{"paper_id":"05b82a55-abb1-4764-8be5-583e27018c47","body_text":"S1\nAbstracts\nA\nB\nC\nD\nE\nF\nG\nPostgraduate Educational \nProgramme\nScientific Sessions \nScientific and Educational \nExhibits 325\n127\n327\n337\n373\n411\n3\nSatellite Symposia\nAuthors’ Index\nList of Authors & \nCo-Authors\nList of Moderators\nSession numbers are prefixed by CC, E3, EF, EM, HL, MC, MS, NH, OL, \nPC, RC, SF, SA, TF\nPresentation numbers are prefixed by the letter A\nSessions and abstracts are listed by days.\nPresentations for which the author(s) have submitted additional material and images to \nEPOS™ are marked with the  icon.\nSession numbers are prefixed by  SS\nPresentation numbers are prefixed by the letter B\nSessions and abstracts are listed by days.\nPresentations for which the author(s) have submitted additional material and images to \nEPOS™ are marked with the  icon.\nAbstracts and authors of EPOS™ presentations no longer appear in the Book of Abstracts. \nEach full EPOS™ presentation can instead be cited by a Digital Object Identifier (DOI) which \nappears with the presentation at www.myESR.org/EPOS\nPresentation numbers are prefixed by the letter D\nThis part lists all first authors (including co-authors) and presentation titles, followed by the \nsession number/topic header/identifyer in brackets and the presentation number. \nThis part lists all authors and co-authors followed by the presentation number in italic letters.\nThis part lists all moderators followed by the session number in italic letters.\nDOI 10.1007/ s -0 -0 -\nInsights Imaging\n13244 011 78 3\n\nThe ECR 2011 Book of Abstracts is a supplement to Insights into Imaging.\nISSN: 1869-4101\n© ESR – European Society of Radiology, 2011\nAll articles published herein are protected by copyright, which covers the exclusive rights to reproduce and distribute the articles, as well all translation rights. No material \npublished herein may be reproduced or stored electronically without first obtaining written permission from the publisher. The use of general descriptive names, trade names, \ntrademarks, etc., in this publication, even if not specifically identified, does not imply that these names are not protected by the relevant laws and regulations.\nWhile the advice and information in this publication is believed to be true and accurate at the date of publishing, neither the authors, the editors, nor the publisher can accept any \nlegal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.\nESR accepts no responsibility for errors or misprints.\nThe Book of Abstracts is printed on environment-friendly paper.\nPrinted by Angerer & Goeschl, Vienna, February 2011\n\nS3\nA\nPostgraduate \nEducational Programme\nCategorical Courses (CC)\nEFOMP Workshop (EF)\nENCITE Session\nESR/EANM Joint Pre-Congress Workshop \nESR meets Sessions (EM)\nEuroAIM Session\nEuropean Excellence in Education (E³)\nGuest Lecture (GL)\nHonorary Lectures (HL)\nMini Courses (MC)\nNew Horizons Sessions (NH)\nOpening Lecture (OL)\nProfessional Challenges Sessions (PC)\nRefresher Courses (RC)\nRTF - Radiology Trainees Forum (TF)\nSpecial Focus Sessions (SF)\nState of the Art Symposia (SA) \nStandards and Audit Session\nWednesday. ...................5\nThursday.....................11\nFriday. .........................23\nSaturday. .....................51\nSunday. .......................79\nMonday..................... 115\n\nPostgraduate.Educational.Programme\nS4\n A B C D E F G H\n\n\nWednesday\nPostgraduate.Educational.Programme\nA\n S5\nCB D E F G H\nWednesday,.March.2\n\n09:15 - 09:45 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 1a \nInstrumentation and technique \nA‑001\t 09:00 \nWelcome on behalf of the ESR \nÉ. Breatnach; Dublin/IE \nA‑002\t 09:07 \nWelcome on behalf of the EANM \nP. Bourguet; Rennes/FR \nA‑003\t 09:15 \nRadiology perspective \nT.R.C. Johnson; Munich/DE \nFor PET-CT, the CT exam is generally performed as standard whole-body exam \nfrom the base of the skull to the upper thighs. Standard parameters are non-ionic \niodinated intravenous contrast material at 0.5 g/kg bodyweight with a venous delay \nof 70 seconds after injection and 3-5 mm thick continuous axial reconstructions with \nmedium soft convolution kernels. CT images frequently contain important diagnostic \ninformation beyond mere ‘anatomic landmarking’, so generally a diagnostic, contrast \nenhanced normal-dose CT should be performed except if a recent diagnostic CT \nscan is available for fusion. Then, a low-dose CT is sufficient for attenuation cor-\nrection. A difference from routine CT protocols is the expiratory position to match \nthe respiratory position of PET acquisition. Also, negative oral contrast material \nshould be applied and the whole body should be included in the field of view to \nallow effective attenuation correction of PET images. Diagnostic reading has to \ninclude lung, soft tissue and bone windows. Optimally, the assessment should \nbe performed by one reader evaluating CT and PET images simultaneously on \nmultiplanar reformats. \nLearning Objectives:\n1. To get acquainted with standard CT examination parameters for oncological \nimaging including the requirements for an effective attenuation correction.\n2. To see the diagnostic value of CT beyond ‘anatomical landmarking’.\n3. To learn effective ways to interpret PET-CT examinations.\nA‑004\t 09:30 \nNuclear medicine perspective \nT. Beyer; Zurich/CH \nCombined PET/CT images were first proposed as early 1984. Since 1998 PET/\nCT became available for broader clinical testing. Since its commercial introduction \nin 2001 more than 5’000 PET/CT systems were installed worldwide. PET/CT is a \nlogical and technical consequence of early, manual or semi-automatic efforts to \nalign functional and anatomical images for easier and improved diagnosis. PET, or \npositron emission tomography, is an emission tomographic imaging method based \non the application of radioactively labelled biomolecules in order to measure and \nquantitate signalling or metabolic pathways. CT, computed tomography, on the \nother hand, uses an external ionising radiation transmission source to generate \nprojection data of the transmitted radiation, thus helping to generate high spatial \nresolution images of the anatomy of the subject. Both sets of information can be \ncombined easily in a PET/CT, whereby both the PET and CT components can be \noperated in close spatial proximity within a single gantry without cross-talk effects. \nThrough the combination of CT and PET overall examination times of oncology PET \nstudies are reduced by 30%. In addition, PET instrumentation has been advanced \nto include time-of-flight measurements for improved signal-to-noise ratio, extended \naxial field-of-view-coverage for higher sensitivity and novel image reconstruction \nfor improved contrast. Today, high-quality one-stop shop staging with PET/CT is \npossible in 10 min, or less. \nLearning Objectives:\n1. To illustrate the origin of combined PET/CT imaging.\n2. To motivate the strength of PET: high spatial sensitivity, quantification and \nfunctional information.\n3. To appreciate the difference between “contrast” and “tracer” imaging.\n4. To highlight novel developments in PET imaging: time of flight (TOF), \nextended axial field-of-view.\nPostgraduate.Educational.Programme\nS6\n A B C D E F G H\n09:45 - 10:15 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 1b \nRadiation exposure \nA‑005\t 09:45 \nRadiology perspective \nH.-C. Becker; Munich/DE \nComputed tomography is the main contribution to diagnostic medial radiation \nexposure to the public. In the year 2001, CT accounted for only 6% of all radiation-\nassociated examinations; however, at the same time it accounted for 47% of the \ntotal radiation exposure. Since the beginning of this century numerous international \nsurveys had been performed with the aim to define diagnostic reference levels in \nEuropean countries. Radiation exposure by CT has increased particularly by cardiac \nCT examination, what has caused awareness to utilise all strategies for radiation \nprotection in CT. Modern CT scanners are equipped with automated anatomical \nor organ sparing exposure control. It is the CT investigators responsibility to check \nthe clinical indication, limit the scan range and decide for the appropriate scan \nprotocol with the least radiation exposure. Newer technical developments in CT \nscanner hard and software will enable to further reduce the dose from CT. All these \nstrategies are essentially necessary since the number of CT investigations and \nthe scope of clinical indications are expanding with advancing medical progress. \nLearning Objectives:\n1. To understand the meaning of diagnostic reference values.\n2. To become aware of dose intense CT protocols.\n3. To learn about strategies for radiation protection in CT.\nA‑006\t 10:00 \nNuclear medicine perspective \nS.P. Mueller; Essen/DE \nDifferent radiopharmaceuticals labelled with positron emitting radioisotopes are \nused to study a multitude of molecular processes using a positron-emission-\ntomography (PET) scanner which nowadays is typically integrated with a CT \nscanner (PET/CT). This lecture will enable the attendee to comprehend that the \nradiation exposure from PET depends on the biodistribution and kinetics of the \nradiopharmaceutical, the physical half-life of the positron emitting radioisotope \nused for labelling, and the injected activity, leading to an understanding that there \nis no generic “radiation exposure from PET or PET/CT”. \nLearning Objectives:\n1. To learn that the comparison of doses for different radiopharmaceuticals \nis based on the concept of the effective dose which expresses the total \nstochastic risk from the non-uniform radiation exposure to individual \nradiosensitive organs in terms of a uniform whole body radiation dose.\n2. To understand that the effective dose from certain radiopharmaceuticals \nmay be reduced by simple means, e.g. if it is renally eliminated by frequently \nvoiding the bladder, and that the effective doses for the most prevalent \nradiopharmaceuticals lie within the typical range of other diagnostic nuclear \nmedicine tests and compare favourably to the radiation exposure from the \nCT portion of a whole-body PET/CT scan.\n10:15 - 10:30 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 2 \nFDG PET \nA‑007\t 10:15 \nPhysiology, normal distribution and pitfalls \nA. Hertel; Fulda/DE \nThe successful use of PET/CT imaging with FDG requires thorough understanding of \nFDG physiology, distribution in order to cope with possible and common pitfalls. FDG \nis normally distributed throughout the body following deoxy-glucose consumption and \nexcretion. Main organ of uptake is the brain. Excretion via kidneys results in intense \nuptake of the genito-urinary system. Prior to imaging the following questions should be \n\nWednesday\nPostgraduate.Educational.Programme\nA\n S7\nCB D E F G H\n11:45 - 12:30 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 3b \nLung cancer \nA‑010\t 11:45 \nRadiology perspective \nF. Gleeson; Oxford/UK \nPET-CT is now recognised as a routine investigation in patients with lung cancer \nprior to radical treatment for attempted cure. However, PET-CT is an expensive \nand limited resource, and its use needs to be targeted to maximise its benefits. This \npresentation will review its use and compare its benefits to CT. It will specifically \nfocus on both the added advantages PET has when compared to CT and also the \nvalue of using the information on PET-CT scans in an additive manner by using the \ninformation available from both the PET and the CT components of a PET-CT scan. \nLearning Objectives:\n1. To learn when PET-CT should be performed in lung cancer.