the tube potential allows for \nsignificant dose savings in thoraco-abdominal trauma CT while image quality is \nmaintained or even improved. Especially younger patients involved in accidents \nmay benefit the most from this development. \nB‑0724 11:15\nUsefulness of low-dose CT with or without adaptive statistical \niterative reconstruction (ASIR) in the diagnosis of acute appendicitis \nJ.J. Fondevila, M.S. Carreras, I. Arrieta, J. Mesa, A.R. Gil, \nT. Marquina, A. Castrillo, I. Aguirregoicoa, L. Martinez; Barakaldo/ES \n(jonfonmon@hotmail.com) \nPurpose: To determine the usefulness of low-dose CT in the diagnosis and ex-\nclusion of acute appendicitis and to compare with low-dose CT taken with ASIR.\nConclusion: Curved MIPs of the meningeal spaces have the potential to shorten \nthe detection time for epi- and subdural hematomas, increase sensitivity, especially \nfor thin hematomas, and reduce the required operator experience for detection. \nAuthor Disclosures:\nH. Ringl: Patent Holder.\nB‑0720 10:39\nSimple and easy way using time-intensity curve of perfusion-\nweighted images to find penumbra in stroke patients within 4.5 \nhours of onset due to the carotid artery occlusion \nT. Mori, T. Iwata, Y. Miyazaki, M. Nakazaki, Y. Takahashi; Kamakura/JP \n(morit-koc@umin.net) \nPurpose: The aim of our study was to investigate whether or not time-intensity curve \n(TIC) of PWI can find penumbra in stroke patients with acute carotid artery occlusion.\nMethods and Materials: Included were patients 1) who were admitted within 4.5 \nhours of onset between January 2006 and January 2011, and 2) in whom emergency \nMRA suggested the affected carotid artery occlusion. We assessed, NIHSS on \nadmission (NIH adm), DWI-ASPECT score, TIC types, successful recanalization \n(SR), NIHSS on the 7 th day (NIH 7 th), and in-hospital death. Early neurological \nimprovement (ENI) was defined as NIH adm-NIH 7th > 0. TICs were generated on \nregion of interests set at symmetrical positions of the bilateral MCA territories. Ac-\ncording to the time to peak (TP) and the peak signal (PS) comparing the affected \nside (a) with the contralateral side (c), we classified TIC into four types and defined \ntype 1 as TPa>TPc and PSaTPc and PSc/2TPc and PSa>PSc, and type 4 as TPa=TPc. Relationship between \nTIC types, in-hospital death and ENI were assessed.\nResults: Eighty-seven patients were analysed. There were 36, 39, 12 and 0 \npatients in TIC type 1, 2, 3 and 4, 39 patients underwent reperfusion therapy (RT) \nand SR was achieved in 18 patients, and 29 patients died. TIC type 1 was the only \ndeterminant of in-hospital death (p < 0.01) and SR coupled with TIC type 2 was \nthe determinant of ENI (p < 0.01).\nConclusion: TIC type 2 means penumbra and type 1 predetermines poor clinical \noutcome.\nAuthor Disclosures:\nT. Mori: Advisory Board; Kaneka medixs. Board Member; ASNR.\nB‑0721 10:48\nCT imaging in an emergency setting is not substantially delayed by \niterative reconstruction \nM.J. Willemink, A.M.R. Schilham, T. Leiner, W.P.T.M. Mali, P.A. de Jong, \nR.P.J. Budde; Utrecht/NL (m.willemink@umcutrecht.nl) \nPurpose: Iterative reconstruction (IR) is a promising noise reducing technique \nwith the potential to reduce radiation-dose with preserved study interpretability or \nimprove image-quality at similar radiation-dose. One of the major drawbacks of IR \nis a longer reconstruction time which may be problematic in the emergency setting. \nThe purpose of the current study was to compare reconstruction time and speed \nof IR and filtered back-projection (FBP) in two commonly encountered emergency \nimaging scan-protocols: total body trauma CT and pulmonary CTA.\nMethods and Materials: Fifteen patients underwent a total body CT after a trau-\nmatic event and twenty-five adults underwent a CTA for evaluation of pulmonary \nembolisms on a 256-slice CT-scanner. All data were reconstructed using FBP and \ntwo IR-levels (iDose 4, Philips Healthcare). Quantification of reconstruction time \nand speed was done with a self-written plug-in for ImageJ (US National Institutes \nof Health).\nResults: The mean delay in reconstruction time on total body trauma CTs was \n44.4±8.1 and 44.9±7.0 seconds for iDose 4-levels 1 and 6, respectively, and on \npulmonary CTAs 10.1±9.6 and 12.0±11.8 seconds for iDose 4-levels 2 and 4, \nrespectively. The mean reconstruction time and speed for total body trauma CTs \nwere 87.3±14.6, 131.7±16.7 and 132.2±17.9 seconds, and 20.1±1.6, 13.2±0.8 and \n13.2±0.6 slices/s for FBP, iDose4-levels 1 and 6, respectively, and for pulmonary \nCTAs 25.5±7.0, 35.6±9.0 and 37.6±12.0 seconds, and 26.7±5.6, 18.7±2.3 and \n18.0±2.8 slices/s for FBP, iDose4-levels 2 and 4, respectively.\nConclusion: CT image reconstruction in an emergency setting is not delayed \nsubstantially by IR. Furthermore, reconstruction time and speed did not differ \nsubstantially between different IR-levels. \n2\n\nScientific Sessions\nS31\nA\n C D E F G\nB\nSunday\nB‑0727 11:42\nPost mortem computed tomography (PMCT) quality management in \ncritical care? \nS. Kirchhoff, M.F. Reiser, O. Peschel, M. Graw, K.-G. Kanz; \nMunich/DE (sonja.kirchhoff@med.uni-muenchen.de) \nPurpose: In the past years the number of clinical-pathological autopsies decreased \nsignificantly due to various reasons. Forensic autopsies are disposed not only with \nregional differences but, however, also with on an average decreasing frequency. \nEspecially in patients who died during trauma room management or emergency \noperation during critical care, no imaging could possibly be performed. Therefore, \nafter termination of all clinical procedures a critical analysis of death and evaluation \nof the standards of medical care is often not possible, although especially regard-\ning medical quality management it is highly desirable. At least to partly close this \ninformation gap we performed a post mortem Computed tomography (pmCT)study.\nMethods and Materials: In this prospective study whole body pmCT was performed \nin patients who died during trauma room management or emergency surgery leav-\ning all installed foreign material, e.g. tube, drainage in place. The pmCT findings \nwere compared with clinical findings and if available with autopsy reports as well.\nResults: Between 1999 and 2008 46 patients were enrolled, 18 of whom underwent \nadditional autopsy. The major clinical diagnosis which had finally led to the termina-\ntion of resuscitation procedures was confirmed by the pmCT findings. The autopsy \nreport showed a high correlation in the corresponding cases to the pmCT-findings.\nConclusion: PmCT offers the possibility to improve quality management during \ntrauma room management regarding the decision for terminating resuscitation ef-\nforts by verifying the important clinical findings. In addition, pmCT findings support \nspecifically the autoptic reporting. \nB‑0728 11:51\nPortrayal of radiology in major medical television series: does it \ninfluence the perception of radiology in the general population? \nT. Heye1, E.M. Merkle2, J.R. Leyendecker3, D.T. Boll1, R.T. Gupta1; \n1Durham, NC/US, 2Basle/CH, 3 Winston-Salem, NC/US (tobias.heye@web.de) \nPurpose: To assess how the portrayal of radiology in medical TV shows is perceived \nby the general population.\nMethods and Materials: A survey was conducted among adult patients scheduled \nfor a radiological examination, technologists and radiologists. The survey gathered \ninformation regarding TV watching habits and interest in medical TV shows. Ques-\ntions addressing the accuracy in portraying radiology in comparison to reality (1-10 \nscale), appearance of radiological examinations and radiological staff were asked \nin regard to House M.D., ER, and Grey’s Anatomy. The online survey conducted \namong radiologists and technologists from two different academic institutions \nserved as reference standard.\nResults: A total of 126 patients and 240 professionals (133 technologists, 107 \nradiologists) participated. A moderate and significant correlation was found be-\ntween the interest in medical TV shows and the perception that clinical reality was \naccurately portrayed in the group of patients (r=0.49, P=0.001) and technologist \n(r=0.38, P=0.001) but no correlation was found for radiologist (r=0.01). While > 60% \nin all survey groups noted the appearance of radiological examinations regularly \nto > 1/show, the appearance of radiological staff was perceived by 45.2-54.0% \nof patients, 31.6-47.4% of technologists and 15.9-23.4% of radiologists. ER was \nranked more accurate than Grey's Anatomy or House M.D.\nConclusion: The more interest in medical TV shows prevails in patients and \ntechnologists, the more are modern medical TV shows perceived as accurate in \nthe portrayal of radiology. Radiological examinations are frequently utilised, but \nimaging is less often performed by radiological staff.\nMethods and Materials: This retrospective study includes 138 patients under \n65 years-of-age with clinically suspected acute appendicitis, who underwent un-\nenhanced low-dose CT on a 64 MDCT. 84 patients (group A) underwent a low-dose \nCT 34 patients (group B) underwent a low-dose CT with ASIR.\nResults: Normal appendix was identified in 52 (61.9.%) in A versus 26 (76.5%) in \nB. In A 22 (26.2%) versus 6 (17.6%) in B were diagnosed with appendicitis. In A \n10 (11.9%) studies versus 2 (5.9%) studies in B the appendix was not identified. \nIn those where the appendix was not identified a conventional CT was performed. \nNo one had appendicitis during one month follow -up for negative studies. The \nsensitivity and specificity of CT low-dose were 88.1% and 100%, respectively, and \nfor low-dose CT with ASIR 94.6% and 100%, respectively. The sensitivity increased \nto 100% for the total protocol for both techniques. The effective dose mean was \n2.4 mSv ±0.8 instead of 2.62 mSv ±0.9.\nConclusion: The low-dose CT is a suitable technique for the diagnosis or exclusion \nof acute appendicitis in young or middle-aged people, making possible inclusion \nas a radiological imaging test in the diagnostic algorithm of acute appendicitis. \nIntroduction of the ASIR improves the low-dose CT technique with a higher sensi-\ntivity for appendix evaluation which increased the diagnostic confidence, slightly \nlowering the dose. \nB‑0725 11:24\nThe diagnostic yield of MSCT in the detection of obscure infection focuses \nS. Schleder, L. Luerken, L.-M. Dendl, P. Wiggermann, C. Stroszczynski, \nA. Schreyer; Regensburg/DE (Stephan.Schleder@klinik.uni-regensburg.de) \nPurpose: To evaluate the diagnostic yield of multislice computed tomography \n(MSCT) in the detection of obscure infection focuses.\nMethods and Materials: Retrospectively, 525 consecutive patients (326 male, \nmean age 59 years) over a period of 24 months were included in this study. All \npatients underwent a MSCT of the thorax (N=96), of the abdomen (N=101) or of \nthorax and abdomen (N=328) because of an clinical uncertain infection without \nobvious focus.\nResults: In 121 patients (23%) the clinical suspected diagnosis was approved, \nin 170 patients (32.4%) a diagnosis which had not been suspected was revealed \nand in 234 patients (44.6%) no infection focus could be located. Furthermore, in \n169 cases (32.2%) the therapy was changed due to MSCT findings (surgery, per-\ncutaneous abscess drainage, change of antiobiosis), while in 356 cases (67.8%) \ntherapy was held on.\nConclusion: The findings of MSCT are of great relevance in the detection of \nobscure infection focuses and can constitute an important contribution in optimis-\ning the therapy. \nB‑0726 11:33\nImpact and appropriateness of emergency department \nultrasonography requests: a prospective study \nE.S. Ventura, Y. Costa, F.V. Gomes; Faro/PT (fvgomes@gmail.com) \nPurpose: The aim of this study was to assess the appropriateness and clinical \nimpact of Emergency Department ultrasonography requests in Hospital Central \nde Faro, Portugal.\nMethods and Materials: In this prospective study, ultrasonography examinations \nrequested by the Pediatric and General Emergency Departments of Hospital Cen-\ntral de Faro, between 19 th and 26th of March 2012 were evaluated. A description \nof the patient’s demographic parameters and medical histories was undertaken \nwith questionnaires and the consultation of the hospital database. Examinations \nwere classified according to clinical impact and, based on the American College \nof Radiology Criteria and the Portuguese Direcção Geral de Saúde Guidelines, to \nappropriateness. Clinical impact of the examinations was correlated with emergency \ndepartment’s provisional diagnosis and appropriateness according to the guidelines. \nThe associations were statistically analysed with the Chi-square independence \ntest and Fisher exact test.\nResults: The vast majority of the ultrasonography examinations performed did not \nagree with the provisional diagnosis (73.6%) and a considerable number did not \nhave any clinical impact (37.9%). According to the American College of Radiology \nand Direcção Geral de Saúde, 57.5% and 10.3% of the scans were inappropriate, \nrespectively. Clinical impact of the ultrasound scans had a statistically significant (P \n< 0.05) association both with the appropriateness of the requests and with having \na well-defined provisional diagnosis.\nConclusion: The clinical impact of ultrasound examinations in the emergency \ndepartment increases both by following the American College of Radiology and \nDirecção Geral de Saúde guidelines and also when a well-defined provisional \ndiagnosis is suggested by the prescribing doctors.\n3\n\nScientific Sessions\nS31\n C A D E F\n G\nB\nRadiologia Medica (SIRM). S. Salerno: Research/Grant Support; Grant support \nby Società Italiana di Radiologia Medica (SIRM).\nB‑0731 10:48\nIs paediatric chest CT achievable at 70 kV? A feasibility study in 130 \nchildren \nT. Niemann, S. Henry, L. Colas, J.-B. Faivre, T. Santangelo, J. Rémy, \nM. Rémy-Jardin; Lille/FR (martine.remy@chru-lille.fr) \nPurpose: To evaluate image quality of paediatric chest CT acquired at 70 kV.\nMethods and Materials: 130 consecutive children undergoing chest CT studies \non a dual-source CT system were prospectively evaluated with a 70-kV scanning \nprotocol. All scanning parameters were kept similar to those usually selected for \nstandard 80-kV protocols, except the milliamperage. Always selected according \nto the patient’s weight, ref mAs were increased by a factor of 1.6 to maintain \ncomparable levels of radiation dose between newly introduced 70-kV and routine \n80-kV protocols. Image quality at 70 kV (group 1) was compared to that of a \npaired paediatric population (group 2) based on the age (±1yr), weight (±1 kg) and \nadministration of contrast material, previously scanned at 80 kV on the same CT \nunit and prospectively stored in our database. Group 1 and group 2 images were \nreconstructed with filtered-back projection.\nResults: Objective noise in group 1 was significantly lower than that measured \nin group 2 (9.9±6.3 HU vs 11.3±6.6 HU; p=0.03). Subjective image quality of lung \nand mediastinal images in group 1 did not significantly differ from that of group \n2 (p=0.18). In group 1, the mean dose-length-product was 15.4±2.3 mGy.cm (< \n1yr; mean weight: 5.3 kg) (n=35); 18.3±2.1 mGy.cm (1-5yr; mean weight: 13.4 kg) \n(n=44), 24.4±3.9 mGy.cm (5-10yr; mean weight: 24.7 kg) (n=33) and 31.7±4.7 \nmGy.cm (10-15yr; mean weight: 33.1 kg) (n=18).\nConclusion: Paediatric chest CT at 70 kV provides similar objective and subjective \nimage quality to that achievable at 80 kV.\nB‑0732 10:57\nAnthropometry of children and mathematical phantoms applied to \ndose reconstruction in paediatric radiology \nM.C. Seidenbusch, K. Schneider; \nMunich/DE (michael.seidenbusch@med.uni-muenchen.de) \nPurpose: Reconstruction of organ doses achieved during paediatric x-ray exami-\nnations is usually done by performing Monte Carlo simulations in mathematical \nphantoms. For reconstruction of valid organ doses, a close-to-reality anatomical \nconstruction of the mathematical phantoms is essential.\nMethods and Materials: At Dr. von Hauner´s Children´s Hospital, University of \nMunich, since 1976 all conventional x-ray examinations and since 2003 all computed \ntomographic (CT) examinations have been stored in a database. The database \nencompasses now clinical and dosimetric data of more than 310000 conventional \nand more than 3000 CT examinations of children of all age groups.\nResults: From the records in the database, various anthropometric data were \nextracted, e.g. body mass and body length of more than 33000 patients, thoracic \ndiameters and the volumes, densities and masses of lungs and mammalian glands \nof more than 2000 patients of all age groups. These data were compared to the \nanthropometric data of the mathematical MIRD phantoms provided by the Finn-\nish centre for radiation safety STUK. It can be shown that in mathematical MIRD \nphantoms of all age groups, body mass, body length and thoracic diameters are \noverestimated, whereas lung volumes and lung masses are underestimated.\nConclusion: A revision of the anthropometry of the mathematical phantoms \ncurrently in use for dose reconstruction in paediatric radiology seems necessary.\n[Research project of the Federal Republic of Germany, Bundesministerium für \nBildung und Forschung, Förderkennzeichen 02NUK016 A)]\nB‑0733 11:06\nRadiation exposure during scanograms (scoutviews) in paediatric \ncomputed tomography (CT) \nK. Schneider, V. Teusch, M.C. Seidenbusch; \nMunich/DE (michael.seidenbusch@med.uni-muenchen.de) \nPurpose: Radiation exposure of patients during computed tomographic (CT) ex-\naminations is determined not only by the scan protocol but also by the scanogram \n(scoutview) parameters. Especially scanograms that exceed the body region of \ninterest cause an unnecessary radiation exposure.\nMethods and Materials: Since 2003, exposure and image data of all CT examina-\ntions performed at the Dr. von Hauner´s Children´s Hospital, University of Munich, \nhave been stored in a database. For 3.300 thoracic and abdominal CT examinations \nof children of all age groups anatomical localisation and length of CT scanograms \n10:30 - 12:00 Room P \nPaediatric \nSS 1312 \nChest, heart and radiation awareness \nModerators: \nW. Hirsch; Leipzig/DE \nP.D. Humphries; London/UK \nB‑0729 10:30\nRadiation dose levels in paediatric chest CT: experience in 506 \nchildren evaluated with dual-source CT \nT. Santangelo, L. Colas, T. Niemann, A. Simeone, M. Rémy-Jardin, J. Rémy; \nLille/FR (martine.remy@chru-lille.fr) \nPurpose: To assess the radiation dose delivered during dual-source chest CT \nexaminations.\nMethods and Materials: We prospectively recorded the dose-length-product (DLP) \nof 506 consecutive children, evaluated in 4 age groups: group 1 (< 1yr; n=109; \n21%) (mean weight: 5.33±1.99 kg), group 2 (1-5 yr: n=169; 33%) (mean weight: \n13.35±3.92 kg), group 3 (5-10 yr: n=136; 27%) (mean weight: 23.77±6.36 kg) and \ngroup 4 (10-15yr; n=92; 18%) (mean weight: 36.83±7.78 kg). All CT examinations \nwere performed with a dual-source CT system using a dual-source, single-energy \nscanning protocol obtained with thin collimation, high pitch and high temporal \nresolution, a weight-adapted selection of the kilovoltage and milliamperage, and \nsystematic reconstruction of images using filtered-back projection.\nResults: Patients were scanned with a pitch of 2.0 (n=165; 33%) or 3.0 (n=341; \n67%), at 80 kV (n=499; 99%) or 100 kV (n=7; 1%) with a milliamperage ranging \nbetween 40 and 90 mAs. The mean duration of data acquisition was 525.8±192.8 \nms. CT examinations consisted of contrast-enhanced (n=190) and noncontrast \n(n=316) studies, obtained in the context of acquired (n=280; 55%) or congenital \n(n=46; 9%) bronchopulmonary disease, cystic fibrosis (n=60; 12%), cardiovascular \ndisease (n=91; 18%), oesophageal atresia (n=8; 1%) and miscellaneous causes \n(n=21; 4%). All examinations were of diagnostic image quality. The mean DLP \nvalue in each age category was 14.29±3.38 mGy.cm (group 1), 17.64±4.44 mGy.\ncm (group 2), 23.87±5.80 mGy.cm (group 3) and 34.61±10.80 mGy.cm (group 4).\nConclusion: The doses delivered in the above-mentioned conditions are lower \nthan those of published recommendations.\nB‑0730 10:39\nMulti-detector CT studies in children: a comparison of radiation \ndoses between paediatric and non-paediatric radiology units. \nResults from the first 2011 Italian SIRM survey \nC. Granata1, F. Palorini2, D. Origgi2, D. Matranga3, S. Salerno3; 1Genoa/IT, \n2Milan/IT, 3Palermo/IT (cgranata@sirm.org) \nPurpose: To provide a comparison of exposure levels in children from multi-detector \ncomputed tomography (MDCT) studies (> 16 slices) carried out in paediatric and \nnon-paediatric Italian radiology units.\nMethods and Materials: All Italian radiology departments executing MDCT studies \nin children were asked to collect data from typical scanning investigations (trauma, \ninfection, staging) in three anatomical regions (head, thorax and abdomen). For \neach examination, the participating centres recorded the delivered dose in term of \nCTDIvol and DLP, previously verified with standard quality assurance tests. The \nstudy was endorsed by SIRM (Società Italiana di Radiologia Medica).\nResults: We show the results from 908 examinations performed between Janu-\nary and June 2011 in 25 radiology units. 513 (56.5%) of all exams were executed \nin paediatric centres. The 75 th percentiles of CTDIvol (mGy) and DLP (mGy*cm) \ndistributions by three age groups (1-5, 6-10 and 11-15 years) in paediatric centres \nare, respectively, 28, 32, 34 and 460, 640, 580 for the “head” protocol; 1.6, 2.9, 3.8 \nand 40, 70, 130 for “thorax”; 5.5, 5.3, 9.2 and 190, 350, 490 for “abdomen”. While, \nin non-paediatric centres we obtain: 35, 58, 60 and 710, 1080, 1110 for “head”; \n4.7, 5.0, 8.4 and 110, 130, 330 for “thorax”; 8.3, 10.5, 15.4 and 330, 560, 860 for \n“abdomen”. CTDIvol and DLP distributions between paediatric and non-paediatric \ncentres were significantly different for each age group and protocol (p < 0.001; \nnon-parametric Wilcoxon rank sum test).\nConclusion: These results suggest that a nation-wide program for optimisation of \nMDCT imaging protocols in children should be implemented. \nAuthor Disclosures:\nC. Granata: Research/Grant Support; Grant support by Società Italiana di \n4\n\nScientific Sessions\nS31\nA\n C D E F G\nB\nSunday\nB‑0736 11:33\nWhole heart 4D haemodynamics in patients with transposition of the \ngreat arteries after switch procedure \nJ. Geiger1, M. Markl2, D. Hirtler1, B. Jung1, B. Stiller1, M. Langer1; 1Freiburg/DE, \n2Chicago, IL/US (julia.geiger@uniklinik-freiburg.de) \nPurpose: To characterise pulmonary and aortic blood flow alterations and their \ncorrelation to postsurgical anatomy in patients with transposition of the great arteries \n(D-TGA) after arterial switch by 4D MRI.\nMethods and Materials: Flow-sensitive 4D MRI (venc=200 cm/s, spatial/temporal \nresolution ~ 2.5 mm³/38 ms) was performed in 17 D-TGA patients and 12 healthy \ncontrols (age=12±5.4 vs. 23±1.6 years). Patients were divided into two groups: \nanterior (n=10) and right anterior (n=7) position of the pulmonary trunk (TP) in rela-\ntion to the ascending aorta (AAo). Blood flow was visualised by time-resolved 3D \nparticle traces. Visual grading (ranking 0-2) of flow disturbances (vortices, helices) \nwas performed. The flow ratio right and left pulmonary artery (RPA:LPA) and flow \nvelocity were quantified at the valves and in the RPA and LPA.\nResults: Patients with anterior TP had increased TP vortices (6/10, mean grade \n1.6) compared with right anterior TP position (1/7). Increased helices were seen \nin the LPA of both patient groups (9/17, grade 1.3), less frequent in the RPA (4) \nand TP (3). Systolic peak velocity in TP was significantly higher in patients (1.74m/\ns±0.63m/s vs. 0.95m/s±0.12m/s in volunteers), in the RPA 2.04m/s±0.43m/s vs. \n0.98m/s±0.14m/s, in the LPA 1.78m/s±0.54m/s vs. 0.89m/s±0.13m/s. The flow ratio \nRPA:LPA was more heterogenous in patients (RPA:LPA=1.56±0.78 vs. 1.09±0.15 \nin volunteers). 11 patients had increased helices in the AAo (grade 1.6).\nConclusion: 4D flow evaluation of postsurgical blood flow in TGA patients revealed \nflow disturbances with frequent helices in the LPA and AAo and enhanced vortices \nfor the haemodynamically unfavourable anterior TP position. \nB‑0737 11:42\nChest-CT protocol standardisation for multicentre trial in cystic \nfibrosis (CF) infants \nP. Ciet1, K. Gonzalez Graniel1, S. Stick2, M. de Bruijne1, H.A.W.M. Tiddens1, \nM. Van straten1; 1Rotterdam/NL, 2Perth/AU (pierluigi.ciet@libero.it) \nPurpose: To standardise the scan protocol for CT scanners of participating cen-\ntres in a multi-centre study (clinicaltrials.gov NCT01270074) for the prevention of \nradiologically defined bronchiectasis in CF infants by ensuring the maximum image \nquality at the minimum radiation dose.\nMethods and Materials: Three different sized phantoms (QRM, Germany) were \nused to assess scanners’ performance of automatic exposure control (AEC). \nCTDI and DLP were recorded. The phantoms contained various inserts to assess \nslice-sensitivity-profile, in-plane spatial resolution, noise and the Hounsfield Unit \n(HU) scale. Scans were made for several dose levels and reconstruction kernels. \nImages were analysed with custom-made software (MatLab, USA) to obtain the \nstandard deviation of the noise, point-spread-function (PSF) and slice thickness.\nResults: Eight different scanners with 64 slices or more from 4 manufacturers \n(GE, Philips, Siemens and Toshiba) were assessed. Despite differences in AEC’s \nperformance, we obtained approximately the same dose level at each center by \nrecommending site and age-specific AEC reference levels. A constant image qual-\nity was only possible by matching the different reconstruction kernels measured \nPSFs at full-width-at-half-maximum. In fact, large part of the differences between \nscanners was related to reconstruction kernels. The relatively high noise images cor-\nresponded with reconstructions using a kernel with edge enhancement such as the \nSiemens B70 kernel or the GE lung kernel that are routinely used in chest imaging.\nConclusion: Objective measurements on CT images allowed for matching of scan \nprotocols among CT scanners of different manufacturers. Use of routine protocols \nmight introduce a bias in the (automated) image analysis.\nB‑0738 11:51\nCystic fibrosis lung disease in children: correlation between MRI and \nHRCT scores \nC. Sileo, H. Corvol, P.-Y. Boelle, E. Blondiaux, A. Clement, H. Ducou Le Pointe; \nParis/FR (chiara.sileo@trs.aphp.fr) \nPurpose: High-resolution computed tomography (HRCT) is known to be a sensitive \nmeans of detecting lung disease in cystic fibrosis (CF), with a significant radiation \nexposure. Magnetic resonance imaging (MRI) becomes increasingly important in \nthe assessment of CF lung disease. The aim of this study was to establish the \nagreement between MRI and HRCT scores in a paediatric population.\nMethods and Materials: HRCT and T2 and post-contrast T1 MRI images were \nacquired on the same day from 17 CF patients (median age 12.7 years; range \n9.1-20.2 years). Two radiologists with either > 20 (HDLP) or 3 years (CS) of ex-\nwere analysed and compared with the corresponding real scan length. For selected \nCT scanners, radiation doses achieved during the scanograms were reconstructed \nusing mathematical MIRD phantoms.\nResults: Depending on the patients´ age, many scanograms considerably exceed \nthe real scan region, thus unjustifiably raising the radiation exposure of the patient. \nThe radiation doses due to CT scanograms are not neglectible as, e.g. the whole \nbody dose achieved during a thorax scanogram can exceed the whole body dose \ncaused by a conventional chest x-ray examination by a factor of 10.\nConclusion: An optimisation of scanogram lengths by defining specific anatomi-\ncal landmarks for standard CT protocols, the optimisation of scanogram exposure \nparameters in paediatric CT examinations and their implementation into national \nand international guidelines seems to be necessary to fulfil the ALARA concept in \npaediatric CT. [Research project of the Federal Republic of Germany, Bundesmin-\nisterium für Bildung und Forschung, Förderkennzeichen 02NUK016 A] \nB‑0734 11:15\nReference values for cardiac valve diameters in extreme preterm infants \nA. Adams, N. Wesseling, J.L.M. Strengers, W.B. de Vries, M.C. Molenschot; \nUtrecht/NL (a.adams@umcutrecht.nl) \nPurpose: To establish reference values for heart valve diameters, assessed by \nroutine echocardiography, in a cohort of extreme preterm infants.\nMethods and Materials: Neonates under 32 weeks’ gestation underwent routine \nechocardiography 24-72 hours after birth. Patients with evident congenital cardiac \nabnormalities were excluded. Heart valve diameters were retrospectively assessed \nin static images by measuring the maximal distance between hinge points at the \nlevel of the annulus. Measurements were performed by two investigators and \nrepeated on another day. Diameters were then related to length, weight, body \nsurface area (BSA), gestational age, and head circumference by linear regression.\nResults: A total of 198 infants (103 males) were included, with a median gestational \nage of 29.7 weeks (range 24.3-31.9), mean birth weight of 1.29±0.40 kg (range \n0.54-2.75), head circumference 27±2.5 cm (range 21-39), and BSA 0.11±0.02m2 \n(range 0.06-0.18). Average valve diameters were 5.2±0.6 mm for aortic valves \n(AV), 8.3±1.1 mm for mitral valves (MV), 6.1±0.8 mm for pulmonary valves (PV), \nand 7.9±1.4 mm for tricuspid valves (TV), respectively. BSA best correlated to \nheart valve diameters (Pearsons-R 0.75 (AV), 0.61 (MV), 0.66 (PV), 0.59 (TV)). \nPrediction formulas for individual predictions with 95% confidence intervals of \nvalve diameters (in mm): AV=2.8 (2.0-3.6)+21.6*BSA, MV=5.0 (3.2-6.7)+30.4*BSA, \nTV=4.2 (2.0-6.3)+34.7*BSA and PV=3.6 (2.4-4.7)+22.7*BSA. Reproducibility was \nexcellent, with intra- and inter-observer intraclass correlation coefficients of 0.97 \nand 0.93-0.96, respectively.\nConclusion: We established reference values for cardiac valve diameters in ex-\ntreme preterm infants, based on BSA. Biological variation, inaccuracy in assessment \nof patient characteristics, inter-operator variability, and limited spatial resolution \nmay account for substantial variability in heart valve diameters found in this cohort.\nB‑0735 11:24\nAsymmetric lung perfusion in congenital heart disease: impact of \ndifferential pulmonary arterial anatomy and pulmonary vascular resistance \nO. Kondrachuk, T. Yalynska, R. Tammo, I. Iershova, N. Rokytska; Kiew/UA \nPurpose: Asymmetry of lung perfusion is relatively common in patients with \ncongenital heart disease. The aim of the study was to evaluate the influence of \ndifferential pulmonary arterial anatomy and pulmonary vascular resistance on blood \nflow distribution in patients with asymmetric lung perfusion.\nMethods and Materials: We retrospectively identified 17 consecutive patients with \ncongenital heart disease who had asymmetry of lung perfusion on phase-contrast \nMRI. The MRI examinations were performed on 1.5 T scanner.\nResults: Fourteen patients had left lung hypoperfusion (blood flow to the left lung < \n35%) and three patients right lung hypoperfusion (blood flow to the right lung < 40%). \nBranch pulmonary artery (BPA) regurgitant fraction (RF) was significantly greater in \nlung with decreased perfusion (16.2±19.0% vs. 1.8±2.8%, P < 0.001). There was \nmoderate negative correlation between BPA RF and BPA differential pulmonary \nblood flow (R = -0.517, P = 0.002). Moderate positive linear relationship between \nBPA size and BPA differential pulmonary blood flow was also found (R = 0.669, \nP = 0.003). There was no significant correlation between BPA RF and BPA size.\nConclusion: Both BPA anatomy and BPA RF are the significant factors for de-\ntermining right and left lung flow split. According to prior reports, BPA RF reflects \ndifferential pulmonary vascular resistance. \n5\n\nScientific Sessions\nS31\n C A D E F\n G\nB\nconsecutively at 80 kVp, 100 kVp, 120 kVp and 140 kVp, respectively, with constant \nmAs settings using a dual-source CT. Differences in calculated dual-energy ratios \n(DEratio) between the tissues and iodine or gold were determined for different \nDE spectra.\nResults: The attenuation of gold has increased at higher kVp-settings compared \nto 80 kVp, while the attenuation of all other specimens decreased. The calculated \nDE ratios at 80/100 kVp, 80/120 kVp and 80/140 kVp, respectively, were 1.31, 1.63 \nand 1.91 for iodine, 0.90, 0.88 and 0.92 for gold, 1.20, 1.30 and 1.45 for compact \nbone, 1.01, 1.03 and 1.08 for muscle. The difference between the DE ratios 80/100 \nkVp, 80/120 kVp and 80/140 kVp, respectively, were 0.11, 0.23 and 0.46 for iodine \nand bone, 0.31, 0.51 and 0.53 for gold and bone, 0.29, 0.59 and 0.83 for iodine \nand muscle, 0.12, 0.15 and 0.16 for gold and muscle.\nConclusion: DE ratio of gold remains relatively stable along the energy spectrum \nof diagnostic CT and allows a reliable material differentiation between gold and \nbone at contiguous low tube voltage settings (80 kV and 100 kV). Thus, gold might \nhave potential as a contrast agent for DECT.\nB‑0741 10:48\nPotential use of intra-articular diluted high-relaxivity gadolinium-\nbased contrast agent for magnetic resonance arthrography (MRA): \nan in-vitro study \nL.M. Sconfienza, A. Aliprandi, P. Cannaò, S. Sdao, M. Bandirali, F. Sardanelli; \nMilan/IT (io@lucasconfienza.it) \nPurpose: Gadobenate dimeglumine (Gd-BOPTA) is a high-relaxivity contrast \nagent that tightly binds to plasmatic proteins, currently used in several clinical \napplications. Our aim was to test in-vitro different concentrations of Gd-BOPTA to \nbe potentially used to perform MRA.\nMethods and Materials: Gd-BOPTA (Multihance, Bracco) was diluted in saline \n(NaCl 0.9%) to achieve different concentrations (4 mmol/l, 2 mmol/l, 1 mmol/l, \n0.67 mmol/l, 0.5 mmol/l). Five mL of these solutions was injected in sterile pipes \nand was added with 0.5 mL of fresh synovial fluid withdrawn from a 71-year-old \nmale knee. In a separate pipe (reference), 0.5 mL of synovial fluid and 5 mL of \ngadopentetate dimeglumine 2 mmol/l (Gd-DTPA; Magnevist) were injected. Pipes \nwere imaged using a T1-weighted sequence (TE=9.8 msec, TR=678 msec, slice \nthickness 3.5 mm, FOV 320x320 mm) at 1.5 T. For each pipe on each slice, signal \nintensity (SI) was calculated.\nResults: Mean Gd-DTPA SI was 1290±48. Mean Gd-BOPTA SI was 1406±36 \n(+9% to reference) at 4 mmol/l; 1532±36 (+15%) at 2 mmol/l; 1583±36 (+19%) at \n1 mmol/l; 1494±44 (+14%) at 0.67 mmol/l; 1235±13 (-4%) at 0.5 mmol/l (P <.001). \nAt post hoc analysis, all one-to-one comparisons were significantly different with \nexception of 2 and 4 mmol/l (P=.105).\nConclusion: Versus Gd-DTPA, a +19% peak SI was achieved with half Gd-BOPTA \nconcentration. A similar SI between the two agents was achieved at 0.5 mmol/l. \nGd-BOPTA high relaxivity and its potential binding with synovial fluid glycoproteins \ncould explain these results. This may improve visibility of intra-articular tears when \nevaluated using Gd-BOPTA MRA.\nAuthor Disclosures:\nL.M. Sconfienza: Author; Springer. F. Sardanelli: Consultant; Bracco Group. \nResearch/Grant Support; Bracco Group, Bayer AG, IMS International Medical \nScientific.\nB‑0742 10:57\nFeasibility of contrast agent volume reduction on 640-slice CT \ncoronary angiography in patients with low heart rate \nZ.-X. Ding, Z. Wang; Hangzhou/CN (wang12345zhen@sina.com) \nPurpose: To optimise the contrast injection protocol for CT coronary angiography \n(CTCA) to achieve more efficient utilisation of contrast agent by investigating the \nimpact of reducing the volume of contrast agent on the attenuation of coronary \narteries and sinus.\nMethods and Materials: A total of 105 subjects with low heart rate (² 65 beats/min) \nand suspected coronary artery disease were randomly divided into three groups \nwith 35 subjects in each group. The patients in Groups A, B and C were injected \nwith a volume of 0.8, 0.7, and 0.6 ml/kg of contrast agent, respectively. In all cases, \ninjection rate was 5.0 ml/s, followed by 30 ml saline flush at the same rate. CT \nvalues within the ascending and descending aorta, left main and right coronary \nartery orifices and coronary sinus were measured and the differences of contrast \nenhancement among the three groups were evaluated.\nResults: The mean injection volume of contrast agent in Groups A, B and C were \n54.1, 47.9 and 41.1 ml, respectively (P < 0.001), and the scan delay time were 23.7, \n23.4 and 22.2 s, respectively (P < 0.05). The CT values within the coronary sinus \nwere 112.7, 93.7 and 81.2 HU for Groups A, B and C, respectively (P < 0.001), \nperience in paediatric pulmonary disease scored independently HRCT, using the \nscoring system developed by Helbich et al, and MRI using two scoring systems \ndeveloped by Helbich et al and Eichinger et al. Readers were blinded to clinical and \nfunctional data and to the other reader's findings. The agreements were assessed \nusing the intraclass correlation coefficient (ICC) and the Bland-Altman plot for the \ntwo readers and the two methods.\nResults: The inter-reader agreement was excellent for the HRCT scores \n(ICC=96%), good for MRI with the Eichinger score (ICC=84%), but less for MRI \nwith the Helbich score (ICC=68%). There was a very good correlation between \nHRCT and MRI-Eichinger scores (ICC=91%), but less between HRCT and MRI-\nHelbich scores (ICC=78%).\nConclusion: The good inter-reader agreement and the high correlation between \nHRCT and MRI-Eichinger scores support the use of lung MRI for the follow-up of \nlung disease in paediatric CF patients.\n10:30 - 12:00 Room Z \nContrast Media \nSS 1306 \nNew agents and protocols \nModerators: \nL. Grazioli; Brescia/IT \nT.C. Lauenstein; Essen/DE \nB‑0739 10:30\nMagnetic resonance imaging diagnosis of metastatic lymph nodes: \nefficacy of the novel ultrasmall superparamagnetic iron oxide agent \nwith monodisperse iron oxide core and multiple-interaction ligands \nR.-E. Yoo1, S. Choi1, H. Cho1, E.-g. Kim2, J. Park2, W.-J. Myeong2; 1Seoul/KR, \n2Daejeon/KR (ry_jjang@hotmail.com) \nPurpose: To evaluate feasibility of detecting lymph node metastasis using the \nnovel USPIO in MR imaging of a rabbit model.\nMethods and Materials: A novel USPIO with monodisperse iron oxide core size \nof 14±1 nm and multiple-interaction ligands inspired from mussel adhesive protein \nwas prepared and its core size, hydrodynamic diameter, and T2 relaxivity were \nmeasured. To make metastatic lymph nodes, VX2 carcinomas were implanted into \nthighs of 24 rabbits 3 or 4 weeks before MR imaging. In each rabbit, MR imaging \nwas performed before and 24 hours after the injection of the USPIO (5.2 mg Fe/kg \n[N=6], 7.8 mg Fe/kg [N=6], and 10.4 mg Fe/kg [N=12]). MR images were correlated \nwith pathologic results and sensitivity, specificity, and accuracy were calculated.\nResults: The novel USPIO demonstrated high stability without aggregation in the \nsaline. The USPIO had a hydrodynamic diameter of 25~30nm and T2 relaxivity \nof 281 mM-1s-1 at 3 T. All USPIO dosages provided good contrast between meta-\nstatic lymph nodes without signal drop and normal lymph nodes with signal drop \nattributable to USPIO uptake. At 10.4 mg Fe/kg, the MR imaging showed 100% \naccuracy with 100% sensitivity (29/29) and 100% specificity (12/12). At 5.2 mg Fe/\nkg, sensitivity, specificity, and accuracy were 100% (10/10), 55% (6/11), and 76% \n(15/21), respectively. At 7.8 mg Fe/kg, sensitivity, specificity, and accuracy were \n100% (4/4), 83% (5/6), and 90% (9/10), respectively.\nConclusion: The novel USPIO MR imaging agent is expected to be a promising \nagent in the oncologic field, by enabling clear demonstration of the lymph node \nmetastasis with high sensitivity and specificity.\nAuthor Disclosures:\n S. Choi: Grant Recipient; Hanwha Chemical Corp. E. Kim: Employee; Hanwha \nChemical Corp. Research/Grant Support; Hanwha Chemical Corp. J. Park: \nEmployee; Hanwha Chemical Corp. Research/Grant Support; Hanwha Chemical \nCorp. W. Myeong: Employee; Hanwha Chemical Corp. Research/Grant \nSupport; Hanwha Chemical Corp.\nB‑0740 10:39\nGold as a potential contrast agent for dual-energy CT \nR. Krissak, M. Elgert, B. Kusch, R. Hünerbein; \nBad Langensalza/DE (r.krissak@hufeland.de) \nPurpose: The K-edge of gold (81 keV) is located within the energy range of di-\nagnostic CT. This might be advantageous for dual-energy CT (DECT). The aim of \nthis in vitro study was to compare the differentiation between iodine or gold and \nbody tissues using DECT at different kV spectra.\nMethods and Materials: A phantom containing specimens with iodine (iopamidol), \ngold (sodium aurothiomalate), compact bone and porcine muscle was scanned \n6\n\nScientific Sessions\nS31\nA\n C D E F G\nB\nSunday\nMethods and Materials: A total of 74 consecutive patients, with clinical vascular \naortic disease, were evaluated on MDCT16 slices scan (Philips-Brilliance16P, \nNL) using low-kV protocol (90 kV), high pitch (1.063) and automated tube current \nmodulation. Low contrast medium volume (50 mL) was administered at 4 ml/s. \nDensity measurements were performed at abdominal aorta, renal arteries and \ncommon iliac arteries. We also calculated the radiation dose exposure (dose \nlength product, DLP). Our results were compared with 40 patients investigated with \nstandard contrast medium volume (100 mL) and standard CT-angiography protocol \n(120 kV; 350 mAs). The noise level (signal-to-noise ratio, SNR), the radiation dose \n(expressed as DLP) and amount of iodinate contrast were analysed and statistically \ncompared between two different groups.\nResults: In all of the patients we obtained an adequate vessel opacification of aorta \nand renal arteries. Mean attenuation value in aorta was 305 HU, in iliac arteries was \n288 HU and in renal arteries was 276 HU, without significant attenuation difference \nwith the control group (aorta 339 HU; iliac arteries 358 HU; renal arteries 303 HU). \nThe radiation dose exposure (meanDLP: 509) was significantly lower (reduction \nof the 48%) in the low-kV protocol than standard examinations at 120 kV (mean-\nDLP: 952). The noise level calculated in low-kV protocol (meanSNR 20) was not \nsignificantly higher than the value obtained in standard protocol (meanSNR 28).\nConclusion: Low-dose CT-angiography protocol represents a feasible technique \nthat allows a significant reduction of contrast material and radiation dose exposure \nwithout losing diagnostic accuracy being useful also in these patients with renal \nfailure.\nB‑0746 11:33\nCT coronary angiography with low concentration (240 mg Iodine/ml) \ncontrast material \nC. Mihl1, J.F. Kalafut2, M. Yanniello2, G. Muehlenbruch3, F.F. Behrendt3, \nJ.E. Wildberger1, M. Das1; 1Maastricht/NL, 2Pittsburgh, PA/US, \n3Aachen/DE (caspermihl@gmail.com) \nPurpose: The use of low concentrated contrast material might be advantageous \nin terms of viscosity. Therefore, the purpose of this study was to evaluate the use \nof low concentrated contrast material (240 mg Iodine/ml) for coronary CT angiog-\nraphy in routine patients.\nMethods and Materials: 29 consecutive patients who were referred for routine \ncoronary CTA were scanned on a 2nd generation DSCT scanner (Definition Flash, \nSiemens). Patients received a standard contrast injection protocol as follows: \nIopromide 240 mg/ml (Ultravist, Bayer) with an injection rate of 9 ml/s (iodine de-\nlivery rate 2.16 g I/s) followed by a saline chaser with the same flow rate. Contrast \nenhancement in the coronaries was measured proximal and distal in all coronaries. \nResults were compared to our standard protocol with Iopromide 300 mg/ml and \nflow rate of 7.2 ml/s (iodine delivery rate 2.16 g I/s). Start delay was evaluated for \nboth groups using the test bolus method. Comparison between both groups was \nperformed using sample t-test.\nResults: Coronary enhancement reached diagnostical attenuation in both protocols. \nOverall comparison between enhancement with 240 mg/ml (mean 445 HU ± 114 \nHU) revealed no statistical significant differences with 300 mg/ml (mean 412 HU \n± 92 HU) (p=0.101). Attenuation levels in LAD dist and Cx dist were significantly \nhigher in the low concentrated contrast material group (LAD dist 387 vs 292 HU, \nP < 0.0001 and Cx dist 392 vs 329 HU, P=0.003, respectively).\nConclusion: The use of low concentrated contrast material is feasible in coronary \nCTA. Higher flow rates are necessary, but lower viscosity might improve attenua-\ntion in the distal segments. \nB‑0747 11:42\nThe impact of MR contrast agent concentration on bolus geometry \nG. Jost, H. Pietsch; Berlin/DE (gregor.jost@bayer.com) \nPurpose: In contrast-enhanced MR-angiography, the luminogram is obtained \nduring the first passage of gadolinium-based contrast agents (GBCA). The bolus \nconcentration in conjunction with the r1-relaxivity determines the vascular signal \nenhancement. The aim was to investigate the impact of a 1 molar GBCA concentra-\ntion on bolus geometry compared to a 0.5 molar agent, systematically.\nMethods and Materials: 6 Göttingen minipigs were injected intravenously with \ngadobutrol and Gd-DTPA in a crossover setting (0.1 mmol/kg, 1 ml/s). Dynamic \nCT measurements (80 kV, 485 mAseff, Δt=0.3s) at the thoracal region were per-\nformed without table feed. Time-density curves were determined and fitted by a \ngamma-variate function in the vena cava, the pulmonary artery and the ascending \nand descending aorta. CT-signals were transformed to Gd-concentrations on the \nbasis of phantom measurements.\nResults: The administration of 1 molar gadobutrol led to a narrower (significantly \nlower full width half maximum) and steeper (significantly higher peak values) bolus \nand CT values within the ascending and descending aorta, and the coronary artery \nwere higher than 300 Hounsfield units in all three groups.\nConclusion: Application of the 0.6 ml/kg protocol in CTCA, a steady contrast \nenhancement in coronary artery, can be achieved using 640-slice volume CT.\nB‑0743 11:06\nThe influence of the contrast media protocol and the scan mode on \narterial enhancement in cardiac CT \nE. Talakic, D. Stocker, P. Täubl, R. Maderthaner, F. Quehenberger, \nH. Schoellnast, M. Tillich; Graz/AT (emina.talakic@medunigraz.at) \nPurpose: To assess the influence of contrast media protocol and scan mode on \narterial enhancement in cardiac CT.\nMethods and Materials: 175 patients (mean age, 62; range, 18-86 years) who \nunderwent cardiac CT were retrospectively divided into 4 groups related to scan \nmode (64-slice helical CT or 320-slice volume CT) and contrast media concentra-\ntion (320, 350 or 400 mgI/mL) - Group 1:, helical, 320 (75 mL); group 2: helical, \n350 (90 mL); group 3: helical, 400 (70 mL), and group 4: volume, 400 (70 mL). \nInjection rate was 5 mL/sec in all patients. ROI measurements were performed in \nthe aorta (coronary arteries level) and cardiac chambers to assess enhancement, \nand in the superior vena cava (SVC) to measure the standard deviation of the \nattenuation values for assessment of inflow artefacts. Spearman Correlation and \nWilcoxon test were used for comparison.\nResults: Patients in group 3 showed significantly higher mean aortal enhance-\nment than patients in group 1 or 2 (334 HU versus 286 HU and 306 HU). Group \n4 showed significantly higher aortal enhancement than group 3 (497 HU). Group \n4 showed significantly lower enhancement in the right atrium and ventricle than \ngroup 3. No significant difference in the standard deviation of attenuation was \nseen within the SVC.\nConclusion: In cardiac CT, the volume mode led to significantly higher aortal \nenhancement and lower contrast within right atrium and ventricle compared with \nhelical mode. Scan mode, iodine dose and flow rate had no influence on hetero-\ngeneity of contrast within the SVC. \nB‑0744 11:15\nMultislice CT angiography with direct intra-arterial ultra-low-dose-\ncontrast injection for the evaluation of renal graft failure: initial study \nM. Guzinski, J. Kurcz, J. Garcarek, M. Sasiadek; Wrocław/PL (guziol@wp.pl) \nPurpose: To present initial experience with direct intraarterial ultra-low-dose-\ncontrast CT angiography (IA-CTA) and its application in assessing renal graft artery \nin patients with renal graft failure.\nMethods and Materials: IA-CTA of renal graft was performed in 18 patients with \nrenal graft failure (GFR2m/s. Pig-tail catheter 4 F was placed in ipsilateral com-\nmon iliac artery via common femoral artery. Subsequently, spiral CTA of pelvis \nwas performed simultaneously to intraarterial administration at 4 ml/s of 6-8 ml of \ncontrast diluted with saline to 18-24 ml.\nResults: Excellent contrast enhancement of renal graft arterial tree was observed \nin all patients. No complications associated with arterial access occurred. Mean \ncreatinine/GRR levels prior to the IA-CTA were 3.30 mg/dl and 27.4 ml/min, respec-\ntively. On the 5th day following the study, mean creatinine/GFR levels amounted \nto 3.36 mg/dl and 27.8 ml/min, respectively. Renal function deterioration was \ndemonstrated on the 3rd day after the procedure (creatinine 3.54 ml/dl, GFR 26.8 \nml/min); nevertheless, it was not statistically relevant (p < 0.71). Contrast-induced \nnephropathy occurred in only one patient (5.6%) with transient creatinine elevation \nby 92%. After detailed vessel analysis graft arterial stenting was performed in 10 \npatients, which improved renal function. The remaining 8 patients were treated \nconservatively.\nConclusion: Trans-catheter ultra-low-dose-contrast IA-CTA for imaging of renal \ngraft arteries can be an effective method with low-risk of nephrotoxicity, which al-\nlows detailed graft arterial tree imaging, especially prior to interventional treatment \nof arterial-related renal graft insufficiency. \nB‑0745 11:24\nFeasibility in low kV CT angiography of the abdominal aorta: \nassessment of image quality, radiation exposure and contrast \nmaterial volume \nC.R.G.L. Talei Franzesi, D. Ippolito, P.A. Bonaffini, V. Bartolo, C. Trattenero, \nS. Sironi; Monza/IT (ctfdoc@hotmail.com) \nPurpose: To assess the image quality, dose reduction and amount of iodinate \ncontrast injected using low-kV CT angiography protocol for the study of abdominal \naorta disease.\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nshape compared to 0.5 molar Gd-DTPA in all investigated vessels. The respec-\ntive Gd-concentrations (mgGd/mL) for gadobutrol vs. Gd-DTPA were 9.5±1.9 vs. \n6.8±1.2 (vena cava), 3.4±0.4 vs. 2.4±0.3 (pulmonary artery) and 2.2±0.2 vs. 1.7±0.2 \n(ascending and descending aorta). The area under the bolus curve analysis yielded \nno significant differences between the GBCAs.\nConclusion: A 1 molar GBCA concentration leads to a more compact bolus shape \nwith significant higher peak concentrations in the major thoracal vessels compared \nto a 0.5 molar agent. This might be especially relevant for the acquisition of 4D \nangiograms and for quantification of tissue perfusion. \nAuthor Disclosures:\nG. Jost: Employee; Bayer Pharma AG. H. Pietsch: Employee; Bayer Pharma \nAG.\nB‑0748 11:51\nTransarterial chemoembolisation (TACE) in malignant liver \nmetastases: evaluation of a fast C-arm CT acquisition protocol with \na robotic multi-axis C-arm system \nT.J. Vogl1, M. von Roden2, E. Mbalisike1, S. Zangos1; 1Frankfurt a. Main/DE, \n2Forchheim/DE (t.vogl@em.uni-frankfurt.de) \nPurpose: To evaluate potential contrast savings and reduction of motion artefacts \nin C-arm CT acquisitions with a higher rotational speed during interventional \nprocedures.\nMethods and Materials: 24 patients (mean 56.8 yrs, range 33-83) were treated \nwith transarterial chemoembolisation (TACE). Prior to the injection of the embolisa-\ntion material, a C-arm CT with a new, fast acquisition protocol was performed. A \nrobotic multi-axis C-arm angiographic system (Artis zeego, Siemens-Healthcare, \nForchheim/Germany) was used with a rotational speed of up to 100°/s. In this \nconfiguration, a C-arm-CT with a rotational trajectory of 200° was acquired in 3s \nversus 5s in a commercially available C-arm system. Two different injection pro-\ntocols were applied and evaluated regarding sufficient tumour visualisation and \nspatial resolution of the vessel tree in the resulting 3D-dataset.\nResults: Injection protocol 1 (6 ml contrast, 12 ml NaCl, flow rate 3 ml/s, x-ray \ndelay 3s, injection site: common hepatic artery) resulted in 3D images with a very \ngood spatial resolution of the vessel trees but poor visualisation of tumours/me-\ntastases. Injection protocol 2 (7 ml contrast, 20 ml NAaCl, x-ray delay 6s) resulted \nin 3D images with excellent spatial resolution and good visualisation of tumours/\nmetastases. From prior experience with a standard 5s protocol the correspond-\ning C-arm CT acquisition would have required a contrast load of 8 ml and 8.5 ml, \nrespectively. Thus, the contrast saving of the fast acquisition protocol was 25% \nand 18%, respectively.\nConclusion: The fast C-arm CT acquisition protocol 2 provides an interesting \npossibility to save contrast media during TACE with excellent spatial resolution of \nthe vessel tree and good visualisation of hypovascular tumours. \nAuthor Disclosures:\nM. von Roden: Employee; Employee at Siemens/Forchheim.\n18\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday, March 11\n19\n\nScientific Sessions\nS32\n C A D E F\n G\nB\nB‑0751 10:48\nNormal laterality index of cerebrovascular reserve of the middle \ncerebral artery: a 100 volunteers’ BOLD fMRI study \nA. Krainik, A. Attye, I. Tropres, L. Lamalle, J.-F. Le Bas; Grenoble/FR \n(akrainik@chu-grenoble.fr) \nPurpose: Functional MRI of cerebrovascular reserve (CVR fMRI) using vaso-\nreactivity to hypercapnia may identify patients at risk of haemodynamical stroke \namong those with severe stenosis of the middle cerebral artery (MCA). However, \nquantification remains challenging because of numerous methodological settings \nand their limitations. We aimed to provide a laterality index (LIMCA) to better identify \nabnormal CVR in clinical practice.\nMethods and Materials: 100 volunteers (40 females; 49.5±21.4 years) without \ncervico-encephalic arterial stenosis had a CVR fMRI using BOLD contrast with a \nblock-design hypercapnic challenge (CO2 7% mixed with: O2 93% (n=83) or air \n(n=17)), using nasal canula (n=57) or mask (n=43), 1.5 T (n=46) or 3 T (n=54). \nAveraged end-tidal CO2 pressure (EtCO2) was used as a physiological regres-\nsor for statistical analyses with a general linear model (SPM8). We conducted \nregions of interest (ROI) measures of %BOLD signal change/mmHg EtCO2 on \nsegmented grey matter of the MCA territories. We calculated a laterality index with \nLIMCA=(Left_CVRMCA-Right_ CVRMCA)/(Left_ CVRMCA +Right_ CVRMCA). \n99% confidence intervals (99%CI) were calculated.\nResults: No adverse reaction to hypercapnia, including panic, anxiety, headache, \nor fatigue, was detected during and after CVR fMRI. CVR values ranged from 0.14 \nto 0.48 with m±sd=0.26±0.07 %BOLD/mmHg EtCO2. The mean laterality index \nwas 0.01 with an interval of fluctuation that covered 0.00. The standard deviation \nwas 0.026. Thus, 99%CI was ±0.07 for MCA. LI values were independent of age, \ngas mixture, sex, inhalation modality, and MR strength.\nConclusion: Subjects without cervico-encephalic arterial stenosis have an absolute \nvalue of LIMCA below 0.08 with a 99% probability.\nB‑0752 10:57\nIn-vivo validation of velocity measurements by quantitative \nphase contrast MR angiography of the brain supplying arteries: a \ncomparison with Doppler sonography \nK.W. Hsieh, F. Kellner-Weldon, C. Zubler, R. Verma, M.-L. Mono, M. Reinert, \nJ. Gralla, G. Schroth, M. El-Koussy; Berne/CH (kety.hsieh@insel.ch) \nPurpose: Non-invasive quantitative phase contrast MR angiography (qMRA) \nhas been utilised for several clinical indications, e.g. intracranial stenosis and \naneurysms. The aim of this study is to validate the flow measurements of qMRA \n(NOVA, VasSol Inc., Chicago) by comparing the obtained velocities with qMRA \nand Doppler ultrasonography (DUS) in-vivo. To our knowledge, no previous reports \nhave addressed this issue.\nMethods and Materials: We retrospectively examined consecutive 24 patients (9 \nwomen, 15 men; mean age 63 years, range 24-80 years) with stenosis of arteries \nsupplying the brain using qMRA and DUS. Velocities were measured in a total of \n209 arterial segments (110 extra- and 99 intracranial).\nResults: Overall there was a good correlation between velocity measurements \nwith both techniques being statistically significant in all six extracranial and five \nout of seven intracranial segments. Velocities were 56% higher in extracranial \nand 45% higher in intracranial segments obtained with DUS comparing to those \nwith qMRA. The reversal of flow direction in the ACA was detected consistently \nwith both methods.\nConclusion: This preliminary study shows a rather good correlation between the \nvelocities employed with qMRA and DUS. QMRA represents a robust MRI tech-\nnique for flow measurements in a reasonable time, which can be integrated in the \ncerebrovascular MRI work-up, especially when intracranial DUS is technically not \nfeasible. However, further in-vivo and in-vitro studies are needed to assess the \nneed for technical optimisation of this technique. \nAuthor Disclosures:\n F. Kellner-Weldon: Grant Recipient; SPUM (Swiss National Science \nFoundation). M. El-Koussy: Grant Recipient; SPUM (Swiss National Science \nFoundation).\n10:30 - 12:00 Room C \nNeuro \nSS 1711 \nBrain ischaemia: perfusion and diffusion \nModerators: \nL. Oleaga Zufiría; Bilbao/ES \nM. Vernooij; Rotterdam/NL \nB‑0749 10:30\nPrognostic impact of perfusion CT data in the early period after \nsubarachnoid haemorrhage \nC. Mathys, D. Martens, D.C. Reichelt, J. Aissa, K. Rybacki, K.-G. Klein, \nG. Antoch, B. Turowski; Düsseldorf/DE (mathys@uni-duesseldorf.de) \nPurpose: To assess the prognostic relevance of perfusion CT (PCT) examinations \nin the early phase after subarachnoid haemorrhage (SAH).\nMethods and Materials: 312 patients were retrospectively interrogated with a \nquestionnaire one year after spontaneous subarachnoid haemorrhage. The modi-\nfied Rankin Scale (mRS) was determined, respectively. Perfusion data from the \nearly period of the disease were available for all patients.\nResults: MTT (mean transit time) values in the early period were significantly \ncorrelated (p ² 0.001, r = 0.422) with the clinical long-term outcome (mRS). Cor-\nresponding to our linear regression analysis, MTT is the second most important \nregressor (behind WFNS grade, which is a measure for the clinical severity of the \nhaemorrhage) for the prediction of the long-term mRS. An MTT value of 4.11 s \ncould be identified as a threshold predicting an unfavourable long-term outcome \n(mRS ³ 2). An MTT value ³ 4.39 s indicated a poor long-term outcome (mRS 4 -6). \nIntraarterial spasmolysis with nimodipine (70 endovascular procedures in 51 of the \nincluded patients) could reduce the average MTT value by 0.89 s.\nConclusion: The presented data corroborate the relevance of PCT data for clinical \nlong-term results of SAH patients and may assist risk-benefit assessment in the \nplanning of invasive procedures (e.g. intraarterial spasmolysis). \nB‑0750 10:39\nAdvanced MRI sequences in the acute evaluation of transient \nischaemic attack (TIA). A comparison between DTI, DWI and ASL \nincluding 8 weeks follow-up scans: preliminary results from the \nCopenhagen TIA-MRI-study \nA. Christensen, C. Ovesen, J. Damm, J. Nielsen, H. Christensen; \nCopenhagen/DK (anderschristensenemail@hotmail.com) \nPurpose: Sensitive documentation of ischaemia is needed in clinical TIA. We \naimed to compare the sensitivity of DTI, DWI and ASL in the detection of acute \nischaemia and further to investigate if chronic ischaemic changes after 8 weeks in \nthe form of gliosis always follow.\nMethods and Materials: The first 40 consecutive patients included during first 3 \nmonths of an MRI-protocol (DWI, DTI and ASL within 72 hours of symptoms) and 8 \nweeks follow-up protocol (T2 and DWI). Patients were included by stroke consult-\nants. Lesion volumes on DWI, DTI and follow -up T2 were compared. Hyper- or \nhypoperfusion on ASL was recorded. One senior neuroradiologist assessed the \nsequences in random order to prevent bias.\nResults: Fourteen patients had acute ischaemic lesions: 2 in the posterior fossa \nand 12 in the cerebral hemispheres corresponding to 35% of referred patients. \nThirteen of these developed gliosis in the affected area and of these 1 was noted \nonly on DTI and 1 only as post-ischaemic hyper-perfusion on ASL. Mean lesion \nvolume was 1.2 mL. Mean difference between volume on DWI and gliose volume \nwas 0.42 mL =71% and between DTI and gliose volume 0.29 mL=40% and DTI \nvolume were significantly closer (p=0.042).\nConclusion: These preliminary results indicate that TIA causes a gliosis lesion \nconsistently, and that the initial lesion as well as the extent of the permanent \nchanges is better described using DTI. ASL seems to be able to contribute to the \ndetection of TIA as this may be sole MRI-sign in some patients increasing detec-\ntion rates with 5%. \n0\n\nScientific Sessions\nS32\nA\n C D E F G\nB\nMonday\nparameter for assessment of ischaemia. We analysed the ability of TTP maps to \npredict eventual infarcts in patients with mild stroke presentations.\nMethods and Materials: We retrospectively reviewed 164 consecutive patients \npresenting with acute stroke in less than 6 hours from onset. Patients presenting \nwith a NIH Stroke Scale Score < 5 were subjected to subgroup analysis. TTP \nperfusion deficit with delays of more than 3 seconds was considered significant \nfor underlying ischaemia. The perfusion parameters were compared to follow -up \nimaging at 24 to 48 hours.\nResults: 41 patients met inclusion criteria. 7 patients had identifiable thrombus. \nThe TTP map had the highest sensitivity in detecting the small infarcts (92%), \nfollowed by CBV and CBF. Importantly, TTP analysis provided very high negative \npredictive value (93%). However, there was a relatively lower specificity (64%) and \na tendency to overestimate the infarct size.\nConclusion: TTP perfusion is highly sensitive in predicting small regions of ischae-\nmia. High negative predictive value is helpful in differentiating stroke from mimics.\nAuthor Disclosures:\nS. Chakraborty: Speaker; GE, Novartis.\nB‑0757 11:33\nReliability of flow-volume mismatch assessment in whole brain \ncoverage CT perfusion in acute stroke patients \nK.M. Thierfelder, L. von Baumgarten, F.G. Meinel, \nK. Nikolaou, F.F. Strobl, M.F. Reiser, W.H. Sommer; \nMunich/DE (kolja.thierfelder@med.uni-muenchen.de) \nPurpose: While flow-volume mismatch is being increasingly used in the selection \nof stroke patients for thrombolytic therapy, there is no consensus on the method \nof mismatch estimation. Our aim was to determine reliability and reproducibility \nof different ways of mismatch assessment in patients who underwent recently \nintroduced whole brain CT perfusion.\nMethods and Materials: We included 27 consecutive stroke patients who under-\nwent 128-row CTP with extended coverage of 10.0 cm in the z-axis. Two experi-\nenced readers assessed the extent of cerebral flow-volume mismatch (MM) twice \nand in three different ways: (1) visually estimated in steps of 10% (Est-MM), (2) \nperforming a volumetric mismatch analysis using Osirix software (Vol-MM), and (3) \nusing the 10-point Alberta Stroke Programme Early CT Score (ASPECTS) scale for \nCTP (ASP-MM). Inter- and intrareader variabilities were determined by intraclass \ncorrelation coefficients (ICCs) and Kappa values.\nResults: Est-MM showed poor interreader and moderate intrareader agreement \n(ICCs: 0.311/0.726). Vol-MM agreement was excellent in large (³50 ml) perfusion \ndeficits (ICCs: 0.962/0.986), while it was poor to moderate in small (< 50 ml) \nperfusion deficits (ICCs: 0.568/0.732). ASP-MM agreement was poor (Kappa: \n0.343/0.540), but there was no case where ASP-MM points difference between \nreadings was ³3. Using the information of Vol-MM would have substantially changed \nthe mismatch estimation and lead to a reclassification in 4/27 cases in Est-MM and \nin 10/27 cases in ASP-MM.\nConclusion: Volumetric mismatch assessment can improve the evaluation of whole \nbrain CT perfusion maps, especially in patients with large perfusion deficits. It might \nserve for a better selection of stroke patients who may profit by thrombolytic therapy. \nB‑0758 11:42\nInfluence of temporal sampling rate of CTP acquisitions on cerebral \nperfusion maps using a digital phantom \nM. Oei1, R. van den Boom1, L.J. Oostveen1, H.O.A. Laue2, B. van Ginneken1, \nR. Manniesing1, M. Prokop1; 1Nijmegen/NL, 2Bremen/DE (m.oei@rad.umcn.nl) \nPurpose: To study the influence of the temporal sampling rate of CTP acquisi-\ntions on cerebral perfusion maps with noise-free synthetic data sets created with \na digital phantom.\nMethods and Materials: Noise-free synthetic data sets were created with a digital \nphantom which consists of a skull derived from a human skull phantom combined \nwith arterial input and venous output functions, white matter (WM) and grey matter \n(GM) time-attenuation curves (TAC) obtained from 5 patients. By manipulating the \ntime tags CTP protocols with a total scan duration of 60s and a temporal sampling \nrate of 1-, 2-, 3- and 4s were simulated. The 1-s protocol was used as reference \nstandard. The 2-, 3- and 4-s protocols were shifted with 1s to measure the influence \nof missing peak points of the curve, resulting in 1, 2, 3 extra data sets, respectively. \nCBF, CBV and MTT maps were calculated using PMA (ASIST-Japan). Mean val-\nues of GM and WM of the protocols were compared with the reference protocol.\nResults: By increasing temporal resolution, CBF values decreased, MTT increased \nand CBV stayed relatively the same for WM and GM: CBF values were within 63, \n75 and 85% of the reference standard for 2s, 3s and 4s protocols, respectively. \nMTT values were within 69, 156 and 238% of the reference standard for 2s, 3s \nB‑0754 11:06\nEligibility of 3-dimensional CT perfusion blood flow-volume \nmismatch to predict time from symptom onset in acute ischemic stroke \nK.M. Thierfelder, L. von Baumgarten, F.G. Meinel, \nA.B. Baumann, K. Nikolaou, M.F. Reiser, W.H. Sommer; \nMunich/DE (kolja.thierfelder@med.uni-muenchen.de) \nPurpose: Our aim was to evaluate if the extent of volumetrically determined blood \nflow-volume mismatch in recently introduced whole brain CT perfusion (WB-CTP) \ncan predict if a stroke is younger than 4.5 hours (time window for thrombolysis).\nMethods and Materials: We retrospectively analysed cerebral blood flow (CBF) \nand volume (CBV) maps and clinical data of 103 acute stroke patients. CT per-\nfusion images were acquired with extended brain coverage of 10 cm in the z-axis. \nMismatch extent was defined as the fraction of CBF perfusion deficit without cor-\nresponding CBV abnormality and was determined volumetrically using Osirix V.4.0 \nimaging software. A logistic regression analysis was performed to predict time from \nsymptom onset of < 4.5 hours. Four mismatch extent categories, CBF perfusion \ndeficit and CBV infarction volume were entered as predictors into the model.\nResults: Mean time from symptom onset was 187 min±101 min. Mean mismatch \nextent was 59.5%±31.1%. After correcting for age and gender, a mismatch extent \nof ³90% was highly predictive for a symptom onset of < 4.5hrs (n=18, OR: 8.70, \np=0.03). Other categories of mismatch extend (³80% (OR: 6.67, n=31, p=0.10), < \n10% (n=13, OR: 0.90, p=0.89), < 20% (n=19, OR: 1.36, p=0.66) as well as CBF \nperfusion deficit volume (p=0.86) and CBV infarction volume (p=0.77) failed to \npredict time from symptom onset.\nConclusion: A large (³90%) volumetrically determined mismatch in WB-CTP is \na predictor for the time from symptom onset in the critical time window. WB-CTP \nmismatch might, in these cases, help to identify patients eligible for thrombolysis \nwhen symptom onset is unknown (e.g. wake up stroke). \nB‑0755 11:15\nWhole brain CT perfusion: volumetric assessment of perfusion \ndeficits in patients with acute ischemic stroke \nK.M. Thierfelder1, L. von Baumgarten1, E. Klotz2, A.B. Baumann1, \nK. Nikolaou1, M.F. Reiser1, W.H. Sommer1; 1Munich/DE, \n2Erlangen/DE (kolja.thierfelder@med.uni-muenchen.de) \nPurpose: Whole brain CT perfusion (WB-CTP) eliminates the major drawback of \nrestricted brain coverage in standard 2-slice CTP. Our aim was to assess reliability \nand reproducibility of a newly introduced volumetric assessment method of perfusion \ndeficits in WB-CTP in patients with acute ischemic stroke.\nMethods and Materials: 24 consecutive patients underwent 128-row WB-CTP with \nextended scan coverage of 10.0 cm in the z-axis using adaptive spiral scanning \ntechnique. Volumetric analysis of cerebral blood volume (CBV), cerebral blood flow \n(CBF), mean transit time (MTT), time to peak (TTP), and time to drain (TTD) was \nperformed twice by two experienced readers using dedicated imaging software \nwith at least 2-week intervals between readings. Inter- and intrareader agreement \nfor individual perfusion parameter maps was assessed by intraclass correlation \ncoefficients (ICC) and Bland-Altman analysis.\nResults: Interreader agreement was highest for TTD (ICC: 0.985), followed by \nCBF (0.969), MTT (0.949), CBV (0.935), and TTP (0.851). Intrareader agreement \nwas also highest for TTD (ICC: 0.995), followed by MTT (0.979), CBF (0.977), \nCBV (9.942), and TTP (0.944). The perfusion deficits showed the highest absolute \nmean volume in the time-related parametric maps and did not differ significantly \nwithin this group, while mean CBF perfusion deficit volume was significantly smaller \n(each with p < 0.01).\nConclusion: Volumetric assessment in WB-CTP in acute stroke patients is reliable \nand reproducible. It therefore might serve for a more accurate assessment of prog-\nnosis of stroke outcome and definition of flow-volume mismatch. TTD had the high-\nest agreement and therefore might be a suitable parameter to define tissue at risk. \nB‑0756 11:24\nTime-to-peak (TTP) maps using whole brain CT perfusion in minor \nstroke: a diagnostic tool beyond penumbra measurement \nS. Chakraborty, M.E. Ahmad, J.K. Wasserman, K. Keyhanian, D. Dowlatshahi, \nG. Stotts; Ottawa, ON/CA (santanoo@gmail.com) \nPurpose: The use of thrombolysis in minor stroke or fluctuating symptoms is \ncontroversial. Treatment decisions may be influenced by identifying patients with \nlarge areas of tissue at risk and distinguishing stroke mimic. Whole brain CT per-\nfusion in Toshiba 320 Aquilon® CT scanner allows possible assessment of these \nparameters and is not limited to selective brain coverage as in previous generations \nof CT scanners. Time-to-peak (TTP) maps have been identified as a sensitive \n1\n\nScientific Sessions\nS32\n C A D E F\n G\nB\n20.9±3.7% 2.1±2.7% in the right, and 12.1±3.0%, 17.1±2.6%, 13.1±2.9%, 2.4±2.5% \nin the left in inspiratory phase, 12.1±1.7%, 19.3±2.5%, 21.7±4.1%, 2.6±2.8% of \nright, and 11.7±2.8%, 16.5±2.5%, 13.2±2.9%, 2.8±3.0% of left in expiratory phase. \n133Xe lung sinchigraphy signal rate was 10.6±2.6%, 19.2±4.1%, 16.8±4.2% and \n5.6±1.6% in the right, and 11.0±3.3%, 18.8±4.7%, 12.9±3.3%, 5.2±1.5% in the \nleft. The each function in tidal respiration dynamic chest x-ray was correlated with \n133Xe lung ventilation scintigraphy (R=0.81, 0.82, 0.85 and 0.82).\nConclusion: Dynamic chest x-ray examination for regional ventilation function \nmust be equivalent to lung scintigraphy. \nB‑0761 10:48\nPerformance evaluation of automatic chest radiograph reading for \ndetection of tuberculosis (TB): a comparative study with clinical \nofficers and certified readers on TB suspects in sub-Saharan Africa \nP. Maduskar1, L. Hogeweg1, B. van Ginneken1, H. Ayles2; 1Nijmegen/NL, \n2London/UK (p.maduskar@rad.umcn.nl) \nPurpose: Digital chest radiography (CXR) is used in high burden countries for \nsuspect screening, active case finding and in prevalence surveys for TB diagnosis. \nAn observer study was conducted to compare performance of automatic software \nwith that of clinical officers and certified expert readers.\nMethods and Materials: A dataset of 166 digital CXRs (2048×2048, 0.25 mm, \nDelft Imaging Systems, The Netherlands) was collected at Kanyama Clinic, Lusaka, \nZambia. Sputum culture was used as reference. An observer study was conducted \nwith four clinical officers who read x-rays in Kanyama Clinic, and with two readers \ncertified to read CXRs according to CRRS standard (University of Cape Town, \nSouth Africa). A software system for detection of TB (CAD4TB-1.08, Diagnostic \nImage Analysis Group, The Netherlands) analysed all the cases. Human readers \nand software scored all the images between 0 and 100. We report area under the \nreceiver operating characteristics curve (Az) with 95% confidence intervals and \npairwise comparisons from bootstrap estimates. p < 0.05 was considered significant.\nResults: The dataset contained 99 positive and 67 negative cases. Az for the \nsoftware was 0.72 (0.63-0.80). Az values of CRRS certified readers were 0.71 \n(0.63-0.79) and 0.72 (0.64-0.78). Mean Az for clinical officers was 0.70 (0.65-0.76). \nThere was no significant difference between any reader and the software, except \nfor one clinical officer who performed significantly worse than automatic reading.\nConclusion: Automatic computer reading has similar performance as clinical offic-\ners and certified readers. The software has potential of being used as a point-of-care \ndecision tool, to diagnose TB or select subjects that should undergo further tests. \nB‑0762 10:57\nDiagnostic imaging costs before and after digital tomosynthesis \nimplementation in patient management after suspected thoracic \nlesions on chest radiography \nE. Quaia, E. Baratella, G. Grisi, R. Cuttin, G. Poillucci, S. Kus, M. Cova; \nTrieste/IT (quaia@units.it) \nPurpose: To evaluate diagnostic imaging costs before and after digital tomosyn-\nthesis (DTS) implementation in patients with suspected thoracic lesions on chest \nradiography (CXR).\nMethods and Materials: Over a period of four years four-hundred-and-sixty-five \npatients (263 males, 202 females; age, 72.47±11.33 years) with suspected thoracic \nlesion (s) after CXR underwent DTS. Two readers prospectively analysed in con-\nsensus DTS images. Each patient underwent CT when a pulmonary non-calcified \nlesion was identified by DTS, while CT was not performed when a benign pulmonary \nor extrapulmonary lesion or pseudolesion was identified. Diagnostic imaging costs \n(including material, staff, and imaging system depreciation) were evaluated during \nthe12-month preceding DTS implementation and during the12-month after DTS \nimplementation. The average imaging cost per patient was calculated by normalising \nthe costs before and after implementation of DTS by the number of indeterminate \nCXR examinations in each of these periods.\nResults: In 229/465 patients who underwent DTS after suspicious CXR, DTS \nshowed 193 thoracic lesions and 36 pleural lesions, while in the remaining 236/465 \npatients lesions were ruled-out as pseudolesions of CXR. In the 12-month pre-\nceding DTS implementation, the proportion of patients who presented suspected \nthoracic lesions and underwent CT was 271/811; after DTS implementation, this \nproportion became 39/800. The average differential per-patient costs of CXR, DTS, \nand CT examinations were 15.15, 41.55, and 113.66 euros, respectively. The per-\npatient change in diagnostic imaging costs before vs after DTS implementation \nwas -24.79 euros.\nConclusion: Per-patient diagnostic imaging costs decreased after DTS implemen-\ntation in patients with suspected thoracic lesions.\nAuthor Disclosures:\nE. Quaia: Consultant; GE Healthcare.\nand 4s protocols, respectively. CBV values stayed within 50% of the reference \nstandard for all protocols.\nConclusion: Cerebral perfusion values are strongly influenced by temporal \nsampling rate. \nAuthor Disclosures:\n R. van den Boom: Research/Grant Support; Toshiba Medical Systems \nCorporation. R. Manniesing: Research/Grant Support; Toshiba Medical \nSystems Corporation. M. Prokop: Research/Grant Support; Toshiba Medical \nSystems Corporation.\n10:30 - 12:00 Room D1 \nChest \nSS 1704 \nTechnological refinements: from x-rays to micro-\nimaging \nModerators: \nA.P. Parkar; Bergen/NO \nC.M. Schaefer-Prokop; Amersfoort/NL \nB‑0759 10:30\nEvaluation of pulmonary nodules by serial radiographs obtained by \na flat-panel detector \nY. Nakano, K. Maeda, S. Kitahara, T. Toyama, M. Kuwabara; Kusatsu/JP \n(ynakano@aurora.dti.ne.jp) \nPurpose: The aim of this study was to compare the detectability of pulmonary \nnodules by serial radiographs obtained by a flat-panel detector (FPD-SR) and \nchest computed radiography (CR) images.\nMethods and Materials: An FPD-SR was assembled from a cassette-type detector \nand a portable x-ray system. The portable system could generate pulse x-rays of \nup to 5 pulses/sec; the pulse width was approximately 70 msec. Twenty FPD-SR \nimages from full inspiration to full expiration were obtained in 4 sec. The total dose \nadministered for FPD-SR was twice that administered for CR. Twenty-seven patients \nwith 33 CT-confirmed lung nodules were included in this study. Receiver operating \ncharacteristic (ROC) analysis using a five-point ordinal categorical scale by five \nradiologists was used to evaluate the lung nodule detectability by both modalities.\nResults: Analysis of variance for ROC analysis showed that FPD-SR was signifi-\ncantly better than CR in detecting nodules (P = 0.025). The estimated mean Az \nvalues were 0.7143 ± 0.076 with FPD-SR and 0.5586 ± 0.048 with CR. The mean \ndiameter of the 33 nodules was 13.1 mm (range, 5-31 mm). FPD-SR showed better \ndetectability of 2 mixed ground-glass opacities and 28 solid opacities. Furthermore, \ntwo nodules detected by FPD-SR were stable in cine-mode display. Severe pleural \nadhesions were confirmed intraoperatively.\nConclusion: FPD-SR is superior to CR in detecting pulmonary nodules and is \nrecommended during follow-up evaluation. FPD-SR provides a noninvasive mean \nvalues for evaluating pleural adhesions before endoscopic surgery.\nAuthor Disclosures:\nY. Nakano: Grant Recipient; Canon Inc.\nB‑0760 10:39\nFunction ventilation analysis in dynamic chest x-ray examination: in \ncomparison with 133Xe lung ventilation scintigraphy \nT. Abe, T. Izuka, N. Motohashi, Y. Shiraishi, N. Koyanagi, A. Kurosaki, M. Ito, \nH. Ogata, S. Kudou; Kiyose, T okyo/JP (takehikoabe@hotmail.com) \nPurpose: This study aimed to evaluate the regional ventilation functional volume \nusing dynamic chest x-ray examination in comparison with 133Xe scintigraphy.\nMethods and Materials: Dynamic chest x-ray and the 133Xe scintigraphy were \nperformed in 41 patients. The institutional review board approval and informed \nconsent were obtained in all persons. The dynamic x-ray was obtained in the \nupright position at 7.5 frames per second, synchronised with the pulsed x-ray. The \neach extracted and divided small area’s inspiratory/expiratory lung functional signal \nextracted by use of a low-pass filter was compared with 133 Xe lung scintigraphy.