\n2. To understand the significance of the CT appearance and PET \ncharacteristics of lung cancers.\n3. To become familiar with the significance of FDG nodal avidity.\n4. To become familiar with the ability of PET-CT to detect metastatic disease.\nA‑011\t 12:07 \nNuclear medicine perspective \nH.C. Steinert; Zurich/CH \nCombined positron-emission tomography and computed tomography (PET-CT) \nhas become an established method for staging of patients with non-small-cell lung \ncancer (NSCLC). Glucose use is markedly accelerated in NSCLC, resulting in high \ntumour uptake of the radiolabeled glucose analogue fluorine-18 fluorodeoxyglucose \n(FDG). It has been shown that combined PET-CT imaging is superior in preoperative \nstaging to CT alone and PET alone (1). The advantage is mainly based on a more \nsensitive and specific assignment of the lymph-node stage (N stage) and the accu-\nrate detection of occult distant metastases. However, limitations of PET-CT imaging \nare well known (FDG negative tumours, FDG uptake in inflammatory cells). New \nPET radiotracers as fluoroethyltyrosine (FET), fluoroalphamethyltyrosine (FMT), \nand deoxyfluorothymidine (FLT) overcome the limitations of FDG. The addition of \nPET-CT to the diagnostic work-up in patients with potentially resectable NSCLC \nhas been shown to significantly reduce both the total number of thoracotomies \nand the number of futile thoracotomies (2). PET-CT can also be used for the ac-\ncurate definition of the radiotherapy treatment field and for monitoring response \nof chemotherapy and radiotherapy. \nLearning Objectives:\n1. To understand the role and limitations of PET/CT in staging of lung cancer.\n2. To discuss the utility of PET/CT in radiotherapy target definition.\n3. To describe the role of PET/CT in therapy monitoring.\n4. To compare different PET radiotracers for lung imaging.\n13:30 - 14:15 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 4a \nGI tumours \nA‑012\t 13:30 \nRadiology perspective \nA. Ba-Ssalamah; Vienna/AT \nThe use of PET-CT, which is a combination of positron emission tomography \n(PET) and computed tomography (CT), has dramatically grown in the daily clinical \nroutine. The synergistic advantage of adding CT is that the attenuation correction \nrequired for PET can also be derived from the CT data, leading to a more comfort-\nable examination and higher patient throughput. Furthermore, the integration of \nboth techniques provides precise localisation of lesions on the PET scans, with \nrelevant functional information within the anatomic and morphologic reference frame \nprovided by contrast-enhanced-CT, thus increasing the sensitivity and specificity \nanswered: Is FDG suitable for the underlying cancer involved? Some tumours have \nnone or low FDG uptake which should not be included in FDG PET/CT imaging like \nprostate cancer, mucinous gastric cancer, most neuro-endocrine cancers including the \nmajority of differentiated primary thyroid cancers and renal cancer. Is the patient properly \nprepared? This requires adequate fasting of at least 10 hours and a sufficiently low \nblood glucose level under 150 mg/dl. Is the suspicious abnormal focus suitable for FDG \nimaging? Routine PET scanner have a physical resolution of around 5 mm. In the lung \nwithout breath triggering structures in the lower lobes should be larger than 8-10 mm. \nVarious organs exhibit a wide range of physiological FDG uptake (salivary glands, \nfloor of mouth, brown fat in the neck, atherosclerosis in large vessels, stomach, colon \nand guts, bone marrow). Intense studying of these different conditions requires own \n3D judgment on the dedicated work station by each and every doctor using PET/CT. \nLearning Objectives:\n1. To learn about patient preparation is essential for avoiding common pitfalls: \ntumour history, current therapy (chemo affects bone marrow, surgery \nproduces uptake in scars), other diseases or habits like smoking (FDG \nuptake in mediastinal lymph nodes due to chronic bronchitis).\n2. To become familiar with FDG uptake that can cause benign processes. \nThis includes inflammation/abscesses, sarcoidosis or recent radiotherapy \n(inflammatory). Also intense regular brain uptake is suitable for Alzheimer \ndiagnosis but not for small brain metastasis (gold standard MRI).\n3. To become familiar with proper technique. This includes correct patient \npositioning, check for patient movement and correct positioning when using \nFDG PET/CT for radiotherapy planning (this should be done commonly with \nthe radio-oncologist).\n11:00 - 11:45 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 3a \nHead and neck including cancer of unknown \nprimary (CUP) \nA‑008\t 11:00 \nRadiology perspective \nS. Bisdas; Tübingen/DE \nCross sectional techniques, like CT and MRI, as well as hybrid imaging, like PET-\nCT, are the main diagnostic radiological approaches in the TNM staging of head \nand neck cancer, including cancer of unknown primary (CUP). \nLearning Objectives:\n1. To consolidate knowledge about the first-choice diagnostic modalities for the \ndifferent anatomic sites of head and neck cancer, including CUP syndrome.\n2. To appreciate the clinical indications and problems in patients referred for \nhead and neck imaging.\n3. To understand from a radiological point of view the advantages and \nshortcomings of each modality concerning the T, N, and M staging.\n4. To choose the most appropriate diagnostic modality for any head and neck \ndisease, including CUP syndrome.\nA‑009\t 11:22 \nNuclear medicine perspective \nR. Hustinx; Liège/BE \nMost head and neck tumours (HNT) are squamous cell carcinomas, which display highly \nincreased FDG uptake with great consistency. On the other hand, recent advances in \nthe PET/CT technology have lead to significant improvement in terms of spatial resolu-\ntion, with either lower injected dose of tracer or shorter acquisition time. This review \nwill first discuss the methodological aspects of PET/CT when applied to HNT imaging. \nClinical indications will then be reviewed, including the staging of proven tumours, the \nevaluation of carcinomas of unknown origin, the assessment of the response to treat-\nment and the contribution of metabolic imaging to the planning of radiation therapy. \nLearning Objectives:\n1. To determine acquisition parameters adapted for HNT imaging, for both the \nPET and the CT part of PET/CT.\n2. To recognise the diagnostic performances of FDG PET/CT in the TNM \nstaging of HN tumours.\n3. To discuss the role of FDG PET/CT in the clinical algorithm for evaluating the \nresponse to chemoradiotherapy, according to the tumour stage and location.\n4. To understand the concept of metabolic target volume in radiation therapy.\n\nPostgraduate.Educational.Programme\nS8\n A B C D E F G H\nA‑015\t 14:37 \nNuclear medicine perspective \nB.J. Krause; Munich/DE \nTo understand the potential of molecular imaging with hybrid imaging technologies \nsuch as PET/CT of imaging urogenital tumours and especially prostate cancer. T o learn \nmore about the metabolic pathways underlying the choline signal in prostate cancer \nimaging. The role of PET/CT in the detection of recurrent prostate cancer and patients \nwith advanced disease. To become familiar with the most common indication of PET/\nCT with radioactively labelled choline derivates in prostate cancer patients, i.e. relapse \nof disease and biochemical recurrence. PET/CT with choline derivatives at present is \nthe imaging modality with the highest sensitivity to diagnose the recurrence. PET/CT \nwith choline derivates has major implications on patient management by allowing to \nindividualise the therapeutic strategy, i.e. curative vs. palliative treatment. In localised \ndisease curative therapy options such as salvage radiotherapy or salvage lymph-\nadenectomy can be considered. In the case of disseminated disease anti-hormonal \ntherapy or chemotherapy can be initiated. In the case of radiation therapy choline PET/\nCT might enable a custom tailored radiation field for local as well as for distant disease. \nT o become familiar with the future developments in molecular imaging prostate cancer: \n(1) new tracers will be introduced which will allow to diagnose prostate cancer with \nhigher sensitivity and specificity. (2) New hybrid imaging technologies are emerging \nsuch as SPECT/CT and especially MR/PET that will also contribute to higher accuracy \nin diagnosing patients with prostate cancer. (3) Molecular imaging techniques have a \nhigh potential for assessment of therapy response with the view towards individualisa-\ntion of therapies in prostate cancer patients. \n15:30 - 16:15 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 5 \nLymphoma \nA‑016\t 15:30 \nRadiology perspective \nM. O’Connell; Dublin/IE \nFrom initial staging, to response evaluation to restaging, CT and PET/CT have \ncomplementary roles. Contrast CT to include solid organ assessment is used at \ninitial diagnosis, followed by low dose PET/CT in the initial staging of Hodgkin’s \ndisease and in some cases of Non Hodgkin’s Lymphoma. Response evaluation \nis typically performed after two cycles of chemotherapy using low dose PET/CT. \nProtocols for restaging lymphoma vary according to the type of tumour and local \nprotocols. Lymphoma can present with unusual patterns in some organ systems \nfor example in urinary tract, colon or the central nervous system. This presentation \nalso discusses the role of MRI in staging and ultrasound in biopsy. A dual qualified \nreader can read PET and CT components as a one study leading to synergy in \ninterpretation of imaging findings and cost benefits. This will also allow a compari-\nson with previous MRI, CT and PET/CT imaging studies. It is also important that \nPET/CT readers attend and contribute to Multidisciplinary Team Meetings (MDM) \nin order to ensure the full impact of PET/CT investigations. \nLearning Objectives:\n1. To outline the role of CT in staging lymphoma in the era of PET/CT.\n2. To examine the role for MRI and ultrasound in lymphoma staging.\n3. To outline some of the less common patterns of lymphoma presentation on \nCT that are identified at PET/CT.\nA‑017\t 15:52 \nNuclear medicine perspective \nA.K. Buck; Munich/DE \nPET and PET/CT are non-invasive, 3-dimensional imaging modalities which have \nbecome standard of care in patients with malignant lymphomas. These modali -\nties have been extensively studied for staging, restaging, monitoring response to \ntherapy, surveillance after definite treatment, and assessment of transformation. \nMore recently, PET tracers have been suggested as surrogate markers for cancer \ndrug development. \nLearning Objectives:\n1. To understand in which clinical scenarios PET and PET/CT imaging are \nsuperior to standard imaging modalities or other diagnostic tests.\n2. To learn the diagnostic accuracy and predictive potential of PET and PET/CT \nfor staging/restaging Hodgkin’s disease and non-Hodgkin’s lymphoma.\nof the examination. Therefore, for oncologic applications, PET-CT has already \ngained widespread acceptance for the initial staging of cancer, the management \nof recurrent cancer, and for monitoring the response to therapy. The development \nof a large variety of radiotracers is an evolving procedure. The most frequent used \nradiotracer in clinical practice, 18 F FDG, is based on the identification of the fun-\ndamental aspects of tumour glucose metabolism. New radiotracers, with promising \npotential for PET-CT, are also currently available to visualise specific cellular and \nmolecular tumour pathway and more being developed. \nLearning Objectives:\n1. To appreciate the advantage of a combined PET-CT technique.\n2. To consolidate our knowledge of optimal examination protocols and to be \naware of the pitfalls that may be encountered using this technique.\n3. To understand the indications for PET-CT in the diagnosis, staging, and \ntherapy monitoring of a large variety of GI tumours.\n4. To become familiar with the different radiotracers to obtain a tailored and \npersonalized diagnosis for the large variety of GI tumours.\nA‑013\t 13:52 \nNuclear medicine perspective \nT.F. Hany; Zurich/CH \nFDG-PET/CT imaging is getting more established in the work-up of several ab-\ndominal malignancies of the gastro-intestinal tract. The main advantage lies in the \ncomprehensive evaluation of the patient, including all body compartments and \ntherefore detection of pivotal, therapy deciding lesions. The performance of FDG-\nPET/CT In the evaluation of primary tumours of the GI-tract is characterised by a \nhigh sensitivity in the detection of distant metastases. Secondary liver tumours like \nmetastases from the GI-tract are detected by FDG-PET/CT at a high rate, making \nthis imaging technology a primary tool in the evaluation of patients with suspicion \nof recurrent colon cancer. Further, full integration of contrast-enhanced CT proto-\ncols improve the diagnostic confidence and reduce the sometimes cumbersome \ndiagnostic pathway for patients. FDG-PET/CT can be reliably used for therapy \nresponse assessment. New tracers like Ga-68-DOTA-TATE or F-18-DOPA will bring \nsignificantly improved diagnostic confidence in the notoriously difficult evaluation \nof patients with neuroendocrine small bowel tumours. \nLearning Objectives:\n1. To understand the correct applications of FDG-PET/CT imaging in GI tumours.\n2. To learn the limits of PET/CT imaging in esophageal cancer imaging.\n14:15 - 15:00 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 4b \nUrogenital tumours \nA‑014\t 14:15 \nRadiology perspective \nC. Nicolau; Barcelona/ES \nIntegrated positron emission tomography (PET)/CT provides combined metabolic \nand anatomic information of malignancies. The addition of CT to PET for urogenital \npurposes is very useful. CT should be performed with oral and intravenous con-\ntrast agent administration as a full diagnostic technique. If performed under these \nconditions, this technique can help to avoid PET pitfalls including focal retained \nactivity in ureters and urinary bladder, and increased uptake in physiologic and \nbenign pelvic processes such as endometrial uptake in the menstrual phase, \nleiomyomatosis, endometriosis or infection. We will describe the use of PET/CT \nin the characterisation, staging and surveillance of urogenital malignancies includ-\ning kidney, prostate, bladder, uterine cervix, endometrium and ovaries. PET/CT is \ninternationally accepted as the most useful surveillance imaging tool in patients \nwith ovarian cancer, and its use as a problem-solving modality has also rapidly \ngrown in the rest of urogenital malignancies. \nLearning Objectives:\n1. To learn the appropriate protocols and settings of a diagnostic CT in PET/CT \nfor urogenital purposes.\n2. To describe advantages and limitations of integrated PET/CT for urogenital \npurposes.\n3. To describe the main indications of PET/CT for diagnosis, staging and \nsurveillance of urogenital cancers.\n4. To discuss the role of PET/CT with respect to other imaging techniques in \nthe diagnostic algorithms of urogenital cancers.\n\nWednesday\nPostgraduate.Educational.Programme\nA\n S9\nCB D E F G H\nshown promising results in the management of various cancers where FDG has \nlimited value. These radiotracers have more specific mechanism of uptake and is \nlikely be investigated in the near future. \nLearning Objective:\n1. To consolidate knowledge of oncological applications, characteristics and \nfuture aspects of non - FDG PET tracers in the daily clinical practice.\nA‑020\t 16:45 \nConcluding remarks from the ESR and the EANM \nÉ. Breatnach1, W. Langsteger2; 1Dublin/IE,  2Linz/AT \nA‑021\t 17:00 \nTest and quiz with evaluation \nÉ. Breatnach1, W. Langsteger2; 1Dublin/IE,  2Linz/AT \n3. T o become familiar with typical imaging findings of vital lymphoma in lymph node \nbasins and non-lymphatic tissues (bone, bone marrow, spleen, liver, soft tissues).\n4. To understand what kind of pitfalls can reduce the sensitivity and specificity \nof PET/CT.\n5. To become familiar with current state of the art data acquisition protocols \nand data postprocessing.\n6. To learn about new technological developments that are underway (i.e. new \nradiotracers enabling molecular imaging of lymphoma such as proliferation \nmarkers and new scanner developments such as PET/MR).\n16:15 - 16:45 Room C \n1st ESR/EANM Joint Pre-Congress Workshop on PET/CT\nWS 6 \nFuture aspects \nA‑018\t 16:15 \nOverview of future developments in CT \nT.R.C. Johnson; Munich/DE \nComputed tomography remains the workhorse of clinical cross sectional imaging \ndue to its good availability, enormous speed, high spatial resolution and sufficient \ntissue contrast to evaluate most diseases based on morphology. Compared to \nPET and SPECT, room for improvement remains in sensitivity and specificity \nfor certain diseases and, compared to ultrasound and MRI, in dynamic imaging. \nHowever, already today there are new CT techniques which can provide diagnosti-\ncally equivalent information as SPECT or PET but with higher spatial resolution, in \nshorter acquisition time and without radioactive tracers. One of these techniques \nis CT perfusion imaging with repeated low-dose acquisitions of the same organ. \nWith this method, a detailed evaluation of brain perfusion is feasible e.g, for stroke \nassessment, or of tumour perfusion, e.g. to assess early therapy response. Another \noption is Dual Energy CT which does not require additional dose but can provide \nadditional important diagnostic information similar to PET or SPECT. Examples are \nthe evaluation of lung ventilation und perfusion with xenon gas and iodine contrast. \nFor oncological imaging, the evaluation of tumour perfusion based on spectral \nidentification of iodine is an attractive option to increase specificity without additional \ndose or radioactivity. Similarly, it is feasible to assess myocardial perfusion along \nwith coronary CT angiography. For some diseases, even the molecular substrate \ncan be identified with this technique, e.g. uric acid in gout patients. These new \ntechniques provide significant advantages in oncological imaging and may further \nadd to disease characterisation if combined in PET-CT. \nLearning Objectives:\n1. To understand the strengths of current CT technology in oncological imaging \nbased on morphology.\n2. To learn about the diagnostic value of CT beyond anatomical referencing.\n3. To appreciate new technology such as dynamic perfusion imaging and Dual \nEnergy CT as options to improve disease characterisation.\nA‑019\t 16:30 \nTracers beyond FDG in daily routine \nM. Beheshti; Linz/AT \nThe ability of positron emission tomography (PET) to study different biological \nprocesses opens up new windows for both researches and daily clinical use. \nAddition of computed tomography (CT) to PET improves detection efficiency and \nresults in better localization of the lesions. The aim of this review is to consolidate \nknowledge of oncological applications of PET tracers other than [(18)F]fluoro-\n2-deoxy-D-glucose] (FDG) in the daily clinical practice. FDG, as a non - specific \ntracer, has limited value in the assessment of different cancers such as prostate \ncancer, neuroendocrine tumours (NET), brain tumours, hepatocellular Carcinoma \n(HCC), and some types of breast cancers. Hence, due to high sensitivity of PET \nin performing non-invasive functional studies, further investigations and develop-\nments are warranted for defining specific PET radiotracers and theirs clinical ap-\nplications regarding different tumour entities. Oncological non-FDG PET tracers \ncan be generally categorized into 3 groups: those labeled with F-18, C -11 and \nother non-FDG tracers. Fluorine-18 and C -11 are labeled with different amino \nacids, substrates involved in fatty acid synthesis, protein synthesis, amino acid \ntransport substrate and tracers linked to nucleic acid synthesis. These tracers \nare also labeled with specific ligands for receptor imaging. The other non-FDG \nradiotracers can be labeled with Ga-68, Cu-60, Cu-64, etc. and are suggested to \nuse in detecting cell hypoxia, bone metabolism and receptor. Many of these have \n\nPostgraduate.Educational.Programme\nS10\n A B C D E F G H\n\n\nThursday\nPostgraduate.Educational.Programme\nA\n S11\nCB D E F G H\nThursday,.March.3\n\nPostgraduate.Educational.Programme\nS12\n A B C D E F G H\n14:00 - 15:30 Room B \nInteractive Teaching Session \nE³ 120 \nCommonly missed diagnosis in musculoskeletal \nconditions \nA‑022\t 14:00 \nCommonly missed diagnosis in musculoskeletal conditions \nF. Kainberger1, K. Bohndorf2; 1Vienna/AT, \n2Augsburg/DE (franz.kainberger@meduniwien.ac.at) \nMany structures of the musculoskeletal system are prone to overuse and degeneration. \nThus, stress-related injuries may mask the clinical appearance of many other entities. \nDocumentation of the patient’s history and the knowledge of certain laboratory findings \nare of enormous help to differentiate overuse syndromes and arthritis from tumours, \ninfections, vascular diseases, or others. With standardised imaging protocols all relevant \nanatomic areas have to be included for documenting the effects of biomechanical stress, \nthe symmetric manifestation of arthritis, the spread of tumours and infection, or trauma. \nThe anatomic distribution of traumatic and stress-related injuries is influenced by \n“kinetic chains”. Bone marrow or soft tissue oedema and many other imaging find-\nings act as footprint patterns for the differential diagnosis. Likewise in inflammatory \ndisorders, the distribution pattern is often characteristic for common and uncommon \nforms of rheumatic diseases or of infections. In tumours, the structure (“matrix”) and \ntheir borders are important features. In conclusion, a standardised diagnostic process \nbases on the analysis of distinct clinical and anatomic patterns. It also includes the \nrecognition of patterns of misinterpretation. \nLearning Objectives:\n1. To learn about the differential diagnosis between stress injuries, \ninflammatory processes, necrosis and tumours.