\nResults: The functional volumetric signals of the dynamic chest x-ray in each up-\nper, middle, lower and subphrenic fields were 12.6±2.4%, 19.1±3.4%, 20.7±5.2% \n2.8±3.0% in the right, and 11.8±4.2%, 16.2±3.6%, 13.5±3.2%, 2.9±2.9% in the \nleft in inspiratory phase, 11.8±3.0%, 18.7±3.7%, 20.9±5.7%, 3.3±3.2% of right, \nand 11.3±4.5%, 16.0±4.2%, 14.3±4.9%, 3.4±3.2% of left in expiratory phase. The \nfunctional differential volumetric signals in each fields were 12.4±1.5%, 19.7±2.6%, \n2\n\nScientific Sessions\nS32\nA\n C D E F G\nB\nMonday\nwithin each cross-sectional image the mean (ADCmean), minimum (ADCmin) and \nmaximum ADC (ADCmax) was determined by two independent radiologists. An \nadditional ROI was placed into the cerebrospinal liquid and set as the reference \ntissue. Statistical analysis included the Wilcoxon test and p-values < 0.05 indicated \nstatistical significance.\nResults: The highest ADC values were determined for the group of adenocarcino-\nmas (ADCmean, 1.98x10-3 mm2/s; ADCmax, 2.44x10-3 mm2/s). Significantly lower \nmean ADCs were found for the squamous cell carcinomas (ADCmean, 1.18x10-3 \nmm2/s; p < 0.0001) and small cell lung cancers (ADCmean, 1.29x10-3 mm2/s; \np=0.01). Determination of the ADC values did not reveal any difference between \nsquamous cell and small cell carcinomas (p> 0.05).\nConclusion: Diffusion-weighted MRI with ADC measurement at 1.5 T reliably \nenables the differentiation of adenocarcinoma from other histological subtypes in \nprimary lung cancer and might therefore be of distinct value in the preoperative \nmanagement of patients suffering from primary lung cancer. \nB‑0766 11:33\nNon-contrast-enhanced perfusion MRI for preoperative assessment \nof lung function in patients with non-small-cell lung cancer (NSCLC) \nG. Sommer, G. Bauman, C. Draenkow, C.-P. Heussel, \nH.-U. Kauczor, H.-P. Schlemmer, M. Puderbach; \nHeidelberg/DE (g.sommer@dkfz-heidelberg.de) \nPurpose: Knowledge about lung function defects is important for predicting func-\ntional outcome and optimising surgery in NSCLC. Fourier decomposition MRI (FD-\nMRI) has been introduced as a method to assess regional lung perfusion without \ncontrast agents. This study evaluates FD-MRI for preoperative assessment of lung \nperfusion in NSCLC patients with dynamic contrast-enhanced MRI (DCE-MRI) as \nstandard of reference.\nMethods and Materials: 15 patients with NSCLC were examined at 1.5 T. Time-\nresolved images of the lungs were acquired in coronal and sagittal plane using \na 2D-bSSFP sequence. Fourier decomposition was used to detect and separate \nperiodic changes of lung proton density caused by respiratory and cardiac \ncycles. Perfusion-weighted images were calculated by pixel-wise integration of \nthe cardiac spectral line. FD and DCE data were analysed visually for perfusion \ndefects. Perfusion proportions of pulmonary lobes were calculated quantitatively \nby regions-of-interest analyses.\nResults: FD-MRI provided diagnostic quality in 14 cases, but failed in one patient. \nSensitivity, specificity and accuracy of FD-MRI for visual detection of perfusion \ndefects were 78%, 92%, and 90%. Quantitative evaluation of perfusion proportions \nprovided good linear correlation between FD-MRI and DCE-MRI for both upper \nlobes and both entire lungs (r=0.70-0.85). Accuracy of FD-MRI in the lower lobes \n(r=0.02-0.03) and the middle lobe (r=0.32) was compromised by artefacts from \ncardiac pulsation.\nConclusion: FD-MRI is useful to detect regional lung perfusion defects in NSCLC \npatients before surgery. For perfusion quantification, FD-MRI is sufficiently accurate \nin both upper lobes and for bilateral comparison, but, in its present form, inaccurate \nin the middle lobe and both lower lobes. \nAuthor Disclosures:\nC. Heussel: Author; Editor of “Medinische Klinik, Intensivmedizin und \nNotfallmedizin”, at Dr. Dietrich Steinkopff (Springer) publishing. Board Member; \nChief executive chest working group of the German Roentgen society; \nConsultant of the European Conference on Infections in Leukemia (ECIL-3); \nFaculty member European Society of Thoracic Radiology. Consultant; Schering-\nPlough, Pfizer, Basilea, Boehringer Ingelheim, Novartis, Roche, Astellas, \nGilead, MSD, Lilly. Employee; Head of Diagnostic and Interventional Radiology \n/ Nuclear Medicine of Thoraxklinik Heidelberg; Member of the German Center \nfor Lung Research. Founder; Founder member of the working team in infections \nin immunocompromized hosts of the German society of Hematology/Oncology. \nPatent Holder; Method and Device For Representing the Microstructure of the \nLungs. IPC8 Class: AA61B5055 FI, PAN:20080208038, Inventors: W Schreiber, \nU Wolf, AW Scholz, CP Heussel. Research/Grant Support; Siemens 2012, \nNovartis 2012, Pfizer 2012. Shareholder; Stada, GSK. Speaker; Gilead, Essex, \nSchering-Plough, AstraZeneca, Lilly, Roche, MSD, Pfizer, Bracco, MEDA \nPharma, Intermune, Chiesi, Siemens, Covidien, Pierre Fabre, Boehringer \nIngelheim, Grifols.\nB‑0763 11:06\nLung ultrasound in the elderly population: investigating the limit \nbetween physiological and pathological patterns \nA. Chiesa, F. Ciccarese, G. Gardelli, F. Feletti, U. Regina, M. Zompatori; \nBologna/IT (ciccarese.f@gmail.com) \nPurpose: The senile lung undergoes paraphysiological changes which have been \ndescribed in several radiological and CT studies, but never investigated through \nultrasound. The aim of the present study was to evaluate a group of elderly-non-\nsmoker-healthy patients in comparison with young subjects, by using ultrasound \nexamination.\nMethods and Materials: 100 elderly subjects (> 70years-mean age: 79.4±6.9) \nand 50 young subjects (< 55years-mean age: 32.5±12.1) were submitted to lung \nultrasound examination. We analysed the anterior, lateral and posterior surface \nof each lung to evaluate the presence/absence of A-lines and B-lines. Fisher test \nwas chosen to compare data obtained in the two groups.\nResults: Absence of A-lines was found in 94/100-94.0% of elderly versus 2/50-4.0% \nof young subjects (p < 0.0001). Presence of B-lines was detected in 37/100-37.0% \nof elderly, with a higher prevalence in posterior lung fields; the number of B-lines \nwas²3 per field (pf) in 27/37-73.0%, > 3pf in 2/37-5.4%; both ²3 and > 3pf-depending \non the evaluated field in 8/37-21.6%. By contrast, 5/50-10.0% young subjects \nshowed B-lines (²3pf in all of cases)- p=0.0004.\nConclusion: To avoid misdiagnosis, we should consider that physiological ultra-\nsound lung findings could be different among old and young people. The majority of \nold individuals did not present A-lines; moreover in a high percentage, B-lines were \nobserved (²3pf in most of them). These results could be explained by a reduction of \nimpedance between lung parenchyma and soft tissue (absence of A-lines) and by \nan increased thickness of interlobular septa (presence of B-lines). Further studies \nshould be proposed to define a cut-off between normal and pathological pattern. \nB‑0764 11:15\nDigital x-ray optical densitometry in assessment of respiratory \nfunction in patients with COPD exacerbation \nN. Gorbunov, V. Laptev; Novosibirsk/RU (n_gorbunov@hotmail.com) \nPurpose: To evaluate respiratory function in patients with exacerbation of chronic \nobstructive pulmonary disease (COPD) before and after treatment by means of a \ndigital x-ray optical densitometry.\nMethods and Materials: The study group comprised 563 patients (140 females, \n423 males; mean age 58±1.3 years, range 36-81 years). All of them were admitted \nto the clinic with an exacerbation of COPD with different (1-3) stage. High-resolution \ndigital radiographic device with a line x-ray sensitive silicate receiver was used. Low-\ndose digital x-ray examination of the chest was performed both in inspiration and \nin expiration phases before and after treatment. Regional and common pulmonary \noptical density was evaluated with further quantitative analysis of respiratory func-\ntion. For these purposes the optical density gradient (ODG) was used. All results \nwere verified by high-resolution computed tomography (HRCT).\nResults: The optical density gradient before and after treatment has been changed. \nThere was a 1.5-1.6 times increasing value of optical density gradient due to treat-\nment of COPD exacerbation. For patients with the first stage of COPD the 64.7% \nODG increasing was estimated. For the second stage of COPD ODG increasing \nwas 63.1% and for the third stage of COPD it was 52.1%. There was a significant \ncorrelation between pulmonary optical density gradient and HRCT density gradient \nbefore and after treatment (r> 0.3; p < 0.05).\nConclusion: A digital x-ray optical densitometry by means of functional high-\nresolution digital radiography allows optimising an evaluation of therapy response \nin patients with COPD exacerbation combined with radiation exposure reduction.\nB‑0765 11:24\nDiffusion-weighted echo-planar MRI with multiple b-values \nin primary lung cancer: a new approach to the non-invasive \ndifferentiation of histological subtypes? \nM. Regier, D. Schwarz, A. Laqmani, F.O.G. Henes, G. Adam; \nHamburg/DE (mregier@uke.de) \nPurpose: To investigate the feasibility of diffusion-weighted echo-planar imaging \n(DW-EPI) with multiple b-values and assessment of the apparent diffusion coef-\nficient (ADC) for the differentiation of histological subtypes in primary lung cancer.\nMethods and Materials: Using a DW-EPI sequence at 1.5 T (TR/TE 2000/66 ms; \nslice thickness, 5 mm; b-factors, 0, 50, 100, 250 and 600 s/mm²) the lungs of 38 \nconsecutive patients suffering from bronchial carcinoma (adenocarcinoma, n=19; \nsquamous cell carcinoma, n=14; small cell carcinoma, n=5) were examined. By \nplacing a Region of Interest (ROI) encovering the entire tumour manifestation \n3\n\nScientific Sessions\nS32\n C A D E F\n G\nB\n10:30 - 12:00 Room D2 \nInterventional Radiology \nSS 1709 \nAbdominal interventions: from TIPS to bile ducts \nModerators: \nR.F. Dondelinger;  Liège/BE \nB. Sekovsky; Split/HR\nB‑0769 10:30\nClinical relevance and interventional-radiological management of \nearly complications after pancreatic surgery: a 12-year single-centre \nexperience on 1285 patients \nG. Agostini, M. Venturini, F. De Cobelli, S. Cappio, M. Salvioni, E. Di Rosa, \nG. Balzano, P. Maffi, A. Del Maschio; Milan/IT (venturini.massimo@hsr.it) \nPurpose: Despite the improvement in technique/expertise, pancreatic surgery \nremains burdened with a high complication rate. Our aim was to report our 12-\nyear single-centre experience about the clinical relevance and the interventional-\nradiological management of the early postoperative complications (treatment/\nprevention) on 1285 patients submitted to pancreatic surgery.\nMethods and Materials: In 2000-2012, 1285 patients were submitted to pan-\ncreatic surgery (duodenum-cephalopancreatectomy, total-pancreatectomy, \ndistal-pancreatectomy). Patients were classified on the basis of the complica-\ntion severity into 5 classes (Clavien-Dindo-classification): class-0=none, class-\n1/2=conservative treatment, class-3a=endoscopic/interventional-radiological, \nclass-3b=surgery, class-4=intensive care, class-5=death. Interventional-radiological \nmanagement was as follows: PTC/biliary-drainage in case of biliary-fistulas (bile \nin surgical drainage, normal bilirubin levels, undilated biliary ducts at US) under \nUS/fluoroscopic-guidance (right approach, puncturing along the course of the \nsixth-segment portal branch with 21G Chiba-needle, or left approach if aerobilia/\nadequate volume of left hepatic lobe); embolisation (microcoils/PVA-particles) or \ncovered-stenting (Viabahn-Gore) in case of bleedings of gastroduodenal/splenic \narteries; percutaneous drainage (US/CT-guidance) of liquid/infected collections. \nPancreatic-islet-intraportal-autotransplantation was performed in case of total-\npancreatectomy to prevent diabetes.\nResults: Patients were classified as follows: 524/1285 (40%) class-0, 210/1285 \n(16%) class-1, 361/1285 (28%) class-2, 72/1285 (6%) class-3a, 55/1285 (4%) \nclass-3b, 24/1285 (2%) class-4, 39/1285 (3%) class-5. 72/1285 (class-3a) and were \nsuccessfully treated as follows: 30/72 PTC/biliary-drainages, 27/72 liquid/infected \ncollection percutaneous-drainages, 9/72 bleedings (7 embolisations, 2 covered-\nstenting), 6/72 endoscopic-procedures. 25/1285 underwent pancreatic-islet-\nintraportal-autotransplantation. One bleeding/1 biliary-fistula needed 2 treatments.\nConclusion: In experienced centres of pancreatic surgery, complication rate can \nbe reduced. Complications can be, however, successfully diagnosed, managed and \nprevented by interventional-radiological procedures, limiting their clinical relevance \nand avoiding a high-risk surgical re-treatment. \nB‑0770 10:39\nManagement of post-surgical biliary leakage with retrievable covered \nstent: preliminary results \nA. Gioppo, A. Campari, J. Parraga, C. Michelozzi, L. Rahali, A. Sacrini, \nF. Melchiorre, G. Cornalba; Milan/IT (andrea.gioppo@unimi.it) \nPurpose: To evaluate technical feasibility and clinical efficacy of retrievable covered \nstents in treating post-surgical biliary leakage.\nMethods and Materials: From April 2008 to date, 16 patients (9 males, 7 females; \nmean age 52 years, range 18-83 years) were retrospectively studied. Patients \nunderwent placement of retrievable covered stents for treat post-surgical bile \nleaks. In 12 cases the procedure was performed by interventional radiologist using \npercutaneous trans hepatic access and in 4 cases by means of hybrid procedure \n(PTBD + ERCP) with both interventional radiologist and endoscopist. The leaks \ninvolved cystic duct stump (n = 6), common bile duct anastomosis (n = 6), left extra \nhepatic duct (n = 1), right extra hepatic duct (n =2) and biliary confluence (n = 1).\nResults: Technical success with correct stent releasing was achieved in 15 cases; \n1 case required post-dilatation ballooning. Immediate clinical and lab test improve-\nments were observed in all patients. Post-operative imaging proved leak resolution \nin all cases. No early complications were observed. In 1 case late stent migration \nwas reported 21 days after the procedure. Twelve stents were removed without \ncomplication after a mean time of 59 days, with complete leak resolution. One stent \nB‑0767 11:42\nComparison of assessment of preoperative pulmonary vasculature \nin non-small cell lung cancer patients by non-contrast-enhanced \nand 4D contrast-enhanced MR angiography at 3 T and by contrast-\nenhanced thin-section MDCT using a 64-detector row system \nY. Ohno1, S. Seki1, M. Nishio1, H. Koyama1, T. Yoshikawa1, S. Matsumoto1, \nS. Satou2, K. Sugimura1; 1Kobe/JP, 2Ohtawara/JP (yosirad@kobe-u.ac.jp) \nPurpose: To prospectively and directly compare pulmonary vasculature assess-\nment before surgical treatment of non-small cell lung cancer (NSCLC) patients by \nnon-contrast-enhanced (non-CE) MR angiography, 4D CE-MR angiography and \nthin-section CE-CT.\nMethods and Materials: A total of 77 consecutive pathologically proven and \nclinically assessed stage I NSCLC patients (41 males, 36 females; mean age: \n71 years) underwent thin-section CE-CT, non-CE-MR angiography and CE-MR \nangiography, and surgical treatment. The capability for anomaly assessment of the \nthree methods was independently evaluated by two reviewers using a 5-point visual \nscoring systems, and final assessment for each patient was made by consensus \nof the two readers. Interobserver agreements for pulmonary arterial and venous \nassessment were evaluated with the kappa statistic. Assessment of variations in \noverall pulmonary vasculature by the three methods was compared by means of \nreceiver operating characteristic analyses on a per-patient basis. Finally, sensitivity, \nspecificity and accuracy for detection of anomalies were directly compared among \nthe three methods by means of McNemar’s test.\nResults: Interobserver agreements for pulmonary artery and vein assessment \nwere substantial or almost perfect (0.72²κ²0.86). For pulmonary arterial and venous \nvariation assessment, non-CE-MR angiography, 4D CE-MR angiography and thin-\nsection CE-CT showed no significant differences (p> 0.05) in terms of area under \nthe curve, sensitivity, specificity and accuracy.\nConclusion: Pulmonary vascular assessment of NSCLC patients before surgical \nresection by non-CE-MR angiography can be considered equal to that by 4D CE-\nMR angiography and thin-section CE-CT.\nAuthor Disclosures:\nY. Ohno: Research/Grant Support; Toshiba Medical Systems. M. Nishio: \nResearch/Grant Support; Toshiba Medical Systems. T. Yoshikawa: Research/\nGrant Support; Toshiba Medical Systems. S. Matsumoto: Research/Grant \nSupport; Toshiba Medical Systems. S. Satou: Employee; Toshiba Medical \nSystems.\nB‑0768 11:51\nIn vivo micro-CT and 18F-FDG micro-PET imaging of SPC-raf and \nSPC-myc transgenic mouse models of lung adenocarcinoma \nT. Rodt, C. von Falck, M. Luepke, K. Hueper, R. Halter, S. Dettmer, C. Boehm, \nJ. Borlak, F. Wacker; Hannover/DE (rodt.thomas@mh-hannover.de) \nPurpose: To report on micro-CT and micro-PET imaging of spontaneously develop-\ning lung tumour in SPC-raf and SPC-myc transgenic mice. Technical considerations \nregarding periprocedural management and imaging technique are addressed; tu-\nmour quantification techniques are presented. Dosage measurements are reported \nand potential adverse effects discussed.\nMethods and Materials: 4 wild-type control, 25 SPC-raf and 7 SPC-myc trans-\ngenic mice were examined in vivo using micro-CT (n=180) and 18F-FDG micro-PET \n(n=14). Specific periprocedural management was established. Different respiratory \ngated and ungated micro-CT protocols were compared. A quantification routine for \ntumour load and growth was validated and examined in a follow-up study. 18F-FDG \nmicro-PET of orthotopic lung tumour was obtained; quantification was performed \non lesion and lung region basis. Findings were correlated to histology. Thermolu-\nminescence dosemeter measurements and dosage calculations for micro-CT and \nmicro-PET were performed.\nResults: No procedure-related deaths occurred for up to 547 days of follow -up. \nRespiratory gated micro-CT protocols yielded better image quality compared with \nungated protocols. Intra- and inter-observer variability of the quantification routine \nwere 5.1 and 6.5%, respectively. Tumour quantification showed significant difference \n(p=0.043) between SPC-raf transgenic and control animals in follow-up. Longitudinal \ntumour development correlated to cross-sectional histological data from literature. \nMicro-PET yielded a tumour-to-non- tumour ratio of 2.47 in SPC-myc transgenic \nanimals. Micro-CT dosage ranged from 174 to 277 mGy. The estimated dosage \ncalculated for micro-PET was 140 mGy.\nConclusion: Micro-CT and 18F-FDG micro-PET provide quantitative data on mor-\nphology and metabolism in orthotopic lung tumour. The techniques can safely be \napplied in animal model phenotyping and therapeutic studies. \n4\n\nScientific Sessions\nS32\nA\n C D E F G\nB\nMonday\npancreatic cancer). 10 Watts for 2 minutes was applied using bipolar endoluminal \nRF device (Habib™ EndoHPB, EMcision Ltd., London, UK), placed in a block us-\ning guidewire technique. RFA is followed by self-expanding or balloon-mounted \nmetal-stent (MS) placement. Drainage catheter was repositioned for follow-up.\nResults: Duct patency restorated in 34 (97.1%) cases; in 1 (2.9%) case procedure \nfiled because of guidewire conduction failure. All cases of balloonoplasty required \nthe repeated procedure followed by stenting. 34 biliary patients maintained stent pat-\nency as long as they are alive. The mean stent patency was 115.9 ± 64.8 (50 - 240) \ndays. There was no 30-day mortality, haemorrhage or pancreatitis following RFA. \nOne complication (bile duct perforation) was observed in a post-balloonoplasty pa-\ntient on repeated (RFA&Stenting) procedure; this case was managed percutaneally.\nConclusion: Percutaneous RFA treatment appears to be safe and effective in the \nmanagement of inoperable biliary and Wirsung duct block. Randomised studies \nwith prolonged follow-up are warranted. \nAuthor Disclosures:\n N. Habib: Shareholder; EMcision ltd.\nB‑0774 11:15\nEffectiveness of therapeutic lymphography on lymphatic leakage \nT. Gruber-Rouh, N.N.N. Naguib, T. Lehnert, A. Thalhammer, S. Zangos, \nB. Schulz, V. Jacobi, T.J. Vogl; Frankfurt/DE \nPurpose: To evaluate the effectiveness of lymphography as minimally invasive \ntreatment option for lymphatic leakage in terms of local control and to investigate \nthe volume of lymphatic drainage per day which influences the success rate.\nMethods and Materials: The study protocol was approved by the ethical com-\nmittee, and informed consent was obtained from all patients prior to treatment. \nBetween June 1988 and January 2012, 66 patients (25 women, 41 men, mean \nage, 52.4 years; age range 42-75 years) with lymphatic leakage underwent lym-\nphography. Sixty-one patients (92.4%) had successful lymphangiography while \nlymphangiography failed in the other 5 cases. The lymphatic leakage was in form \nof lymphatic fistulas (n=31), lymphocele (n=7), chylothorax (n=13) and chylous \nascites (n=10). Therapeutic success was evaluated and correlated to the volume \nof lymphatic leakage.\nResults: Signs of leakage or contrast extravasation were directly detected in 61 \n(100%) patients. Based on the lymphangiography findings, 19 patients (19/61; \n31.2%) underwent surgical intervention with a complete occlusion of the lymphatic \nleakage. Of 61 patients, 42 patients (42/61; 68.8%) were cured after lymphography. \nThe lymphatic leakage could be completely occluded in 96.8% (30/31) of patients \nwhen the lymphatic drainage volume was less than 200 mL/day (n=31). Even when \nlymphatic drainage was higher than 200 mL/day (n=30), therapeutic lymphography \nwas still successful in 56.7% (17/30) of the patients.\nConclusion: Lymphography is an effective, minimally invasive method in the \ndetection and treatment of lymphatic leakage. The volume of lymphatic drainage \nper day is a significant predictor of the therapeutical success rate.\nB‑0775 11:24\nTips for TIPS: 12-year experience \nC. Zini, F. Fanelli, M. Bezzi, E. Boatta, M. Corona, P. Lucatelli, A. Cannavale, \nC. Cirelli, F.M. Salvatori; Rome/IT \nPurpose: Transjugular portosystemic shunt (TIPS) materials and techniques are \ndramatically changed during the past decade to become more effective and reli-\nable. We report 12-year experience with e-PTFE covered stent-graft evaluating \ntechnical aspects, results, and complication rate.\nMethods and Materials: From January 2000 to January 2012, 379 consecutive \npatients had de novo TIPS with VIATORR (W.L. Gore and Associates-Flagstaff-\nAZ-USA). 348 patients (226 men; mean age 53 years) with a minimum follow-up of \n12-months were included in this study. Patients were Child-Pugh class A (18.4%), \nB (62.6%), C (19%) with acute/recurrent variceal bleeding (54.6%), refractory \nascites (37.9%),hepatic hydrothorax (1.2%) and Budd-Chiari Syndrome (6.3%).\nResults: Technical success was achieved in all cases with haemodynamic suc-\ncess (PSG < 12 mmHg) in 90.1% patients. Porto-systemic gradient mean value \ndropped from 21.4±5.4 mmHg to 7.5±2.9 mmHg (p=0.0001). Reduction of varices \nwas observed at one-month follow-up (F2: 104 vs. 29 - F3: 142 vs. 6) (p=0.001). \n52 re-interventions were necessary in 42 patients; primary patency rate was 87.93 \n% and secondary patency rate was 97.41%. Mortality rate was 9.2% (early) and \n35.4% (late). TIPS was a \"bridge to transplant\" in 66 patients. Hepatic encepha-\nlopathy occurred in 49.4% of patients; 23 cases refractory to conventional medical \ntherapy were managed with shunt-reduction.\nConclusion: VIATORR plays an important role in TIPS scenario but its outcomes \nare strictly related to technical aspects such as intrahepatic tract completely cov-\nered, no concern about liver transplant, device never advanced in the portal vein \nfor more than 3 cm, 10-mm VIATORR has to be considered the best compromise. \nwas removed 4 days after the procedure, during an open re-do for intra-abdominal \nbleeding. Three stents are still in place.\nConclusion: Placement and removal of retrievable covered stents appear to \nbe technically feasible and could represent an excellent option in treating biliary \ndisorders.\nB‑0771 10:48\nBioabsorbable biliary stent in the percutaneous treatment of benign \nbiliary stricture: preliminary experience \nG. Mauri, C. Michelozzi, V. Pedicini, D. Poretti, M. Tramarin, F. Melchiorre, \nG. Cornalba, G. Brambilla; Milan/IT (vanni.mauri@gmail.com) \nPurpose: To report the outcome of patients treated with a novel bioabsorbable \nbiliary stent for benign biliary strictures.\nMethods and Materials: Ten bioabsorbable polydioxanone biliary stents (Ella-DV \nbiliary stent, ELLA-CS, Czech Republic) were deployed in 9 patients with increased \nlevel of bilirubin due to postsurgical benign biliary stricture. This stent is made \nof polydioxanone, a material that allows to obtain a high radial force, but that is \nreabsorbed by the body within 6 months. All patients had stricture recurrence after \nmultiple standard bilioplasty (2 to 5). All patients were followed with clinical visit, \nultrasound and serum bilirubin level.\nResults: The procedure was successfully performed in all patients and immediate \nrestoration of the normal caliber of the biliary duct was obtained. No immediate or \nlate complications occurred and no patients had recurrence of the initial stricture \n(median follow-up 13 months, range 5-18 months).\nConclusion: Percutaneous bioabsorbable biliary stent placement is feasible and \neffective in the treatment of benign biliary strictures and in which standard bili-\noplasty has failed. In the future, this novel treatment may replace percutaneous \nbilioplasty a retrievable biliary stent placement as soon as long-term follow -up \ndata will be available. \nB‑0772 10:57\nPatient doses in liver-transplanted children with biliary strictures \ntreated with interventional radiology procedures: a single centre survey \nL. Maruzzelli, G. Mamone, R. Miraglia, L. Indovina, A. Luca; Palermo/IT \n(gmamone@ismett.edu) \nPurpose: To report the radiation doses in liver-transplanted children with biliary \nstrictures treated with interventional radiology procedures in a single centre.\nMethods and Materials: 29 liver transplant recipients with biliary strictures under-\nwent 125 procedures, the dose-area product (DAP) and fluoroscopy time (FT) were \nmeasured. Mean age 71 months (4 - 192), mean weight 17 kg (4 - 41). Procedures \nwere classified into percutaneous trans-hepatic cholangiogram and biliary catheter \nplacement (PTBD), cholangiogram and balloon dilatation (CBD), cholangiogram \nand biliary catheter change or removal (BCC). 92 procedures performed in an \nangiographic suite with image intensifier digital system, 33 procedures performed \nusing a flat-panel detector angiographic suite.\nResults: With the image intensifier digital system PTBD (n=22), CBD (n=32), BCC \n(n=38), mean DAP was: PTBD 3089 ± 2196 cGy × cm², CBD 1406 ± 1340 cGy × \ncm² and BCC 1038 ± 1420 cGy × cm²; mean FT was: PTBD 807± 436 sec, CBD \n470 ± 317 sec, BCC 344 ± 401 sec. With the flat panel system PTBD (n=9), CBD \n(n=9), BCC (n=15), mean DAP was: PTBD 1941 ± 2999 cGy × cm², CBD 652 ± \n453 cGy × cm² and BCC 111 ± 183 cGy × cm²; mean FT was PTBD 1043 ±760 sec, \nCBD 466 ±134 sec, BCC 126 ± 85 sec. Mean DAP in the 3 categories was major \nin the image intensifier digital system group; however, statistical significance, likely \ndue to the low number of procedures, was reached only for the group of patients \nwho underwent BCC (P=0.01).\nConclusion: The use of flat panel angiography equipment decreases the radia-\ntion dose. \nB‑0773 11:06\nEndoluminal RFA with subsequent ductoplasty for biliary and \npancreatic duct malignant block recanalisation \nM. Mizandari1, N. Habib2; 1Tbilisi/GE, 2London/UK (mgmizandari@gmail.com) \nPurpose: This study aimed to demonstrate the efficacy of percutaneous intraductal \nRFA in treating patients with malignant biliary and Wirsung duct obstruction.\nMethods and Materials: 35 patients with biliary (14 pancreatic cancer, 11 cholangi-\nocarcinoma, 2 metastatic invasion, 5 gallbladder cancer, 2 hepatocellular carcinoma \nand 1 -papilla of Vater tumour) unresectable malignant block received percutane-\nous endoluminal RFA. All biliary patients finally underwent the stent placement. 5 \nof them (3- cholangiocarcinoma and 2- pancreatic tumour) were after preliminary \nballoon ductoplasty. Wirsung duct recanalisation was performed in 2 patients (both \n5\n\nScientific Sessions\nS32\n C A D E F\n G\nB\ntechnical and clinical success, recurrence and complication rates. Log rank test \nwas used to compare primary patency rates. (SPSS 15.0)\nResults: Non significant differences were found related to technical success (A \n87.5%; B 100% P: 1), clinical success (A 87.5%; B 75% P: 1), major complications \n(A 25%; B 25% P: 1), recurrence rate, (A 0%; B 25% P: 0.467), patient survival \n(A 87.5%; B 87.5% P: 1) and graft survival (A 100%; B 87.5% P: 1). Regarding \nto the primary patency rates (3/6/12/ 60 months), they were slightly higher in \ngroup A (A 1.00.1.00.1.00, 1.00.; B 0.93, 0.93, 0.93, 0.70), and showed trend to \nsignification (P: 0.097)\nConclusion: 1. Endovascular treatment with stent placement in patients with HVOO \nshows excellent outcomes. 2. There are no significant differences of long-term out-\ncomes in patients with early and late HVOO were found. 3. There might be a trend \nto a slightly higher primary patency rate in the group of patients with early HVOO. \n10:30 - 12:00 Room E1 \nMusculoskeletal \nSS 1710 \nHip: CT and MRI applications \nModerators: \nM.H. Maurer; Berlin/DE \nA. Vieira; Porto/PT\nB‑0779 10:30\nRetrospective analysis of CT as secondary imaging in the diagnosis \nof occult femoral neck fracture \nK.J. Partington, P. Robinson, H. Gupta; Leeds/UK (kjpartington@doctors.org.uk) \nPurpose: Improvements in CT technology, reconstruction algorithms and availability \nmay allow modern CT to have a similar accuracy to MRI in the diagnosis of occult \nfemoral neck fracture. We analysed the accuracy of CT as second line imaging in \nthe diagnosis of occult hip fracture.\nMethods and Materials: Retrospective review of 96 CT examinations with standard \nmulti-planar reconstructions was performed in two centres over 2 years for occult \nhip fracture on 64 (90 studies) and 8 (6 studies) slice MDCT scanners. Diagnosis, \nthird-line and follow-up imaging was documented. Surgery or healing on follow-up \nimaging was considered positive for fracture. Negative radiological or clinical \nfollow-up was considered negative for fracture.\nResults: Fifteen patients (16%) had a femoral neck fracture with 14 confirmed at \nsurgery; and 1 managed conservatively (subsequent healing on radiographs). 1 \npatient (1%) had an equivocal CT (8 detector scanner with MRI performed due \nto continuing clinical concern showing an undisplaced subcapital fracture. The \n64-slice MDCT demonstrated 100% sensitivity and specificity for femoral neck \nfracture. Mean follow-up for those with a negative CT of 223 days was achieved \nwith 3 patients undergoing further imaging, all of which were negative. 45 patients \n(47%) had other abnormalities demonstrated including pubic rami, acetabular or \ngreater trochanter fractures.\nConclusion: CT is an accurate technique for ruling out an occult neck of femur \nfracture. Given its availability, rapid acquisition, familiarity to clinicians and lower \ncosts it should be used first in the investigation of occult femoral neck fracture, \nwith MRI reserved for cases of ongoing uncertainty.\nB‑0780 10:39\nMRI or CT for occult hip fracture: Do either miss clinically relevant \nfractures? \nK. Sneddon, H. Rehman, Z. Davis, F. Perks, T.O. White, R.G.E. Clement; \nEdinburgh/UK (crabbykerry@hotmail.com) \nPurpose: There are 75,000 patients that sustain a fractured neck of femur (#NOF) \nin the UK, annually, with up to 10% missed on initial plain radiographs. Additional \nimaging is recommended where there remains high index of suspicion. In some \ncircumstances, MRI may be unavailable or contraindicated, thus CT is used. It is \nsuggested (not prove) MRI is superior. We aim to review the use of CT and MRI \nscans for suspected #NOF.\nMethods and Materials: Retrospective review of all patients presenting to The \nRoyal Infirmary of Edinburgh with a suspected occult hip fracture, negative initial \nplain radiographs, undergoing CT or MRI, over a 5-year period.\nResults: A total 201 patients were included in this study. 118 underwent MRI and \n83 had CT. The average time to further imaging was 8.31 and 6.94 days for MRI \nand CT, respectively. Occult #NOF was identified in 37/118 (31.4%) of MRI scans \nand 38/83 (45.8%) on CT. 78.4% of patients with positive MRI and 73.7% with \nB‑0776 11:33\nA new trial with a newly designed Y-shaped covered stent for the \npalliative treatment of hilar malignant obstruction of liver: mid-term result \nB. Kang1, G. Jung2; 1Seoul/KR, 2Busan/KR (kangbc@ewha.ac.kr) \nPurpose: To investigate the efficacy of a newly designed Y-shaped covered stent \nfor the hilar malignant biliary obstruction.\nMethods and Materials: From June 2011 to June 2012, we inserted the Y-shaped \ncovered stents to treat palliatively in the patients with the hilar malignant biliary \nobstruction. To have a Y-configuration for the biliary drainage of both lobes of liver, \nwe used two pieces of covered stent system: one covered main piece stent and \none contra-lateral covered stent. Before and 3 days after Y-covered stent insertion, \ncholangiograms were obtained through the IHD for the evaluation of biliary drainage \nof both lobes of liver. We checked the blood bilirubin levels before, 1 week after \nand every 1 month after the stenting.\nResults: They were 16 patients including 12 women and 4 men. They had inoper-\nable intrahepatic cholangiocarcinomas in 15 and two metastatic biliary obstructions \ndue to breast and stomach cancers. Obstructive types were 2 in I, 7 in II, 5 in IIIa \nand 2 in IV. The placement of the Y-shaped covered stent was successful in all \ncases. The mean follow-up period was about 6 months. All cases had showed ad-\nequate biliary drainages in the follow-up tubograms. The bilirubin levels had been \nnormalised 2 weeks after being the Y-covered stent inserted except one patient. \nThere were no clinical infectious signs during the follow-up period. Mean patency \nrate was about 6.2 months (185 days).\nConclusion: A newly designed Y-shaped covered stent would be clinically effec-\ntive for the palliative treatment of hilar obstructive malignant carcinoma of liver. \nB‑0777 11:42\nThe comparison of balloon-occluded retrograde transvenous \nobliteration for gastric varices using liquid and foam sclerosants \nJ. Koizumi1, K. Myojin1, C. Itou1, N. Mori1, T. Sekiguchi1, T. Hara1, \nT. Ichikawa1, Y. Imai1, B. Janne d’Othée2; 1Isehara/JP, 2Baltimore, MD/US \n(jkoizumi@is.icc.u-tokai.ac.jp) \nPurpose: Liquid ethanolamine oleate which has been used traditionally for balloon-\noccluded retrograde transvenous obliteration (BRTO) of the gastric varices (GV) \nmay cause severe complications including haemolysis, allergy, etc. if overdosed. \nThus, we introduced foam sclerotherapy to reduce the dose and compared the \nsafety and efficacy of BRTO using liquid and foam sclerosants.\nMethods and Materials: Forty-three patients with gastric varices were performed \nBRTO since October ‘01. Of these, three patients were excluded because simul-\ntaneous TACE or PSE was performed. Twenty patients using liquid ethanolamine \noleate with iodine contrast (EOI) before March ‘05 and twenty patients using \npolidocanol foam (POF) after May ‘05 were included in this study. The success \nrates, side effects and complication rates were compared among the two groups.\nResults: Complete stasis of the gastric varices was obtained in all patients of both \ngroups. Abdominal symptoms during BRTO were significantly (p < 0.05) higher in \nEOI (55%) than POF (15%). Postprocedure fever (> 38.0) was also significantly (p < \n0.01) higher in EOI (55%) than in POF (0%). In both groups total bilirubin increased \nand platelet counts decreased significantly (p < 0.01). However, the decrease \nratio of platelet counts was significantly (p < 0.05) higher in EOI (-21.1±15.8%) \nthan POF (-9.4±13.1%). Although lactate dehydrogenase increased significantly \n(p < 0.01) from 366.1±168.2 to 969.4±420.7 in EOI group, it was stable (from \n229.7±36.5 to 244.6±86.5) in POF group. One patient died of ARDS one week \nafter BRTO using EOI.\nConclusion: Foam polidocanol provided less invasive BRTO than liquid eth-\nanolamine oleate with comparative clinical success. \nB‑0778 11:51\nComparison of outcomes of endovascular treatment with stent \nplacement in patients with early and late hepatic venous outflow \nobstruction (HVOO) \nG. Viteri, J. Etxano, P. Slon, F. Rotellar, J.I. Herrero, A. Benito, J.I. Bilbao; \nPamplona/ES (gviteri@unav.es) \nPurpose: To retrospectively evaluate the long term results of stent placement in \npatients with early and late HVOO after orthotopic liver transplantation.\nMethods and Materials: 8 patients with early HVOO (A) and 8 patients with late \nHVOO (B) were recruited from 1996 to 2011. All patients were treated with self \nexpandable stents and pre/post procedural pressure gradients were measured. \nFollow-up included venographic studies, cross-sectional imaging and laboratory \ntests. Pearson’s chi-squared test was used to compare patient and graft survival, \n6\n\nScientific Sessions\nS32\nA\n C D E F G\nB\nMonday\nB‑0783 11:06\nLower-limb MRI examination as a predictive factor of articular \ncollapse in haematological young patients with femoral head \nosteonecrosis: lesion surface versus lesion volume \nA. Masetto, D. Ippolito, P.A. Bonaffini, D. Fior, A.S. Casiraghi, S. Sironi; \nMonza/IT (dr.masetto@gmail.com) \nPurpose: To compare the reliability of the femoral head volume (FHV) versus \nfemoral head surface (FHS) to predict articular collapse in paediatric patients with \nosteonecrosis and lymphoproliferative disease.\nMethods and Materials: 109 patients with lymphoproliferative disease and clinical \nsuspicion of femoral head osteonecrosis following therapy underwent a lower-limb \nMRI examination between November 2006 and August 2012. The study was per-\nformed on a 1.5 T scanner (Philips, Achieva) with step-table technique, acquiring \nshort tau inversion recovery (STIR) and T1-weighted sequences in the coronal \nplane, from the hips to the ankles. 13 patients (7 males, mean age 15.2±4.8 years) \ndeveloped femoral head osteonecrosis, without articular deformity (23 heads af-\nfected). During the follow-up (9.2±2 months), 13 femoral heads developed articular \ndeformity. On baseline MRI two radiologists measured FHV, FHS, the osteonecrosis \nvolume (ONV) and the articular surface involved by osteonecrosis (ONS). The \nrelative involvement of the femoral heads in terms of volume (RV: ONV/FHV) and \narticular surface (RS: ONS/FHS) was then calculated.\nResults: Using ROC curve analysis, and considering a threshold of 24% of vol-\nume involvement, RV predicted articular deformity in 13/13 femoral heads, with \nsensitivity=100%, specificity=90%, accuracy=95%, PPV=93% and NPV=100%. \nConsidering a threshold of 50% of articular involvement, RS predicted articular \ndeformity in 10/13 femoral heads, with sensitivity sensitivity=77%, specificity=100%, \naccuracy=87%, PPV=100% and NPV=77%.\nConclusion: RV proved to be a more reliable parameter than RS, with a high \nprognostic value, in predicting femoral head deformity, and can be considered a \nvalid complementary---diagnostic tool in the follow-up of haematologic paediatric \npatients with osteonecrosis.\nB‑0784 11:15\nAlpha angles and herniation pits: revisited on MRI in 80 \nasymptomatic hip joints \nE. Lee, J.-A. Choi, G. Lee, H. Kang; Seongnam-si/KR \n(silvercherry20@gmail.com) \nPurpose: To evaluate alpha angles and herniation pits on MRI in asymptomatic \nhip joints and analyse their associations with demographic variables and with \neach other.\nMethods and Materials: 80 hip joints of 44 adults who underwent hip MRI due \nto trauma or unilateral pelvic symptoms from September 2011 through June 2012 \nwere retrospectively studied, among the initial 114 hips of 57 patients.\nResults: The range of alpha angles was 27.73-65.03 degrees with average 41.97 \ndegrees. 11 out of 80 (13.75%) hip joints showed alpha angle of greater than 50 \ndegrees. There was no significant correlation between alpha angle and age, gender, \nand laterality of hip joint. There was no significant difference of prevalence of alpha \nangle greater than 50º in joints with herniation pit and joints without herniation pit. \nThe intraobserver agreement of alpha angle measurements was excellent (0.808 \nin right, 0.823 in left). Of 80 hip joints, 19 (23.75%) joints had herniation pits, with \nno difference according to age, gender, or laterality of hip joint.\nConclusion: The prevalence of herniation pit in asymptomatic patients was 23.75%, \nsimilar to those reported in FAI. Alpha angle may be reliably evaluated on oblique \naxial MR images and shows a wide range in asymptomatic patients. Therefore, \nthe presence of herniation pit and increased alpha angle may not be necessarily \nassociated with FAI. \nB‑0785 11:24\nGluteus tendinopathy in femoroacetabular impingement (FAI): \nfindings with MR-artrography of the hip \nE. Lanza1, G. Pozzi1, C. Garcia Parra2, R. Bisogno1, A. Zerbi1; 1Milan/IT, \n2Bergamo/IT \nPurpose: Femoroacetabular impingement (FAI) is suspected in patients with groin, \nhip or gluteal pain. Magnetic Resonance Arthrography (MRA) of the hip is used for \ndiagnosis of FAI and study of extra-articular tissues. We incidentally observed a \nrelevant number of gluteus medius and minimus tendinopathy (GT). Our purpose \nwas to study associations between FAI and GT.\nMethods and Materials: We retrospectively reviewed 59 symptomatic patients \n(26 women,41%; 36 men, 59%; mean age 42 ±11.6) who underwent MRA of the \npositive CT underwent surgery. Occult acetabular fractures were detected in 15.9% \nof patients with negative scans for #NOF, and pubic rami fractures in 17.5%. No \npatient with a negative scan was readmitted for surgery within 12 months.\nConclusion: CT and MRI can both be equally effective tools in assessing occult \n#NOF. Clinically significant occult fractures are not missed by either modality. In \norder to achieve targets for surgery within 48 hours of admission, the imaging \nmodality that can be completed within the shortest time-frame should be selected. \nB‑0781 10:48\nDigital tomosynthesis in diagnosis of occult hip fractures \nM. Geijer1, D. Collin2, J.H. Göthlin2; 1Lund/SE, 2Mölndal/SE (ecr2013@geijer.info) \nPurpose: Digital linear tomosynthesis has recently been introduced not only for \nmammography but also for chest and musculoskeletal indications. The clinical \nutility in musculoskeletal applications has been validated in only a few reports. The \npurpose of the current study was to evaluate the clinical utility of tomosynthesis \nin suspect occult hip fracture.\nMethods and Materials: In a retrospective review 70 tomosynthesis hip examina-\ntions on 49 women and 21 men performed for further evaluation of suspect hip \nfracture were retrieved from the radiology archive. Three observers scored the \ntomosynthesis scans separately from the radiography examinations, into the cat-\negories no proximal femur fracture, suspect proximal femur fracture (femoral neck, \ntrochanteric, or greater trochanteric avulsion) or definite proximal femur fracture. \nCT, MRI or clinical outcome was used as reference.\nResults: Observer variation was moderate to substantial for three observer pairs \nregarding radiography (k=0.56-0.8) and improved to substantial to almost perfect \nfor tomosynthesis (k=0.76-0.93). Eleven patients were operated on for femoral neck\nfracture. Tomosynthesis detected ten of these, and the eleventh patient was oper-\nated on without diagnostic confirmation from any imaging modality. One patient had \nbeen operated with dynamic hip screw for intertrochanteric fracture. The remaining \ntrochanteric fractures were incomplete and were treated conservatively. There were \nno false-positive tomosynthesis diagnoses reported. There were no significant false-\nnegative tomosynthesis diagnoses. The distinction between incomplete/complete \ntrochanteric fractures and greater trochanteric avulsions is sometimes difficult.\nConclusion: Tomosynthesis has the possibility to aid in diagnosis and strengthen \nthe diagnosis in suspect occult hip fracture. \nB‑0782 10:57\nAdvanced core decompression for patients with avascular necrosis \nof the hip: therapeutic success monitored by MRI \nA. Lazik, O. Kraff, T. Claßen, S. Landgraeber, F. Grabellus, T.C. Lauenstein, \nJ.M. Theysohn; Essen/DE (andrea.lazik@uk-essen.de) \nPurpose: Advanced core decompression (ACD) is in clinical evaluation for patients \nwith avascular necrosis (AVN) of the hip. In opposition to standard core decompres-\nsion, ACD uses an expandable reamer allowing optimal debridement of necrosis \nafter drilling a core to the femoral head. The bone defect is filled with a bone graft \nsubstitute. We aimed to constitute the therapeutic success of ACD based on MRI.\nMethods and Materials: Twenty patients (17 males, 3 females, mean age 49.9 \nyears) underwent 3 T MRI of the hip prior to, 30 days and 0.5 - 2 years after ACD. \nThe protocol included TIRM, PD/T2w TSE, high-resolution T1w, DESS and T1w \nVIBE sequences. Sequences were evaluated regarding delineation of necrosis, \nbone, graft and transformation zone in between. The volume of necrosis was \nmeasured before and after ACD.\nResults: AVN prior to ACD as well as the defect filled with the graft after ACD and \nthe residual necrosis could be imaged with reproducible high quality at 3 T. T1w and \nPDw sequences provided best contrast to measure the volume of necrosis. Each \npatient showed a reduction of necrosis after ACD (17.7 % to 90.8 %, mean 43.0, \nSD 24.2). The granulation zone around the graft could especially be visualised by \nT2w TIRM and PDw sequences. The arrangement of different layers correlated \nwith histological findings.\nConclusion: Structural changes and reduction of necrosis after ACD can be \nmonitored by MRI. ACD does significantly reduce the volume of necrosis in AVN \nof the hip.\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nConclusion: The MRE study after oral administration of PEG solution provides an \naccurate assessment of small-bowel involvement, allowing an evaluation of disease \nactivity in patients with known CD, reducing the radiation exposure in young patients.\nB‑0788 11:51\nMetal artefact reduction in hip prosthesis with iterative reconstructions \nF. Morsbach1, S. Bickelhaupt1, G. Wanner1, A. Krauss2; B. Schmidt2, H. Alkadhi1, \n1Zurich/CH, 2Forchheim/DE \nPurpose: To evaluate the effect of a novel iterative frequency split-normalised \n(IFS) metal artefact reduction (MAR) on image quality of computed tomography \n(CT) in hip-prosthesis.\nMethods and Materials: In the first study-part, an artificial hip-phantom with steel \nand titan-based shafts, using three inlays of water, fat and contrast-media placed \nin the pelvis, was used to test and optimise the IFS algorithm. Image quality and \naccuracy of CT number measurements of inlays were determined. In the second \nstudy-part, 41 consecutive patients with unilateral (n=32) or bilateral (n=9) hip-\nprosthesis were included. Datasets using filtered back projection (FBP), IFS and a \npreviously published MAR algorithm using linear-interpolation were reconstructed. \nTwo readers evaluated axial, coronal and sagittal CT image reformations for overall \nimage quality and evaluated image quality of pelvic organ depiction; CT numbers in \nthe urinary bladder, gluteal muscle and subcutaneous fat were measured.\nResults: Ex-vivo experiments revealed the best image quality for IFS. Measure-\nments of CT numbers of the inlays were more accurate for IFS. In patients, we \nfound a significant improvement in overall image quality for all reformations (P < \n0.001) and a significantly increased image quality of pelvic organs (P < 0.001) for \nthe IFS algorithm. CT numbers of the bladder (P < 0.001) and muscle (P=0.043) \nwere significantly less variable for IFS as compared with images reconstructed with \nFBP and the linear interpolation MAR algorithm, whereas we found no significant \ndifference for fat (P=0.159).\nConclusion: The IFS algorithm significantly reduces metal artefacts from hip-\nprostheses, increases image quality and improves measurement accuracy of CT \nnumbers as compared with FBP and linear interpolation MAR algorithms. \nAuthor Disclosures:\nB. Schmidt: Employee; Siemens Healthcare, Germany.\n10:30 - 12:00 Room E2 \nGI Tract \nSS 1701a \nCT/MR colonography: technical issues and clinical \nstudies \nModerators: \nD. Cano; Pamplona/ES \nD.Z. Saranovic; Belgrade/RS \nB‑0789 10:30\nCT colonography: accurate registration of prone and supine \nendoluminal surfaces of the colon \nT.E. Hampshire, H.R. Roth, E. Helbren, A. Plumb, D. Boone, G. Slabaugh, \nS. Halligan, D.J. Hawkes; London/UK (thomas.hampshire.09@ucl.ac.uk) \nPurpose: Computed tomographic (CT) colonography is a technique for detecting \nbowel cancer or potentially precancerous polyps. Because retained fluid and stool \ncan mimic pathology, CT data are acquired with the patient in both prone and supine \npositions. Radiologists then match endoluminal locations between the two acquisi-\ntions to determine whether pathology is real. This process is hindered by the fact \nthat the colon can undergo large deformations that often occur during repositioning \nof the patient. Automated registration between datasets could potentially improve \nefficiency and diagnostic accuracy.\nMethods and Materials: We have developed software to establish correspondence \nbetween prone and supine endoluminal surfaces. An initialisation step generates \nimage patches at the positions of haustral folds using depth map renderings and \nis optimised by virtual camera registration. Additional neighbourhood information \nis then included in a Markov Random Field model to establish landmark-based \ncorrespondences. Subsequently, the complexity of the registration task is reduced \nby mapping both prone and supine surfaces onto a cylindrical domain in which \ncorrespondence is established using non-rigid image registration.\nResults: The registration was applied to 17 CTC cases including cases exhibiting \nluminal collapse, achieving fold matching accuracy of 96%. Providing an accurate \nhip for clinical suspect of FAI in a seven-month period. Intra-articular gadolinium \ninjection (10 cc) was obtained under fluoroscopic guidance.\nResults: MRA confirmed FAI in 45 patients (76%): 7 (15.6%) showed a PINCER \nimpingement, 26 (57.8%) patients had a CAM type and 12 (26.7%) showed a mixed \ntype. No impingement was found in 14 (23.8%) patients. In 30 patients (51%) we \nfound degenerative alterations of medius and minimus gluteus tendons; 22 (37.3%) \nhad a concurrent diagnosis of FAI; 8 (13.6%) had no alterations. Overall, 22 patients \n(37.3%) showed both FAI and GT; 23 patients (39%) had FAI alone; 8 patients \n(13.6%) had isolated GT; 6 patients (10%) had a negative examination. GT showed \nto be more common in a 40-60 age range (p < 0.0001) and in females (53.3%) (p \n< 0.044). Younger patients (< 40years) did not show alterations in 82.8% of cases.\nConclusion: Gluteus medius and minimum tendinopathy occurs among patients \nwith clinically suspected FAI and may contribute to pain. In some patients it may be \nthe only responsible for symptoms. Careful study of the great trochanteric entheses \nshould not be undervalued when looking for FAI. \nB‑0786 11:33\nEvaluation of a new method for the assessment of anterior \nacetabular coverage and hip joint space narrowing \nR. Ferré, E. Gibon, A. Feydy, H. Guerini, R. Campana, N. Zee, C. Bourdet, \nM. Hammadouche, J.-l. Drapé; Paris/FR (kn638@yahoo.fr) \nPurpose: The Lequesne’s false profile (LFP) view is commonly used to evaluate \nhip joint space narrowing (JSN) and anterior acetabular coverage using the vertical-\ncenter-anterior margin (VCA) angle. A novel low-dose biplanar slot scanner (SS) \nallows simultaneous acquisitions of weight-bearing oblique views of both hip joints. \nThe aim was to compare LFP views versus biplanar oblique views obtained by SS.\nMethods and Materials: LFP views were obtained on 56 hips on a computed \nradiography system. On the same hips, simultaneous oblique views of both hips \nwere acquired in the SS, with the patient’s pelvis positioned at 45° from each ac-\nquisition plane. Two independent observers measured VCA angle and JSN on each \nacquisition. JSN was evaluated through the joint space/femoral head diameter ratio. \nMeasurements from both techniques were compared using the student t-test and \nthe Pearson’s correlation coefficient. Interobserver agreement of VCA angle and \nJSN assessments were calculated with the intraclass correlation coefficient (ICC).\nResults: VCA angle was 33.5° (SD = 6.2°) with SS and 35° (5.6°) with LFP views \n(p < 0.05). Pearson correlation coefficient between two techniques was 0.78 (p < \n0.01). JSN was 0.114 (SD = 0.03°) with SS and 0.108 (SD = 0.03°) with LFP views \n(p < 0.05). Pearson correlation coefficient was 0.85 (p < 0.01). ICCs for VCA angle \nwere 0.91 with SS and 0.69 with LFP views. ICCs for JSN evaluation were 0.76 \nfor both SS and LFP views.\nConclusion: SS is a reliable, easy, and low-dose evaluation of JSN and VCA angle \ndespite a slight angular positioning compared with LFP. \nB‑0787 11:42\nDiagnostic value of MR enterography (MRE), after oral administration \nof glucose-polyethylene, in the determination of the activity of \ndisease in patients with known Crohn’s disease: a prospective \nsingle centre study \nV. Bartolo, D. Ippolito, C. Trattenero, P.A. Bonaffini, V. Besostri, S. Sironi; \nMonza/IT (bartolo.valentina@yahoo.it) \nPurpose: To evaluate the role of magnetic resonance enterography (MRE) after \noral administration of isotonic glucose-polyethylene glycol (PEG) in monitoring \ndisease activity in Crohn’s disease (CD).\nMethods and Materials: Forty-eight patients (M 32, mean age 43) with histological \ndiagnosis of CD and suspicion of recurrence based on clinical data and CD activity \nindex (CDAI) underwent an MRE study 45 minutes after the oral administration of \n1.5-2 litres of PEG, on 1.5 T magnet and using a surface phased-array body coil. \nThe study protocol included axial and coronal T1-weighted, sSShT2 and sBTFE \nsequences and dynamic contrast-enhanced THRIVE. The intestinal and extra-\nintestinal manifestations of disease were evaluated by two radiologists blinded to \nclinical and pathological findings, analysing: the degree of bowel distention, wall \nthickening and enhancement, lymph-node enlargement, stranding of fat tissue, \npresence of fistulas or abscesses.\nResults: Oral administration of PEG solution was well tolerated by patients, \nwithout major complications (moderate diarrhoea in 4 patients). A good relaxation \nof the small intestine was obtained in 44 patients (91%). The MRE study showed \nrecurrence in 37 patients (77%) as mural enhancement in 36 cases (74%), layered \nenhancement in 24 (50%), comb sign in 14 (29%), stranding of fat tissue in 10 \n(20%), mesenteric node involvement with intense enhancement in 18 (37%) and \nextra-intestinal manifestations (fistulas and sclerosing cholangitis) in 14 (29%).\n28\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nrecurrences in 3 patients (2 hepatic and 1 lung metastases) but missed a 7 mm \nsessile polyp and 2 flat lesions. CTC quality was inadequate in the 11% of patients.\nConclusion: CTC can be effective and represents a valid alternative to colonoscopy \nfor surveillance for colorectal cancer recurrence after surgery.\nB‑0792 10:57\nCT colonography: comparative study of experienced vs non-\nexperienced radiologists using 3D flythrough approach with and \nwithout CAD software \nF. Vecchietti, M. Rengo, D. Caruso, C.N. De Cecco, D. Bellini, A. Laghi; Latina/IT \n(fabrizio.vecchietti@gmail.com) \nPurpose: To compare performances of different experienced readers using a \nprimary 3D flythrough approach with and without the use of a CAD analysis.\nMethods and Materials: Three readers evaluated 50 patients with 100 endoscopi-\ncally proved polyps (ranging from 3 mm to 40 mm) and different colonic preparations \n(18 fluid tagging, 32 full cathartic preparation). Dataset analyses were performed \non a GE ADW 4.6 workstation equipped with VCAR colon software. Per-polyp \nsensitivity, inter-reader agreement, mean reporting time and false positive were \nevaluated for each approach.\nResults: Less experienced readers increased per-polyp sensitivity, respectively, \nfrom 75% and 64% for 3D analysis to 86% and 74% for primary 3D+CAD analysis \nwith a significant difference (p=0.001 and p=0.04) while no significant differences \nwere found for the expert reader (p=0.06). Less experienced readers were faster \nwhen assisted by CAD but no significant differences were found on mean reading \ntime for all readers (p= 0.5/0.07/0.1). Mean false-positive findings for CAD stand-\nalone analysis were 12 (+-13). All readers decrease false positive when assisted \nby CAD especially less experienced ones. Inter-reader agreement was higher \namong all readers when assisted by CAD (0.33 to 0.63/0.39 to 0.62/0.58 to 0.65)\nConclusion: Our study demonstrated that if less experienced readers were assisted \nby CAD they increase their sensitivity significantly. They have other non-significant \nadvantages like the reduction of false positive rate and mean reporting time. \nB‑0793 11:06\nCT colonography bowel preparation: influence of a laxative agent on \na fluid tagging preparation \nM. Rengo, D. Bellini, M.M. Maceroni, F. Vecchietti, D. Caruso, P. Lucchesi, \nA. Laghi; Latina/IT (marco.rengo@gmail.com) \nPurpose: To compare two different bowel preparation in terms of patient accept-\nance and image quality.\nMethods and Materials: Seventy-five consecutive patients were prospectively \nrandomised into two groups. Both groups followed a low residue diet for two days \nbefore the examination. Both preparations were based on fluid tagging, using a \niodinate contrast medium (gastromiro). Group 1 received 180 ml of fluid tagging \nagent the day before the study. Group 2 received 60 ml of fluid tagging agent the \nday of the exam and 500 ml of a laxative agent (Lovol-esse) the day before the \nstudy. Patient acceptance was evaluated using a visual assessment scale. Quality \nof bowel preparation was evaluated using quantitative (tagged fluid density and \nnumber of untagged residue per segment) and qualitative (homogeneity per seg-\nment on a 4 point scale) scores.\nResults: Bowel preparation was complete in all patients. No statistical significant \ndifferences for tagged fluid density, number of residue and tagging homogeneity \nbetween the two groups were founded. A significant higher patient acceptance was \nfounded in group 2 (P=0.02).\nConclusion: The preparation based on the combination of a laxative and a fluid \ntagging agents was better accepted. Adding a laxative agent to a fluid tagging \npreparation did not improved image quality but was associated with an higher \npatient acceptance. Moreover, the if a laxative agent is added to a fluid tagging \nbowel preparation the amount of iodine can be reduced. \nB‑0794 11:15\nFlat lesions: CTC with and without CAD \nG. Mazza, T. Natilla, M. Morone, B. Frittoli, G. Baiocchi, L. Grazioli; Brescia/IT \n(dottormazza@gmail.com) \nPurpose: To retrospectively evaluate the diagnostic accuracy of computed to-\nmography colonography (CTC) to identify the flat lesions (reference standard: \noptical colonscopy OC) by an expert reader and a novice reader. To evaluate the \ncontribution provided by a CAD system as a second reader.\nMethods and Materials: From 2010 to 2011, 90 patients underwent over a period \nnot exceeding four months both examinations of CTC and OC. Considering the \nlatter as a reference method, CTC examinations were retrospectively and blindly \ninitialisation, the method significantly improved the cylindrical registration (p < \n0.001), achieving a mean error of 6.0 mm measured at 1743 reference points.\nConclusion: The proposed method can successfully establish correspondence \nbetween prone-supine locations on the endoluminal surface derived from CT \ncolonography. The ability to rapidly and automatically match polyps between \nacquisitions will facilitate CT colonography interpretation. \nAuthor Disclosures:\nT.E. Hampshire: Research/Grant Support; MedicSight sponsered early \nwork of CMIC project. G. Slabaugh: Employee; Ex-employee of MedicSight. \nS. Halligan: Grant Recipient; Holds NIHR Programme Grant in clinical radiology \n(CTC).\nB‑0790 10:39\nA multi-centre randomised double-blind placebo-controlled trial \nto evaluate the value of a single bolus intravenous alfentanil in CT \ncolonography \nT.N. Boellaard, M.P. van der Paardt, M.W. Hollmann, S. Eberl, J. Peringa, \nG. Kavaliauskiene, J.H. Runge, J.A.W. Tielbeek, J. Stoker; Amsterdam/NL \n(t.n.boellaard@amc.uva.nl) \nPurpose: To evaluate whether a single intravenous alfentanil bolus has a clinically \nrelevant analgesic effect compared with placebo in patients undergoing elective \nCT colonography.\nMethods and Materials: A prospective multi-centre randomised double-blind \nplacebo-controlled trial was performed in 90 consenting symptomatic or surveil-\nlance patients scheduled for elective CT colonography. Patients were randomised \nto receive either a bolus of 7.5 μg/kg alfentanil (n=45) or placebo (n=45). The \nprimary outcome was the difference in maximum pain during colonic insufflation on \nan 11-point numeric rating scale (one-sided t test). We defined a clinically relevant \neffect as a maximum pain reduction of at least 1.3 points. Secondary outcomes \nincluded total pain and burden of CT colonography (5-point scale), most burden-\nsome aspect, side effects and recovery time measured by the Aldrete score.\nResults: Maximum pain scores during insufflation were lower with alfentanil as \ncompared with placebo, 5.3 versus 3.0 (p < 0.001). Total CT colonography pain \nand burden were also significantly lower with alfentanil (2.0 vs. 1.6 and 2.1 vs. \n1.7, respectively). With alfentanil fewer patients rated the insufflation as most \nburdensome aspect (56.1% vs. 18.6%; p=0.001). No clinically relevant desatura-\ntions occurred. Episodes with desaturations < 90% SpO2 and dizziness were \nmore common with alfentanil (4.4% vs. 37.8%; p < 0.001 and 8.1% vs. 44.4%; p < \n0.001). Aldrete scores in the alfentanil group were significantly lower immediately \nafter the procedure, but similar at 30 and 60 minutes.\nConclusion: A low-dose intravenous alfentanil bolus provides a clinically relevant \nreduction of maximum pain during CT colonography. Alfentanil may improve the \nacceptance of CT colonography. \nB‑0791 10:48\nThe possible role of contrast material-enhanced computed \ntomographic colonography (CTC) in the surveillance after surgery \nfor colorectal cancer \nM. Morone, G. Mazza, T. Natilla, G. Baiocchi, M. Ghedi, E. Dettori, B. Frittoli, \nL. Grazioli; Brescia/IT (mariomorone@libero.it) \nPurpose: To evaluate the accuracy of contrast material-enhanced computed to-\nmographic colonography (CTC) for follow-up after curative surgery for colorectal \ncancer without evidence of disease recurrence.\nMethods and Materials: 86 patients underwent CTC and colonoscopy (within \n4 months) after colorectal cancer surgery. Patients with the suspicion of disease \nrecurrence underwent pathologic confirmation. Patients performed bowel cleansing \nand faecal tagging; bowel distention was achieved using CO2. Both prone and \nsupine scans, one after intravenous contrast material administration during the \nportal phase, were obtained using a 64-detector CT (“Brilliance” Philips with iDose). \nImages were reconstructed with a section thickness of 0.75 mm, transferred to a \nworkstation and interpreted by one radiologist with experience reading several \nhundred CTC cases. Sensitivity, specificity, positive predictive value (PPV), and \nnegative predictive value (NPV) of CTC for anastomotic and non-anastomotic \ncolonic lesions (metachronous or flat lesions and polips) were determined and \ncompared to endoscopy.\nResults: CTC detected all 2 anastomotic recurrences, all 3 metachronous le-\nsions (sensitivity and specificity=100%) and a perianastomotic recurrence. In 13 \npatients CTC depicted 16/17 polips > 5 mm (sensitivity=94.1%, specificity=100%, \nVPP=100%, VPN=98.6%, accuracy= 98.8%) and in 1 patient detected 1 of 3 flat le-\nsions (sensitivity=33.3%, specificity=100%). CTC enabled detection of extracolonic \n29\n\nScientific Sessions\nS33\n C A D E F\n G\nB\nprevalence and distribution was related to patient gender (p> 0.05). In sigma, ad-\nvanced disease (grade 2/3) shows a significant positive correlation with reduced \ncolonic distension (p < 0.05). No correlation was found between severity of sigmoid \ndiverticula and symptoms onset.\nConclusion: Prevalence and severity of diverticular disease increased over time \nin all colonic segments. An elevated number of asymptomatic diverticula is present \nin the right colon. An high percentage of patients with severe sigmoid diverticular \ndisease remain asymptomatic. \nB‑0797 11:42\nAccuracy of water enema-MDCT in colon cancer staging: a \nprospective study \nC. Ridereau-Zins1, E. Sibileau1, A. Pavageau1, D. Vanel2, \nE. Lermite1, E. Metivier-Cesbron1, C. Aube1; 1Angers/FR, 2Bologna/IT \n(Caridereauzins@chu-angers.fr) \nPurpose: To assess the accuracy of water-enema multi-detector computed tom-\nography (WE-MDCT) in extra-rectal colon cancer staging.\nMethods and Materials: Fifty-three patients (mean age 70 years) with extra-rectal \ncolon cancer proven by colonoscopy and biopsy were prospectively evaluated \nby preoperative WE-MDCT. CT scans were both intraluminally (water enema or \nWE) and intravenous (iodinated) contrast enhanced (CE). All patients underwent \nsurgery. Tumours were classified with the TNM staging system. Noted CT features \nwere: tumour size and location; tumour form and edges; spread to the pericolic \nfat or neighbouring organs; thickening of retroperitoneal fascia; number, size and \nenhancement of the peritumoral lymph nodes. Tumours were classified on CT into \n3 T-stage groups: T1/T2, T3 and T4. Lymph nodes were classified by their density \nafter injection (positive over 100 Hounsfield units (HU)).\nResults: Tumour localisation to the specific colon segment was correct in all the \ncases. The agreement between WE-MDCT staging and histopathology staging was \ngood (k=0.64). A stiff aspect of the external edges of tumours provided excellent \nsensitivity for T3/T4 inclusion (Se 97.7%, NPV 85.7%). Thickening of a fascia or \nthe abdominal wall provided good specificity for T4 stage (Sp 88.1%, NPV 94.9%). \nEnhancement over 100 HU of at least one peritumoral lymph node was the best \ncriterion of N+ staging (Sp 67.7%, NPV 87.5%).\nConclusion: WE-MDCT permits good staging of colon cancer based on objec-\ntive features. \nB‑0798 11:51\nFeasibility study of low-dose CT colonography using model-based \niterative reconstruction: preliminary findings in 20 patients \nV. Vardhanabhuti, C. Roobottom; Plymouth/UK (vvar@me.com) \nPurpose: To compare image quality on computed tomographic (CT) images ac-\nquired at standard dose (SD) and low dose (LD) using adaptive statistical iterative \nreconstruction (ASIR) and model-based iterative reconstruction (MBIR) techniques.\nMethods and Materials: 20 patients were prospectively recruited for the study \nwith informed consent. They underwent standard dose (SD) and low-dose (LD) \nCT colonography. Low-dose parameters were based on our phantom study with \nusing vendor-specific automatic tube current modulation known as noise index. \nBoth sets of scans were reconstructed with ASIR and MBIR. Objective and subjec-\ntive image qualities were assessed as well as diagnostic accuracies for significant \nlesions (e.g. polyps, cancer, etc). Effective doses for each scans were recorded.\nResults: Objective image analysis supports significant noise reduction and superior \ncontrast-to-noise ratio with low-dose scans using MBIR technique (p < 0.05) despite \nbeing acquired at lower doses. Subjective image parameters were equivalent for \nLD MBIR and SD ASIR for both colonic and extra-colonic findings. Diagnostic ac-\ncuracies for polyp detection and other significant lesions were comparable. Dose \nrecorded were substantially lower for MBIR (range 45-75% reduction compared \nwith ASIR) with mean average being 4.2 mSv in our population group.\nConclusion: MBIR shows superior reduction in noise whilst maintaining image \nquality and most importantly substantial dose reduction can be achieved. More \npatients are being recruited to substantiate diagnostic accuracies data with full \nresults to be presented at the ECR 2013. \nreviewed by two readers separately respectively having a degree of initial and ad-\nvanced experience (for both primary 3D view). Calculated values were sensitivity, \nspecificity, NVP, PVP for patient-to-segment and both without and with the use of \nthe CAD system (im3D-Turin) as the second reader.\nResults: The OC showed 54 flat lesions in 23 patients. The values [[Unable to \nDisplay Character: ​]][[Unable to Display Character: ​]]of sensitivity, \nspecificity, NVP, PVP reported by the novice radiologist were respectively: 55%, \n76%, 55% and 80%, while the values obtained by the radiologist with advanced \nexperience were equal to 67%, 89%, 75%, 91%. With the use of CAD as a second \nreader the novice player has achieved an improvement of the sensitivity to 62%, \nwhile the skilled reader did not obtain a significant increase of’ diagnostic accuracy.\nConclusion: The sensitivity and NPV of CTC for flat lesions depend on the experi-\nence of the radiologist reader. CAD seems to be an effective aid for the novice \nradiologist only. \nB‑0795 11:24\nMR colonography to screen for colorectal neoplasia in asymptomatic \nadults \nA. Graser, A. Melzer, E. Lindner, P. Stieber, M.F. Reiser, B. Göke, F.T. Kolligs; \nMunich/DE (anno.graser@med.uni-muenchen.de) \nPurpose: To test whether high field MR colonography could serve as a screening \ntest for adenoma ³6 mm and advanced adenoma in asymptomatic adults.\nMethods and Materials: 286 asymptomatic adults aged 40-82 years underwent \nFOBT testing, same-day 3 Tesla MR colonography and colonoscopy. Segmental \nunblinding of the colonoscopist to the results of MR colonography. MR was per-\nformed after injection of Gadolinium contrast agent using high resolution 3D VIBE \nsequences. All detected lesions were removed or biopsied during colonoscopy. \nFor each of six colonic segments, presence or absence of polyps was assessed. \nPer-polyp sensitivities and per-patient sensitivities, specificities, positive and nega-\ntive predictive values including 95% confidence intervals (CI) were determined for \nadenoma of various size categories and advanced adenoma.\nResults: 133 adenomas and 2 cancers were diagnosed in 86 patients. 37 adenom-\nas were ³6 mm and 20 adenomas were advanced. Sensitivities of MR colonography \nand colonoscopy for adenoma ³6 mm were 78.4% (95% CI, 61.8-90.2) and 97.3% \n(85.8-99.9), and 75% (50.9-91.3) and 100% (83.2-100.0) for advanced adenoma, \nrespectively. MR colonography, colonoscopy, and FOBT identified 86.7% (96.3-\n96.2), 96.7% (82.8-99.9), and 6.9% (0.8-22.8) of individuals with adenoma ³6 mm, \nand 82.4% (56.6-96.2), 100% (80.5-100.0), and 12.5 (1.6-38.3) of individuals with \nadvanced adenoma, respectively. Specificity of MR colonography, colonoscopy, \nand FOBT for individuals with advanced adenoma was 81.0% (75.8-85.5), 48.5% \n(42.4-54.7), and 92.2% (88.2-95.2).\nConclusion: 3 Tesla MR colonography has high sensitivity and specificity for \nadenoma ³6 mm and advanced adenoma. Its sensitivity and strongly outperforms \nFOBT. MR colonography is a potent radiation-free screening tool for colorectal \nneoplasia. \nAuthor Disclosures:\nA. Graser: Advisory Board; Siemens AG Healthcare. Consultant; Siemens AG \nHealthcare, Bayer AG. Grant Recipient; Bayer Healthcare. Investigator; Pfizer \nPharma. Speaker; Siemens AG Healthcare, Bayer AG, Bracco, Pfizer Pharma.\nB‑0796 11:33\nRetrospective evaluation of diverticular disease in a large cohort of \n1091 patients who underwent CT colonography \nM. Ciolina1, C. De Cecco2, P. Baldassari1, M. Iannitti1, A. Pichi1, F. Iafrate1, \nA. Laghi2; 1Rome/IT, 2Latina/IT (mariaciolina@gmail.com) \nPurpose: To evaluate the prevalence of diverticular disease according to age, \ngender, colonic segments, disease severity and symptoms in a group of patients \nwho underwent CT colonography (CTC).\nMethods and Materials: Population included 1091 consecutive Caucasian patients \nwho underwent CTC examination. Patients with diverticular disease were retro-\nspectively stratified into 7 groups according to age (25-85 yrs). Each group was \nfurther stratified according to sex, symptoms and colonic segment involvement. \nSeverity of diverticular disease was evaluated using a 3-point scale: grade 1 (rare< \n6 diverticula), grade 2 (multiple 6-20) and grade 3 (several> 20).\nResults: Diverticular disease was observed in 561 patients (321 women and 240 \nmen, mean age 68±12 yrs). Symptomatic disease was present in 47.4% cases. \nIn 60% of patients ²45 years at least one diverticulum in the sigmoid colon was \nobserved. Disease severity increased over time in all colonic segments, especially \nin sigmoid colon where grade 3 ranged from 2.7% at 25 yrs to 24.4% at 85 yrs. Also \nin advanced age, diverticula prevalence remains significant higher in sigma than \nright colon (cecum 7.8%, ascending 6.7%).No significant difference in diverticula \n0\n\nScientific Sessions\nS33\nA\n C D E F G\nB\nMonday\nwas not statistically significant (p = 0.50), indicating no substantial constant bias. \nScatter-plots show that the RECIST-based volume overestimates lesion volume. \nThe intraclass correlation between 'true' and WHO-based volume relative changes \nwas 0.95, showing nearly perfect agreement between methods.\nConclusion: Our proposed formula, if based on WHO-measurements, allows for \na very good estimate of relative volume changes (RECIST-based formula over-\nestimates the true volume). \nAuthor Disclosures:\nM. D’Anastasi: Research/Grant Support; Merck KGaA. R.P. Laubender: \nResearch/Grant Support; Merck KGaA. V. Heinemann: Research/Grant \nSupport; Merck KGaA. M. Schlichting: Employee; Merck KGaA. A. Graser: \nSpeaker; Siemens.\nB‑0801 10:48\nChemotherapy response evaluation with magnetic resonance (MR) \nand FDG-PET/CT in gastroesophageal tumours (GT): apparent \ndiffusion coefficient (ADC) and standardised uptake volume (SUV) \nchanges compared with tumour regression grade (TRG) at histology \nF. Giganti, F. De Cobelli, C. Canevari, E. Orsenigo, L. Albarello, E. Mazza, \nC. Staudacher, L. Gianolli, A. Del Maschio; Milan/IT \nPurpose: To compare ADC and SUV modifications during neoadjuvant chemo-\ntherapy (NC) with TRG (5 grade-histological indicator of treatment response) to \nevaluate if their modifications may help to differentiate between Responders (R) \nand Non Responders (NR) to NC.\nMethods and Materials: 17 patients with GT (3 oesophageal, 3 GEJ and 11 gastric \ncancer) were evaluated on a 1.5-T MR system. MR protocol included Diffusion-\nWeighted Imaging (DWI) with b value 0-600 s/mm2, before and 3 weeks after the \nend of NC and ADC was calculated. Patients underwent FDG-PET/CT scans before \nand after NC, obtaining SUV each time. All patients were then submitted to radical \nsurgery and the results were compared with TRG. TRG 1, 2 or 3 patients were \nclassified as R; TRG 4 or 5 patients as NR.\nResults: 8 patients were considered R and 9 as NR. 8/17 patients showed an \nincrease, 5/17 a reduction of ADC while no significant changes for 4/17. ADC \nsignificantly increased in R group compared with NR (p < 0.01). ADC showed \nsignificant inverse correlation with TRG (R = - 0.79; p < 0.01). Concerning PET \nfindings, 3/17 patients showed an increment and 10/17 a reduction of SUV while \nno significant changes for 4/17; SUV and TRG were not correlated (R = 0.21; p> \n0.05). No correlation was found between SUV and ADC (R = - 0.18; p> 0.05).\nConclusion: In evaluating tumour response, DWI-MR seems to be more accurate \nthan FDG-PET and SUV. ADC modifications represent a reproducible tool to as-\nsess tumour response to NC. \nB‑0802 10:57\nTreatment response assessment in Hodgkin lymphoma: in search \nfor morphological correlates of metabolic activity \nT. Knogler, G. Karanikas, M. Weber, K. El-Rabadi, M.E. Mayerhoefer; Vienna/AT \n(thomas.knogler@meduniwien.ac.at) \nPurpose: To predict early treatment response with three-dimensional texture \nfeatures (TF) in patients with Hodgkin lymphoma (HL) after radio-chemotherapy \nextracted from contrast-enhanced CT.\nMethods and Materials: 21 patients with histologically proven HL were included \nin this study. Contrast-enhanced (18)F-FDG PET/CT was obtained on a dedicated \nPET/CT scanner. Volumes-of-interest and long- and short-axis diameter were \nmanually defined on 48 HL manifestations prior and post-radio-chemotherapy on \nthe CT image stack. Three-dimensional texture features derived from the grey-level \nhistogram, co-occurrence matrix, run-length matrix and absolute gradient were \ncalculated for the VOIs. A stepwise logistic regression with forward selection was \nperformed to find classic radiologic features (i.e. lesion diameter, lesion volume) \nand TF, which correctly classify treatment response (i.e. full response and partial \nresponse). Classification in PET/CT was used as reference.\nResults: Difference in short axis diameter best fit as classic feature with a sensi-\ntivity of 100%, a specificity of 54.5% and an accuracy of 89.6%. Combination of \n“S_0_0_1_Entrp” and difference of “vertl_fraction” best fit as TF with a sensitivity \nof 97.3%, a specificity of 72.7% and an accuracy of 91.7%.\nConclusion: Texture features extracted from contrast-enhanced CT in patients \nwith HL are superior in differentiation between responders and non-responders \nwithout the need for PET examinations, compared to classical radiological features. \nHowever, PET/CT as state-of-the-art imaging technique has a sensitivity and \nspecificity > 90%, so that further research with larger patient number is needed to \ninvestigate this new method.\n10:30 - 12:00 Room F1 \nOncologic Imaging \nSS 1716 \nResponse evaluation in oncology: beyond RECIST \nModerators: \nT. Denecke; Berlin/DE \nM.I. Furmanek; Warsaw/PL\nB‑0799 10:30\nCalibration of computed tomography (CT) volumetric measurements \nfor assessing tumour response to drug therapy in a randomised \nmulticentre oncology study \nR. Avila1, D. Yankelevitz2, V. Archer3, G. Zahlmann4; \n1Clifton Park, NY/US, 2New York, NY/US, 3 Welwyn Garden City/UK, 4Basle/CH \n(rick.avila@kitware.com) \nPurpose: Quantification of tumour diameter and volumetric measurement variability, \ndue to CT acquisition properties, for patients participating in a clinical NSCLC trial.