\n2. To recognise the consequences of insufficient consideration of clinical \ninformation and symptoms in the interpretation of imaging studies.\n3. To recognise the consequences of inappropriate imaging requests.\n4. To understand the importance of a systematic approach to the interpretation \nof imaging, particularly radiographs.\n14:00 - 15:00 Room Z \nThe Beauty of Basic Knowledge:  \nInterpretation of the Chest Radiograph \nMC 21A \nInterpreting the chest radiograph: basic concepts \nA‑023\t 14:00 \nInterpreting the chest radiograph: basic concepts \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nAll conventional radiology is based in the interplay of four basic densities: air, fat, \nsoft tissues and calcium. The chest radiograph is an excellent method for detecting \npulmonary abnormalities: we see the process because of the superposition of a soft \ntissue density on the air density of the lung. The silhouette sign can be rephrased \nas: to detect a lesion in conventional radiography, its density should be different \nfrom that of the surrounding tissues. The modern approach to conventional chest \nradiograph aims to detect the presence of abnormalities and to decide if additional \nprocedures are necessary. \nLearning Objectives:\n1. To review the significance of radiographic densities.\n2. To evaluate the role of the chest radiograph in the detection of diseases.\n3. To understand the role of chest radiography as a filter for cross-sectional \nimaging.\n16:00 - 17:30 Room B \nInteractive Teaching Session \nE³ 220a \nCommon radiological problems: incidental \nabdominal masses \nA‑024\t 16:00 \nA. The incidental adrenal mass \nR.H. Reznek; London/UK (r.h.reznek@qmul.ac.uk) \nWith the increasing use of abdominal cross-sectional imaging, incidental adrenal \nmasses are being detected more often. The important clinical question is whether \nthese lesions are benign adenomas or malignant primary or secondary masses. Benign \nadrenal masses such as lipid-rich adenomas, phaeochromocytomas, myelolipomas, \nadrenal cysts and adrenal haemorrhage have pathognomonic cross-sectional imaging \nappearances. However, there remains a significant overlap between imaging features \nof some lipid-poor adenomas and malignant lesions. The nature of incidentally detected \nadrenal masses can be determined with a high degree of accuracy using computed \ntomography and magnetic resonance imaging alone. Positron emission tomography is \nalso increasingly used in clinical practice in characterising incidentally detected lesions \nin patients with cancer. The performance of the established and new techniques in CT, \nMRI and to a lesser extent PET, that can be used to distinguish benign adenomas and \nmalignant lesions of the adrenal gland will be reviewed. \nLearning Objectives:\n1. To appreciate the range of adrenal pathology that can present incidentally \nand recognise their imaging features.\n2. To appreciate the need to characterise these lesions in the clinical context of \nthe patient’s management.\n3. To become familiar with the specialised CT and MRI techniques required to \nestablish the true nature of an incidentally detected indeterminate adrenal \nmass.\nA‑025\t 16:45 \nB. Renal mass \nM. Prokop; Nijmegen/NL (M.Prokop@rad.umcn.nl) \nWith the increasing use of imaging, incidentally detected renal masses are very com-\nmon. While masses detected by CT or MR usually can be properly classified, renal \nmasses detected by ultrasound frequently require further workup. The following con-\nsiderations determine the diagnostic workup: simple cysts are very common but may \npresent atypically. Renal cell carcinomas may be cystic but usually display at least a \nsmall solid component. Renal cell carcinomas have a bad prognosis when metastasized \nbut metastases hardly every develop before the tumour has reached 3 cm in diameter. \nDifferentiation between solid tumours by imaging alone is exceedingly difficult, save \nfor the identification of angiomyolipomas in adults. This course will discuss suitable \ndiagnostic algorithms based on the initial presentation of the mass. Typical imaging \nfindings of various benign and malignant renal masses will be presented. The role \nof the Bosniak classification will be illustrated. Newer developments such as a wait-\nand-see approach or primary biopsy for small solid renal masses will be discussed. \nLearning Objectives:\n1. To learn how to detect and characterise a renal mass.\n2. To understand how to apply adequate protocols according to the clinical \nsituation.\n16:00 - 17:30 Room C \nInteractive Teaching Session \nE³ 220b \nLung cancer: what the radiologist must report \nA‑026\t 16:00 \nA. Staging \nA.R. Larici; Rome/IT (anna.larici@rm.unicatt.it) \nDefinition of stage is essential for an accurate management of neoplastic patient. A \nrecent review of NSCLC (non-small cell lung cancer) staging system has underlined \nlimitations of the previously accepted classification. Staging system is based on the \n\nThursday\nPostgraduate.Educational.Programme\nA\n S13\nCB D E F G H\nassessment of disease extent. Non-invasive imaging modalities (CT and PET-CT) \nplay a central role in this attempt and in providing indications for further invasive \nprocedures. Radiologists should know what to report and how to perform a proper \nradiological work-up to define the correct stage in each patient. They should also be \naware of the actual role of invasive modalities (transbronchial and transesophageal \nultrasound, mediastinoscopy) in staging lung cancer. \nLearning Objectives:\n1. To learn about the new lung cancer staging system.\n2. To understand the proper use of different imaging modalities and invasive \nprocedures for staging lung cancer.\n3. To understand the rationale of lung cancer staging.\n4. To understand the value of diagnostic and invasive procedures (chest x-ray, \nCT and PET/CT) during lung cancer follow-up.\n5. To learn diagnostic criteria and imaging pitfalls during the management of \ntumour recurrence and treatment complications.\nA‑027\t 16:45 \nB. Follow-up \nN. Howarth; Chêne‑Bougeries/CH (nigel.howarth@grangettes.ch) \nCarcinoma of the lung is one of the most frequent neoplasms in the Western world. \nMost radiologists know how to diagnose lung cancer. With advances in imaging \ntechnology and treatment options, it is essential to know how to evaluate response \nto treatment and complications. In treated patients, signs of recurrence should be \ndistinguished from undercurrent diseases and post-radiotherapy changes. The value \nof diagnostic (chest x-ray, CT and PET/CT) and invasive procedures (bronchoscopy, \nradiofrequency ablation) will be discussed. Integrated PET/CT imaging has an \nestablished role in the management of cancer patients and is now recommended \nfor all patients with curative non-small cell lung cancer. PET/CT provides informa-\ntion essential for staging and prognosis, for choice of management and monitoring \nof treatment and for the detection of recurrence. Radiologists should understand \nimportant aspects of molecular imaging to improve their contribution to patient \nmanagement. Imaging pitfalls must be recognised to avoid both false-positive and \nfalse-negative interpretation. Specific examples will be discussed to demonstrate \nhow the combined information of images of human anatomy upon which biological \ninformation within body structures is added improves delineation of disease, can \nguide surgical and radiation planning and biopsy, help in the management of tumour \nrecurrence and of treatment complications. The need for close collaboration with \nnuclear medicine specialists will be promoted. \nLearning Objectives:\n1. To learn about the new lung cancer staging system.\n2. To understand the proper use of different imaging modalities and invasive \nprocedures for staging lung cancer.\n3. To understand the rationale of lung cancer staging.\n4. To understand the value of diagnostic and invasive procedures (chest x-ray, \nCT and PET/CT) during lung cancer follow-up.\n5. To learn diagnostic criteria and imaging pitfalls during the management of \ntumour recurrence and treatment complications.\n16:00 - 17:30 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 216 \nThe hand and wrist \nModerator: \nR. Schmitt; Bad Neustadt a. d. Saale/DE \nA‑028\t 16:00 \nA. How I do it \nJ.-L. Drapé; Paris/FR (jean‑luc.drape@cch.aphp.fr) \nMRI of hand and wrist require some specificities: high spatial resolution, perfect \nimmobility, and homogeneous fat suppression. These goals are reached with: \nphased array dedicated wrist coil, extended arm upon the head close to the center \nof the magnet, firm contention devices, avoid obliquity of the wrist (magic angle \nphenomenon) and small field of views (FOV) with high spatial resolution and short \nacquisition times. In case of “mysterious” painful wrist a first axial STIR or T2 FSE \nFS sequence (“bone scan” sequence) is compared with an axial FSE T1 sequence \nto assess both soft tissues and bones. A coronal 3D PD FS may be added to assess \nligaments and cartilage. Intravenous injection of gadolinium is not mandatory but \nis often helpful for mechanical pathologies. The three planes may be systemati-\ncally acquired. Some indications need to modify the protocol. Wrist ligaments: MR \narthrography with very thin 3D slices, tendon ruptures: retractions may be extensive \nand require two successive coil positioning, synovial cyst: thin 3D sagittal T2-wi \nFS to depict tiny pedicles, Kienböck disease: intravenous gadolinium injection in \ncoronal and sagittal planes (subtraction may be helpful), carpal tunnel syndrome: \ndouble obliquity slices along the median nerve, dynamic studies to detect tendon \ninstability (pronosupination or metacarpophalangeal joint flexion), rheumatoid \narthritis: T1 FS sequences with gadolinium to assess polysynovitis, eventually MR \nangiography and bilateral study, finger pathologies: dedicated microcoil with small \nFOV (up to 2 cm) if the abnormalities remain focal. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑029\t 16:25 \nB. Normal variants and pitfalls \nJ. Hodler; Zurich/CH \nThe wrist and hand are characterised by variability of bones, fibrocartilage, \nligaments, muscles and neurovascular structures. Coalitions (most commonly \nlunotriquetral, prevalence of 0.1%), ulnar impaction positive variance of the ulna, \ncarpe bossu and an accessory medial lunate facet associated with osteoarthritis \nare typical variants of bone. The triangular fibrocartilage complex (TFCC) and the \ninterosseous ligaments often present with small defects. Radial TFCC defects are \npresent in 64% of symptomatic but also in 46% asymptomatic wrists. In addition, \ntheir prevalence increases with age, apparently without increasing symptoms. \nAccessory muscles are common and may clinically mimick a neoplasm. Disease \nmay also be mimicked by imaging artifacts. Magic angle effects cause increased \ntendon signal and may thus lead to the incorrect diagnosis of tendinopathy. The \nlunate appears to be more dorsally tilted on sagittal MR images than on standard \nradiographs (radiolunate angle ~20° larger on MR images). This value increases to \n~37° if the wrist is positioned in ulnar deviated as is commonly the case when the \nwrist is examined in the “superman position”, with the arm above the head. Magic \nangle artefacts are commonly encountered in the wrist. The extensor and flexor \npollicis longus are especially prone to such artefacts, due to their oblique course \napproaching the critical 55° with regard to the B0 field. In conclusion, variability is \nrather the rule than the exception in the hand and wrist. Only part of the findings \nhave clinical meaning. Technical aspects add another dimension of variability. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑030\t 16:50 \nC. Identifying and reporting abnormal findings \nL. Cerezal; Santander/ES (lcerezal@gmail.com) \nWrist pain and dysfunction are common disabling complaints that may be caused \nby a broad spectrum of disorders. These injuries may be the result of a single \nincident, such falling on an outstretched hand, or the result of repeated overuse, \nespecially ongoing athletic or occupational activities. Diagnosis and management \nof wrist disorders represent one of the most clinically challenging processes. Clini-\ncally, they are usually nonspecific, and similar findings can be found among the \ndifferent pathologic conditions in the wrist, so accurate diagnosis is a key element \nfor successful treatment plan. Outcome may be improved by timely implementation \nof various treatment options. Recent advances in diagnostic imaging have improved \nour ability to establish a noninvasive anatomic diagnosis. In this presentation, we \nreview MR imaging findings of the most common injuries of the wrist, with special \nemphasis on key findings for an accurate diagnosis and its differential diagnosis. \nFinally, we will review the proper terminology to describe pathological findings \nand how to structure a radiological report clearly and concisely allowing efficient \ncommunication with clinicians. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\n\nPostgraduate.Educational.Programme\nS14\n A B C D E F G H\nA‑034\t 16:51 \nC. Solid organ trauma \nJ. Cazejust; Paris/FR (julien.cazejust@sat.aphp.fr) \nIn abdominal trauma, spleen and liver are the most frequently affected organs. \nInitial FAST-US is especially dedicated to patient with haemodynamic instability, \nin which the presence of a massive haemoperitoneum prompts for surgery without \nany further examination. In other cases, the management of the patient is more \nand more conservative, associating supportive care and interventional radiology, \nwhile surgery is seldom performed. The severity of the injury is best assessed by \nmultidetector CT, which can only be performed in a patient with controlled hae-\nmodynamic parameters. MDCT protocol should adapt to the purposes: thin slices \nallow multiplanar reconstruction, iodine injection provides detection of bleeding, as \nwell as road mapping when intervention is necessary. Arterial phase is mandatory, \nalthough bleeding can sometimes be more conspicuous on portal venous phase. \nHepatic or splenic lesions range from simple contusion or minor laceration to organ \nfracture (linear lesion >  3 cm), vascular avulsion or complete devascularisation, \naccording to the AAST classification. The optimal patient selection for angiog -\nraphy and embolisation is still matter of debate. However, intervention might be \nnecessary shortly after CT when active bleeding is seen in a haemodynamically \nunstable patient; or in case of any vascular lesion (post-traumatic false aneurysm \nor arteriovenous fistula). Many different types of embolic materials are available \n(temporary material such as gelfoam pledget or permanent material such as coils, \nparticles, occlusion device, glue or onyx). In all cases, a close follow-up is neces-\nsary, as well as multidisciplinary concertation with regard to potential recurrence. \nLearning Objectives:\n1. To review causes and imaging appearances of solid organ trauma.\n2. To review various IR methods of treatment.\n3. To review results and appropriate follow-up strategies.\nPanel discussion: \nDo we need IR in the ER? 17:14 \nDoes it make sense to have a level one trauma centre without IR on call day and \nnight and an interventional angio suite in close relation to the emergency rooms? \nWhat is the optimal size of population as basis for a trauma centre? When is IR \nthe first choice in the trauma patient and what are the most important limitations \nof emergency IR in the trauma patient? \n16:00 - 17:30 Room E1 \nSpecial Focus Session \nSF 2 \nChild abuse: right images, right behaviour, right \nwords \nModerator: \nM.I. Argyropoulou;  Ioannina/GR \nA‑035\t 16:00 \nChairman’s introduction \nM.I. Argyropoulou; Ioannina/GR (margyrop@cc.uoi.gr) \nImaging is important in the diagnostic approach of child abuse. Its role is to identify \nlesions typical of child abuse, to date and to evaluate the extent of injury and to \nelucidate imaging findings mimicking non-accidental trauma. Skeletal injuries such \nas classic metaphyseal lesions, posterior rib fractures, spinous process, scapular \nand sternal fractures represent a strong radiologic indicator of abuse. Radiographic \nskeletal survey, using high detail preferentially digital imaging systems represent an \nimportant part of the diagnostic work up of these patients. Bone scintigraphy, CT \nand MRI may offer additional valuable information. Central nervous system injuries \nare life threatening and represent the principle cause of fatalities of the abused \nchild. Subdural haemorrhagic collections of different ages, retinal haemorrhage, \nsubarachnoid haemorrhage, cortical contusion, hypoxic ischaemic injury and diffuse \naxonal injury represent lesions that may be found in the context of child abuse. \nThe imaging modalities that are useful to detect these lesions are CT and MRI. In \nthe radiologic report all abnormalities should be described separately and in detail \nand the differential diagnosis should be given. But how far the radiologist can go, in \nsuggesting the diagnosis of abuse? The radiologic report is a document that can be \nused in the court. How the radiologist’s testimony should be prepared for the court? \n16:00 - 17:30 Room D2 \nInterventional Radiology \nRC 209 \nThe trauma patient \nModerator: \nA. Nicholson;  Leeds/UK \nA‑031\t 16:00 \nChairman’s introduction \nA. Nicholson; Leeds/UK (tonynick@tonynick.karoo.co.uk) \nIn this session we would like to explore the patient journey from accident to the \nemergency room and onto definitive imaging and intervention either by surgery or \nby image guided. Outcomes will be considered and the evidence presented. By \nthe end of the session delegates will have a better understanding of team working, \nimaging organisation and appropriateness of intervention. \nA‑032\t 16:05 \nA. Imaging modalities and logistics \nJ. Ferda; Plzen/CZ (ferda@fnplzen.cz) \nThe imaging of the trauma stratifies the severity and the treatment strategy. The \nleading modalities in low-energy trauma are x-ray and ultrasound. The different \napproach has to be used in high-energy trauma - the silent life-threatening injury \nmust be actively searched. Although the first examination on the site of the accident \ncould estimate whether the severe trauma is present, the imaging must confirm \nor exclude it. Besides fast transport to the trauma centre has the extraordinary \nimpact on survival the diagnostic algorithm. The installation of CT, ultrasound \nand x-ray directly within the emergency department is extremely important for the \ntrauma management. If the focused assessment sonography for trauma (FAST) \nis replaced by whole body CT, the life-threatening injury is detected at fastest. \nProtocol includes imaging of non-enhanced CT head and cervical spine followed \nby the contrast-enhanced CT of the entire thorax, abdomen and pelvis, in cases of \nlower extremities trauma covering whole body. CT could be performed also under \nresuscitation, because whole imaging takes about three to five minutes. Following \nfindings listed recently according to their impact on survival must be confirmed \nor excluded: intracranial injury, cervical spine trauma, aortic injury, overpressure \npneumothorax, severe bleeding in the abdominal cavity, organs injury, peripheral \nvascular trauma, bone trauma; the trauma team including anaesthesiologist, sur-\ngeon and radiologist discusses the findings and plans of the treatment. \nLearning Objectives:\n1. To understand appropriate triage of trauma patients to imaging.\n2. To learn the appropriate imaging techniques.\n3. To review imaging appearances.\nA‑033\t 16:28 \nB. Management of arterial trauma \nM. Katoh; Homburg/DE (marcus.katoh@uks.eu) \nOver the last two decades, spiral-CT has become a highly reliable imaging modal-\nity to diagnose haemorrhage in trauma, while the role of catheter angiography has \nchanged from a diagnostic to a therapeutic modality. Traumatic injuries of the heart \nand aorta lead to sudden death occurring at the accident site, whereas uncontrollable \nhaemorrhage from larger arteries and parenchymal organs is the most frequent cause \nof mortality during the first 4 h following severe trauma. In patients with ruptured aorta \nor major arteries, stenting and temporary balloon occlusion may contribute to saving \nlives, while transcatheter embolisation may prevent exsanguination in haemorrhage \nfrom visceral organs, arteriovenous fistulas, and secondary onset haemorrhage. \nHowever, a haemodynamically stable patient is a prerequisite for all angiographic \ninterventions. Definite haemostasis using the above-mentioned techniques can be \nobtained in 80-100% (major and periphery arteries) and 82-100% (visceral organs), \nrespectively. Possible complications following angiographic haemostatic interven-\ntions depend very much on the treated vessel bed but are, in general, as low as 5%. \nLearning Objectives:\n1. To understand potential treatment options and when to treat and when not \nto treat.\n2. To learn about the different embolisations and other interventional treatment \ntechniques.\n3. To review results and possible complications.\n\nThursday\nPostgraduate.Educational.Programme\nA\n S15\nCB D E F G H\nto current best practice, restriction of opinions to one’s own expertise, expression \nof opinions that take into consideration all of the material facts, and the readiness \nto change that opinion if additional information becomes available. Any unusual, \ncontradictory or inconsistent features of the case should be highlighted. The expert \nshould highlight whether a proposition is a hypothesis (in particular a controversial \nhypothesis) or an opinion deduced in accordance with peer-reviewed technique, \nresearch and experience accepted as a consensus in the scientific community. \nHe/she should indicate whether the opinion is provisional (or qualified), stating the \nqualification and the reason for it, and identify what further information is required to \ngive an opinion without qualification. When there is a range of opinion on any ques-\ntion to be answered by the expert, (a) the range of opinion should be summarised, \n(b) highlight whether that range of opinion includes an ‘unknown cause’ (because of \nlimited facts of the case or limited research/peer-reviewed publications), and (c) give \nreasons for the opinion expressed. Reprints of scientific publications will assist the \ncourt, but will also enable the attorneys to undertake a more robust cross examination! \nLearning Objectives:\n1. To learn about imaging findings in relation to whether or not abuse has \noccurred.