\nMethods and Materials: A validated ‘pocket phantom’ was scanned with patients; \nimage acquisition was standardised. Volumetric and diameter measurement per-\nformance in X, Y , and Z axes was evaluated. Fully automated software detected and \nanalysed phantoms. A precision-manufactured 15.88 mm diameter teflon sphere \nwithin each phantom was segmented, using constant thresholding, and measured.\nResults: Data were acquired from 77 patients at various time points during the \ntrial using 13 different scanner models across three manufacturers. The mean, \nstandard deviation (SD) and coefficient of variation (CV) were calculated in the X, \nY and Z axes of the scanner. Mean, SD and CV for diameter measurements were \n15.7 mm, 0.13 mm and 0.8%, respectively (X axis); 15.6 mm, 0.15 mm and 1.0% \n(Y axis); 15.8 mm, 0.71 mm and 4.5% (Z axis). Mean, SD and CV of volumetric \nmeasurements were 1,989 mm3, 99 mm3 and 5.0%, respectively. Variability of Z-axis \ndiameter measurements was > 4 times that of X and Y axes. For 45 patients with \n> 1 scan, volumetric measurement CV was 5.3%. Maximum volumetric change for \nconsecutive CT scans was 44%. Exclusion of six patients with maximum variation \nreduced CV to 2.2%. All six of these patients' images were acquired using 16- and \n8-row scanners from a single manufacturer.\nConclusion: Axial diameter measurements had consistently low variability across \nall scanners and acquisition parameters. Large variation occurred for Z diameter \nmeasurements and volumetric measurements. \nAuthor Disclosures:\nR. Avila: Employee; Kitware Inc. Shareholder; Kitware Inc. Other; Consultant \nto Roche. D. Yankelevitz: Research/Grant Support; F. Hoffmann-La Roche \nsponsored this research. David Yankelevitz had no personal gain from the \nsponsorship. Other; David Yankelevitz is a named sponsor on related patents \nand patent applications. V. Archer: Employee; Venice Archer is an employee \nof F. Hoffmann-La Roche. G. Zahlmann: Employee; Gudrun Zahlmann is an \nemployee of F. Hoffmann-La Roche.\nB‑0800 10:39\nEvaluating the agreement between tumour volumetry and the \nestimated volumes of tumour lesions using an algorithm \nM. D’Anastasi, R.P. Laubender, V. Heinemann, M.F. Reiser, M. Schlichting, \nA. Graser; Munich/DE (melvin.danastasi@med.uni-muenchen.de) \nPurpose: To evaluate the agreement between true tumour volume and tumour vol-\nume derived from (i) a new formula based on longest lesion (RECIST) diameter, (ii) \na new formula based on longest diameter and longest orthogonal (WHO) diameter.\nMethods and Materials: 89 baseline and follow -up CTs were available in 20 \npatients with metastastic colorectal cancer from the randomised phase II multi-\ncenter CIOX trial. Target lesions were defined at baseline and followed over time. \nLesions were evaluated by (i) semi-automated volumetry using Siemens Syngo.via \nand (ii) volumetric assement using a newly developed formula based on manual \nmeasurement of the longest diameter and the longest orthogonal diameter. True, \nWHO- and RECIST-based volumes were calculated. We compared the agreement \nof the true volume to the WHO- and RECIST-based volume. We also compared \nthe agreement between ‘true’ and WHO-based volume relative changes by means \nof the intraclass correlation.\nResults: A total of 151 lesions were evaluated. Using a variance components \nmodel it was shown that the difference between true and RECIST-based volume \nis statistically significant (p < 0.001) indicating a substantial constant bias. The \nsame model showed a difference between true and WHO-based volume, which \n1\n\nScientific Sessions\nS33\n C A D E F\n G\nB\nB‑0805 11:24\nReal-time imaging of the therapeutic response of tumours to anti-\nvascular treatment in mice by gadofosveset-enhanced MRI \nA.J. Höink1, T. Persigehl2, J. Ring1, R.M. Mesters1, W.E. Berdel1, \nW.L. Heindel1, C. Bremer1, C. Schwöppe1; 1Münster/DE, \n2Cologne/DE (anna.knauer@ukmuenster.de) \nPurpose: Tumour treatment by retargeted truncated protein derivatives of the \nhuman tissue factor (tTF) results in tumour vessel infarction, necrosis and subse-\nquent tumour growth retardation and regression. A novel method of gadofosveset-\nenhanced MRI, that enables the visualisation of the response to this treatment in \nreal-time, is introduced.\nMethods and Materials: Dynamic gadofosveset-enhanced MRI (3 T) was per-\nformed in eight tumour-bearing (U87) nude mice. In the course of an ultrafast \nT1-weighted gradient echo sequence, a gadolinium-based blood pool contrast \nagent (gadofosveset trisodium) was injected intravenously via a tail vein catheter. \nAfter the maximum contrast intensity inside the tumour was obtained, 150 µl of \ntTF-NGR (a retargeted tTF derivative which binds to CD13-overexpressing tumour \nendothelial cells) were injected intravenously via a second tail vein catheter (n = \n4; saline solution as control: n = 4), and the contrast behaviour of the tumour was \nmonitored by region of interest (ROI) analysis.\nResults: Following the injection of tTF-NGR (approx. 500 sec. after the beginning \nof the sequence), the contrast intensity inside the tumours of the treated mice \ndecreased more instantly and more strongly than in the tumours of the control \nmice (AUC 1121.3 ± 0.65 vs. 1164.4 ± 0.52 AU).\nConclusion: Gadofosveset-enhanced MRI allows for the visualisation of the thera-\npeutic response of tumours to anti-vascular treatment in real-time. Considering the \nintended clinical application of tTF-NGR, this method might be a simple and quick \nsurrogate parameter for the monitoring of the therapeutic response to vascular \ndisrupting agents in humans. \nB‑0806 11:33\nReproducibility of therapy response evaluation between experienced \nand less experienced readers of pleural mesothelioma by mRECIST, \nRECIST 1.0, RECIST 1.1, and WHO \nL. Stahlhut1, A. Bunck1, Y. Tan2, M. Steen1, X. Guo2, D. Maintz1, \nL. Schwartz2, B. Zhao2, T. Persigehl1; 1Cologne/DE, 2New York, NY/US \n(leandra.stahlhut@uk-koeln.de) \nPurpose: The specific growth pattern of pleural mesothelioma along the pleural \nsurface makes therapy monitoring using common measurement criteria, such as \nRECIST 1.0, difficult. Therefore, Byrne et al. developed modified RECIST criteria \nfor pleural mesothelioma. In this study we evaluated the accordance between \nexperienced and less experienced readers for RECIST 1.0, RECIST 1.1, mRE-\nCIST, and WHO.\nMethods and Materials: A total of 43 baseline and follow -up-CT scans from 15 \npatients from a clinical multi-centre pleural mesothelioma trial were retrospectively \nevaluated by different experienced radiologist (about 1 year and more than 10 \nyears), who selected target lesions independently according to mRECIST, RECIST \n1.0, RECIST 1.1 and WHO criteria. CT scans were then re-measured after an \ninterval of greater than one month. The inter- and intra-reader variability using the \ndifferent response criteria was analysed.\nResults: Both, the intra-reader- and inter-reader variability were best when using \nmRECIST (95 % limits of agreement of -28.4/ 12.9 and of -32.1/ 20.7) compared \n‘with RECIST 1.0, RECIST 1.1 and WHO. Further, regarding the objective response \n(PR = partial response, SD=stable disease and PD = progressive disease), mRE-\nCIST showed the most reliable intra-observer outcome with only one differently \nclassified examination and the most reliable inter-observer outcome with four \ndifferently classified examinations.\nConclusion: Our results suggest that mRECIST is most reliable for treatment \nresponse evaluation of pleural mesothelioma between experienced and less ex-\nperienced readers compared with RECIST 1.0, RECIST 1.1 and WHO. To confirm \nthese findings, the inclusion of further readers and more patient data is warranted. \nB‑0807 11:42\nUse of multimedia structured reporting for tumour response assessment \nD.J. Vining1, A. Pitici2, I. Aghenitei2, C. Popovici2, M. Jurca2, \nR. Rosu2, A. Tsimberidou1; 1Houston, TX/US, 2Chapel Hill, NC/US \n(dvining@mdanderson.org) \nPurpose: Response Evaluation Criteria in Solid Tumours (RECIST) is used to \nassess patient response to anticancer therapy. However, radiologists often fail to \nreport target lesions, perform tumour measurements and accurately compare serial \nB‑0803 11:06\nPredictive values of MRI parameters for the progression-free \nsurvival after radioembolisation in patients with metastases of \nneuroendocrine tumours \nW.H. Sommer, F. Ceelen, P. Paprottka, M.F. Reiser, D. Theisen; \nMunich/DE (wieland.sommer@med.uni-muenchen.de) \nPurpose: The aim of this study was to define the role of MRI in the pretherapeutic \nprediction of treatment response in patients with liver metastases of neuroendocrine \ntumours (NET) undergoing radioembolisation.\nMethods and Materials: In 45 patients with proven hepatic metastases NET, MRI \nwas performed at baseline (3 T MRI scanner, Gd-EOB-DTPA). Furthermore, PET-CT \nexaminations with somatostatin-specific tracer 68Ga-DOTATATE were performed \nat baseline. The following imaging predictors were defined: patient age/gender, \nproliferation marker Ki-67, tumourload (%), vascularisation of metastases, tumour \nnecrosis and haemorrhage. The status of somatostatin receptor was defined by \nanalysing mean and maximum SUV in PET-CT. As primary end point we defined the \nprogression-free survival (PFS) using RECIST criteria in MRI follow-up examinations \n(every 3 months). The effects of the predictors on the progression-free survival \nwere analysed using Kaplan-Meier statistics.\nResults: The mean follow-up time was 445±411 days. The mean PFS was 699 days \n(95%CI 326-964). Hypovascular metastases showed significant earlier progress \n(255 vs. 727 days; p < 0.01). A proliferation marker < 2% was significantly associ-\nated with a longer PFS than a proliferation marker between 2-20% and > 20% (p < \n0.001). Patient age, gender, tumour load in the liver, tumour necrosis, haemorrhage \nas well as radioreceptor status pre-SIRT did not show any impact on PFS (p> 0.05).\nConclusion: Radioembolisation in neuroendocrine liver metastases is most ef-\nficient in hypervascular metastases with low proliferation index. Tumour-load as \nwell as radioreceptor status do not have influence on the progression-free survival \nin contrast to other therapeutic options in NETs.\nAuthor Disclosures:\nW.H. Sommer: Consultant; Bayer.\nB‑0804 11:15\nOne-month apparent diffusion coefficient-determined response at \ndiffusion-weighted MRI is an independent predictor of response to \ntransarterial chemoembolisation for hepatocellular carcinoma \nV. Vandecaveye, K. Michielsen, F. De Keyzer, W. Laleman, M. Komuta, \nF. Nevens, T. Roskams, C. Verslype, G. Maleux; Leuven/BE \n(vincent.vandecaveye@uzleuven.be) \nPurpose: To evaluate 1 month diffusion-weighted (DWI) magnetic resonance \nimaging (MRI) for predicting response to transarterial chemo-embolisation (TACE) \nof unresectable hepatocellular carcinoma (HCC).\nMethods and Materials: Thirty-eight HCC patients underwent 1.5 Tesla MRI, \nincluding DWI and dynamic contrast-enhanced sequences, before and 1 month \nafter the first TACE. One month response was assessed using RECIST 1.1, EASL, \nmRECIST and apparent diffusion coefficient changes (ADCratio). Eight patients \nwere transplanted 2 months post-TACE which additionally allowed correlation of \n1-month imaging with histopathological necrotic ratio using a Mann-Whitney U test. \nIn the remaining 30 patients, the univariate effect on progression-free survival (PFS) \nand overall survival (OS) of RECIST, EASL, mRECIST, ADCratio and pretreat-\nment variables was examined with the Kaplan-Meier and log-rank tests finalized \nby multivariate analysis. Comparative accuracy of 1-month response assessment \nwas determined by receiver operator characteristic curves.\nResults: In the 8 transplanted patients, correlation was only significant between \nthe ADCratio and the pathologically determined percentage tumoral necrotic ratio \n(p=0.03). In the 30 followed patients, median PFS and OS were, respectively, 5 \nand 48 months. Univariate analysis showed significant correlation of EASL and \nADCratio with PFS (p < 0.05) but multivariate analysis showed significant correla-\ntion between ADCratio and PFS (p < 0.001). ADCratio correlated substantially \nwith OS (p=0.07). For predicting 5-month PFS, sensitivity was 91% and specificity \n79% for the ADCratio, 46% and 74% for mRECIST and EASL and 82% and 32% \nfor RECIST 1.1.\nConclusion: One month ADCratio post-TACE is an independent predictor of PFS. \nThe ADCratio shows near-significant correlation with OS. \n2\n\nScientific Sessions\nS33\nA\n C D E F G\nB\nMonday\n10:30 - 12:00 Room F2 \nBreast \nSS 1702 \nTomosynthesis: a role in clinical practice? \nModerators: \nS. Allen; Sutton/UK \nE.M. Jung; Regensburg/DE \nB‑0809 10:30\nThe role of additional tomosynthesis combined with digital mammography \nP. Martínez1, J. Echano2, M. Sainz1, I. Simon2, G. Viteri2, \nA. Garcia Lallana1, C. Minguillon1, L. Pina2; 1Zaragoza/ES, 2Pamplona/ES \n(paulamartinezmiravete@yahoo.es) \nPurpose: To evaluate the detection rate of breast cancer using digital tomosynthesis \nas an additional tool combined with digital mammography in ACR density patterns \n2, 3 and 4 in a clinical setting.\nMethods and Materials: From December 2010 to September 2012, 9301 combo \nretrospective studies (2D-digital mammography plus tomosynthesis) were per-\nformed in ACR density patterns 2, 3 and 4 to evaluate the role of the tomosynthesis \nin the detection of additional cancers. Statistical analysis was performed calculating \nthe Pearson Chi-square test and using the SPSS software.\nResults: 118 breast tumours were detected on conventional digital mammography \n(detection rate 1.26%). Seventy-one additional cancers were detected on tomosyn-\nthesis and not seen on standard mammograms: 14 cases on ACR 2 (the detection \nrate was increased by 0.61%), 27 cases in ACR 3 (0.74%) and 30 cases in ACR \n4 (0.87%). No statistical differences were found in the detection rate among the \nthree patterns (p=0.78). Tomosynthesis increased the detection rate by 0.76%, so \nthe total detection rate using the combo studies was 2.03%.\nConclusion: The addition of digital tomosynthesis increases the detection rate \nfrom 1.26% to 2.03%. There are no significant differences among the three ACR \ndensity patterns, so tomosynthesis can be useful not only in dense patterns but \nalso in pattern 2.\nB‑0810 10:39\nDoes breast tomosynthesis combined with 2D digital mammography \nincrease the detection rate of breast cancer? \nR. Saiz-Mendiguren1, C. Marginet-Mangas1, A. Garcia-Lallana2, \nE. Martinez1, C. Ibarburen1; L. Pina Insausti3; 1Palma de Mallorca/ES, \n2Santurce/ES, 3Pamplona/ES (saiz.ramon@gmail.com) \nPurpose: To evaluate the incidence of breast cancer screening with digital mam-\nmography combined with breast tomosynthesis in the ACR density patterns 1 to 4.\nMethods and Materials: Retrospective study: from September 2011 to August \n2012, 2778 consecutive women were examined retrospectively with a Selenia® \nDimensions System 3D (Hologic®). The distribution among the ACR density patters \nwas studied. All women underwent a “combo” study, which consisted of a 2D-DM \n(2 projections) and 3D-DBT (2 projections). The increase in the detection of ad-\nditional breast cancers due to the 3D-tomosynthesis studies has been evaluated. \nChi-square test with SPSS for windows (15.0 Chicago, IL) has been used to evaluate \nif there were any statistically significant differences (p < 0.05 was considered sta-\ntistically significant). The clinical, radiologic and pathologic findings are described.\nResults: Among all ACR density pattern, 15 breast cancers were diagnosed with \nthe 2D-DM studies (detection rate 0.54%). 7 additional cancers were diagnosed \ndue to the 3D-DBT imaging findings (four in ACR density patter 2, one in ACR \ndensity pattern 3 and two in ACR density pattern 4). The global detection rate \nincreased to 0.79%. No statistical differences were found regarding the detection \nrate among all density patterns.\nConclusion: In our group of patients the use of 3D-DBT combined with conven-\ntional 2D-DM increased the rate of breast cancer diagnosis from 0.54 to 0.79%. \nNo statistical significant differences were found among all ACR density patterns. \n3D-DBT may be useful not only in dense breasts (ACR 3 and 4) but also in medium \ndensity breasts (ACR 2). \nexams. We present a structured reporting system, called ViSion, which captures \na radiologist’s measurements and key images in an efficient manner to generate \ndisease timelines and automate the calculation of RECIST.\nMethods and Materials: We analysed serial radiology reports from ten patients \nwith cancer to determine if radiologists reported tumour measurements, saved \nmeasurements in PACS, and whether there was correlation of tumour metrics \nbetween exams. In addition, we created a structured reporting solution that uploads \nscreen captures and audio descriptions of image findings to a computer server \nwhere each finding is labelled with anatomy and pathology terms, presented in a \nmultimedia structured report, and can be used to calculate RECIST.\nResults: The analysis of baseline and subsequent radiology reports revealed that \nradiologists reported measurements in 90% of cases, saved measurements in 20% \nof baseline and 50% of follow-up studies, and correlated measurements between \nexams in only 40%. The application of ViSion enabled a means to record tumour \nmeasurements in 100% of cases by providing a visual record of where target le-\nsions were previously measured, facilitating the linking of image findings between \nexaminations and displaying the findings in disease timelines.\nConclusion: The ViSion structured reporting system provides a means for more \nreproducible tumour response assessment. \nAuthor Disclosures:\nD.J. Vining: Founder; VisionSR, Inc. A. Pitici: Employee; Eloquentix, Inc. \nI. Aghenitei: Employee; Eloquentix, Inc. I. Aghenitei: Employee; Eloquentix, \nInc. C. Popovici: Employee; Eloquentix, Inc. M. Jurca: Employee; Eloquentix, \nInc. R. Rosu: CEO; Eloquentix, Inc.\nB‑0808 11:51\nComparison of breast-MRI vs. standard prognostic factors for the \nprediction of local recurrence after treatment of primary breast cancer \nP.A.T. Baltzer1, M. Dietzel2, H. Habrecht3, R. Zoubi4, C. Jerowski3, \nI.B. Runnebaum3, W.A. Kaiser3; 1Jena/DE, Vienna/AT, 2Erlangen/DE, Jena/DE, \n3Jena/DE, 4Bielefeld/DE, Jena/DE \nPurpose: To identify the potential of breast MRI vs. standard prognostic factors \nto predict tumour recurrence after successful treatment of primary breast cancer.\nMethods and Materials: Consecutive patients receiving staging MRI and sub-\nsequent guideline-approved therapy of primary breast cancer at our academic \nbreast centre were investigated. Standard prognostic factors including TNM stag-\ning, tumour typing, tumour grading, progesterone/estrogen receptors, HER2NEU \nscore and associated DCIS component were assessed. Follow-up was performed \n(endpoint: “tumour-recurrence” after complete remission). For analysis of breast-\nMRI a dedicated CAD software was used (computer-aided analysis). It enables \nsemi-automatic analysis of enhancement characteristics of the whole tumour (3D \nanalysis of early vs. delayed phase) and the “hot-spot” (i.e. voxel with highest wash-\nin/wash-out ratio). Potential of breast MRI characteristics vs. standard prognostic \nfactors to stratify the endpoint separately and in combination was investigated using \nlogistic regression. To identify significant and independent predictors, backward \nfeature selection was applied (pentry/removal: < 0.05/> 0.01).\nResults: 223 patients were included (endpoint: n=13/5.8%, loss-to follow -up: \nn=7/3.1%). If tested separately, logistic regression identified moderate potential \nfor breast MRI (AUCMRI=0.79, p=0.001) and standard prognostic factors (AUC-\nstandard=0.71; p=0.01) to stratify the endpoint. If breast MRI characteristics \nand standard prognostic factors were combined, predictive performance could \nbe increased considerably (AUCcombined=0.90, p < 0.001, sensitivity=84.6%, \nspecificity=87.3%). Feature selection identified one standard prognostic factor \n(M-Stage) and four breast MRI characteristics (hot-spot: Wash-in, washout-ratio; \n3D-analysis: tumour voxels showing wash-out plus weak wash-in, tumour voxels \nshowing plateau and weak wash-in) as the most significant and independent \npredictors of tumour recurrence.\nConclusion: As standalone methods both breast MRI characteristics and standard \nprognostic factors have limited potential to predict local tumour recurrence. Yet, they \nhave additive prognostic effect on each other: If used in combination, they showed \npromising potential to predict this important endpoint (AUC=0.90). \n3\n\nScientific Sessions\nS33\n C A D E F\n G\nB\nof these 2290 patients, 76 were found to have suspicious lesions on conventional \nmammography (BI-RADS categories 4&5), among them 41 had breast cancer. \nThus, 2214 patients with normal or benign mammograms (BI-RADS categories 1 \nto 3) were included in this study. Statistical analysis was performed to compare the \nrate of additional cancers detected on TS with regards to the ACR density patterns, \ncalculating a Pearson Chi-square test (SPSS 15.0).\nResults: Conventional digital mammography detected 41 cancers (detection rate \n1.79%). TS after normal or benign digital mammography detected 13 additional \nmalignant cases (additional detection rate 12/2290: 0.40%): 5 cases in ACR 2 \n(0.17%); 7 cases in dense patterns ACR 3&4 (0.23%). No statistical differences \nwere found between the ACR density patterns (p=0.35).\nConclusion: In our experience, additional TS in oblique mediolateral view after \nnormal mammograms increases the detection rate from 1.37% to 1.77%. Moreover, \nit can be useful not only in dense patterns (3&4) but also in scattered fibroglandular \ndensities (pattern 2).\nB‑0814 11:15\nInfluence of breast density on diagnostic performance of digital \nbreast tomosynthesis (DBT) after digital mammography (DM) \nfocusing on recall rate reduction \nL.A. Carbonaro1, R.M. Trimboli1, N. Verardi1, M. Fedeli2, G. Di Leo1, \nF. Sardanelli1; 1San Donato Milanese/IT, 2Milan/IT (luca.carbonaro@gmail.com) \nPurpose: To estimate the influence of breast density on diagnostic performance \nof DBT added to DM (DM+DBT), focusing on recall rate reduction.\nMethods and Materials: Seventy-five women were recalled for 77 findings on DM \nscreening examination and further investigated according to usual protocols (ad-\nditional DM views, ultrasonography, and/or core needle biopsy). The final conven-\ntional assessment was: 7 cancers (4 invasive ductal carcinoma, 2 invasive lobular \ncarcinomas) and 68 negative/benign cases. Before this conventional work-up, 1- or \n2-view DBT was obtained (Giotto, IMS, Italy) for an off-line further evaluation. Two \nindependent readers, blinded to final conventional assessment, retrospectively \nassigned a BI-RADS score to each lesion on both DM only and DM+DBT. Breast \ndensity was scored according to ACR categories from 1 to 4. χ2 test was used.\nResults: None of the 7 cancers was missed on DM+DBT by each of the two read-\ners; of 14 readings, 7 (50%) had an increased BI-RADS score. Of 136 readings \nof 68 benign/negative cases, density was ACR1 in 24 (18%), ACR2 in 60 (44%), \nACR3 in 42 (31%) and ACR-4 in 10 (7%); the BI-RADS score was increased in \n3 (2%), unchanged in 61 (45%) and decreased in 72 (53%). BI-RADS was de-\ncreased for 11/24 (46%) ACR1, 34/60 (53%) ACR2, 25/42 (59%) and 4/10 (40%) \nACR4 (p= 0.595).\nConclusion: Breast density does not influence the capability of DBT, as added to \nDM, to decrease the BI-RADS score of negative/benign cases recalled for further \nassessment at screening DM. \nB‑0815 11:24\nRecall rate reduction by adding double reading digital breast \ntomosynthesis (DBT) to digital mammography (DM) \nL.A. Carbonaro1, R.M. Trimboli1, N. Verardi1, K. Khouri Chalouhi2, G. Di Leo1, \nF. Sardanelli1; 1San Donato Milanese/IT, 2Milan/IT (luca.carbonaro@gmail.com) \nPurpose: To estimate the reduction in recall rate induced by adding double read-\ning DBT to DM.\nMethods and Materials: During 21 weeks of screening-activity, women with at \nleast one mammographic suspicious finding were further investigated according \nto usual protocols (additional views, ultrasonography, and core needle biopsy). \nBefore this standard exams, 1- or 2-view DBT was acquired (Giotto, IMS, Italy). \nOf a total of 1,286 DM screening-exams, 74 were initially recalled (recall rate of \n5.8%) for 77 suspicious findings. Two independent readers (who did not perform \ninitial standard reading and blinded to final diagnosis) retrospectively evaluated DM \nand DBT. Each lesion was scored according to BI-RADS classification, considering \n3, 4a-b-c, and 5 as recalls.\nResults: Two DBTs (two findings) were excluded for technical problems. At com-\nbined DM+DBT evaluation each of the two readers recalled 37/72 (51%) women; \nconsidering each case judged as BI-RADS 3-5 by at least one of the two readers \nas recalled (double reading), a total of 49 cases were recalled with a reduction \nin recall rate of 23/72 (32%). Of 14 readings of 7 cancers (5 IDCs, 2 ILCs), we \nhad BI-RADS upgrade for 7 (50%), confirmation for 6 (43%), and downgrade for \n1 (7%). Of 136 readings of 68 negative cases, we had a BI-RADS upgrade in 3 \n(2%), confirmation in 61 (45%), and downgrade in 72 (53%).\nConclusion: No cancers were missed. The use of double reading DBT as an \nadjunct to DM could allow for a reduction of recall rate by 32%, from 5.8% to 3.9%. \nB‑0811 10:48\nDetection rate for suspicious lesions of digital breast tomosynthesis \nin combination with digital mammography or 2D central projection \nimaging \nC. Zuiani1, P. Clauser1, V. Londero1, C. Molinari1, R. Girometti1, \nA. Taibi2, S. Vecchio3, M. Bazzocchi1; 1Udine/IT, 2Ferrara/IT, 3Bologna/IT \n(clauser.p@hotmail.it) \nPurpose: Based on a novel approach, Digital Breast Tomosynthesis (DBT) may \nsimultaneously acquire 2D and 3D images of the breast. Variable dose geometry is \nused to give a sufficient dose in the central projection (2D-CP) for that image to be \na 2D mammogram. We aimed to assess the detection rate for suspicious lesions \n(ACR-BIRADS 3-5) of DBT associated with Digital Mammography (DM) or 2D-CP.\nMethods and Materials: 45 asymptomatic women who performed DM and DBT \nwith 2D-CP as screening examinations were included. Two experienced radiolo-\ngists, blinded to final diagnosis, evaluated images in separate sessions according \nto two different strategies of reading: DM+DBT (set-A) and 2D-CP+DBT (set-B). \nThey assessed breast lesions as benign or suspicious in case of ACR-BI-RADS \nscoring of 1-2 and 3-5, respectively. Discordant cases were reviewed in consensus. \nAgreement was assessed with weighted-kappa statistic.\nResults: Both modalities detected 31 lesions that appeared as 22 masses, 7 \nmicrocalcifications and 2 masses with microcalcifications. Lesions assessed as \nsuspicious were 83.8% (CI95%=67.4-92.9%) for set-A and 74.2% (CI95%=56.7-\n86.3%) for set-B, respectively, corresponding to an excellent agreement (k=0.86). \nSet-A detected as suspicious three small masses that were classified as benign \nwith set-B.\nConclusion: An all-in-one, dose-sparing examination using DBT with 2D-CP \nprovides a good agreement in detecting suspicious lesions compared to combined \nDM+DBT. Of note, a difference in the classification of small masses was identified. \nB‑0812 10:57\nDigital mammography in comparison with digital breast \ntomosynthesis in detection of multicentric breast cancer \nN. Prvulovic, D. Djilas, M. Prvulovic, D. Bogdanovic, K. Koprivsek; Novi Sad/RS \n(prvulovicn@gmail.com) \nPurpose: The aim of this study was to demonstrate the diagnostic significance of \ndigital mammography with tomosynthesis (3D) versus digital mammography (2D) \nin the group of histologically proven multicentric breast cancer.\nMethods and Materials: In the group of 110 patients examined in this study, 2-D \nmammography showed suspicious breast lesions. All patients were sent to the \nOncology Institute of Vojvodina for further examination and biopsy. At our institution \nafter initially clinical breast exam, 2D and 3D mammography were performed in the \nsame act. All imaging procedures were performed on Hologic Selenia Dimensions \nequipment. Two radiologists independently read mammograms and core needle \nbiopsy were performed in all BIRADS 4 and 5 groups. All patients had fibroglandular \nor heterogeneously dense breasts (ACR2 and ACR3).\nResults: In the group of 110 patients, pathologic findings revealed 80 unifocal \nand 30 multicentric cancers for a total of 152 malignant foci. All unifocal cancers \nwere detected by both methods. With 2D mammography, additionally 15 suspi-\ncious lesions were found and using 3D mammography 31 suspicious mass were \nfound. Both 2D and 3D mammography showed the same 15 lesions but 3D mam-\nmography showed 16 “new” lesions which were obscured on 2D mammography. \nOverall sensitivity was 82% (125/152) for 2D mammography and 94% (141/152) \nfor 3D mammography (p < 0.05). Results showed that in 10% of multicentric foci \nwere in situ carcinomas (DCIS).\nConclusion: 3D mammography was more sensitive than 2D mammography for the \ndetection of multicentric foci in fibroglandular or heterogeneously dense breasts. \nB‑0813 11:06\nThe role of tomosynthesis after normal mammography according to \nACR density patterns \nJ. Etxano, P. Slon, I. Simon-Yarza, R. Zalazar, A. Elizalde, L. Pina; Pamplona/ES \n(jetxano@unav.es) \nPurpose: To assess the detection rate of breast cancer using tomosynthesis (TS) \nas an adjunct tool after normal mammography regarding the ACR density patterns.\nMethods and Materials: This prospective study was performed from October 2011 \nto September 2012. During this time, 3615 consecutive women (mean age 52.3, \nrange 29-88) underwent digital mammography (Inspiration, Siemens, Erlangen, \nGermany) in a reference centre. After the evaluation of the breast density by a \nradiologist, tomosynthesis (TS) was performed using the oblique mediolateral \nview in all patients with ACR density patterns 2 (901), 3 (1165) and 4 (224). Out \n4\n\nScientific Sessions\nS33\nA\n C D E F G\nB\nMonday\nB‑0818 11:51\nThe STORM trial of screening mammography: screening with \ntomosynthesis or standard mammography \nS. Ciatto (posthumous)1, N. Houssami2, D. Bernardi1, F. Caumo3, P. Macaskill2; \n1Trento/IT, 2Sydney/AU, 3Verona/IT (nehmath@med.usyd.edu.au) \nPurpose: To examine the incremental effect of adding 3D-mammography with \ntomosynthesis to standard 2D digital mammography in population breast screening.\nMethods and Materials: STORM is a prospective comparative study of integrated \n2D/3D and 2D-only mammography that investigated screening in two phases [2D \nrelative to 2D/3D obtained with Combo®], yielding paired data for each screening \nexamination. Women aged ³49 years who attended population-based screening \nservices in Trento and Verona (Italy), from September 2011 to March 2012, were \nincluded. Screens were interpreted sequentially using standard double-reading, \nwith recall of a positive screen at either reading phases. Paired proportions were \ncompared using McNemar's Chi-square test.\nResults: Based on 5000 screens, 33 breast cancers were detected: 23 cancers \nwere detected at both 2D and 2D/3D reading, 10 cancers were detected only with \nintegrated 2D/3D screening, and no cancers were detected only at 2D reading \n(p=0.002); incremental detection attributable to 2D/3D screening was 2.0/1000 \nscreens (95% CI 0.8-3.2/1000) or an incremental 30.3% (95% CI 15.6-48.7%) of \ncancers. There were 299 false positive (FP) recalls: 141 were FP at both reading \nphases, 106 were FP at 2D-only, and 52 were FP at 2D/3D reading (p < 0.001). \nHad recall been conditional to 2D/3D screen-positivity, FP recalls would have been \nreduced by 18.1% (95% CI 13.9-22.9%) without missing any of the breast cancers \nidentified to date in the study population.\nConclusion: Integrated 2D/3D mammography has the potential to enhance \nbreast screening outcomes by improving cancer detection as well as by reducing \nFP recalls. Randomised trials of 2D/3D screening versus standard 2D screening \nare needed.\nAuthor Disclosures:\nN. Houssami: Grant Recipient; Receives research support via National Health \nand Medical Research Council program grant 633003 to the Screening & Test \nEvaluation Program. Other; Travel support was provided by Hologic (USA/Italy) \nfor attendance at collaborators/research meetings. D. Bernardi: Equipment \nSupport Recipient; Technologic support for trial from Hologic USA/Italy. \nOther; Travel support from Hologic to attend collaborators/research meetings. \nF. Caumo: Equipment Support Recipient; Technologic support for the trial \nreceived through Hologic. Other; Travel support to collaborators meetings was \nreceived through Hologic. P. Macaskill: Grant Recipient; Receives research \nsupport through National Health and Medical Research Council program grant \n633003 to STEP.\n10:30 - 12:00 Room G/H \nGenitourinary \nSS 1707 \nHints on haematuria and adrenals for all \nModerators: \nO. Nikolic; Novi Sad/RS  \nH. Sugimura; Miyazaki/JP \nB‑0819 10:30\nImpact of patient mobilisation on interpretation of upper urinary tract \nfilling defects seen on MDCT urography \nJ.M. Froehlich, A. Joeres, P.J. Probst, F. Nussberger, H.C. Thoeny; Berne/CH \n(froehlich@klus-apotheke.ch) \nPurpose: To evaluate whether patient mobilisation before the excretory phase \nhas an impact on the misinterpretation rate of upper urinary tract filling defects \nseen on MDCT urography.\nMethods and Materials: 641 consecutive patients undergoing contrast-enhanced \nCT urography (Philips ASH,120 kVp,250 mA,rotation time 0.75sec) examinations for \nvarious reasons between Oct 2009 and Dec 2011 were reviewed for upper urinary \ntract filling defects and lesion location by two readers. After August 2010 all patients \n(n=246) were systematically mobilised after accomplishing the early nephrographic \nscan. After a standardised preparation with 1L of oral water over 60 min, the patient \nis asked to empty the bladder. Initially the patient receives intravenously (iv) 20 mg \nof furosemide. Contrast administration consists of a fixed iv volume of 110-120 ml \nIobitridol 300 mgI/ml followed by 20 ml saline solution injected at a rate of 2-3 ml/s. \nAfter 10 min and subsequently every 2 min first low-radiation scouts are acquired \nB‑0816 11:33\nBreast tomosynthesis versus digital mammography: evaluation of \ndiagnostic potential in women with abnormal screening mammograms \nM.A. Shaaban; Cairo/EG (marwaadelmm@hotmail.com) \nPurpose: To compare the diagnostic potential of digital mammography with \ntomosynthesis.\nMethods and Materials: 100 women with abnormal screening mammograms,187 \nfindings, and definite imaging or histopathological diagnosis were included. The \nscreening mammography interpretation consisted of direct comparison of the \ntomosynthesis (DBT) examination with full field digital mammography (FFDM) \nimages. The study radiologists subjectively rated the equivalence of the image \nquality of both the DBT and the FFDM examinations with no use of additional mam-\nmography, magnification views or comparison mammography. The next step was \ncategorising the findings in both FFDM and DBT separately according to BIRADS \nclassification and the statistical analysis evaluated the p values of DBT and FFDM \nas well as their sensitivities.\nResults: All findings categorised as BIRADS 3 according to mammography showed \nreduction in number,particularly for masses, when examined with tomosynthesis. \nThe image quality of tomosynthesis was subjectively rated as equivalent (53.5%) \nor superior (43.3%) to digital mammography in 96.8% of the total of findings; the \ntest was highly significant (p < 0.001). For masses, tomosynthesis image quality \nwas rated as equivalent in 40.5% or superior in 58.1% of findings. Masses were \n53% of findings in which tomosynthesis had superior image quality. The FFDM \nSensitivity was of 91.9 % compared with 95.2% for DBT.\nConclusion: The diagnostic potential of digital breast tomosynthesis is superior \nto that of full-field digital mammography by evaluating their image quality and their \nsensitivity. Based on a subjective analysis, DBT showed a significantly higher im-\nage quality compared with digital mammography in all finding types, especially in \nthe characterisation of masses. \nB‑0817 11:42\nAnalysis of discordant screening-detected cancers at FFDM (2D) \nversus 2D plus tomosynthesis (combo mode) in a population-based \nscreening program: results from the Oslo tomosynthesis screening trial \nP. Skaane, R. Gullien, M. Krager, U. Haakenaasen, M. Izadi, I.N. Jebsen, \nU. Ekseth, E.B. Eben; Oslo/NO (perska@ous-hf.no) \nPurpose: To compare discordant screen-detected cancers in FFDM (“2D-mode”) \nversus 2D plus tomosynthesis (2D+3D or “combo-mode”) in a population-based \nscreening program.\nMethods and Materials: Oslo Tomosynthesis Screening Trial (OTST), a large \nprospective study comparing FFDM with 2D plus tomosynthesis in breast cancer \nscreening, is part of the Norwegian Screening Program. Women 50-69 are invited \nbiannually to mammography using independent double reading. The two main arms \nof OTST have independent double reading. One 2D arm is modified with CAD and \none combo-arm with synthetic 2D. The four arms are read by independent radiolo-\ngists. From 22.11.2010 to 31.12.2011, 121 screen-detected cancers were found.\nResults: Cancers detected: Arm A (conventional FFDM) 77, arm B (2D+CAD) 77, \narm C (2D+tomo) 101, and arm D (synthetic 2D+tomo) 94. Merging arm A and B \n(“2D-mode”) and C+D (“combo-mode”), 90 cancers were detected by “2D-mode” \nand 119 by “combo-mode” (32.2% relative increase). Discordant rate (screen-\ndetected cancer with TP score by only one reader) was 28.9% (26/90) for “2D-mode” \nand 36.1% (43/119) for “combo-mode”. For cancers manifesting as spiculated mass \nor distortion (n=63) the discordant rate was 31.0% (13/42) for “2D-mode” and 30.6% \n(19/62) for “combo-mode”. For cancers with microcalcifications the values were \n25.7% (9/35) and 39.5% (17/43), respectively.\nConclusion: Combined FFDM and tomosynthesis showed a 32% relative increase \nin cancer detection as compared with FFDM. Discordant cancer rate was ap-\nproximately the same or higher for “combo-mode” as compared with “2D-mode”. \nIndependent double reading should be the standard of care when tomosynthesis \nis implemented into mammography screening. \nAuthor Disclosures:\nP. Skaane: Equipment Support Recipient; Equipment support by Hologic. \nResearch/Grant Support; Hologic supported with equipment and financial \nsupport for overtime reading. M. Krager: Research/Grant Support; Financial \nsupport from Hologic for overtime reading. U. Haakenaasen: Research/\nGrant Support; Financial support from Hologic for overtime reading. M. Izadi: \nResearch/Grant Support; Financial support from Hologic for overtime reading. \nI.N. Jebsen: Research/Grant Support; Financial support from Hologic for \novertime reading. U. Ekseth: Research/Grant Support; Financial support from \nHologic for overtime reading. E.B. Eben: Research/Grant Support; Financial \nsupport from Hologic for overtime reading.\n5\n\nScientific Sessions\nS33\n C A D E F\n G\nB\nB‑0822 10:57\nRenal cell carcinoma subtype differentiation on single-phase \ncontrast-enhanced CT \nF. Veloso Gomes1, J. Palas2, A. Matos2, V. Mascarenhas3, V. Herédia4, \nS. Duarte3, M. Ramalho2; 1Faro/PT, 2Almada/PT, 3Lisbon/PT, 4Évora/PT \n(fvgomes@gmail.com) \nPurpose: To decrease the radiation dose, many abdominal computed tomography \n(CT) protocols exclude the unenhanced phase. Our purpose was to compare the \nability to differentiate renal cell carcinoma (RCC) subtype between multiphasic \nand arterial single-phase post-contrast acquisitions, using previously described \nand novel indices using the psoas muscle as a surrogate.\nMethods and Materials: A multicentric, retrospective study was performed. \nAt surgery, 80 renal tumours were identified (53 clear-cell, 13 papillary and 14 \nchromophobe). Region-of-interest measurements within tumour, uninvolved renal \ncortex and the ipsilateral psoas muscle, on unenhanced and corticomedullary \nphases were used to calculate tumour-percentage-enhancement (TE) and tumour-\nto-cortex-enhancement (TCI) indices. One-way ANOVA for independent samples \nwas used to test for mean differences between the three tumour subtypes. Receiver \noperating characteristic (ROC) curve analysis was performed for the comparison \nof clear cell and papillary RCCs.\nResults: Multi-phase contrast-enhanced-CT revealed significantly lower mean \nTE in papillary tumours in comparison with clear-cell (p < 0.01). The TCI was also \nlower for papillary tumours (p < 0.01). Papillary tumours can be distinguished from \nclear-cell tumours with TE< 53% and TCI< 0.22 (area under ROC curve of 0.997 \nand 0.995, respectively). Single-phase contrast-enhanced-CT revealed a lower \nmean TE for papillary tumours when compared with both clear-cell and cromophobe \n(p < 0.01). Papillary tumours can be distinguished from clear-cell with a TE< 23% \n(AUC under ROC curve 0.954), but not with TCI.\nConclusion: Subtype RCC differentiation can be assessed on a single-phase con-\ntrast-enhanced-CT study when unenhanced CT is not available. Papillary tumours \ncan be distinguished from clear-cell tumours with high sensitivity and specificity. \nB‑0823 11:06\nTo assess parameters within CT findings to aid distinction of \nhistological subtype of renal cell carcinoma within our institute \nM.J. Conneely, D. Ferguson, C. Donagh, M. Quinlan, T. McHale, P. McCarthy; \nGalway/IE (m.conneely11@nuigalway.ie) \nPurpose: Early determination of histological subtype of renal cell carcinoma \noptimises patient management. Using CT, we aim to assess parameters to aid \ndiagnosis of histological subtype within our institute.\nMethods and Materials: A retrospective chart review was performed to identify \npatients who underwent nephrectomy, between 2009 and 2011, for renal cell \ncarcinoma. Review of associated imaging was performed, by a consultant uro-\nradiologist. Note was made of the presence of necrosis, calcification and degree of \narterial and delayed enhancement present on CT studies performed preoperatively. \nComparison with histological findings was undertaken.\nResults: 115 patients were identified of which 84%, 10.4% and 5.6% of patients \nwere diagnosed with clear cell, papillary and chromophobe subtype, respectively. \nNecrosis was present in 80% of tumours with necrosis most prevalent in clear \ncell subtype. Calcification was more prevalent in papillary subtype (25%) when \ncompared with clear cell (14.4%). Using combined values of increased arterial \nphase enhancement of < 25 HU and decreased delayed phase attenuation of < \n10 HU, the sensitivity and specificity for differentiating papillary cell subtype were \n80% and 100%, respectively. Using the converse attenuation values (i.e. > 25 HU \nand > 10 HU), the sensitivity and specificity for differentiating clear cell carcinoma \nwithin our study were 79% and 67%. Chromophobe tumours demonstrated a \nmore uniform enhancement pattern within the tumour, but with varying values of \nenhancement/washout.\nConclusion: Using attenuation values stated, CT can aid the determination of \npapillary renal cell carcinoma histological subtype, within our institute, given their \nreduced levels of enhancement/washout.\nin order to optimise the depiction of the excretory phase. Standard of reference \nfor comparison was histology or follow-up of at least 6 months.\nResults: 63 endoluminal filling defects were detected: 26 of these occured in the \ngroup with movement, while 37 were detected in the group without mobilisation. 29 \n/ 63 of the lesions were subsequently confirmed to be tumours, while 27 endolu-\nminal filling defects were contrast media attributed leading to misinterpretation; 23 \nof these occured in the group without mobilisation, while only 4 were encountered \nafter mobilisation (p < 0.0001).\nConclusion: Patient mobilisation is a prerequisite to avoid misinterpretation of \nfilling defects during MDCT. \nAuthor Disclosures:\nJ.M. Froehlich: Consultant; Guerbet.\nB‑0820 10:39\nEvaluation of diagnostic strategies for hematuria using risk stratification \nN.C. Cowan; Birmingham/UK (nccowan.uro@gmail.com) \nPurpose: To evaluate diagnostic imaging strategies for hematuria using a system \nof risk stratification to determine the choice of imaging technique.\nMethods and Materials: The clinical cohort consisted of 840 consecutive patients \npresenting with nonvisible (NVH) and visible (VH) hematuria. The low-risk cohort \nconsisted of Groups 1&2: < 40-years with NVH and VH and Group 3: > 40-years \nwith NVH. Group 4 (high-risk) was > 40-years with VH. Low-risk cohort underwent \nunenhanced CTKUB and/or ultrasonography; high-risk cohort underwent CT \nurography. The prevalence of disease according to cohort and diagnostic accuracy \nof each imaging technique for causative disease were calculated. The reference \nstandard was cystoscopy, histopathology, unenhanced CT, histopathology and \nimaging follow-up (1-year).\nResults: Disease prevalence for Groups 1-4, respectively, was stone disease; 11/83 \n(13%), 8/49 (16%), 61/419 (15%) and 56/289 (19%), renal cell cancer (RCC): 0% \n(0/83), 2/49 (4.1%), 2/419 (0.5%) and 4/289 (1.4%). Upper urinary tract urothelial \ncancer (UTUC) and bladder cancer (BCa) were present only in groups 3 and 4. \nThe prevalence of UTUC for groups 3 and 4 was 2/419 (0.5%) and 3/289 (1.0%) \nand for BCa, 4/419 (1.0%) and 49/289 (17.0%). For high-risk cohort, CT urography \nwas positive in 46% (118/256) overall and for tumours in 70/256 (27%). Sensitivity \nof CT urography for RCC was 100%, (4/4) and UTUC, 100% (3/3), and specificity \nwas 99% (248/251) and 98% (247/253), respectively.\nConclusion: Risk stratification of clinical cohorts for urothelial cancer reduces \nredundant diagnostic testing, maintains diagnostic accuracy and reduces costs. \nCT urography for investigating hematuria should be reserved for populations at \nhigh-risk for urothelial cancer.\nB‑0821 10:48\nUse of novel iterative reconstruction in CT KUB: approach on \nimproving image quality \nV. Vardhanabhuti, C. Roobottom, S. Ilyas; Plymouth/UK (sumaira.ilyas@nhs.net) \nPurpose: To compare image quality on computed tomographic (CT) images \nacquired with filtered backprojection (FBP), adaptive statistical iterative recon-\nstruction (ASIR) and model-based iterative reconstruction (MBIR) techniques in \nCT KUB examination.\nMethods and Materials: 20 patients were scanned with standard protocol CT \nKUB at our institution. Same raw data were reconstructed using FBP, ASIR and \nMBIR. Objective and subjective image qualities were assessed. Quantitative data \nsuch as objective image noise and mean attenuation were analysed by comparing \nstandard deviations, 95% confidence interval and calculating percentage difference. \nMean image noise values and attenuation values were compared between different \nreconstruction algorithms using ANOVA. The interobserver variation and percent-\nage agreement between the two radiologists for each of the assessed subjective \nimage quality and lesion assessment parameters were estimated by using weighted \nk-statistics. Kruskal-Wallis rank sum test was used to test for equality of median \nscores among all subjective parameters.\nResults: Objective image analysis supports significant noise reduction and supe-\nrior contrast-to-noise ratio with new MBIR technique (p < 0.05). Subjective image \nparameters were maximally rated for MBIR followed by ASIR then FBP and show \nstatistical significance differences (p < 0.05).\nConclusion: MBIR shows superior reduction in noise and improved image quality \n(both objective and subjective analysis) compared with ASIR and FBP in the context \nof CT KUB scanning which is inherently a noisy study. At same dose, we have \nshown that image quality can be improved by applying MBIR in clinical practice, \nand if available should be utilised. \n6\n\nScientific Sessions\nS33\nA\n C D E F G\nB\nMonday\nResults: Hyperattenuating adrenal masses included 40 adenomas and 16 nonad-\nenomas. The sensitivity, specificity, and accuracy for adenoma at CT were 100% \n(40/40), 75% (12/16), and 93% (52 of 56), respectively, and at MRI were 75% \n(30/40), 56% (9/16), and 70% (39/56), respectively. CT helped identify 10 more \nadenomas and three more non-adenomas than did MR. There was significant \ndifference between CT and MRI regarding accuracy for adenoma (p=0.0044).\nConclusion: Contrast-enhanced CT is better than chemical shift MRI for charac-\nterising lipid-poor adenoma.\nB‑0827 11:42\nFunctional MRI with diffusion-weighted imaging and ADC map in \ncharacterisation of undetermined adrenal lesions: comparison with \nchemical shift imaging \nC.R.G.L. Talei Franzesi, D. Ippolito, P.A. Bonaffini, C. Capraro, V. Besostri, \nS. Sironi; Monza/IT (ctfdoc@hotmail.com) \nPurpose: To evaluate the diagnostic performance of diffusion-weighted imaging \nand apparent diffusion coefficient value, in the characterisation of indeterminate \nadrenal lesions.\nMethods and Materials: A prospective study was conducted in 83 patients with \ndifferent adrenal lesions (adenomas, myelolipomas, adrenal metastasis and \nprimitive carcinomas). All patients underwent MRI scan (1.5 T, Achieva, Philips) \nwith a phased array multi-coil using a conventional protocol that included also \ndiffusion-weighted imaging (DWI) with b-value of 0, 300, 500 and 1000 mm2/sec. \nDWI images were compared with T1 FFE in- and out of phase. The mean ADC \nvalue of adrenal lesions were calculated and correlated with MRI findings. ROI \nwere manually drawn along the contours of adrenal lesion on ADC maps. The \nobtained data were compared and correlated with chemical shift images and then \nstatistical analysis was performed.\nResults: The diagnosis of the adrenal lesions was proved by follow-up examination \n(size increase of over a period of time) or through biopsy (oncologic patients). All \nadrenal lesions showed restriction of diffusion and motion of water protons on DWI \nimages. There was no significant difference in obtained ADC values between adeno-\nmas (mean value: 1150±95.4 mm2/sec), myelolipomas (mean value: 1263±210.8 \nmm2/sec) and primitive tumour (mean value: 1124±78.5 mm2/sec). The adrenal \nmetastases (mean value: 1050 ±87.5 mm2/sec) presented lower ADC value in \ncomparison to the other adrenal lesions but not statistical significant (p> 0.05).\nConclusion: The diffusion-weighted images and ADC map were not useful to dif-\nferentiate between benignant and malignant adrenal lesions. The chemical shift \nimaging technique is still the most helpful sequences in typing of indeterminate \nadrenal lesions.\nB‑0828 11:51\nNon-contrast-enhanced MR adrenal venography for adrenal venous \nsampling \nH. Ota, K. Takase, N. Satani, T. Kimura, K. Seiji, Y. Ono, R. Morimoto, F. Sato, \nS. Takahashi; Sendai/JP (h-ota@rad.med.tohoku.ac.jp) \nPurpose: In patients with primary aldosteronism, adrenal venous sampling (AVS) \nis essential to distinguish unilateral aldosterone producing adenoma from bilateral \nidiopathic adrenal hyperplasia. Identification of bilateral adrenal veins, especially \nthe right adrenal vein that has anatomical variations and is smaller than the left \none, is important for successful AVS. This study aims to identify the right adrenal \nvein using non-contrast-enhanced MR imaging at 3 T.\nMethods and Materials: Consecutive 28 patients scheduled for AVS underwent \nMR scans at 3 T. A three-dimensional respiratory-triggered true fast imaging with \nsteady-state precession sequence with transverse acquisition was used for MR \nadrenal venography. The image quality of the right adrenal vein was evaluated on \na five-point scale (1=invisible, 5=excellent). The level of orifice was documented \nas upper, middle or lower third of a vertebra. Presence of a common trunk of the \nright adrenal vein with an accessory hepatic vein was documented. MR findings \nwere compared with catheter venography at AVS.\nResults: MR venography demonstrated right adrenal veins in all the patients \n(100%). AVS was successful in all the patients (100%). Mean image quality was \n3.8 (range 2-5). The right adrenal vein formed a common trunk with the accessory \nhepatic vein in two cases (7%), which were confirmed by catheter venography. \nThe orifices on MR venography were located between T11 and Th12 vertebrae. \nDifferences of the orifice levels between MR and catheter venography ranged within \ntwo thirds of vertebrae, which were explained by respiratory motion.\nConclusion: Non-invasive MR adrenal venography is useful for planning of AVS. \nB‑0824 11:15\nMDCT in differentiating pT1-2 from pT3 tumours in clear cell RCC \nO. Le, C. Wood, P. Tamboli, R. Vikram; Houston, TX/US \n(ott.le@mdanderson.org) \nPurpose: This study aimed at determining the accuracy of multi-detector com-\nputed tomography (MDCT) in distinguishing pT1-2 from pT3 clear cell renal cell \ncancer (cRCC).\nMethods and Materials: 66 consecutive patients who had radical nephrectomy for \ncRCC with preoperative staging CT using dual injection technique were included. \nThe study included non-contrast, corticomedullary and combined nephrographic/\nexcretory phases (from two separate contrast injections; 0.625-1.25 mm). Sagittal \nand coronal reconstructions were performed. Involvement of calyces, renal sinus fat, \nperinephric fat & renal vein were assessed by two blinded readers and correlated \nwith final pathology results. Distortion or clear invasion and not mere abutment were \nconsidered to indicate invasion of calyces or renal sinus fat. Presence of a tumour \nthrombus or encasement by more than 180 degrees of the cross-sectional circum-\nference of renal vein or its branches was considered a sign of renal vein invasion.\nResults: The sensitivities and specificities on CT were renal sinus fat 97% and 24%; \ncalyces 100% and 15%; perinephric fat 46% and 72%; renal vein 90% and 59%.\nConclusion: MDCT has high sensitivity but poor specificity in predicting renal \ncalyceal, renal sinus fat and renal hilar vein involvement. CT is poor in predicting \nperinephric fat involvement. \nB‑0825 11:24\nReader variability in urinary stone size estimation: training does not help \nM. Lidén, T. Andersson, H. Geijer; Örebro/SE (matsliden@yahoo.com) \nPurpose: Within narrow limits, the CT estimated size influences the prognosis for \nspontaneous passage of a ureteral calculus. In the present experiment, we tried to \nreduce the inter-reader variability in urinary calculus size estimation by measuring \nthe variability before, immediately after and late after a training session.\nMethods and Materials: A retrospectively generated anonymous urinary calculi \nCT image data bank consisting of 50 unenhanced CT-stacks demonstrating ure-\nteral or kidney calculi was used. Eleven readers, radiologists and residents (mean \nexperience 13 years) independently estimated the largest axial diameter of the \ncalculi in three sessions: baseline, post-training and follow-up. Immediately before \nthe post-training session each reader received training on eight calculi aimed at \nreducing inter-reader variability without affecting the mean reader size estimate. \nFollow-up session was performed four to eight weeks later without further training.\nResults: Per-calculus standard deviation between readers was 0.44, 0.42 and 0.51 \nmm and inter-reader limits of agreement were ±1.3, ±1.2 and ±1.5 mm for baseline, \npost-training and follow-up session, respectively. Friedman test showed significant \ndifference for per-calculus standard deviation (p < 0.001). Pairwise Wilcoxon signed-\nranks test showed increased variability in follow-up session compared to baseline \n(p < 0.001) and post-training session (p < 0.001). The small reduction in variability \nin post-training session compared to baseline was not statistically significant.\nConclusion: The small statistically non-significant reduction of inter-reader vari-\nability from the tested training protocol had no long-term effect, where an increase \nin variability was seen. Other approaches such as reader-independent urinary cal-\nculus size estimation seem more promising for reduction of inter-reader variability.\nB‑0826 11:33\nContrast-enhanced CT and chemical shift MRI: accuracy for lipid-\npoor adenoma characterisation \nY.A. Choi, B.K. Park, J.M. Seo, S.Y. Park, C.K. Kim; Seoul/KR \n(ya84.choi@samsung.com) \nPurpose: To compare the accuracy of contrast-enhanced CT and chemical shift \nMRI for diagnosing lipid-poor adenoma.\nMethods and Materials: Fifty-six hyperattenuating adrenal masses (> 10 HU) \non unenhanced CT images were found in 56 patients (41 men and 15 women; \nmean age, 54.6 years) by reviewing radiologic reports. These lesions were ret-\nrospectively analysed with contrast-enhanced CT and chemical shift MR. The \ndiagnostic accuracy of CT using absolute percentage loss of enhancement (PLE) \nand relative PLE and of chemical shift MRI using adrenal-to-spleen ratio (ASR) or \nsignal intensity index (SII) were obtained to determine which modality was more \naccurate for lipid-poor adenoma. For CT, an adenoma was diagnosed if a mass \nhad an absolute PLE > 60% or a relative PLE > 40%. For MR, an adenoma was \ndiagnosed if a mass had an ASR < 0.71 or an SII > 16.5%. Either follow-up imaging \nor pathologic review was considered standard reference. McNemar test was used \nto compare CT and MR regarding accuracy for adenoma.\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nB‑0831 10:48\nCorrelation of measurements of diffusion-weighted MR imaging and \nGd-EOB-DTPA-enhanced MR imaging in hepatic malignant tumours: \nADC versus signal intensity on hepatobiliary phase \nS. Choi, Y. Park, C. Lee, K. Kim, J. Choi, J. Lee, C. Park; Seoul/KR \n(monetoile84@hanmail.net) \nPurpose: To evaluate correlation of apparent diffusion coefficient (ADC) on \ndiffusion-weighted imaging (DWI) and signal intensity (SI) on hepatobiliary phase \nwith Gd-EOB-DTPA-enhanced MRI in malignant hepatic tumours.\nMethods and Materials: A total 63 patients with malignant hepatic tumours (30 \nhepatocellular carcinoma (HCC), 9 cholangiocarcinoma (CCC), 41 colorectal cancer \nmetastasis (CM), 9 breast cancer metastasis (BM)) underwent both DWI and Gd-\nEOB-DTPA-enhanced MRI. Mean ADC of tumours was measured by averaging \nthree ROI measurements. Lesion-to-liver SI ratio of tumour on hepatobiliary phase \nwas evaluated with ROI measurement. EOB-cloud of tumour was considered when \nlesion-to-liver SI ratio on hepatobiliary phase was > 0.6. We evaluated incidence \nof EOB-cloud of malignant hepatic tumour. Mean ADCs between hepatic tumours \nwith EOB-cloud and without EOB-cloud were evaluated using t-test. We also evalu-\nated difference of mean ADC between malignant hepatic tumours with EOB-cloud \nusing Kruskal-Wallis test.\nResults: EOB-cloud was noted in 34 cases (34/89, 38.2%), which included 16 \nHCC (16/30), 8 CCC (8/9), 7 CM (7/41), and 3 BM (3/9). Mean ADC was 1.22±0.29 \n(×10-3 mm²/sec) in 34 tumours with EOB-cloud and 1.25±0.46 in 55 tumours without \nEOB-cloud. Mean ADC was not significantly different between these two groups \n(P=0.07). Among malignant hepatic tumours with EOB-cloud, mean ADC was \n1.12±0.23 in HCC, 1.32±0.33 in CCC, 1.18±0.24 in CM, and 1.56±0.42 in BM. \nThere was no significant difference between these tumours (P=0.22).\nConclusion: EOB-cloud is not infrequently observed in malignant hepatic tumours. \nMean ADC values were not significantly different between tumours with EOB-cloud \nand without EOB-cloud. Therefore, SI on hepatobiliary phase might not reflect ADC \nrelated to perfusion and diffusion factors.\nB‑0832 10:57\nNon-invasive assessment of solid benign and malignant focal liver \nlesions by quantitative analysis of functional MRI with diffusion-\nweighted imaging \nM. Colombo, D. Ippolito, P.A. Bonaffini, C. Trattenero, V. Bartolo, S. Sironi; \nMonza/IT (maddalenacolombo1982@gmail.com) \nPurpose: To assess the added value of functional sequences, using diffusion-\nweighted imaging and apparent diffusion coefficient value, to conventional MRI \nimaging examination in the differential diagnosis from benign and malignant focal \nliver lesions.\nMethods and Materials: A total of 53 patients with known focal liver lesions \nincluding 36 benign (25 angiomas, 8 FNH, 2 abscesses) and 18 malignant (9 \nmetastases, 7 HCCs, 2 cholangiocarcinomas) underwent 1.5-T MRI examination \n(Achieva, Philips). The study was performed with a phased array multi-coil using \na conventional protocol that included also diffusion-weighted imaging (DWI) with \ndifferent b-values. The ROIs were manually drawn on focal liver lesions and on \nsurrounding normal hepatic parenchyma in ADC maps, and statistical analysis of \nADC mean values was performed.\nResults: Lesions were proved either by follow-up (benign lesions) or biopsy (ma-\nlignant lesions).Following mean ADC values were obtained for different types of \nbenign lesions: angiomas (1794.27±125, 2x10-3 mm2/sec), FNH (1486.74±156, \n8x10-3 mm2/sec), abscesses (1133±145, 5x10-3 mm2/sec) while in the neoplastic \nlesions were: metastases (1025, 6±93x10-3 mm2/sec), HCCs (887, 6±71, 10x10-3 \nmm2/sec) and cholangiocarcinomas (1285±25x10-3 mm2/sec). In normal hepatic \nparenchyma, mean perfusion values were (1158, 4±158, 7x10-3 mm2/sec). A statis-\ntical higher values (p < 0.001) were obtained in diffusion parameters among benign \nthan those of malignant lesions (1563±142, 4 vs 1066±138, 3x10-3 mm2/sec).\nConclusion: Diffusion-weighted images offer useful quantitative information (by \nevaluation of ADC maps) that differs significantly in solid and malignant liver lesions, \ndue to tumour different vascularity and cellularity. \n10:30 - 12:00 Room I/K \nAbdominal Viscera \nSS 1701b \nDWI in pancreatic and hepatobiliary diseases \nModerators: \nG.J. Munneke; London/UK  \nD. Weishaupt; Zurich/CH \nB‑0829 10:30\nFeasibility of abdominal diffusion Kurtosis imaging compared to \nstandard diffusion weighted imaging at 1.5 and 3 Tesla \nJ. Hansmann, A. Lemke, J. Wambsganss, S.O. Schönberg, U. Attenberger; \nMannheim/DE (jan.hansmann@medma.uni-heidelberg.de) \nPurpose: To demonstrate the feasibility of diffusion kurtosis imaging (DKI) for the \ndepiction and differentiation of liver and kidney abnormalities in comparison to \nstandard diffusion weighted imaging (DWI) at 1.5 and 3 T.\nMethods and Materials: 109 consecutive patients underwent a routine abdominal \nMR protocol including standard DWI and DKI. 1.5 and 3 T b-values for DKI were \nidentical: b=0-100-500-1000-1500-2000 s/mm². 55 liver and 36 kidney lesions were \nevaluated at 1.5 T, and 16 liver and 11 kidney lesions, respectively, at 3 T. DKI \nwas assessed by an in-house built software. Kurtosis values were quantified by \nregion-of-interest analysis and compared between lesions and normal parenchyma \nby a Wilcoxon rank sum test.\nResults: Mean kidney kurtosis values were identical at 1.5 and 3 T in normal \nparenchyma (K=0.5) and cysts (K=0.4). Differences dependent on field strength \nwere only found in malignant tumours (0.8 vs 0.5). At 1.5 as well as 3 T, cysts, \ntumours and normal kidney parenchyma could be differentiated with significance \n(p < 0.0413) using the kurtosis values. At both field strengths, cysts, benign and \nmalignant liver tumours could be differentiated with statistical significance from \nnormal parenchyma (p < 0.001, p < 0.0071, p < 0.001). However, malignant and \nbenign liver tumours were significantly different at 1.5 T (p=0.0382). Abnormalities \nand normal parenchyma could be visually differentiated on both, DWI and DKI.\nConclusion: DKI of kidney and liver abnormalities is feasible at both, 1.5 and \n3 T and allows for a quantified differentiation between normal parenchyma and \npathologic lesions.\nAuthor Disclosures:\nU. Attenberger: Consultant; Bayer Healthcare.\nB‑0830 10:39\nDifferential diagnosis of benign from malignant distal biliary \nstrictures: value of adding diffusion-weighted imaging to \nconventional magnetic resonance cholangiopancreatography \nR.-E. Yoo, J. Lee, J. Yoon, J. Kim, J. Han, B. Choi; Seoul/KR \n(ry_jjang@hotmail.com) \nPurpose: To determine the value of adding diffusion-weighted imaging (DWI) to \nmagnetic resonance cholangiopancreatography (MRCP) in differentiating benign \nfrom malignant distal biliary strictures.\nMethods and Materials: Two independent readers reviewed three image sets \n(1: MRCP alone, 2: MRCP and DWI combined, and 3: MRCP, DWI, and contrast-\nenhanced T1-weighted imaging (T1WI) combined) of sixty patients with suspected \ndistal biliary strictures at two-week interval and rated the probability of malignancy. \nDiagnostic performance (Az value) and accuracy were compared using the ROC \ncurves and McNemar test. Additionally, accuracy was also analysed for two sub-\ngroups (group 1: sphincter of Oddi stricture and group 2: distal bile duct stricture). \nκ coefficients were calculated to assess the interobserver agreement.\nResults: Az value and accuracy improved significantly after additional review of \nDWI for both readers: Az=0.780 vs. 0.916 ( P=.003) for reader 1 and 0.784 vs. \n0.853 (P=.037) for reader 2; accuracy=69% vs. 93% for reader 1 ( P <.001) and \n57% vs. 85% for reader 2 ( P <.001). For both readers, no significant difference \nin the Az value and accuracy was found between MRCP and DWI combined and \nMRCP, DWI, and contrast-enhanced T1WI combined ( P>.200). In subgroups, \nadditional review of DWI improved the accuracy of both readers with or without \nstatistical significance. There was substantial interobserver agreement in all three \nimage sets (κ=0.695-0.732).\nConclusion: Addition of DWI to MRCP significantly improved diagnostic accuracy \nin the characterisation of distal biliary strictures. The diagnostic performance of \nMRCP and DWI combined was comparable with that of MRCP, DWI, and contrast-\nenhanced MRI combined.\n38\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nwith complete eradication of T2-relaxation time effects. T2-STE was assessed as \npresent when lesion hyperintensity on b800 DW image corresponded to iso- to \nhypo-intensity on the E-ADC-map. Analysis of prevalence was stratified for benign \nand malignant FLLs.\nResults: The prevalence of the T2-STE was high, involving 41 of 73 FLLs (56.7%; \n95%C.I. 44.0-67.7). No significant difference (p> 0.05; Fisher exact test) was found \nbetween the prevalence of T2-STE in benign (10/19; 52.6%, 95%C.I. 28.8-75.5) \nvs. malignant (31/54; 57.4%, 95%C.I. 43.2-70.7) FLLs. Among malignant FLLs, the \nT2-STE occurred with a comparable frequency both in hepatocarcinoma (n=17) \nand metastases (n=14).\nConclusion: The T2-STE occurred in more than one-half of lesions in our series, \nsuggesting that contamination of DW signal from the T2 relaxation time still occurs \nat higher b-values currently used at 1.5 T. \nB‑0836 11:33\nDWI magnetic resonance imaging in the evaluation of HCC \nrecurrence after trans-arterial chemoembolisation (TACE): \ncomparison with contrast-enhanced MR imaging \nM. Di Martino, R. Di Miscio, M. Del Monte, C. Lombardo, D. Geiger, C. Catalano; \nRome/IT (dimase81_6@hotmail.com) \nPurpose: To qualitatively compare contrast-enhanced MR Imaging and DWI MR \nImaging in the evaluation of HCC recurrence in patients treated with TACE in \npatients in list for liver transplantation.\nMethods and Materials: Thirty cirrhotic patients with 80 HCCs underwent MR \nImaging at 1.5 T. MR acquisitions comprised unenhanced breath-hold T2W images \nand volumetric 3D Gd-BOPTA-enhanced (0.1 mmol/kg; MultiHance®, Bracco) T1W \nGRE images acquired at 25s, 60s, 180s (dynamic phase). DWI was performed by a \nbreath-hold SSEPI sequence (TR = 2028, TE = 76, matrix = 192x125, slice thickness \n5.00 mm, GRAPPA, b-values 0, 50, 500, 800 sec/ mm2). Three datasets of images \nwere independently read by two readers: 1) Precontrast sequences plus DWI, 2) \nprecontrast and post-contrast sequences, 3) precontrast plus post-contrast and DWI \nsequences. All patients underwent liver transplantation. Sensitivity, specificity and \ndiagnostic were calculated for statistical analysis and compared with each other.\nResults: Good interobserver agreement was found. The third dataset of images \nreported a trend to a better mean sensitivity (8% vs 85%) specificity (92% vs 89%) \nand diagnostic accuracy (.89 vs.87) compared to the second datasets. The first \ndataset was significantly inferior to second and third one.\nConclusion: The combined interpretation of post-contrast and DWI images helps \nto a better diagnostic accuracy in the evaluation of tumour recurrence after TACE. \nB‑0837 11:42\nMRI of pancreatic adenocarcinoma including diffusion-weighted \nimaging: assessment of tumour conspicuity and pathologic correlation \nL. Legrand, V. Duchatelle, V. Molinié, I. Boulay-Coletta, E. Sibileau, M. Zins; \nParis/FR (legrand.lau@gmail.com) \nPurpose: To identify the best MR sequences for pancreatic adenocarcinoma \nconspicuity and determine whether MR signal and apparent diffusion coefficient \n(ADC) values correlate with pathological findings.\nMethods and Materials: 25 consecutive patients with pathologically proven pancre-\natic adenocarcinoma who underwent MRI (1.5 or 3 T) before surgical resection were \nincluded. Fat-suppressed (FS) T1-weighted gradient-echo (GRE), FS T2-weighted \nfast-recovery fast spin echo, 3D FS dynamic T1-weighted gadolinium-enhanced \nGRE during arterial, portal and delayed phases and diffusion-weighted imaging \n(DWI) with b values of 0 and 600 or 800 sec/mm2 were obtained. Two observers \nreviewed MR sequences for size, signal characteristics and lesion conspicuity \nusing a four-point rating scale. ADC of tumours were calculated. Histological \ncharacteristics (differentiation, fibrosis, necrosis) were correlated with MRI features.\nResults: 95% of pancreatic adenocarcinomas were hypointense on 3D FS T1 \nGRE arterial phase, which was the best sequence for tumour conspicuity, followed \nby portal phase. DWI was not useful for delineating 26% of tumours. Maximum \ndiameter at pathological examination ranged from 18 to 60 mm (mean 33 mm). It \nwas best correlated with MR tumour size on DWI. No correlation was found between \nADC (mean value : 1.76x10-3 mm2/sec) and differentiation, fibrosis or necrosis. \nAll homogeneous hyperintense lesions on delayed phase (23% of tumours) were \npredominantly fibrous tumours.\nConclusion: 3D FS T1 GRE arterial phase sequence is superior to DWI for pancre-\natic adenocarcinoma conspicuity but it underestimates the size of the tumour. DWI \nis the best sequence for size evaluation when the tumour is correctly delineated.\nB‑0833 11:06\nQuantitative data analysis of the diffusion-weighted MR-images in \nthe differential diagnosis of metastatic liver disease of colorectal \nand pancreatic aetiology \nY. Savchenkov, S. Bagnenko, G. Trufanov, V. Fokin; St. Petersburg/RU \n(yura_savchenkov@mail.ru) \nPurpose: To develop differential diagnosis metastatic liver disease on the basis \nof quantitative data analysis of DWI.\nMethods and Materials: 57 metastatic liver lesions colorectal (37 lesions) and \npancreatic (20 lesions) aetiology were analysed in 20 patients. We used DWI with \nthe factors b-50,300,800,1200,1500s/mm2. All measurements were carried out \nwithin a single axial slice (for each pulse sequence separately). We used the coef-\nficients, calculated on the basis of the ratio measured values in several organs, in \ndifferent parts of the liver or in one and the same region of the liver.\nResults: The most informative in the native study is the ratio of SIlesionb300/SIaorta b300, \nSIlesionb50/SIaortab50 и SIlesionb50/SIliverb50 (р<0.001). Somewhat less informative demon-\nstrated is the ratio of SI lesionb300/SIliverb300 и ADClesion50-300-800 (р<0.001 and р=0.003). \nEvaluation of the mean values for group informative indicator ratios on the maps of \nthe ADC (b-50,3008,800s/mm2) revealed the distinctive features. The metastatic \nlesions of pancreatic aetiology characterised by higher value ADC in comparison \nwith colorectal metastases are (115.75±10.9) х10-5 mm2/s and (77.46±6.81) х105 \nmm2/s accordingly. Similar changes were observed in the following relations: \nSIlesionb50/SIaortab50, SIlesionb300/SIaortab30, SIlesionb50/SIliverb50, SIlesionb300/SIliver b300 (pancreatic \naetiology - 5.39±0.72, 4.12±0.52, 3.76±0.55, 2.78±0.35, accordingly; colorectal \naetiology - 2.71±0.19, 2.17±0.13, 1.88±0.14, 1.7±0.1). \nConclusion: DWI is a promising additional method allowing to make progress in \nthe issue of the differential diagnosis of metastatic liver lesion of colorectal and \npancreatic aetiology.\nB‑0834 11:15\nDoes the ADC-map eradicate the T2-shine-through effect affecting \nDW images of focal liver lesions? A study with exponential ADC-maps \nR. Girometti, M. Maieron, S. Pullini, E. Minighin, L. Cereser, G. Como, \nM. Bazzocchi, C. Zuiani; Udine/IT (rgirometti@sirm.org) \nPurpose: In clinical practice, the Apparent Diffusion Coefficient (ADC)-map is \nsupposed to eradicate the T2-shine-through effect (T2-STE) potentially affecting \nthe Diffusion-weighted (DW) signal of focal liver lesions (FLLs) at higher b-value. \nWe investigated whether this assumption is valid.\nMethods and Materials: Included were forty-five patients with 73 focal liver lesions \n(54 malignant and 19 benign) detected on a 1.5 T system (cysts and haemangiomas \nwere excluded from analysis). DW examination was performed using a single-shot \nEchoplanar sequence with b values of 50, 500 and 800 sec/mm 2, leading to the \ngeneration of (a) the ADC-map, using a 3-point regression analysis and (b) the \nexponential ADC-map (E-ADC-map), using the b800/b50 images ratio, which pro-\nvides a diffusion-weighted image with complete eradication of T2-relaxation time \neffects. By performing an analysis of differential signal patterns, two experienced \nradiologists in consensus estimated the prevalence of the T2-STE when combining \nDW images with the ADC-map or E-ADC-map.\nResults: The number of FLLs affected by the T2-STE was significantly larger (p < \n0.05;McNemar test) as assessed by the E-ADC-map (41/73; 56.7%; 95%C.I. 44.0-\n67.7) than the ADC-map (35/73; 47.9%, 95%C.I. 36.1-59.9). Additional T2-STE was \nfound by E-ADC-map in the case of 1 benign (1 focal nodular hyperplasia) and 5 \nmalignant (3 hepatocarcinomas and 2 metastases) FLLs, respectively.\nConclusion: The ADC-map is unsuited to correct for all cases of T2-STE affecting \nDW images. E-ADC-map should be alternatively used in the visual analysis of FLLs. \nB‑0835 11:24\nPrevalence of the T2-shine-through effect on DW images of focal \nliver lesions: a study with exponential ADC-maps at 1.5 T \nR. Girometti, M. Maieron, E. Minighin, S. Pullini, L. Cereser, G. Como, \nM. Bazzocchi, C. Zuiani; Udine/IT (rgirometti@sirm.org) \nPurpose: The aim of this study was to assess the prevalence of the T2-shine-\nthrough effect (T2-STE) when imaging focal liver lesions (FLLs) with Diffusion \nWeighted (DW) Magnetic Resonance Imaging at 1.5 T.\nMethods and Materials: We retrospectively enrolled forty-five patients with 73 focal \nliver lesions (54 malignant and 19 benign) detected on a highly performing 1.5 T \nsystem (cysts and haemangiomas were excluded from analysis). DW examina-\ntion was performed using a single-shot Echoplanar sequence with b values of 50, \n500 and 800 sec/mm2. Exponential ADC-map (E-ADC-map) was then generated \nusing the b800/b50 DW images ratio, which provides a diffusion-weighted image \n39\n\nScientific Sessions\nS34\n C A D E F\n G\nB\nB‑0840 10:39\nSpectral reconstruction algorithm for digital breast tomosynthesis \nI. Sechopoulos, V. Mejia-Bustamante, S.S.J. Feng, J. Nagy; Atlanta, GA/US \n(isechop@emory.edu) \nPurpose: To develop a novel spectral reconstruction algorithm for digital breast \ntomosynthesis (DBT) that results in reduced artifacts and improved image quality.\nMethods and Materials: Current reconstruction algorithms assume that the x-\nray source emits a mono-energetic x-ray beam, resulting in artifacts and possibly \nsub-optimal image quality. To avoid this, a mathematical model of DBT acquisition \nthat includes the spectral nature of the x-ray source was developed, resulting in a \nlarge scale non-linear inversion problem which we solve using an iterative, gradient \ndescent method. The resulting algorithm was tested using breast phantoms with \nlesions resembling masses and calcifications. The breast phantoms were imaged \nwith a clinical DBT system using the automatic exposure control system. The result-\ning spectral reconstructions were compared to the system’s filtered backprojection \n(FBP) reconstruction, which assumes a mono-energetic x-ray source.\nResults: The signal difference-to-noise ratios of the masses in the spectral re-\nconstruction were all superior to those of FBP by a mean factor of 2.6. In addition, \nthe masses exhibited better homogeneity and no artifacts in the direction of x-ray \ntube travel, typically seen in DBT images. The microcalcifications also resulted in \nimproved signal difference and without artifacts seen in the FBP reconstructions. \nSubjective comparison of images of heterogeneous breast phantoms showed \nan overall improvement in image quality, substantial reduction of artifacts, and \nlower noise.\nConclusion: Spectral reconstruction can improve image quality and reduce artifacts \nin DBT images. This new algorithm also allows for investigation of novel acquisition \ntechniques that could result in further improvements in DBT imaging.\nAuthor Disclosures:\nI. Sechopoulos: Research/Grant Support; Hologic, Inc., Fuji.\nB‑0841 10:48\nContrast-detail visibility analysis for digital breast tomosynthesis \nversus digital mammography \nS. Elie, W.J.H. Veldkamp, R.E. van Engen, M.J.M. Broeders; Nijmegen/NL \n(s.elie@lrcb.nl) \nPurpose: Digital breast tomosynthesis (DBT) is expected to improve visibility of \nlesions by reducing overprojection of tissue. This phantom study investigates the \nimage quality of DBT images by comparing in-plane contrast and detail performance \nto digital mammography (DM) images in simulated mammographic background \nconditions.\nMethods and Materials: Contrast-detail visibility was compared by imaging a 0.1 \nmm aluminium contrast-detail phantom (CDmam 3.4) that was positioned between \ntwo layers containing a breast-simulating material with comparable scatter and \nprimary transmission properties. To obtain increased phantom thickness PMMA \nwas added. The related simulated breast thicknesses were 32, 60 and 90 mm. Im-\nages were acquired with the following systems: Sectra Microdose L30 (DM, Sectra \nprototype DBT) and Hologic Selenia Dimensions (both DM and DBT mode). For \neach imaging mode and thickness eight images were acquired. X-ray spectra corre-\nsponded to clinical practice, where the mean glandular dose (MGD) of the DM mode \nwas matched to the MGD of the DBT imaging mode. The CDmam images were \nscored by human observers and contrast and detail performance was evaluated.