\n2. To understand in which cases the diagnosis of child abuse should be raised \nin the radiology report.\n3. To become familiar with the terms that should be used when highly specific \nimaging indicators are identified in an otherwise normal infant.\nPanel discussion: \nThe radiologist at the eye of the storm 17:14 \nImaging plays a central role in the diagnosis of child abuse. Is there \nany risk of the radiologist having a detrimental impact on either the wel -\nfare of the patient or the judicial process by either under-diagnosing \nor over-diagnosing child abuse? \n16:00 - 17:30 Room E2 \nState of the Art Symposium \nSA 2 \nOvarian cancer: update and what’s next \nModerator:\nR. Forstner; Salzburg/AT \nA‑039\t 16:00 \nChairman’s introduction \nR. Forstner; Salzburg/AT (r.forstner@salk.at) \nOvarian cancer continues to be a challenge to radiologists and clinicians, as it is \none of the most lethal female tumours. This is mainly due to its diagnosis in an \nadvanced stage in the majority of patients. However, new developments can be \nobserved: new insights in tumour biology, advances in imaging and new concepts \nof ovarian cancer treatment and surveillance. Furthermore, a multidisciplinary \nexpert team approach has also substantially changed the management of patients \nwith suspected ovarian cancer. The findings of radiology are becoming pivotal in \na more individualised patient care. The role of radiology includes (a) characterisa-\ntion of sonographically indeterminate adnexal masses, (b) staging as guidance \nfor surgery and treatment planning (including identification of sites of non optimal \nresectabilty) in suspected ovarian cancer, (c) assessment of recurrent disease, and \n(d) in selected cases image-guided biopsy. In this session we provide an update \non the aetiology and current concepts of treatment of ovarian cancer and on the \ncontribution of radiology in characterisation and staging in patients with the working \ndiagnosis of ovarian cancer. The panel discussion will focus on the role of radiology \nin multidisciplinary conferences in suspected ovarian cancer. \nSession Objectives:\n1. To learn about new concepts in etiology and treatment of ovarian cancer.\n2. To become familiar with optimised imaging protocols to diagnose ovarian \ncancer.\n3. To learn about the value of CT and PET/CT as a basis for treatment planning \nin ovarian cancer.\n4. To appreciate the role of the radiologist in multidisciplinary consensus \nconferences.\nSession Objectives:\n1. To learn about current imaging practices in the evaluation of suspected child \nabuse.\n2. To learn about imaging changes which permit a firm diagnosis of child \nabuse.\n3. To become familiar how to construct a comprehensive report providing \nevidence of child abuse.\nA‑036\t 16:05 \nHow to image and detect patterns of skeletal injury indicating child abuse \nP.K. Kleinman; Boston, MA/US (Paul.Kleinman@childrens.harvard.edu) \nIn infants, skeletal injury may form the basis for the diagnosis of abuse. The first \nstep is the acquisition of a skeletal survey utilising meticulous technique adhering \nto a rigorous imaging protocol. A proper interpretation is ensured when the radiolo-\ngist is familiar with the various patterns of skeletal injury, their specificity for abuse \nand those entities which may simulate inflicted injury. Appreciation of the lesion \nmorphology, the fundamental pathologic alterations and mechanism of injury are \nessential in assessing the significance of the findings and placing them in the clinical \ncontext. Dating fractures poses a significant challenge, but in most cases, injuries \ncan be placed in a certain time frame, especially if a follow -up skeletal survey is \nobtained. Although radiography forms the basis of skeletal imaging, ultrasound, CT, \nscintigraphy and MRI may clarify findings and optimise diagnosis and management. \nThe radiology report must be constructed with care and the language should be \ncrafted with the expectation that the radiologist may be called to testify in court, a \ndaunting challenge in an often highly adversarial environment. \nLearning Objectives:\n1. To learn about the appropriate imaging protocols and quality for skeletal \nsurvey in suspected child abuse.\n2. To learn about patterns of skeletal injury typical of child abuse.\n3. To become familiar with findings that point to alternative diagnoses.\nA‑037\t 16:28 \nImaging strategies to fully determine intracranial injury resulting from \nchild abuse \nC. Adamsbaum, C. Rey-Salmon; Paris/FR (c.adamsbaum@svp.ap‑hop‑paris.fr) \nRadiologists play a key role in the early diagnosis of abusive head trauma (AHT). \nSymptoms are various and may range from coma to asymptomatic children. Changing \nelements of the history provided previous injuries, bruising in non-ambulatory children \nand delay in seeking care raise a high index of suspicion. The most common finding \nin AHT is of multifocal subdural haematomas over the cerebral hemispheres, the \nconvexity, the posterior interhemispheric fissure and the posterior fossa. The haema-\ntomas are often associated with hypoxic-ischaemic injury and retinal haemorrhages. \nCT is the first diagnostic examination to be used for patients with acute injury. It can \nreveal intracranial haemorrhage, fracture and soft tissue swelling with a high degree of \nsensitivity. CT should be repeated after a time interval if the findings are doubtful or if \nthere is a discrepancy with the neurological picture. MRI (including T1, T2, T2*, diffusion \nsequences and cervical spine examination) is required to fully determine intracranial \ninjury as it can exquisitely demonstrate hypoxic-ischaemic injuries by showing areas \nof cytotoxic oedema. It is impossible to date precisely a haematoma whose pattern is \ninfluenced by numerous factors. However, the main point is to determine the presence \nof ‘age-different’ lesions. This not only provides a strong argument for the diagnosis \nbut also suggest repetitive violence and thereby, a high risk for further injury unless \nprotective action is undertaken. Brain imaging must be performed in all siblings younger \nthan 2 years, living in the same conditions as the index case. \nLearning Objectives:\n1. To learn about imaging protocols designed to:\n a) detect acute treatable conditions\n b) depict fully and determine the timing of all injuries.\n2. To become familiar with imaging findings that are highly suggestive of  \nchild abuse.\n3. To learn about head trauma that may simulate child abuse.\nA‑038\t 16:51 \nWhat is the information required by any court and how the radiological \nreports should be phrased \nS. Chapman; Birmingham/UK (stevechapman@doctors.org.uk) \nThis presentation will describe the role of a paediatric radiologist as an expert witness \n(as opposed to a witness to fact). The expert has an overriding duty to the court that \ntakes precedence over any obligation from whom the expert has received instruc-\ntions or by whom the expert is paid. Particular duties include advice that conforms \n\nPostgraduate.Educational.Programme\nS16\n A B C D E F G H\na crucial role in identifying patients with unresectable disease thus triaging them \nto neo-adjuvant chemotherapy rather than primary surgery. Accurate evaluation \nof CT images and a detailed reporting of the site, volume and extent of metastatic \ndisease guide the surgeon to areas of disease they may be difficult to identify \nsurgically leading to an optimal cytoreductive surgery. MRI is best reserved as a \nproblem solving modality. Multiphase dynamic contrast-enhanced MRI and diffusion \nweighted MRI improve the evaluation of pelvic side wall invasion and detection of \nsmall peritoneal and serosal implants leading to higher staging accuracy compared \nto CT and standard multiplanar T2W sequences. The role of PET/CT in primary \nstaging of ovarian carcinoma is controversial. However, PET/CT is the integrated \nfunctional/anatomical modality of choice in detecting relapse with its greatest utility \nin women with rising CA 125 levels and negative CT results. Furthermore, PET/CT \ncan modify the assessment of the distribution of recurrent ovarian cancer, which \nmay, in turn, alter patient management. \nLearning Objectives:\n1. To understand the role of CT in staging of ovarian cancer with emphasis on \ntreatment selection and treatment planning.\n2. To appreciate the added value of dynamic contrast-enhanced and diffusion-\nweighted MRI in staging ovarian cancer.\n3. To understand the role of PET/CT in staging of primary ovarian cancer and \ndetection of tumour recurrence.\nPanel discussion: \nThe illustrated role of the radiologist in multidisciplinary consensus \nconferences 17:14 \nMultidisciplinary cancer conferences have become standard of care. They serve to \noptimise treatment and as educational forums. It is therefore important to know the \nrole of the radiologist in this multidisciplinary setting for a patient with suspected \novarian cancer. What are the considerations for defining the individualised, ap-\npropriate treatment regimen in ovarian cancer? Furthermore, in which setting may \nradiology alter treatment by providing image-guided biopsy. \n16:00 - 17:30 Room F1 \nFunctional Imaging of Tumours: How to do it\nMC 222 \nBasics you should know \nModerator: \nJ. Stoker; Amsterdam/NL \nA‑043\t 16:00 \nA. Tumour angiogenesis and perfusion parameters \nD. Sahani; Boston, MA/US (dsahani@partners.org) \nAngiogenesis is an essential process whereby tumours derive vascular supply from \nadjacent tissue to sustain tumour growth and metastatic spread. Newer targeted \nantiangiogenic therapies differ significantly from current therapies for cancer in that \nthey their mechanism of action is not cytotoxic. The methods of dose selection are \neither invasive, such as biopsy and histology, or time consuming, such as tumour \nshrinkage and time to disease progression, both of which take months to assess \nand fraught with other limitations. Moreover, cancer is a very variable disease, \nwhich means that some patients will respond to a particular therapy while others \nwill not. There is, therefore, a great need to establish surrogate markers for drug \nresponse that are both rapid and reliable, not only for clinical trials of new drugs \nbut also to aid in the selection of optimal treatment for individual patients. Angio -\ngenic vasculature is typically dilated, tortuous, disorganised and more permeable \nand the flow within tumours is spatially and temporally heterogeneous. Although \nmicrovessel density count has been established as a prognostic indicator for \nmany cancers, it is invasive, has several other limitations and often impractical. \nOn the other hand, imaging is non-invasive and can assess much larger volumes \nthan can biopsies. Dynamic CT and MRI using a kinetic model can derive tumour \nvascular characteristics by capturing temporal changes in contrast enhancement \nreflecting the tumour vascular physiology. Various approaches for data acquisition \nand processing have been described with their inherent benefits and limitations. \nLearning Objectives:\n1. To understand the mechanism and triggers of tumour angiogenesis.