\nResults: Results showed that the contrast resolution (object diameters 0.4-2.0 mm \nand object thicknesses 0.03-0.16 µm) improves in DBT. However, DBT showed a \nloss in spatial resolution (object diameters 0.06-0.31 mm and object thicknesses \n0.2-2.0 µm) compared to DM.\nConclusion: The in-plane DBT images are less affected by overprojecting struc-\ntures resulting in better contrast resolution. However, smaller objects are better \nvisualised with DM, due to superior spatial resolution in DM images compared to \nin-plane DBT images.\nB‑0842 10:57\nCan a colour representation of grey-scale images improve object \ndetectability in mammography? \nE. Salvagnini1, L. Cockmartin1, K. Michielsen1, J. Jacobs2, N.W. Marshall1, \nL. Struelens3, H. Bosmans1; 1Leuven/BE, 2Heverlee/BE, 3Mol/BE \n(hilde.bosmans@uzleuven.be) \nPurpose: To examine the influence of display colour scales on human detection \nthresholds using a contrast-detail (c-d) phantom imaged with structured background.\nMethods and Materials: This study used a CDMAM phantom imaged in combina-\ntion with PMMA and the CIRS BR3D phantom to add structured background to the \nB‑0838 11:51\nEvaluation of diffusion-weighted MR imaging for detection of \ninfection in acute pancreatic collections and/or necrosis: preliminary \nresults \nF. Islim, A.E. Salik, S. Bayramoglu, K. Guven, H. Alis, A.N. Turhan; Istanbul/TR \n(fislim@yahoo.com) \nPurpose: To evaluate the contribution of diffusion-weighted magnetic resonance \nimaging (DW MRI) for detection of infection that has a critical role in the prognosis \nof acute pancreatitis.\nMethods and Materials: 21 DW MRI at b values of 0, 500 and 1000 were \nprospectively performed on 20 patients with acute pancreatitis. The collections \nand necrosis with peripheral bright signal on DW MR Images were accepted as \npositive. Apparent diffusion coefficient (ADC) values of peripheral (if DW MRI was \npositive) and central parts of the collections and/or necrosis were measured by \nthree radiologists. Intra and inter-observer reliabilities were analyzed. Student`s \nt-test was used to compare the ADC values between infected and sterile groups.\nResults: Except 1 false positive result DWI could successfully estimate the pres-\nence of infection. The mean ADC value of peripheral diffusion restricted areas \nwas found to be 1.16 ± 0.14 x10 -3 mm2/s. The mean ADC values measured from \ncentral parts of the collections and/or necrosis in infected and sterile groups were \nsignificantly different (p < 0.05) (2.58 ± 0.36 x10 -3 mm2/s and 2.86 ± 0.29 x10 -3 \nmm2/s respectively).\nConclusion: Diffusion weighted MRI may be helpful for detection of infection in \nacute pancreatic collections and/or necrosis. \n10:30 - 12:00 Room L/M \nPhysics in Radiology \nSS 1713 \nBreast imaging and novel CT techniques \nModerators: \nN. Karssemeijer; Nijmegen/NL \nM. Koutalonis; Colchester/UK \nB‑0839 10:30\nComparative detector evaluation of full field digital mammography \n(FFDM) systems using the Fourier definition of the Hotelling-\nobserver signal-to-noise ratio (SNR) \nR. Wise, I. Delakis, E. Kulama, D. McRobbie; London/UK \nPurpose: Evaluation and optimisation of image quality plays an important role in \nenhancing the diagnostic value of mammography studies. Mammographic image \nquality is typically assessed on the basis of analysing images of the CDMAM \ncontrast-detail phantom for mammography. However, CDMAM analysis can suffer \nfrom intra-observer variations and limited statistics. The purpose of this work was \nto apply Hotelling-observer SNR analysis in a comparative evaluation of FFDM \ndetectors.\nMethods and Materials: The generalised normalised noise power spectrum (GN-\nNPS) was measured by collecting flat field images of 4 cm PMMA phantom. The \ngeneralised modulation transfer function (GMTF) was then measured by placing \na 0.02-mm Tungsten edge in the middle of the 4 cm PMMA phantom. This setup \nallowed for scatter and focal-spot unsharpness to be incorporated in the measure-\nments. The Hotelling-observer SNR was calculated for input signal originating from \ngold discs of varying thicknesses and diameters, to replicate CDMAM analysis.\nResults: For each FFDM detector, Hotelling-observer SNR increased with the \ndiameter and thickness of the gold disc. The Hotelling-observer SNR results showed \nvariations in the performance of FFDM detectors evaluated, demonstrating the use \nof this metric as a differentiator. In addition, Hotelling-observer SNR values were \nhigher for systems displaying better CDMAM analysis results, demonstrating the \nrelation between the two metrics.\nConclusion: We used Hotelling observer-SNR to evaluate the performance of \nFFDM detectors, on the basis of a methodology accounting for focal-spot unsharp-\nness and scatter. The calculated task SNR values varied across the detectors \nevaluated, in a manner commensurate with CDMAM analysis results. \n0\n\nScientific Sessions\nS34\nA\n C D E F G\nB\nMonday\ncontrast of the monochromatic X-rays was better than that of the polychromatic \nx-rays. Mean values of standard deviation of linear attenuation reduction charac-\nteristics of the phantom were 2.78% and 0.87% on conventional polychromatic \nand monochromatic DEXA, respectively.\nConclusion: Monochromatic DEXA using a multilayer mirror would be provided \na precise measurement of bone mineral density by achieving the better perform-\nance with lower radiation dose than that of the conventional polychromatic DEXA. \nB‑0845 11:24\nPhase contrast imaging using grating interferometer: preliminary results \nD. Kang, K.-H. Yoon, Y.-H. Lee, E. Kang, C.-H. Lee; Iksan/KR \n(sharp8588@naver.com) \nPurpose: Phase-contrast radiography is an emerging technique for producing medi-\ncal imaging with more soft tissue contrast than traditional absorption radiography. \nThe goal of this study is to evaluate the feasibility of phase contrast imaging using \ngrating interferometer for clinical use.\nMethods and Materials: We developed a prototype of phase contrast x-ray imaging \nsystem using micro-focus x-ray source, grating interferometer and CMOS detec-\ntor. The source contains a tungsten anode x-ray tube that can operate from 38 \nkV at 0.35 mA and focal spot size of 0.3 mm. A specification of phase grating was \n4.714um period, Ni 6.08um height and 30x70 mm2 area; and analyser grating was \n2.4um period, Au 20.3um height and 20x60 mm2 area. With application of phase \nretrieval algorithm, phantoms such as acryl ball, honey bee and goldfish images \nwere obtained. We compared with images of conventional absorption radiography \nand evaluated the phase intensity by phase stepping method.\nResults: Phase contrast image shows a detailed view of the edge of the acryl \nball. On the phase contrast image there are dark and light lines running along the \nhole. These lines represent the phase-contrast edge enhancement effect. A similar \neffect is evident at the honeybee and goldfish images. The phase contrast edge \nenhancement effect is visible in the phase contrast radiography, but not in either \nof the absorption contrast image.\nConclusion: The phase contrast imaging using grating interferometer will ultimately \nprovide a novel x-ray imaging system that enables with high contrast, which can \nbe valuable in medical imaging such as breast, cartilage and vessels.\nB‑0846 11:33\nFirst in-vitro results of microbubbles as a scattering contrast agent \nfor x-ray dark-field imaging measured at a first pre-clinical x-ray \nphase-contrast and dark-field CT scanner \nA. Velroyen1, M. Bech1, A. Tapfer1, M. Ingrisch2, C.C. Cyran2, \nS. Auweter2, K. Nikolaou2, M.F. Reiser2, F. Pfeiffer1; 1Garching/DE, \n2Munich/DE (astrid.velroyen@ph.tum.de) \nPurpose: Dark-field and phase-contrast imaging, which generate contrast from \nultra-small angle scattering and refraction of x-rays in matter, have been shown to \nincrease soft-tissue contrast and provide complementary information to conven-\ntional absorption-based imaging. To further improve image quality and explore \npossible alternatives to commonly applied iodine-based contrast agents, the use \nof microbubble-based ultrasound contrast agents as an x-ray scattering dark-field \ncontrast medium was investigated.\nMethods and Materials: Using the first pre-clinical phase-contrast and dark-field \nCT scanner with polychromatic x-ray source and grating interferometer installed on \na rotating gantry, absorption, phase-contrast and dark-field images of microbubble-\nbased contrast-agent samples were acquired in-vitro. For quantitative comparison, \nthe contrast-to-noise ratio relative to a reference was calculated for varying detector \nresolutions (29-928 micrometer) in absorption and dark-field images.\nResults: It was possible to generate an improved contrast-to-noise ratio in the dark-\nfield image compared to the absorption-based image (6.88 versus 1.41, pixel size \n29 micrometer) by exploiting the x-ray scattering through microbubbles. With larger \npixel sizes (928 micrometer), the relative contrast gain increased to 78.82 for dark \nfield, whereas, with 1.06, it remained in the same order of magnitude for absorption.\nConclusion: The proved feasibility of microbubble-based dark-field contrast-\nenhancement with clinically compatible pixel sizes, together with the large potential \nof the introduction of grating interferometry into a clinical environment as shown \nby the successful implementation of the technology into a rotating gantry, strongly \npromote the use of microbubbles as a dedicated dark-field x-ray contrast agent \nand warrant further investigation in an experimental in-vivo setting. \nimages. Four thicknesses of the combined phantoms were imaged with a digital \nmammography unit. Of each thickness, four images were acquired under automatic \nexposure control. Images were displayed under standard clinical conditions: first on \ntwo 5 megapixel medical grade monitors calibrated to the DICOM GSDF standard, \nthen on a 6 megapixel colour monitor, displaying the images in green-scale. Green-\nscale was chosen as this wavelength matches a peak in human visual response. \nReading was performed with the Sara 2 software which displays each CDMAM \ncell under random rotation, reducing reader memorization. Readers performed a \n4-alternative forced choice task; five readers scored all images.\nResults: Threshold gold thickness (TGT) increased as beam quality and thickness \nincreased, indicating a reduction in object detectability with increasing object thick-\nness. Results obtained for the grey-scale display had a higher TGT compared to \ngreen-scale results; TGT values obtained with green-scale display were between \n7% and 31% lower than grey-scale display TGT. P values for the different diameters \nobtained from Wilcoxon matched pairs tests ranged from < 0.01 to 0.68 for 2 cm \nand < 0.01 to 0.44 for 7 cm.\nConclusion: Observer performance measured by c-d curves was equal or better \nfor images displayed in green-scale rather than grey-scale, indicating potential \nbenefit for using green-scale displays in medical applications.\nB‑0843 11:06\nVolumetric breast-density measurement using spectral mammography \nA. Gooßen1, M. Lundqvist2, K. Erhard1, E. Fredenberg2; 1Hamburg/DE, \n2Solna/SE (erik.fredenberg@philips.com) \nPurpose: Volumetric breast density (VBD) quantification is useful for assessing \ndiagnostic accuracy and the risk of developing breast cancer. The purpose of this \nstudy is to evaluate spectral imaging as a method to improve the accuracy of VBD \nmeasurements compared to conventional non-spectral methods.\nMethods and Materials: The VBD is the volumetric fraction of fibro-glandular \ntissue in the breast. To measure VBD in a conventional non-energy resolved mam-\nmogram, assumptions have to be made on the breast thickness. Spectral imaging, \non the other hand, enables simultaneous measurement of breast thickness and \nglandularity by employing the spectral difference in x-ray attenuation between \nadipose and fibro-glandular tissue. Spectral mammograms were acquired in a \nsingle exposure using a photon-counting mammography system. The VBD was \nmeasured by material decomposition based on calibration to tissue-equivalent \nmaterial. For reference, VBD was measured with a conventional non-spectral \nmethod in a similar group of patients.\nResults: Spectral mammograms of 75 patients, aged 50-69 years, were examined. \nThe correlation in VBD between contralateral breasts was r=0.97. 246 patients \nwere examined with conventional methods, which returned a correlation between \ncontralateral breasts of r=0.92. The VBD distribution was similar in the two groups \nas measured with the two different methods.\nConclusion: Spectral imaging provides an efficient measure of VBD. The VBD \ndistributions over the group of patients were comparable in the spectral and non-\nspectral measurements, but the correlation between contralateral breasts was \ntighter using spectral imaging, which indicates higher consistency. \nAuthor Disclosures:\nA. Gooßen: Employee; Philips. M. Lundqvist: Employee; Philips. K. Erhard: \nEmployee; Philips. E. Fredenberg: Employee; Philips.\nB‑0844 11:15\nMonochromatic dual-energy x-rays for precise measurement of bone \nmineral density: preliminary results \nC.-H. Lee, K.-H. Yoon, Y.-H. Lee, E. Kang, D. Kang; Iksan/KR \n(99 lch99@hanmail.net) \nPurpose: The feasibility of monochromatic dual-energy x-ray absorptiometry \n(DEXA) using multilayer reflector for precise measurement of bone mineral density \n(BMD) was examined.\nMethods and Materials: A multilayer mirror was fabricated to select an x-ray peak \nwith an energy of 40 keV and 59.3 keV generated from an x-ray tube with a tungsten \ntarget. Experimental set-up of monochromatic DEXA was installed by dual-energy \nof monochromatic x-rays source and CZT detector. The performance of the system \nwas evaluated using a DEXA phantom, spectrometer and radiation dosimeter. \nWe compared the image quality and the attenuation reduction characteristics of \nthe phantom to determine precision of BMD on conventional polychromatic and \nmonochromatic DEXA.\nResults: The monochromatic beam from the multilayer reflector had a full-width-\nat-half-maximum of 2.69 keV at 40 keV and 5.8 keV at 59.3 keV, the reflectivity \nwas 0.60 and 0.58, respectively. Conventional polychromatic and monochromatic \nDEXA showed radiation doses of 0.32 mGy and 0.05 mGy, respectively. The image \n1\n\nScientific Sessions\nS34\n C A D E F\n G\nB\n10:30 - 12:00 Room N/O \nCardiac \nSS 1703 \nBiomarkers, tissue characterisation and remodelling \nModerators: \nM. Das; Maastricht/NL \nK. Gruszczynska; Katowice/PL \nB‑0849 10:30\nBiomarkers of atherosclerotic and myocardial remodelling: \ncorrelation with plaque volume in cardiac CT \nL.L. Geyer1, A. Krazinski1, J.R. Silverman1, F. Bamberg2, \nU. Ebersberger2, P. Costello1, U.J. Schoepf1; 1Charleston, SC/US, \n2Munich/DE (Lucas.Geyer@med.lmu.de) \nPurpose: We aimed at correlating the plasma levels of circulating biomarkers in \nthe context of atherosclerotic disease activity and myocardial remodelling with \ncoronary dual-source CT angiography (cCTA) findings.\nMethods and Materials: 75 patients with suspected coronary artery disease (CAD) \nunderwent cCTA. Patients were evaluated for coronary plaque type and the pres-\nence and the severity of CAD. A semi-automated software was used for measur-\ning non-calcified and mixed plaque volumes; lipid-rich and fibrous contents were \ndiscriminated. Cardiac function parameters were obtained. Plasma samples were \ncollected and a cytokine and protease profiling panel was performed by multiplex \nanalysis. The plasma concentrations of seven biomarkers were measured: TNFα, \nIL-6, IL-8, matrix metalloproteinase (MMP)-2, MMP-3, MMP-7, MMP-8. Data were \nanalysed using Spearman’s rank correlation and Mann-Whitney-U-test.\nResults: Data of 75 patients (81% male, 59±10 years) were evaluated. 60/75 \npatients showed atherosclerotic changes in at least one vessel based on cCTA. \n46 non-calcified, 129 calcified, and 86 mixed plaques were identified. We found a \nstatistically significant (p < 0.05) positive correlation between the plasma concen-\ntrations of MMP-8 and the lipid-rich, fibrous, and total plaque volumes per patient. \nMoreover, IL-8 and TNFα showed a significant (p < 0.05) positive correlation with \nmyocardial mass. Patients with diabetes mellitus showed significantly reduced \nMMP-7 (2.9±1.6 ng, 4.9±3.0 ng, p < 0.05). MMP-2, MMP-3, and MMP-9 did not \nshow any significant correlations.\nConclusion: Our study suggests that elevated levels of MMP-8 are associated \nwith evidence of greater plaque volume in cCTA. IL-8 and TNFα may also indicate \nmore active myocardial remodelling with higher myocardial mass in CT. \nAuthor Disclosures:\nL.L. Geyer: Speaker; GE Healthcare, Germany.F. Bamberg: Research/\nGrant Support; Bayer Healthcare (Germany). Speaker; Siemens Healthcare \n(Forchheim, Germany).U.J. Schoepf: Consultant; Bayer-Schering, Bracco, \nGeneral Electric, Medrad, Siemens, TeraRecon. Research/Grant Support; \nBayer-Schering, Bracco, General Electric, Medrad, Siemens.\nB‑0850 10:39\nMorpho-functional and metabolic assessment of the heart in \nadult-onset growth hormone (GH) deficiency patients with cardiac \nmagnetic resonance (CMR) and 31P MR spectroscopy (31P-MRS) \nM. Cava, F. De Cobelli, A. Esposito, G. Perseghin, A. Rossini, R. Lanzi, M. Losa, \nT. Canu, A. Del Maschio; Milan/IT \nPurpose: Growth Hormone seems to play an important role in cardiovascular \nsystem function: structural and morpho-functional alterations could be related to its \ndeficiency, with an increased mortality risk. In recent years some studies reported \nechocardiographic evaluations in patients with GH-deficiency, but no significant \ndata concerning CMR and 31P-MRS are available now.\nMethods and Materials: CMR study (before and after Gadolinium injection) and \n31P-MRS were performed on a 1.5 T magnet (Philips Intera Master) in 16 adult \npatients with adult onset GH-deficiency (GHD:10 males and 6 females, 49.3±13.7 \nyears). Left and right ventricle morpho-functional evaluation, structural (with late-\nenhancement assessment) and metabolic feature estimation (as PCr/ATP ratio) \nwere performed. 16 healthy individuals were the matched control group (Co).\nResults: GHD showed normal biventricular function. Median left ventricular mass \n(Mass/BSA GHD 49.7±18.3 vs CO 80 ± 20 p < 0.001) and mass/volume ratio were \nreduced (0.68±0.15 vs 1.09±0.13 p < 0.001) with normal volumes. DT (trans-mitral \ndeceleration time) was shortened (148.5±38.4 vs 192.5±35.8 p=0.003). GHD had \nslightly lower right ventricle median volume (p=0.03). GHD pts showed lower PCr/\nB‑0847 11:42\nIn vivo urinary stones chemical compound identification using dual-\nenergy CT \nT. Kraśnicki, M. Guziński, P. Podgórski, J. Bladowska, A. Czarnecka, \nK. Tupikowski, M. Sąsiadek; Wrocław/PL (tomasz.krasnicki@gmail.com) \nPurpose: The aim of the study was to identify in vivo urinary stones composition by \nanalysing Z effective (Zeff -weighted mean atomic number) values and to compare \nobtained results to the chemical analysis of the stones.\nMethods and Materials: Twenty-eight patients with urolithiasis symptoms were \nexamined using dual-energy CT (pitch 0.5, tube voltage with fast kVp switching \n80/140 kVp, DFOV 5×5 cm). Data obtained during the examination were analysed \non a clinical workstation with dedicated software (GSI Viewer). Urinary stones were \nevaluated separately by measuring Zeff value using small ROI method. The Zeff \nvalues were assigned to the corresponding composition and were compared to \nthe results of chemical analysis after the removal of stones from the urinary tract.\nResults: The Zeff analyses revealed 3 types of calculi: homogenous stones (22 \ncases) with the high Zeff value: 13.52 (± 0.6); homogenous stones (3 cases) with \nthe low Zeff value (from 6.9 to 7.1, mean 6.98); heterogeneous stones (3 cases) with \nZeff values 11.23 to 11.9 (mean 11.45) and 14.50 to 14.90 (mean 14.74). The cases \nof first group correspond to calcium oxalate stones. The second group Zeff values \ncorrespond to uric acid stones, while the third group was compatible the stones \ncontaining mixed struvite and apatite crystals. Urinary stones chemical analysis \nconducted after urinary tract removal confirmed the Zeff measurements results.\nConclusion: Dual-energy CT is able to identify in vivo chemical composition of \nurinary stones and it may be useful in planning the optimal patient management. \nB‑0848 11:51\nValue of monoenergetic low-keV dual-energy CT datasets for \nimproved image quality of abdominal CT angiography \nS. Sudarski, D. Schneider, P. Apfaltrer, S.O. Schönberg, T. Henzler; \nMannheim/DE (sonja_sudarski@gmx.de) \nPurpose: High vessel attenuation and a high contrast-to-noise (CNR) ratio are \nprerequisites for highly diagnostic abdominal CT angiography (CTA) examinations. \nWe compared image-quality of standard 120 keV polyenergetic images (PEIs) with \ncalculated low-keV monoenergetic images (MEIs) in dual-energy CTA studies of \nthe abdomen.\nMethods and Materials: Datasets of fifty patients (42 men, 71 ± 10 years) who \nunderwent abdominal dual-energy CTA were retrospectively evaluated. The 80- and \n140-keV dual-energy image data was used to calculate MEIs in 10-keV intervals \nfrom 120 keV to 40 keV. Vessel attenuation and image noise were measured in \nthree regions-of-interest (infrarenal aorta, external iliac artery and superior me-\nsenteric artery) and the signal-to-noise ratio (SNR) and CNR were subsequently \ncalculated. Differences between measurements in MEIs and PEIs were evaluated \nusing the Student's t-test.\nResults: SNR and CNR of 70-keV MEIs were highest compared to MEIs at other \nlow-keV levels. When comparing MEIs at 70 keV to PEIs, vessel attenuation and \nimage noise were significantly higher in MEIs in all three regions-of-interest (+14%, \n+13%, +14%; p < 0.05 and +12%, +6%, +9%; all p < 0.05). SNR was slightly in-\ncreased in 70-keV MEIs (+4%, +7%, +6%; p < 0.05). CNR was also significantly \nhigher in MEIs when compared to PEIs (+18%, +16% and +18%; p < 0.05).\nConclusion: Calculated 70-keV MEIs show improved vessel attenuation, SNR \nand CNR in abdominal dual-energy CTA studies when compared to the standard \n120-keV PEIs. Thus, lowering the total amount of iodinated contrast material might \nbecome feasible with monoenergetic low-keV imaging. \n2\n\nScientific Sessions\nS34\nA\n C D E F G\nB\nMonday\nB‑0853 11:06\nExposure to a high fat diet during early development increases the \nsusceptibility to cardiac lipid accumulation \nP.A. van Ewijk, S. Paglialunga, J. Slenter, J.E. Wildberger, J. Glatz, \nM.K.C. Hesselink, P. Schrauwen, V.B. Schrauwen-Hinderling, M.E. Kooi; \nMaastricht/NL (eline.kooi@mumc.nl) \nPurpose: It was shown in mice the exposure to a high fat (HF) diet during early \ndevelopment increased the susceptibility to high-fat diet-induced hepatic steatosis \nand decreased markers of hepatic mitochondrial function. We aim to investigate \nwhether early exposure to a HF diet also increases the susceptibility to cardiac \nfat storage and diminishes cardiac mitochondrial function and ejection fraction.\nMethods and Materials: Male and female C57BL6 mice were fed a HF diet \n(45% kcal fat) or standard chow diet (9% kcal fat (LF)), starting at least 6 weeks \nbefore conception and continuing during gestation and lactation. From weaning \nonwards, all offspring were fed the HF diet, generating two groups: HF/HF and LF/\nHF. Cardiac function and myocardial fat content were measured in male offspring \nat 15 weeks of age (n=26) using magnetic resonance imaging and spectroscopy \non a 7T MR System (Bruker Biospin GmbH). Cardiac mitochondrial respiration \nwas determined in parallel groups (n=11), using high resolution respirometry \n(OROBOROS Instruments).\nResults: At 15 weeks of age, the HF/HF group showed significantly higher cardiac \nlipid content (p=0.02) compared to the LF/HF group. No significant differences in \ncardiac mitochondrial function and ejection fraction were detected.\nConclusion: Mice exposed to HF feeding during early development were more sus-\nceptible for high-fat diet-induced cardiac lipid accumulation. This was not (yet) ac-\ncompanied by decreased mitochondrial function and/or decreased ejection fraction.\nB‑0854 11:15\nCardiac and hepatic iron and heart function by MR in thalassaemia \nmajor patients treated with combined deferiprone and \ndesferrioxamine regimen versus monotherapies: a multi-centre, \nobservational and prospective study \nC. Tudisca1, P. Ricchi2, A. Meloni3, E. Grassedonio1, M. Santodirocco4; \n1Palermo/IT, 2Naples/IT, 3Pisa/IT, 4San Giovanni Rotondo/IT \nPurpose: Due to the limited data available in literature, the aim of this multi-\ncentre study was to prospectively assess in thalassaemia major ( TM) the efficacy \nof combined deferiprone (DFP) and desferrioxamine (DFO) regimen versus DFP \nand DFO in monotherapy by quantitative magnetic resonance imaging (MRI) over \na follow-up of 18 months.\nMethods and Materials: Among the first 1135 TM patients in the MIOT (Myocar-\ndial Iron Overload in Thalassaemia) network, we evaluated those who had been \nreceived combined regimen (N=51) or DFP (N=39) and DFO (N=74) monothera-\npies between the two MRI scans. Iron overload was measured by T2* multiecho \ntechnique. Biventricular function parameters were quantitatively evaluated by \ncine images.\nResults: The percentage of patients that maintained a normal global heart T2* \nvalue was comparable between DFP+DFO versus both groups. Among the patients \nwith myocardial iron overload at baseline, the changes in the global heart T2* \nand in biventricular function were not significantly different in DFP+DFO versus \nthe DFP group. The changes in the global heart T2* were significantly higher in \nthe DFP+DFO versus DFO group, without a difference in biventricular function. \nAmong the patients with hepatic iron at baseline the increase in liver T2* values \nwas significantly higher in combination versus both groups.\nConclusion: In TM patients at the dosages used in the real world, combined \nDFP+DFO regimen was more effective in removing cardiac iron load only versus \nthe DFO group and in clearing hepatic iron versus both groups. Combined therapy \ndid not show an additional effect on heart function. \nAuthor Disclosures:\nC. Tudisca: Author; Dr. Pepe Alessia received speaker’s honoraria from Chiesi, \nApoPharma Inc. and Novartis. Research/Grant Support; The MIOT project \nreceives “no-profit support” from industrial sponsorships (Chiesi Farmaceutici \nS.p.A., ApoPharma Inc. and Bayer-Shering). This study was also supported by: \n“Ministero della Salute”.\nATP ratio (1.9±0.28 vs 2.15±0.3 p=0.03). In late enhancement sequences there \nwere no structural abnormalities.\nConclusion: Our data suggest that CMR in association with 31P-MRS could to \nidentify early myocardial alterations in morphology, function, structure and metabo-\nlism in patients with adult onset GH-deficiency. Overall myocardial mass reduction \ncould be related to a reduced energy load, maybe due to an anabolic impairment: \neven if at preliminary stages ventricular function could be normal, this process may \nanticipate subsequent functional loss. \nB‑0851 10:48\nRight ventricular remodelling after ST-elevation myocardial infarction \nM. Tille, M. Gutberlet, H. Thiele, M. Grothoff; \nLeipzig/DE (mandy.tille@herzzentrum-leipzig.de) \nPurpose: Right ventricular (RV) injury is common after ST-elevation myocardial \ninfarction (STEMI) and can be accurately detected by cardiac magnetic resonance \n(CMR). In this longitudinal study we sought to analyse RV myocardial remodelling \nafter STEMI.\nMethods and Materials: We studied 41 patients with RVI 1-4 days after primary \nangioplasty in STEMI. T2-weighted and late-gadolinium-enhancement (LGE) CMR \nwas used for visualising oedema and necrosis. Cine-imaging was performed to \naccess volumes and wall motion abnormalities (WMA), which, in combination with \noedema were considered diagnostic for RVI. A second CMR examination was \nperformed with a mean follow-up period of 5.2 months.\nResults: The initial examination showed 17/41 patients with LGE. The remaining \n24 patients demonstrated oedema and WMA only. There was no difference in RV \nejection fraction (RV-EF) between these two groups (43.9±7.4% vs. 49.5±4.6%, \np < 0.001); however, RV-EF was decreased in both. In follow-up, no oedema was \ndetectable and mean RV-EF was within a normal range again in both, patients \nwith LGE (49.5±5.6%) and patients without LGE (48.8±5.6%, p=0.69). LGE was \nsignificantly smaller in follow -up compared to the first examination (p=0.023). In \nmultivariate regression analysis, RV oedema was the only parameter that was \nassociated with a significant improvement of RV-EF.\nConclusion: The significant decrease of LGE in the follow-up examination implies \nthat the area of hyperenhancement might represent necrosis. We furthermore \nconclude that the extend of RV scar is too small to permanently impair RV-EF \nfunction in the majority of patients in follow-up. \nB‑0852 10:57\nInfluence of periprocedural myonecrosis assessed by magnetic \nresonance delayed enhancement in patients with bifurcation lesions \nangioplasty on prognosis at one-year follow-up \nR. Gil, J. Walecki, D. Vassilev, M. Furmanek, A. Michałek, M. Odyniec-Nowacka, \nA.J. Piliszek; Warsaw/PL (agnieszka.piliszek@gmail.com) \nPurpose: The factors governing periprocedural myocardial injury (PMI) and its \ninfluence on the prognosis at follow-up are not completely clear. We used delayed \nenhancement magnetic resonance imaging (LGE MRI) to assess myonecrosis \nafter PCI.\nMethods and Materials: Forty-three patients with stable coronary artery disease \nwere studied with 1.5 T MRI before and after (within 72h) stenting of bifurcation \nlesions. The left ventricular function and LGE were assessed. We performed angi-\nographic measurements of the vessel diameters, and bifurcation angles pre- and \npost-intervention.\nResults: After interventional procedure 24 (56%) patients had troponin I elevation \nand 14 (32.6%) patients had evidence of new myocardial enhancement (4.5 ± 2.9 \ngrams, 4.4% ± 4.5% of left ventricle mass). Troponin I cut-off value for new LGE \nwas 0.7 ng/ml (p=0.018). Ten (23.3%) patients had new LGE at the area supplied \nby SB, eight (18.6%) patients at the area of distal embolisation and four (9.3%) \npatients in both localisations. There was clear correlation between LGE localisation \nand geometry of the bifurcation (smaller modified distal bifurcation angle in SB area \nLGE group 22 ± 9° vs 41 ± 13°, p=0.001). At 13 moths' follow -up the MACE rate \nwas 14%. There was no correlation between periprocedural myonecrosis expressed \nas a new area of LGE and MACE.\nConclusion: Occurrence of PMI after coronary bifurcation stenting is high; it is pos-\nsible to predict the PMI localisation based on the bifurcation geometry; but PMI mass \nis small, usually < 5 g and has no influence on serious cardiac events at follow-up. \n3\n\nScientific Sessions\nS34\n C A D E F\n G\nB\nof RV failure after repairing TOF to deliberate correlations between DE and RV \nfunction when evaluating by cardiac magnetic resonance (CMR).\nMethods and Materials: In a retrospective cohort study, the clinical and CMR \ndata of 110 Iranian symptomatic patients with repaired TOF during 35 years ago \nwere collected. Cardiac function indexes were compared in two groups of patients \nwith and without DE.\nResults: Patient’s mean age was 21.9±6.9 years. 65 (59.1%) patients were male \nand 45 (40.9%) were female. DE was positive in 103 (93.6%) and negative in 7 \n(6.4%) patients. The position of DE was \"right ventricular outflow tract (RVOT) \nwithout other sites\" in 81 (78.6%) and \"RVOT with other sites\" in 22 (21.4%) pa-\ntients. Mean right ventricle end diastolic volume (RVEDV) in DE positive and DE \nnegative was 258.2 mL/m2±91.8 and 185.5 mL/m2±38.2, respectively (P=0.047). \nMean of right ventricle end systolic volume (RVESV) in DE positive and DE nega-\ntive was 162.8 mL/m2±71.1 and 103.3 mL/m2±35.9, respectively (P=0.045) and \nmean of right ventricle ejection fraction (RVEF) in DE positive and DE negative \nwas 38.2%±7.7 and 44.8%±9.1, respectively (P=0.010).\nConclusion: DE is a common finding in symptomatic patients with repaired TOF. \nUsing CMR modality, we found DE as an indicative of ventricular scarring or fibrosis \nin these patients showing a direct correlation with RV dysfunction. \nB‑0858 11:51\nDiastolic versus systolic acquisition of T1 maps of normal human \nmyocardium at 1.5 T magnetic resonance imaging \nU. Reiter1, G. Reiter1, K. Dorr1, A. Greiser2, R. Maderthaner1, M.H. Fuchsjäger1; \n1Graz/AT, 2Erlangen/DE (ursula.reiter@klinikum-graz.at) \nPurpose: Variation of myocardial blood volume during the cardiac cycle suggests \ndependence of longitudinal myocardial T1 relaxation time with cardiac phase. \nDifferences and relations between diastolic and systolic T1 times of normal myo-\ncardium were investigated.\nMethods and Materials: 40 healthy subjects (20 females and 20 males, age 23±3 \nyears, age range 20-35 years) underwent 1.5 T magnetic resonance T1-mapping \nwith motion-corrected MOLLI (Modified Look Locker Inversion Recovery) acquired \nin three short axes (basal, mid-ventricular and apical) in systole and end-diastole. \nRegional T1 values were determined in all 16 AHA-segments; their mean was \ninterpreted as myocardial T1 time. Resulting T1 values were analyzed employing \nt-test, analysis of variance and correlation analysis.\nResults: Mean myocardial T1 times (984±28 ms in diastole and 959±21 ms in \nsystole) as well as all segmental mean T1 values in diastole and systole differed \nsignificantly (p < 0.0001 for all comparisons). Correlations between diastolic and \nsystolic T1 times were, however, strong (r=0.98 for myocardial and r=0.81 for \nsegmental T1 times). Mean diastolic versus systolic T1 values in different AHA-\nsegments differed significantly (p < 0.0001 in both phases), but there was a strong \ncorrelation between segmental mean T1 values in diastole and systole (r=0.83). \nSystolic-to-diastolic increase of T1 was above average in lateral (p < 0.0001) and \napical (p < 0.0001) segments.\nConclusion: T1 relaxation times of normal myocardium differ significantly be-\ntween diastole and systole at 1.5 T. Their strong correlation facilitates translation \nof diastolic and systolic T1 normal values. Regional deviations from the mean \nsystolic-to-diastolic increase of T1 might be associated with regional differences \nin myocardial perfusion. \nAuthor Disclosures:\nG. Reiter: Employee; Siemens. A. Greiser: Employee; Siemens.\nB‑0855 11:24\nAre the preferential patterns of myocardial iron overload preserved \nat the CMR follow-up? \nC. Tudisca1, A. Meloni2, G. Giuffrida3, E. Grassedonio1, E. Chiodi4, \nA. Pietrapertosa5, M. Lombardi2, M. Midiri1, A. Pepe2; 1Palermo/IT, 2Pisa/IT, \n3Catania/IT, 4Ferrara/IT, 5Bari/IT \nPurpose: We aimed to determine if a preferential pattern of myocardial iron overload \n(MIO) was preserved between two Cardiac Magnetic Resonance (CMR) scans in \nthalassaemia major (TM) patients.\nMethods and Materials: Three short-axis views of the left ventricle were acquired \nand analysed using a 16-segment standardised model. The T2* value on each \nsegment and the global value were calculated. Four main circumferential regions \n(anterior, septal, inferior and lateral) were defined. 259 TM patients with a CMR \nfollow-up (FU) study at 18±3 months and with significant MIO at baseline (global \nT2*< 26 ms) were selected and divided into two groups: severe (N=80, global T2*< \n10 ms) and mild-moderate MIO (N=179, global T2* 10-26 ms).\nResults: For each group there was a significant improvement in the global as well as \nin regional T2* values. For the whole patient population as well as for both groups, \nat basal the mean T2* value over the anterior region was significantly lower than \nthe mean T2* values over the other regions, and the mean T2* over the inferior \nregion was significantly lower than the T2* values over septal and lateral regions. \nThe same pattern was present at the FU, with a little difference for patients with \nmild-moderate MIO.\nConclusion: In conclusion, a preferential pattern of iron store in anterior and inferior \nregions was present at both basal and FU CMRs, with an increment of T2* values \nat FU due to a basal CMR-guided chelation therapy. The anterior region seems to \nbe the region in which the iron accumulates first and is removed later. \nB‑0856 11:33\nThe effect of partial volume averaging on peak velocity \nmeasurements in phase contrast magnetic resonance angiography \n(PCMRA) \nJ.C.L. Rodrigues1, K. Minhas1, G. Pieles1, C. Bucciarelli-Ducci1, R. Tulloh1, \nN.E. Manghat1, C.J. Occleshaw2, M.C.K. Hamilton1; 1Bristol/UK, 2Auckland/NZ \nPurpose: ECG-gated PCMRA is an established non-invasive in vivo method to \nmeasure blood flow. By default, the Siemens Argus PCMRA flow analysis software \ncalculates a voxel averaged peak velocity. The voxel with the highest velocity in \nthe data set is first determined. This value is then averaged with this the velocities \nof its neighbouring 4 voxels to generate the voxel averaged peak velocity. This \nmay underestimate peak velocity. The aim of this study was to determine if voxel \naveraging leads to a lower calculated peak velocity.\nMethods and Materials: 145 peak velocity measurements in 14 different ana-\ntomical locations in 37 subjects (healthy volunteers, congenital and acquired heart \ndisease patients) were analysed by default voxel averaging method and single \nvoxel technique and compared. The effects of flow velocity, scan protocol (breath \nhold versus free breathing) and scanner type (Siemens Symphony versus Siemens \nAvanto) were also assessed. Statistical significance was defined as P < 0.05.\nResults: There was a highly significant mean percentage increase in peak ve-\nlocity of 7.1% when peak velocity was calculated by single voxel compared with \nvoxel averaging technique (P < 0.0001). Significant increases in peak flow were \nobserved by single voxel compared with voxel averaging regardless of patient \ntype, anatomical location, CMR scanner or scan technique in terms of breathing \ncommand (p < 0.05). Disabling the voxel averaging technique had no effect on \nthe volume of flow recorded.\nConclusion: The use of voxel averaging produces a consistent underestima-\ntion of peak velocity. At peak velocities > 300 m.s -1, the error may be clinically \nsignificant, e.g. misclassifying the severity of aortic stenosis. For this reason, it is \nrecommended that for the assessment of peak velocity by PCMRA voxel averag-\ning should not be used. \nB‑0857 11:42\nDifferent patterns of delayed cardiac enhancement in symptomatic \npatients with post-total correction of tetralogy of fallot assessed \nby cardiac MRI and its correlation with right ventricular function: a \nreport from Iran \nF. Akhavan, M. Motevalli, N. Abolfat-h-Zadeh Ghale Joughi; T ehran/IR \n(akhavan79@yahoo.com) \nPurpose: The underlying mechanisms that contribute to global right ventricular \n(RV) dysfunction in patients with repaired TOF are incompletely understood. We \nsought to quantify delayed enhancement (DE) as a possible factor in development \n4\n\nScientific Sessions\nS34\nA\n C D E F G\nB\nMonday\nB‑0861 10:48\nDo vascular events impact brain maturation of twin pregnancies \ncomplicated with twin-to-twin transfusion syndrome? \nS. Bargy; Paris/FR (sophiebargy@gmail.com) \nPurpose: To evaluate foetal brain maturation during twin pregnancies complicated \nwith twin-to-twin transfusion syndrome (TTTS).\nMethods and Materials: Over a period of 4 years, we retrospectively evaluated \n44 MRIs of women with monochorionic twin pregnancies complicated with TTTS. \nMRI scans were realized at an average of 31 weeks of gestation. All pregnancies \ncomplicated with TTTS and successfully treated with fetoscopic laser were included. \nEighty-eight foetal brains were analysed and compared with an MRI brain atlas \nand with the co-twin. Biparietal brain diameter, cerebellar transverse diameter, \nsulcation, operculation, and myelination were analysed.\nResults: Among the 88 foetuses, 4 (4.2%) developed severe brain damage \n(unilateral brain atrophy, clastic lesion of corpus callosum with cyst) and showed \nunusual delay of brain maturation. In others cases of successfully treated TTTS, \nwe found no difference in brain\nmaturation between twins.\nConclusion: Brain maturation during twin pregnancies with treated TTTS is well \npreserved except in cases with a severe vascular complication.\nB‑0862 10:57\nMicrostructural changes of white matter tracts in small for \ngestational age very preterm infants evaluated at term equivalent age \nL.C. Tzarouchi, A. Drougia, A. Zikou, P. Kosta, L. Astrakas, S. Andronikou, \nM.I. Argyropoulou; Ioannina/GR (ltzar@cc.uoi.gr) \nPurpose: Very preterm infants suffer a wide range of neurodevelopmental dis-\nabilities. The purpose of the study was to assess the relationship between body \ngrowth and white matter (WM) microstructure maturation, in very low-birth weight, \nextremely preterm infants.\nMethods and Materials: Twenty-seven extremely premature infants (gestational \nage: 29.11±1.9 weeks) with normal brain US studies and normal MRI at term equiva-\nlent age (41.1±1.03 weeks) were enrolled in the study. Using a diffusion-weighted \nsequence, fractional anisotropy (FA) was measured bilaterally in 16 fibre tracts \nwith the region-of-interest method. The effect of sex and the relationship between \nsomatometric measurements (birth and body weight, crown to heel length and head \ncircumference) and FA was evaluated using a general linear model. Two-tailed \nStudent's t-test was used to assess differences between small for gestational age \n(SGA) and appropriate for gestational age (AGA) infants.\nResults: A positive correlation was found between body weight and FA in the ante-\nrior corona radiata, the posterior limb of internal capsule, the external capsule, the \ninferior fronto-occipital fasciculus, the superior longitudinal fasciculus, the middle \ncerebellar peduncles and the fornix. Decreased FA was observed in the superior \nlongitudinal fasciculus and the fornix in SGA infants (p < 0.05).\nConclusion: In extremely premature infants body growth correlates with changes \nin WM microstructure. Compromised growth at term equivalent age is associated \nwith microstructural abnormalities in areas related to attention, language, memory \nand executive functioning.\nB‑0863 11:06\nThe “tail sign” in the differential diagnosis of vermian pathologies in \nfoetuses under 24 weeks: role of foetal MRI \nP. Sollazzo, M. Sergi, V. Vinci, S. Bernardo, M. Saldari, L. Manganaro; Rome/IT \n(paolosollazzo@hotmail.it) \nPurpose: To define by foetal MRI the “tail sign” and it’s meaning in the differential \ndiagnosis of vermian pathologies.\nMethods and Materials: We performed 357 foetal MRI and including 41 cases \nunder 24 weeks of gestation with the US suspect of posterior cranial fossa pathol-\nogy. Foetal MRI was performed with a 1.5-T Magnet. We evaluated the biometrical \nparameters of the cerebellum, vermis morphology and biometry, IV ventricle, cer-\nebellopontine angle, cisterna magna and tentorium insertion. We highlighted the \npresence of a linear hypointensity on T2 images in correspondence of the inferior \npart of the vermis, the “tail sign”; this feature corresponds histologically to a thick-\nness of the 4th ventricle roof that appears raised and dysplastic.\nResults: Foetal MRI detected alterations of the posterior cranial fossa in 38/41 \ncases and excluded the US suspicion of pathologies in the remaining 3 cases. \nMRI results were compared with post-mortem results in 20/38 cases or after birth \nfollow-up in the remaining. Results were confirmed in 36/38 cases and disconfirmed \nin 2 cases. We identified the “tail sign” in the 100% of Dandy-Walker malformation \n10:30 - 12:00 Room P \nPaediatric \nSS 1712 \nFoetal and neonatal imaging \nModerators: \nN. De Graaf; Rotterdam/NL \nH. Ringertz; Linköping/SE \nB‑0859 10:30\nAntenatal blood flow quantification by phase-contrast MRI using a \nnew triggering method: comparison with Doppler ultrasound in a \nsheep model \nB.P. Schönnagel, C. Much, J. Yamamura, G. Adam, F. Ueberle, \nM. Tavares de Sousa, H. Kooijman, U. Wedegärtner; \nHamburg/DE (b.schoennagel@uke.de) \nPurpose: To demonstrate feasibility of antenatal flow velocimetry using phase-\ncontrast MRI in the foetal aorta for the first time using a newly developed Doppler \nultrasound device for triggering the foetal heart beat and to compare MR measure-\nments with standard Doppler ultrasound in a foetal sheep model.\nMethods and Materials: Four pregnant sheep carrying singleton foetuses (gesta-\ntional age 123 days) were anaesthetized to undergo foetal MR examination on a \n1.5 T imager. A newly developed MR-compatible Doppler ultrasound sensor was \nplaced on the abdomen of the ewe, above the foetal heart. The recorded signal \nof the foetal heart was transferred to the ECG trigger unit of the MR scanner and \nused for foetal cardiac triggering. Blood flow velocity measurements of the foetal \ndescending aorta were assessed and compared with Doppler ultrasound measure-\nments performed following MR examination. Time-volume curves were assessed \nand mean peak velocities were calculated.\nResults: Triggering of the foetal heart rate was possible in all MR examinations \nallowing high quality flow measurements of the foetal aorta. Comparison of both \nmethods revealed concordant results, both revealing characteristic arterial flow \nwaveforms and average peak flow velocities of 60 cm/s (±3.4) and 62 cm/s (±9.2), \nrespectively.\nConclusion: Phase-contrast MRI flow velocimetry of the foetal aorta was suc-\ncessfully performed using the newly developed MR-compatible Doppler-ultrasound \ndevice for foetal cardiac triggering in a foetal sheep model. Comparison with foetal \nDoppler ultrasound revealed concordant results.\nAuthor Disclosures:\nH. Kooijman: Employee; Philips Healthcare.\nB‑0860 10:39\nRelationship between body growth and regional brain volume \nchanges in extremely premature small for gestational age babies \nL.C. Tzarouchi, A. Drougia, A. Zikou, A. Charisiadi, P. Kosta, L. Astrakas, \nS. Andronikou, M.I. Argyropoulou; Ioannina/GR (ltzar@cc.uoi.gr) \nPurpose: Extremely low birth weight and/or low gestational age has been as-\nsociated with alterations in brain development. The purpose of the study was to \nassess whether early body growth catch-up reflects regional brain volume (rBV) \nchanges by evaluating small for gestational age (SGA) extremely premature babies \n(gestational age< 32weeks) at term equivalent age.\nMethods and Materials: Twenty-five extremely premature infants (GA: 29.8±2.1 \nweeks) with normal brain US studies and normal MRI at term equivalent age \n(41.5+1.6 weeks) were enrolled. Thirteen were appropriate for gestational age at \nbirth and at term (AGA), 5 SGA at birth and AGA at term (SGA+) and 7 SGA at \nbirth and term (SGA-). T1-weighted high-resolution 3D images were segmented \nusing the SPM 5.0 and volumes of 90 individual GM areas were calculated using \nthe IBASPM toolbox. Two-tailed Student's t-test was performed to test for differ-\nences in rBV between groups.\nResults: There was no difference in rBV between AGA and SGA+ (body growth \ncatch-up at term). In SGA- (persistent body growth restriction at term), areas of \nlate maturation (frontal lobes, caudate nucleus) presented lower rGMv. There was \nno difference in rBV between AGA and SGA- in brain areas of early maturation \n(occipital cortex, thalami) (p < 0.05).\nConclusion: In extremely premature babies, body growth catch-up is associated \nwith rBV catch-up at term equivalent age. RBV changes start from areas with great \npotential for early maturation.\n5\n\nScientific Sessions\nS34\n C A D E F\n G\nB\npurpose of this study was to investigate changes in foetal lung volume (FLV) in \nCDH patients and to calculate weekly growth rates of the FLV using serial MRI.\nMethods and Materials: MR-FLV was measured in 89 foetuses with CDH between \n19 and 39 weeks gestation. All foetuses received two MR examinations with at \nleast four weeks in between. In addition to the absolute MR-FLV (aMR-FLV) and \nthe observed to expected MR-FLV (o/eMR-FLV) a weekly growth rate of the aMR-\nFLV was determined for each foetus.\nResults: In all but two foetuses the aMR-FLV increased between the two examina-\ntions (mean 11.1 ml, range 1.5-37.7 ml). Mean o/eMR-FLV at the first MRI (mean \n26.0±3.1 weeks gestation) was 33.3±12.2% (range 10.5-79.1%) and 29.5±10.9% \n(range 10.8-63.7%) at the second MRI (mean 33.9±2.4 weeks gestation). 54/89 \nfoetuses (60.7%) showed a decrease of the o/eMR-FLV during pregnancy with \na mean reduction of 9.4% (range 2.2-31.7%), 23 foetuses (25.8%) increasing \no/eMR-FLVs with a mean increase of 7.7% (range 2.2-26.2%) and 12 foetuses \n(13.5%) revealed stable values. CDH patients had lower weekly growth rates with \nan average growth rate of only 26% compared to healthy foetuses.\nConclusion: The individual development of FLV in CDH patients during pregnancy \nis variable with decreasing, stable and increasing o/eMR-FLVs. In individual cases, \nthe o/eMR-FLV relatively changed by more than 80% during pregnancy. Follow-up \nexaminations are advisable prior to decision-making about pre- and postnatal \ntherapeutic options. \nB‑0867 11:42\nPeriventricular nodular heterotopia: prenatal ultrasound findings \nE. Blondiaux, C. Sileo, C. Nahama-Allouche, M.-L. Moutard, \nA. Gelot, J.-M. Jouannic, H. Ducou le Pointe, C. Garel; Paris/FR \n(eleonore.blondiaux@trs.aphp.fr) \nPurpose: To describe the prenatal sonographic findings suggestive of periven-\ntricular nodular heterotopia (PVNH).\nMethods and Materials: This retrospective study included foetuses referred for \nmagnetic resonance imaging (MRI) and diagnosed with PVNH, which was confirmed \nby post-natal MRI or autopsy. The type of PVNH, associated ventriculomegaly and \nassociated malformations were reported.\nResults: 11 foetuses were included (9 females, 2 males) with a mean gestational \nage at diagnosis of 31 weeks’ gestation (23-34). PVNH were small and diffuse \n(n=7), large and multiple (n=1) or single (n=3). A targeted ultrasonographic (US) \nscan performed before foetal MRI missed the diagnosis in 4 cases [diffuse (n=1) \nand single (n=3)]. Another US scan performed after MRI diagnosed PVNH in 2 \nof these 4 cases. Ventriculomegaly was present in 6 cases [uni-(n=4) or bilateral \n(n=2)]. All PVNH appeared as nodules of intermediate echogenicity protruding into \nthe ventricular lumen. In all cases of diffuse PVNH, the frontal horns and bodies of \nthe lateral ventricles displayed a square shape with irregular borders. Associated \ncerebral malformations were observed in 7 cases and included corpus callosum \nagenesis (n=4 with additional malformations in 2 cases) and retrocerebellar cyst \n(n=3). Extracerebral malformations were also present (n=2). Maternal MRI was \nperformed in 5/6 cases of isolated small and diffuse PVNH in female foetuses and \ndemonstrated PVNH in 2 cases.\nConclusion: PVNH are underdiagnosed at prenatal US even on targeted scans. \nIndented ventricular borders on axial views and irregular square shaped lateral \nventricles on coronal views are suggestive of PVNH at prenatal US.\nB‑0868 11:51\nRole of foetal MR in the evaluation of gastrointestinal tract anomalies \nS. Bernardo, V. Vinci, P. Sollazzo, M. Sergi, M. Saldari, L. Manganaro; Rome/IT \n(silviabernardo@live.it) \nPurpose: To determine if foetal MRI may confirm, complete or change the diagnosis \nin cases of sonographically detected GI tract abnormalities.\nMethods and Materials: This is a prospective study (December 2010-June 2012) \nof 27 foetal abdominal MRI scans. The exam was performed between 24 and 38 \nweeks of gestation on a 1.5-T magnet. MRI exam was performed within two weeks \nfrom the US examination. US diagnoses included: omphalocele (n=3); bowel \ndilatation (n=7), associated with ascites in 4 cases, foetal abdominal cyst (n=5), \noesophageal atresia (n=2), hyperechoic bowel (n=3), associated with ascites in \n1 case; meconium peritonitis (n=3), only ascites (n=2). MRI protocol included T1 \nW fast gradient-echo (Flash 2D) and T2 W half-Fourier acquired single-shot turbo \nspin-echo (HASTE) sequences in axial, coronal and sagittal planes.\nResults: Foetal MRI examination made correct diagnoses in 25 patients, it changed \nUS diagnoses in 5 cases of foetal abdominal cysts and in one case of hyperechoic \nbowel it excluded any intestinal abnormalities. It provided more informations than \nUS in the cases of intestinal dilatation, where foetal MRI was able to identify the \nlevel of obstruction and in 2 patients where it revealed the presence of a microcolon. \nand in 6/10 cases of partial vermis agenesis. We had no evidence of “tail sign” in \nall cases of vermis hypoplasia, vermis malrotation and rhombencephalosynapsis.\nConclusion: Foetal MRI represents a useful imaging technique for the diagnosis \nof posterior cranial fossa pathologies to confirm and characterise different cerebel-\nlar malformations.\nB‑0864 11:15\nReal time cine-MRI in children and foetuses with head and neck pathology \nT. Feygin, A. Pollock, J. Stein, T. Victoria; Philadelphia, PA/US \n(Joel.Stein@uphs.upenn.edu) \nPurpose: To determine the feasibility and applications of real-time cine-MRI in \nfunctional evaluation of selected pathologic entities of head and neck in children \nand foetuses.\nMethods and Materials: For the foetal assessment, cine-MRI evaluations were \nperformed in 370 patients in addition to routine foetal MR evaluation of different \norgan systems. Different patterns of foetal swallowing were identified in foetuses \nwith head and neck pathologies. Real time MR techniques were applied in 12 vol-\nunteers and 5 patients with 22q deletion for swallowing and phonation evaluation. \nPreliminary comparison was done for compatibility of value of MR cine technique \nand barium swallowing with video recording.\nResults: Real-time cine MRI was technically feasible in evaluation of various \nprenatal and postnatal head and neck pathologies. Foetal swallowing in patients \nwith head and neck masses, cleft lip and palate, micrognathia differs from control \ngroup of foetuses with variety of other entities, not involving head and neck. The \nvarious phases of swallowing were identifiable, providing information that could be \nused in planning of foetal delivery. The MR patterns of swallowing and phonation in \nhealthy volunteers and children with 22 q deletion were identifiable and the obtained \ninformation was seemingly compatible with fluoroscopy data.\nConclusion: Cine-MRI methods are technically feasible and valuable tools in both \nprenatal and postnatal assessment, with increasing applications in the functional \nevaluation of head and neck pathology. \nB‑0865 11:24\nMagnetic-resonance-imaging-based ratio of fetal lung volume \nto foetal body volume as a new prognostic marker in congenital \ndiaphragmatic hernia \nM. Weidner, C. Hagelstein, A. Debus, A. Walleyo, S.O. Schönberg, T. Schaible, \nK.A. Büsing, S. Kehl, K.W. Neff; Mannheim/DE (Meike.Weidner@gmx.de) \nPurpose: To evaluate prognostic accuracy of the magnetic resonance imaging \n(MRI)-based ratio of fetal lung volume (FLV) to fetal body volume (FBV) concerning \nsurvival and need for extracorporeal membrane oxygenation (ECMO) therapy in \ncongenital diaphragmatic hernia (CDH).\nMethods and Materials: The local research ethics committee approved this study \nand written informed consent was obtained. MRI was performed in 96 fetuses \nwith CDH and in 44 fetuses without any affection of lung and body volume. FLV \nand FBV were measured and used to calculate the ratio of FLV/FBV. Additionally, \nsubgroup analysis of all fetuses whose growth development was less than 80 % \nof the expected value was performed. Logistic regression analysis was used to \nmodel the dependence of survival and ECMO requirement on the ratio. Prognostic \naccuracy was evaluated by applying the area under the curve (AUC).\nResults: 78 (81 %) fetuses survived and 35 (36 %) neonates needed ECMO thera-\npy. The ratio of FLV/FBV was significantly higher in surviving fetuses (0.013±0.006 \nvs. 0.007±0.004; p < 0.0001; AUC=0.829). Neonates receiving ECMO therapy \nshowed prenatally a significant lower ratio (0.009±0.006 vs. 0.014±0.005; p=0.0001; \nAUC=0.811). According to subgroup analysis for fetuses with growth restriction \n(n=13), AUC increased to AUC=0.875 for prediction of survival.\nConclusion: The ratio FLV/FBV is able to predict neonatal survival and ECMO \nrequirement in children with CDH. Unlike other prognostic parameters (i.e. observed/\nexpected MR-FLV, ultrasound observed/expected lung-to-head ratio) it is independ-\nent of reference to a control group and may enhance prognostic accuracy especially \nin patients whose growth development differs from expectation.\nB‑0866 11:33\nRepetitive MR measurements of lung volume in foetuses with \ncongenital diaphragmatic hernia to investigate the individual \ndevelopment of pulmonary hypoplasia during pregnancy \nC. Hagelstein, M. Weidner, A. Debus, A. Walleyo, S.O. Schönberg, T. Schaible, \nS. Kehl, K.A. Büsing, K.W. Neff; Mannheim/DE (Claudia.Hagelstein@umm.de) \nPurpose: Little is known about the individual development of lung hypoplasia \nin foetuses with congenital diaphragmatic hernia (CDH) during pregnancy. The \n6\n\nScientific Sessions\nS34\nA\n C D E F G\nB\nMonday\nConclusion: It was moderate to poor agreement between the two centres, for \nthe overall score and the MLO score. A possible reason for the poor agreement \nmight be because of the differences in the national quality assurance manual. It is \nimportant to further analyse and investigate the reasons for the low accordance. \nB‑0871 10:48\nRadiation dose levels assessment in mammography \nC. Lourenço, P. Sousa, S.I. Rodrigues, A.F.C.L. Abrantes, L.P.V. Ribeiro, \nK.B. Azevedo, R.P.P. Almeida; Faro/PT (a35589@ualg.pt) \nPurpose: To measure radiation dose levels in mammography of two different \ninstitutions (A and B) and to compare them with international guidelines.\nMethods and Materials: A survey of exposure parameters (kV and mAs) and \nsociodemographic and anthropometric characteristics (age, gender, weight and \nheight) of patients was used to perform the calculation of entrance skin dose (ESD) \nmedium glandular dose (MGD) of the 548 examinations observed. For viability \nmeasurements, the dose rate and quality control using the RF detector Unfors \nXi were carried out. Through mathematical formulas, the values of ESD (Gy) and \nMGD (mGy) were calculated.\nResults: The values [[Unable to Display Character: ​]][[Unable to Display \nCharacter: ​]]of the ESD for a full examination were 6.59 ± 3.61 mGy to \ninstitution A and 6.27 ± 3.15 mGy to B institution. Also, the values [[Unable to Display \nCharacter: ​]][[Unable to Display Character: ​]]of MGD obtained for \na full examination were 1.40 ± 0.43 mGy for institution A and 1.39 ± 0.57 mGy for \ninstitution B. About ESD, only the value of institution B was slightly higher than the \nsame in France and was lower than all other international guidelines. The MGD \nwas lower than the international guidelines in both institutions.\nConclusion: The ESD values were generally lower than international guidelines, \nwith only one exception. This exception must be analysed to achieve the lowest \npossible dose. MGD values [[Unable to Display Character: ​]][[Unable to \nDisplay Character: ​]]calculated were found below the diagnostic reference \nlevels, but it is important to keep reconsidering the protocols used, to optimise them.\nB‑0872 10:57\nQuality control in digital mammography: radiographers practice at 5 \nhospitals of Lisbon \nC. Tomás, C. Gonçalves, C.I.S. Reis; Lisbon/PT (claudiatomas90@gmail.com) \nPurpose: To investigate quality control/(QC) guidelines in use for digital mam-\nmography/(DM) in 5 hospitals, to identify radiographer’s practice in QC concerning \nDM and to identify the causes of exam rejection/repetition.\nMethods and Materials: Questionnaires were developed and applied to 30 radi-\nographers working in DM (computed-radiography or direct-digital-mammography/\n(DDM)) in 5 hospitals to characterise the QC practices (guidelines in use, performed \ntests, tests frequency). Rejected/repeated analyses was performed in one\nhospital with DDM equipment using the checklist proposed by the International \nAtomic Energy Agency/(IAEA).\nResults: Guidelines for QC are followed by 70% (20) of the radiographers: 55% \nfollow American-guidelines, 20% the Portuguese, 15% the European/EUREF and \n10% other guidelines. There is more than one guideline followed by radiographers \nin three institutions. The QC tests performed by radiographers in the same institu-\ntion (proposed by IAEA to test image acquisition and display systems) were not \nthe same and in the right frequency. The main causes for mammography image \nrejection/repetition were improper positioning in 85% of the analysed images due \nto non-inclusion of pectoral muscle in mediolateral oblique projection and inner \nand outer quadrants asymmetry for craniocaudal projection.\nConclusion: In this group of hospitals with DM, there is no uniformity of QC \npractices. This can have impacts in mammography costs. This may be justified \nby the absence of certification programs concerning mammography departments. \nContinuous education and training programs frequency to work with DM are not \nmandatory and also QC is not required by law in Portugal.\nB‑0873 11:06\nAn investigation into the psychological anxiety of Maltese women \nbefore and after a mammogram \nC. Falzon; Sta Lucija/MT (valeview@maltanet.net) \nPurpose: To investigate whether there is a difference in anxiety levels between \nMaltese women with and without a family history of breast cancer, before and \nafter a mammogram.\nMethods and Materials: The study involved the participation of 150 Maltese \nwomen aged 35 years and over. The women were divided into two groups; group \n1 without and group 2 with family history of breast cancer. Anxiety levels pre- and \nFinally, MRI made correct diagnosis in 4 of 6 foetuses with expansive formations, \nwhereas in one of these cases we suspected a choledochal cyst and it was a \ngastric duplication and in another patient we diagnosed an ascites and it was an \nintrabdominal cystic lymphangioma.\nConclusion: Our preliminary results suggest that MRI has a supplemental value to \nsonography in anatomic evaluation and characterisation of GI abnormalities. Ultra-\nfast imaging sequence MRI is helpful to confirm, refine or exclude US diagnosis. It \nalso provides useful informations in prenatal counselling and perinatal management.\n10:30 - 12:00 Room Q \nRadiographers \nSS 1714 \nMammography \nModerators: \nS.J. Foley; Dublin/IE \nP. Vahtramae; Pärnu/EE \nB‑0869 10:30\nOnline portfolio for radiographers attending the breast cancer \nscreening mammography certificate in Switzerland \nN. Richli Meystre, L. Flaction, R. Le Coultre; Lausanne/CH \n(nicole.richli@hesav.ch) \nPurpose: In order to achieve high image quality with breast cancer screening mam-\nmography, the European guideline recommends training programs dedicated to \nradiographers. Those training programs are very helpful for practitioners but back at \ntheir workplace it might be difficult for them to apply the achieved knowledge in their \ndaily practice. To support radiographers to transfer good mammography practice \nin their daily screening activity, an online portfolio is realized by each radiographer \nduring the following 6 months after the training session.\nMethods and Materials: Every month, the trainee radiographer posts about 4 \nmammography examinations including the quality self-assessment on a dedicated \nelectronic platform. Experienced radiographers from the screening program of \nwestern Switzerland comment the picture quality as well as the accuracy  of the \nself assessment. Tips and tricks, to improve quality, are also given.\nResults: Actually 26 portfolios have been completed. The majority of the radiog-\nraphers appreciated the personalized comments given by the experts. They found \nthe tips very helpful and they say the portfolio helped them to continuously improve \nthe quality of the performed mammograms. Nevertheless, some radiographers \nwere upset because of the high time investment necessary to the realization of \nthis kind of portfolio.\nConclusion: In western Switzerland, where there are many decentralized breast \ncancer screening units, the online portfolio is an interesting tool to support radiogra-\nphers with the development and the transfer of competences in their daily practice.\nB‑0870 10:39\nInter-observer agreement among PGMI radiographer in Cambridge/\nUK and Oslo/NO in assessing each other’s and their own \nmammography screening exams \nR. Gullien1, E. Rostad1, A.E. Haakull1, R.L. Hammond1, M. Hauge1, K. Taylor2, \nJ.G. Andersen1; 1Oslo/NO, 2Cambridge/UK (uxroeb@ous-hf.no) \nPurpose: To evaluate the inter-observer agreement between PGMI radiographers \nin UK/Cambridge and Norway/Oslo in the PGMI classification of mammograms \nusing the recommendations stated in their own national quality assurance manual.\nMethods and Materials: Four experienced PGMI radiographers from both loca-\ntions (UK/Cambridge and Norway/Oslo) independently assessed and classified a \nselection of 112 exams (CC and MLO of each breast) from each centre, by giving \neach image a separate PGMI score and an overall score for the exam: P=perfect=3, \nG=good=2, M=moderately good=1, and I=inadequate=0. The selected exams \ncontained all four categories of PGMI. We assessed the overall score for the exam \nand additionally chose to assess the MLO score. Inter-observer agreement was \nassessed for both groups (Kappa analysis).\nResults: Kappa analyses of overall score gave poor agreement (Mean Kappa < \n0.2) between the PGMI radiographers in Cambridge and Oslo when both Cambridge \nand Oslo exams were assessed. Analyses of the score for MLO images gave fair \nagreement (Kappa 0.2-0.29) between the two centres assessing the Cambridge \nimages. Analyses of the Oslo MLO images gave a poor Kappa agreement. Indi-\nvidual Kappa agreement of the MLO varied from moderate (Kappa 0.48) to poor \nagreement (< 0.2) between the radiographers at both centres.\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nB‑0876 11:33\nPatient satisfaction assessment in mammography exams \nL. Borralho, L.P.V. Ribeiro, C.A. Silva, A.F.C.L. Abrantes, J. Pinheiro, \nR.P.P. Almeida; Faro/PT (leilapatricia90@hotmail.com) \nPurpose: This study aimed at measuring patient satisfaction in mammography \nexams and satisfaction-related factors.\nMethods and Materials: Research was conducted in several private practice clinics \nwith a total of 183 subjects using the Myasthenia Gravis questionnaire for assessing \npatient satisfaction concerning four dimensions: structure (physical environment), \nprocess (performing the exam), discomfort (physical and psychological) and general \nsatisfaction (present and future).\nResults: Overall patient satisfaction was high (90%), with technical performance \n(process) and psychological discomfort having the major influence on patient \nsatisfaction. Exam costs and age had very low, or no impact, on satisfaction. Also, \nthe greater patient’s education levels, the greater were their demands for process \nrequirements, unlike patients with lower education levels which presented higher \nsatisfaction levels.\nConclusion: The great amount of patients of high age groups and respective \npathologies may have influenced results when related to satisfaction and educa-\ntion level. The numbers of mammography exams have increased over the years \nand therefore it is essential to assess patient satisfaction so that improvements \ncan be made. \nB‑0877 11:42\nImpacts of digital mammography in radiographers practice \nL. Painho, T. Fernandes, C.I.S. Reis; Lisbon/PT (tiagojpfernandes@gmail.com) \nPurpose: To characterise the techniques in use by radiographers for digital mam-\nmography/(DM) utilisation and compare analogue with digital technologies.\nMethods and Materials: A total of 1492 images obtained with DM equipment, \nconsidering patient’s characteristics, exposure parameters, compression-force, \nwere analysed. The image quality/(IQ) was evaluated according to PGMI-scale. \nResults: The thickness increases on mediolateral-oblique view/(MLO)/(r=0.818). \nThe compression-force increased when compared to the craniocaudal/(CC) to \nMLO view/(r=0.36). The mean energies were 29.4 and 29.6 kVp for CC and MLO, \nrespectively, while mean intensities were 79.5 for CC and 83.4 mAs for MLO. The \nmean-glandular-dose/(MGD) was variable (0.40-3 mGy). The anode-filter combina-\ntion always used was W/Rh. Global IQ was P (perfect) for CC, while in MLO the \nmean was G (Good). The radiographers experience varied between 2 and 28 years.\nConclusion: The compression force depends on breast compressed thickness. It \ncan vary between 6 and 10N for breast thickness range of 45 to 76 mm. The tech-\nnique suffered changes when the analogue was compared with digital technologies: \nthe energy is higher, the intensity is lower and the anode-filter has changed from \nMo/Mo to Rh/Rh and W/Rh. Breast symmetry absence on CC projection, inframam-\nmary folds absence and skin folds presence were the criteria not achieved more \nfrequently in this study, according to European Guidelines on Quality Criteria for \nDiagnostic Radiographer Images. IQ of all exams was classified as appropriated \n(perfect and good (362 out 373)). Nevertheless, it is noticeable that some variation \nexists concerning the radiographer practice when comparing breasts with the same \nfeatures. The radiographers experience and training can also affect the results. \nB‑0878 11:51\nImaging ethics \nB. Hofmann; Oslo/NO (b.m.hofmann@medisin.uio.no) \nPurpose: The benefits of modern medical imaging technology are obvious. How-\never, the ethical challenges are less acknowledged. The purpose of the study is \nto highlight and to address core ethical challenges with modern medical imaging.\nMethods and Materials: A review of literature in radiology reveals a series of \nethical challenges in modern medical imaging that are analysed with standard \nmethods in modern bioethics.\nResults: The ethical challenges are divided into four categories, i.e. challenges \nwith 1) existing, and 2) new imaging techniques, 3) altered use of existing imaging \ntechniques, and 4) challenges with basic concepts and end points in diagnostic \nimaging. A series of ethical challenges are identified within these categories, such as \n(radiation) safety, rationing, and justice (1), implementation without evidence-based \noutcome (2), reduced diagnostic accuracy, patient autonomy (3), and challenges \nwith underuse, overuse, and futile imaging (4).\nConclusion: Behind great benefits of modern imaging, a series of ethical chal-\nlenges can be identified. While praising the benefits, the challenges need to be \nappraised to maintain confidence and trust in the profession, as well as a sound \nand fruitful development in the field.\npost-mammogram were measured using the well-established State and Trait \nInventory for Adults (STAI) developed by C.D. Spielberger.\nResults: There was a significant difference (p0.05). A negative correlation was \nobtained when the mean S-anxiety scores (pre: group1, r=-0.123 and group 2, \nr=-0.245 and post: group1, r=-0.046 and group 2, r=-0.78) of both groups were \ncompared with age.\nConclusion: The factor causing anxiety in women was mainly related to the \nprocedure because their anxiety diminished significantly after the mammogram. \nThe correlation showed that those who scored high pre-mammogram anxiety also \nscored high post-mammogram anxiety. No significant difference in the anxiety levels \nbetween the two groups existed before and after the mammogram. A negative \ncorrelation existed between age and S-anxiety of the women, resulting in younger \nwomen being more anxious than older women.\nB‑0874 11:15\nErgonomic and environmental assessment in digital mammography \nroom: impact on radiographers’ activity \nS. Costa, E. Oliveira, F. Serranheira, S. Viegas, C.I.S. Reis; Lisbon/PT \n(stefaniebcosta@gmail.com) \nPurpose: To investigate ergonomic-characteristics of the equipment, environmental \nconditions and its impact on radiographers’ activity and to identify opportunities to \noptimise the practice and reduce the probability of WRMSDs occurrence.\nMethods and Materials: Radiographer’s mammography procedures were ob-\nserved and organized in tasks time-scale-graphic. Interviews were applied to 7 \nradiographers working in digital-mammography to characterise the practice (work \npatterns, mammographic equipment, exam room, environmental conditions) and \nto identify the presence of WRMSDs symptoms. Postural analyses were evaluated \nthrough video and pictures acquired during mammography positioning. Measure-\nments of angles were done with Meazure2.0.158 software and classified according \nto the European Standard/EN100-4:2005+A1:2008.\nResults: The task-time scale showed that the average duration of each exam is \n5 minutes and also that the task which took more time was the indications given \nto the patient. 45.5% of the radiographers referred that the most exhaustive \nprocedure is the positioning of MLO-view and short-stature patients (22.7%). In \nthis specific case, the anatomical areas that can suffer more WRMSDs are neck, \narms and back presenting an angle of 87.2º, 118.6º and 63.6º, respectively. The \nvisual contact with the patient was compromised only during the right-MLO-view \nacquisition. Considering the environmental conditions the illuminance values are \nnot in accordance with the guidelines.\nConclusion: The ergonomic characteristics of the equipment do not provide comfort \nto the radiographers. In order to reduce the probability of work-related musculoskel-\netal disorders in mammography positioning and patient safety, new equipment \nfeatures should be developed. Environmental conditions are adequate concerning \nthe international references for temperature and humidity but not for illuminance.\nB‑0875 11:24\nAccuracy of students, and radiographers, with and without, \nmammography post-graduation in interpretation of mammography images \nR.B.J. Cópio1, K.B. Azevedo1, A.F.C.L. Abrantes1, L.P.V. Ribeiro1, \nR.P.P. Almeida1, C.A. Silva2; 1Faro/PT, 2Evora/PT (rita.copio.rc@gmail.com) \nPurpose: To evaluate the sensitivity, specificity and diagnostic accuracy of radiog-\nraphers with and without mammography post-graduation and last year students of \nthe Radiography Course in the interpretation of mammography images.\nMethods and Materials: A grid of socio-demographic characteristics and View-\nDEX software (Viewer for Digital Evaluation of x-ray Images) for the interpretation \nof mammography images by participants were used. Each of the 16 cases was \nbuilt with the four basic images. After viewing images, the 22 participants showed \ntheir level of confidence about the presence of abnormal radiological findings in \nrelation to the case.\nResults: The results obtained showed values of sensitivity of 81%, 89% and 80% \nfor the last year students, radiographers without post-graduation and post-graduate \nradiographers, respectively. For specificity, the values were 63%, 75% and 50% \nfor the same groups, respectively. With regard to diagnostic accuracy, the values \nobtained were 80% for the group of students in the last year, 88% for the group of \nradiographers without post-graduation and 78% for post-graduate radiographers. \nThe mean response time was 46.9 seconds to the last year students, 59.8 seconds \nfor radiographers without post-graduation and 64.6 seconds to post-graduate \nradiographers.\nConclusion: The sensitivity, specificity and diagnostic accuracy varies between \neach group. However, there are not significant differences between them. Also, \nparticipants with a higher formation have higher average response time. \n48\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nConclusion: Hybrid FMT-XCT targeting Annexin V enables monitoring of the \nbeneficial effects of c-kit cell treatment after myocardial ischemia in a murine \nischemia-reperfusion model.\nB‑0881 10:48\nMagnetic resonance imaging of murine myocardial infarction with an \nelastin-binding contrast agent \nM. Wildgruber1, M. Settles1, I. Bielicki1, K. Kosanke1, A.M. Huber1, \nE.J. Rummeny1, R.M. Botnar2; 1Munich/DE, 2London/DE \nPurpose: To study elastin-targeted magnetic resonance imaging (MRI) of murine \nmyocardial infarction.\nMethods and Materials: Myocardial infarction (MI) was induced in C57BL/6J mice \nby permanent ligation of the left anterior descending artery (LAD). Elastin-target \ned MRI was performed on day 7 following myocardial infarction using CP-1052 in \ncomparison to conventional Gd-DTPA-enhanced cardiac MRI. Competition experi-\nments were carried out with La-1052, in which the paramagnetic gadolinium core \nis replaced by lanthanum. Further, delayed enhancement studies were compared \nto ex-vivo 2.3,5-triphenyltetrazolium chloride (TTC) staining.\nResults: CNR after Gd-DPTA injection peaked at 10 minutes and returned to pre-\ninjection values at 60 minutes. After injection of CP-1052, the CNR peaked at 45 \nminutes and was significantly higher than Gd-DTPA at 30 minutes (p=0.04), 45 \nminutes (p=0.02) and 60 minutes (p=0.02). Competition experiments with La-1052 \nrevealed a significantly reduced CNR indicating specific binding. Ex-vivo TTC \nstaining of explanted hearts revealed good correlation for infarct size determination \nwith elastin-targeted MRI.\nConclusion: Elastin-targeted cardiac MRI enables visualisation of injured myo-\ncardium in an experimental mouse model of myocardial infarction with a higher \nCNR and enhanced binding characteristics. Improved dynamic MRI with CP-1052 \nis attributed to its higher relaxivity and its affinity for elastin. \nB‑0882 10:57\nComparison of nanobodies and conventional monoclonal antibodies \nfor in vivo fluorescence imaging of lymphomas \nP. Bannas, A. Lenz, V. Kunick, W. Danquah, F. Haag, M. Trepel, G. Adam, \nH. Ittrich, F. Koch-Nolte; Hamburg/DE (p.bannas@uke.de) \nPurpose: To compare different formats of llama-derived nanobodies as alternatives \nto monoclonal antibodies for specific in vivo near-infrared fluorescence (NIRF) \nimaging of lymphomas in a mouse model. \nMethods and Materials: We used ecto-enzyme ART2 on lymphoma cells as model \ntarget and compared three different formats of ART2-specific nanobodies with a \nconventional antibody (150kD): a monovalent llama nanobody (15kD), a bivalent \ndiabody (30kD), and a bivalent Fc-fusion protein (80kD). All constructs were labeled \nwith AlexaFluor680 and injected in nude mice, bearing ART2-positive and ART2-\nnegative tumors. Circulating and excreted conjugates were monitored in plasma \nand urine and in vivo NIRF-imaging was performed over 24h. Tumor tissue pen-\netration and target binding were analysed by FACS and fluorescence microscopy. \nResults: In vivo NIRF-imaging revealed specific labeling of ART2-positive tumors \nbut not of ART2-negative tumors with all AF680-conjugates. The smaller nanobody \nand diabody revealed rapid renal elimination with highest signal-to-background \nratios of ART2-positive tumors. The larger Fc-fusion protein and conventional an-\ntibody revealed long circulation times in plasma, resulting in unspecific background \nsignals. FACS and Immunohistochemistry of tumors revealed deeper penetration \nand more homogenous labeling of tumor tissue with the nanobody and diabody \nthan with the Fc-fusion protein and conventional antibody. \nConclusion: Renally excreted small nanobody-formats (< 60kD) can be used \nfor specific in vivo imaging of lymphomas with a significantly higher signal-to-\nbackground ratio than larger antibody-constructs (> 60kD) that are retained in \ncirculation. Therefore, single domain and bivalent nanobodies seem particularly \nsuited for short-term diagnostic imaging, whereas reformatted nanobody-Fc fusion \nproteins appear suited for long-term applications. \nB‑0883 11:06\nThe design of a dual-functional imaging contrast agent for targeting \nto tumour endothelial marker (TEM8) \nQ. Quan1, X. Huang2, J. Xie2, Y. Yan3, H. Gao2, G. Zhang1, \nX. Chen2; 1Shanghai/CN, 2Bethesda, MD/US, 3Madison, WI/US \n(quanquan527@gmail.com) \nPurpose: We have previously designed QQM peptide that binds specifically to the \nextracellular domain of TEM8. In this study, we would like to develop a QQM-based \nnanoplatform for dual-modality-targeted imaging of TEM8 expression.\n10:30 - 12:00 Room Z \nMolecular Imaging \nSS 1706 \nMolecular imaging in cancer and degenerative \ndiseases \nModerators: \nJ. Hakumäki; Kuopio/FI \nE. Lopci; Rozzano/IT \nB‑0879 10:30\nImproving current preclinical therapy monitoring methods by \nmultiparametric MR using a hNIS-expressing tumour xenograft \nmouse model \nE.J. Koziolek1, I. Apostolova2, A. Tarkowska1, U. Schumacher1, W. Brenner2, \nG. Adam1, M.G. Kaul1; 1Hamburg/DE, 2Berlin/DE (ekoziole@uke.de) \nPurpose: Preclinical methods for validation of tumour therapy response are gener-\nally limited to manual tumour size estimation using a calliper. The purpose of our \nstudy was to establish tumour xenograft mouse models allowing non-invasive, \nmultimodal tumour imaging and monitoring. To further characterise tumour tissue \nfor early therapy response, multiparametric MR was established.\nMethods and Materials: Tumour cells of human origin (colon, mamma) were \nstably transfected with the human sodium iodine symporter (hNIS) gene. Mouse \ntumour xenograft models were established. Imaging was performed on 7T MRI \n(ClinScan, Bruker) and SPECT/CT (NanoSPECT, Mediso). To monitor tumour \ngrowth by MRI, size was measured using a T2-weighted sequence. Additionally, \ndiffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI (0.15 \nmmol/kg Gd-DTPA) were performed. To analyse tracer accumulation and retention \ntime, SPECT was performed using Tc99m (100 MBq).\nResults: hNIS expression in both tumour entities was visualised by a strong \nTc99m-uptake via SPECT-imaging when compared to hNIS-negative tumour xe-\nnografts. MR imaging allowed a precise delineation of tumour mass and volume. \nSignal enhancement measured by DCE was predominantly found in the tumour \nperiphery, whilst homogenous tumour tissue showed a more uniform contrast agent \ndistribution. Increased apparent diffusion coefficient (ADC) in the tumour centre \nmay indicate necrotic tissue.\nConclusion: The hNIS-transfected tumour xenograft model is a promising tool for \ntumour imaging and monitoring. Tumour tissue characterisation can be analysed \nby MR parameters such as diffusion, perfusion and permeability in order to predict \ntherapy response. A further characterisation is possible by pharmacokinetic model-\nling of tumour-specific tracer uptake. \nB‑0880 10:39\nIn vivo assessment of the anti-apoptotic effect of c-kit+ pluripotent \nbone marrow cells on ischaemic myocardium in mice with hybrid \nfluorescence molecular tomography - x-ray computed tomography \nM. Wildgruber, A. Ale, K. Kosanke, R. Braren, R. Meier, E.J. Rummeny, \nV. Ntziachristos; Munich/DE \nPurpose: To investigate the anti-apoptotic effect of pluripotent c-kit+ bone marrow \ncells after murine myocardial infarction by hybrid fluorescence molecular tomogra-\nphy - x-ray computed tomography targeting Annexin V (FMT-XCT).\nMethods and Materials: Myocardial ischemia (MI) was induced in kit+/+ mice, \nc-kit-deficient KitW/W-v mice and bone marrow reconstituted KitW/W-v mice by \ntransient ligation of the left anterior descending artery. Mice were injected with an \nAnnexin-V-targeted molecular imaging probe 4 hours prior to imaging. Hybrid FMT-\nXCT was performed 6 hours, 24 hours and 7 days after induction of ischemic injury. \nMolecular imaging signal for Annexin-Vivo750 was validated by ex-vivo cryoslicing, \nimmunohistochemistry and flow cytometry.\nResults: Successful image acquisition of FMT and CT was achieved in all mice. \nIn control kit+/+ mice, the FMT signal for Annexin V peaked at 6 hours after myo-\ncardial infarction with subsequent decrease at 24 hours and 7 days after onset \nof ischemic injury. KitW/W-v mice revealed an increased and prolonged in-vivo \napoptosis signal, which was associated with progressive decline in heart function. \nBone marrow reconstitution was able to reduce cardiomyocyte apoptosis and \nrescue KitW/W-v mice from progressive heart failure. In-vivo apoptosis signal was \nverified after killed by apoptosis staining using immunohistochemistry (TUNEL) and \nflow cytometry (Caspase-3). Hybrid acquisition of x-ray computed tomography al-\nlowed exact localisation of the FMT signal to the left-ventricle and facilitated organ \nsegmentation and attenuation correction.\n49\n\nScientific Sessions\nS35\n C A D E F\n G\nB\nflow cytometry and determining the dissociation constant. For detecting apoptosis \nin vivo, CAL-27 tumour-bearing mice were treated with PDT and injected with the \nannexin V probe two days and two weeks after therapy. The fluorescence intensity \nof the tumours was evaluated semiquantitatively over time.\nResults: The annexin V probe showed nearly the same absorption (715 nm) and \nemission (750 nm) spectrum like the free dye and possessed a high binding af-\nfinity to apoptotic cells (KD-value 20 nM). Therapeutic efficiency of PDT could be \ndetected in vivo in the tumours via apoptotic cells shortly after therapy. Our probe \naccumulated significantly stronger in treated tumours at two days in contrast to \ntwo weeks after therapy.\nConclusion: In summary, we could successfully image the therapeutic efficiency \nof PDT with the new designed fluorescence optical annexin V probe. Apoptotic \ncells could be detected in the tumour short time periods (2 days) but not longer \ntime (2 weeks) after PDT.\nB‑0886 11:33\nBimodal NIRF nanoparticles as an optical and MRI contrast agent for \nimaging cells of the mononuclear phagocyte system \nJ. Domey1, C. Bergemann2, I. Krumbein1, J.R. Reichenbach1, S. Bremer-Streck1, \nW.A. Kaiser1, I. Hilger1; 1Jena/DE, 2Berlin/DE (Jenny.Domey@med.uni-jena.de) \nPurpose: Even though approaches for multimodal imaging of targeted structures \nlike in tumours have been suggested, fewer investigations have been made on \nbimodal optical and MR-imaging of inflammatory diseases via passive targeting \nof cells of the mononuclear phagocytic system (MPS). However, non-targeted \nnanoparticles (NP) could represent a simple and effective labelling tool being \nrapidly phagocytized from the blood stream by mononuclear cells which are then \nmigrating to the site of inflammation.\nMethods and Materials: For the production of bimodal NP iron oxide cores were \nenclosed by a near infrared (NIR)-fluorochrome (IR780) and surrounded by a starch-\nmatrix. The spectroscopic and MR-imaging properties of the bimodal particles were \ndetermined in agarose phantoms and in vivo using a near infrared fluorescence \n(NIRF) small animal imaging system and 1.5 and 3 T-MRI, respectively. In vivo \noptical and MR-imaging was performed on mice with hind leg oedema.\nResults: A specific NIRF- (average fluorescence signal 0.004 scaled counts/s \nfor 25 µg/ml NP) and MR-signal (1.5 T: r1=6 mM-1 * sec-1, r2=583 mM-1 * sec-1, \nr2*=613 mM-1 * sec-1) was detected for the bimodal NP in vitro. In vivo-MR and \nNIRF-imaging studies confirmed specific signalling of the particles within oedema.\nConclusion: Our bimodal non-targeted fluorescent iron oxide NP successfully \nlabelled cells of the MPS in vitro and in vivo without specific target recognition \nby antibodies. Additionally, the ability of specific NIR-signalling and MR-tracking \nof mononuclear cells makes them suitable for application as a simple and potent \nNIRF-optical and MRI contrast agent for visualisation of inflammatory diseases.\nB‑0887 11:42\nAssessment of in vivo cell viability of Gd or SPIO cells using MRI and BLI \nJ. Guenoun, A. Ruggiero, G. Doeswijk, R. Janssens, G.A. Koning, G. Kotek, \nG.P. Krestin, M.R. Bernsen; Rotterdam/NL (j.guenoun@erasmusmc.nl) \nPurpose: To assess whether MRI can distinguish viable from non-viable trans-\nplanted cells in vivo, using either Gd-liposomes or SPIO as cell labelling agent.\nMethods and Materials: Gd-DTPA was incorporated in cationic liposomes. Rat \nmesenchymal stem cells (rMSCs) were transduced to constitutively express \nfirefly luciferase and labelled with either SPIO (215µg Fe/ml) for 24h or 125µM \nGd-liposomes (4 h). A cell concentration of 5x105 viable or non-viable rMSCs were \ninjected in rat musculoskeletal tissue. MRI and BLI were performed on days 2, 5, \n10 and 15 after injection. MRI T1 mapping (TR variation) and T2 and T2* mapping \n(TE variation) were performed on a 3 T clinical scanner using customised coils. Bio-\nluminescence imaging was performed after intraperitoneal injection of D-Luciferin \n(100 mg/kg). At end-point (day 15) animals were sacrificed for immunofluorescent \nstaining on iron and macrophages.\nResults: While MRI signal from non-viable Gd-MSCs disappeared < 1 day post-\ninjection, signal void from non-viable SPIO-MSCs remained visible up to at least \n2 weeks. Histology showed the iron to remain in situ. Viable Gd-MSCs could be \ndistinguished from non-viable Gd-MSCs, based on both visible contrast changes \nand r1 and r2 relaxivity measurements. Differences in viability of SPIO-MSCs, \nhowever, could not be detected visually or by r2 measurements.\nConclusion: Gd-liposomes can be used as a cell labelling tool to distinguish be-\ntween viable and dead transplanted MSCs in vivo. For this purpose Gd-liposomes \nare favoured over SPIO nanoparticles, due to the low specificity of the latter. \nMethods and Materials: Near-infrared dye ZW-800 (Z) and QQM peptide (Q) were \nconjugated onto the surface of iron oxide nanoparticles (IO). The Z-IO-Q particles \nwere characterised by TEM, DLS, fluorescence intensity. MR and optical imaging \nwere carried out on 4T1 cells in vitro and tumour xenografts. The receptor specificity \nof the dual-modality imaging probe was also confirmed by a blocking experiment \nin the presence of excess amount of non-labelled QQM peptide.\nResults: The Z-IO-Q conjugate had an overall hydrodynamic particle size of \n47.8nm. Incubation of 4T1 cells leads to more significant T2* signal drop (82.18 \n± 2.84%) than Z-IO (17.48 ± 0.50%) (P < 0.01). In vivo MR imaging showed \nsignificantly higher accumulation of Z-IO-Q than Z-IO in 4T1 tumour xenograft, \nwith T2* signal drop of 47.51 ± 10.26% versus 15.02 ± 5.13% at 2 h and 41.80 ± \n6.94% versus 2.93± 9.0% at 24 h post-injection for Z-IO-Q and Z-IO, respectively. \nThe higher fluorescence intensity in the optical imaging of Z-IO-Q group was also \nobserved. Both MR enhancement and optical imaging contrast were effectively \nblocked in the presence of QQM peptide.\nConclusion: We have successfully developed QQM peptide as a tumour TEM8 \ntargeting ligand that can promote both MR and optical imaging contrast enhance-\nment in TEM8 positive tumours. \nB‑0884 11:15\nFolic acid-modified dendrimer-entrapped gold nanoparticles as \nnanoprobes for targeted computed tomography imaging of human \nlung adenocarcinoma \nL.-F. Zheng, H. Wang, C. Peng, M.-W. Shen, X.-Y. Shi, G.-X. Zhang; \nShanghai/CN (zhenglinfeng04@yahoo.com.cn) \nPurpose: To study the new usage of folic acid-modified dendrimer-entrapped \ngold nanoparticles (Au DENPs-FA) as nanoprobes for in vitro and in vivo targeted \ncomputed tomography (CT) imaging of human lung adenocarcinoma\nMethods and Materials: Au DENPs prepared using amine-terminated genera-\ntion 5 poly (amidoamine) dendrimers as templates were covalently linked with \nFA, followed by an acetylation reaction to neutralise the remaining dendrimer \nsurface amines. The formed Au DENPs-FA was used for both in vitro and in vivo \ntargeted CT imaging of human lung adenocarcinoma cells (SPC-A1 cells) and \nthe xenograft tumour model, which express folic acid receptors (FAR) verified by \nimmunohistochemical staining.\nResults: Micro-CT images show that SPC-A1 cells can be detected under x-ray \nafter incubation with the Au DENPs-FA in vitro and the xenograft tumour model \ncan be imaged after intravenous, intratumoral, and intraperitoneal administra-\ntion of the particles. Transmission electron microscopy data confirm that the Au \nDENPs-FA is able to be uptaken dominantly in the lysosomes of the cells. Com-\nbined morphological observation of cells after hematoxylin and eosin staining, \nMTT (3-(4.5-dimethylthiazol-2-yl)-2.5-diphenyltetrazolium bromide) assay of cell \nviability, and flow cytometric analysis of cell cycle and apoptosis shows that the Au \nDENPs-FA does not affect cell morphology, viability, and cell cycle and apoptosis, \nindicating their good biocompatibility at the given concentration range.\nConclusion: These findings suggest that the developed Au DENPs-FA have a \ngreat potential to be used as imaging probes for targeted CT imaging of human \nlung adenocarcinoma.\nAuthor Disclosures:\nL. Zheng: Research/Grant Support; the Shanghai Jiao Tong University \nmedical engineering crossover Fund Project (No. YG2011MS47) and Natural \nScience Foundation of Shanghai Science and Technology Commission (No. \n12ZR1424900). H. Wang: Research/Grant Support; the National Natural \nScience Foundation of China (30901730). G. Zhang: Research/Grant Support; \nthe Key Program of Science and Technology Commission of Shanghai \nMunicipality (No.11JC1410500).\nB‑0885 11:24\nImaging of the therapeutic efficiency of photodynamic therapy with a \nnew designed fluorescence optical annexin probe \nK. Haedicke, S. Gräfe, F. Lehmann, W.A. Kaiser, I. Hilger; \nJena/DE (Katja.Haedicke@med.uni-jena.de) \nPurpose: Photodynamic therapy (PDT) destroys tumour tissue via generating \nreactive oxygen species after administration of a photosensitizer and illuminating \nthe tumour with light. Next to many other molecular processes, apoptosis occurs in \nthe tumour after this therapy. We designed a new fluorescence optical probe based \non annexin V to detect this therapeutic effect after PDT in vivo via non-invasive \nnear-infrared fluorescence optical imaging.\nMethods and Materials: Annexin V was labelled with the near-infrared dye DY-\n734-NHS and characterised spectroscopically. Binding affinity of the probe to \napoptotic tongue-squamous epithelium carcinoma (CAL-27) cells was analysed by \n0\n\nScientific Sessions\nS35\nA\n C D E F G\nB\nMonday\nB‑0890 14:09\nSynchrotron radiation micro-CT imaging of the mouse brain \nA. Chabrol1, H. Rositi1, M. Marinescu1, M. Langer2, C. Olivier2, F. Peyrin2, \nC. Frindel1, M. Wiart1, Y. Berthezène1; 1Lyon/FR, 2Grenoble/FR \n(aurelie_chabrol@yahoo.fr) \nPurpose: MRI coupled with the injection of ultrasmall particles of iron oxide (US-\nPIO) has been successfully applied for pre-clinical and clinical studies of cerebral \ninflammation following stroke. Current limitations of this approach are represented \nby the difficulty of interpreting MR signal changes in terms of exact USPIO lo-\ncalisation. To overcome this limitation, we introduce Synchrotron Radiation phase \nmicro-computerized tomography (SR-PCT) as a new method to visualise USPIO \ndistribution into the whole brains of mice with cerebral ischaemia.\nMethods and Materials: The sensitivity of the technique was assessed by per-\nforming SR-PCT and MRI back-to-back in 10 mice stereotaxically injected with a \nrange of USPIO concentrations. Eight mice with cerebral ischaemia were then \nintravenously injected with USPIOs and imaged back-to-back with MRI and SR-PCT.\nResults: SR-PCT showed hyperintense areas in the regions of MR signal loss. In \nstereotaxically injected animals, SR-PCT proved sensitive enough to detect iron \nin nanomolar quantities. In ischaemic animals, some of these hyperintense areas \nconsisted of bright spots about 40-μm in diameter, compatible with USPIO-labelled \nmacrophages. Immunohistochemistry demonstrated the presence of iron-labelled \ncells, most probably macrophages, at the same location. The SR-PCT pipeline, \nmoreover, identified brain anatomy as clearly as histology, without the need for \nsectioning or staining, with an examination time of 44 minutes per brain at an \nisotropic spatial resolution of 8 μm.\nConclusion: Phase-contrast x-ray tomography may become an invaluable com-\nplement to USPIO-enhanced MRI to study post-ischaemic inflammation in intact \nbrain, with unequaled neuroanatomic analysis.\nB‑0891 14:18\nEffect of dose reduction on cerebral CT perfusion maps: results \nfrom a hybrid digital perfusion phantom \nR. van den Boom1, M. Oei1, L.J. Oostveen1, H. Laue2, \nB. van Ginneken1, R. Manniesing1, M. Prokop1; 1Nijmegen/NL, \n2Bremen/DE (R.vandenBoom@rad.umcn.nl) \nPurpose: To quantitatively evaluate the effect of dose reduction of a standard head \nCTP protocol on the perfusion maps.\nMethods and Materials: A hybrid digital perfusion phantom was used to simulate \ndose reduction in a CT perfusion acquisition. Noise patterns were obtained by \nscanning an epoxy filled human skull phantom on multiple mAs levels on a 320-\nrow scanner and combined with tissue attenuation curves obtained from 5 patient \ndata for grey matter (GM), white matter (WM), artery and vein. We simulated a \nreal clinical CTP head protocol available on the Toshiba CT console (1 scan at \n200 mAs, 13 scans at 100 mAs, 5 scans at 75 mAs and all at 80 kV) with a total \nduration of 55s (5 mm slab thickness) and artificially reduced the dose from 100% \nto 10% in steps of 10%. CBF, CBV and MTT maps were calculated using PMA \n(ASIST-JAPAN). Mean values of GM and WM were evaluated.\nResults: Absolute CBF and CBV values stay within 20% of the values at original \ndose for CTP acquisitions at more than 50% of the original dose for both GM and \nWM. At 10% of the original dose, WM CBV values were overestimated with 24-\n107%, GM CBV values with 4-32%, and WM CBF values with 42-106%. GM CBF \nvalues were within 20% of the values at 100% of original dose. MTT values were \nless affected by dose reduction.\nConclusion: Absolute CBF and CBV values require sufficient dose to be correct: \nvalues at low dose are overestimated.\nAuthor Disclosures:\nR. van den Boom: Research/Grant Support; Toshiba Medical Systems \nCorporation. R. Manniesing: Research/Grant Support; Toshiba Medical \nSystems Corporation. M. Prokop: Research/Grant Support; Toshiba Medical \nSystems Corporation.\nB‑0892 14:27\niDose hybrid iterative reconstruction algorithm improves image \nquality in brain CT and partly compensates for radiation dose reduction \nA. Löve, R. Siemund, P. Höglund, D. van Westen, L. Stenberg, C. Petersen, \nI.M. Björkman-Burtscher; Lund/SE (askell.love@skane.se) \nPurpose: To evaluate the potential of the reconstruction algorithm iDose to pre-\nserve image quality in brain-CT acquired with 30% reduced radiation dose and to \nevaluate image quality assessment methods.\nB‑0888 11:51\nInteraction of magnetically labelled multipotent mesenchymal \nstromal cells and E-/P-selectins monitored by magnetic resonance \nimaging in mice \nJ. Salamon, K. Peldschus, D. Wicklein, C. Lange, H. Ittrich, U. Schumacher, \nG. Adam; Hamburg/DE (j.salamon@uke.de) \nPurpose: This study’s purpose was to analyse the influence of E- and P-selectins \non the migratory pattern of magnetically labelled multipotent mesenchymal stromal \ncells (MSC) in E-/P-selectin deficient (KO) and wildtype (WT) mice using MRI and \nfluorescence microscopy.\nMethods and Materials: Murine MSC were labelled with fluorescent iron-oxide \nmicro-particles and carboxyfluorescein succinidylester. The ability to bind selectins \nand the expression of typical MSC markers were assessed by flow cytometry. La-\nbelled MSC were injected into KO- and WT-mice applying doses of 5 × 104 cells \nintracardially, 1 × 106 cells intravenously and 5 × 106 cells intraperitoneally. Mice \nunderwent sequential MRI at 3.0 T using high-resolution T2* 3D and 2D coherent \ngradient-echo sequences and histological evaluation after 7 days.\nResults: Expression of typical MSC markers and binding abilities to E-/P-selectins \nwere found similar after labelling. After intravenous cell injection in KO-mice sig-\nnificant SNR decrease was assessed solely in the liver from day 0 to 1; WT-mice \nrevealed an increasing SNR decrease of liver, spleen and bone marrow within 7 \ndays. After intraperitoneal injection no significant SNR changes were observed in \nKO-mice; WT-mice showed an increasing SNR decrease of liver, spleen and bone \nmarrow within 7 days. After intracardiac injection multiple susceptibility artefacts \ncould be detected no longer then day 4 in KO mice but persisted up to day 7 in \nWT-mice. Fluorescence microscopy confirmed MRI findings.\nConclusion: This study demonstrates that MSC retain their binding ability to E-\n/P-selectins after magnetic labelling. E-/P-selectin deficiency in mice significantly \nalters the distribution of magnetically labelled MSC. \n14:00 - 15:30 Room B \nNeuro \nSS 1811a \nLatest developments in neuroimaging \nModerators: \nS. Haller; Geneva/CH \nE. Papadaki; Iraklion/GR \nB‑0889 14:00\nImproved image quality for higher diagnostic accuracy of cranial \ncomputed tomography using iterative image reconstruction \nH. Haubenreisser1, C. Fink2, P. Apfaltrer1, B. Schmidt3, M. Sedlmair3, \nS.O. Schönberg1, T. Henzler1; 1Mannheim/DE, 2Celle/DE, \n3Forchheim/DE (holger.haubenreisser@medma.uni-heidelberg.de) \nPurpose: To prospectively compare the image quality of cranial computed tomog-\nraphy (cCT) with thin slice widths using traditional filtered back projection (FBP) \nand sinogram-affirmed iterative image reconstruction (SAFIRE).\nMethods and Materials: 40 consecutive studies (19 men; 71.6±16.6 years) \nreferred for cCT were prospectively included. Each cranial CT raw data set was \nreconstructed with FBP and SAFIRE with decreasing slice widths (5 mm-1 mm). \nObjective image quality was assessed by measuring image noise in three predefined \nregions of the brain (white matter, thalamus, cerebellum) using identical regions of \ninterest (ROIs). Subjective image quality was assessed by 2 experienced radiolo-\ngists by ranking the reconstructed data sets with respect to overall image quality. \nThe Mann-Whitney U-test and Cohen's Kappa were used for statistical analysis.\nResults: Image noise was statistically significantly reduced in all SAFIRE images \nat identical slice widths when compared to the images reconstructed with FBP \n(4.26±0.43 HU vs. 7.67±1.19 HU at 1 mm slice width) (p < 0.001). Mean signal \nattenuation for each region and slice width remained constant between the two \nreconstruction methods (p> 0.5). SNR was comparable between 1 mm SAFIRE \nimages and 5 mm FBP images. Subjective image quality of SAFIRE images was \nrated consistently higher than that of the FBP images (p < 0.001). Interobserver \nagreement was excellent between both radiologists (Cohen's K = 0.79-0.86).\nConclusion: Iterative image reconstruction significantly reduces image noise, while \nincreasing image quality. In cCT this may be used to decrease slice width and thus \nreduce partial volume effects, which may lead to increased diagnostic accuracy. \nAuthor Disclosures:\n B. Schmidt: Employee; Siemens Healthcare. M. Sedlmair: Employee; \nSiemens Healthcare.\n1\n\nScientific Sessions\nS35\n C A D E F\n G\nB\nusing MarsBaR (Marseilles, FR). CBF values were compared between conditions \n(FT, R), and resting and delta CBF (CBF[FT]-CBF[R]) values between sessions \nusing paired t-tests.\nResults: CBF values were significantly higher during FT than R in both sessions \n(52.30 versus 47.70 ml/100 cc GM/min, p < 0.01; 52.32 versus 48.45 ml/100 cc \nGM/min p < 0.01). There was no significant difference in resting (47.70 versus \n48.45 ml/100 cc GM/min, p> 0.05) or delta CBF between sessions (4.60 ml/100 \ncc GM/min versus 3.87 ml/100 cc GM/min, p> 0.05).\nConclusion: Mean resting and delta CBF as measured with p-CASL were con-\nsistent over sessions, while a significant increase of CBF during motor activity \ncould be quantified. Current efforts are directed towards assessing inter-vendor \nreproducibility in a larger population: the VESPA study. \nB‑0895 14:54\nAre quantitative pharmacokinetic data of dynamic contrast-\nenhanced MRI influenced by observer-related bias? New data with \nspecial focus on reproducibility, precision, accuracy, reliability, \nrepeatability and systematic bias \nM. Dietzel1, M. Saake1, P.A.T. Baltzer2, S. Lang1, B. Volbers1, \nT. Struffert1, T. Engelhorn1, A. Dörfler1; 1Erlangen/DE, 2Vienna/AT \n(dietzelmatthias2@hotmail.com) \nPurpose: Quantitative T1-weighted perfusion imaging is promising. However, cur-\nrent software solutions are still semi-automatic and results are therefore potentially \nprone to observer-related bias. Surprisingly, this aspect of DCE-MRI is still poorly \ninvestigated. We aimed to systematically address this matter using a dedicated \nimaging protocol and semi-automatic workflow for quantitative pharmacokinetic \nanalysis.\nMethods and Materials: An ultra-fast high-spatial and high-temporal resolution \nprotocol was used for T1-weighted perfusion imaging (Magnetom Aera @1.5 T; \ndynamic view-sharing 3D gradient-echo-sequence/TWIST: temporal-resolution: \n1.81s, in-plane resolution: 1.1 mm 3, 6 ml Gadovist @2 ml/s, acquisition time: \n62s). For the assessment of pharmacokinetic parameters (ktrans, two-compartment \nTofts-model, fast Arterial-Input-Function) a dedicated semi-automatic software \nsolution was used. Enhancing intracranial tumours were independently evaluated \ntwo times by one experienced neuroradiologist (> 4000 MRI, 8-year experience in \nDCE-MRI). Results of pharmacokinetic parameters for each reading were docu-\nmented in a database. Variability of ktrans measurements was assessed by means \nof reproducibility (concordance correlation coefficient), precision (Pearson ρ), \naccuracy (Bias correction factor/Cb), reliability (intraclass correlation coefficient), \nrepeatability (coefficient of repeatability/Cr) and systematic bias (Bland-Altmann \nplot: regression coefficient/Rc).\nResults: 15 malignant and 8 benign intracranial tumours were included. Appropri-\nate values for median (1st/2nd measurement: 0.113/0.104), range (1st/2nd measure-\nment: 0.518-0.054/0.520-0.061) and standard deviation (1 st/2nd measurement: \n0.099/0.100) of k trans were identified within both measurements. Reproducibility \n(concordance correlation coefficient=0.993), precision (Pearson ρ=0.993), ac-\ncuracy (Bias correction factor/Cb=0.999), reliability (intraclass correlation coeffi-\ncient=0.996), repeatability (coefficient of repeatability/CR=0.045) reached excellent \nvalues. With a regression coefficient of -0.020 there was no substantial evidence \nof systematic bias.\nConclusion: T1-weighted perfusion imaging with subsequent pharmacokinetic \nanalysis showed excellent reproducibility, precision, accuracy, reliability and re-\npeatability. According to our results it is a robust quantitative MRI method and not \ninfluenced by observer-related or systematic bias.\nB‑0896 15:03\nMR elastography (MRE) for non-invasive differentiation of \nintracranial tumours: results of a histology correlated study \nM. Simon1, J. Guo2, M. Bonsanto1, D. Petersen1, I. Sack2, J. Würfel3; \n1Lübeck/DE, 2Berlin/DE, 3Göttingen/DE (martin.simon@radiologische-allianz.de) \nPurpose: We investigated the potential of MR elastography (MRE) to non-invasively \ndifferentiate intracranial tumours by quantifying the tumour tissue viscoelasticity or \n“firmness” in a preoperative setting and subsequently correlated MRE parameters \nto histology.\nMethods and Materials: Twelve patients with suspected intracranial malignoma \nand planned surgery were selected from routine. Tumours showing signs of \nbleeding, aberrant vessels or aneurysms were excluded. MRE was performed on \nan 3 Tesla MRI scanner, applying motion encoding EPI sequences in three direc-\ntions and monofrequent shear wave generation by a head cradle as previously \ndescribed. Viscoelasticity was measured for tumour tissue as well as for healthy \nwhite matter as reference.\nMethods and Materials: 40 patients (mean age 77 years, range 65-93) gave \ninformed consent for this prospective research ethic committee-approved study \nand underwent two consecutive brain CT-scans, with normal radiation dose (ND) \n(CTDIvol 57 mGy, 2.6 mSv) and 30% reduced dose (RD). ND scans were recon-\nstructed using filtered backprojection (FBP), while RD scans were reconstructed \nusing FBP and two iDose levels, ID2 and ID4. Image quality was assessed with \ngrading and ranking by six neuroradiologists. Mean Hounsfield units (HU) and noise \nwere measured. Data were analysed using linear mixed models, and the Tukey \nmethod for multiple comparisons.\nResults: For all reconstructions image quality was graded adequate for clinical \nuse. Image quality was graded good/excellent in 93% of cases for ND, 83% of \ncases for ID4, 79% for ID2, and 67% for RD. For all quality parameters ID4 and \nID2 were graded better than RD (p < 0.0055 and p < 0.035) but worse than ND (p \n<< 0.001). Pooled ranking results were equivalent despite considerable variation in \nindividual assessments. HU were identical between reconstructions. Image noise \nwas similar in ND, ID2 and ID4 but higher in RD.\nConclusion: The iterative reconstruction algorithm improves image quality of \nreduced-dose images and consistently delivers sufficient clinical image quality, \nalthough it does not fully compensate for 30% dose reduction. Pitfalls related to \nsubjective assessment can be addressed with careful study design. \nB‑0893 14:36\nMRI susceptibility-weighted imaging (SWI): role in the differentiation \nof inflammatory pathologies from high-grade glioma \nS. Chu1, Y. Wang1, Z. Yang1, F. Xv1, O. Boyko2; 1Shanghai/CN, \n2Los Angeles, CA/US (chushu1018@hotmail.com) \nPurpose: To determine whether MRI susceptibility-weighted imaging can assist in \ndiscriminating between inflammatory pathologies and high-grade glioma.\nMethods and Materials: Susceptibility-weighted imaging (SWI) was performed at \n3.0 T (Siemens Medical Systems) and images were reviewed retrospectively in 17 \npatients with cerebral inflammatory pathologies and 25 patients with histologically \nproven high-grade gliomas. Only gliomas without MR findings of haemorrhage on \nT1WI were included in the study. The morphological pattern of the susceptibility \nsignal and the anatomic positional relationship between the contrast enhancement \nareas and susceptibility signals were retrospectively reviewed by consensus of 2 \nreviewers. The SWI morphological pattern was scored as: patchy, nodular, dot-like \nor linear and designated as inside or outside the zone of contrast enhancement.\nResults: In total, 17 clinically proven inflammatory diseases (7 parasitic granulomas, \n3 inflammation-demyelinating and 7 neurovasculitis) and 23 lesions were reviewed. \nPatchy, nodular, dot-like susceptibility were demonstrated in both inflammatory \nand neoplastic lesions, whereas linear susceptibility signals were only identified \nin the inflammatory diseases. Nine of 23 (39%) susceptibility signals were situ-\nated outside the contrast enhancement areas in inflammatory pathologies with no \nsusceptibility signals found outside the border of the contrast enhancement areas \namong all the high-grade gliomas.\nConclusion: On SWI, linear susceptibility signal and/or susceptibility signal lo-\ncated outside the area of contrast enhancement was more frequently presented \nin inflammatory processes and not found with the high-grade gliomas. This finding \nmay reflect a different pathophysiologic mechanism and distinction of bleeding/\nmicrobleeding occurrence and presentation in inflammatory pathologies compared \nto high-grade gliomas.\nB‑0894 14:45\nInter-session reproducibility of cerebral blood flow (CBF) in the \nprimary motor cortex as assessed in the VESPA (vendor-specific \nfeatures of ASL-MRI) study \nR.M.E. Steketee1, H.-J.M.M. Mutsaerts2, G.C. Houston3, C.B.L.M. Majoie2, \nA.J. Nederveen2, M. Smits1; 1Rotterdam/NL, 2Amsterdam/NL, 3Zeist/NL \n(r.steketee@erasmusmc.nl) \nPurpose: Arterial spin labelling (ASL) is a non-invasive magnetic resonance imaging \n(MRI) technique to quantify cerebral blood flow (CBF). To reliably use quantitative \nCBF in clinical practice, inter-session variability needs to be established. The current \nstudy assesses reproducibility of resting and delta CBF in the primary motor cortex \nmeasured with pseudocontinuous-ASL (p-CASL) during rest (R) and fingertapping \n(FT) in healthy volunteers.\nMethods and Materials: Ten participants (mean age 22y, 5 male) underwent \n3D p-CASL and T1w scanning at 3 T (GE Healthcare, US) twice. Sessions were \nseparated by 1-4 weeks. During p-CASL participants performed 2 min of 1-Hz \nauditory paced bimanual FT alternated with 2 min of R, 4 times per session. Data \nwere realigned, coregistered and normalised using SPM8 (London, UK). CBF \nvalues from gray matter only were extracted from the bilateral primary motor cortex \n2\n\nScientific Sessions\nS35\nA\n C D E F G\nB\nMonday\nConclusion: The presented method allows fully automated observer-independent \nquantification of microangiopathic HU-induced reduction of the white matter in CT \nwith high correlation to gold standard MRI. \n14:00 - 15:30 Room C \nNeuro \nSS 1811b \nSpinal imaging \nModerators: \nM. Buruian; Targu-Mures/RO \nA. Cianfoni; Lugano/CH \nB‑0899 14:00\nDiagnosis of lumbosacral transitional vertebrae on lumbar MRI: role \nof spinal and paraspinal anatomic markers and value of additional \nwhole-spine localiser \nN. Tokgoz, M. Ucar, B. Erdogan Sendur, K. Kılıc, C. Ozcan; Ankara/TR \n(niltokgoz@yahoo.com) \nPurpose: Diagnosis of lumbosacral transitional vertebrae (LSTVs) is very important \nto avoid wrong level surgery. The aim of this study with a large patient group was \nto evaluate the role of spinal and paraspinal anatomic markers in identification of \nLSTVs on lumbar MRI and to assess the need for whole-spine localiser (WSL).\nMethods and Materials: Lumbar MRI of 1049 adult patients was studied. The \nmorphology of S1-2 disc, L5 and S1 body and lumbar spinous processes were \nevaluated. The positions of aortic bifurcation (AB), right renal artery (RRA), superior \nmesenteric artery (SMA) and conus medullaris (CM) were described. Comparing \nwith WSL, the diagnostic error in numbering vertebral segments on lumbar MRI \nwas evaluated.\nResults: In lumbarisation, all patients revealed a well-formed S1-2 disc with squared \nS1 body. A rhombus-shaped L5 body in sacralisation and a rectangular-shaped S1 \nbody in lumbarisation were found. L3 had the longest spinous process. The most \ncommon sites of spinal and paraspinal structures were AB at L4 body (71.1%), RRA \nat L1 body (53.6%) and L1-2 disc (34.1%), SMA at L1 body (55.1%) and T12-L1 \ndisc (31.6%), and CM at L1 body (44.8%). They were located higher in sacralisa-\ntion and lower in lumbarisation. On lumbar MRI, the diagnostic error in evaluation \nof vertebral segmentation was 14.1%.\nConclusion: The morphologic features and locations of the spinal and paraspinal \nstructures on lumbar MRI are not completely reliable in diagnosis of LSTVs and \nidentification of the vertebral levels. On lumbar MRI, accurate localisation of the \nvertebral segments should be done with the help of additional WSL. \nB‑0900 14:09\nIntravertebral gas in the cervical spine \nP. Slon, J. Etxano, G. Viteri, I. Simón-Yarza, M. Páramo, P. García, J.C. Pueyo, \nJ. Larrache; Pamplona/ES (pslon@unav.es) \nPurpose: The presence of intravertebral gas in the lumbar and thoracic spine, \nusually secondary to trauma, is a well-recognised radiological phenomenon (Küm-\nmel’s Disease). However, intravertebral gas within a cervical vertebral body is a \ncommon but unknown process. We present a series of 27 patients with gas in the \ncervical vertebral bodies, not associated with traumatism. The aim of this study is \nto describe this radiological finding and its possible aetiology.\nMethods and Materials: Our study group included 27 patients who underwent a \nroutine neck CT examination for reasons not related with the cervical spine. All the \npatients presented air within a cervical vertebral body. We analysed several factors \nsuch as age, sex, location of the gas, history of radiotherapy, chemotherapy, the \npresence of degenerative disease, previous infections or corticosteroid therapy.\nResults: The mean age was 67 years (age range 29-82), 21 men and 6 women. \nThe main affected body was C6 (48%), followed by C5 (33%). Most of the lesions \nwere adjacent to the inferior endplate of the vertebral body. Most subjects showed \ndegenerative changes (96%), although none had gas within intervertebral discs. \n34 % of the patients received radiotherapy. None of the patients had a history of \ntrauma, infection or treatment with corticosteroids.\nConclusion: The presence of gas within a cervical vertebral body seems to be a \ncommon but unknown process. This phenomenon could be related with cervical \ndegenerative disease. Further studies should be conducted to verify this hypothesis \nand to elucidate the nature of this finding. \nResults: The study comprised of n=12 intracranial tumours, among these menin-\ngeomas (n=2), solitary metastasis (n=3), as well as WHO grade II - IV tumours \n(n=7). Compared to reference tissue, meningeomas were significantly stiffer. \nMetastases were either slightly firmer or softer than reference tissue. WHO grade \nII and III tumours (n=4) were softer than white matter in all cases. The highest \nloss of tissue stiffness was represented by WHO grade IV tumours. Viscoelasticity \nparameters were supplemented by a histopathology work-up. In summary, high \nWHO grade tumours were significantly softer than tumours of lower staging, the \nrange of metastatic viscoelasticity was slightly higher than primary brain tumours. \nMRE was well tolerated by all patients.\nConclusion: MR elastography of cerebral tumours at 3 Tesla reliably quantifies \ntissue firmness for preoperative planning. According to our histology correlated \npreliminary results, tumour viscoelasticity may be an additional diagnostic parameter \nfor non-invasive tumour differentiation. \nB‑0897 15:12\nIntra- and inter-scanner test-retest reliability of whole-brain arterial \nspin labeling perfusion MRI \nB. Wu, X. Wu, X. Lou, M. Ge, L. Ma; Beijing/CN (646173826@qq.com) \nPurpose: Perfusion MRI can be used to identify and monitor patients with acute \nischaemic stroke. The objective of this study was to investigate whether it is pos-\nsible to pool together whole brain arterial spin labelling (ASL) perfusion imaging \ndata at different times, or from different scanners, located at two different sites.\nMethods and Materials: Eight healthy subjects were scanned on two different 3.0 \nT scanners with 3D pseudo-continuous labelling technique. Scans were repeated \nintra-session and inter-session after 7-30 days. The ASL data with two postlabelling \ndelay time (PLD) of 1.5 and 2.5 seconds were acquired. High-spatial-resolution \nwhole brain T1-weighted images were also acquired for image registration and \nnormalisation into a standardised space within the SPM8. The cerebral blood \nflow (CBF) values of grey matter, white matter, frontal lobe, parietal lobe, occipital \nlobe, temporal lobe, putamen, posterior cingulate, and thalamus were extracted for \ncomparison, using WFU Pickatlas tool. The intra- and inter-scanner reliability was \nevaluated with the intraclass correlation coefficient (ICC). For this study, two-way \nmodel, single-measures ICC were calculated using SPSS.\nResults: The CBF data demonstrated high measurement reliability (total ICC: 0.910; \nintra-scanner ICC: 0.923; inter-scanner ICC: 0.862) for 1.5s PLD, compared with \n2.5s PLD (total ICC: 0.928; intra-scanner ICC: 0.944; inter-scanner ICC: 0.884).\nConclusion: Although inter-scanner reliability is lower than intra-scanner, there \nis a very high similarity of the outcomes at different times and from two different \nscanners. Our findings support the feasibility of cross-site pooling of whole-brain \nASL data, and CBF values with longer PLD time could be more reliable. \nB‑0898 15:21\nSoftware for the radiological view: fully automated CT-based \nquantification of microangiopathic density reduction in white matter \nin comparison to gold standard MRI \nU. Hanning1, I. Noelte2, G. Homann1, T. Niederstadt1, V. Hesselmann1, \nW. Heindel1, A. Kemmling3; 1Münster/DE, 2Mannheim/DE, \n3Hamburg/DE (uhanning@uni-muenster.de) \nPurpose: Assessment of white matter lesions is primarily a domain of magnetic \nresonance imaging (MRI); however, computed tomography (CT) is the more fre-\nquently used diagnostic procedure. The reduction of density of white matter in \nCT images can be used as a surrogate for the severity of microangiopathic WM \nchanges. We present a new CT-based fully automated rater-independent method \nfor quantification of microangiopathic white matter changes.\nMethods and Materials: Tissue segmentation was performed in 600 normal brains \nMRI (3.0 Tesla, T1-3D-Turbo-Field-Echo) of two large population studies (BiDirect \nand SEARCH-Health Study) to obtain a probabilistic WM-tissue-map in standard \nMNI-152 space (published previously).The tissue-specific density (Hounsfield \nUnit, HU) within WM-space was determined by the mean of all voxel densities \nweighted by WM content: Σ (HUxyz × Pxyz (WM))/ Σ (Pxyz (WM); (HUxyz = density \nof voxelxyz; Pxyz = partial WM content at voxelxyz). The reduction of HU over \nWM-space in CT images was correlated with gold standard MR-based WM lesion \nvolume measurements. Results were compared with rater-based Fazekas scores \nfor severity of WM disease\nResults: The process of CT-based tissue-specific segmentation was reliable in \n103 cases with varying occurrence of microangiopathy. In comparison with MRI \nFLAIR-based WM-lesion volume, the CT- based HU-weighted reduction of the \nwhite matter showed a significant correlation coefficient (0.87).\n3\n\nScientific Sessions\nS35\n C A D E F\n G\nB\ncord and CSF flow artefacts were graded by consensus of 2 experienced readers \nin comparison to the TSE sequence.\nResults: The basic BLADE version with 1 or 2 concatenations was significantly \ninferior to TSE (2-sided Wilcoxon test, P < 0.05). Using additional flow compensation \nor an increased k-space coverage resulted in no significant differences of BLADE \ncompared with TSE - with a minor advantage in favour of the BLADE technique \nwith increased k-space coverage.\nConclusion: The value of the BLADE technique for artefact reduction in transverse \nimaging of the cervical spine is strongly dependent on dedicated parameter setting. \nWe present a setting which might be promising for application in a patient study. \nB‑0904 14:45\nRole of 3D MRI with ProSet technique in the evaluation of lumbar \nradiculopathy \nD. Grasso, C. Borreggine, C. Bristogiannis, L.P. Stoppino, D. Melchionda, \nL. Macarini; Foggia/IT (daniela.grasso@hotmail.it) \nPurpose: The aim of our study is to demonstrate the effectiveness of 3D MRI in \nthe diagnosis of lumbar radiculopathy in comparison with clinical and neurophysi-\nological data.\nMethods and Materials: 32 patients with L5 or S1 monoradiculopathy caused \nby a posterolateral or intraforaminal disk herniation underwent MRI examination \nafter preliminary clinical assessment and electromyography (EMG). We performed \nconventional spin-echo and 3D coronal FFE sequences with selective water excita-\ntion (ProSet imaging). Using 3D coronal FFE sequences indentation, swelling and \ntilting angle of the nerve root were evaluated. The tilting angle was compared with \nthe asymptomatic contralateral side of the nerve root. All the data were processed \nusing Epi Info 3.3 software (CDC, Atlanta, GA, USA) and were compared by means \nof Fisher exact test.\nResults: ProSet sequence revealed abnormal tilting angle in 18 patients (57.2 \n%; p < 0.05), monolateral swelling or indentation of roots and spinal nerves in 28 \npatients (85.7%; p < 0.001). In 10 patients EMG demonstrated an involvement of \nmore than one nerve roots, whereas the ProSet revealed only one involved root. \nIn 2 patients the nerve alterations were revealed only by EMG.\nConclusion: EMG has an improved ability to highlight the early changes of the roots \ncaused by mechanical and biochemical alterations due to compression. ProSet \nImaging demonstrates high sensitivity in identifying the exact level of the involved \nroot and can provide a useful tool to plan surgical treatments.\nB‑0905 14:54\nAssessing severity of peripheral neuropathy with DTI \nC. Mathys, J. Aissa, G. Meyer zu Hörste, D.C. Reichelt, G. Antoch, \nB. Turowski, H.-P. Hartung, K.A. Sheikh, H.C. Lehmann; \nDüsseldorf/DE (mathys@uni-duesseldorf.de) \nPurpose: To investigate the utility of DTI in detecting nerve injury or neuropathic \nchanges in proximal nerve segments in patients with peripheral neuropathy.\nMethods and Materials: Twenty-four age-matched individuals with (n=14) and \nwithout (n=10) peripheral neuropathy underwent DTI of a defined sciatic nerve \nsegment. Patients and controls were evaluated by clinical examination and nerve \nconduction studies at baseline and six months after the initial DTI scan. Four patients \nwere scheduled for a second scan six months after the initial MRI.\nResults: The mean FA value was significantly lower in sciatic nerves from patients \nwith peripheral neuropathy as compared to controls. Sciatic nerve FA values posi-\ntively correlated with clinical disability scores and electrophysiological parameters \nof axonal damage, i.e. the compound muscle action potential amplitudes of the \nperoneal and tibial nerve at baseline and six months after MRI scan. No correlation \nwas found with axial and radial diffusivities.\nConclusion: DTI-derived FA values are a sensitive measure to discriminate healthy \nfrom functionally impaired human sciatic nerve segments. This technique might be \npotentially useful in estimating the proximal axonal degeneration burden in patients \nwith peripheral neuropathies.\nB‑0906 15:03\nLeukodystrophy with brainstem and spinal cord involvement and \nlactate elevation (LBSL): assessment of the involved white matter \ntracts by MRI \nH.M.H. Kassem1, S. Radwan1, M.H.I. Elmahdy1, A.A.S.W. Wafae2, \nH.R.S. Farghaly1; 1Riyadh/SA, 2Cairo/EG (kassem_hassan60@yahoo.com) \nPurpose: The purpose is to describe the imaging features of the involved brainstem \nand spinal cord tracts in cases of leukodystrophy with brainstem and spinal cord \ninvolvement and brain lactate elevation (LBSL).\nB‑0901 14:18\nThe importance of craniovertebral and cervicomedullary angle on \ncervicogenic headache \nG. Çoban1, I. Çöven1, E.B. Çifçi1, E. Yıldırım1, C.A. Yazıcı2, B. Horasanlı1; \n1Konya/TR, 2Ankara/TR (drgokcencoban@gmail.com) \nPurpose: Many studies indicated that cervicogenic headache (CH) may originate \nfrom cervical structures innervated by the upper cervical spinal nerves and the \ntrigeminal nerve branches. Studies to date have not investigated whether the \nnarrowing of the craniovertebral angle (CVA) and cervicomedullary angle (CMA) \naffects the nerve branches and causes pain. The aim of this study was to investigate \nthe effect of the narrowing of the CVA and CMA values on the occurrence CH.\nMethods and Materials: Between January 2011 and May 2012, 205 patients with \nthe diagnosis of CH were included in the study. The pain scores in patients were \ncarried out using a visual analogue scale from 1 to 4 (pain groups). Non-headache \ncontrol group consisted of 40 volunteers. Brain MRI was performed in all. CVA \nand CMA were measured on the sagittal T2-weighted MRI. Each CVA and CMA \nvalues were measured on two occasions by two radiologists in four-week intervals.\nResults: Ages of the pain groups and control group were homogeneous (p=0.538). \nIntraclass correlation coefficients were found to be over 98% of all measurements. \nPain scores showed an increase with decreasing CVA and CMA values and it was \nstatistically significant (p < 0.001). For multiple comparisons, Bonferroni's test was \napplied. The relationship between the CMA and CVA values [[Unable to Display \nCharacter: ​]][[Unable to Display Character: ​]]and pain scores were \nstatistically significant for each group (p < 0.05).\nConclusion: Our study showed that the narrowing of CVA and CMA values af-\nfects the occurrence CH. Also there is an inverse relationship between the angle \nvalues and pain scores.\nB‑0902 14:27\nAcute low back/leg pain due to lumbar disc herniation: intradiscal \nand intraforaminal injections of oxygen-ozone vs steroid and anaesthetics \nA. Alexandre1, G. Izzo1, G.G. Giardina1, L. Coro’2, A. Alexandre2; 1Rome/IT, \n2Treviso/IT \nPurpose: Prospective comparison of the clinical effectiveness of intraforaminal and \nintradiscal injections of a mixture of steroid and a local anaesthetic, with respect to \nintraforaminal and intradiscal oxygen-ozone (O2-O3) administration, in the manage-\nment of radicular pain related to acute lumbar disk herniation. \nMethods and Materials: Medical Ethical Committee approval and informed \nconsent were obtained. Two hundred fifty-nine patients (186 men, 73 women; age \nrange, 18-66 years) were included and were randomly assigned to two groups. \n127 patients (group A) underwent intradiscal and intraforaminal injections of a \nsteroid and an anaesthetic, and 132 patients (group B) underwent intraforaminal \nand intradiscal treatment with O2-O3 mixture. Procedures were performed under \nfluoroscopy. Roland Morris Questionnaire and VAS pain evaluation were admin-\nistered before treatment and at intervals, the last at 12-month follow-up. Patients \nand clinicians were blinded as to which treatment was performed. Results were \ncompared with the X2 test. \nResults: After 12 months, treatment was successful in 47% patients of group A and \nin 74% patients in group B. The difference was significant (P < 0.01). \nConclusion: Intraforaminal and intradiscal injections of O2-O3 are more effective \nat 12 months than injections of only a steroid and an anaesthetic in the same sites. \nB‑0903 14:36\nOptimising a BLADE sequence for T2-weighted MRI of the cervical \nspine in transverse orientation: is there a chance for artefact reduction? \nC. Fellner1, C.M. Wendl1, C. Stroszczynski1, T. Finkenzeller2; 1Regensburg/DE, \n2Nürnberg/DE (claudia.fellner@ukr.de) \nPurpose: Due to their intrinsic in-plane motion correction BLADE (synonym: \nPROPELLER) sequences are advantageous for sagittal T2-weighted MRI of \nthe cervical spine by reducing motion and flow artefacts. For transverse images, \nhowever, severe CSF flow artefacts have been described. The aim of this study \nwas to evaluate if BLADE with an optimised parameter setting might overcome \nthose limitations.\nMethods and Materials: 15 volunteers (age: 26-50 years) were examined on a 1.5 \nT scanner (Magnetom Avanto, Siemens Healthcare). Our routine turbo spin echo \nsequence with conventional k-space filling (TSE) was compared with TSE with \nrotating and partially overlapping filling (BLADE). 4 BLADE sequences with different \nparameter settings were applied in all subjects: with additional flow compensation \nin slice selection direction, with an increased coverage of “blades” (186%), and \nwith only 1 concatenation (instead of 2 of the basic version). Delineation of spinal \n4\n\nScientific Sessions\nS35\nA\n C D E F G\nB\nMonday\n14:00 - 15:30 Room D1 \nCardiac \nSS 1803 \nCardiac imaging: into the future \nModerators: \nR.W. Bauer; Frankfurt a. Main/DE \nE. Canet Soulas; Bron/FR \nB‑0909 14:00\nAblation of atrial flutter guided by magnetic resonance imaging \nM. Grothoff, P. Sommer, C. Piorkowski, J. Hoffmann, G. Hindricks, M. Gutberlet; \nLeipzig/DE (grothoff@gmx.de) \nPurpose: Fluoroscopy-guided radiofrequency (RF) catheter ablation is the standard \ntherapy in atrial flutter and is associated with substantial radiation exposure. We \nintroduce the method of RF ablation using real-time magnetic resonance (MR) \nguidance.\nMethods and Materials: RF ablation was performed in 10 patients with typical atrial \nflutter in a standard 1.5 Tesla MRI. Fully MR compatible 8.5 F ablation catheters \nand an MR compatible electrophysiology (EP) recording system (Imricor Medical \nSystems, Burnsville, Minnesota) were used to map/ablate the cavotricuspid isthmus. \nMR-guidance was performed using a standard cine steady-state-free-precession \nreal-time sequence with a frame-rate of 8/s for passive tracking in two orthogonal \nplanes, comparable to right anterior oblique and left anterior oblique projections. \nAblation was performed with RF pulses of 40 W and 60 seconds burning time. \nPostablation imaging was performed using T2-weighted and late gadolinium en-\nhancement imaging for visualisation of oedema and necrosis.\nResults: Time in the MRI scanner was 72±12 minutes. A total isthmus block could \nbe achieved in one patient and was confirmed in the conventional EP environment. \nIn the remaining 9 patients a partial isthmus block was verified. No adverse events \noccurred during the procedures or within the first 30 days to follow -up. Postabla-\ntion imaging clearly showed oedema and necrosis of the cavotricuspid isthmus.\nConclusion: We demonstrated the feasibility of MRI-guided cavotricuspid isthmus \nablation using a standard 1.5 Tesla MRI and a standard real-time SSFP sequence \nfor passive catheter tracking. Further development will concentrate on materials to \noptimise the steerability of the catheter. \nB‑0910 14:09\nQuantitative BOLD response of the left ventricular myocardium to \nhyperoxic respiratory challenge at 1.5 T and 3.0 T cardiac magnetic \nresonance imaging \nS. Winklhofer, S. Pazahr, R. Manka, H. Alkadhi, A. Boss, P. Stolzmann; \nZurich/CH (sebastian.winklhofer@usz.ch) \nPurpose: To quantify the changes of myocardial transverse relaxation times (ΔT2*) \ninduced by hyperoxic respiratory challenge at different field strengths in an intra-\nindividual comparison of healthy volunteers.\nMethods and Materials: Blood oxygen level-dependent (BOLD) cardiovascular \nmagnetic resonance (CMR) data were acquired in ten healthy volunteers (5 women; \n5 men; median age 29 years, range 22-35 years) at 1.5 T and 3.0 T. Medical air \n(21% O2), pure oxygen and carbogen (95% O2, 5%CO2) were alternatively ad-\nministered in a block-design temporal pattern to induce normoxia, hyperoxia and \nhyperoxic hypercapnia, respectively. Parametrical T2* relaxation time maps were \ncomputed, average T2* values were derived from Region-of-Interest analysis by \ntwo independent and blinded readers in 16 standard myocardial segments on 3 \nshort axis slices per patient.\nResults: Inter- and intra-reader correlations of T2* measurements were good \n(ICC=0.75 and ICC=0.79, both P < 0.001). Under normoxia, the mean T2* values \nwere 30.6+7.0 ms at 1.5 T and 27.6+7.6 ms at 3.0 T. Both hyperoxic gases induced \nsignificant (P < 0.001) relaxation time increases ΔT2* (oxygen: 1.5 T, 3.5+5.9 ms; \n3.0 T, 2.1+6.3 ms; carbogen: 1.5 T, 2.9+7.1 ms; 3.0 T, 4.3+7.6sm). As opposed to \n1.5 T, the magnitude of ΔT2* response was higher at 3.0 T and under carbogen \nas compared with oxygen breathing (p < 0.01).\nConclusion: The myocardial ΔT2* response to hyperoxic respiratory challenge \ncan reliably be quantified with BOLD CMR. The magnitude T2* increases signifi-\ncantly with a higher field strength as well as with carbogen as compared to oxygen \nbreathing. Future studies are warranted to investigate the potential diagnostic role \nof BOLD response in assessing patients with coronary cardiomyopathy. \nMethods and Materials: We retrospectively reviewed the imaging features and \nenhancement pattern of the selectively involved white matter tracts in sixteen \n(16) genetically proven cases of leukodystrophy with brainstem and spinal cord \ninvolvement and elevated brain lactate (LBSL). All patients were presented with \nslow progressive cerebellar sensory ataxia with spasticity and dorsal column dys-\nfunction. MRI of the brain and spine and MRS of the brain were done to all patients.\nResults: In all cases, MRI showed signal abnormalities in the sensory and py-\nramidal white matter tracts in addition to inhomogeneous signal abnormalities \nin the periventricular and deep white matter, brain stem, cerebellar connections \nand dorsal columns of the spinal cord. The subcortical U fibres were spared in all \ncases. Proton MRS showed consistent elevation of the lactate within the abnormal \nwhite matter. In eleven cases, diffusion restriction was found in most of the length \nof the corticospinal and sensory tracts in addition to involvement of the superior \nand inferior cerebellar peduncles and the mesencephalic trigeminal tracts. These \nparts of the white matter tracts also displayed heterogeneous enhancement after \ngadolinium administration.\nConclusion: Distinct diffusion restriction and characteristic enhancement of the \nselectively involved white matter tracts should lead to the diagnosis LBSL with the \nhelp of the other MRI and MRS diagnostic criteria.\nB‑0907 15:12\nDiffusion tensor imaging of the spondylotic cervical spinal cord: a \nnew biomarker in cervical spinal cord myelopathy? A preliminary study \nF.W. Cartes-Zumelzu, S. Ingorokva, H. Kostron, G.M. Feuchtner, \nC. Kremser, R. Granata, G. Broessner, C. Thomé; Innsbruck/AT \n(fabiola.cartes-zumelzu@i-med.ac.at) \nPurpose: The purpose of this study was to evaluate the role of DTI in assessing \ncervical spondylotic myelopathy (CSM).\nMethods and Materials: We prospectively evaluated 65 Patients with symptomatic \nCSM. The JOA (Japanese Orthopedic Association) myelopathy score was used to \nassess the clinical situation, dividing patients into groups with minimum myelopathy \n(MIM), moderate myelopathy (MOM) and severe myelopathy (SEM). All patients \nunderwent examination on a 3.0 T MRI scanner (Verio, Siemens). DTI of the spinal \ncord was performed in 30 directions (b-value of 0 and 900). Fractional anisotropy \n(FA), apparent diffusion coefficients (ADC), Eigenvalues (E1, E2.3) were measured.\nResults: Mean patient age was 58. 8 y/- 12, 2 SD. According to the JOA Clas-\nsification, 33 patients were classified into the MIM Group and 29 into the MOM \nand 3 into the SEM Group. Significant differences were seen in ADC (0.9±0.2 vs \n1.1±0.2) values and FA (0.7±0.1 vs 0.5±0.1) when comparing normal with patho-\nlogical levels as well as in E1 (1.9±0.4 vs 2.3±0.4) and E2.3 (0.37±0.24 vs 0.5 ± \n0.29), respectively. Significant elevation of ADC and reduction of FA was seen in \nabsolute vertebrostenotic segments. Significant Elevation of E1 and E2.3 were \nseen in vertebrostenotic segments compared with normal.\nConclusion: Our results suggest a high sensitivity of DTI metrics in the assessment \nof CSM. Significant increases in longitudinal and transverse diffusion were seen in \nour results which might represent a novel biomarker of CSM. \nB‑0908 15:21\nDiffusion tensor imaging and magnetisation transfer imaging of \nspinal cord in MS patients \nM. Gencturk, Y. Anik, H. Efendi, A. Demirci; Kocaeli/TR \n(drm.gencturk@hotmail.com) \nPurpose: The aim of this study was to evaluate the spinal cord involvement in \nmultiple sclerosis (MS) patients with diffusion tensor imaging (DTI) and magnetisa-\ntion transfer imaging (MTI) and to compare FA, ADC and MTR values among MS \npatients with and without spinal plaque with that of the control group.\nMethods and Materials: Sixteen of thirty-two MS patients that had plaque in the \nspinal cord and 16 that did not have plaque in the spinal cord were included. As \na control group 16 healthy volunteered patients were integrated. All patients were \nexamined via 3 T MR. DTI, dynamic MTI and conventional were obtained. ROI \nlocalisations were set as plaque, periplaque, normal-appearing spinal cord, from \ncentral/posterior and both lateral sides.\nResults: In MS patients with spinal plaque FA and MTR values were significantly \ndecreased compared with periplaque (p=0.041, p=0.012), and normal-appearing \ncord (p=0.010, p < 0.0001). Comparisons of normal-appearing spinal cord among \nMS patients with/without spinal plaque and control group revealed a significant \ndecrease of FA and MTR in MS patients with plaque (p < 0.01, and at significance \nlimit in MS patients without plaque (p=0.051, p=0.050) compared with that of the \ncontrol group.\nConclusion: FA and MTR values alter in plaque and periplaque regions and even \nnormal-appearing spinal cord which can be attributed to disease burden. DTI FA \nand MTR values seem to be a promising in assessment of spinal involvement in \nMS patients. \n5\n\nScientific Sessions\nS35\n C A D E F\n G\nB\n(Bayer Pharma) or gadoterate meglumine (Guerbet Group) in a random order. \nMOLLI was performed at a mid-ventricular slice location pre- and 4-20 min (2 \nmin intervals) post-contrast administration. T1 values of the blood pool and the \nmyocardium were measured for each time point and ECV assessment was based \non myocardial ΔR1 assessment (pre and post) in relation to ΔR1 blood pool and \nincorporation of the haematocrit.\nResults: While pre-contrast T1 values were similar (p=0.3), post-contrast T1 values \nwere significantly shorter at any measured time point post-injection after gadobutrol \napplication (p < 0.047). Myocardial ECV data though calculated for both agents did \nnot show significant differences (p> 0.21). In addition, ECV data related to both \nagents did not show any significant differences over the assessed time course of \n4-20 min p.i. (p> 0.14, gadobutrol; p> 0.09, gadoterate meglumine).\nConclusion: Gadobutrol leads to a significantly higher shortening of myocardial \nT1 values as compared to gadoterate meglumine. The ECV assessment which is \nindependent of the CA properties can be adequately evaluated as early as 4 min \np.i. in normal myocardium.\nAuthor Disclosures:\nK.U. Bauner: Equipment Support Recipient; Bayer Pharmaceuticals. T. Sander: \nEquipment Support Recipient; Bayer Pharmaceuticals. H. Pietsch: Employee; \nBayer HealthCare Pharmaceuticals. G. Jost: Employee; Bayer HealthCare \nPharmaceuticals.B.J. Wintersperger: Equipment Support Recipient; Bayer \nHealthCare Pharmaceuticals.\nB‑0914 14:45\nNoninvasive diagnosis of pulmonary hypertension via magnetic \nresonance vortex flow detection: definition of cut-off criteria \nG. Reiter1, U. Reiter1, G. Kovacs1, A. Stalder2, M.A. Gulsun3, A. Greiser2, \nH. Olschewski1, M.H. Fuchsjäger1; 1Graz/AT, 2Erlangen/DE, 3Princeton, NJ/US \n(gert.reiter@siemens.com) \nPurpose: Existence of vortical blood flow in the main pulmonary artery as diagnostic \ncriterion for diagnosis of pulmonary hypertension was analysed in 3-dimensional \n(3D) vector field and streamline representations.\nMethods and Materials: 50 subjects with known or suspected pulmonary hyperten-\nsion (23 patients with and 27 without pulmonary hypertension, age 58±13 years) \nunderwent right heart catheterisation and time-resolved, 3D phase contrast imaging \nof the main pulmonary artery. Blood flow patterns were visualised as 3D velocity \nvector fields projected on 2-dimensional anatomical images (3D-vectors) and as \n3D streamlines using 4D-Flow software (Siemens). Relative period of existence of \nvortical blood flow within the cardiac cycle (tvortex) was evaluated. Comparison of \nmethods for using tvortex as diagnostic criterion for pulmonary hypertension was \nperformed by receiver operating characteristic analysis.\nResults: Areas under the curve for diagnosis of pulmonary hypertension did not \ndiffer significantly (p=0.30) and were 0.998 (95%-confidence interval 0.983 to 1.000) \nin case 3D-vector vortex detection and 0.991 (95%-confidence interval 0.948 to \n0.999) in case of streamline vortex detection. The optimal tvortex cut-off value \nmaximising sum of sensitivity and specificity was tvortex=0.15 for both visualisa-\ntions. Resulting 95%-confidence intervals for sensitivity and specificity were 0.86 \nto 1.00 and 0.82 to 0.99 in case 3D-vector vortex detection and 0.79 to 0.99 and \n0.82 to 0.99 in case 3D streamline vortex detection.\nConclusion: Main pulmonary artery blood flow patterns provide an accurate tool for \nthe diagnosis of pulmonary hypertension with the optimal tvortex cut-off value 0.15. \nAuthor Disclosures:\nG. Reiter: Employee; Siemens.A. Stalder: Employee; Siemens. M.A. Gulsun: \nEmployee; Siemens. A. Greiser: Employee; Siemens.\nB‑0915 14:54\nFeasibility study for an image-based enhancement of low-dose intra-\nprocedural 4D C-arm cardiac flat-detector CT (4D-FD-CT) \nY. Kyriakou1, C. Koehler1, S. de Buck2, D. Nuyens2, H. Heidbuchel2; \n1Forchheim/DE, 2Leuven/BE (yiannis.kyriakou@siemens.com) \nPurpose: To assess the image quality after image-based processing of low-dose \nsingle-rotation intra-procedural 4D-FD-CT (SR 4D-FD-CT).\nMethods and Materials: Multiple rotation contrast-enhanced 4D-FD-CT is as-\nsociated with many C-arm projections (~1000 projections) and a high amount of \ncontrast agent (CA). In this feasibility study, we used a single-rotation of the C-arm \n(Artis zee biplane, Siemens AG, Healthcare Sector, Germany) accompanied by \ncardiac pacing acquiring a reduced number of low-dose projections (~100-400). \nHowever, fewer projections per single cardiac phase may cause sampling and \nstreak artefacts. An image-based temporal gradient is calculated to generate a \nrespective motion map which after appropriate frequency-space analysis sepa-\nrates cardiac motion from other temporal changes, e.g. sampling artefacts. Then \na motion-map-dependent merging of different cardiac phases is performed aiming \nB‑0911 14:18\nHigh-resolution susceptibility-weighted magnetic resonance imaging \nof rat heart microvasculature \nE. Blondiaux, L. Pidial, G. Autret, D. Balvay, C.-A. Cuenod, H. Ducou le Pointe, \nO. Clément; Paris/FR (eleonore.blondiaux@trs.aphp.fr) \nPurpose: To demonstrate that myocardial microvessels detection is feasible at \nhigh-resolution susceptibility-weighted MR imaging (SWI).\nMethods and Materials: Fourteen Wistar rats underwent ex vivo cardiac MR imag-\ning on a 4.7 Tesla scanner using a cryogenic device. Thin, tubular hypointensities \nwithin the myocardium of normal rat hearts at high-resolution susceptibility-weighted \nMR imaging (group 1, n=6) were presumed to be intramyocardial microvessels. \nTo prove that these “strand-like” structures were microvessels, a reference map of \nthe myocardial macrovessels (group 2, n=4) after direct intracoronary injection of \nbarium sulphate, a viscous contrast media was defined. Then, a superparamag-\nnetic contrast agent (ferumoxsil, Lumirem ®), an intravascular contrast agent, was \ninjected to stack up the distribution of intramyocardial microvessels (group 3, n=4). \nFor groups 2 and 3, 3D fast imaging with steady state in precession (3D FISP) \nsequences was performed. The results of images in group 1 (spatial resolution: 39 \nμm) and group 3 (spatial resolution: 39x39x39 μm3) were qualitatively compared.\nResults: After intracoronary artery injection of barium sulphate, the main coronary \narteries were visible up to the third-order branches (group 2). Beyond this level, \nthe coronary microvasculature was opacified with ferumoxsil (group 3) as dem-\nonstrated by the presence of ferumoxsil inside the microvessels on MR-matched \nhistological sections. The regional distribution of microvessels was similar between \ngroups 1 and 3.\nConclusion: Myocardial microvessels appear as “strand-like” structures on high-\nresolution MRI without injection of contrast media. This provides new methods \nfor evaluation of neovascularization in preclinical models of myocardial infarction.\nB‑0912 14:27\nT2-weighted dark blood cardiac imaging using a dual-source parallel \nradiofrequency transmission with RF shimming at 3 T compared \nwith standard MR imaging at 3 T \nM. Rasper, M. Settles, B. Gramer, M. Souvatzoglou, E.J. Rummeny, A. Huber; \nMunich/DE (armin.huber@tum.de) \nPurpose: To prospectively compare the image quality and homogeneity of car-\ndiac T2-weighted dark blood images using a dual-source parallel radiofrequency \n(RF) transmission MR system with RF shimming at 3.0 T and conventional MR \nimaging at 3.0 T.\nMethods and Materials: Dual-source parallel RF transmission 3.0 T MR system \nwith local RF shimming was used to obtain T2-weighted dark blood images in 31 \npatients and compared with standard MRI at 3.0 T. SNR was determined in the \ninterventricular septum (IS), the lateral wall (LW), the right ventricular cavity (RV) \nand left ventricular cavity (LV) in the anterior wall (AW), posterior wall (PW) and in \nthe left ventricular cavity (LV) in two-chamber orientation.\nResults: Mean SNR values were 15.2 (IS), 8.4 (LW), 16.9 (AW), 22.5 (PW), 3.2 \n(RV) and 6.6 (LV) using dual-source RF transmission with RF shimming. Mean \nSNR values were 10.7 (IS), 7.5 (LW), 21.2 (AW), 12.7 (PW), 2.2 (RV) and 6.5 (LV) \nwith conventional shimming. Mean CNR values were 4.8 (IS-RV) and 3.5 (PW-LV) \nusing dual-source parallel radiofrequency transmission with RF shimming. Mean \nCNR values were 3.3 (IS-RV) and 3.3 (PW-LV) for conventional RF shimming. Mean \nsubjective image quality was 3.8 / 3.7 (reader 1 / reader 2) for dual-source parallel \nRF transmission with RF shimming and 2.9 / 2.7 for conventional MRI (p < 0.05).\nConclusion: Dual-source parallel RF transmission with RF shimming at 3.0 T \nimproves homogeneity of cardiac T2-weighted dark blood images based on SNR \nand CNR measurements and improves subjective image quality. \nB‑0913 14:36\nMyocardial T1-mapping and myocardial extracellular volume (ECV) \nfraction: intraindividual comparison of gadobutrol and gadoterate \nmeglumine in an animal model \nK.U. Bauner1, T. Sander1, D. Theisen1, H. Pietsch2, G. Jost2, M.F. Reiser1, \nK. Nikolaou1, B.J. Wintersperger3; 1Munich/DE, 2Berlin/DE, 3 Toronto, ON/CA \n(kerstin.bauner@med.uni-muenchen.de) \nPurpose: To assess dynamic T1 shortening effects of equimolar doses of gadobutrol \nand gadoterate meglumine in myocardium and the effect on extracellular volume \nfractions (ECV) in an animal model.\nMethods and Materials: 10 rabbits underwent cardiac MRI under general an-\naesthesia on a 1.5 Tesla scanner using an 8-element knee coil. Exams included \nSSFP cine imaging as well as pre- and post-contrast myocardial T1-mapping using \na modified look locker inversion recovery (MOLLI) technique. Each animal was \nscanned twice with a 24-h interval after receiving either 0.1 mmol/kg gadobutrol \n6\n\nScientific Sessions\nS35\nA\n C D E F G\nB\nMonday\nConclusion: Using MBIR significantly reduced the need for vessel-wall boundary \ncorrections compared to other reconstruction algorithms, particularly at the side of \ncalcifications. Thus, MBIR improves the feasibility of automated plaque assessment \nin CCTA and potentially its clinical applicability.\nB‑0918 15:21\nCalcium score of small coronary calcifications on multi detector \ncomputed tomography: a phantom study \nJ.M. Groen1, K.F. Kofoed2, M. Zacho2, R. Vliegenthart1, T.P. Willems1, \nM.J.W. Greuter1; 1Groningen/NL, 2Copenhagen/DK (m.j.w.greuter@umcg.nl) \nPurpose: To assess the feasibility of a new phantom which enables establishment \nof a calcium scoring protocol for multidetector computed tomography (MDCT) that \nyields calcium scores comparable to electron beam tomography (EBT) values and \nto physical mass.\nMethods and Materials: A phantom containing 100 small calcifications ranging \n0.5-2.0 mm was scanned on EBT using a standard coronary calcium protocol, and \non a 320-row MDCT scanner using different scanning, reconstruction and scoring \nparameters (tube voltage 80-135 kV, slice thickness 0.5-3.0 mm, reconstruction \nkernel FC11-FC15 and scoring threshold 110-150 HU). The Agatston and mass \nscore were compared and the influence of the parameters was assessed.\nResults: On EBT, the Agatston and mass scores were 0-20, and 0-3 mg, respec-\ntively. On MDCT, the Agatston and mass scores were 0-20, and 0-4 mg, respec-\ntively. The Agatston score on MDCT differed 52% between 80 and 135 kV, 65% \nbetween 0.5 and 3.0 mm and 48% between FC11 and FC15. More calcifications \nwere detected with a lower tube voltage, a smaller slice thickness, a sharper kernel \nand a lower threshold. An acquisition protocol with 100 kV and two reconstructions \nprotocols could be defined. This protocol yielded Agatston scores as close to EBT \nas possible, as well as mass scores as close to physical mass as possible.\nConclusion: With the new phantom a calcium scoring protocol can be found which \nyields Agatston scores comparable to EBT values and to physical mass. \n14:00 - 15:30 Room D2 \nInterventional Radiology \nSS 1809 \nNew approaches to aortic and peripheral \ninterventions \nModerators: \nS. Kudrnova; Budapest/HU \nR. Morgan; London/UK\nB‑0919 14:00\nPaclitaxel-coated balloons for the failing dialysis access: a \nprospective randomised controlled trial \nP.M. Kitrou, K. Katsanos, S. Spiliopoulos, N. Cristeas, M. Kuriakopoulou, \nD. Karnabatidis, D. Siablis; Patras/GR (panoskitrou@gmail.com) \nPurpose: Τo report 1-year results of a prospective randomised controlled trial \ninvestigating angioplasty with paclitaxel-coated balloons (PCB) versus plain bal-\nloon angioplasty for the treatment of failing arteriovenous dialysis access either a \nfistula (AVF) or a graft (AVG).\nMethods and Materials: This was a non-inferiority hypothesis trial registered in \nclinicaltrials.gov (NCT01174472). Enrollment criteria included an angiographic \nand clinical diagnosis of dysfunctional dialysis access due to at least one stenotic \nlesion in patients with AVF or AVG circuits. Forty patients were randomised to \nundergo either PCB dilatation (n=20) or standard PTA (n=20) of a venous outflow \nstenotic lesion. Regular angiographic follow -up was scheduled every 2 months. \nStudy primary endpoints included technical success (defined as residual stenosis \nof the treated lesion > 30% without any significant dissection) and 1-year primary \npatency of the treated site (defined as angiographic visualisation of a patent lesion \nwith < 50% restenosis and no need for any additional repeat procedure within the \npreviously treated lesion due to failing access).\nResults: Baseline variables were comparably distributed among the two groups. \nTechnical success was 100% for both groups. Additional post-dilation with a high-\npressure balloon was necessary in 11/20 (55%) of the PCB-treated cases. At 1 \nyear, cumulative target lesion primary patency was significantly higher after PCB \napplication (35% in PCB group versus 5% in PBA group, p < 0.001, HR (95%CI) \n= 0.27 (0.13-0.58)).\nConclusion: PCB angioplasty might have a place in our quiver for the treatment \nof stenotic venous outflow lesions of failing dialysis access.\nfor better trade-off of high temporal resolution, less noise and streak artefacts. This \nis combined with an automatic segmentation and suppression of catheter-induced \nstreaks. This preliminary study included 5 in vivo porcine models. Images were \nevaluated by experienced cardiologists with respect to noise, temporal resolution \nand artefact susceptibility.\nResults: An enhancement of temporal resolution was shown by a decreased full-\nwidth at half maximum of catheter cross sections using SR 4D-FD-CT as compared \nto static reconstructions. Motion-map-processing of individual phases increased the \ncontrast-to-noise ratio for each heart phase, e.g. in the left ventricle by an average \nof 30%. Visual impression confirmed a significant streak reduction.\nConclusion: First results show the potential of SR 4D-FD-CT for pragmatic 4D-\ninterventional imaging. SR 4D-FD-CT allows for dynamic segmentation of cardiac \nchambers and valves. \nAuthor Disclosures:\nY. Kyriakou: Employee; Siemens AG. C. Koehler: Employee; Siemens AG. \nS. de Buck: Research/Grant Support; Siemens AG. D. Nuyens: Consultant; \nSiemens AG. H. Heidbuchel: Consultant; Siemens AG.\nB‑0916 15:03\nAssessment of HU-value stability in dynamic CT-scans for \nquantitative estimation of myocardial perfusion \nM. Handler1, T. Rienmüller1, P. Ourednicek2, V. Makarenko3, L. Bockeria3, \nS. Zhorzholiani3, I. Krestinich3, R. Rienmüller4, C. Baumgartner1; 1Hall in Tirol/AT, \n2Prague 5/CZ, 3Moscow/RU, 4Graz/AT (michael.handler@umit.at) \nPurpose: For quantitative measurement of left ventricular myocardial perfusion, \nstability of HU-values in Dynamic CT-scans is essential. A phantom study is used \nto evaluate this stability over slices and time using the Philips iCT256-slice scanner.\nMethods and Materials: Seven time series of CT-images with 11 slices (5 mm) \nover 30 seconds of a CATPHAN phantom were acquired using the iCT256 at 100 \nkVp/100 mAs. Six different regions of interest (ROI) were placed into the water \nregions of the phantom for all slices and time steps. Five ROIs were arranged in \na star-like pattern in order to enable evaluation of intra slice variability. One ROI \ncovered the entire water-region. Stability over time and slices as well as within \neach slice was statistically examined.\nResults: The absolute difference in the mean values of the entire water ROI in all \nseven phantom studies was maximum 5.4 HU. The examination of the inter-slice \nvariability revealed a drift of maximal 0.057 HU/slice. Over time, a maximal drift of \n0.043 HU/s could be observed. The maximum intra-slice difference of the mean \nvalues was at 7 HU. This slightly higher value is due to beam hardening artefacts \nin the ROIs close to the high-density /bone simulating/ structure in the phantom.\nConclusion: The absolute difference of the mean values in all ROIs over time/\nslices remained below 5.4 HU. Hence, the HU variation of the Philips iCT256-\nslice scanner lies within an acceptable range for the quantitative estimation of left \nventricular myocardial perfusion. \nB‑0917 15:12\nImpact of iterative image reconstruction algorithms on the \nfeasibility of automated plaque assessment in coronary computed \ntomographic angiography \nS. Puchner, M. Ferencik, M. Károlyi, S. Do, P. Maurovich-Horvat, U. Hoffmann, \nC. Schlett; Boston, MA/US (stefan.puchner@meduniwien.ac.at) \nPurpose: To evaluate the impact of iterative image reconstruction algorithms \nincluding adaptive statistical (ASIR) and model based (MBIR) on the feasibility of \nautomated plaque assessment in coronary computed tomography angiography \n(CCTA) as compared to filtered-back-projection (FBP) reconstructed algorithm.