\n2. To know the physiological parameters of tissue microcirculation.\n3. To understand the principles of dynamic contrast enhanced imaging.\nA‑040\t 16:05 \nOvarian cancer: update and role of radiology \nJ.A. Spencer; Leeds/UK (johnaspencer50@hotmail.com) \nOvarian cancer is known as the ‘silent killer’. It is usually diagnosed late and most \nwomen have disease disseminated to the peritoneum (and/or pleura) at presenta-\ntion. Standard treatment comprises cytoreductive surgery followed by platinum-\nbased chemotherapy. An alternative is neoadjuvant chemotherapy followed by \ninterval debulking surgery (IDS) then completion chemotherapy. Data from the \nEORTC 55971 trial show this to be as effective as the standard of care. There are \nstrong genetic predispositions to ovarian, fallopian tube and primary peritoneal \ncancers. There is linkage with breast cancer in women with BRCA gene mutations \nand with colon cancer with the HNPCC gene. Ongoing trials are screening women \nin the general population and at high risk of the disease. These use the serum \ntumour marker CA125 followed by US as screening tools. MR imaging is an effective \ntool to assess sonographically indeterminate adnexal masses and offers an earlier \ndiagnosis of cancer than interval reassessment with US. CT is the most commonly \nused modality for assessment of disease extent prior to surgery. Image-guided \nbiopsy is necessary prior to starting neoadjuvant chemotherapy. The EORTC 55955 \nand MRC (UK) OV05 trials of women with treated ovarian cancer have shown no \noutcome advantage for women treated early at ‘CA125 relapse’ of disease versus \nlater with clinical or CT evidence of relapse. This questions the role of CA125 in \nfollow-up and argues against investigation of the ‘CA125 +ve, CT -ve’ woman with \nmore expensive and scarce imaging resources such as CT-PET and DCEMR. \nLearning Objectives:\n1. To become familiar with clinical features of ovarian cancer.\n2. To learn about the etiology of ovarian cancer, including genetic \npredisposition and the current research into screening.\n3. To become familiar with new concepts of treatment ovarian cancer and \nsurveillance of the treated patient and their impact for the use and choice of \nimaging modalities.\nA‑041\t 16:28 \nImaging of adnexal masses: is it feasible to diagnose ovarian cancer? \nI. Thomassin-Naggara; Paris/FR (isabelle.thomassin@tnn.aphp.fr) \nAdnexal masses can be depicted by many imaging modalities (US, CT, MR and \nPET-FDG). However, the characterisation of adnexal tumours is mainly based on \ntwo techniques: US and MRI. For complex adnexal masses, MR imaging add to \nconventional criteria of malignancy common to all imaging modalities (bilaterality, \ntumour diameter larger than 4  cm, predominantly solid mass, cystic tumour with \nvegetations, and secondary malignant features, such as ascites, peritoneal involve-\nment, and enlarged lymph nodes) specific features based on the characterisation of \nthe solid tissue (including vegetation, thickened irregular septa, and solid portion) \nof the adnexal tumour. Signal intensity of solid tissue on T2 sequence (fibrous tis-\nsue), perfusion (neoangiogenesis), and diffusion (cellularity) are combined to make \na decision tree analysis. Low T2 signal, absence of high b1000 signal, and time \nintensity curve type 1 are predictive of benignity whereas high T2 signal and time \nintensity curve type 3 are predictive of malignancy. Combining common classical \nfeatures and specific MR features for predicting malignancy, MR imaging has a high \ndegree of accuracy (96%) for characterising complex adnexal tumours. This high \ndiagnostic confidence rate may help young women wishing to preserve childbear-\ning potential to opt for conservative surgery and avoid the systematic removal of \nbenign complex adnexal masses in menopausal women. \nLearning Objectives:\n1. To understand the role of ultrasonography in assessing and managing \ncomplex adnexal lesions.\n2. To learn how to optimise the MRI protocol and how to improve the \ncharacterisation of indeterminate complex adnexal masses.\n3. To understand the added value of functional sequences (DCE MRI and DWI) \nin diagnosing adnexal masses.\nA‑042\t 16:51 \nStaging ovarian cancer: what technique is the best? \nE. Sala; Cambridge/UK (es220@radiol.cam.ac.uk) \nAlthough ovarian cancer is formally staged surgically, the FIGO committee encour-\nages the use of imaging techniques to assess the important prognostic factors such \nas resectable disease and lymph node status. Therefore, cross-sectional imaging \nby means of CT, MRI and PET/CT plays a crucial role in staging, treatment selec-\ntion and treatment planning in patients with ovarian cancer. CT is the modality of \nchoice for staging ovarian carcinoma as it is a relatively quick, readily available \nwhole body imaging technique and has a reported accuracy of 70-90%. CT plays \n\nThursday\nPostgraduate.Educational.Programme\nA\n S17\nCB D E F G H\ncancer, US should be used in order to guide the biopsy of the probably malignant \nlesion and also in order to stage the disease, locally as well as in the axilla. Local \nstaging should include the size of the lesion as well as the presence or absence of \nmultifocal, multicentric or contralateral disease. US is also the technique of choice \nto determine the lymph node status of the patient. After a breast MRI is performed \nfor a more accurate map of the disease’s extension, second-look ultrasound is also \nvery frequently used to evaluate all the additional lesions detected by breast MR, \nwith a very high diagnostic yield. \nLearning Objectives:\n1. To review the efficacy of US in screening for breast cancer.\n2. To appreciate the additional role of US in staging of breast cancer.\n3. To review its accuracy in diagnosis of breast cancer with different clinical \npresentations.\nA‑047\t 16:30 \nB. The role of US in premalignant and benign lesions \nI. Günhan-Bilgen; Izmir/TR (isilbilgen@hotmail.com) \nThe goal of breast US is to make a more specific diagnosis than can be made \nwith clinical findings and mammography (MG) alone and to prevent as many un-\nnecessary biopsies as possible and to find cancers missed by MG. In addition to \nits well known role of distinguishing cystic from solid masses, US can differentiate \namong types of normal tissues and characterise complex cysts and solid nodules. \nBenign solid nodules may have specific US findings such as pure and intensely \nhyperechoic texture, oval shape, parallel orientation, circumscribed margin and \npresence of a complete thin capsule. Also, the absence of any malignant finding is \nnecessary. Specific benign diagnosis will be reviewed in the lecture. Premalignant \nbreast lesions are atypical ductal hyperplasia (ADH), atypical lobular hyperplasia \n(ALH), lobular carcinoma in situ (LCIS), phylloides tumour, radial scar and juvenile \npapillomatosis. Specific premalignant diagnosis will be reviewed in the lecture. To \nincrease US specificity, it is necessary to improve US technique by following US \nguidelines published by ACR. Use of dynamic procedures (movement of the breast, \nfocal compression), Doppler US, compound imaging (in evaluation of margin and \ninternal echotexture), tissue harmonic imaging (in visualisation of a lesion against \na fatty background) and elastography (in differentiation of complicated cysts from \nsolid nodules) are helpful if used appropriately. In addition to its role in the detection \nand characterisation of lesions, US is also used to guide interventional procedures, \nsuch as cyst aspiration, abscess drainage, biopsy and galactography. \nLearning Objectives:\n1. To learn the US features of benign and premalignant lesions.\n2. To understand the role of US in the management of premalignant and \nbenign lesions.\n3. To learn how to avoid unnecessary biopsies.\nA‑048\t 17:00 \nC. New technologies in US \nR. Salvador; Barcelona/ES (rafasalvador@telefonica.net) \nThe European and American guidelines include breast ultrasound in a restricted \ndiagnostic scenario for breast cancer diagnosis. The fourth edition of the European \nguidelines (2006) reviewed in 2008 refers to US in only twice. ACR in its 2007 ACR \nPractice guideline reduces breast ultrasound examination to seven situations. \nEvaluation of the axilla and ultrasound as a screening tool on high risk women is \nconsidered an area of research. The progression of US makes guidelines become \nobsolete very fast. Its application still remains pending on the results of clinical \ntrials. Image smoothing on sono-CT or multiple frequency transducers will produce \nimages, eventually with more diagnostic information. Second tissue harmonics \nwill produce sharper and more clear images. CAD systems, Doppler and contrast \nDoppler will help in diagnosis. 3D with the new software and automatic probes \nconstitute a very promising work in progress. They will make a dramatic change in \nour workload. The radiologist will be released of performing the exam, to review the \nimages in the workstation. Sonoelastography has evolved from the manual to the \nactual automatic shearwave. This system measures the transversal transmission \nof sound in biologic tissues. It is a new and promising technology, probably more \nobjective and non-operator dependant, that is able to differentiate benign from ma-\nlignant conditions. All of these systems will be reviewed and evaluated for its actual \nsituation. The problem now is how to introduce new terms, new descriptors, and \nnew technologies in the BI-RADS system, once clinical evidence is demonstrated. \nLearning Objectives:\n1. To understand the new technologies in breast US.\n2. To appreciate advantages and disadvantages of these methods.\n3. To understand the potential role of new technologies in breast imaging.\nA‑044\t 16:30 \nB. Diffusion imaging \nB. Taouli; New York, NY/US (bachir.taouli@mountsinai.org) \nDiffusion-weighted MRI (DWI) is a promising technique in oncology. It can be used \nfor in vivo quantification of the combined effects of capillary perfusion and diffusion. \nUsing echoplanar imaging (EPI), DWI is possible with fast imaging times minimis-\ning the effect of gross physiologic motion from respiration and cardiac movement. \nIn this lecture, we will discuss the acquisition, post-processing and quantification \nmethods and results of DWI in abdominal and pelvis tumours. We will also review \nthe mechanisms associated with diffusion changes in tumours. MRI-pathologic \ncorrelation will be shown. Finally, limitations and future directions of the technique \nwill be reviewed. \nLearning Objectives:\n1. To understand the physical basis of diffusion.\n2. To understand the basis of diffusion measurement with MRI.\n3. To understand why diffusion imaging provides information on the structure \nand viability of solid tumours.