\nMethods and Materials: Three ex-vivo human hearts were imaged by CCTA \nand reconstructed with FBP, ASIR and MBIR. An automated plaque quantification \nsoftware (Vitrea Cardiac Solutions, MN) was applied for each of the algorithms \nto fit the outer and inner vessel-wall boundaries. Each coronary cross section, in \nwhich the automated software detected wrongly the boundaries, was corrected \nin a random and blinded fashion. The percentages of corrections were compared \nbetween the reconstruction algorithms using Chi-square-test.\nResults: A total of 2295 CCTA cross sections with 0.5 mm increments were as-\nsessed which equals to 765 co-registered triplets (FBP/ASIR/MBIR). Any boundary \ncorrections were performed in a total of 712 cross sections (31.0%), including outer \n(N=400) and inner (N=381) vessel-wall. The percentage of corrected cross sections \nwas lower for MBIR (24.1%) as compared to ASIR (32.4%, p=0.0003) and FBP \n(36.6%, p < 0.0001), and marginal between ASIR and FBP (p=0.09). Regional \nagreement of performed corrections existed between reconstruction algorithms \n(kappa=0.53). The benefit of MBIR above FBP was associated to the presence \nof moderate and severe calcification (OR: 2.9 and 5.7, p < 0.0001, respectively).\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nwere reviewed to classify arterial involvement according to: 1) TASC II, 2) Graziani’s \nmorphological classification, 3) Joint Vascular Society Council calf and foot scores. \nClinical results (healing, non-healing, major amputation) were compared to baseline \nclinical data and angiographic results.\nResults: 202 percutaneous procedures were performed; the immediate technical \nsuccess rate was 93.6%. Preprocedurally, the mean±SD calf and foot scores were \n7.8±1.6 and 7.3±2.3, respectively; 132 patients (65.3%) were in Graziani's mor-\nphological classes 4 to 7; in 112 (55.4%) cases TASC II was inapplicable, for the \nabsence of femoro-popliteal lesions. Post-procedurally, mean calf and foot scores \nwere 4.8±2.3 and 5.9±2.6, respectively, and 86.6% of cases were into the Graziani's \nclasses 1 and 2, whereas TASC II was inapplicable in all cases. Healing and major \namputation rates were 66.8% and 3.9%, respectively; only pre- and post-procedural \nfoot scores were significantly associated with the clinical outcome (P <.05).\nConclusion: Endoluminal revascularization represents a valuable treatment option \nin diabetic patients with CLI. In this population, TASC II is inadequate to describe \nperipheral arterial involvement. Pre- and post-procedural foot scores represent \nthe most significant angiographic parameter to evaluate treatment success, thus \naggressive treatment of foot arteries should be attempted whenever possible.\nB‑0923 14:36\n12 months results of a randomised trial comparing mono- or \ndual-antiplatelet therapy in interventionally treated patients with \nperipheral arterial disease \nF.F. Strobl1, J. Schmehl2, K. Brechtel2, T. Zeller3, C.D. Claussen2, \nG. Tepe4; 1Munich/DE, 2Tübingen/DE, 3Bad Krozingen/DE, \n4Rosenheim/DE (frederik.strobl@med.lmu.de) \nPurpose: In this trial, peri- and postinterventional dual antiplatelet therapy sig-\nnificantly reduced rate of target lesion revascularisation after 6 months. It is not \nknown whether this effect persists after stopping clopidogrel. Thus, we conducted \nan additional follow-up after 12 months.\nMethods and Materials: In this double-blinded, randomised trial, we enrolled 80 \npatients who were treated with PTA or stenting in the upper leg. 40 patients received \npre- and postinterventional dual therapy with aspirin and clopidogrel. The other \n40 patients received same doses of aspirin and placebo instead of clopidogrel. \nClopidogrel/placebo was stopped after 6 months and patients remained on aspirin \nonly. TLR and mortality rate were reevaluated 12 months after the intervention.\nResults: We initially enrolled 80 patients (42 male, 70±10y), 40 in each group in \nthe study. 12 months after the intervention, 36 clopidogrel and 37 placebo patients \ncould be reevaluated. At 6 months, clopidogrel patients had significantly lower rates \nof TLR compared to placebo patients: 2 (5%) vs.8 (20%), p=0.04. After stopping \nclopidogrel/placebo, there was no more significant difference in TLR 12 months after \nstudy inclusion with 9 (25%) clopidogrel vs.12 (32.4%) placebo patients (p=0.35). \nMortality was 0 vs. 1 at 6 months (p=0.32) and 0 vs. 3 at 12 months (p=0.08).\nConclusion: In contrast to the first follow -up 6 months after the intervention ac-\ncording reduction of TLR, this advantage of dual antiplatelet therapy does not \npersist after stopping clopidogrel. Prolonged dual therapy (> 6 months) should be \nevaluated and considered in patients with high risk for restenosis. \nB‑0924 14:45\nComparing 2D angiography, 3D rotational angiography, and pre-\nprocedural CT image fusion with 2D fluoroscopy for endovascular \nrepair of thoraco-abdominal aortic aneurysm \nV. Tacher1, M. Lin2, P. Desgranges1, T. Grünhagen3, A. Luciani1, \nJ.-P. Becquemin 1, J.-F. Deux 1, A. Rahmouni 1; 1Creteil/FR, \n2Briarcliff Manor, NY/US, 3Best/NL \nPurpose: To evaluate the feasibility of pre-procedural arterial phase computed \ntomography image fusion with intra-procedural fluoroscopy (or Image fusion: IF) \nroad-mapping in endovascular repair of thoraco-abdominal aortic aneurysm (EVR-\nTAAA) compared to current road-mapping methods (2D and 3D angiographies) in \nterms of x-ray exposure, injected contrast volume, and procedure time.\nMethods and Materials: Single-institution prospective study (Internal institute \napproved), on 37 patients, informed written consent provided, and treated for \nEVRTAAA. All interventions were performed on the same angiographic system. \nPatients were consecutively placed in three groups in a seven-month period: “2D \nangiography” (2DA) (9 patients), “3D rotational angiography” (3DA) (14 patients) \nand “image fusion” (IF) (14 patients). Injected contrast volume, x-ray exposure \n(dose-area-product: DAP) and procedure time were recorded. To compare the \ngroups in terms of the above measures and general patient characteristics, statisti-\ncal tests using Fisher’s Exact, Kruskal-Wallis and Mann-Whitney were performed.\nResults: Patient characteristics and stenting types were similar between all \nthree groups with no statistically significant differences (p-value> 0.05). The IF \nB‑0920 14:09\nLower limb multilevel treatment with drug eluting balloon: 12-month \nresults from the “DEBELLUM” trial \nF. Fanelli, A. Cannavale, P. Lucatelli, A. Wlderk, C. Cirelli, F.M. Salvatori; \nRome/IT (fabrizio.fanelli@uniroma1.it) \nPurpose: To report 12-month results of the “DEBELLUM”-drug-eluting balloon \nevaluation for lower limb multilevel treatment-trial performed to evaluate the ef-\nficacy of drug-eluting balloon-DEB versus conventional balloon catheter-NCB in \nthe treatment of peripheral arterial disease.\nMethods and Materials: Fifty consecutive patients (mean age 67±21 years) with \nsymptomatic peripheral arterial disease were randomised between DEB (25 pa-\ntients-57 lesions) (Inpact®-Medtronic) and NCB (25 patients-65 lesions). Inclusion \ncriteria were native single or multiple stenosis or occlusion (mean lesion length 7.5 \n± 3.5 cm) in the femoro-popliteal or below the knee (BTK) regions. Dilatation was \nperformed in each group either for native lesions (26 DEB; 30 NCB) or post-stent \nimplantation (31 DEB; 35 NCB). Primary end points were late lumen loss (LLL) \nat 6 and 12 months. Secondary end-points were target lesion revascularisation \n(TLR), amputation and thrombosis rate.\nResults: One-hundred-twenty-two lesions were treated: 75.4% in the femoro-\npopliteal area; 24.6% BTK; 21.3% total occlusions. LLL was 0.5±1.4 mm (DEB) vs. \n1.6±0.7 mm (NCB) (p < 0.01) at 6 months and 0.64±0.9 mm (DEB) vs. 1.81±1.1 \nmm (NCB) P=0.001 at 12 months. One-year results showed a reduced TLR 4/25 \n(16%) vs. 10/25 (40%) p < 0.01. Thrombosis was 4% (DEB) vs. 5.2% (NCB) p=0.6. \nAmputation rate 4% (DEB) vs. 7.9% p=0.46. Sub-group analysis showed for native \nstenosis a LLL of 0.63±0.9 mm (DEB) vs. 1.70±0.6 mm (NCB) p < 0.01. After stent \nimplantation 0.65±0.7 mm (DEB) vs. 1.91±0.3 mm (NCB) p < 0.01. Ankle-brachial-\nindex improved more using DEB, baseline: 0.55±0.06; post-procedure: 0.81±0.3 / \nNCB, baseline: 0.57±0.05; post-procedure: 0.68±0.13 (p < 0.05).\nConclusion: Results confirmed DEB as effective in treatment of peripheral arte-\nrial disease. \nB‑0921 14:18\nDirectional atherectomy of chronic total femoropopliteal occlusions: \nmiddle-term outcomes \nM. Rossi, G.M. Varano, F. Laurino, G. Orgera, A. Zolovkins, N. Maltzeff, \nM. Citone, V. David; Rome/IT (gianluca.varano@gmail.com) \nPurpose: This study aimed at assessing retrospectively the middle-term clinical \noutcome of the femoropopliteal chronic total occlusion (CTOs) treatment by means \nof directional atherectomy (DA).\nMethods and Materials: Between January 2008 and March 2012, 47 patients (51 \nlimbs, patient age 70±10 years) were included in the study with mean follow-up of \n20 months (6-51). 51 femoro-popliteal CTO in 47 Patients with severe intermittent \nclaudication (N=15; 49.4%) or critical limb ischaemia (CLI) (N=16; 51.6%) were \ntreated with SilverHawk or TurboHawk atherectomy followed by angioplasty in 10 \n(32.2%) cases. Clinical and USCD follow -up was set at 3, 6 and 12 months and \nyearly thereafter. Immediate technical success, disease-free patient survival and tar-\nget lesion revascularisation (TLR) rates were assessed with Kaplan-Meier analysis.\nResults: Technical success rate was 98% with a lesion length of 80±56 mm. Limb-\nsalvage and survival rates were 87.5 and 90.3% at 2 years, respectively. At 6, 12 \nand 24 months disease-free patient survival was 88.7, 79.9 and 64.6%. Whereas \nadjunctive PTA was performed in 32% cases to improve the angiographic result, \n12% required an associated tibial vessel treatment. No perioperative mortality was \nobserved. One complication (2%) occurred.\nConclusion: Percutaneous directional atherectomy is a safe and effective tech-\nnique in lower limb revascularisation. Preliminary results supported by short-mid \nterm data encourage use of DA with SilverHawk and TurboHawk catheter in the \nfemoro-popliteal obstructive lesions also in traditionally “forbidden districts”. Long-\nterm data are missing. \nB‑0922 14:27\nPredictive value of angiographic scores for the integrated \nmanagement of the ischaemic diabetic foot \nF.M. Turini, I. Bargellini, A. Piaggesi, A. Cicorelli, R. Cervelli, E. Iacopi, R. Cioni, \nC. Bartolozzi; Pisa/IT (francesca_turini@libero.it) \nPurpose: To retrospectively evaluate the agreement between angiographic scores \nand clinical outcome after endoluminal revascularization in diabetic patients with \ncritical limb ischaemia (CLI).\nMethods and Materials: Data were retrospectively collected of consecutive diabetic \npatients with stage IV CLI who underwent percutaneous lower limb revascularization \nfrom January 2009 to June 2011. Pre- and post-procedural angiographic images \n58\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nB‑0927 15:12\nCompletely CT-guided treatment of lumbar artery fed type 2 \nendoleaks after stent graft repair of abdominal aortic aneurysms \nwith direct sac puncture and embolisation with the liquid embolic \nagent ethylene vinyl alcohol copolymer (Onyx) \nM. Treitl1, M. Sadeghi2, K. Eberhardt1, D. Maxien1, M.F. Reiser1; 1Munich/DE, \n2Erding/DE (mtreitl@med.uni-muenchen.de) \nPurpose: Treatment of lumbar artery fed type 2 endoleaks (lafT2E) after abdominal \nendovascular aneurysm repair (aEVAR) exhibits high failure and recurrency rates. \nWe report our preliminary results of CT-guided direct sac puncture, followed by \nembolisation with the liquid embolic agent ethylene vinyl alcohol copolymer (Onyx®).\nMethods and Materials: 17 male patients (mean age 76 ±6 yrs) with lafT2E were \nincluded after failure of conservative treatment. All received CT guided direct sac \npuncture under local anaesthesia, followed by CT fluoroscopic embolisation with \nOnyx 34® or 20®. Follow-up examination included contrast-enhanced ultrasound \n(CEUS) and dual-phase CT angiography every 6 months for at least 2 years \n(ongoing).\nResults: Technical success was achieved in all cases, requiring dual puncture of \nthe aneurysm sac in 8 cases (47.1%). Average duration of the procedure was 60 \n± 12 min. In mean 7.5 ml of Onyx 34® were used per procedure. In 6 cases Onyx \n20® was additionally used for complete filling of the endoleak. Repeat interven-\ntion was necessary in 3 cases (17.3%) due to new endoleak development in the \nfollow-up period of 12 ± 8 months. The procedure failed permanently in 1 case. \nComplications such as major bleeding, spinal ischaemia or non-target embolisa-\ntions were not observed.\nConclusion: Completely CT-guided treatment of lafT2E is a feasible and safe \ntreatment alternative. Difficulties lay in the determination of the necessary amount \nof Onyx and the end point of the intervention. Several punctures as well as repeat \nintervention might be necessary to achieve permanent endoleak occlusion. \nAuthor Disclosures:\nM. Treitl: Advisory Board; Covidien. Consultant; Covidien, Biotronik.\nB‑0928 15:21\nEndovascular treatment of type 1 endoleaks after stent graft repair \nof aortic aneurysms: effectiveness and safety of the ethylene vinyl \nalcohol copolymer Onyx as liquid embolic agent \nM. Treitl1, M. Sadeghi2, K. Eberhardt1, D. Maxien1, M.F. Reiser1; 1Munich/DE, \n2Erding/DE (mtreitl@med.uni-muenchen.de) \nPurpose: Treatment of type 1 endoleaks after endovascular aneurysm repair \n(EVAR) can be challenging. We describe a technique for direct embolisation with \nthe liquid embolic agent ethylene vinyl alcohol copolymer Onyx by direct catheter \naccess to the endoleak, and present first results.\nMethods and Materials: 18 patients (16 male, 2 female, mean age 72 +- 7 yrs) \nwith a type 1a (n = 13) or a type 1b (n = 5) endoleak were treated. In 13 cases, it \nwas applied as stand-alone procedure, and in 5 cases in combination with stent \ngraft extension. Access was trans-brachial for type 1a endoleaks, and trans-inguinal \nfor type 1b endoleaks. A multi-purpose catheter was placed between the aortic \nwall and the stent graft to access the endoleak, followed by coaxial introduction \nof a dimethyl sulfoxide (DMSO) compatible micro-catheter into the endoleak, and \nconsecutive Onyx embolisation.\nResults: Technical success was achieved in all cases. A mean volume of 11 ml \n+- 5 ml of Onyx 34 was used. In 5 cases, additional coils were used as an anchor \nfor Onyx. 1 patient developed reperfusion of the endoleak during follow -up of 12 \n+- 8 months, which was successfully treated with the same technique. Non-target \nembolisation, catheter encasement, or anaphylactic reactions to DMSO were not \nobserved.\nConclusion: The described technique is feasible, safe, and effective for treat-\nment of type 1a and 1b endoleaks with excellent technical success rates, and low \nrelapse rates. It can be used as stand-alone procedure or easily be combined with \nstent graft extension. \nAuthor Disclosures:\nM. Treitl: Advisory Board; Covidien. Consultant; Covidien, Biotronik.\ngroup showed significant reduction (p-value< 0.0001) in injected contrast volume \ncompared to the other groups (2DA: 235±145 ml; 3DA: 225±119 ml; IF: 65±28 \nml). Although not statistically significant (p-value=0.18), DAP showed a trend in \nreduction for the IF group (2DA: 1188±1067Gy×cm²; 3DA: 984±581Gy×cm²; IF: \n655±457Gy×cm²). There was no statistical difference (p-value=0.59) in procedure \ntime between groups (2DA: 233±123 minutes; 3DA: 181±53 minutes; IF: 189±60 \nminutes).\nConclusion: Image fusion road-mapping for EVRTAAA is feasible and is associ-\nated to a statistically significant reduction in contrast volume and a trend towards \nDAP reduction while maintaining similar procedure time. \nB‑0925 14:54\nEndoleak complications of thoracic endovascular aortic repair \n(TEVAR): long-term outcomes and survival \nA. Rampoldi, P. Fratto, M. Solcia, R. Vercelli, C. Migliorisi, F. Barbosa, D. Foresti, \nM. Nichelatti, G. Cornalba; Milan/IT \nPurpose: To assess the endoleak complications and survival after TEVAR.\nMethods and Materials: Between July 2005 and July 2011, 77 patients (64 male \nand 13 female) were underwent TEVAR. 24 were in emergency and 17 of proce-\ndures were hybrid. The medium term follow-up was 24 months. Cross-tabulations \nwere checked with chi-squared test, or by Fisher’s exact test. Survivorships were \nanalysed by Kaplan-Meyer product limit method and by Cox semiparametric \nregression.\nResults: Technical success was achieved in 98.7%. 14/77 presented endoleaks \nduring the follow-up (type 1=7, type 2=6 and type 3=1). During the follow-up there \nwere 7 mortalities, mean time 19.82 months (range 3-48). In survival rates there \nwas no difference between hybrid procedures group (p=0.3387) and elective \nor emergency group (p=0.3608). There was a statistical difference on survival \nbetween the group that had endoleaks during the follow -up (p=0.0093) and who \nhad had necessity of a second endovascular interventional (p=0.0184). Statistical \ndifference on survival was also seen between patients who developed type 1 and \n2 endoleaks (p=0.0336).\nConclusion: TEVAR is a safe and effective treatment. The presence of endoleak, \nspecial type 1 and the necessity of a second endovascular intervention reduces \nsignificantly the survival. \nB‑0926 15:03\nSelective coverage of the left subclavian artery without \nrecanalization in patients with patent vertebro-vertebral arterial \ncommunications during TEVAR: a single centre study \nM. Lee; Seoul/KR (eterna0@yuhs.ac) \nPurpose: To evaluate the safety and effectiveness of selective coverage of the left \nsubclavian artery (LSCA) without recanalization during TEVAR in patients with pat-\nent vertebro-vertebral arterial communications and to assess morphologic change \nof the vertebral artery (VA) after the procedure.\nMethods and Materials: Among 126 patients who underwent TEVAR, 29 patients \nrequiring LSCA coverage without pre-emptive recanalization were retrospectively \nanalysed. The patients’ ages ranged from 45 to 84 years. Vertebro-vertebral arterial \ncommunications in all patients were evaluated by contrast-enhanced computed \ntomography (CECT), time-of flight magnetic resonance angiography, or conven-\ntional angiography. Neurologic complications such as spinal cord ischaemia (SCI) \nor cerebrovascular accidents (CVA) were analysed. Pre- and post-procedural \nchanges in VAs were evaluated on follow-up CECT.\nResults: The overall 30-day mortality was 6.9% (2/29). None of the patients had an \nSCI or stroke of posterior circulation alone. CVA from embolic infarctions occurred \nin two patients (7.4%). Transient left arm ischaemic symptoms were present in 5 \npatients (18.5%), but none required secondary interventions. Delayed development \nof type I endoleak occurred due to stent deformity in one patient, who underwent \nsurgery. One patient required re-intervention after a pseudoaneurysm developed at \nthe distal margin of the previously placed stent-graft at ten-month follow-up CECT. \nHypertrophy of the right VA after TEVAR was seen in 7 of 27 patients (25.9%); two \npatients showed bilateral hypertrophy of VAs.\nConclusion: LSCA coverage without recanalization can be safely performed during \nTEVAR in patients with patent vertebro-vertebral communications. Hypertrophy of \nthe right VA was noted in 25.9% of patients after LSCA coverage.\n59\n\nScientific Sessions\nS36\n C A D E F\n G\nB\nB‑0931 14:18\nDynamic contrast-enhanced imaging for detection of complications \nafter double-bundle reconstruction of the anterior cruciate ligament \nY.-C. Lin1, Y.-H. Juan1, Y.-C. Cheung1, W.-L. Yeh1, C.-H. Chiu1, C.-F. Tan1, \nC.-M. Kuo2; 1T aoyuan/TW, 2Ilan/TW (yuching1221@gmail.com) \nPurpose: Double-bundle reconstruction with stump preservation has revolutionised \nthe surgical treatment for anterior cruciate ligament (ACL) injury. However, poor \nrevascularization at the osteoligamentous interface (OI) of the tibia tunnel remains \na major cause of graft complications. In this study, we applied dynamic contrast-\nenhanced (CE) magnetic resonance imaging (MRI) to quantify the OI enhancement \nvalues of the tibia tunnels and ACL stump. We aimed to determine the relationship \nbetween graft complications and OI and stump enhancements.\nMethods and Materials: From October 2011 to April 2012, 34 patients were \nenrolled in our study (mean postoperative duration, 7.3 months). All patients un-\nderwent one 1.5-T MRI study with the imaging pulse-sequence protocol of proton \ndensity-weighted imaging (WI), T2WI, pre-enhanced and post-enhanced T1WI, \nand dynamic CE MRI. Graft complications, including cystic degeneration and tear, \nwere evaluated using pre-enhanced MRI, and peak enhancement (ePeak) values \nwere acquired from a dynamic CE study. The receiver operating characteristic \n(ROC) analysis was used to obtain optimal cut-off values for complicated grafts.\nResults: Our study included 28 patients (mean age, 25.5 years). Nine patients \n(32.1%) had cystic degeneration and 1 (3.6%) had complete posterolateral (PL) \nbundle tear. Mean ePeak percentages for graft with or without complications \nwere 84.19%/127.69% for anterior--medial (AM) bundle, 107.54%/128.21% for \nPL bundle, and 171%/151.06% for stump, respectively. ROC analysis yielded the \noptimal ePeak cut-off values of 126%, 104%, and 35% for AM bundle, PL bundle, \nand stump, respectively.\nConclusion: Graft complications were directly associated with higher tibial OI \nvalues but inversely associated with higher stump values.\nB‑0932 14:27\nSusceptibility artifacts on knee MRI: their frequency, change over \ntime, and their relation with radiography-detected calcifications and \njoint space narrowing, and MR-detected meniscal tears \nM. Jarraya1, D. Hayashi1, A. Guermazi1, C.K. Kwoh2, M.J. Hannon2, C.E. Moore3, \nJ.M. Jakicic2, S.M. Green2, F.W. Roemer4; 1Boston, MA/US, 2Pittsburgh, PA/US, \n3Houston, TX/US, 4Augsburg/DE (mohamedjarraya@gmail.com) \nPurpose: We assessed the frequency of susceptibility artefacts (SA) on DESS and \nIW-fs, and their associations with calcifications and joint space narrowing (JSN) \non x-ray (XR), and meniscal tears in the medial TFJ.\nMethods and Materials: 346 knees of 177 subjects aged 35-65 with pain were \nincluded. 3 T MRI performed at baseline and 6-month follow -up (f/u). AP knee \nXR taken at baseline and calcifications within medial TFJ, and medial JSN were \nrecorded. SA in TFJ space assessed on coronal DESS and IW fs. XR and MR im-\nages, each read on separate reading sessions. Kappa statistics applied to define \nagreement between findings on the baseline DESS/IW fs and XR.\nResults: Mean age was 52±6 years, 54% men, mean BMI was 29±4. Medial \nmeniscal tears and medial JSN were seen in 126 and 44 knees, respectively. At \nbaseline, 13 knees showed SA on DESS, of which 6 were seen at f/u and 7 disap-\npeared. Knees with SA were more likely to have medial meniscal tears (9/13 vs. \n117/333, p=0.017) and medial JSN (5/13 vs. 39/333, p=0.016). On IW-fs, 4 knees \nshowed SA at baseline. Of 7 knees with calcifications on XR, 2 demonstrated SA \non DESS. Agreement between DESS and IW-fs was κ=0.46 (95%CI 0.17-0.75), \nand between SA on DESS and calcification on XR was κ=0.18 (95%CI -0.06-0.42).\nConclusion: SA on DESS in the TFJ were seen in < 5% of knees. It rarely cor-\nresponded to calcifications on XR and commonly showed longitudinal changes, \nsupporting the hypothesis that it represents vacuum phenomenon. \nAuthor Disclosures:\nA. Guermazi: Consultant; Genzyme, Novartis, Merck Serono, Stryker. Founder; \nBoston Imaging Core Lab (BICL). LLC. Shareholder; Boston Imaging Core \nLab (BICL). LLC.F.W. Roemer: Consultant; National Institute of Health, Merck \nSerono. Shareholder; Boston Imaging Core Lab (BICL). LLC.\n14:00 - 15:30 Room E1 \nMusculoskeletal \nSS 1810 \nKnee: new horizons \nModerators: \nM. Aparisi Gomez; Valencia/ES \nA. Cotten; Lille/FR \nB‑0929 14:00\nPCL index as an objective MRI tool to evaluate anatomic ACL \nreconstruction during functional activities \nA. Ntoulia1, F. Zampeli1, E. Pappas2, S. Ristanis1, A. Georgoulis1; 1Ioannina/GR, \n2Brooklyn, NY/US \nPurpose: To test if the posterior cruciate ligament (PCL) index is predictive of \nrotational knee kinematics during pivoting activities and anterior tibial translation \n(ATT) in patients after anatomic single-bundle (SB) anterior cruciate ligament \nreconstruction (ACLR).\nMethods and Materials: Sixteen patients with SB-ACLR were prospectively evalu-\nated with 3D-motion analysis during (1) descending and pivoting, and (2) landing \nand pivoting. The side-to-side difference of tibial rotation range of motion (SSDTR) \nbetween the ACLR and the contralateral intact knee was calculated. ATT SSD was \nmeasured with a KT-1000 arthrometer. MRI was used to measure the PCL index \nfor the study group and a control group. Linear regression models were used with \nPCL index as predictor of SSDTR for each task and side to side anterior translation \ndifferences. Unpaired sample t-test was used to compare PCL index group means \nbetween the study and control group. The level of significance was set at α=0.05.\nResults: PCL index of the ACLR knee was significantly lower compared to the \nhealthy control knee (p < 0.001). The PCL index was predictive of low SSDTR during \npivoting after descending and landing tasks (R2=0.472, p=0.003 and R2=0.477, \np=0.003 respectively). PCL index was not predictive of ATT with 134 N or maximum \nmanual force (R2=0.13, p=0.17 and R2=0.009, p=0.726 respectively).\nConclusion: The PCL index after anatomic SB ACLR is predictive of rotational \nkinematics during dynamic pivoting activities. These results suggest that after \nanatomical ACLR the PCL index can serve as an indicator of tibial-femoral position \nand may predict dynamic tibial rotation. \nB‑0930 14:09\nMicrostructural evaluation of the cruciate ligaments with MR \ndiffusion tensor imaging (DTI): correlations with knee stability \nL. Di Clemente1, D. Tortora1, V. Panara1, M. Savastano1, V. Calvisi2, \nP. Palumbo2, A. Tartaro1, A.R. Cotroneo1, M. Caulo1; 1Chieti/IT, 2L’Aquila/IT \n(lorisdiclemente@gmail.com) \nPurpose: The evaluation of knee stability is currently based on tibio-femoral \nsagittal plane motion measurement as evaluated using the KT-1000 arthrometer. \nConventional MRI cannot evaluate knee stability. The aim of the study was to as-\nsess the use of MR-Diffusion Tensor Imaging (DTI) as a tool for a microstructural \nexamination of the anterior and posterior cruciate ligaments and to correlate DTI \nfinding with clinically evaluated stability.\nMethods and Materials: 11 subjects (6 females) without previous history of knee \ninjuries underwent MRI using conventional and DTI sequences. Fractional anisot-\nropy (FA) values were calculated in each anterior and posterior cruciate ligament \nwithin 3 different ROIs placed in the lower, middle and upper portion of the liga-\nments. Knee stability was assessed using KT-1000 arthrometer in 4 progressive \nactive displacements: 15 lbs, 20 lbs, manual maximum displacement and under \nquadricipital muscle contraction. Statistical analysis was performed using Inde-\npendent t-Test and Kendall tau rank correlation test, where appropriate (p < 0.05).\nResults: FAs of the ACL (mean: 0.573±0.047) were significantly lower compared \nwith the PCL (mean: 0.676±0.046) (p < 0.001), whereas no side differences were \nnoted. A significant negative correlation between FA and KT-1000 arthrometer \nvalues at 15 lbs was present in the PCL (r=-0.341; p=0.029). No correlations were \nobserved between the FA and KT-1000 values in the ACL.\nConclusion: Functional assessment of the microstructural organisation of the \ncruciate ligaments with DTI expands MRI applications beyond simple morphologi-\ncal studies and could help bridge the gap between imaging and clinical evaluation \nof knee stability. \n0\n\nScientific Sessions\nS36\nA\n C D E F G\nB\nMonday\nThe Schatzker classification for tibial plateau fractures and the amount of articular \ndepression were assessed using MDCT. Magnetic resonance images were evalu-\nated for crucial and collateral ligament injury, meniscal tears and patellar retinaculum \nlesions. Statistics included logistic regression and analysis of covariance.\nResults: Associated soft-tissue injuries were identified in 82% of the patients. \nLogistic regressions revealed a significant impact of increasing amounts of tibial \nplateau fracture depression on the incidence of meniscus lateralis tears (P = 0.025) \nand lesions of the anterior cruciate ligament (P = 0.018). Analysis of covariance \ndemonstrated a significant correlation between the amount of articular depression \nand the absolute number of soft-tissue injuries (P = 0.001).\nConclusion: Articular depression is a potential predictor of specific meniscal and \nligamentous injuries in acute tibial plateau fracture. Due to the high incidence of \nassociated soft-tissue lesions, magnetic resonance imaging is generally recom-\nmended, especially in cases with distinct tibial plateau fracture depression at \nMDCT imaging. \nB‑0936 15:03\nAnatomical risk factors in patients after patellar dislocation: a case-\ncontrol study using MRI \nT. Köhlitz, S. Scheffler, T. Jung, E. Wiener, B. Vollnberg, G. Diederichs; \nBerlin/DE (bernd.vollnberg@charite.de) \nPurpose: To assess anatomical risk factors in patients after lateral patellar disloca-\ntion (LPD) and controls using MRI. \nMethods and Materials: MR images of 186 knees after LPD and of 186 age- and \ngender-matched controls were analysed. The presence of trochlear dysplasia was \nassessed by evaluation of trochlear inclination, facet asymmetry, and trochlear \ndepth; patella alta was evaluated by Insall-Salvati-index and Caton-Deschamps-\nindex; and lateralized force vector was measured by the tibial tuberosity-trochlear \ngroove (TT-TG) distance.\nResults: Compared with controls, dislocators had significantly lower values for all \nthree parameters of trochlear dysplasia (-32%, -32%, -44%) and significantly higher \nvalues for patella alta (+14%, +13%) and TT-TG (+49%) (all P < 0.001). Trochlear \ndysplasia was observed in 112 dislocators (66%), of whom 61 (36%) additionally \nhad patella alta and 15 (9%) an abnormal TT-TG. As isolated risk factors, patella \nalta (15%) and abnormal TT-TG (1%) were rare. Only 25 dislocators (15%) had \nno anatomical risk factor. Trochlear dysplasia in conjunction with abnormal TT-TG \nor patella alta is associated with a 37-fold and 41-fold higher risk.\nConclusion: Most dislocators have anatomical risk factors, varying in severity and \nconstellation. Trochlear dysplasia is the main risk factor for LPD, while patellar \nalta and abnormal tibial tuberosity-trochlear groove distance may be additional \nfactors. Patient-specific evaluation of risk factors following LPD may help future \nmanagement.\nB‑0937 15:12\nEarly changes of trabecular bone structure in asymptomatic \nsubjects with knee malalignment \nT. Baum, J. Penzel, M. Sauerschnig, E.J. Rummeny, K. Wörtler, J.S. Bauer; \nMunich/DE (thbaum@gmx.de) \nPurpose: Knee malalignment is a risk factor for knee osteoarthritis (OA). The pur-\npose of this study was to investigate whether alterations of trabecular bone structure \ncan already be found in young, asymptomatic subjects with knee malalignment.\nMethods and Materials: Forty-eight asymptomatic subjects (25 females, 23 males; \nage: 26±2years) without history of knee injury or surgery were included in this \nstudy. Based on MR measurements, knee joint alignment of both lower extremi-\nties was assessed and subjects were divided into four groups (each including 12 \nsubjects, i.e. 24 knees): neutral (up to 1° varus/valgus), mild varus (2°-4°), severe \nvarus (greater 4°), and valgus (2°-4°). A T1-weighted 3D-FLASH sequence (spatial \nresolution: 0.25x0.25x1.2 mm³) was obtained of each knee at 1.5 T to determine \nhistomorphometric and texture parameters of the trabecular bone in the medial/\nlateral femur/tibia (MF,LF,MT,LT). The calculated parameters were compared be-\ntween the four groups in each compartment using ANOVA including Bonferroni \ncorrection for multiple comparisons.\nResults: Apparent bone volume fraction was significantly different between the \nsevere varus and valgus group in the MT compartment (0.35±0.02 vs. 0.32±0.02; \np=0.022). Furthermore, apparent trabecular thickness in the MT compartment was \nlower in the valgus group (0.36±0.03 mm) compared to the mild varus (0.40±0.08 \nmm; p=0.025) and severe varus group (0.40±0.04; p=0.020). In the MF compart-\nment, fractal dimension was significantly greater in the severe varus than in the \nvalgus group (1.68±0.01 vs. 1.66±0.02; p=0.022).\nConclusion: Early trabecular bone changes can be found in asymptomatic sub-\njects with knee malalignment. This finding may have important implications for the \nprevention of knee OA.\nB‑0933 14:36\nMeniscal pathology demonstraded by MRI and low level laser \ntherapy: a double-blinded placebo controlled trial \nO. Kiritsi1, N. Malliaropoulos2, K. Tsitas2, K. Omar1; \n1Gorleston on sea, Great Yarmouth/UK, 2Thessaloniki/GR (kirolga@hotmail.com) \nPurpose: We performed a randomised, double blinded, placebo controlled study \nto assess the effectiveness of LLLT in patients with knee pain related to meniscal \npathology.\nMethods and Materials: The study trial number is ISRCTN24203769. We only \nincluded symptomatic patients with tiny focus of Grade 3 attenuation (seen only \non 0.7 thickness sequences) or intrasubstance tears with spot of Grade 3 signal \nintensity approaching the articular surface. None of the patients in the study group \nunderwent arthroscopy or new MRI investigation. A paired samples t-test was \nused to detect significant changes in subjective knee pain over the experimental \nperiod within groups, and ANOVA was used to detect any significant differences \nbetween the two groups.\nResults: Pain was significantly improved for the LLLT group than for the placebo \ngroup (F=154, p < 0.0001). Pain scores were significantly better after LLLT. Four \n(12.5%) patients did not respond to LLLT. At baseline, the average Lysholm score \nwas 77 ± 4.6 for the LLLT group, and 77.2 ± 2.6 for the placebo group [p> 0.05]. \nFour weeks after LLLT or placebo therapy, the laser group reported an average \nLysholm score of 82.5 ± 4.6, the placebo group scored 79.0 ± 1.9. At 6 months, the \nlaser group had an average Lysholm score of 82.2 ± 5.7, an after one year they \nscored 81.6 ± 6.6 (F=14.82923, p=0.002). Treatment with LLLT was associated \nwith a significant decrease of symptoms compared to placebo.\nConclusion: In patients with small meniscal tears who do not wish to undergo \nsurgery, LLLT should be considered as a non-invasive alternative. \nB‑0934 14:45\nMeniscal tears are associated with adjacent tibiofemoral cartilage \ndegeneration assessed using 3 T MRI T2 relaxation time \nH. Alizai, W. Lin, H. Liebl, L. Nardo, C. McCulloch, J. Lynch, M. Nevitt; \nSan Francisco, CA/US \nPurpose: The causal relationship between meniscal tears and Osteoarthritis (OA) \nis not clear, i.e. whether meniscal injury leads to cartilage degeneration or vice \nversa. Therefore, we aimed to evaluate the impact of meniscal tears on adjacent, \nmorphologically intact knee cartilage using T2 relaxation time, a sensitive biomarker \nfor early cartilage degeneration, and compare with healthy controls.\nMethods and Materials: Sixty-nine subjects without evidence of OA were recruited \nfrom the Osteoarthritis Initiative. Thirty-five Subjects (26-women) with a normal \nmedial meniscus were used as controls (age 61±8, BMI 27±5). Thirty-four subjects \n(20-women) had either a simple (non-displaced tear; n=19, age 61±9, BMI 28±5) \nor complex tear (displaced tear; n=15, age 60±9, BMI 29±5) of the posterior horn \nof the medial meniscus. None of the tear-subjects had morphological lesions of \nthe medial tibio-femoral cartilage. T2-measurements were performed in the whole \nmedial tibia (MT) and the medial femur compartments (MF), and in tibio-femoral \nsubregions adjacent to the torn meniscus (sMT & sMF). Multiple linear-regression \nmodels were used to compare mean T2-values of individuals with meniscal tears \nwith normal controls.\nResults: The sMT had significantly higher T2-values in the tear group (35 ms) \ncompared with controls (32 ms, p=0.01). When comparing individuals with simple \nversus complex tears, the complex tear group had significantly higher T2-values \nin the MT (p=0.04), MF (p=0.02), sMT (p=0.03) and sMF (p=0.002). T2-values in \nthe cartilage sMT in the tear group were significantly higher than MT T2-values \n(p < 0.0001).\nConclusion: Presence and severity of meniscal injuries are associated with \nincreased cartilage degeneration as measured with T2 relaxation time, most \npronounced in cartilage adjacent to the tears. \nB‑0935 14:54\nArticular depression assessed by MDCT as a predictor of soft-tissue \ninjuries in tibial plateau fractures: intraindividual correlation to \nfindings at magnetic resonance imaging \nM. Regier, A. Spiro, F.O.G. Henes, G. Adam; Hamburg/DE (mregier@uke.de) \nPurpose: The aim of the present study was to determine whether the amount of \narticular depression or fracture type assessed at MDCT may predict the incidence \nand number of associated soft-tissue injuries in tibial plateau fractures compared \nwith Magnetic Resonance Imaging.\nMethods and Materials: The medical reports of 54 patients with acute tibial \nplateau fractures who were admitted to the emergency department of a university \nmedical centre were reviewed. MDCT and MRI were performed in every patient. \n1\n\nScientific Sessions\nS36\n C A D E F\n G\nB\nB‑0940 14:09\nMRI-based selection of clinical complete and good responders after \nchemoradiation for rectal cancer allows for successful minimal \ninvasive treatment \nL. Heijnen1, M. Maas1, M.H. Martens1, D.M.J. Lambregts1, J.W.A. Leijtens2, \nR.G.H. Beets-Tan1, G.L. Beets1; 1Maastricht/NL, 2Roermond/NL \n(luc.heijnen@mumc.nl) \nPurpose: Patients with good or complete response after neoadjuvant chemoradia-\ntion have excellent long-term outcome. Minimal invasive treatment (i.e. transanal \nendoscopic microsurgery (TEM) and wait-and-see policy) are increasingly con-\nsidered as an alternative to major surgery. With this prospective cohort study we \naimed to evaluate long-term outcome of strictly MR-based selected patients who \nhave been treated with minimal invasive treatment.\nMethods and Materials: Eight weeks after chemoradiation, endoscopy and re-\nstaging MRI were performed (including diffusion-weighted MRI for yT-staging and \ngadofosveset-enhanced MRI for yN-staging). Complete responders were selected \nfor wait-and-see policy and good responders with small tumour remnant for TEM. \nBoth treatment groups underwent intensive 3-to-6 monthly follow -up, using MR \nimaging (DWI+gadofosveset), CEA, CT of thorax and abdomen and endoscopy \nwas performed. Long-term outcome was estimated with Kaplan-Meier curves.\nResults: Forty-one patients were included, thirty-three in the wait-and-see group \nand eight in the TEM-group. Mean follow -up was 26 months (range 6-91). For \nthe TEM-group, 4 patients had ypT0 and 4 had ypT2. Two patients, both in the \nwait-and-see group, developed a local recurrence within two years and underwent \nsurgery, leading to a 2-year local recurrence rate of 9%. Both recurrences were \ndetected on (DWI-)MRI in an early stage. The cumulative probabilities of 2-year \ndisease-free survival and overall survival were 93% and 100%, respectively. No \nrecurrences occurred in the TEM-group.\nConclusion: Both selection and follow-up of good and complete responders after \nchemoradiation for rectal cancer with MRI is feasible. Long-term outcome so far \nis excellent. (DWI-)MRI seems to be a reliable tool for early recurrence detection. \nB‑0941 14:18\nDiffusion-weighted-based volumetry in the assessment of response \nin patients with rectal cancer treated with neo-adjuvant therapy: \nfeasibility study \nS.F. Carbone, M. Palumbo, V. Ricci, L. Pelliccia, E. Cacchiarelli, L. Volterrani; \nSiena/IT (fracarb@gmail.com) \nPurpose: To establish the reproducibility of volumetric magnetic resonance diffu-\nsion (VDWI) and compare it with the conventional volume (VC) in the assessment \nof response in patients with rectal cancer treated with chemoradiotherapy (CRT).\nMethods and Materials: We retrospectively examined 21 patients (mean age 68.9 \nyears) with rectal cancer who have performed MRI before and after 45 ± 15 days \nof the CRT after undergoing anterior resection of the rectum. After surgery, ypTN \nand TRG (tumour regression grading) according to Mandard classification were \nobtained. We considered patients with TRG 1-2 responder and non-responder \npatients with TRG 3-5. Two radiologists, blinded, have extrapolated the volume \nVC and VDWI lesions pre-and post-CRT. The inter-observer agreement and the \nagreement between Vc and VDWI pre- and post-CRT were calculated by intraclass-\ncorrelation coefficient (ICC).\nResults: The inter-observer agreement for VC and VDWI was 0.948 and 0.916 \nrespectively, while the correlation between VC and VDWI investigating pre-CRT \nwas 0.828 and in the post-CRT in 0.151. After CRT, VC shows a correlation with the \nTRG of rho = 0.154 (p < 0542), while a significant linear relationship was evident \nbetween VDWI and TRG with rho = 0556 (p < 0.05). Post-CRT the VDWI shows a \nsignificant difference between responders and nonresponders (p = 0.018).\nConclusion: The VDWI is a reproducible quantitative technique in assessing the \nresponse to CRT in patients with rectal cancer and shows a better correlation with \nthe residue of the disease compared with the VC. \nB‑0942 14:27\nTherapy response assessment in locally advanced rectal cancer: \ncomparison between functional dynamic and diffusion parameters in MRI \nR. Fusco, V. Granata, M. Petrillo, M. Sansone, A. Petrillo; Naples/IT \n(roberta.fusco@unina.it) \nPurpose: We investigated the diagnostic performance of DCE-MRI and DW-MRI \nin evaluating neoadjuvant chemo-radiotherapy (CRT) response in LARC. We \ncompared a semiquantitative dynamic feature, the standardised index of shape \n(SIS) and the diffusion parameters obtained using intravoxel incoherent method.\nB‑0938 15:21\nTotal knee arthroplasty MR imaging with the WARP-technique, \nfeaturing slice-encoding metal artefact correction (SEMAC) and \nview-angle tilting (VAT): reduction of metal artefacts for STIR and \nintermediate-weighted sequences \nR. Sutter, R. Hodek, S.F. Fucentese, C.W.A. Pfirrmann; Zurich/CH \n(reto.sutter@balgrist.ch) \nPurpose: To compare image quality and detection of clinical findings of the new \nWARP sequence versus conventional optimised MR sequences in patients with \ntotal knee arthroplasty (TKA).\nMethods and Materials: Forty-two patients with TKA underwent 1.5 T MRI in this \nprospective study. Slice-encoding metal artefact correction (SEMAC), view-angle \ntilting (VAT), and increased bandwidth were combined by the “WARP”-turbo spin \necho sequence. Twenty-four patients underwent CT as a reference standard. \nCoronal STIR-WARP and sagittal intermediate-weighted (PD) WARP-sequences \nwere compared to standard sequences optimised with high readout bandwidth \n(STIR-hiBW/PD-hiBW). Signal void was quantified. Qualitative criteria (depiction \nof anatomy, distortion, blurring, noise) were assessed on a five-point scale (1, no \nartefacts; 5, severe artefacts) by two readers. Clinical findings (e.g. periprosthetic \nosteolysis) were noted. A t-test (quantitative data) and a Wilcoxon signed rank test \n(qualitative data) served for statistics.\nResults: Signal void areas were smaller for STIR-WARP than STIR-hiBW (mean; \n20.1 cm2/27.0 cm2), and for PD-WARP than PD-hiBW (14.2 cm2/16.5 cm2; p <.001 \nfor all comparisons). Depiction of anatomic structures was better on STIR-WARP \nversus STIR-hiBW (2.9-3.7 vs. 4.2-4.9; p <.001), and on PD-WARP versus PD-\nhiBW (2.5-3.5 vs. 3.1-3.8; p <.007). Distortion and image noise were lower for \nWARP than for the standard sequences (p <.002), while blurring was similar for \nboth techniques. There was a statistically significant advantage for detection of \nclinical findings for STIR-WARP versus STIR-hiBW (74 and 37 findings; p <.001) \nand for PD-WARP versus PD-hiBW (63 and 34 findings; p <.001).\nConclusion: The WARP sequences showed a statistically significant improve-\nment for most image criteria. Detection of clinically relevant findings was markedly \nincreased. \n14:00 - 15:30 Room E2 \nGI Tract \nSS 1801a \nColorectal cancer: diagnostic biomarkers and \nresponse assessment \nModerators: \nA. Filippone; Chieti/IT \nJ. Husty; Brno/CZ\nB‑0939 14:00\nMR imaging evaluation of rectal cancer before and after \nchemoradiation therapy \nR. Cazzato, C.L. Piccolo, R. Del Vescovo, F. Giurazza, R.F. Grasso, \nB. Beomonte Zobel; Rome/IT (C.Piccolo@unicampus.it) \nPurpose: To determine the diagnostic accuracy of MR in patients with rectal carci-\nnoma by comparing post-chemoradiation MR imaging with pathological specimens.\nMethods and Materials: We enrolled 39 patients with a locally advanced rectal \ncancer. All patients received chemoradiation therapy before surgery. Those patients \nunderwent a neoadjuvant chemoradiation therapy followed by MR scans. The MR \nimages were analysed by a team of two expert radiologists to whom clinical and \nhisto-pathological findings were unknown.\nResults: Following neoadjuvant chemoradiation therapy, we observed 23 (59%) \npatients with a rectum disease staged ² T2 and 16 (41%) patients with a disease \nstaged > T2, after MR images analysis. Post-treatment histological staging (TNM) \nanalysis revealed 13 patients with a disease > T2 and 26 patients with a disease \n² T2. By arranging the Kappa Cohen test to find the agreement value between \npost-chemoradiation MR staging and histological response, we found that with a \ndisease confined to the sierosa (² T3) the agreement was 83.6%. We found an \nagreement of 97.22% between MR and histology for a disease ² N1 and an accord \nof 33.33% for a disease more advanced than N1 (> N1).\nConclusion: MR is critical in discovering a T3 disease; moreover, with morphologic \nMR Imaging we do not have always the opportunity to discern a few residual cancer \ncells hidden in the fibrotic tissue that could cause a CRM involvement on histology. \n2\n\nScientific Sessions\nS36\nA\n C D E F G\nB\nMonday\nfascia infiltration was present on the surgical specimen. In 33 patients reticular \n(n=18) or linear-shaped (n=15) mesorectal enhancing strands were observed. \nReticular-shaped mesorectal enhancing strands were predictors of mesorectal \nfat infiltration (odds ratio, 7.36; 95% confidence intervals, 1.87-28.98; P < 0.05) \nbut not of mesorectal fascia infiltration (0.86; 0.08-8.87; P=0.9). The enhancing \nstrands reaching the mesorectal fascia represent a predictors of mesorectal fascia \ninfiltration (3.61, 0.99-13.15; P < 0.05).\nConclusion: The evidence of enhancing strands reaching the mesorectal fascia \nrepresents a predictor of mesorectal fascia infiltration and should suggest to \nintensify the CRT.\nAuthor Disclosures:\nE. Quaia: Consultant; Bracco.\nB‑0945 14:54\nNeoadjuvant therapy in locally advanced colon cancer: the role of MDCT \nI. Gonzalez Crespo, D. Cano, J. Etxano, P. Slon, J. Arredondo; Pamplona/ES \n(dcanor@unav.es) \nPurpose: To show the utility of MDCT assessing the tumour response in locally \nadvanced colon cancer treated with neoadjuvant chemotherapy.\nMethods and Materials: 22 consecutive patients who underwent this therapy \nduring a 15-month period were included. All tumours were staged before treat-\nment using MDCT 64 or PET-CT scan, and after neoadjuvant treatment other scan \nwas performed by calculating the differences in tumour volumes making use of \na dedicated software for semiautomatic volume segmentation, to assess tumour \nresponse before surgery. Maximum standard uptake value (SUV max) by PET-CT \nbetween the time of initial diagnosis and after neoadjuvant chemotherapy was also \nmeasured. Surgical-related complications and oncological outcomes were obtained.\nResults: Tolerance to chemotherapy was excellent in 86.4% of patients and \n95.5% completed the entire chemotherapy initially planned. After neoadjuvant \ntreatment, 69.5% reduction of tumour volume was observed by CT-scan and up \nto 59.9% decrease of SUVmax (Standard Uptake Value) was achieved by PET/\nMDCT. None of the patients showed tumour progression during the preoperative \ntreatment, and all of them underwent the previously planned surgical procedure. \nFour patients developed postoperative complications. Median time between the \nend of chemotherapy and surgery was 22 days.\nConclusion: Preoperative chemotherapy induces a tumour response that can be \nmeasured by imaging methods (MDCT). \nB‑0946 15:03\nAssessment of the variation in the contrast-to-noise ratio across \na range of CT scanners in a multicentre perfusion CT study of \ncolorectal cancer (PROSpeCT): a phantom study \nM. Lewis, V.J. Goh; London/UK \nPurpose: To determine the effect of CT scanner models, iterative reconstruction \n(IR) and phantom size on CNR of perfusion CT scans.\nMethods and Materials: A 22-cm diameter water phantom containing different \niodine contrast inserts from 2.5 mg/ml to 25 mg/ml was scanned on seven CT \nscanners from four manufacturers using the Perfusion CT acquisition protocols of a \nmulti-centre clinical trial in colorectal cancer (PROSPeCT). All acquisition protocols \nemployed 100 kV and ~5 mm reconstructed slice. Images were reconstructed with \nfiltered back projection and iterative reconstruction, where available. CT numbers \nand background noise levels were measured and displayed CTDIvol values noted. \nA sub-set of measurements was obtained on a 30-cm diameter phantom. The re-\nlationship between CT number and iodine density was determined for all datasets \nand CNR values calculated.\nResults: A linear relationship between CT number and iodine density was observed, \nwith small variations between CT scanners. No change in linearity was observed \nwith IR of different ‘strengths’. CTDIvolvalues varied by a factor > 2. For the lowest \ndensity insert, CNR varied from 2.9 to 4.4. With IR, CNR increased by a factor of 1.15 \nto 2.3 depending on IR'strength'. CNR decreased by ~50% in the 30 cm phantom.\nConclusion: The CNR varied by a factor of 1.5 across the range of scanners \nutilised in this mutlicentre study. The variation was largely due to image noise dif-\nferences. IR does not affect contrast enhancement and can be used to achieve a \ngiven CNR at a reduced dose. \nAuthor Disclosures:\n V.J. Goh: Equipment Support Recipient; Siemens Healthcare, GE Healthcare, \nTexRAD. Research/Grant Support; NIHR HTA grant.\nMethods and Materials: 14 consecutive patients with LARC were enrolled. \nPatients underwent DCE-MRI and DW-MRI (1.5 T, Magnetom Simphony TIM, \nSiemens, Erlangen). An expert radiologist performed a manual segmentation of \nthe whole lesion on a derived series obtained subtracting the basal and the 5 th \npost-contrastographic series and on DWI with b value=800. SIS and pure diffusion \ncoefficient, pseudo-diffusion coefficient and perfusion fraction were calculated pixel \nby pixel. After surgery, tumour regression grade (TRG) was obtained. Patients with \nTRG 1-2 were considered responders and patients with TRG 3-4-5 were considered \nnon-responders. The value changes of each parameters from baseline to presurgi-\ncal scan were assessed and correlated with the TRG. Sensitivity, specificity, ROC \nanalysis were applied. Youden Index was used to obtain the optimal cut-off value. \nMc-Nemar test was performed to underline statistical difference.\nResults: Seven patients were classified as responders and 7 as non-responders \nat histology. The diffusion parameter (fraction perfusion) showed a sensitivity of \n100%, specificity of 25% and area under ROC 0.4750 (optimal cut-off value 86.3%); \nSIS showed a sensitivity of 90%, a specificity of 100% and area under ROC 0.7265 \n(optimal cut-off value 36.0%). A p value of < 0.05 was obtained comparing SIS vs \ndiffusion parameter.\nConclusion: SIS can achieve the best results in discriminating patients respond-\ners from non-responders.\nB‑0943 14:36\nReproducibility of MRI texture analysis in primary rectal cancer \nS. Gourtsoyianni1, G. Ljungqvist1, A. Khan2, R. Glynne- Jones2, \nB. Ganeshan3, K. Miles3, V. Goh1; 1London/UK, 2Northwood/UK, 3Falmer/UK \n(sgty76@gmail.com) \nPurpose: This study aimed at assessing the feasibility and reproducibility of MRI \ntexture analysis in rectal cancer.\nMethods and Materials: Following IRB approval, 14 patients (11 male, mean \n68.3years) with primary rectal cancer underwent two baseline MRIs. T2-W axial \nsequences were exported for texture analysis (TexRAD, University of Sussex). A \nLaplacian of Gaussian band-pass filter was applied to highlight different spatial \nscales (fine (1.0), medium (1.5-2.0) and coarse (2.5) texture). Texture was quantified \nas entropy (E), uniformity (U), kurtosis (K), skewness (S) and standard deviation of \nthe histogram (SDH) and recorded as for absolute scale values for each tumour. \nGreater heterogeneity is represented by higher E, greater K, S and SDH and lower \nuniformity. Overall group median values were recorded and reproducibility (test-\nretest agreement) was assessed using Bland-Altman statistics.\nResults: All tumours were greater than Stage II; mean length 5.5 cm. Good re-\nproducibility was achieved across all filters (1.0-2.5) for E, U and SDH with mean \ndifferences ranging from -0.007 to +0.002 for E; -0.11X10 -3 to + 0.001 X10 -3for \nU; and +1.60 to +4.97 for SDH; and within subject coefficients of variation from \n2.09-2.55% for E, 10.3-12.7% for U, and 14.3-16.1% for SDH. There was greater \nvariability for K and S: mean differences ranged from +0.168 to + 0.334 for K; and \n+0.089 to +0.272 for S; within subject coefficients of variation from 31.3-93.7% for \nK, and 21.5-49.6% for S.\nConclusion: MRI texture analysis is feasible in rectal cancer and a reproducible \ntechnique in the trial setting. \nB‑0944 14:45\nPredictors of mesorectal fascia infiltration on spectral pre-saturation \ninversion-recovery (SPIR) MR imaging sequence after gadolinium \ninjection in patients with rectal carcinoma after neoadjuvant chemo- \nand radiation therapy \nE. Quaia, L. De Paoli, A. Gennari, B. Cabibbo, M. Cova; Trieste/IT \n(quaia@units.it) \nPurpose: To retrospectively assess the value of spectral pre-saturation inversion-\nrecovery (SPIR) MR imaging sequence after gadolinium injection to identify pre-\ndictors of mesorectal fat and mesorectal fascia infiltration in patients with locally \nadvanced rectal carcinoma after neoadjuvant chemo- and radiation therapy (CRT).\nMethods and Materials: Sixty-five consecutive patients (mean age: 68.93 years, \nrange: 48-83 years, M:F 39:26) with locally advanced rectal carcinoma underwent \nCRT followed by surgery. MR imaging was performed before and after completion \nof CRT using T2-weighted fast spin-echo and T1-weighted SPIR sequences before \nand after gadolinium injection. MR images were assessed by two radiologists in \nconsensus. The evidence of reticular (interwoven strands within the mesorectal \nfat creating a meshwork) or linear-shaped enhancing strands (strands travelling \nseparately through the mesorectal fat) on MR images were retrospectively cor-\nrelated to the histopathological findings.\nResults: After CRT the disease was either limited to the rectal wall (n=31 pa-\ntients) or presented mesorectal fat infiltration (n=34). In 5 patients mesorectal \n3\n\nScientific Sessions\nS36\n C A D E F\n G\nB\n14:00 - 15:30 Room F1 \nBreast \nSS 1802a \nNewer techniques in breast imaging and therapy \nModerators: \nF. Chamming’s; Paris/FR \nM. Sklair-Levy; Tel Aviv/IL \nB‑0949 14:00\nThe impact of contrast-enhanced digital mammography on the \ncharacterisation of breast lesions \nM.H. Helal, R.M.K. Fouad, M.A. Aly, R. Wessam, I. Gouda, N. AbdelShafi, \nO.M. Nada, S. Mansour, M. Elbadawy; Cairo/EG (maha_helal@yahoo.com) \nPurpose: To evaluate the impact of dual-energy contrast-enhanced digital mam-\nmography (CEDM) on the characterisation of breast lesions.\nMethods and Materials: In this prospective study, we performed standard mam-\nmograms and dual-energy CEDM to assess 210 breast lesions using Senobright GE \nDigital System. Selection of cases was based on the identification of indeterminate \nmammography lesions. Two different radiologists analysed the lesions’ morphology \nand pattern of contrast uptake.\nResults: The study included 132 (62.8%) malignant and 78 (37.2%) benign breast \nlesions. The calculated sensitivity, specificity, positive and negative predictive \nvalues of CEDM were 93.9%, 89.6%, 93.9% and 89.6%, respectively, as com-\npared to 85.6%, 55.1%, 76.3%, and 69.3% for FFDM. False negative results were \nencountered in 8 cases (3.8%) which included 3 invasive carcinomas, 2 mucinous \ncarcinomas and 3 duct carcinomas in situ. False positive results were encountered \nin 8 cases (3.8%) including 5 abscess cavities and 1 case of operative bed fat \nnecrosis both showing a ring pattern of contrast uptake and 2 atypical fibroadeno-\nmas. Enhancing malignant lesions included 124 cases showing different patterns \nof contrast uptake. A ring pattern was seen in 20 cases (16.1%), ductal branching \nsegmental pattern in 5 cases (4.1%), intense homogeneous pattern in 20 cases \n(16.1%) and intense heterogeneouspattern in 79 cases (63.7%).\nConclusion: CEDM has a potential impact on the characterisation of breast le-\nsions. Intensely enhancing lesions are strongly indicative of a malignant nature, \nyet, overlap of enhancement patterns still exists and therefore further studies with \na larger number of studied population are recommended.\nB‑0950 14:09\nClinical feasibility of contrast-enhanced dual-energy mammography \n(CEDEM) with a tungsten (W)/titanium (Ti) anode/filter combination: \na prototype report \nT. Knogler1, R. Leithner1, M. Hörnig2, F. Semturs1, M. Waitzbauer1, \nG. Langs1, P. Homolka1, K. Pinker-Domenig1, T.H. Helbich1; 1Vienna/AT, \n2Erlangen/DE (thomas.knogler@meduniwien.ac.at) \nPurpose: To test the feasibility of CEDEM with a W/Ti anode/filter combination for \nhigh energy images in a clinical setting.\nMethods and Materials: Fifteen female patients with 15 breast lesions were \nincluded in this study. CEDEM was performed with a Mammomat Inspiration pro-\ntotype (Siemens, Germany) before and after i.v. administration of 2-ml Iomeron® \n400 (Bracco, Italy) per kg b.w. at a rate of 3.5 ml/sec. Dual-energy images were \nacquired with 28-32 kVp and a W/Rhodium (Rh) anode/filter combination for low-\nenergy and 49 kVp and a W/Ti anode filter combination for high energy. Weighted \nsubtraction images were computed for diagnostic work-up. Images were assessed \nby two readers with respect to lesion-enhancement and image quality. A histological \nwork-up was performed in all lesions.\nResults: Histopathology revealed eight malignant lesions and seven benign lesions \n(size range from 8 to 38 mm). All malignant lesions enhanced and were seen from \nboth readers on weighted subtraction images. Benign lesions did not enhance thus \nthey were not visualised on weighted subtraction images. Image quality was rated \nexcellent from both readers. Based on the visibility of the lesion CEDEM allowed \nan accurate differentiation of benign and malignant breast lesions.\nConclusion: CEDEM with a W/Ti anode/filter combination is suitable and feasible. \nLesion visibility and image quality were excellent. Further research is needed to \ndetermine the value of CEDEM in a clinical setting. \nB‑0947 15:12\nDiffusion-weighted-based MRI: volumetry and apparent diffusion \ncoefficient \nS.F. Carbone, M. Palumbo, T. Carfagno, V. Ricci, L. Pirtoli, L. Volterrani; Siena/IT \n(fracarb@gmail.com) \nPurpose: To assess the diagnostic accuracy of volumetric magnetic resonance \ndiffusion (VDWI) and Apparent Diffusion Coefficient (ADC) in the assessment of \nresponse in patients with rectal cancer treated with chemoradiotherapy (CRT).\nMethods and Materials: We retrospectively examined 30 patients (mean age \n68.1 years) with rectal cancer, who have performed MRI before and after 45 ± 15 \ndays of the CRT after undergoing to anterior resection of the rectum. After surgery, \nypTN and TRG (tumour regression grading) according to Mandard classification \nwere obtained. We considered responders patients with TRG 1-2 or with a negative \nfollow-up recurrence in the next 12 months (only three cases). Two radiologists, in \nconsensus and using commercial software, have extrapolated pre-and post-CRT \nVDWI of the lesions and calculated the ADC.\nResults: The ADC did not show significant differences between responders and \nnot-responders (p = 0.08 pre-CRT, p = 0.1 post-CRT); the VDWI of responders \nwas significantly lower in both pre-CRT (p = 0.0065) and in post-CRT (p = 0.006) \ncompared with not-responders VDWI. The accuracy in the evaluation of response \nwas of 70 and 91%, respectively, for the ADC and VDWI.\nConclusion: The VDWI is more reliable than ADC to assess the response to CRT \nin patients with rectal cancer. \nB‑0948 15:21\nComputed tomography of the bowel: a prospective comparison \nstudy between four techniques \nM. Revelli, F. Paparo, L. Bacigalupo, A. Garlaschi, L. Cevasco, E. Biscaldi, \nG. Rollandi; Genoa/IT \nPurpose: Our purposes were to compare the grade of bowel distension obtained \nwith four different CT techniques dedicated for examination of small intestine \n(CT-enteroclysis and CT-enterography), colon (CT with water enema), or both \n(CT-enterography with water enema) and to assess patient tolerance towards \neach protocol.\nMethods and Materials: We recruited four groups of 30 patients. Each group \ncorresponded to a specific CT technique, for a total of 120 consecutive patients \n(65 male, 55 female; mean age 51.09±13.36 years). CT studies were evaluated in \nconsensus by two gastrointestinal-dedicated radiologists who performed quantita-\ntive and qualitative analysis of bowel distension. Presence and type of adverse \neffects were recorded.\nResults: CT-enteroclysis provided the best distension of jejunal loops (median \ndiameter 27 mm; range 17-32 mm) compared with all other techniques (p < 0.0001). \nFrequency of patients with an adequate distension of the terminal ileum was not \nsignificantly different among the four groups (p=0.0608). At both quantitative and \nqualitative analysis CT with water enema and CT-enterography with water enema \ndetermined a greater and more consistent luminal filling of the large intestine \ncompared with the one provided by both CT-enteroclysis and CT-enterography (p \n< 0.0001 for all colonic segments). Adverse effects were more frequent in patients \nfrom the CT-enteroclysis group (p < 0.0028).\nConclusion: CT-enteroclysis allows an optimal distension of jejunal loops, but it \nis the most uncomfortable CT protocol. When performing CT with water enema, \nan adequate retrograde distension of the terminal ileum was provided in a high \npercentage of patients. CT-enterography with water enema provides a simultane-\nous optimal distension of both small and large bowel. \n4\n\nScientific Sessions\nS36\nA\n C D E F G\nB\nMonday\nMethods and Materials: Twenty-five breast lesions classified suspicious in \nmammography or ultrasound (BIRADS 4/5) were included in this prospective \nIRB-approved study. All patients underwent 7T MRI (Siemens Magnetom, Erlan-\ngen, Germany) using a dedicated 4-channel breast coil and a high temporal and \nspatial resolution 3D T1-weighted sequence (TWIST, fat-sat, 0.7 mm isotropic, \ntemporal resolution 14sec, examination time 9 min) with a single dose of contrast \nagent (Dotarem, Guerbet). One patient had to be excluded due to insufficient \ndata quality. Two readers trained in different institutions independently assessed \nlesion morphology and enhancement kinetics and classified them according to \nBI-RADS. Lesion size, localisation and image quality were assessed. Sensitivity, \nspecificity, diagnostic accuracy and interrater agreement (kappa statistics) were \ncalculated for both observers. The histopathological diagnoses were used as the \nstandard of reference.\nResults: There were three benign and 21 malignant lesions. Mean histopathological \nsize was 25 mm (range 8-51 mm). On the basis of lesion morphology and enhance-\nment patterns, all lesions were correctly classified as benign (n=3) and malignant \n(n=21) by 7T CE-MRI. Sensitivity, specificity and diagnostic accuracy were 100%. \nInterrater agreement for BI-RADS ratings was excellent (0.928). Kappa agreement \nfor single BI-RADS descriptors ranged between 0.709 and 1.\nConclusion: High spatial and temporal resolution imaging in clinical practice \nis feasible using 7T MRI, revealing excellent diagnostic accuracy and interrater \nagreement. \nB‑0954 14:45\nEvaluation of T1/T2 ratios in a pilot study as a potential biomarker of \nbiopsy: proven benign and malignant breast lesions in correlation \nwith histopathological disease stage \nM.A. Malikova, J.N. Tkacz, P.J. Slanetz, A. Aakil, C.-Y. Guo, H. Jara; \nBoston, MA/US (mmalikov@bu.edu) \nPurpose: To study a potential role of quantitative MRI (qMRI) using T1/T2 ratios \nto differentiate benign from malignant breast lesions, assess contralateral breast \ninvolvement and monitor response to treatment.\nMethods and Materials: A cross sectional study of 41 women with 46 breast le-\nsions were scanned with the mixed-TSE pulse sequence, which is multispectral in \nT1 and T2, therefore, affords maps of T1/T2. Patients were grouped according to \nhistopathological stage of disease: untreated malignant tumor, treated malignancy \nand benign disease. qMRI assessment of the same quadrant of contralateral breast \nthat did not have cancerous lesion was performed and compared to the breast \nthat was subjected to chemotherapy and/or radiation therapy in order to monitor \nresponse to treatment.\nResults: Elevated T1/T2 means of 6.44 ± 1.05 (N=7) were observed for biopsy \nproven malignant lesions and 5.98 ± 0.63 (N=21) for malignant lesions that were \ntreated prior to qMRI with chemotherapy and/or radiation as compared to 3.88 ± \n0.43 (N=18) for benign lesions. The higher stage of cancer determined by histopa-\nthology analysis was also strongly associated with higher T1/T2 ratio (p= 0.0093). \nEstrogen and progesterone receptors negative status was strongly correlated with \nhigher T1/T2 ratio p=0.060 and p=0.0427, respectively. Her2/neu receptor status \nshowed no significant correlation with T1/T2 ratio (p=0.1506).\nConclusion: The T1/T2 ratios provide measures that strongly correlate with \nhistopathological findings. This quantitative information of tissue properties can \nprovide basis for improving the specificity of diagnostic breast imaging and serve \nas a tool to assess response to treatment and contralateral breast involvement. \nB‑0955 14:54\nImproved differentiation of breast tumours using novel imaging \nsystem based on co-registered opto-acoustic tomography and ultrasound \nP. Otto1, K. Kist1, N.C. Dornbluth1, T. Stavros1, D. Herzog1, B. Clingman1, \nJ. Zalev1, P. Lavin2, A. Oraevsky3; 1San Antonio, TX/US, 2Southborough, MA/US, \n3Houston, TX/US (ottop@uthscsa.edu) \nPurpose: A novel system called Imagio combines ultrasound and opto-acoustics \n(OA) to more accurately distinguish malignant from benign tumours. We analysed \nreaders’ ability to assess probability of malignancy (POM) using OA versus con-\nventional diagnostic ultrasound (DUS) alone.\nMethods and Materials: 73 patients with breast masses were assessed with \nOA and DUS. All the masses were biopsied. Histology was the gold standard. \nOA employs near-infrared laser pulses at two different wavelengths (to provide \ncontrast between oxygenated haemoglobin in benign lesions and de-oxygenated \nhaemoglobin in malignant lesions) to illuminate tissues through a fibreoptic bundle \nincorporated into a prototype duplex hand-held ultrasound probe. It detects the \nlaser-generated ultrasonic pressure waves that are then used for reconstruction \nof two-dimensional OA images. OA maps of total haemoglobin and blood oxygen \nB‑0951 14:18\nComparison of contrast-enhanced dual-energy mammography \n(CEDEM) with contrast-enhanced magnetic resonance imaging (CE-\nMRI) in breast lesions: a prototype report \nT. Knogler1, R. Leithner1, M. Hörnig2, M. Waitzbauer1, F. Semturs1, \nG. Langs1, P. Homolka1, K. Pinker-Domenig1, T.H. Helbich1; 1Vienna/AT, \n2Erlangen/DE (thomas.knogler@meduniwien.ac.at) \nPurpose: To test the feasibility of CEDEM, by comparing its results with CE-MRI \nin breast lesions.\nMethods and Materials: Fifteen female patients with 15 breast lesions were in-\ncluded in this study. CEDEM was performed with a Mammomat Inspiration prototype \n(Siemens, Germany) before and after i.v. administration of 2 ml Iomeron® 400 \n(Bracco, Italy) per kg b.w. at a rate of 3.5 ml/sec. The same lesions were assessed \nwith CE-MRI (Tim Trio, Siemens, Erlangen, Germany) using a standard protocol \nand the administration of 0.2 mmol Dotarem® (Guerbet, France) per kg b.w. Images \nof both modalities were assessed by two readers with respect to morphology and \nenhancement characteristics. A histological work-up was performed in all lesions.\nResults: Histopathology revealed eight malignant and seven benign lesions (size \nrange from 8 to 38 mm). Morphology and enhancement characteristics were similar \nand comparable with both techniques. All malignant lesions showed strong contrast \nuptake and suspicious morphologic signs, whereas benign lesions tend to enhance \nless strong on both techniques. Based on the morphologic and enhancement \ncharacteristics CEDEM and CE-MRI allowed accurate differentiation of benign \nand malignant breast lesions.\nConclusion: CEDEM allows adequate differentiation of benign and malignant \nbreast lesions using morphologic and enhancement characteristics. CEDEM imag-\ning features are comparable to those of CE-MRI. CEDEM offers a feasible and low \ncost alternative to CE-MRI in breast lesions.\nAuthor Disclosures:\nM. Hörnig: Employee; Siemens AG, Healthcare, Germany.\nB‑0952 14:27\nMetabolic imaging of breast tumours with dedicated breast 18 F-FDG \nPET-CT: comparison with contrast-enhanced MRI at 3 T (3 T CE-MRI) \nH.F. Magometschnigg, T.H. Helbich, H. Bickel, G. Wengert, B. Brück, \nK. Pinker-Domenig; Vienna/AT (h.magometschnigg@gmail.com) \nPurpose: To assess metabolic imaging of breast tumours with breast 18 F-FDG \nPET-CT and compare it with 3 T CE-MRI.\nMethods and Materials: 159 suspicious breast lesions were included in this \nIRB-approved prospective study. All patients were examined with 18 F-FDG \nPET-CT and 3 T CE-MRI of the breast. The MRI protocol consisted of a T2-w \nand a contrast-enhanced high-resolution 3D-T1-w sequence with a single dose \nof contrast agent (Dotarem®, Guerbet). All patients were subjected to prone 18 \nF-FDG PET-CT scanning. CT data were used for attenuation correction. Breast \nPET-CT was assessed for 18 F-FDG-avidity of lesions. Tumours were classified \nas positive when 18 F-FDG-uptake was greater than blood-pool activity. Lesions \nwithin tissues demonstrating moderate/high physiologic background activity were \nconsidered positive if the activity was greater than the adjacent physiologic activity. \n3 T CE-MRI was assessed for lesion morphology and enhancement kinetics and \nclassified according to BI-RADS®. All lesions were histopathologically verified.\nResults: PET-CT had a sensitivity of 96%, a specificity of 76% and diagnostic \naccuracy of 90%. CE-MRI had a sensitivity of 100%, a specificity of 80% and a \ndiagnostic accuracy of 94%. There were 46 benign and 113 malignant lesions \n(mean lesion size 26.03 mm; range 5-90 mm). The 5 false-negative lesions in \nPET-CT were small lesions (mean 11.2 mm), had a very low SUV (mean SUVmax \n1.59) or were adjacent to tissue with high physiologic activity or low grade IDCs.\nConclusion: 3 T CE-MRI is superior to PET-CT for assessment of breast lesions, \nbut dedicated breast PET-CT is a valid alternative in patients, who are unsuitable \nfor MRI.\nB‑0953 14:36\nHigh spatial and temporal resolution breast imaging at 7 Tesla goes \nclinical \nK. Pinker-Domenig, P.A.T. Baltzer, T. Helbich, S. Gruber, W. Bogner, \nO. Zaric, L. Minarikova, H. Moosbauer, S. Trattnig; Vienna/AT \n(katja.pinker@meduniwien.ac.at) \nPurpose: To validate a contrast-enhanced (CE) combined high spatial and tem-\nporal resolution imaging protocol for the assessment of breast tumours at 7 Tesla \nin clinical practice.\n5\n\nScientific Sessions\nS36\n C A D E F\n G\nB\nby sclerosing adenosis in 13.5% (7/52), followed by fibrocystic changes in 11.5% \n(6/52) and ADH in 7.6% (4/52). DCIS was encountered in 5.8% (3/52) and IDC \noccurred in only 3.8% (2/52). Re-surgery for more margin was done in 5 cases in \nspite of 2 mm margin free after BLES.\nConclusion: BLES is not for cancer therapy but it can be an adequate method \nfor diagnosis of problematic cases especially the unclassified microcalcifications. \nBLESS is an available option for the management of small NPM. BLES offers \ncomplete lesion removal thus much indicated in borderline lesions.\nB‑0958 15:21\nCryoablation as local therapy for patients with breast cancer bone \nmetastases (BCBM) \nC. Pusceddu1, S. Pilleri2, G. Amucano1, L. Melis1, G. Meloni2; 1Cagliari/IT, \n2Sassari/IT (clapusceddu@gmail.com) \nPurpose: The aim was to evaluate the safety and efficacy of CRA as local therapy \nfor breast carcinomas with bone metastases.\nMethods and Materials: Sixteen CRA breast lesions, mean size 2.4 (range 0.8-\n6.7 cm) in thirteen consecutive patients, mean age 52 (36-81) with core-needle \nbiopsy-proven breast carcinoma and bone metastases were enrolled in this \nstudy. 10 patients had one lesion and three patients had 2 lesions. Under local \nanaesthesia and mild conscious sedation, the tumour and surrounding breast tis-\nsue were ablated with percutaneous CT-guided CRA. Cryoablation consisted of \n2 cycles each of 10 minutes of freezing followed by a 4-min active thawing phase \nand a 4-min passive thawing phase for each one. Ten patients underwent one \nCRA session and two patients 2 CRA sessions. One patient is treated with two \nsessions for the same lesion.\nResults: All CRA sessions were successfully completed and all breast tumours \nwere ablated. Morbidity consists in transient and mild ecchymotic changes and \npost-procedural oedema seen in two cases and alteration in skin pigmentation \nseen in the point of insertion of the cryoprobes in other two cases. The therapeutic \noutcomes were evaluated by contrast-enhanced TC or MRI at 1-, 3- and 6-month \ninterval. The absence of tumour enhancement TC or MR image was considered \nto indicate complete tumour necrosis.\nConclusion: During the mean follow -up of 11 months (3- 24 months) none of \nthe patients had shown local relapses. A patient died for liver tumour progression \nafter 16 months.\n14:00 - 15:30 Room F2 \nBreast \nSS 1802b \nMaximising cancer detection in breast screening \nModerators: \nM. Álvarez-Benito; Córdoba/ES \nE. Szabó; Szeged/HU \nB‑0959 14:00\nBreast cancer prediction modelling based on common \nmammographic findings in screening \nJ. Timmers1, A.L.M. Verbeek1, R.M. Pijnappel2, J. in ‘t Hout1, M.J.M. Broeders1, \nG.J. den Heeten3; 1Nijmegen/NL, 2Utrecht/NL, 3Amsterdam/NL \n(j.timmers@lrcb.nl) \nPurpose: To develop a prediction model for breast cancer (nomogram) based \non common mammographic findings on screening mammograms. The model is \ndesigned to reduce interobserver variation in assigning BI-RADS in the Dutch \nbreast cancer screening programme.\nMethods and Materials: We retrospectively reviewed 352 positive (digital) screen-\ning mammograms of women participating in the Nijmegen region of the Dutch \nscreening programme (December 2006-November 2008). The following mam-\nmographic findings were assessed by consensus reading of 3 expert radiologists: \nmasses and features of masses, calcifications, parenchymal deformity, asymmetric \ndensity and mammographic density and BI-RADS. Data on age, diagnostic work-\nup, final diagnosis and surgical procedures were collected from patient records. \nMultivariable logistic regression analyses were used to build our breast cancer \nprediction model, presented as a nomogram.\nResults: Breast cancer was diagnosed in 108 cases (31%). The highest positive \npredictive value (PPV) was reported for spiculated masses (96%) and the lowest \nfor well-defined masses (9%). Characteristics included in the nomogram based \nprovide functional information that is co-registered with the morphological informa-\ntion from B-mode grey scale ultrasound images.\nResults: Five blinded readers independently assessed POM for OA and DUS. \nOA provided > 40% higher mean POM for all malignant lesions; a > 30% higher \nmean POM for malignant BIRADS 4B lesions; and > 10% higher mean POM for \nmalignant BIRADS 5 lesions than did DUS. OA also could spare 23.7% more \nnegative biopsies than DUS at the critical 2% POM level.\nConclusion: The fused functional OA and grey scale anatomic information sig-\nnificantly improved distinction of benign from malignant breast masses compared \nwith DUS alone, especially within the BIRADS 4b category, where OA better distin-\nguishes benign from malignant lesions and thereby prevents unnecessary biopsies.\nAuthor Disclosures:\nP. Otto: Consultant; Seno Medical Instruments.T. Stavros: Employee; Seno \nMedical Instruments. D. Herzog: Employee; Seno Medical Instruments. \nB. Clingman: Employee; Seno Medical Instruments. J. Zalev: Employee; \nSeno Medical Instruments. P. Lavin: Consultant; Seno Medical Instruments. \nA. Oraevsky: Board Member; Seno Medical Instruments. Consultant; Seno \nMedical Instruments.\nB‑0956 15:03\nBreast lesion excision system (BLES) - innovative breast biopsy \ntechnology: experience under sterotactic guidance in small \nmicrocalcification clusters \nS. Vigano’, G.P. Scaperrotta, C. Ferranti, L. Suman, M. Marchesini, E. Capalbo, \nP. Panizza; Milan/IT (sar.vigano@gmail.com) \nPurpose: Stereotactic vacuum-assisted biopsy (VABB) is the first choice technique \nto characterise suspicious microcalcification clusters; however, considerable \nproportion of understaged invasive cancer (IDC) at subsequent surgical histology \nhas been reported. BLES, thanks to a radiofrequency excisional system, remove \na larger not fragmented histological sample (25x20 mm, weight 3 g). Our aim was \nto prospectively assess BLES diagnostic and eventually therapeutic efficiency in \na selected cohort of patients with suspicious microcalcification cluster.\nMethods and Materials: From September 2010, patients with small microcalcifica-\ntion cluster, < 1 cm, staged 4a-4b according to BI-RADS classification system, were \nproposed for excisional biopsy with BLES. Written informed consent was obtained.\nResults: Up to now, 80 patients underwent BLES at our centre; 32 of them (40%) \nhad malignant lesion, 7 were IDC and 25 (78%) in-situ (DCIS) carcinoma. Ration-\nale of the study was to completely remove microcalcification clusters, obtaining \nenough surrounding tissue for histological margins’ evaluation. Complete histologi-\ncal concordance was obtained in 100% of atypical hyperplasia. All patients with \nDCIS underwent surgical excision: upgrading to IDC resulted in only 3/25 (12% \nunderestimation proportion); among DCIS cases, surgical excision demonstrated \ncomplete removal of the lesion by BLES in 18/25 patients (72%).\nConclusion: In our experience, BLES is a valid, simple and safe alternative to \nVABB, providing better diagnostic performance evaluated as histologic accuracy \nwith lower underestimation rate compared to previously reported for VABB. In \nselected cases, particularly in small microcalcification clusters, BLES may repre-\nsent an interesting new therapeutic strategy considering the high rate of complete \nlesion removal. \nB‑0957 15:12\nPercutaneous breast lesion excision system (BLES): a new tool for \ncomplete closed excision of high risk lesions \nN.M. Abdel Razek; Cairo/EG (naglaabdelrazek@yahoo.com) \nPurpose: The objective of the study is to assess the use of “Intact” Breast lesion \nexcision system as the primary method for histopathology diagnosis in suspicious \nsmall and borderline lesions as well as the unclassified microcalcifications.\nMethods and Materials: 58 cases were included (Feb-August 2012). Inclusion \ncriteria: small lesion less than 20 mm, unclassified microcalcifications, asymmetric \ndensities, focal distortion.\nResults: 52 cases were successfully done, 88.5% (46 /52) cases were done \nunder ultrasound guidance and 11.5% (6/52) cases were done under stereotactic \nguidance. 38.5% (20/52) lesions were removed using the 15 mm probe and 61.5% \n(32/52) lesions were removed using the 20 mm probe size. The main indication \nwas complete removal of a small mass (20/52) followed by biopsy of unclassified \nmicrocalcifications, either without mass (8/52) or associated with a mass (8/52). \nAsymmetry and distortion were the indications in (6/52) and finally clustered micro \ncysts (8/52). As regards the histopathology after total excision; 90.4% (47/52) of \nlesions were benign and only 9.6% (5/52) of lesions were malignant. Fibroadenoma \nwas the commonly encountered benign lesion in the study group, it was encoun-\ntered in 38.5% (20/52), followed by papilloma found in 19.3% (10/52), followed \n6\n\nScientific Sessions\nS36\nA\n C D E F G\nB\nMonday\nB‑0962 14:27\nFirst experiences with a self-test for Dutch breast screening \nradiologists as a quality assurance tool \nJ. Timmers1, A. Verbeek1, R. Pijnappel2, M. Broeders1, G. den Heeten3; \n1Nijmegen/NL, 2Utrecht/NL, 3Amsterdam/NL (j.timmers@lrcb.nl) \nPurpose: To evaluate the use of a self-test as a quality assurance tool for screening \nradiologists in the Dutch breast cancer screening programme.\nMethods and Materials: 144 screening radiologists were invited to voluntarily \ncomplete a test set of 60 screening mammograms. The following grading criteria \nwere assigned regarding the most suspicious lesion: location, level of suspicion, \nBI-RADS, laterality, type (well defined mass, ill defined mass, spiculated mass, \nmicrocalcification clusters, architectural distortion and asymmetric density) and \nmammographic density are assigned. Also, several reader characteristics, such \nas years of experience and number of cases read per year, were to be completed. \nCase and lesion sensitivity and specificity were determined for all readers. The \nspearman correlation coefficient was used to determine correlation between reader \ncharacteristics and performance measured by the area under the receiver operator \ncharacteristics (ROC) curve (AUC).\nResults: 112 radiologists completed the test set (78%). The mean age was 49 \n(range 33-68) and on radiologists read on average 10,000 (range 700-60,000) \nscreening mammograms per year. The median AUC value was 0.91, case sen-\nsitivity 91%, lesion sensitivity was 91% and specificity 94%. The AUC was not \ncorrelated to reader characteristics. The test-set revealed interobserver variation \nin assigning lesion types.\nConclusion: Overall, a good performance was seen among all screening radiolo-\ngists. Readers are able to determine their educational needs and compare it with \npeers during training or audits. It is therefore a useful quality assurance tool. Medical \neducation should be dedicated to reducing interobserver variation. \nB‑0963 14:36\nTransition from analogue to digital screening mammography \nsignificantly increases the proportion of women referred twice for \nthe same lesion \nL.E.M. Duijm, H. Wiersma; Eindhoven/NL (LEMDuijm@hotmail.com) \nPurpose: To determine the effect of transition from analogue to digital screen-\ning on the proportion of women referred twice for the same lesion and to assess \nscreening outcome.\nMethods and Materials: We included 302,912 consecutive analogue screens \n(obtained between January 2000 and April 2010) and 90,288 consecutive digital \nscreens (obtained between July 2009 and July 2011). Review of the screening \nmammograms of women who had been referred twice was performed to determine \nwhether their initial and second referral comprised the same lesion. During 1-year \nfollow-up, radiology reports, surgical correspondence and pathology reports of \neach referred woman were collected.\nResults: The overall positive predictive value (PPV) of referral was 37.3% at ana-\nlogue screening and 22.0% at digital screening (P < 0.001). Among women who had \nonly been assessed by analogue screens, 37 (0.9% of referrals) had been referred \ntwice for the same lesion. These referrals included 13 malignancies (PPV 32.4%). \nAmong the 90,288 women who received their first digital screen following one or \nseveral previous analogue screens, 52 (1.9% of digital referrals, p < 0.001) were \nreferred again for a lesion for which she had been referred previously at analogue \nscreening. These second referrals included 8 malignancies (PPV 15.4%, p=0.03).\nConclusion: Implementation of digital screening significantly increased the pro-\nportion of women referred twice for the same lesion. Their PPV was significantly \nlower than the one found in women who had been referred repeatedly for the same \nlesion during analogue screening.\nB‑0964 14:45\nAudits as part of quality assurance in the Dutch breast cancer \nscreening programme \nT.D. Geertse, R. Holland, C.G.C.M. van Landsveld-Verhoeven, J.M.H. Timmers, \nK.H. Schuur, R. Pijnappel, F. Jansen, M.J.M. Broeders, G.J. den Heeten; \nNijmegen/NL (t.geertse@lrcb.nl) \nPurpose: To determine the impact of audits as a quality assurance tool to improve \nbreast cancer screening performance.\nMethods and Materials: The Dutch centrally organised breast cancer screening \nprogramme offers biennial mammography to women aged 50-75 years. A team \nof the National Expert and Training Centre for Breast Cancer Screening with peer \nradiologists conducts audits of all 16 reading units every 3 years as part of the \nquality assurance programme. Data on screening outcomes are assessed and a \non statistical significance and clinical relevance are: age, mass, calcifications, \nparenchymal deformity and asymmetric density.\nConclusion: With our nomogram we developed a tool to assist screening radiolo-\ngists in determining the chance of malignancy based on mammographic findings. \nWe propose cut-off values for assigning BI-RADS categories in the Dutch screening \nsetting based on our nomogram which will need to be validated in future research. \nThese values can easily be adapted for use in other screening programmes.\nB‑0960 14:09\nNon-blinded versus blinded double reading of screening \nmammograms in the Netherlands: a population-based study \nL.E.M. Duijm1, G.J. den Heeten2, J. Nederend1, M.J.M. Broeders2; \n1Eindhoven/NL, 2Nijmegen/NL (LEMDuijm@hotmail.com) \nPurpose: To determine screening mammography outcomes at non-blinded versus \nblinded double reading.\nMethods and Materials: We included a consecutive series of 87,487 digital \nscreening mammograms, obtained at 3 screening units in the Netherlands between \nJuly 1, 2009 and July 1, 2011. A total of 12 certified screening radiologists partici-\npated. Every other month, screening mammograms were double read, either in a \nnon-blinded fashion (2nd reader was informed about the 1 st reader’s decision) or \nin a blinded fashion (2nd reader was not informed about the 1st reader’s decision). \nWomen with discrepant readings were always referred for further evaluation. Dur-\ning 1-year follow-up, we collected the radiology reports, surgical correspondence \nand pathology reports of all referred women.\nResults: 42,996 and 44,491 screens had been read either in a non-blinded or \nblinded fashion, respectively. Referral rate was significantly higher at blinded double \nreading (3.3% versus 2.8%, p < 0.001), whereas the cancer detection rate (7.2 \nversus 6.5, p=0.24) and positive predictive value (PPV) of referral (21.5% versus \n23.0%, p=0.36) were comparable. The 2 reading strategies showed no differences \nin the proportion of ductal cancers in situ among screen detected cancers (23.1% \nversus 25.6%, p=0.46), proportion of smaller tumours (T1a-c) among invasive can-\ncers (81.1% versus 80.0%, p=0.76) or axillary lymph node metastasis in invasive \ncancers (17.6% versus 22.0%, p=0.45).\nConclusion: Cancer detection rates were similar for both reading strategies, \nwhereas blinded double reading resulted in a significantly higher referral rate. \nPPV of referral and tumour stage of screen detected cancers were comparable \nfor both reading strategies.\nB‑0961 14:18\nDiscrepant screening mammography assessments at double \nreading: impact of arbitration by a third reader on screening outcome \nL.E.M. Duijm1, G.J. den Heeten2, J. Nederend1, M.J.M. Broeders2; \n1Eindhoven/NL, 2Nijmegen/NL (LEMDuijm@hotmail.com) \nPurpose: To determine the value of adding a third reader for arbitration of discrep-\nant screening mammography assessments at double reading.\nMethods and Materials: We included 84,927 consecutive digital screening mam-\nmograms obtained at a Dutch screening mammography programme. The mam-\nmograms were double read in a non-blinded (41,397 screens) or blinded (43,530 \nscreens) fashion by a group of 12 screening radiologists and discrepant readings \nwere always referred for further evaluation. Each discrepant reading was then \nrandomly assigned to a third screening radiologist, who retrospectively decided \nwhether he would have referred the woman. This third reader was blinded to screen-\ning outcome. During 1 year follow-up, radiology reports, surgical correspondence \nand pathology reports of each referred woman were collected.\nResults: Discrepant readings comprised 28.9% (340/1,175) and 56.9% (834/1,465) \nof referrals at non-blinded and blinded double reading, respectively (p < 0.001). \nAt non-blinded double reading, arbitration would have decreased the referral rate \n(from 2.8% to 2.3%, p < 0.001) and cancer detection rate (CDR, from 6.6 to 6.3 per \n1,000 screens, p=0.9) and increased the positive predictive value (PPV) of referral \n(from 23.1% to 27.5%, p=0.03). At blinded double reading, arbitration would also \nhave resulted in a decreased referral rate (from 3.4% to 2.2%, p < 0.001) and CDR \n(from 7.3 to 6.7, p=0.5), and an increased PPV (from 21.7% to 30.7%, p < 0.001).\nConclusion: Both at non-blinded and blinded double reading, arbitration would \nhave resulted in a significantly lower referral rate and significantly higher positive \npredictive value, at the expense of a non-significantly reduced CDR.\n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\nB‑0967 15:12\nAdding 3D automated breast ultrasound (ABUS) to service screening \nmammography in dense breasts \nB. Wilczek, K. Hågemo, B. Adalsteisson, M. Janicijevic, K. Thorneman, \nC. Hinzer, K. Leifland; Stockholm/SE (brigitte.wilczek@unilabs.com) \nPurpose: Describe the impact on recall rates by adding ABUS service.\nMethods and Materials: From November 2010 to February 2012, 1676 asymp-\ntomatic women with more than 50% density at visual mammographic assessment \nwere enrolled. Bilateral ABUS (somo.vu® U-Systems, Inc. Sunnyvale, CA, USA) \nacquisitions were obtained and reviewed in combination with double-read two-\nview full-field digital mammography (FFDM). The bilateral ABUS examinations \nwere performed by a radiographer. The image assessment was performed by \na radiologist who was the first FFDM screening reader. All ABUS examinations \nwere double read by the second reader if the FFDM findings from either reader, \nor ABUS findings from the first reader, led to discussion among the two readers.\nResults: 10 % led to discussion among the two readers. In 8 cases of discussion \ncaused by FFDM images, ABUS let to avoid recall (0.5 %). 2.3 % who underwent \nFFDM and ABUS, were recalled compared with 3.0 % of women in the year 2010 \nwho had only FFDM in the service screening program. 0.9 % were recalled be-\ncause of FFDM findings, where ABUS was either normal or abnormal. 1.4 % were \nrecalled for ABUS findings with normal FFDM. Breast -cancer detection was 0.7%.\nConclusion: Adding ABUS to service screening mammography with FFDM did not \nnegatively affect the recall rate in asymptomatic women with dense breast tissue \nand even improved the cancer detection. \nAuthor Disclosures:\nB. Wilczek: Equipment Support Recipient; Unrestricted use of the equipment \nfrom U-systems. K. Hågemo: Equipment Support Recipient; Unrestricted \nuse of the equipment from U-systems. B. Adalsteisson: Equipment Support \nRecipient; Unrestricted use of the equipment from U-systems. M. Janicijevic: \nEquipment Support Recipient; Unrestricted use of the equipment from \nU-systems. K. Thorneman: Equipment Support Recipient; Unrestricted use \nof the equipment from U-systems. C. Hinzer: Equipment Support Recipient; \nUnrestricted use of the equipment from U-systems. K. Leifland: Equipment \nSupport Recipient; Unrestricted use of the equipment from U-systems.\nB‑0968 15:21\nFeasibility of automated 3D breast ultrasound scanning in screening \nof women with high risk \nJ.C.M. van Zelst, R.D.M. Mus, T. Tan, N. Karssemeijer, R.M. Mann; Nijmegen/NL \n(janvanzelst@me.com) \nPurpose: Automated 3D-breast ultrasound (ABVS) is investigated as a six-monthly \naddition to annual breast cancer screening with MRI+mammography (MM) in high-\nrisk women (LTR> 50%). ABVS, an inexpensive radiation-free technique, allows \nmore frequent screening and temporal comparison. This study assesses effects \nof additional ABVS examinations at baseline.\nMethods and Materials: The study population consists of 234 women in whom \nABVS and MM were performed on the same day. All ABVS and MM examinations \nwere read by one of 4 breast radiologist. The recall rate (RR), biopsy rate (BR), \ncancer detection rate (CDR), sensitivity and specificity of ABVS and MM screen-\ning were analysed.\nResults: Based upon MM, 28 patients were recalled for further examination \n(RR=12%). With ABVS 12 of these patients were also recalled, as well as 17 \nother women. Consequently, the RR increased to 45/234. Biopsies were deemed \nnecessary in 21 patients after MM and increased to 26 with ABVS added, an \nincrease from 9%-11%. 17 additional ABVS findings were resolved with targeted \nultrasound. In total 4 cancers were found by MM (CDR 1.7%, sensitivity 100%, \nspecificity 89%). Two of these cancers were also detected by ABVS (CDR 0.9%, \nsensitivity 50% specificity 88%). The two missed cancers were retrospectively \nvisible, but misinterpreted due to post-operative scarring.\nConclusion: Adding ABVS to high-risk MM screening increased RR and BR at \nbaseline. Whether these negative effects are reduced when radiologists gain more \nexperience and whether they are balanced by earlier detection of breast cancer \ndue to the six-month interval of ABVS remain to be determined. \nradiological review is performed (40 interval cancers, 40 screen detected stage-II \ncancers and 40 consecutive recalled cases). The audit is completed with a report, \nsummarising the results and giving recommendations. This study compares four \naudit series (1996-2000/2001-2005/2003-2007/2010-2011).\nResults: Recall rates (subsequent screens) increased from 6, 10, 12 to 14 per \n1000, respectively, in the four series. Detection rates also increased from 3.3, 4.3, \n4.7 to 5.7 per 1000. Distribution of tumour size and lymph-node status of invasive \ntumours remained stable (p=0.4). The percentage interval and screen-detected \nstage II cancers classified as “missed” during the review did not change (22% to \n25%, p=0.1). Review of consecutive recalled cases showed an increasing number \nof cases the audit team would not have recalled with a higher recall rate of the \nscreening radiologists.\nConclusion: We found audits are helpful in controlling the balance between (false \npositive) recalls and detected breast cancers. It also serves as a learning and \nfeedback tool as it triggers discussion between screening radiologists. Overall, it \ncan be seen as an important quality assurance tool.\nB‑0965 14:54\nAvoidable surgical consultations in women with a positive screening \nmammogram: experience from a southern region of the Dutch breast \nscreening programme \nI.L. Schreutelkamp, R.M. Kwee, M. de Booij, M.E.A.P. Adriaensen van Roij; \nHeerlen/NL (miraude@gmail.com) \nPurpose: According to current Dutch guidelines, all women following a positive \nscreening mammogram are referred for a full hospital assessment including surgi-\ncal outpatient clinic and radiology department. Till 2007, all women with a positive \nscreening mammogram in our screening region were only referred for further \nassessment to our radiology department. Purpose of this study was to determine \nhow often surgical consultation in women with a positive screening mammogram \ncould be avoided by a radiological pre-assessment.\nMethods and Materials: All women with a positive screening mammogram, \nn=1014, referred to our radiology department from 2002 to 2007 were included. Data \nwere prospectively collected by a senior breast radiologist. In-hospital follow-up data \nwere available till September 2012. Descriptive statistics were used. Percentage of \npatients only assessed by a radiologist was determined. Negative predictive value \nfor malignancy was calculated from the in-hospital follow-up.\nResults: 427 of 1014 women (42%) were only assessed at the radiology department \nwithout further surgical consultation. During follow-up, 8 of these 427 women (2%) \ndeveloped a malignancy in the same breast. At least 6 of these malignancies were \nlocated at a different location than the original screening findings which led to the \ninitial referral. The estimated negative predictive value for malignancy was 99.5%.\nConclusion: By referring women with a positive screening mammogram to the \nradiology department for a pre-assessment, a surgical consultation was avoided \nin 42%, with an estimated negative predictive value for malignancy of 99.5%. \nB‑0966 15:03\nBI-RADS 3 category, a pain in the neck for the radiologist: which \ntechnique detects more cases? \nJ. Etxano, I. Simon-Yarza, G. Viteri, M. Paramo, A. Elizalde, L.J. Pina Insausti; \nPamplona/ES (ljpina@unav.es) \nPurpose: This study aimed at evaluating the rate of BI-RADS 3 lesions detected \nby digital mammography, ultrasonography and tomosynthesis.\nMethods and Materials: From October 2011 to August 2012, 2256 patients un-\nderwent digital mamography, US and tomosynthesis and all of them showing ACR \ndensity patterns 2, 3 & 4. For each imaging modality, all the patients were classified \naccording to the BI-RADS categories 0-6. We compared the rate of BI-RADS 3 \nlesions detected on each technique using a Pearson Chi-square test (SPSS 15.0)\nResults: Mammography detected 227 BI-RADS 3 lesions (10.06 %), US detected \n471 BI-RADS 3 lesions (20.88 %) and tomosynthesis detected 270 BI-RADS lesions \n(11.97 %). There were statistically significant differences between mamography \nand US (p < 0.001), US vs tomosynthesis (p < 0.001) and mammography vs to-\nmosynthesis (p=0.04). Four cancers were diagnosed: one of them was a BI-RADS \n3 lesion in all imaging modalities and the 3 remaining cases were BI-RADS 3 on \nmammography but BI-RADS 4 or 5 on US or tomosynthesis.\nConclusion: Our results indicate that both US and tomosynthesis detect more \nadditional BI-RADS 3 lesions than mammography alone. US detects twice as many \nBI-RADS 3 as mammography. Tomosynthesis detects more BI-RADS 3 lesions \nthan mammography; however, the ratio is smaller (11.97 % vs 10.06 %; p=0.04). \n68\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nB‑0971 14:18\nRenal cell carcinoma subtype differentiation: CT vs MRI \nF. Veloso Gomes1, A. Matos2, J. Palas2, V. Herédia3, V. Mascarenhas4, \nM. Ramalho2; 1Faro/PT, 2Almada/PT, 3Évora/PT, 4Lisbon/PT \n(fvgomes@gmail.com) \nPurpose: To compare the diagnostic accuracy of both multiphasic contrast-\nenhanced computed tomography (CT) and magnetic resonance imaging (MRI) in \ndifferentiating the three most common renal cell cancer (RCC) subtypes.\nMethods and Materials: A multicentric, retrospective study of all surgically removed \nRCCs was performed. 114 renal tumours were identified (53 clear cell, 13 papillary \nand 14 chromophobe at CT and 25 clear cell, 16 papillary and 5 chromophobe \nat MRI). Quantitative image analysis was performed by placing region-of-interest \nover the tumours and uninvolved renal cortex on unenhanced and arterial phases. \nTumour percentage enhancement (TE) and tumour/cortical index (TCI) were \ncalculated. One-way ANOVA for independent samples was used to test for mean \ndifferences between the three RCC subtypes. Receiving operating characteristic \n(ROC) curve analysis was performed and independent ROC curves were compared.\nResults: Papillary tumours showed significantly lower mean TE than clear cell \ntumours (p < 0.01) at both, CT and MRI. Similarly, the TCI was significantly lower \nfor papillary tumours (p < 0.01) whilst no difference was found between cromo-\nphobe and either clear cell or papillary types at multiphase contrast-enhanced-MRI. \nPapillary tumours can be diagnosed with thresholds of TE< 53% and TCI< 0.22 \n(area-under-curve of 0.997 and 0.954) for CT and thresholds of TE< 55.5% and \nTCI< 0.33 (AUC/ROC curves of 0.885 and 0.917).\nROC curves comparison revealed no significant differences.\nConclusion: Similar contrast-enhancing behavior was observed in CT and MRI \nbetween RCC subtypes. CT showed higher sensitivity and specificity to differenti-\nate papillary from clear cell tumours for both indices, but ROC curve comparison \nfailed to demonstrate significant differences. \nB‑0972 14:27\nCharacterisation of complex cystic renal masses according to the \nBosniak criteria: results after a 5-year follow-up with CEUS \nM. Bertolotto, V. Savoca, W. Toscano, S. Kus, C. Cercato, M.A. Cova; Trieste/IT \n(bertolot@units.it) \nPurpose: To investigate the effectiveness of CEUS in the follow-up of complex cystic \nrenal lesions. Category IIF cysts are presumably benign, but require follow-up as \nlong as 5 years to prove benignity. If performed with CT, it requires significant radia-\ntion. Although they are considered surgical lesions, also category III cysts may be \nfollowed-up in poor surgical candidates. CEUS proved effective in characterisation \nof complex renal cysts. No studies, however, reported data after a 5-year follow-up.\nMethods and Materials: Images and clips of complex cystic renal masses inves-\ntigated with CEUS before August 2007 and followed-up with the same technique \nwere retrospectively evaluated. There were 41 patients with category IIF cysts and \n12 patients with category III cysts who were not operated because of patient refusal \n(n=2) or severe comorbidities. Fourteen patients (12 category IIF, 2 category III) \nwere ruled-out because of follow-up < 5 years. Five category III and 2 category IIF \nlesions were operated after 2-3 years of follow -up. Eventually, 32 complex renal \ncysts (27 category IIF, 5 category III) had 5-year follow-up.\nResults: 10/27 category IIF cysts increased in size, but not in complexity during \nthe follow-up. Reduction in size was observed in 3/27 category IIF cysts, while the \nother remained stable. Four/5 category III cysts increased in complexity (category \nIV). One of these patients developed metastases. One category III cyst reduced \nin complexity within 3 months (IIF) and then remained stable.\nConclusion: Complex cystic renal massed can be effectively followed-up with \nCEUS without radiation. \nB‑0973 14:36\nDifferentiation between benign Leydig cell and malignant germ \ncell testicular tumours with qualitative and quantitative contrast-\nenhanced ultrasound assessments \nD.Y. Huang, R.J. Eckersly, M.E. Sellars, P.S. Sidhu; London/UK \n(dean.huang@nhs.net) \nPurpose: To evaluate the feasibility of applying qualitative and quantitative assess-\nments with contrast-enhanced ultrasound (CEUS) in differentiating benign Leydig \ncell and malignant germ cell testicular tumours.\nMethods and Materials: CEUS examination of 22 patients (median age 40 years, \nrange, 21-63 years) with 22 testicular lesions (11 Leydig cell tumours: median size \n5 mm, range 3-16 mm; 11 germ cell tumours: median size 15 mm; range 3-38 mm) \nwas evaluated. Histopathologic confirmation was obtained following orchidectomy \n14:00 - 15:30 Room G/H \nGenitourinary \nSS 1807 \nMixed modalities in GU imaging \nModerators: \nA.J. Beer; Munich/DE \nI. Vivas; Pamplona/ES \nB‑0969 14:00\nSimultaneous [18 F] choline PET/MRI of the prostate: initial results \nA. Wetter, C. Lipponer, F. Nensa, T. Olbricht, H. Rübben, A. Bockisch, \nT. Lauenstein; Essen/DE (Christine.Lipponer@uk-essen.de) \nPurpose: To to present first results of simultaneous [18 F] choline PET/ MR imag-\ning of the prostate.\nMethods and Materials: 13 consecutive patients were examined with simultaneous \n[18 F] choline PET/MRI. At the time of analysis, eight patients had histologically \nproven prostate cancer, 3 patients had negative prostate biopsies and two patients \nhad suspected prostate cancer in the presence of an elevated or rising PSA level but \ndid not have a prostate biopsy so far. Sequence protocol consisted of T2-weighted \nhigh-resolution images and diffusion-weighted images of the prostate in addition \nto PET imaging. Image quality was assessed by two radiologists and PET images \nwere evaluated qualitatively and quantitatively.\nResults: Simultaneous [18 F] PET/MRI of the prostate proved to be robust without \ntechnical failure in all patients. Image quality was diagnostic in all examinations. \nHigh-resolution T2-weighted images allowed exact correlation of elevated focal \nor diffuse choline uptake of the prostate. Whereas all prostate carcinomas were \nPET-positive, diffusion-weighted imaging was inconspicuous in three out of eight \nprostate cancers.\nConclusion: Simultaneous [18 F] PET/MRI of the prostate combines high-resolution \nprostate images with metabolic/molecular imaging and is feasible for routine use. \nThe PET component is superior over DWI in identifying and localising tumor in \nthe prostate.\nB‑0970 14:09\nAdvantage of hybrid whole body 3 T PET-MRI scanner for prostate \ncancer imaging \nT. de Perrot, O. Rager, M. Pusztaszeri, L. Koehl, A. Figueiral, M.-F. Pelte, \nC. Iselin, O. Ratib, J.-P. Vallee; Geneva/CH \nPurpose: To define the benefit of 18 F-fluorocholine PET-MRI combined in a single \nsession with pelvic MRI on a 3 Tesla PET-MRI scanner in prostate cancer patients \nbefore radical prostatectomy.\nMethods and Materials: Twenty-six patients scheduled for a prostate PET-MRI \nbefore radical prostatectomy were retrospectively analysed. The examinations \nwere performed on a Philips 3 Tesla PET-MRI with prostate MR protocol included \nT2, diffusion (ADC) and perfusion imaging followed by a PET acquisition. Using \nhistology as reference, logistic regression was performed to compute ROC curves \nwith and without PET.\nResults: A complete protocol was obtained in 23 patients, three exclusions due \nto prosthesis artefacts or no endorectal coil. Prostate cancer was found in 53 sec-\ntors over 184. With only 12 positive sectors in the transitional zone, analysis was \nfocused on the peripheral zone. Following the registration of PET and T2, SUV \nwas increased in the peripheral sectors with prostate cancer by comparison with \nnormal sectors (4.26±2.03 versus 2.15±0.66; p < 0.001). After stepwise parameters \nselection in logistic regression, best MR parameter to combine with the PET was \nADC. An improved area under the curve was observed by the PET adjunction \n(AUCpetmr=0.893 versus AUCmr=0.834; p=0.027). From the ROC analysis, the \nbest cutoff was for the ADC 1.190*10-3 mm2/sec and for the SUVmax 2.882.\nConclusion: 18 F-fluorocholine hybrid PET-MRI of the prostate was feasible in a \nsingle session with state-of-the-art MR and PET examinations. PET registration with \nT2-weighted MRI allowed confident SUVmax measurements. Combined with the \nADC images, the PET acquisition led to a better diagnostic accuracy than MRI alone. \n69\n\nScientific Sessions\nS37\n C A D E F\n G\nB\nexcellent (0.9/0.9), but worse for VEE (0.7/0.6). Correlations of small arbitrary ROIs \nwere lower for all parameters.\nConclusion: Perfusion and permeability parameters of DCE-MRI of RCC are in-\nfluenced by ROI-size and positioning. The best inter- and intraobserver correlation \nshowed definition of whole tumour ROI with morphological sequences or plasma \nflow maps. Evaluating tumours or monitoring antiangiogenic therapy, perfusion \nparameters are more reliable, while permeability parameters are more susceptible \nto interobserver variability.\nB‑0976 15:03\nCan a contrast-enhanced ultrasound nephrostogram be used instead \nof a fluoroscopic nephrostogram: preliminary findings \nM. Daneshi, K. Patel, D. Huang, M. Sellars, P. Sidhu; London/UK \nPurpose: The use of contrast-enhanced ultrasound (CEUS) has extended beyond \ntraditional uses, and the possibility to delineate percutaneous tubes and drains is \nachievable. We have compared the traditional fluoroscopic nephrostogram using \niodinated contrast agents with CEUS nephrostogram to ascertain the accuracy, \nutility and convenience of the CEUS nephrostogram.\nMethods and Materials: The standard conventional nephrostogram was per-\nformed immediately prior to the CEUS nephrostogram. The CEUS nephrostogram \ntechnique involved diluting 0.2 ml of SonoVue with 40 ml of normal saline and \nintroduced into the renal collecting system via the nephrostomy tube. Digital cine-\nclips and still images were recorded to allow accurate retrospective comparison \nby two independent reviewers to the reference standard.\nResults: Twelve nephrostomies in 10 patients (median age 64 yrs, range 29-91 \nyrs, 6 females and 4 males) were performed and reviewed. The renal pelvicalyceal \nsystem was visualised in both CEUS and fluoroscopic nephrostograms in 11/12 \n(92%) with one nephrostomy tube identified as being misplaced. The entire ureter \nwas visualised in 6/12 (50%) with a CEUS nephrostogram compared with 8/12 \n(75%) using traditional nephrostogram. Fluoroscopic nephrostogram showed \ndrainage of contrast into the bladder in 10/12 (83%) cases compared with 9/12 \n(75%) using CEUS.\nConclusion: Preliminary results suggest that CEUS nephrostogram is a feasible \nmethod to confirm the correct positioning of the nephrostomy tube, image the \nureters and determine if there is satisfactory drainage into the bladder. CEUS ne-\nphrostogram is a suitable alternative for the traditional nephrostogram in patients \nwith contraindications to iodinated contrast agents or if the procedure needs to be \nperformed at the bedside. \nB‑0977 15:12\nVena cava anomalies associated with horseshoe kidney on MDCT \nT. Ichikawa, J. Koizumi, S. Kawada, Y. Imai; Isehara/JP \n(tamaki-i@mars.sannet.ne.jp) \nPurpose: The incidence of vena cava (VC) anomalies in horseshoe kidney (HSK) \npatients is relatively high because of embryogenesis. We evaluated prevalence and \nvariation of anomalous inferior vena cava (IVC) and superior vena cava (SVC) in \nHSK patients detected using CT.\nMethods and Materials: Seventy-one patients with HSK and 2292 patients with \nnormal kidney (NK) who underwent chest CT were evaluated of prevalence and \nvariation of anomalous SVC and 205 patients with HSK and 1990 patients with \nNK who underwent abdominal CT were evaluated of prevalence and variation of \nanomalous IVC. We reviewed axial CT images with 5-mm reconstruction interval \nand compared prevalence of anomalous VC between HSK and NK patients using \nChi-square test.\nResults: Anomalous SVC was identified in 3 patients (4.2%) in HSK patients: 2 \ndouble SVCs and 1 persistent left SVC without right SVC and 5 patients (0.22%) in \nNK patients: 3 double SVCs and 2 persistent left SVC without right SVC. Anoma-\nlous IVC was identified in 8 patients (3.9%) in HSK patients: 1 preisthmic IVC with \nretrocaval ureter, 4 double IVCs, 2 left IVC, and 1 IVC with azygos continuation \nand 12 patients (0.6%) in NK patients: 8 double IVCs, 3 left IVC, and one IVC with \nazygos continuation. There was a significantly higher prevalence of anomalous \nVC in patients with HSK than in those NK on MDCT (P < 0.001).\nConclusion: HSK patients were frequently found anomalous VC and detection \nof those anomalies in HSK patients is important during central venous catheter \nprocedures and operation.\nor excision biopsy. Qualitative analysis of cine loops was assessed for each CEUS \nexamination by two observers and consensus reached on the pattern and timing of \ntumour enhancement. Perfusion quantification of the lesions was performed where \npossible, with time-intensity curves were analysed.\nResults: Distinct differentiation on enhancement patterns was observed between \nLeydig cell and germ cell tumours. All 11 Leydig cell tumours displayed intense early \nenhancement which persisted for longer than the normal testicular parenchymal \nenhancement. The germ cell tumours showed loss of the normal linear vascular \npattern, but with a more rapid washout of contrast. Quantitative analysis confirms \nthe observation, with longer full width at maximum (FWHM) and slower contrast \noutflow on the time-intensity curves observed in Leydig cell tumours comparing to \ngerm cell tumours. With improved diagnostic confidence, testicular-sparing exci-\nsions were performed for 5 lesions following pre-operative CEUS analysis and \nunnecessary orchidectomies avoided.\nConclusion: We describe, to date the first, consistent differentiating characteristic \nCEUS enhancement pattern in rare benign Leydig cell tumours. This observation \nincreases diagnostic confidence, thus allows for testicular-preserving options to \nbe considered. \nB‑0974 14:45\nUS and colour-Doppler findings in testicular lymphoma and their mimics \nM. Bertolotto1, L.E. Derchi2, M. Secil3, M. Valentino4, P. Pavlica5, M.A. Cova1; \n1Trieste/IT, 2Genoa/IT, 3Izmir/TR, 4T olmezzo/IT, 5Bologna/IT (bertolot@units.it) \nPurpose: To describe US and colour-Doppler findings in testicular lymphoma \nand their mimics.\nMethods and Materials: We reviewed the US and colour-Doppler findings in 10 \npts with pathology-proven lymphoma of the testis and compared them with those \nin 7 patients in whom lymphoproliferative disease was suspected on clinical and \nUS grounds and pathology showed only inflammatory changes.\nResults: Lymphoma patients’ age range was 34-76 years. Six had testicular \ninvolvement in systemic disease or recurrence; four had primary disease. One \nhad bilateral involvement. Seven testes in 6 patients were diffusely involved (4 \nhomogeneously; 3 heterogeneously); four had nodular hypoechoic lesions which, \nin 1 testis, were multiple. All lesions, either focal or diffuse, were hypervascular, with \nvessels of normal rectilinear shape. In patients with nodular lesions, there was no \ndistorsion of vascular course at the point where vessels entered the mass. Findings \nsuggested an infiltrative process, and were confirmed at pathology. The remaining \nseven patients had history and US features suggesting testicular lymphoproliferative \ndisease. All had hypoechoic focal hypervascular lesions containing vessels with \nrectilinear course that were eventually proved inflammatory changes (2 chronic \nfocal orchitis, 2 idiopathic granulomatous orchitis, 2 brucellosis, 1 tuberculosis).\nConclusion: In patients over 60 and/or with known lymphoproliferative disease, the \npresence of hypoechoic, hypervascular testicular lesion with absence of vascular \ndistorsion must suggest lymphoma. Care must be taken since, albeit rarely, inflam-\nmatory lesions may present the same imaging pattern in the absence of clinical \nsigns and symptoms of inflammation. \nB‑0975 14:54\nPerfusion and permeability DCE-MRI measurements in renal cell \ncarcinoma and metastases: effect of ROI size and positioning on \ninter- and intraobserver variability \nM. Braunagel, E. Radler, M. Ingrisch, M. Staehler, A. Crispin, K. Nikolaou, \nM.F. Reiser, M. Notohamiprodjo; Munich/DE (margarita.braunagel@med.lmu.de) \nPurpose: To assess the influence of region of interest (ROI) size and positioning \non parameters of perfusion and permeability and inter- and intraobserver variability \nof DCE-MRI of renal cell carcinoma (RCC) and metastases.\nMethods and Materials: 33 patients with RCC and 17 patients with metastases \nwere examined with dynamic contrast-enhanced (DCE) MRI at 1.5 T with a half \nbody weight-adapted dose of gadobutrol. Analysis with a two-compartment ex-\nchange model provided four parameters: plasma flow (Fp), plasma volume (Vp), \npermeability-surface-product (Ps) and interstitial volume (VEE). Arterial input \nfunction and retrospective respiratory triggering were applied. ROIs of the whole \ntumour, circular edge and an arbitrary vital region were defined on morphological \nsequences and on parametric plasma flow maps.\nResults: Paired t-tests showed no significant differences between the results of \nboth readers. Intraclass correlation coefficient (ICC) for interobserver correlation \nfor whole tumour ROI were excellent for Fp (morphology: 0.97/parametric maps: \n0.95), Vp (0.95/0.89) but moderate for VEE (0.6/0.6) and PS (0.79/0.5). Correlation \nof circular ROIs was also excellent for Fp (0.92/0.94) and Vp (0.9/0.8), but worse \nfor VEE and PS. Intraobserver correlation for the parameters Fp, Vp and PS were \n0\n\nScientific Sessions\nS37\nA\n C D E F G\nB\nMonday\nB‑0980 14:09\nDiagnostic accuracy of dynamic gadoxetic-acid-enhanced MRI and \nPET-CT in patients with liver metastases from neuroendocrine neoplasms \nW.H. Sommer1, C. Zech1, S. Sourbron2, M. Armbruster1, M.F. Reiser1; \n1Munich/DE, 2Leeds/UK (wieland.sommer@med.uni-muenchen.de) \nPurpose: To evaluate the diagnostic accuracy of dynamic gadoxetic-acid-enhanced \nMRI parameters in comparison to standardised uptake values (SUV) from both \n18F-FDG- and 68Ga-DOTATATE PET-CT in patients with proven liver metastases \nof neuroendocrine neoplasms (NEN).\nMethods and Materials: Data were acquired in 47 patients with hepatic metas-\ntases from NEN. DCE-MRI was performed at 3 T with Gd-EOB-DTPA and a 3D \nsequence acquiring 48 slices of data every 2.2 seconds for 5 minutes. Up to three \nregions of interest (ROIs) were defined in metastases (> 2 cm) and liver tissue in \nmorphological images. Corresponding ROIs were defined in the DCE-MRI dataset \nand in the PET-CT dataset. Diagnostic accuracy for all perfusion parameters were \nevaluated for the differentiation between metastases and liver tissue: arterial and \nvenous plasma flow (APF and VPF), extracellular mean transit time (exMTT), \nextracellular volume (exVol), intracellular uptake rate (UR) of Gd-EOB-DTPA and \narterial flow fraction (AFF) as well as SUVs derived either from 18F-FDG or from \n68Ga-DOTATATE-PET-CT.\nResults: Area under the curve for different DCE-MRI parameters was between \nAUC=0.559 (extracellular mean transit time) and 0.901 (arterial plasma flow - sen-\nsitivity: 91.9%, specificity: 77.3%, cut-off value: 26.0 ml/min/100 ml). Sensitivity and \nspecificity of SUVmean derived from 68Ga-DOTATATE were 92.6% and 93.8%, \nrespectively (AUC = 0.966). SUVmean derived from 18F-FDG-PET-CT showed a \nsensitivity and specificity of 95.0% and 91.3%, respectively (AUC = 0.989).\nConclusion: Both PET-CT parameters and DCE-MRI-perfusion parameters - espe-\ncially flow and uptake-related DCE-MRI parameters show the ability to distinguish \nbetween liver metastases and normal liver tissue and may provide additional \ninformation in unclear cases.\nAuthor Disclosures:\nC. Zech: Consultant; Bayer. Speaker; Bayer. S. Sourbron: Consultant; Bayer.\nB‑0981 14:18\nThe LiMAx test as adjunct to CT for assessing liver function after \nportal vein embolisation \nA.H. Mahnken1, A. Roeth2, P.H. Alizai2, C. Kuhl2, R.M. van Dam3, \nU. Neumann2, M. Schmeding2; 1Marburg/DE, 2Aachen/DE, 3Maastricht/NL \n(mahnken@med.uni-marburg.de) \nPurpose: To compare CT volumetry and the LiMAx-test, a metabolic 13C-Meth-\nacetin respiratory test was performed, for examination of the effects of portal vein \nembolisation (PVE) on liver function over time.\nMethods and Materials: 27 patients (16 males; 11 females 63±9.5 ys) with PVE \nof the right portal vein prior to major liver resection for colorectal metastases \n(n=11), Klatskin tumours (n=8), HCC (n=2), CCC (n=3) and liver metastases of \nother cancers (n=3) were included in this study. Liver function was investigated \nwith the LiMAx test prior to PVE, 24 hours after embolisation and immediately \nprior to resection. CT volumetry of the right and left liver was performed prior to \nPVE and prior to resection.\nResults: The average time between PVE and resection was 32±11 days. The \naverage LiMAx values before and after PVE were 374 µg/h/kg and 312 µg/h/kg, \nrespectively. Preoperatively, the LiMAx value increased to 380 µg/h/kg (p < 0.05). \nIn parallel, the average volume of the future liver remnant significantly increased \nfrom 576 ml to 706 ml (p=0.006), whereas the mean right liver volume decreased \nfrom 1288 ml to 1121 ml (p=0.001).\nConclusion: The postinterventional decrease in LiMAx values corresponds to the \nloss in function with subsequent shrinkage of the embolised right liver over time. The \nnormalisation of the LiMAx value after regeneration proofs the functional relevance \nof the hypertrophy of the remnant left liver. When compared to volumetry alone, the \ncombination of imaging and LiMAx test permits monitoring the functional relevance \nof liver hypertrophy. This may help identify the optimal point for resection after PVE.\nAuthor Disclosures:\nA.H. Mahnken: Research/Grant Support; Siemens. Speaker; Bayer.C. Kuhl: \nSpeaker; Bayer.\nB‑0978 15:21\nComparison of dynamic transperineal ultrasound with evacuation \nproctography for the evaluation of patients with posterior \ncompartment pelvic disorders \nM.J. Webb, Y. Ron, S. Zelber-Sagi, E. Tiomni, Z. Halpern, E. Santo; T el Aviv/IL \n(murielw1999@yahoo.fr) \nPurpose: Evacuation proctography (EP) is still considered the gold standard imag-\ning technique for patients suffering from defecation disorders. Dynamic transperineal \nultrasound (DTPU) is a non-invasive imaging modality to explore such patients. To \nassess the value of DTPU compared with EP in patients with defecation disorders.\nMethods and Materials: Between January 2008 and November 2010, 102 con-\nsecutive patients that underwent both DTPU and EP for obstructed defecation were \nreviewed. The tests were performed by two different operators, each one unaware \nof the results of the other. Comparison was made between the two modalities.\nResults: EP revealed a rectocele in 49%, enterocele in 17%, intussusception in \n28%, and anismus in 20% patients. DTPU revealed a rectocele in 53%, enterocele \nin 15%, intussusception in 37% and anismus in 27% patients. The degree of \nagreement of the two techniques calculated by kappa measure was for rectocele \n0.69, for enterocele 0.7, for intussusception 0.4 and for anismus 0.53. The accu-\nracy of the DTPU as compared with EP was 84% for rectocele (sensitivity 88.0%, \nspecificity 81.0%), 92% for enterocele (sensitivity 70.6%, specificity 96.5%) 74 % \nfor intussusception (sensitivity 69.0%, specificity 75.3%) and 83 % for anismus \n(sensitivity 75%, specificity 85%).\nConclusion: The degree of concordance between the two modalities is good in the \ndiagnosis of rectocele and enterocele, but only fair for intussusception and anismus. \nWith regard to intussusceptions and anismus, correlation with other modalities may \nbe warranted. These preliminary data indicates that DTPU can be an alternative \nto EP in assessing patients with defecation disorders. \n14:00 - 15:30 Room I/K \nAbdominal Viscera \nSS 1801b \nLiver volume, function and focal lesions \nModerators: \nB. Choi; Seoul/KR \nC.M. Nyhsen; Sunderland/UK \nB‑0979 14:00\nROC curve analysis of diagnostic confidence of CT and MR in focal \nliver pathology \nL. Saba1, M. Di Martino2, C. Catalano2, M. Piga1; 1Cagliari/IT, 2Rome/IT \n(lucasaba@tiscali.it) \nPurpose: To evaluate and compare ROC curve of diagnostic confidence of \nmulti-phase CT and MR after administration of Gd-EOB-DTPA in the diagnosis of \nmalignant\\benignant neoplasm of the liver.\nMethods and Materials: Forty patients underwent multi-phase CT and MR after \nadministration of Gd-EOB-DTPA. After CT and MR all patients underwent biopsy. All \nexams were evaluated by 2 experienced examiners independently that expressed \ntheir diagnostic confidence in a five-degree scale: 1 (certainly benign), 2 (probably \nbenign), 3 (uncertain), 4 (probably malignant), 5 (certainly malignant). ROC curve \nanalysis and area under the curve (AUC) were calculated for each observer and \ntheir difference was tested according to the different methodology used.\nResults: In our population there were 15 malignant neoplasms and 25 benignant \nneoplasms. For the CT analysis AUC was 0.792 (SE = 0.088, 95% CI from 0.634 \nto 0.903) and 0.701 (SE = 0.099, 95% CI from 0.535 to 0.835) for observers 1 and \n2, respectively, whereas for the MR analysis AUC was 0.923 (SE = 0.058, 95% CI \nform 0.793 to 0.983) and 0.934 (SE = 0.054, 95% CI from 0.808 to 0.987). For both \nobservers a statistically significant difference in diagnostic confidence between the \nAUC of CT and MR (p value < 0.05) was found.\nConclusion: Our results indicate that for both readers the diagnostic confidence \nusing MR with Gd-EOB-DTPA is statistically significantly superior to CT with multi-\nphase technique.\n1\n\nScientific Sessions\nS37\n C A D E F\n G\nB\n/ SI of liver. ER of HBP and SDP were calculated and compared between each CP \nclass liver damage groups. Chi square test was used for statistics and p < 0.05 \nwas considered statistical significant.\nResults: In poor HBP cases (n=76), ER of HBP and SDP were 0.88±0.16 and \n0.64±0.16. In control cases (n=20), ER of HBP and SDP were 0.54±0.08 and \n0.39±0.06. ER of HBP and SDP in CP-A poor HBP (n=27), CP-B poor HBP (n=47), \nCP-C poor HBP (n=2) were 0.83±0.14 and 0.60±0.13, 0.90±0.16 and 0.65±0.16, \n1.03±0.16 and 0.99±0.19, respectively (all combinations except CP-C showed \nsignificance difference).\nConclusion: In most of the poor HBP image cases, SDP image improve paren-\nchymal and vascular contrast except CP-C liver damage cases.\nB‑0985 14:54\nEstimation of liver function using T1 mapping on Gd-EOB-DTPA-\nenhanced MR imaging \nM. Haimerl, N. Verloh, C. Fellner, C. Nießen, C. Stroszczynski, P. Wiggermann; \nRegensburg/DE (michael.haimerl@ukr.de) \nPurpose: To determine the ability of T1 mapping of liver on Gd-EOB-DTPA-\nenhanced MR imaging (MRI) for estimating liver function and to compare the \nestimated liver function to the model for end-stage liver disease (MELD) score.\nMethods and Materials: 24 patients underwent Gd-EOB-DTPA-enhanced MRI on \na 3 T system. Patients were classified into two groups: MELD score < 9 (n=15) and \nMELD score ³9 (n=9). Two TurboFLASH sequences (TI = 400 ms, 1000 ms) were \nacquired before and 20 minutes after Gd-EOB-DTPA administration to obtain T1 \nmaps. T1 relaxation times were determined indicating Gd-EOB-DTPA liver-uptake \nand correlated to the MELD score.\nResults: Significant changes between T1 relaxation times of non-enhanced MRI \n(794 ms ±136 ms) and Gd-EOB-DTPA-enhanced MRI (351 ms ± 141 ms) were \nobserved (p < 0.001). T1 relaxation time for non-enhanced MRI showed no sig-\nnificant differences (p=0.387) between the group with MELD score < 9 (776 ms ± \n157 ms) and the group with MELD score ³9 (824 ms ± 90 ms). After administration \nof Gd-EOB-DTPA T1 relaxation time of patients with MELD score < 9 (284 ms ± \n104 ms) and patients with MELD score ³9 (465 ms ±123 ms) shows a significant \ndifference (p=0.002). The shortening of T1 relaxation time was significantly lower \nfor patients with a higher MELD score (p=0.002).\nConclusion: Patients with advanced liver disease showed significantly lower \nchanges in T1 mapping. Therefore, evaluation of changes in T1 mapping of the \nliver parenchyma may serve as a useful method to determine whole liver func-\ntion, to improve the estimation of segmental liver function and finally to define the \ngrade of liver disease.\nB‑0986 15:03\nLiver dysfunction induced by amiodarone therapy: evaluation by \nsequential CT studies \nY. Sonoyama, T. Tajima, T. Shiga, N. Hagiwara, S. Sakai; T okyo/JP \n(y-sonoyama@rad.twmu.ac.jp) \nPurpose: To evaluate the relationship between the sequential changes of CT at-\ntenuation of the liver (CTL) and liver damage after administration of amiodarone \n(AMD) for treatment of refractory ventricular arrhythmias.\nMethods and Materials: This was a retrospective study of 45 patients (26 men, \n19 women: age range 19-89, mean 59) with AMD administration. Serum level of \ndrugs (AMD and desethylamiodarone (d-AMD), a metabolic product of AMD), the \npercentage of rises in serum alanine transaminase (ALT) level (ALT%) and total \nadministered dose of AMD at evaluation CT were evaluated and compared with \nthe CTL. As regards to 23 patients who underwent CT before the initiation of AMD \nadministration, the medication periods and total administered doses of AMD were \ncompared with changes in CTL.\nResults: There was a mild correlation between CTL and mean medication period \n(p=0.0238, r=0.337). There was a strong correlation between CTL and serum level \nof AMD (p < 0.0001, r=0.699), whereas there was a moderate correlation between \nCTL and serum level of drugs (AMD) (p < 0.0001, r=0.574). There were significant \ncorrelations between total doses of administered drug and the CTL (p=0.0008, \nr=0.480) and between ALT% and the CTL (p=0.0078, r=0.420).\nConclusion: CTL was demonstrated to correlate with total administered doses of \nAMD, ALT%, medication periods and serum level of drugs, especially of d-AMD. \nSerial changes in CTL can be a sensitive less-invasive biomarker in patients \ntreated with AMD.\nB‑0982 14:27\nFuture remnant liver function after portal vein occlusion measured \nwith 99mTc-mebrofenin SPECT/CT \nI. Dudás, T. Györke, C. Korom, P. Pajor, A. Zsirka-Klein, E. Horvath, A. Bozó, \nP. Kupcsulik, O. Hahn; Budapest/HU (oszkarhahn176@gmail.com) \nPurpose: To compare the results of 99mTc-mebrofenin SPECT/CT volumetry and \nCT volumetry after portal vein occlusion techniques, i.e. portal vein embolisation \n(PVE), portal vein ligation (PVL) prior to extended liver resections.\nMethods and Materials: Between March 2011 and September 2012 forty patients \npresenting with primary or secondary liver tumours were included. The estimated \nfuture liver remnant volume (FLRV) of these patients after the planned extended \nhepatectomy measured with CT-volumetry was less than 30 (normal liver), or \n40% (cirrhosis). To increase the FLRV, portal vein occlusion techniques (32 PVE, \n8 PVL) were performed. Eight weeks after portal occlusion CT-volumetry and to \nmeasure functional future liver remnant volume (FLRVf)-SPECT/CT volumetry \nwith 99mTc-mebrofenin were performed. Postoperative complication rates (using the \nClavien criteria) were also measured. Patients with “borderline” FLRV (25-32%) \nwere evaluated with special interest.\nResults: Eight weeks after portal vein occlusion, FLRVf was significantly higher \nthan FLRV (mean FLRVf: 51.2% vs. mean FLRV: 32.9%; p < 0.05). 32/40 patients \nbecame resectable. Postoperative complication rates were lower if FLRVf was sig-\nnificantly higher than FLRV. In patients with \"borderline\" FLRV (n=17) these results \nwere even more convincing (mean FLRVf: 46.5% vs. mean FLRV: 27.8%; p < 0.05).\nConclusion: 99mTc-Mebrofenin SPECT/CT can be useful in the measurement of \nfuture liver remnant functional volume after portal vein occlusions. This can make \nsurgeons decision easier than CT volumetry in planning extended hepatectomies. \nB‑0983 14:36\nComparison of percutaneous portal vein embolisation, portal vein \nligation and portal vein occlusion combined with ipsilateral hepatic \nartery cannula implantation prior to major liver resection \nP. Pajor, I. Dudás, A. Zsirka Klein, P. Kupcsulik, J. Tamás, O. Hahn; \nBudapest/HU (oszkarhahn176@gmail.com) \nPurpose: To evaluate the results of percutaneous portal vein embolisation (PVE), \nportal vein ligation (PVL) and portal vein ligation combined with hepatic artery can-\nnula implantation (PVL+can) prior to extended hepatectomy.\nMethods and Materials: Between 2004 and 2012 hundred and thirty-eight patients \npresenting with multiple or large liver metastases or large hepatocellular carcinoma \nwere included. The estimated residual liver volume (FLR) of these patients after \nthe planned extended hepatectomy was less than 30% (normal liver), or 40% \n(cirrhotic liver). To increase the FLR portal vein occlusion techniques (50 PVE, \n88 PVL alone, or PVL combined with hepatic artery cannula implantation into the \nipsilateral hepatic artery - PVL+can) were performed. They were evaluated with \nMDCT including volume assessment, before and 8 weeks after these procedures.\nResults: 110/138 patients became resectable (PVE, PVL, PVL+can; 74.3%, 80%, \n88.5%). FLR% increase 8 weeks after PVE, PVL or PVL+can was 17.6%, 16.5%, \n19%, the complication rate of the various portal occlusion techniques were 4.5%, \n3.6%, 11.5%, respectively. At least 4 segments were resected during hepatectomy. \nOverall postoperative morbidity and mortality rates were 13% and 2.5%, respec-\ntively. Complication and mortality rates did not differ significantly in the 3 groups.\nConclusion: Patients with previously unresectable liver tumours can benefit from \nresection after all kinds of portal occlusion techniques. Although complication rate \nof portal occlusion combined with hepatic artery canule implantation is higher, \nmore patients become resectable due to higher increase rate of FLR in this group.\nB‑0984 14:45\nHepatic parenchymal and vascular contrast improvement in super-\ndelayed phase images of Gd-EOB-DTPA-enhanced MRI \nS. Kobayashi, O. Matsui, T. Gabata, W. Koda, T. Minami, K. Kozaka, A. Kitao; \nKanazawa/JP (satoshik@staff.kanazawa-u.ac.jp) \nPurpose: To elucidate the parenchymal and vascular contrast improvement effect \nof super-delayed phase (SDP) images of Gd-EOB-DTPA (EOB)-enhanced MRI in \npoor hepatobiliary phase (HBP) image cases special focus on Child-Pugh (CP) \nclassification.\nMethods and Materials: 76 cases, who have examined EOB-enhanced MRI for \ncloser examination of hepatic lesions, and taken SDP images approximately 90 \nminutes after iv administration of EOB because of poor HBP image are subjected \nto this study. 20 hepatobiliary disease cases who had also taken SDP images which \nshow normal HBP images were used as control. Hepatic vascular/parenchymal \nenhancement ratios (ER) were defined as signal intensity (SI) of intrahepatic vessel \n2\n\nScientific Sessions\nS37\nA\n C D E F G\nB\nMonday\n14:00 - 15:30 Room L/M \nPhysics in Radiology \nSS 1813 \nPatient dose management and dose surveys \nModerators: \nH. Bosmans; Leuven/BE \nW. Stiller; Heidelberg/DE \nB‑0989 14:00\nEuropean population dose and differences in radiological \nprocedures between European countries \nR. Bly1, A. Jahnen2, H. Olerud3, J. Vassileva4, H. Järvinen1, S. Vogiatzi5; \n1Helsinki/FI, 2Luxembourg/LU, 3Østerås/NO, 4Sofia/BG, 5Athens/GR \n(ritva.bly@stuk.fi) \nPurpose: Population doses from radiodiagnostic (x-ray and nuclear medicine) \nprocedures in Europe were estimated for the first time in the recent DOSE DA-\nTAMED 2 (DDM2) project (www.ddmed.eu) launched by the European Commission.\nMethods and Materials: Data of 34 countries were collected to an established \ndatabase.\nResults: The estimated population dose per caput is 1 mSv, which is lower than \ncorresponding dose in USA (3 mSv) or in Australia (1.7 mSv). The highest average \ncontribution is from CT, 56 %. From plain radiography, fluoroscopy and interventional \nradiology the proportional fractions are 19%, 17% and 7.5 % respectively. From di-\nagnostic nuclear medicine procedures, the estimated mean effective dose per caput \nis 0.036 mSv. Heart and bone examinations contribute 40% and 36%, respectively.\nConclusion: There were high variations between countries in frequencies (for \nexample, in thorax radiography about ten-fold between Spain or Portugal and \nGermany) and typical effective doses (for example, in CT head four-fold between \nDenmark and Luxembourg). This presentation will review the available data in Eu-\nrope using graphs in which countries can be identified. Furthermore, the procedures \ncontributing most to the population dose are highlighted.\nB‑0990 14:09\nRadiation dose from multidetector CT examinations in adults in Italy: \nresult of the first Italian survey \nS. Salerno1, C. Granata2, D. Matranga1, F. Palorini3, D. Origgi3; 1Palermo/IT, \n2Genoa/IT, 3Milan/IT (sergio.salerno@unipa.it) \nPurpose: The first large-scale Italian survey on radiation dose delivered to adult \npatients in multidetector CT (MDCT) examinations was performed.\nMethods and Materials: All the Italian radiology departments and the radiologists’ \nmembers of the Italian society of radiology (SIRM) were invited to take part in the \nsurvey. The minimum criteria for participation were: MDCT apparatus from 16 to \n64 rows, a referring radiologist and medical physicist for the survey, at least 10000 \nexaminations per year performed. 82 radiology units were considered eligible. \nThe data for three common CT examinations (head, chest and abdomen) were \nretrospectively collected during 2011 for common clinical indications: head CT for \nstroke, haemorrhage trauma; chest for trauma, infection, cancer diagnosis and \nfollow-up; abdomen for trauma infection, cancer diagnosis and follow-up. Patient \ndata and technical parameters (kVp, mAs, tube rotation speed, thickness, collima-\ntion, scan length, pitch, filtration, etc). of the examinations, including CTDIvol and \nDLP, were collected in a database.\nResults: Data of 6845 different patients were collected. 65/82 centres completed \nthe survey. The 75th percentiles of CTDIvol (mGy) and DLP (mGy*cm) distributions, \nrespectively, are: 69 and 1382 for head CT; 16 and 754 for chest CT; 19 and 2157 \nfor CT of the abdomen. The 31% of chest studies and the 71% of abdominal studies \npresent more than one sequence.\nConclusion: The analysis performed constitutes the first Italian database on radia-\ntion dose in MDCT study and can aid to define new European diagnostic reference \nlevels (DRLs) including the MDCT practice.\nAuthor Disclosures:\nS. Salerno: Research/Grant Support; Italian Society of Radiology SIRM. \nC. Granata: Research/Grant Support; Italian Society of Radiology SIRM.\nB‑0987 15:12\nFeasibility of a volumetric measurement of the left liver lobe with 3D \nultrasound compared with MRI \nE. Danse, O. Lebecque, N. Michoux, R. Reding; Brussels/BE \n(etienne.danse@uclouvain.be) \nPurpose: To assess the feasibility of the volumetric estimation of the left liver lobe, \nwith 3D ultrasound, with MRI comparison and surgical specimen.\nMethods and Materials: The data of 19 consecutive patients referred for giving \ntheir left liver lobe to a child were reviewed (living donor transplantation program). \nThe measurements of the 3D volumes of the segments II and III were performed \nretrospectively with comparison of the same evaluation performed with MRI (the \nreference and routine technique for the preoperative assessment of the liver size). \nAll the examinations were done twice by 2 experts radiologists and radiologists \nin training. The results were statistically analysed (variance test, Gage R&R and \nBland-Altman). 3D and MRI measurements were compared and related to surgi-\ncally proved volume quantification.\nResults: Intra- and inter-observators reproducibility was poorly conclusive (for US \nand MRI): gage R&R analysis is related to a PRR of 57% for US and 54% for MRI. \nBland-Altman analysis was giving an underestimation of volume measurements \nwith US (bias from -11 ml to -44 ml). Agreement limits (-1.96SD to +1.96SD) for \nthe 4 observators were included between -174.3 ml and +103 ml (from -71.6% \nto + 43.5%).\nConclusion: Correct estimation of the left liver lobe volume performed with 3D or \nMRI is related to a low repeatability and a low reproducibility for both techniques. \nBland-Altman analysis is also related to significative differences of volume meas-\nurement in both techniques.\nB‑0988 15:21\nAn accurate formula for a quick estimate of liver volume in \npolycystic liver disease \nM. Chrispijn, T.J.G. Gevers, J.P.H. Drenth; Nijmegen/NL \n(melissachrispijn@gmail.com) \nPurpose: Polycystic liver disease (PLD) patients have severe hepatomegaly. \nPrimary aim of treatment is total liver volume (TLV) reduction. The gold standard to \nassess TLV is CT volumetry which involves manual delineating of the liver outline. \nThis is time consuming and requires expertise. There is a clear need for an easy \nand fast approach to estimate TLV in routine practice.\nMethods and Materials: All PLD patients with ³1 CT scan were considered for \ninclusion. We measured the liver in transverse (T), anterioposterior (AP) and \ncraniocaudal (CC) directions and performed CT liver volumetry. We had access \nto an inception and a replication cohort. We performed multiple linear regression \nto predict TLV using the three dimensions in the inception cohort. Liver volumes \nwere transformed logarithmically. The goodness of fit of the prediction model \nwas assessed and stated as R2. Finally, we validated the prediction model in our \nreplication cohort.\nResults: The inception cohort included 54 PLD patients (median TLV 3890 mL \n(range 1084-13611 mL)). All three diameters were significantly correlated with \nTLV (p < 0.001). The linear regression model resulted in the following formula: \npredicted TLV = 4,179+(0.009*T)+(0.007*AP)+(0.001*CC). Our model predicted \nTLV accurately in the inception cohort (R 2=0.907). We validated our prediction \nmodel in a replication cohort of 22 PLD patients (median TLV 3603 mL, range \n1261-16746 mL). TLVs predicted by our model were highly correlated with TLVs \nmeasured by CT volumetry (R2=0.95), indicating that this model can be reproduced \nin other PLD patients.\nConclusion: TLV can easily, quickly and accurately be estimated based on three \nliver dimensions.\n3\n\nScientific Sessions\nS37\n C A D E F\n G\nB\nconsider tube current modulation (TCM). The aim of this study was to include TCM \neffects in MC dose simulations and to validate this approach.\nMethods and Materials: All measurements were performed on a SOMATOM \nDefinition Flash scanner (Siemens Healthcare, Forchheim, Germany) using three \nanthropomorphic phantoms: adult Alderson-Rando, 5-year-old child and 1-year-\nold child. The phantoms were scanned with a trunk protocol using an online TCM \nsystem (CareDose4, Siemens Healthcare, Forchheim, Germany). Organ dose \nvalues were measured using 94 calibrated thermoluminescent dosimeters (TLD) \nfor each phantom. MC simulations were performed using ImpactMC software (CT \nImaging GmbH, Erlangen, Germany) based on the 3D voxelised data derived from \nacquired CT images. The tool was modified to take TCM curves into account. The \ncurrent values for different tube positions were extracted from the raw data using \nmanufacturer software. Simulated dose values were compared with TLD measure-\nments on a chip-by-chip basis.\nResults: For MC calculations without taking TCM data into account the mean dif-\nferences between measured and simulated dose values amounted to 92%, 83%, \n71% for adult, 5-year-old child and 1-year-old phantoms, while modelling with TCM \nreduced the mean differences to 5.3%, 7.5% and 6.4%, respectively.\nConclusion: MC dose estimates including TCM data were in good agreement \nwith measurements. This technique can significantly improve the accuracy of \n3D-dose assessment. \nAuthor Disclosures:\nB. Schmidt: Employee; Siemens Healthcare. W. Kalender: Consultant; \nSiemens Healthcare.\nB‑0994 14:45\nEvaluation of patient dose reduction after introduction of iterative \nreconstruction in routine MDCT \nD. Defez1, P. Coulon2, P.C. Douek3, L. Boussel4; 1Pierre Benite/FR, \n2Suresnes/FR, 3Bron/FR, 4Lyon/FR (didier.defez@chu-lyon.fr) \nPurpose: To evaluate patient dose reduction with iterative reconstruction (IR) \ntechnique, on routinely 64-detector computed tomography (CT).\nMethods and Materials: All consecutive patients addressed for a CT scanner to \nour University Hospital (Lyon, France) between March 2011 and March 2012 were \nincluded in this study. Dose length product (DLP) was prospectively recorded before \n(2438 scans) and after (2823 scans) the installation of iDose4 IR on a Brilliance 64 \nCT scanner (Philips HealthCare), with a software tool created by our radio physics \ndepartment. Dose were compared for routinely performed brain, full dose chest, \nlow dose chest follow -up, chest-abdomen-pelvis, inferior limbs and ECG-gated \ncardiac examination.\nResults: The global average dose reduction over all kind of examinations was \n31.9% with some variations depending mainly on the initial dose level and the clinical \napplication. The average dose reduction measured on DLP was 19.3% for brain with \n840.3±79.3 vs 678.3± 91.7 mGy.cm (p < 0.0001) before and after upgrade, 33.7% \nfor standard chest (357.7± 184.1 vs 237.2±118.2 mGy.cm, p < 0.0001), 24.5% for \nlow dose chest follow-up (126.7±72.2 vs 95.7±33.3 mGy.cm, p=0.004), 36.3% for \nchest-abdomen-pelvis (683.2±290.5 vs 435.2±254.2 mGy.cm, p < 0.0001), 36.3% \nfor inferior limbs (1075.0±514.5 vs 684.3±231.8 mGy.cm, p=0.001), 42.7% for \ncardiac CTA (842.9± 206.9 vs 484.7± 213.3 mGy.cm, p < 0.0001).\nConclusion: On Brilliance 64 CT scanner, introduction of IR reduced patient \nradiation dose between 19 and 43% in routine practice, depending on the clinical \napplication.\nAuthor Disclosures:\nP. Coulon: Employee; PHILIPS.\nB‑0995 14:54\nAdjusting and measuring CT dose in severely obese patients \nR. Marcus, F. Bamberg, K. Neumaier, M.F. Reiser, T.R.C. Johnson; \nMunich/DE (roy.marcus@med.uni-muenchen.de) \nPurpose: CT in morbidly obese patients remains a challenge with respect to dose \nand image quality. Automatic adaptation of parameters results in high dose length \nproducts which do not reflect the actual dose due to the shielding by the fat. Aim \nof this study was to determine the actual dose and image quality.\nMethods and Materials: An Alderson phantom was equipped with 116 thermolumi-\nniscent detectors. Scans were performed using three set-ups: (I) ‘Obese’ phantom \nin 30-cm circumferential fat (simulating 175 cm/300 kg patient) with a dual--source \nprotocol at 2x140 kVp with current modulation; (II) Obese phantom with automatic \npotential and current modulation; (III) Slim phantom with automatic potential and \ncurrent modulation; dose was calculated according to IRCP-103 and based on DLP . \nImage quality was assessed subjectively and by image noise.\nB‑0991 14:18\nPatient-specific whole body voxel model for accurate Monte Carlo \nCT dose estimation \nN. Saltybaeva, Y. Smal, D. Kolditz, W. Kalender; \nErlangen/DE (natalia.saltybaeva@imp.uni-erlangen.de) \nPurpose: The accuracy of CT dose estimates based on Monte Carlo (MC) tech-\nniques is limited as data is only available for the scanned volume. The purpose \nof this study was to generate and to validate whole body voxel models using the \npatient CT images extended by established voxel phantoms.\nMethods and Materials: Measurements were performed on a SOMATOM Defini-\ntion Flash scanner (Siemens, Forchheim, Germany) using the anthropomorphic \nRando-Alderson phantom. The absorbed dose was measured using a set of 90 \ncalibrated thermoluminescent dosimeter (TLD) chips for thorax protocols with tube \nvoltage of 80, 100 and 120 kV. Whole body voxel models were built as a combina-\ntion of the patient CT images and the ICRP Adult Male Reference voxel phantom. \nMC simulations were performed using the ImpactMC software (CT Imaging GmbH, \nErlangen, Germany) for only the scanned volume and for the combined whole body \nmodel. Measured and simulated dose values were compared for each TLD chip.\nResults: At 120 kV, the dose values obtained by MC simulations based on only \nCT images differed from TLD measurements by 19% on average with a maximum \ndifference of 37% for the border slices, while the whole body model allowed for a \nmean difference of 6%. The difference between measured and calculated results \nwas reduced by 53%, 60% and 68% for 80, 100 and 120 kV, respectively, when \nusing the whole body voxel model instead of the CT-scanned volume only.\nConclusion: The proposed whole body voxel model for Monte Carlo simulations \nsignificantly improves the accuracy of patient-specific CT dose estimates. \nAuthor Disclosures:\n W. Kalender: Consultant; Siemens Healthcare.\nB‑0992 14:27\nA simple algorithm for dose estimation in CT imaging considering \npatient size \nY. Smal, N. Saltybaeva, W. Kalender; \nErlangen/DE (yulia.smal@imp.uni-erlangen.de) \nPurpose: Accurate patient dose estimation using CT imaging is important par-\nticularly as the modality is being increasingly used. Body habitus varies and the \nuse of Monte Carlo simulations for “standard man” phantoms does not provide \naccurate dose estimation for non-standard patient sizes. The study proposes an \nalgorithm for dose estimation for an individual patient from simulated data from \nmathematical phantoms.\nMethods and Materials: The algorithm interpolates doses simulated for ORNL \nmathematical phantoms accounting for differences on patient and phantom sizes. \nFour patient models were produced using 2 anthropomorphic phantoms (repre-\nsenting 1- and 5-year-old children) with and without an additional fat-equivalent \nlayer. All phantoms were scanned at 80 and 120 kV (trunk protocol). Doses were \nmeasured with 60 TLD dosimeters. Additionally, DICOM images were segmented \nfor organs and data were used as input for dose simulation. All simulations were \nperformed with validated tool (ImpactMC). Doses for phantoms and patients were \nestimated from the MC simulations using the proposed algorithm. Calculated and \nmeasured doses were compared.\nResults: The algorithm improved accuracy in dose estimation by 49, 35, 30, and \n21% for small thin, small thick, large thin and large thick phantom sizes, respectively, \ncompared with estimates based on ORNL phantoms only. For patient data the ac-\ncuracy in lung dose estimates improved from 15 to 4%, and from 108 to 15%, for \n2- and 6-year-old patients, respectively.\nConclusion: The proposed algorithm improves dose estimation accuracy for indi-\nvidual paediatric patients. It is simple and suitable for implementation in software \ntool for dose calculation. \nAuthor Disclosures:\nW. Kalender: Consultant; Siemens Healthcare.\nB‑0993 14:36\nMonte Carlo tool for 3D-dose simulation in computed tomography \ntaking into account tube current modulation \nN. Saltybaeva1, D. Kolditz1, B. Schmidt2, W. Kalender1; 1Erlangen/DE, \n2Forchheim/DE (natalia.saltybaeva@imp.uni-erlangen.de) \nPurpose: Monte Carlo (MC) methods are widely used in v-ray computed tomog-\nraphy (CT) for accurate 3D dose calculation; in most cases, however, they do not \n4\n\nScientific Sessions\nS37\nA\n C D E F G\nB\nMonday\nB‑0998 15:21\nActive personal dosimeters to support optimisation of radiation \nprotection in interventional radiology \nR. Padovani, F. Bonutti, A. Trianni, G. Bernardi; Udine/IT \n(padovani.renato@aoud.sanita.fvg.it) \nPurpose: The combined availability of DICOM radiation dose structured report \nand active personal dosimeters in interventional radiology (IR) can support the \noptimisation of radiation protection, both of patient and staff.\nMethods and Materials: For nine months, interventionalists performing interven-\ntional cardiology procedures have used a personal active dosimeter (DoseAware, \nPhilips) worn over the apron. Information is displayed in real-time and transmitted \nto a database. The patient dosimetry report (Allura FD10, Philips) has been also \nautomatically collected for all procedures. A Matlab routine integrates both informa-\ntion on procedure data and patient and staff exposures, providing a tool aiming to \nidentify high and/or non-optimised exposures.\nResults: On a sample of 45 coronary angiography and percutaneous angioplasty \nprocedures the derived mean KAP (SD, maximum) per procedure was 69.0 (53.1, \n236.2) Gycm2. The first operator mean (range) personal equivalent dose was19 \n(0.65 ÷ 27.3) µSv/procedure. The mean (SD) scatter equivalent dose measured on \nthe C-arm at the machine isocentre level per unit of KAP was 2.32 (0.50) µSv/Gycm2.\nConclusion: The availability of the DICOM structured patient dosimetry report \nand the technology advancement of personal dosimetry can conveniently support \nthe optimisation radiation protection process in IR. The described experience \nsupports the initiative of ISEMIR project (IAEA, Austria) that recommends the \ndevelopment of active dosimetry technology for a better monitoring of operators \nin IR and the development of a DICOM operator structured dosimetry report as \nprerequisite to define and develop software platforms aiming to combine patient \nand staff exposure information. \n14:00 - 15:30 Room N/O \nVascular \nSS 1815 \nVascular research \nModerators: \nS. Kuribayashi; Tokyo/JP \nA. Pellegrin; Trieste/IT \nB‑0999 14:00\nHybrid-MRA steady state VIBE imaging - a delayed closer look at the \nvessels: evaluation of the additional diagnostic benefit in patients \nwho undergo a peripheral magnetic resonance angiographic protocol \nM. Ong, K. Hausotter, S.O. Schönberg, H.J. Michaely; \nMannheim/DE (melissa.ong@umm.de) \nPurpose: The purpose of this study was to evaluate the additional diagnostic benefit \nof high-resolution steady state VIBE imaging in peripheral MRA.\nMethods and Materials: In this retrospective IRB-approved study 224 patients (72 \nwomen, 152 men, age 67.3±13.9) were included who had undergone a peripheral \nMRA exam after injection of 0.1 mmol/kg gadobutrol including a large field of view \nMRA, time-resolved MRA of the calf station and steady state 3D VIBE sequence \n(3 T Siemens TimTrio, 1.3 mm isotropic spatial resolution, PAT 3, 1:26 min Tacq \nper station) prior to the time-resolved MRA. One board-certified radiologist rated \nimage quality of the VIBE sequences on an ordinal three-point scale and analysed \nthe images for additional diagnostic findings. Descriptive statistics and demographic \npatient data were used for further evaluation.\nResults: The image quality of the VIBE sequences of the pelvis, upper and lower \nleg was excellent in up to 88%, 84% and 47%, respectively. Poor image quality was \nonly detected in the upper (2%) and lower leg (6%). The VIBE sequence yielded an \nadditional diagnostic benefit in 44% of the patients overall. There was no significant \ndifference in terms of additional findings between men and women (46% and 40%, \np=0.4601). The patient sample revealed a distribution of 59% inpatients and 41% \noutpatients with additional pathology found in approximately 44% for each group.\nConclusion: Steady-state 3D VIBE sequences in peripheral MRA yield additional \nrelevant diagnostic findings in 44% and above in patients older than 60 years ir-\nrespective of gender and patient status.\nAuthor Disclosures:\n H.J. Michaely: Consultant; Bayer Healthcare.\nResults: In set-up III, measured and calculated dose agreed well (3.05 vs. 3.0mSv). \nSet-ups I and II showed a discrepancy of 72% between measured and calculated \ndose (9.52 vs. 34.20mSv and 10.69 vs. 37.43mSv). Image quality in set-ups I and II \nwas rated sufficient, compared to the excellent image quality in set-up III. Set-up.i. \nshowed a lower image noise (9 vs. 33 HU) and lower dose (12%) than set-up II.\nConclusion: Morbidly obese patients receive higher dose in CT examinations, \nwhich is required to achieve diagnostic image quality. Calculations based on DLP \nand standard conversion factors overestimate the dose by approx. 70% in 300 \nkg patients, while the actual equivalent dose remains within the reference limits. \nB‑0996 15:03\nThe effects of head size/shape, head positioning, and bow-tie filter \nselection on peak tissue doses from brain perfusion 256-slice CT \nK. Perisinakis1, I. Seimenis2, A. Tzedakis1, A.E. Papadakis1, J. Damilakis1; \n1Iraklion/GR, 2Alexandroupolis/GR (Kostas.Perisinakis@med.uoc.gr) \nPurpose: To determine peak doses to skin, eye lens, brain parenchyma and cranial \nred bone marrow (RBM) of adult individuals subjected to low-dose brain perfusion \n256-slice CT studies, and investigate the effects of patient head size/shape, head \nposition and bow-tie filter selection.\nMethods and Materials: Peak doses to radiosensitive tissues were measured in \n106 individual-specific head phantoms subjected to the standard low dose brain \nperfusion CT on a 256-slice CT scanner using a novel Monte Carlo simulation soft-\nware. The effects of head size/shape, head position during acquisition and bow-tie \nfilter on resulting peak doses were investigated. The effects of head mis-centering \nand use of narrow bow-tie filter on image quality were assessed.\nResults: The mean peak doses to eye lens, skin, brain and RBM were found to \nbe 124, 120, 95 and 163 mGy, respectively. Patient head size/shape was found to \nhave minimal effect on peak doses, since maximum differences were less than 7%. \nBow-tie filter selection and head mis-centering were found to have a considerable \neffect on peak tissue doses with minimal image quality deterioration. The use of \nthe narrower bow-tie filter available resulted in 35% reduction of peak tissue doses.\nConclusion: Typical peak doses to skin, eye lens, brain and RBM from the standard \nlow dose brain perfusion 256-slice CT exposure are well below the corresponding \nthresholds for induction of deterministic effects. The use of narrow bow-tie filters \nmay considerably reduce peak absorbed dose to all above radiosensitive tissues \nwith minimal degradation of image quality.\nB‑0997 15:12\nDetector dose vs image quality in radiography with digital detectors: \na visual grading analysis \nR. Decoster, H. Mol, D. Smits; Brussels/BE (robin.decoster@hubrussel.be) \nPurpose: The introduction of digital detectors in the radiology predicted a dose \nreduction. Due to the dynamic range, radiographs of sufficient quality can be \nproduced with a lower detector air kerma (DAK). However, this reduction was not \nobserved. Some authors indicate a creep toward higher DAK, explained by better \nappreciation of the radiographs due to a higher contrast-to-noise ratio.\nMethods and Materials: To investigate the relation between the DAK and the \nappreciation of image quality by radiologists, 172 anterior-posterior (AP) radio-\ngraphs of the knee and 152 radiographs of the pelvis where collected randomly in \n19 radiologic centres. A visual grading analysis (VGA) with a five-point scale was \nused to judge the image quality of seven anatomic structures. The mid-point of \nthe scale was equalised to diagnostic image quality. Six radiologists scored both \ndatasets, in a controlled environment, with ViewDex®. Every observer received \nan instruction and a training dataset. To determine intra-observer variability twenty \nradiographs were repeated.\nResults: The intra-observer variability was not significant (p> 0.05) in both data-\nsets. The knee AP obtained a VGA score of 3.92, the pelvis obtained VGA score \nof 3.71. In both cases, the inter-observer correlations are high and significant. The \ncorrelation between the VGAS and the DAK (CR 1.54µGy-5.48µGy; DR 0.38µGy-\n6µGy) was not significant in either dataset. Neither were other analyses based on \ntechnical parameters.\nConclusion: The VGA revealed a mean image quality higher than diagnostic nec-\nessary. Based on the DAK, an overexposure is suspected. The relation between \nthe DAK range and the appreciation of the radiograph needs further investigation.\n5\n\nScientific Sessions\nS37\n C A D E F\n G\nB\nB‑1002 14:27\nVascular enhancement and image quality of lower-extremity CT \nvenography using 100 kVp and ultrahigh pitch: comparison of \nconventional lower-extremity CT venography using 120 kVp and \nstandard pitch \nK. Choo, J. Park, J. Kim, J. Roh, C. Park; Busan/KR (dorae007@hotmail.com) \nPurpose: The objective of our study was to compare lower-extremity CT Venogra-\nphy (CTV) using 100 kVp and ultra-high pitch with conventional lower-extremity CTV \nusing 120 kVp and standard pitch in the vascular enhancement and image quality.\nMethods and Materials: The 100 patients with suspected deep vein thrombosis \nand varicose vein were divided into two groups; one group (group A, 50 patients) \nwas 100 kVp and ultra-high pitch (3) and the other group (group B, 50 patients) 120 \nkVp and standard pitch (0.6). Vessel enhancement and image noise were assessed \nin the inferior vena cava (IVC), femoral vein, and popliteal vein. Two radiologists \nwho were blinded to the protocol assessed image quality score by consensus using \na 5-point visual scale. Effective dose was estimated using the dose-length product \n(DLP). The Wilcoxon rank test was used to evaluate differences between the two \ngroups using statistics software (SPSS, version 13.0).\nResults: Mean vascular enhancement of IVC, femoral vein and popliteal vein \nwas significantly higher in the group A than in the group B and the images of the \ngroup A had significantly higher image noise. However, there were no significant \ndifferences in image quality score of the IVC, femoral vein and popliteal vein. The \nmean DLP in the group A (402.10±94.29 mGy · cm) was significantly lower than \nthat in the group B (973.36±63.20 mGy · cm) (p < 0.001).\nConclusion: Although lower-extremity CTV using 100 kVp and ultra-high pitch \nincreased venous enhancement, it provided sufficient image quality and lower \nradiation dose. \nB‑1003 14:36\nCT textural analysis of culprit lesions in transient ischaemic attack \nand/or stroke: correlation with immunohistochemistry \nE. Barden1, L. Menezes1, B. Ganeshan1, M. Rodriguez-Justo1, R. Endozo1, \nC.W. Kotze2, S.W. Yusuf2, A.M. Groves1; 1London/UK, 2Brighton/UK \n(edward.barden@doctors.net.uk) \nPurpose: To investigate if texture analysis of computed tomography (CT) carotid \nangiograms can identify culprit lesions in Transient Ischaemic Attack (TIA) and/\nor stroke, and correlate CT texture with immunohistochemistry of endarterectomy \nspecimens, identifying neo-angiogenesis (VEGF) and macrophage density (CD68).\nMethods and Materials: Following institutional review board approval, 14 con-\nsecutive patients with symptomatic carotid stenosis awaiting endarterectomy \nwere enrolled: 12 males, 2 females, mean age (±SD) 67.6 ±6.7 years. CT carotid \nangiography was performed. Axial CT images of the carotid bifurcation on each \nside were evaluated using TexRAD®, a commercially available texture analysis \nsoftware algorithm. This comprised extracting texture features at fine, medium and \ncoarse scales followed by quantification of the distribution of greyness, coarseness \nand heterogeneity within each lesion using mean grey-level intensity (MGI, aver-\nage brightness) and proportion of positive pixels (PPP). The data were compared \nbetween symptomatic and asymptomatic sides (using Wilcoxon paired test), and \ncorrelated with quantitative immunohistochemical staining for macrophage density \n(CD68) and vascular endothelial growth factor (VEGF) of the endarterectomy \nspecimens (using non-parametric Spearman's rank correlation).\nResults: Medium textures differentiated between symptomatic and asymptomatic \nsides (MGI and PPP, p = 0.041). Medium textures also correlated significantly \n(positively) with immunohistochemical markers (MGI vs CD68, rs = 0.680, p = \n0.007 and PPP vs VEGF, rs = 0.640, p = 0.014).\nConclusion: CT textural analysis can identify culprit lesions in TIA and/or stroke \nand possibly distinguish between the pathophysiological basis (neo-angiogenesis \nversus macrophage infiltration) of vulnerable plaque. \nB‑1004 14:45\nNon-contrast-enhanced MR angiography combined with peripheral \ncardiac gating at 3 T: comparison of respiratory triggered and breath \nheld technique \nT. Masui1, M. Katayama1, K. Sato1, K. Terauchi1, N. Takei2, K. Tsukamoto1, \nK. Mizuki1, M. Miyoshi2, H. Sakahara1; 1Hamamatsu/JP, 2Hino/JP \n(masui@sis.seirei.or.jp) \nPurpose: In non-contrast MRA (NCMRA) using FIESTA (GEHC) at 3 T, we found \nsignal inhomogeneity due to systolic flow effects in aorta. The purpose was to evalu-\nate feasibility of NC MRA at 3 T with peripheral pulse gating (PG) for evaluation \nB‑1000 14:09\nMultimodal imaging of atherosclerotic plaques using SPIO and \nquantum dot labelled high density lipoproteins in ApoE-/- mice \nC.S.L. Jung, H. Ittrich, M.G. Kaul, T. Ducic, O. Bruns, B. Freund, J. Hereren, \nG. Adam; Hamburg/DE \nPurpose: To estimate superparamagnetic iron oxide (SPIO) and quantum dot (QD) \nlabelled high density lipoproteins (HDL) for imaging of atherosclerotic plaques with \nMR and several ex vivo imaging techniques in ApoE-/- mice.\nMethods and Materials: HDL nanosomes (HDL-NS) were synthesised by in-\ncorporation of QD and SPIO into the lipid core HDL-NS were characterised by \ndynamic light scattering (DLS), size exclusion chromatography (FPLC) and by \ncholesterol and fluorescent measurements. For evaluation of biodistribution and \nblood clearance Fe59 radioactive-labelled HDL-NS were applied intravenously (iv) \nand intraperitoneally (ip) into ApoE-/- mice. Radioactivity measurements of differ-\nent organs were performed using a whole body y-counter (HAMCO). In vivo MRI \nusing a T2*w-gradient echo sequence at 7T (Clinscan, Bruker) was matched with \nex-vivo MRI, ex vivo confocal fluorescence microscopy (CFM), x-ray fluorescence \nmicroscopy (x-ray FM) and histological analysis (Prussian-Blue (PB) stains) to \nvisualise the uptake of HDL-NS in atherosclerotic plaques.\nResults: In vitro analyses confirmed equal size of HDL-NS compared to endog-\nenous HDL. Radioactivity measurements at HAMCO showed a significant higher \nuptake of HDL-NS into atherosclerotic plaques after ip injection (p < 0.006) in \naddition to a predominant accumulation in liver and spleen. Blood concentration \ntime curves of iv and ip application showed a biphasic progress. Ex-vivo MRI, x-ray \nFM, CFM and PB stains of aortic specimens showed an uptake of HDL-NS into \natherosclerotic lesions of ApoE-/- mice.\nConclusion: Synthesis of HDL-NS with equal properties compared to native HDL \nwas established. HDL-NS accumulation in atherosclerotic plaques can be visualised \nnon-invasively by MRI proven by ex-vivo imaging techniques. \nB‑1001 14:18\nSkin autofluorescence, a non-invasive marker for AGE accumulation, \nis elevated in subjects with evidence for subclinical atherosclerosis \nM.A.M. den Dekker, M. Zwiers, E.R. van den Heuvel, L.C. de Vos, A.J. Smit, \nM. Oudkerk, R. Vliegenthart, J.D. Lefrandt, D.J. Mulder; Groningen/NL \n(m.a.m.Dekker@rad.umcg.nl) \nPurpose: Skin autofluorescence (AF) is a non-invasive marker for advanced \nglycation endproducts (AGEs) and predicts cardiovascular disease (mortality) in \ndiabetes and renal disease. We examined whether skin AF is increased in subclini-\ncal atherosclerosis and whether it is associated with the degree of atherosclerosis \nindependent of diabetes and renal function.\nMethods and Materials: Cross-sectional study of 223 patients referred for primary \n(PP;N=163) or secondary (SP; N=60) prevention. Skin AF was measured using \nthe AGE-reader and the degree of atherosclerosis was assessed based on ultra-\nsonographically detected plaques in carotid and femoral arteries (in PP only), and \ncomputed tomography-derived coronary artery calcium score (CACS). PP group \nwas divided into subjects with subclinical atherosclerosis defined as > 1 plaque or \nCACS > 100 (N=67;age 53 years [interquartile range 48-56];49% male) and those \nwithout (controls; N=96;43 years [38-51];55%) SP group consisted of patients with \nsymptomatic peripheral arterial disease (PAD;64 years [58-70];73%).\nResults: Skin AF was higher in subjects with subclinical and clinical atherosclerosis \ncompared with controls (skin AF 2.11 [1.83-2.46] and 2.71 [2.15-3.27] vs. 1.87 \n[1.68-2.12], respectively; P = 0.005 and < 0.001). In controls and PAD, skin AF was \nhigher in those with CRP above median compared with below. In a multiple regres-\nsion analysis, the association of skin AF with the 3 atherosclerosis categories was \nindependent of age, gender, diabetes, Framingham Risk score, and kidney function.\nConclusion: Skin AF is increased in subjects with subclinical and clinical athero-\nsclerosis, independently of known confounders. These data suggest that AGEs \nare associated with the burden of atherosclerosis. \nAuthor Disclosures:\nA.J. Smit: Founder; DiagnOptics.\n6\n\nScientific Sessions\nS37\nA\n C D E F G\nB\nMonday\n23 keV; pixel size 5.4µm), or at a laboratory set-up with a conventional x-ray tube \n(n=3, 35 kVp, 70 mA, pixel size 100µm). Tomographic images were reconstructed \nand compared to histopathology. Independent readers determined vessel dimen-\nsions and signal-to-noise ratios (SNR) between gb-PCI and absorption images.\nResults: In total, 51 sections were included in the analysis. Images from both set-\nups provided sufficient contrast to differentiate vessel layers. There was a strong \npositive correlation between PCI and histology with respect for lumen, intima and \nvessel wall area for both synchrotron and laboratory-based measurements (Pear-\nson’s R > 0.94 and p < 0.01 for all). Synchrotron-based images were characterised \nby significantly higher SNRs than laboratory-based images (p < 0.001). Both \ngb-PCI set-ups had superior SNRs compared to corresponding absorption-based \nimages (p < 0.001). Inter-reader reproducibility was excellent, with ICCs > 0.98 for \nsynchrotron and > 0.84 for laboratory-based measurements.\nConclusion: Our results demonstrate the feasibility of gb-PCI for carotid athero-\nsclerotic plaque imaging using both synchrotron and laboratory-based experimental \nset-ups. The technique holds promise for accurate vessel wall characterisation.\nB‑1007 15:12\nSingle contrast medium dose peripheral MR angiography is feasible \nwithout subtraction using two-point Dixon fat saturation \nT. Leiner1, J. Habets1, B. Versluis2, L. Geerts3, J. Hendrikse1, \nE.-J. Vonken1, H. Eggers4; 1Utrecht/NL, 2Maastricht/NL, 3Best/NL, \n4Hamburg/DE (t.leiner@umcutrecht.nl) \nPurpose: To investigate the feasibility and image quality of subtractionless first-\npass single contrast medium dose (0.1 mmol/kg) peripheral contrast-enhanced \nmagnetic resonance angiography (MRA) using two-point Dixon fat-saturation \n(2DixFS) compared with conventional subtraction-based MRA with regard to vessel-\nto-background contrast, signal-to-noise ratio (SNR) and subjective image quality.\nMethods and Materials: 28 patients (13M, 15 F; mean age±SD, 66±16) with known \nor suspected peripheral arterial disease underwent single contrast medium dose \n(0.1 mmol/kg body weight) 1.5-T MRA using 2DixFS during first arterial passage \nof contrast material. Results were compared with data obtained using a conven-\ntional, subtraction-based approach. A phantom study was performed to assess \nsignal-to-noise ratio (SNR) of both MRA techniques. Vessel-to-background (VTB) \ncontrast and SNR were measured and compared with the paired samples t-test. \nTwo experienced observers scored subjective image quality. Fisher's exact test \nwas used to compare subjective image quality. Agreement regarding subjective \nimage quality was expressed in quadratic weighted κ values.\nResults: Patient data showed improved VTB contrast in all anatomical locations with \n2DixFS versus the conventional, subtraction-based MRA method (all P < 0.001). \nSubjective image quality was uniformly higher with 2DixFS when compared with \nsubtracted images. In all cases this was significant (P < 0.03), except the aortoiliac \narteries for observer 1 (P=0.052). Phantom studies indicated a 15% higher SNR \nwith the Dixon technique (31.9 vs 27.6).\nConclusion: This study demonstrates the feasibility of single contrast medium \ndose subtractionless lower extremity MRA using 2DixFS method. Both objective \nand subjective image quality are better compared with subtraction based MRA of \nthe peripheral vascular tree. \nAuthor Disclosures:\nT. Leiner: Advisory Board; Bayer Healthcare, Philips Healthcare.L. Geerts: \nEmployee; Philips Healthcare.H. Eggers: Employee; Philips Healthcare.\nB‑1008 15:21\nCorrelation of cardiovascular risk factors and occult atherosclerotic \nfindings using whole body magnetic resonance imaging of the \nvascular system in an asymptomatic patient collective: initial results \nS. Mangold, E. Randrianarisoa, P. Krumm, C. Bretschneider, \nA. Seeger, K. Rittig, B. Balletshofer, C.D. Claussen, U. Kramer; \nTübingen/DE (Stefanie.Mangold@med.uni-tuebingen.de) \nPurpose: To evaluate the prevalence of atherosclerotic disease, myocardial inf-\narction and cerebrovascular disease in asymptomatic patients with cardiovascular \nrisk profile including whole body magnetic resonance imaging (WB-MRI) of the \ncardiovascular system into the framework of a comprehensive prevention concept.\nMethods and Materials: Prospectively, 52 patients without any known cardiovas-\ncular disease (34 men, 18 woman, mean age 50.1±7.4 years) but suffering from \ncardiovascular risk factors such as arterial hypertension [AHT], impaired glucose \ntolerance, hyperlipidaemia and obesity, were clinically assessed including family \nhistory, blood collection, blood pressure assessment and oral glucose tolerance \ntest. Furthermore, the carotid intima-media thickness [CIMT], potentially indicative \nfor atherosclerotic disease was assessed by ultrasound and a WB-MR angiogra-\nphy (1.5 T, Avanto, Siemens Medical Solutions) containing an examination of the \nof renal artery using respiratory triggered (RT) or breath held (BH) in reference to \ndynamic contrast MRA (CMRA).\nMethods and Materials: 33 patients were involved (median age 61 years). RT \nand BH NC MRAs using PG were obtained at 3 T (Discovery MR750, GEHC) \nusing Inflow inversion recovery (IFIR) 3D FIESTA with fan beam k-space view \nordering in a coronal plane. CMRA with 3D EFGRE was obtained as reference \n[0.1 mmol/kg Gd-chelate, injection 3 ml/sec]. Evaluation, image quality, artefacts \n(1 undiagnostic-5 excellent) and visualisation of aorta and renal arteries were \nranked with 5-point scale. Contrast was calculated (SI artery/surrounding tissue). \nWilcoxon signed rank test and Student’s t test with Bonferroni correction was used \nfor statistical evaluation.\nResults: ALL NCMRAs were diagnostic (3.7-4.7). Scores for image quality and \nartefacts of RT NCMRA were better than those of BH NCMRA (NS) although \nvisualisation of aorta was slightly better with BH than RT NCMRA. RT NCMRA \nprovided better visualisation of distal renal arteries and better contrast than those \nwith CMRA (p < 0.05). Contrasts of aorta and proximal renal arteries were slightly \nbetter in CMRA than those in NCMRAs (NS).\nConclusion: With PG, homogenous SI in aorta was obtained in NCMRA. When \nimage quality of RT NCMRA is not enough to evaluate arteries, BH NCMRA can \nbe used as substitute.\nAuthor Disclosures:\nN. Takei: Employee; GE Healthcare.M. Miyoshi: Employee; GE Healthcare.\nB‑1005 14:54\nLow kV settings CT-angiography with ultra low contrast medium \nvolume for the assessment of thoracic and abdominal aorta disease: \na feasibility study \nC.R.G.L. Talei Franzesi, D. Ippolito, P.A. Bonaffini, D. Fior, O. Minutolo, S. Sironi; \nMonza/IT (ctfdoc@hotmail.com) \nPurpose: To evaluate the quality, the diagnostic performance and the radiation \nexposure of low-kV CT angiography protocol (100 kV) with ultra low-contrast me-\ndium volume (40 mL) in the assessment of the aorta disease.\nMethods and Materials: Seventy patients with thoracic or abdominal aortic dis-\nease were prospectively examined with 256MDCT scan (Brilliance iCT, Philips) \nusing ultra low-dose radiation protocol (100 kV; automated tube current modula-\ntion) and ultra low-contrast volume (40 mL; 4 mL/s; 350 mgI/mL). In the thoracic \naorta assessment we performed ECG-gated retrospective protocol, necessary \nfor the evaluation of ascending aorta. Density measurements were performed on \nascending, arch, descending, abdominal aorta, renal arteries and common iliac \narteries. A control groups of 50 patients who underwent standard CT-angiography \nprotocol (120 kV; 350 mAs) and standard contrast volume (120 mL) were also \nevaluated. The obtained data in terms of radiation dose exposure (dose-length \nproduct, DLP), administered contrast and intravessels density were compared \nand statistically analysed.\nResults: In every CT-exam we could correctly visualise and evaluate main branch \nof thoracic and abdominal aorta. No significant difference of density measurements \nwas achieved between the low-kV protocol: mean attenuation value of thoracic aorta \n304 HU, abdominal aorta 343 HU and renal arteries 331 HU; and control group: \nmean value of thoracic aorta 320 HU, abdominal aorta 339 HU and renal arteries \n303 HU. The radiation dose exposure in low-kV protocol was significantly reduced \n(p < 0.05) in comparison with control group, obtaining the following value for thoracic \nscan: 490DLP and abdominal scan: 335DLP, while in control group we obtained \nfor the thoracic scan: DLP625 and for the abdominal scan: DLP952, respectively.\nConclusion: Low-kV protocol provides a comparable diagnostic performance \nwith standard protocol, decreasing significantly the radiation dose exposure (over \n40%) and allowing also a significant reduction of contrast material volume (40 mL), \npreserving renal function.\nB‑1006 15:03\nX-ray phase-contrast imaging of arterial vessel wall: translation from \nsynchrotron radiation to a conventional lab-based x-ray source \nH. Hetterich1, M. Willner2, S. Fill1, F. Bamberg1, J. Herzen2, \nM. Stockmar2, F. Pfeiffer2, M.F. Reiser1, T. Saam1; 1Munich/DE, \n2Garching/DE (holger.hetterich@med.uni-muenchen.de) \nPurpose: Phase-contrast imaging (PCI) is a novel x-ray-based technique that \nprovides excellent soft tissue contrast but so far was depending on synchrotron \nradiation. The aim of this study was to evaluate the feasibility of visualising human \ncarotid arteries by grating-based PCI (gb-PCI) at two different experimental set-\nups: (1) applying synchrotron radiation and (2) using a conventional x-ray tube.\nMethods and Materials: Five ex-vivo carotid artery specimens were examined with \ngb-PCI either at a synchrotron facility using a monochromatic x-ray beam (N=2; \n7\n\nScientific Sessions\nS3\n C A D E F\n G\nB\ndeveloped for adult trauma patients in 2008 and a novel approach based on recent \nliterature and our additional observations.\nResults: Of the 14 years considered, 136 cases met the inclusion criteria. In 33 \ncases a NAHI was assumed. 17 cases showed SDHy. Only one SDHy case was \nassumed to be related to an accident. The new classification system for traumatic \nSDHy in children will be introduced and discussed.\nConclusion: As demonstrated for different SDHy appearances, neuroradiologists \nshould be aware of the possible presentations of NAHI. In addition, investigation \nof SDHy’s may allow for new insights into the pathogenesis of phenomena such \nas the shaken baby syndrome. \nB‑1012 14:18\nApparent kurtosis coefficient (AKC) in brain: a feasibility study in \npaediatric populations \nI. D’Errico, A. Ciccarone, M. Esposito, M. Mortilla, C. Fonda; Florence/IT \n(igni77@hotmail.it) \nPurpose: Diffusion-weighted imaging (DWI) depends on the b-values employed \nin acquisition. At low b values (lower than 500 s/mm2) the signal attenuation is \nbi-exponential and is influenced both by diffusion and perfusion. At high b values \n(higher than 1000 s/mm2) the signal attenuation is influenced by restricted water \ndiffusion and hence follows a non-Gaussian distribution. Diffusion Kurtosis Imag-\ning (DKI) provides quantifiable information about the deviation from Gaussian \ndistribution in water diffusion process. Our purpose was to apply DKI method to \npaediatric patients with different pathologies (tumours, ischaemia) and to establish \nits feasibility in detecting brain diseases.\nMethods and Materials: We examined 20 patients from newborn to 16-year-old. \nDiffusion weighted imaging was performed with 5 b values from 500 to 2500 with \nstep 500 s/mm2. Fitting all b values we were able to discriminate Diffusion and \nKurtosis parameters. A home-made software performed all fitting and DWI, ADC, \nAKC maps.\nResults: AKC maps revealed additional information for tissue characterisation. \nIn ischaemia, AKC demonstrated more details of pathologic tissue changes and \nprovided information about prognosis. In tumours, AKC maps were used for dis-\ncriminating low-grade from high-grade lesions revealing a better accuracy than \nconventional diffusion parameters.\nConclusion: AKC maps are non-invasive methods that are well tolerated by pae-\ndiatric patients and that provide a more detailed characterisation of neural tissue in \nthe clinical context. Their application in pathological conditions such as ischaemia \nand tumours provides additional information about microstructural tissue changes, \ndifferential diagnosis and prognosis. \nB‑1013 14:27\nWhich T1 pulse should be used to study the preterm brain with a 3 \nTesla scanner? \nD. Tortora, V. Panara, P.A. Mattei, S. Salice, M. Tagliamonte, C. Briganti, \nA.R. Cotroneo, A. Tartaro, M. Caulo; Chieti/IT (domenicotortora@hotmail.it) \nPurpose: The loss of contrast on MR T1-weighted images obtained at 3 Tesla (3 \nT) may negatively influence the detection of punctate hyperintense lesions, which \nare indicative of periventricular leukomalacia (PVL) in preterm neonates. In this \n3 T MR study we compared the sensitivity of different T1-weighted sequences in \nidentifying PVL.\nMethods and Materials: The presence of non cystic-PVL was retrospectively \nevaluated in 3 Tesla (3 T) MR brain studies of 200 preterm neonates acquired at \nterm-corrected age. In 30 neonates with PVL, T1 hyperintense punctate lesions \nwere counted by two neuroradiologists in consensus on 4 different axial T1-weighted \nsequences: 3 mm Inversion Recovery (IR), Spin Echo (SE), reformatted 3D-Fast \nField Echo (FFE) and 1 mm reformatted 3D-FFE. Sequences were presented \nrandomly. Statistical differences of the number of hyperintense lesions detected by \nthe different sequences were evaluated using the Student’s paired t test (p < 0.05).\nResults: The greater number of T1 hyperintense punctate lesion was identified \nusing the 1 mm axial reformatted 3D-FFE sequence (381 lesions), which resulted \nto be the most sensitive sequence in identifying PVL lesions (p < 0.0001). Axial 3 \nmm FFE, IR and SE sequences identified 213, 146 and 94 hyperintense punctate \nlesions, respectively. No statistical differences were found between 3 mm-T1 \nsequences (p> 0.05).\nConclusion: When using a 3 Tesla MR scanner 1 mm axial reformatted T1-3D-FFE \nis the most sensitive T1-weighted sequence for detecting punctate hyperintense \nlesions which may affect the brain of preterm neonates. \nbrain and the heart was performed. A vessel score, determined from the sum of \narteriosclerotic changes of all evaluated vessel divided by the number of vessels \nwith a range from 1, normal to 6, stenosis > 99%, was introduced and score's as-\nsociation with risk factors was assessed.\nResults: The mean MRI score was 1.51±0.18.The WB-MR angiography-based \nscore was significantly associated with the body mass index [BMI] (p=0.024) and \nAHT in combination with an elevated BMI (p=0.042). No significant associations \nwere found for age (p=0.706), sex (p=0.502), impaired fasting glucose (p=0.277), \nhyperlipidaemia (p=0.218) and CIMT (p=0.183). No patients with myocardial infarc-\ntion and 2 patients with cerebrovascular disease were found.\nConclusion: WB-MR angiography allows the detection of occult atherosclerotic \ndisease in asymptomatic patients with cardiovascular risk profile especially in \ncases of AHT and/or obesity.\n14:00 - 15:30 Room P \nPaediatric \nSS 1812 \nPaediatric brain \nModerators: \nM.A. Lucic; Sremska Kamenica/RS \nM. Stenzel; Jena/DE \nB‑1010 14:00\nUltra-low-dose CT of the inner ear with adaptive statistical image \nreconstruction in infants candidate to cochlear prosthesis \nimplantation: preliminary experience \nL. Faggioni, E. Neri, L. Bruschini, V. Seccia, S. Sellari Franceschini, \nC. Bartolozzi; Pisa/IT (lfaggioni@sirm.org) \nPurpose: To evaluate image quality and radiation dose of ultra-low-dose CT exami-\nnations of the inner ear performed using adaptive statistical image reconstruction \n(ASiR) in infants candidate to cochlear prosthesis implantation.\nMethods and Materials: We evaluated 24 infants (14 males, 10 females, age 4-29 \nmonths, mean 17 months) with sensorineural deafness who underwent CT of the \ninner ear before cochlear prosthesis implantation. Out of them, 13 were imaged \non a 128-row CT scanner (Discovery CT750 HD, General Electric, Milwaukee, WI) \nusing an ultra-low dose protocol (80 kV, 10 mA, 0.5s gantry rotation time) and a \nmodel-based iterative reconstruction algorithm (ASiR™), while in the remaining 11 \nCT had been performed on a 64-row scanner before the introduction of the 128-row \nCT equipment at our Institution, using a regular paediatric protocol (100 kV, 30 mA, \n0.5s gantry rotation time) with conventional filtered backprojection. Dose-length \nproduct (DLP) values were obtained from dose reports generated from the scanner \nat the end of each examination. Image quality was rated in blind by two radiologists \nusing a Likert scale (1=non-diagnostic through 5=excellent).\nResults: None of the examinations were rated as non-diagnostic. Image qual-\nity was comparable between the 128- and the 64-row CT group (4.45±0.63 vs \n4.51±0.56, respectively; p=0.31). DLP was significantly lower in the 128-row CT \ngroup (5.46±0.35 vs 25.69±0.83 mGy*cm, respectively; p < 0.001).\nConclusion: Compared with a regular paediatric protocol, ultra-low-dose CT of \nthe inner ear with ASiR allows for markedly reduced radiation dose with preserved \nimage quality.\nB‑1011 14:09\nTraumatic subdural hygromas in children between 0 and 2 years: a \nretrospective CT and MRI study \nM.L. Hahnemann1, A. Schmeling2, M. Schlamann1, M. Forsting1, H. Pfeiffer2, \nD. Wittschieber2; 1Essen/DE, 2Münster/DE \nPurpose: Non-accidental head injuries (NAHI) represent a leading cause of death \nin infants. In this context, the role of traumatic subdural hygromas (SDHy) as pos-\nsible acute or chronic finding in child abuse, especially in shaken-baby-syndrome, \nis not well understood and still a matter of debate. By modern imaging techniques, \nthe present study aimed to investigate the characteristics of SDHy.\nMethods and Materials: From the years 1999-2012, we retrospectively analysed \nthe images of all children between 0 and 2 years who were suspected to have a \ncraniocerebral injury and got an initial cranial computer tomography at the University \nHospital Essen. In cases where additional MR examinations existed these MR \nimages were also analysed. All skeletal and cerebral pathologies, demographic \ndata, and, if existing, related clinical anamneses and findings were recorded. All \nSDHy cases were classified according to both a classification system originally \n78\n\nScientific Sessions\nS3\nA\n C D E F G\nB\nMonday\nB‑1016 14:54\nEvaluation of metabolic changes within the normal appearing grey \nand white matters in children with growth hormone deficiency: \nmagnetic resonance spectroscopy and hormonal correlation \nJ. Bladowska, A. Zimny, A. Zacharzewska, T.M. Gondek, A. Banaszek, T. Żak, \nA. Noczyńska, M. Sąsiadek; Wroclaw/PL (asia.bladowska@gmail.com) \nPurpose: The pathogenesis of idiopathic growth hormone deficiency (GHD) in \nchildren, including possible cerebral metabolic alterations, remains unclear. The \naim of the study was to evaluate the metabolic changes within the normal appearing \nbrain in children with GHD using MR spectroscopy (MRS) and to correlate MRS \nmeasurements with hormonal concentrations.\nMethods and Materials: Seventy-one children with GHD (mean age 6.9 yrs) and \n11 healthy controls (mean age 8.4 yrs) were enrolled in the study. The MRS ex-\naminations were performed on 1.5 T scanner. Voxels were located in the posterior \ncingulate gyrus (PCG) and the left parietal white matter (PWM). The NAA/Cr, Cho/Cr \nand mI/Cr ratios were analysed in both groups. There were also evaluated correla-\ntions between the metabolite ratios and hormonal concentrations: growth hormone \n(GH) in two stimulation tests and GH during the night, as well as IGF-1 (insulin-\nlike growth factor) and IGFBP3 (insulin-like growth factor-binding protein) levels.\nResults: There was statistically significant (p < 0.05) decrease of the NAA/Cr ratios \nin PCG and PWM in children with GHD compared to the normal subjects. Other \nmetabolite ratios showed no significant differences. We found also statistically \nsignificant positive correlations between NAA/Cr ratio in PWM and IGFBP3 level, \nas well as GH concentration in stimulation test with glucagon.\nConclusion: The reduction of NAA/Cr ratios may suggest loss of neuronal activity \nwithin normal appearing grey and white matters in children with GHD, thus MRS \ncould be sensitive marker of cerebral metabolic disturbances associated with GHD \nand additional indicator for therapy with recombinant GH.\nB‑1017 15:03\nFunctional correlation of the spastic hemiplegic patients with MR findings \nK. Hayakawa, S. Yoshida, H. Tatekawa, Y. Yamori, T. Kanda, N. Yoshida, \nH. Hirota, M. Iwami, K. Nakamura; Kyoto/JP (hayakawakatsumi@hotmail.com) \nPurpose: The objective of this study is to correlate MR findings with their clinical \nfunction of children with congenital spastic hemiplegia.\nMethods and Materials: The subjects consisted of 20 male and 16 female patients \ndiagnosed as congenital spastic hemiplegia. Their ages at MR exam ranged from \n9 months to 27 years (mean age=5.5 years). Their MR lesion categories were \nclassified into the three types comprising periventricular white matter lesion (PV) \n(N=17), cerebral cortical and subcortical lesion (CSC) (N=11), malformation (Mal) \n(N=8). We evaluated the correlation between these three lesion categories and \nMR findings and their clinical functions.\nResults: The incidences of mental retardation were correlated with lesion cat-\negory (25% in PV, 18% in CSC and 100% in Mal, p=0.0004). Those of epilepsy \nwere correlated with lesion category (24% in PV, 64% in CSC and 88% in Mal, \np=0.007), cerebral hemiatrophy (p < 0.001), brainstem hemiatrophy (p=0.004) and \nventriculomegaly (p=0.04). Those of walking age by the 18 months were correlated \nwith lesion category (82% in PV, 70% in CSC and 13% in Mal, p=0.002). Those of \nschool performances (the percentage of handicapped class) were correlated with \nlesion category (14% in PV, 11% in CSC and 100% in Mal, p=0.001). Those of the \nipsilateral hand functions were not correlated with any parameter. The favourable \nclinical outcomes were correlated with the disease category of PV. The worse \nfunctional outcomes were correlated with the disease category of Mal.\nConclusion: The functional prognosis of spastic hemiplegia is significantly cor-\nrelated with three types of brain lesion on MRI. \nB‑1018 15:12\nDiffusion tensor tractography and fractional anisotropy in paediatric \ncortical abnormalities evaluation with TBSS analysis \nA. Ciccarone, I. D’Errico, M. Esposito, M. Mortilla, C. Fonda; Florence/IT \n(a.ciccarone@meyer.it) \nPurpose: The microstructure of tissues and white matter tracts in vivo may be \nstudied with DTI. The alterations involving the cerebral cortex associated in vari-\nous degrees with subcortical white matter abnormalities often affect the projection \nwhite matter tracts. The white matter in cortical brain abnormalities is evaluated \nwith diffusion tensor imaging (DTI) and Tract-Based Spatial Statistics (TBSS).\nMethods and Materials: 65 patients (1year-14year range) 39 males and 26 \nfemales) with different pattern of cortical alterations were studied. The DTI data \nwas processed in FSL. For each DTI exam, brain extraction only of images with \nb value equal to zero was performed so that a mask of entire brain was created. \nB‑1014 14:36\nPaediatric brain tumour classification by quantitative methods of \nmagnetic resonance imaging: combination of DTI, PWI and MRS \nS. Chełstowska, E. Jurkiewicz, I. Pakuła-Kościesza, K. Nowak, \nK. Malczyk, S. Rączkowska, M. Armata, J. Walecki; Warsaw/PL \n(sylwia.chelstowska@gmail.com) \nPurpose: Preoperative classification of brain tumours have limitations. Advanced \nimaging techniques, including diffusion tensor imaging (DTI), perfusion-weighted \nimaging (PWI), and magnetic resonance spectroscopy (MRS) can provide more \ninformation than conventional magnetic resonance imaging.\nMethods and Materials: We retrospectively evaluated 45 patients (27 girls and \n18 boys, aged 2-19 years old, mean age 13) with histologically proven 29 low- and \n16 high-grade gliomas. Standard MR oncological protocol includes MRS, DTI and \nPWI. 2D CSI sequence was used, with short (30 ms) and long (135 ms) TE and TR \n= 1500 ms. The U Mann-Whitney and Wilcoxon tests were employed to compare \napparent diffusion coefficient (ADC) and fractional anisotropy (FA) generated from \nDTI, cerebral blood volume (rCBV) generated from PWI and MRS data, keeping \nthe division for low and high grade tumours. p value of up to 0.05 was considered \nstatistically significant.\nResults: It was observed statistically significant difference for rCBV maps calculated \nas a ratio of tumour and normal tissue. Moreover NAA/Cr and Cho/Cr ratios were \nalso statistically significant for low- and high-grade tumours. ADC maps, FA data \nwere correlated with rCBV maps. Analysis of the metabolites ratios showed strong \ncorrelation between increased ratios of Cho/NAA and Cho/Cr and malignancy \nof the tumour. The presence of lactate and lipid was predominantly detected in \nhigh-grade gliomas.\nConclusion: Combination of PWI, DTI and MRS with conventional MR imaging \nincreases the accuracy of estimation of tumour malignancy. The best statistically \nsuitable parameter was found to be the perfusion rCBV maps. \nB‑1015 14:45\nPerfusion parameters of pilocytic astrocytomas: additional oddities \nof these tumours \nM. Martucci, S. Gaudino, E. Gangemi, R. Colantonio, G. Di Lella, C. Colosimo; \nRome/IT (matia.martucci@gmail.com) \nPurpose: To present perfusion data of 8 paediatric pilocytic astrocytomas (PA). To \ncompare these data with those of low-grade gliomas (LGG), high-grade gliomas \n(HGG) and metastases (Met). To discuss their clinical relevance.\nMethods and Materials: We reviewed conventional, diffusion and perfusion \n(DSC-GRE EPI) MRI of 8 paediatric PA. Maximum rCBV within enhancing and \nnon-enhancing tumours, minimum and mean percentage of signal recovery (PSR) \nwere obtained. PSR-Tmax was calculated as the percentage of signal intensity \nrecovered at the end of acquisition (time maximum). The increasing of the curve was \ndefined as the difference between PSRTmax and PSR. Results were compared with \nthose from 8 HGG, 8 LGG and 8 Mets. Data were presented as mean value±SD. \nStatistical comparisons were performed with Student's t and Mann-Whitney tests \n(p < 0.05 significant).\nResults: rCBV of PA (1.44±0.27) did not show significant differences between \nenhancing and non-enhancing regions and resulted slightly higher than LGG \n(1.2±0.35,). PSR was higher than 80% in PA and LGG; Mets showed lowest PSR \n(PSRmean 61.07±11.17). At Tmax PA showed highest PSR (> 90%), and in 5 \ncases the curve overshot the baseline. PA demonstrated increasing of the curve \ncloser to HGG than LGG.\nConclusion: Perfusion parameters should be considered additional oddities of \nPA: some perfusion behaviour resulted peculiar (curve crossing the baseline), \nother dissimilar to LGG (higher rCBV) and other similar to HGG (curve increasing \nin time). These characteristics may be explained by the peculiar vascular wall and \nthe size of interstitial space. \nAuthor Disclosures:\nC. Colosimo: Consultant; Research Consultant Bracco Group, Research \nConsultant Bayer AG.\n79\n\nScientific Sessions\nS38\n C A D E F\n G\nB\nis a major cause too (N=26). Spearman rho correlations between radiographer’s \ntime of experience and frequency of MRI exams repetitions were poor and not \nsignificant (r=0.141; p=0.297). The correlations between radiographer’s tiredness \nand frequency of MRI exams repetitions were negative, weak and not significant \n(r= -0.151; p=0.263).\nConclusion: The patients’ movement may disrupt the examination or degrade the \nimages with artefacts. The level of experience does not influence the repetitions \nof MRI exams, it seems that senior radiographers do not have improvements in \nperformance as it should be expected. It is recommendable to do training courses \nregularly to improve the performance and systematically evaluate. Several features \nwill need to be identified which would decrease the MRI exams repetitions.\nB‑1021 14:18\nFunctional mapping of the visual word form area with frequent \nwords of the Portuguese lexicon: an fMRI study \nC. Ferreira1, P. Martins2, G. Cunha1, N. Canário1, C. Nunes1, A.C. Miranda2, \nJ. Ribeiro2, S. Afonso2, M. Castelo-Branco1; 1Coimbra/PT, 2Aveiro/PT \n(c_dferreira@yahoo.com) \nPurpose: The visual word form area (VWFA), part of the fusiform gyrus in the \ntemporal lobe underlies word form encoding. Impairment of this region causes \nreading deficits, including alexia. The aim of this study is to functionally map VWFA \nat the individual subject level using frequent words of the Portuguese lexicon, to \ndevelop a paradigm potentially useful for clinical patients.\nMethods and Materials: Functional magnetic resonance images (fMRI) were \nacquired in from nine subjects. The visual paradigm used consisted of 13 blocks \n(30 seconds block duration): 7 baseline (checkerboard stimuli), 3 blocks of frequent \nwords and 3 of pseudo-words (40 words/pseudowords per block). General linear \nmodel analysis was performed using BrainVoyager Qx to identify brain regions \nencoding word form.\nResults: An area corresponding to VWFA could be mapped in both hemispheres \nin all subjects at a statistical threshold of 0.001, corrected for multiple comparisons. \nSeven of the cases had predominant activation in the left hemisphere, one has \nequivalent activations bilaterally and one subject has predominant activation in \nthe right hemisphere. The number of activated clusters was significantly larger \nin the left hemisphere at the group level (p = 0.015, Wilcoxon signed rank test).\nConclusion: Bilateral activation was replicated in VWFA in all subjects, with a clear \nleft hemispheric dominance demonstrating the robustness of the paradigm, making \nit potentially useful in a clinical setting, e.g. pre-surgical mapping.\nB‑1022 14:27\nA survey of the various methods and techniques employed in \nmyocardial stress testing \nK. Borg Grima1, L. Rainford2, P. Bezzina1, D. O’Leary2; 1Msida/MT, 2Dublin/IE \n(karen.borg-grima@um.edu.mt) \nPurpose: Literature suggests a range of pharmacological stress agents and \nradioactive tracers, together with a variety of defined protocols that may be used \nin conducting myocardial stress testing prior to cardiac scintigraphy imaging. An \nonline survey was performed to evaluate current practice.\nMethods and Materials: A survey was developed comprising of twelve ques-\ntions, by using ‘Survey Monkey’, which aimed to identify the variances present in \nconducting myocardial stress testing and in clinical protocol details if available. \nProfessional groups working in Nuclear Medicine, such as the medical-physics-\nengineering community and virtual radiopharmacy, were targeted. Access to the \nsurvey remained open for eight months. Forty-three members, including both radi-\nographers and medical physicists responded from across Europe and Australasia. \nSPSS was used to evaluate the results obtained, based on Chi-square tests and \ncomparisons between multiple responses.\nResults: The majority (72%) of the participants were from United Kingdom, 18% \nfrom other European countries and 9% from Australasia. In 39 centres pharmaco-\nlogical stress testing was performed either alone or in conjunction with exercise \nstress testing. The results indicated that 60% of the participants were aware of \nlocal stress test protocols; however, guidelines indicating which patients were not \nsuitable for pharmacological stress tests may require clarification.\nConclusion: Results suggest that for pharmacological stress testing there is a \nneed for increased awareness of protocols, and across all responders the need \nfor improved knowledge and understanding of local protocols was identified. This \ninitial survey justifies further research towards increase protocol compliance and \nstandardisation of practice during myocardial stress testing. \nTemplates were built taking into account the age of patients. Artefact movements \nand eddy current distortions were removed. Mean diffusivity (MD) and fractional \nanisotropy (FA) were quantified together to the three principal directions of diffusion \n(eigenvectors) with their own eigenvalues (tensor diagonalization). So analysis of \nsingle fibre orientation for each voxel with a bayesian algorithm was executed. \nVoxelwise statistical analysis of the FA, MD and axial diffusivity data was carried \nout using TBSS between focal cortical abnormalities sites and normal ones.\nResults: Different pattern of cortical organization and white matter projections are \nevidenced depending of lesional load and extension, site and age. In focal cortical \nabnormalities the TBSS analysis revealed significant differences (p < 0.05) between \naffected cortical sites and normal ones.\nConclusion: Different FA data were collected. The reductions of FA, the associated \nelevation of diffusivity in altered contiguous or distal area are evidenced. \n14:00 - 15:30 Room Q \nRadiographers \nSS 1814 \nChallenges of different imaging techniques \nModerators: \nH.H. Hjemly; Olso/NO \nJ. McNulty; Dublin/IE \nB‑1019 14:00\nOccupational exposition to electromagnetic fields in MR: \nunderstanding the discussion around the directive 2004/40/EC \nC.S.L. Santos, D.P. Rocha, M.M.C.P. Ribeiro; Lisbon/PT \n(catiasantos.rm@gmail.com) \nPurpose: The magnetic resonance imaging (MRI) uses the magnetic field ef-\nfects to its functioning. This study aimed to clarify the EMF Directive 2004/40/EC \ndiscussion which imposes limits to electromagnetic fields (EMF) regarding the \noccupational exposure.\nMethods and Materials: It was explored policy documents, regulations, guide-\nlines, laws and other official documents on this subject. To understand the reason \nof this controversy, the evidence of consequences from the EMF exposure over \nprofessionals was analysed. From the information obtained an online survey was \ndeveloped, with national and international coverage, towards 11 professional \ngroups considered involved in the controversy. The opinions were analysed by the \nforce field analysis diagram, through the Policymaker K4-health™ application to \nspeculate the influences, forces, power and strategies developed in this process.\nResults and Conclusion: From 50 respondents 62% do not know the ESR’s posi-\ntion, the Directive and its contents. 60% know the safety measures to apply in the \nMR room and report adverse events for lack of compliance with safety standards, \nbeing the levels of SAR, the most topic referred. They do not know the limits imposed \nand have no opinion about the Directive’s controversy (40%). The political impact \nis considered neutral (49%) against the negative clinical and economic impacts \n(54%) that falls over the equipment manufacturers (62%). The professional societies \nhave most decision, followed by physicists, doctors, manufacturers, government \ndecision-makers and health-managers. The manufacturers, radiographers and \nsupervisors have median influence, and the patients have weak influence over \nthis process. On this matter influences and pressure strategies over the European \nCommission and Council were recognised.\nB‑1020 14:09\nRadiographers perceptions of magnetic resonance imaging: a study \nof the causes that lead to the repetition of exams \nT.R. Filipe1, L.P.V. Ribeiro1, R.P.P. Almeida1, S.I. Rodrigues1, K.B. Azevedo1, \nC.A. Silva2, A.F.L. Abrantes1; 1Faro/PT, 2Évora/PT (tiagofilipe__@hotmail.com) \nPurpose: To know how often repetitions of MRI exams and sequences occur in \nradiology departments.\nMethods and Materials: A self-applied questionnaire was used as instrument and \nassigned to 57 radiographers who performed MRI exams to determine which were \nthe causes that lead to the repetition. The questionnaires were interpreted and \nstatistically analysed through descriptive statistics and Spearman’s rho correlation.\nResults: At a 95% confidence interval, the major results suggest that the patient’s \nmovement during the MRI exams is the main cause to repeat this exams (mean of \n3.88 on a 5-point Likert scale). However, there are causes related to the radiogra-\npher’s and the results showed that the introduction of wrong imaging parameters \n0\n\nScientific Sessions\nS38\nA\n C D E F G\nB\nMonday\nResults: The percentage of depression among MRI technologists included in \nour sample was found to be 25% which is considered to be much more than the \npercentage (10%) found among the dentists in USA (6.5%) and among community \npopulation in Saudi Arabia.\nConclusion: It was found that there is a strong relationship between the incident \nof depression among MRI technologists and the incident is higher among technolo-\ngists working for more than 5 years.\nB‑1026 15:03\nDevelopment and implementation of a synthetic data evaluation \nscenario for image fusion algorithms based on discrete wavelet \ntransform and principal component analysis \nV. Weiss; Wiener Neustadt/AT (volker.weiss@hotmail.com) \nPurpose: Successful image fusion reduces the amount of data without significantly \nreducing the amount of relevant information. This study aims to answer the question \nwhether the image fusion results were calculated successfully and what successful \nimage fusion actually means.\nMethods and Materials: The study presents two new approaches for the quan-\ntitative evaluation of image fusion schemes. It provides the development and \nimplementation of a synthetic data evaluation scenario for image fusion algorithms \nbased on discrete wavelet transform (DWT) and principal component analysis \n(PCA). Furthermore, it presents a medical application visualising and comparing \nfused axial CT slices, reconstructed from a CT volume data set with identical \nposition but calculated with different convolution kernels. The study provides a \nground truth data-based performance evaluation, as well as a comparison of the \nDWT and PCA to each other by computing and visualising significant differences \nin their performance. \nResults: In the present study, the DWT, compared to the PCA, turns out to be the \nmore powerful and therefore more suitable image fusion method, both qualitatively \nand quantitatively.\nConclusion: According to estimates of certain surveyed medical specialists, to \nwhom the results have been shown, a serious diagnosis solely on the basis of \nfused images is conceivable. The fused images would also be conceivable for \ndocumentation purposes and printouts for the referring physicians. Finally, storing \nfused image series instead of individual series would reduce the amount of memory \nrequired in long-term archives by half.\nB‑1027 15:12\nImage registration and fusion of CT and micro-CT of a sheep’s cochlea \nS. Leitner; Berndorf/AT \nPurpose: The sheep’s cochlea seems to be most similar to human ones. Hence, \nit is of great interest in the fields of developing cochlea implants and improving \noperation techniques of electrode implantation in ENT- (ear-nose-throat) surgery.\nMethods and Materials: For investigating the sheep as a suitable large animal \nmodel, data sets of high resolution micro-CT and CT of its cochlea were acquired. \nThe research on inner-ear diseases and ENT-surgery methods require image \nprocessing methods, such as image registration and image fusion. In this thesis, \nthe micro-CT data set was registered with the CT data set in a common coordinate \nsystem using two different software packages.\nResults: The registration was successful with both types of software. In order to \nevaluate the results visually, the fused multimodal data were represented by means \nof colour overlay as well as 3D rendering techniques.\nConclusion: The basis of image-registration of these two modalities was laid and \nserves as comparison between the image information of the high resolution micro-\nCT and the conventional CT in order to overcome an interpretation gap between \nthese two modalities. The appropriate 3D visualisation of the vestibule-cochlea \nsystem by means of the highest resolution image devices and medical image \nprocessing methods support fundamental research on macro-and micro-mechanical \nprocesses of hearing and basic understanding for developing therapeutic and \npreventive methods for ear diseases. \nB‑1023 14:36\nImportance of scout imaging in neuroradiologic studies \nD.C. Martin, S.H. Erbay, M. Hakky, K.D. Erbay, N. Erbay, D. Marrero; \nBurlington, MA/US (dann.martin@tufts.edu) \nPurpose: Scout images are essential in neuroradiology. Though these images may \nhave limited diagnostic quality, they visualise larger parts of the body. Therefore, \ncertain radiologic findings may be visualised only or largely in the scout images and \ntruly constitute unexpected radiologic findings (UF). Impact related to spinal location \nand imaging modality on to the incidence and distribution of UF remains unknown.\nMethods and Materials: 500 patients undergoing CT and 500 patients undergoing \nMRI of spinal column between 11/01/2009 and 1/31/2010 are included. UF reported \nin the original dictations are separated into 3 groups: scout only (I), scout+diagnostic \nimages (II) and diagnostic images (III) only. In addition to type of imaging and spinal \nlocation, locations and organ system of these findings are recorded.\nResults: There were 81 UF in CT and 113 in MRI group. In both groups, patients \nwith UF were significantly older than the ones without UF, with a slight female \npreponderance. Majority of UF in CT were seen in diagnostic images. UF seen \nonly in scout images of CT were exception although these were significant find-\nings. UF distribution in MRI was more even. Equal numbers of UF were seen in \ngroups II and III. Approximately 17% of UF seen in MRI were present in group I.\nConclusion: Scout images of neuroradiologic studies may harbour significant \nnumber UF. This is especially true in MRI where 17% of UF seen only in scout \nimages. Although UF seen solely in scout images of CT is rare, these are predomi-\nnantly significant findings. \nB‑1024 14:45\nComparison of a 12-channel- with a 32-channel head coil using SNR \nmeasurements \nC. Vandulek, D. Kaczur, E. Vinczen, I. Repa; Kaposvár/HU \n(cvandulek@gmail.com) \nPurpose: One of the key attributes characterising the quality of an MRI head coil \nis the signal-to-noise ratio (SNR). The purpose of this study was to compare a \n12-channel- with 32-channel head coil using standardised SNR measurements.\nMethods and Materials: The measurements were performed on a 1.5 T MRI \nscanner. The SNR measurements were performed on the coils’ phantoms and on \nvolunteers. The SNR protocol consisted of axial T1 FSE and T2 FSE measure-\nments. Analysis of the SNR calculations was performed using ROI’s positioned in \nthe phantoms and the brain tissue of the volunteers.\nResults: The results of the SNR measurements of the phantoms show that the \nSNR of the 32-channel coil is double that of the 12-channel head coil. However, \nthe SNR of the volunteers showed only a 65% increase of SNR with the T1 FSE \nmeasurement, and a 30% increase with the T2 FSE on the 32-channel coil. There \nwere no artefacts observed on either measurements of the phantoms and human \nvolunteers.\nConclusion: This study confirmed a difference of the SNR between the 12- and \n32-channel head coil. While the phantom measurements showed a twofold increase \nof SNR between the two coils, this rate was not confirmed on the human volunteers. \nThe results of this study amplify the advantage of using the 32-channel coil for \nneuroradiological examinations (e.g. fMRI, MRS), whereas the 12-channel coil is \nsufficient for routine brain examinations. \nB‑1025 14:54\nPsychological effect of chronic exposure to high magnetic field on \nMRI technologists \nN.M. Mishah, W. Hamed; Jeddah/SA (nabeel747@hotmail.com) \nPurpose: The purpose of this study is to measure the incident of depression among \nMRI technologists since they are chronically exposed to high magnetic fields that \nmay carry occupational hazard on central nervous system and on their brain chemi-\ncals. This may cause a long-term psychological side effects such as depression.\nMethods and Materials: The data and the statistical information of this project \nwere based on BECK Depression Inventory BDI, 1996 version which is used \nby healthcare professionals as depression screening tool. The questionnaire of \ndepression screening tool was delivered to all MRI technologists working in major \nhospitals within large cities in Makkah region. The total completed questionnaire \nreceived was 45 and only 40 was accepted with a rejection rate of 11.11%. The \nreceived data were analysed using a computer-aided statistical tool then the per-\ncentage of depression found among MRI technologists included in our study will be \ncompared to previous study conducted on dentists in USA and among community \npopulation in Saudi Arabia.\n1\n\nScientific Sessions\nS38\n C A D E F\n G\nB\nB‑1030 14:09\nDynamic enhancement pattern of Gd-EOB-DTPA compared to \ngadobutrol in patients with HCC \nS. Kinner, C. Kloeters, L. Umutlu, N. Sippel, T.C. Lauenstein; \nEssen/DE (Sonja.Kinner@uni-due.de) \nPurpose: Gd-EOB-DTPA as liver-specific contrast agents comprises high r1 and \nr2 values and seems to be well suited for dynamic MR imaging in addition to liver-\nspecific characteristics. Aim of this study was to compare Gd-EOB-DTPA to the \nextracellular contrast compound gadobutrol at dynamic abdominal MRI.\nMethods and Materials: Dynamic contrast-enhanced liver imaging was performed \nin 42 patients with HCC with a T1-weighed volume interpolated breath-hold exami-\nnation. Gd-EOB-DTPA (0.25 mmol/ml) and gadobutrol (1 mmol/ml) were injected \nbody weight adapted using care bolus technique and a power injector (2 ml/s) on \ntwo consecutive days. SNR values of abdominal vessels and CNR values of HCC \nlesions during arterial phase were evaluated. For statistical evaluation a Wilcoxon-\nsigned-rank-test was used.\nResults: All MR images were of diagnostic image quality. SNR of aorta in gado-\nbutrol-enhanced images amounted to 106±15, with Gd-EOB-DTPA to 77±14 (p = \n0.12). The portal vein (pv) and vena cava (vc) exhibited similar SNR values in the \nportalvenous/venous contrast phase (pv: SNR gadobutrol = 68±6, SNR Gd-EOB-\nDTPA = 63±3; p = 0.6; vc: SNR gadobutrol = 59±4, SNR Gd-EOB-DTPA = 52±3; p = \n0.64). CNR values of HCC lesions amounted to 27±4 for Gd-EOB-DTPA, whereas \nwith gadobutrol CNR = 41±6 (p = 0.14).\nConclusion: Despite the higher r1 value of Gd-EOB-DTPA, SNR and CNR values \nfor gadobutrol were higher. This might be due to the higher gadolinium concentra-\ntion. To achieve best image quality, the agent used in liver MR should be adapted \nto the clinical question: Gadobutrol should be used for vascular analysis, whereas \nGd-EOB-DTPA should be used for lesion characterisation. \nB‑1031 14:18\nGadoxetic acid-enhanced hepatobiliary phase MRI and high b-value \ndiffusion-weighted imaging (DWI) in the differential diagnosis \nbetween benign to malignant liver lesions \nP. Arcuri, G. Fodero, S. Roccia, S. Molica, V. Arcuri; Catanzaro/IT \n(arppaolo@alice.it) \nPurpose: The aim of our experience was to evaluate the value of gadoxetic acid-\nenhanced hepatobiliary phase imaging and high b-value DWI in the differential \ndiagnosis between benign and malignant liver lesions.\nMethods and Materials: Twenty-four malignant liver lesions (fourteen small HCC \nand ten metastatic lesions) and twelve benign lesions (five FNH, four adenomas \nand three regenerative nodules in cirrhotic liver) were studied. A retrospective evalu-\nation was made. The qualitative analysis was obtained by the evaluation of two \nradiologists of the lesions’s signal intensity compared with that of the surrounding \nliver parenchyma on hepatobiliary phase images and DWI (b-value=600s/mm2). \nThe contrast-to-noise ratio (CNR) and relative contrast enhancement of lesions \non hepatobiliary phase images and the apparent diffusion coefficient (ADC) val-\nues were assessed (by ROIs) for quantitative analysis. Statistical analysis was \nperformed by the Mann-Whitney U test. P value less than 0.05 was considered \nstatistically significant.\nResults: In the qualitative analysis, nineteen malignant lesions (79%) and three \nbenign lesions (25%) were hypointense on hepatobiliary phase images; five malig-\nnant lesions (21%) and nine benign lesions (75%) were iso- or hyperintense in the \nsame phase. Twenty malignant lesions (83%) and four benign lesions (33%) were \nhyperintense in DWI; four malignant lesions (17%) and nine benign lesions (75%) \nwere iso-hypointense in DWI. In the quantitative analysis the mean relative contrast \nenhancement ratio of the malignant lesions was higher than that of benign lesions.\nConclusion: Hypointensity on gadoxetic acid-enhanced hepatobiliary phase im-\nages and hyperintensity on DWI (b-factor=600 s/mm2) suggest malignant lesions \nrather than benign hepatocellular nodules.\nB‑1032 14:27\nGadoxetic acid-enhanced MRI of the liver: correlation between \nGadoxetic acid uptake and serum hepatic enzymes levels \nE. Talakic, H. Schoellnast, T. Wimmer, J. Steiner, F. Quehenberger, U. Reiter; \nGraz/AT \nPurpose: To assess the correlation between enhancement of the liver during the \ndynamic phases and the hepatobiliary phase and serum hepatic enzyme levels in \nGadoxetic acid-enhanced MRI of the liver.\nMethods and Materials: 75 patients who underwent gadoxetic acid-enhanced MRI \nof the liver were enrolled. Images were obtained before contrast injection, during the \nB‑1028 15:21\nEvaluation of image quality optimisation using VGC and ordinal \nregression analysis \nF. Zarb1, M.F. McEntee2, S. Foley3, L. Rainford3; 1Msida/MT, 2Sydney/AU, \n3Dublin/IE (francis.zarb@um.edu.mt) \nPurpose: To evaluate observer performance involving absolute visual grading \nanalysis of image criteria using visual grading characteristic curves (VGC) and \nordinal regression analysis during CT examination optimisation.\nMethods and Materials: Images obtained from current and optimised head CT \nprotocols (n=120) from 4 suites were presented using ViewDex on Advantage \nWorkstations for evaluation by radiologists (n=6), grading the visibility of anatomical \nstructures sourced from the European guidelines on quality criteria for CT.\nResults: VGC analysis in terms of the area under the curve showed no significant \ndifferences (p> 0.05) from the 0.5 threshold value, indicating similar image quality \nbetween data sets. Ordinal regression analysis indicated no significant (p> 0.05) \nchange in image quality in suites 1 and 3 but discriminated between the data sets \nfor suite 2 and 4 (p < 0.05). Analysis on individual criteria indicated a difference \n(p < 0.05) in image quality between the protocols for all criteria in suite 2 but no \ndifference (p> 0.05) in suite 4. Discussion: VGC curves demonstrated general \ntrends between protocols. Findings of ordinal regression analysis not only indicate \nsignificant differences in image quality but also identify specific anatomical criteria \ncontributing to those differences. The importance of selecting the most appropriate \nmethod of analysis in optimisation techniques is highlighted as findings influence \nprotocol implementation based on clinical requirements.\nConclusion: An overall 15% radiation dose saving was achieved as a result of \noptimisation of the head CT protocols. Optimised protocols were implemented \nfor initial diagnosis for three suites and only for follow -up cases excluding initial \ndiagnosis for the remaining suite. \n14:00 - 15:30 Room Z \nContrast Media \nSS 1806 \nFunctional studies and safety \nModerators: \nT. Gleeson; Wexford/UK\nE.M. Merkle; Basle/CH \nB‑1029 14:00\nMeasuring hepatic functional reserve using low temporal resolution \nGd-EOB-DTPA dynamic contrast-enhanced MRI: a comparison study \nwith galactosyl-human serum albumin scintigraphy and indocyanine \ngreen retention \nK. Saito1, J.R. Ledsam2, S.P. Sourbron2, T. Hashimoto1, Y. Araki1, S. Akata1, \nK. Tokuuye1; 1T okyo/JP, 2Leeds/UK (um07jrl@leeds.ac.uk) \nPurpose: To investigate if tracer kinetic modelling of low temporal resolution \ndynamic contrast-enhanced (DCE) MRI with gadoxetic acid (Gd-EOB-DTPA) has \nthe potential to replace technetium 99m galactosyl human serum albumin (GSA) \nscintigraphy and indocyanine green (ICG) retention for the measurement of liver \nfunctional reserve.\nMethods and Methods: 28 patients (18 males, 10 females; mean age 67y) awaiting \nliver resection for various cancers underwent DCEMRI, GSA-scintigraphy and ICG \nas part of routine pre-operative evaluation. Examinations were conducted within \na single month. Underlying liver disease was present in 4 patients. The Gd-EOB-\nDTPA MRI sequence acquired 5 images: pre-contrast, double arterial phase, portal \nphase, and 4 minutes after injection. GSA-scintigraphy images were acquired every \n10s following contrast injection. Contrast uptake rate (UR) and extracellular volume \n(Ve) were calculated from DCE-MRI, and the ratio of GSA radioactivity of liver to \nheart-plus-liver and percent of contrast uptake at 15 minutes (LHL15 and LU15, \nrespectively) from GSA-scintigraphy. ICG retention at 15 minutes, Child-Pugh cir-\nrhosis score (CPS) and post-operative Inuyama fibrosis biopsy criteria were also \nrecorded. Statistical analysis was with SPSS17.\nResults: Significant correlations were obtained for: UR and LHL15, LU15 and \nICG15 (all 0.4-0.6, p < 0.05); UR and CPS (-0.642, p < 0.001); Ve and Inuyama \n(0.440, p=0.041); ICG15 and UR, LHL15, LU15, CPS and Inuyama (all 0.4-0.6, p \n< 0.05); LU15/LHL15 with Inuyama (-0.65, p=0.001) and CPS (-0.492 and -0.618, \nrespectively, p < 0.01).\nConclusion: Measures of liver function obtained by routine Gd-EOB-DTPA \nDCEMRI with tracer kinetic modelling may provide a suitable alternative for evalu-\nation of liver functional reserve.\n2\n\nScientific Sessions\nS38\nA\n C D E F G\nB\nMonday\ngroup were higher than in group-1 and-4, but significantly lower than the scores \nof the group-2 (p < 0.05).\nConclusion: NAC could be useful to prevent the renal tissue from CIN, especially \nin high-risk patients.\nB‑1035 14:54\nEvaluation of enhancement properties of gadolinium-labelled \nnanoparticles for contrast-enhanced MRI in rats with experimental \nliver tumours at 9.4 T \nP. Fries1, D. Morr1, A. Müller1, F. Lux2, O. Tillement2, J. Palm1, G. Schneider1, \nR. Seidel1, A. Buecker1; 1Homburg/DE, 2Lyon/FR (drpeterfries@googlemail.com) \nPurpose: To compare a Gd-labelled nanoparticle (AGulX) with a standard extracel-\nlular Gd-based contrast agent (Gd-DOTA) for dynamic contrast-enhanced MRI at \n9.4T in rats with hepatic colorectal cancer metastases.\nMethods and Materials: 10 rats with hepatic colorectal cancer metastases were \nsubjected to MRI (9.4T, Bruker, Germany) acquiring T1w retrospectively self-gated \nFLASH sequences (TR/TE=45/2.5 ms, FA= 45°, TA=1:23 min, FOV= 5.12x5.12 \ncm2, matrix=256x256) before and at 10 consecutive time points after contrast \ninjection. First, each animal received 0.1 mmol/kg BW Gd-DOTA intravenously. Two \ndays later, AGulX was applied at 0.01 mmol/kg BW (representing equal Gd-doses). \nSNR of normal liver tissue (SNRliver) and tumour (SNRtumour), CNR and lesion en-\nhancement (LE) were calculated based on ROI measurements. Statistical analyses \nincluded paired t-tests and Wilcoxon matched-pairs signed-rank tests (p < 0.05). \nHistopathologic evaluation confirmed the presence of metastases in all animals.\nResults: Mean SNRliver (±SD): Gd-DOTA 14.5 (±0.7)/AGulX 23.3 (±1.7), SN-\nRtumour: Gd-DOTA 18.0 (±1.1)/AGulX 30.60 (±2.9), CNR: Gd-DOTA 3.5 (±0.5)/\nAGulX 6.7 (±1.2) and LE: Gd-DOTA 3.0 (±0.6)/AGulX 15.1 (±2.9) were each \nsignificantly higher for AGulX for all time points and groups (p=0.001-0.04). Both \ncompounds demonstrated comparable kinetics with an early peak followed by a \nwashout without plateau.\nConclusion: The Gd-labelled nanoparticle provides higher SNR, CNR and LE \nat 9.4T as compared to the standard extracellular compound for equal doses of \napplied Gd. This is most likely based on the complex structure of AGulX and the \nsubsequent increased interaction with protons leading to a higher relaxivity. Despite \nthe increased molecular size, AGulX shows perfusion-kinetics comparable to the \nextracellular agent during the first 20 min after application. \nAuthor Disclosures:\nA. Buecker: Research/Grant Support; German Ministry of Education and \nResearch (Grant Number: 0314101).\nB‑1036 15:03\nRegorafenib monotherapy effects on experimental human \ncolon carcinoma xenografts monitored by DCE-CT with \nimmunohistochemical validation \nP.M. Kazmierczak, H. Hirner, L. Havla, M. Schneider, \nO. Dietrich, C. Bruns, M.F. Reiser, K. Nikolaou, C.C. Cyran; \nMunich/DE (Philipp.Kazmierczak@med.uni-muenchen.de) \nPurpose: To investigate dynamic contrast-enhanced computed tomography (DCE-\nCT) for monitoring the effects of regorafenib on experimental colon carcinomas \nin rats by quantitative assessments of tumour microcirculation parameters with \nimmunohistochemical validation.\nMethods and Materials: Colon carcinoma xenografts (HT-29) implanted sub-\ncutaneously in female athymic rats (n=25) were imaged at baseline and after a \none-week treatment with regorafenib by DCE-CT (128 slice dual source CT). The \ntherapy group (n=13) received regorafenib daily (10 mg/kg bodyweight) via gavage. \nQuantitative parameters of tumour microcirculation (plasma flow, mL/100 mL/min), \nendothelial permeability (PS, mL/100 mL/min), and tumour vascularity (plasma vol-\nume, %) were calculated using a 2-compartment uptake model. DCE-CT parameters \nwere validated with immunohistochemical assessments of tumour microvascular \ndensity (CD-31), tumour cell apoptosis (TUNEL), and proliferation (Ki-67).\nResults: Regorafenib significantly (p < 0.05) suppressed tumour perfusion \n(12.8±2.3 to 8.8±2.9 ml/100 ml/min) and tumour vascularity (15.7±5.3 to 5.5±3.5 \nml/100 ml/min). Significantly lower microvascular density was observed in the \ntherapy group (CD-31; 48±10 vs. 113±25, p < 0.05). In regorafenib-treated tumors, \nsignificantly more apoptotic cells (TUNEL; 11,844±2,927 vs. 5,097±3,463, p < 0.05) \nand significantly less proliferating cells (Ki-67; 4,277±1017 vs. 4,841±1,593, p < \n0.05) were observed. DCE-CT tumour perfusion and tumour vascularity correlated \nsignificantly (p < 0.05) with microvascular density (CD -31; r=0.84 and 0.66) and \ninversely with apoptosis (TUNEL; r=-0.66 and -0.71).\narterial phase, portal venous phase, hepatovenous phase, equilibrium phase, and \nhepatobiliary phase which was 20 minutes after Gadoxetic administration. A test \nbolus was used to optimise the contrast injection protocol. Signal intensity of the liver \nparenchyma in all phases was defined using region-of-interest (ROI) measurements \nfor enhancement calculation. Serum hepatic enzyme levels (bilirubin; cholineste-\nrase, CHE; aspartat-aminotransferase, AST; alanine-aminotransferase, ALT; \ngamma-glutamyl-transpeptidase, GGT; alkaline phosphatase, AP) were available \nin all patients. Spearman correlation test was used to test the correlation between \nliver enhancement during the different phases and serum hepatic enzyme levels.\nResults: At late time points after contrast injection all serum hepatic enzymes were \ncorrelated with liver enhancement. Bilirubin and CHE showed stronger correlations \nthan the other serum hepatic enzymes and they became correlated at earlier time \npoints. The strongest correlation was observed between bilirubin and enhancement \nduring the hepatobiliary phase and between CHE and enhancement during the \nhepatobiliary phase. Bilirubin showed negative and CHE showed positive correla-\ntion. The Spearman correlation coefficient was -0.64 for bilirubin and 0.61 for CHE.\nConclusion: In gadoxetic acid-enhanced MRI of the liver gadoxetic uptake during \nthe hepatobiliary phase is strongest correlated with bilirubin and CHE serum levels, \nwhereas the other serum hepatic enzymes show weak or moderate correlations. \nB‑1033 14:36\nMRCP using hepatospecific contrast media (GD-EOB-DTPA) in biliary leaks \nR. Faletti, M. Fronda, F. Barisone, C. Bogetti, A. Dominguez, A. Rapellino, \nL. Marchisio, P. Fonio, G. Gandini; Turin/IT \nPurpose: Aim of the study is to evaluate the use of MRCP using hepatospecific con-\ntrast media (GD-EOB-DTBA) to confirm biliary leak suspect and treatment planning.\nMethods and Materials: 13 consecutive patients (7 males, 6 females - average age \n64 years), during 13 months (April 2011 to May 2012) underwent MRCP study using \nGD-EOB-DTBA due to clinical suspect of biliary leak. Using an 1.5 T MRI scanner, \nT1-weighted 3D GRE pulse sequences before and in hepatospecific phase, after \nGD-EOB-DTBA injection, were performed. All patients with biliary leak underwent \nendoscopic, interventional radiology (IR) or surgical approach for treatment.\nResults: Biliary leak was clinically suspected in 13 patients and underwent ab-\ndominal surgery (7 laparoscopic cholecystectomy, 5 various hepatic resections, \n1 resection of a pancreatic-duodenal mass) after 33 days (AV; range 4 to 107). \nIn 11/13 biliary leak was found at 44 minutes (AV; range 20 to 76 minutes) from \nGD-EOB-DTBA injection, from intrahepatic ducts (6/11) site, cystic duct stump \n(2/11), both intrahepatic and principal biliary duct (2/11) and from a biliodigestive \nanastomosis (1/11). Biliary leak was confirmed and successfully treated by percu-\ntaneous transhepatic cholangiography (8/11), endoscopic approach (1/11), IR and \nendoscopic “rendez-vouz” technique (1/11) and by surgical laparotomy (1/11). In \n2/13 patients, no biliary leak was found and only clinical monitoring was performed, \nwith good outcome. Any adverse reaction or technical problem occurred during \nthe MRCP examination.\nConclusion: MRCP with GD-EOB-DTBA is an high sensitivity, safe and fast ex-\namination to confirm the suspect and to locate precisely a biliary leak, concurring \nbest planning for treatment.\nB‑1034 14:45\nN-acetylcysteine for the prevention of contrast-induced nephropathy \nin rats \nM.F. İnci1, I. Şalk2, O. Solak2, Ü. Vurdem3, R. İnci1; 1Kahramanmaraş/TR, \n2Sivas/TR, 3Kayseri/TR (drfatihinci@gmail.com) \nPurpose: To date, there is no effective treatment of contrast-induced nephropathy \n(CIN). N-acetylcystein (NAC) has yielded some promising results recently in the \nprevention of CIN. In this study, the structural effects of NAC on CIN were analysed.\nMethods and Materials: Forty adult Wistar albino male rats were randomly al-\nlocated to four groups. The first group was the control group (n=9) which received \nonly distilled water; second group was the contrast group (n=10) which received \nCM; the third group was the contrast plus NAC group (n=8) which received CM and \nwas treated with NAC; and the last group was NAC group (n=10) which received \nonly NAC. At the end of the 3 rd day, the right and left kidneys were removed and \nreserved for histopathological examination. All tissue sections were examined with \nlight microscope looking for histopathological changes by the same experienced \npathologist, without knowledge of the prior treatment. Histopathological examination \nwas conducted in a blinded fashion, and glomerular injury scores, arteriolar injury \nscores and tubulointerstitial injury scores were calculated.\nResults: There was a significant difference among the scores of glomerular injury, \narteriolar injury and tubulointerstitial injury in all groups (p < 0.05).The scores of \nglomerular, arteriolar and tubulointerstitial injury of the group-1 and group-4 were \nnot significantly different from each other (p < 0.05). Renal injury scores in group-3 \n3\n\nScientific Sessions\nS38\n C A D E F\n G\nB\nConclusion: Regorafenib significantly suppressed tumour perfusion and vascular-\nity quantified by DCE-CT in experimental colon carcinomas in rats with good to \nmoderate correlations to an immunohistochemical gold standard. Tumour response \nbiomarkers assessed by DCE-CT might be a promising future approach to a more \npersonalised and targeted cancer therapy. \nAuthor Disclosures:\nK. Nikolaou: Research/Grant Support; Bayer Healthcare, Germany. \nC.C. Cyran: Research/Grant Support; Bayer Healthcare, Germany.\nB‑1037 15:12\nContrast-induced nephropathy in patients undergoing intravenous \ncontrast-enhanced computed tomography and the relationship with \nrisk factors: a meta-analysis \nS.I. Moos, J. Stoker, S. Bipat; Amsterdam/NL (s.i.moos@amc.uva.nl) \nPurpose: To summarise the incidence of contrast-induced nephropathy (CIN) \nand to study associations between CIN and risk factors in patients undergoing \nintravenous contrast-enhanced computed tomography (CECT).\nMethods and Materials: We searched the MEDLINE, EMBASE and Cochrane \ndatabases from 2002 till July 2012. Two reviewers checked inclusion criteria and \nextracted data. Mean CIN incidence and associations between risk factors and \nCIN were pooled by random-effect approach.\nResults: Twenty-three articles with 20,000 patients (mean age 64.5 years, mean \neGFR at baseline 55.17 mL/min) were included. CIN was defined as absolute or \nrelative (44.2 µmol/L/> 25%) serum creatinine increase, mostly within 72 hours. \nAll studies included a high proportion of patients with risk factors; chronic kidney \ndisease (CKD) in 52% of all patients, diabetes mellitus (DM) in 14%, hypertension \n(HT) in 54% and congestive heart failure (CHF) in 21%. The mean incidence of \nCIN was 3.7% (95% CI: 2.5%-5.6%). Data analysis showed an increased risk for \nCIN in the presence of DM ((odds ratio 1.73 (95% CI: 1.07-2.82), p=0.03)) and \nCKD (2.52 (95% CI: 1.56-4.08), p=0.0002). HT and CHF were not associated with \nan increased risk (p=0.07, p=0.19).\nConclusion: The mean incidence of CIN after CECT was 3.7% and is associated \nwith DM and CKD. The incidence of CIN is mostly reported in studies with a high \nproportion of patients with risk factors. Therefore, the reported CIN incidence and \nassociated risk factors for CECT might be overestimated compared to the CIN \nincidence in a general population undergoing CECT.\nB‑1038 15:21\nRenal MR angiography at 7 Tesla: how much gadolinium do we need? \nL. Umutlu, A. Fischer, M. Forsting, M.E. Ladd, S. Maderwald, O. Kraff, \nT.C. Lauenstein; Essen/DE (Lale.Umutlu@uk-essen.de) \nPurpose: To determine whether contrast agent (CA) dose reduction to one-half \nand one-quarter of the standardised dosage allows for preserved image quality of \nrenal MR angiography at 7T.\nMethods and Materials: MR examinations were performed in 6 healthy subjects \non a 7T MR system (Magnetom 7T), utilising a custom-built 8-channel RF body \ncoil. Dynamic 3D FLASH data sets were obtained pre contrast and 20sec after \nthe application of contrast agent. Examinations were performed at three different \ntime points for injection of three dosages of CA (Gadobutrol, Bayer Healthcare): (1) \n0.1 mmol/kg body weight (BW), (2) 0.05 mmol/kg BW and (3) 0.025 mmol/kg BW. \nContrast ratios (CR) were measured pre and post contrast in the aorta and both \nrenal arteries in correlation to adjacent psoas major muscle. Qualitative analysis \nwith regard to delineation of the pre-contrast and post-contrast renal arterial vas-\nculature was performed by two radiologists using a five-point-scale (5=excellent \nto 1= non diagnostic).\nResults: Non-enhanced T1w MRI provided an inherently high signal intensity of \nvasculature, yielding a good overall pre-contrast arterial delineation (mean 3.65). \nThe application of contrast agent showed improved vessel delineation in qualita-\ntive and quantitative analysis for all three dosages, yielding comparable results in \nsubjective ratings of qualitative analysis (mean0.025Gd 4.55; mean0.05Gd 4.50; \nmean0.1Gd mean 4.60). Quantitative analysis of contrast ratios showed only minor \nincrease of mean values with increasing Gadolinium dosage (mean0.025Gd 0.08; \nmean0.05Gd 0.15; mean0.1Gd mean 0.18).\nConclusion: 7T CE-MRA allows for a significant dose reduction to one-quarter \nwhile maintaining high image quality. \n4","source_license":"CC-BY-4.0","license_restricted":false}