\nA‑045\t 17:00 \nC. Metabolic imaging using PET/CT \nG. Antoch; Düsseldorf/DE (antoch@med.uni‑duesseldorf.de) \nDiagnostic potentials - as well as limitations - associated with morphological \ncross-sectional imaging on the one hand and functional imaging on the other are \nincreasingly well understood. It has become obvious that in many cases both \nkinds of imaging complement one another. Hence, hybrid PET/CT imaging must \nbe considered one of the most promising new developments in medical imaging. \nHowever, some questions have to be raised and challenges have to be met to avoid \noverrating PET/CT in oncology. PET/CT with [18  F]-2-fluoro-2-deoxy-D-glucose \n(FDG) as a radioactive tracer has been reported to be more accurate than either \nimaging modality alone and sometimes even more accurate than CT and PET \nread side by side. However, the clinically important question should rather be the \nfollowing: Does this higher accuracy have an impact on patient management? \nFurthermore, some tumours do not have an increased glucose metabolism making \nthem FDG-PET negative. The most recently launched line of PET/CT scanners \ncombines high-definition PET with high-end multislice CT. These imaging systems \nnot only provide a higher diagnostic accuracy based on detection of smaller le-\nsions with CT and PET, but also offer integration of complex CT protocols into the \nPET/CT scan. These protocols include CT perfusion, three-dimensional CT image \nreconstruction or virtual fly-through. The aim of this talk is to give an overview \nconcerning PET/CT in oncology. The mechanism of radionuclide uptake, different \ntracers, the indications of PET/CT in oncology and its accuracy will be addressed. \nLearning Objectives:\n1. To understand why uptake of the tracer provides information on the viability \nof solid tumours.\n2. To learn whether PET/CT is able to give reliable quantitative information.\n3. To know whether PET/CT is a valuable tool for tumour response to \ntreatment.\n16:00 - 17:30 Room F2 \nBreast \nRC 202 \nBreast US \nModerator: \nE. Azavedo; Stockholm/SE \nA‑046\t 16:00 \nA. The role of US in screening, diagnosis and staging of breast cancer \nJ. Camps Herrero; Valencia/ES (juliacamps@ono.com) \nBreast ultrasound (US) is an invaluable adjunct to mammography and also the \nmost frequent modality used for guidance in interventional procedures and in the \nevaluation of additional lesions seen in breast MRI. Its role as a diagnostic tool in \nbreast cancer will center the discussion of this talk. US B-Mode’s value as a screen-\ning technique has not been established, although new advances in sonography \n(volumetric ultrasound) will very possibly change this view. US signs have been \nvalidated throughout many published papers in the literature and are very helpful in \norder to decide the management of palpable and non-palpable lesions, their positive \nand negative predictive value being very high. After a diagnosis of invasive breast \n\nPostgraduate.Educational.Programme\nS18\n A B C D E F G H\nto gain additional functional information. Functional imaging techniques such as \ndiffusion tensor imaging and tractography as well as fMRI are increasingly used \nand relied on in clinical practice. With diffusion tensor imaging and tractography \nthe location, course and integrity of the major white matter tracts can be depicted, \nwhile with fMRI the brain’s cortical function is visualised. Despite major technical \nadvances, these techniques are still time consuming, labour intensive and have \nseveral limitations. They therefore need to be used and interpreted with care. The \npurpose of this lecture is to review the functional anatomy of the brain in a clinically \nrelevant context and to illustrate when additional functional imaging techniques may \nbe indicated. The most important eloquent brain areas are addressed and include \nthe motor, visual and language systems. \nLearning Objectives:\n1. To learn classic neurological and other clinical symptoms in correlation to \nbrain anatomy.\n2. To understand which neurological/clinical symptoms the patient might have \nbased on the imaging findings.\n3. To consolidate which imaging techniques are the best to answer the clinical \nquestion based on the patient’s clinical/neurological symptoms.\n16:00 - 17:30 Room I/K \nCardiac \nRC 203 \nCardiac imaging: what’s up Doc? \nModerator: \nC. Peebles; Southampton/UK \nA‑052\t 16:00 \nA. 3 T cardiac imaging: twice as good? \nM. Gutberlet; Leipzig/DE (matthias.gutberlet@herzzentrum‑leipzig.de) \nRoutine clinical cardiac MRI requires speed and efficiency as a result of physical \nmotion. Consequently, the challenges and benefits of rapid MRI are nowhere more \napparent than in the field of cardiovascular MR imaging. To meet these challenges, \none must balance the competing constraints of signal-to-noise ratio (SNR), contrast-\nto-noise ratio (CNR), spatial resolution, temporal resolution, scan time, and image \nquality. One of the main determinants of SNR is the static magnetic field strength. \nHence, cardiovascular MRI at 3.0 T or more holds the promise to overcome some \nof the SNR limitations and to extend the capabilities of cardiac MRI. All studies in \ncardiac MRI at higher field strength have proven the feasibility of cardiac MRI for \nthe comprehensive assessment of cardiac morphology and function. The studies \ndemonstrated a significant SNR increase, but also outlined image-quality problems \nassociated with B1-field inhomogeneities and specific absorption rate (SAR) con-\nstraints. With regard to acquisition speed, parallel imaging MRI capabilities form \nan important enabling factor, especially if enough SNR is available. Therefore, the \ncombination of higher field strength and parallel imaging strategies may help to \novercome several of the present limitations in cardiac MRI like cardiac perfusion \nand coronary artery imaging. The present indications, advantages and limitations \nof cardiac MRI at 3.0 T will be discussed. \nLearning Objectives:\n1. To learn the advantages of cardiac MR at 3 T.\n2. To understand how to optimise protocols and reduce artefacts.\n3. To be aware of areas that need improvement.\nA‑053\t 16:30 \nB. Cardiac CT: how low can dose go? \nS. Leschka; St. Gallen/CH (sebastian.leschka@kssg.ch) \nThe risks associated with the exposure of ionising radiation has raised increasing \nconcerns in the radiological community. The recent years have shown an overall \nincrease in the use of CT for the imaging of the heart and the coronary arteries. \nThe downside of this increased use of cardiac CT is the increase in the collective \nradiation dose with cardiac CT which have been reported to be associated with \nan effective radiation dose of 20 mSv or more. Increased awareness of the radia-\ntion dose with cardiac CT led to the development of several effective radiation \ndose reduction strategies including prospective ECG gating technique, anatomy \nand ECG-based tube current modulation, high pitch acquisition, and adaptation \nof the CT scanning parameters to the body habitus. However, the dose reduction \nstrategies should be selected carefully on an individual patient basis in order to \navoid serious image quality impairment by noise and artefacts. The lecture outlines \nthe different radiation dose saving techniques currently used in clinical practice, \n16:00 - 17:30 Room G/H \nNeuro \nRC 211 \nIntroduction to the brain \nModerator: \nT. Stosic‑Opincal;  Belgrade/RS \nA‑049\t 16:00 \nA. Brain anatomy made easy \nT.A. Yousry; London/UK (t.yousry@ion.ucl.ac.uk) \nThe anatomy of the brain is often perceived as being complicated. Especially the cortex is \nseen as an irregular arrangement of variable structures, which are difficult to differentiate \nand to identify. We will review the overall subdivision of the brain into lobes and describe \ntheir boundaries and their major gyri and sulci. We will then describe the location of spe-\ncific functions. 1. Primary sensorimotor cortex: motor is located in the precentral gyrus, \nsensory in the postcentral gyrus around the central sulcus (CS), hence the importance \nof always correctly identifying the CS. We will present 4 interlocked methods to identify \nthe CS in the axial plane (a) knob, (b) lateral axial, (c) medial axial, (d) gyral/cortical \nthickness and 3 to identify it in the sagittal plane (a) lateral sagittal, (b) hook, (c) medial \nsagittal. 2. Primary auditory cortex (A1): centred at the postero-medial part of Heschl’s \ngyrus (HG), we will present simple landmarks in each of the 3 planes: (a) axial: adhaesio \ninterthalamica, (b) sagittal: omega/heart shape of HG, (c) coronal: omega shape of HG. \n3. Primary visual cortex (V1): Centred on the calcarine sulcus, we will discuss the char-\nacteristic shape that allows the identification of this structure in all 3 planes. At the end \nof this lecture, you will know the subdivision of the cortex; the methods and landmarks \nnecessary to identify the primary sensorimotor, speech, auditory, and visual areas. \nLearning Objectives:\n1. To recapitulate basic brain anatomy.\n2. To be able to correlate different anatomic locations to CT and MR images.\n3. To consolidate knowledge of the important landmarks for anatomic \nstructures on images.\nA‑050\t 16:30 \nB. Pattern recognition and normal variants to know \nM.M. Thurnher; Vienna/AT (majda.thurnher@meduniwien.ac.at) \nMagnetic resonance imaging (MRI) has undergone a rapid development in the \nlast decade with numerous new techniques. Nevertheless, pattern recognition of \nbrain lesions based on signal intensities on conventional MR sequences (T1- and \nT2-weighted, FLAIR) is the first step in diagnostic “work up”. Good examples for \npattern recognition are lesions with T1-shortening (“bright” on T1WI) such as: fat \ncontaining lesions (lipoma), melanoma, lesions with colloid content, calcifications, \nand haemorrhagic metastatic lesions. T2-shortening (“dark” on T2WI) in enhanc-\ning lesions is suggestive of lymphoma and certain infections (tuberculosis, fungal \nabscesses). Flow void (absence of signal) reflects high velocity flowing blood or \nCSF, and will help in diagnosing vessel abnormalities and related pathologies. The \npurpose of this lecture is to refresh knowledge on patterns and normal variants \nuseful for clinical practice. A simplified “pipeline” consisting of easy consecutive \nsteps will be introduced. \nLearning Objectives:\n1. To learn important normal variants of different structures and lesions in the \nbrain.\n2. To learn about recognition patterns that might be helpful in suggesting the \nmost likely etiology of common brain lesions.\n3. To consolidate the key imaging findings in different types of lesions and \nnormal variants.\nA‑051\t 17:00 \nC. Clinical symptoms correlated to brain anatomy \nM. Smits; Rotterdam/NL (marion.smits@erasmusmc.nl) \nDiagnostic neuro-imaging heavily depends on a thorough understanding of brain \nanatomy in relation to the brain’s function. Clinical neurological symptoms and \ndeficits not only give us an indication of the brain area(s) involved but may also \ndirect us towards the use of specific imaging techniques, such as diffusion tensor \nimaging and tractography, as well as functional magnetic resonance imaging (fMRI). \nSpecific imaging findings, on the other hand, may direct clinical management in \na neurologically intact patient, such as the decision to resect a brain tumour in \nor near an eloquent brain area. Again, specific imaging techniques may be used \n\nThursday\nPostgraduate.Educational.Programme\nA\n S19\nCB D E F G H\nA‑056\t 16:05 \nEvaluation of tumour response to therapy: the role of radiology \nM. O’Connell; Dublin/IE (oconnellm@mater.ie) \nEvaluation of response to treatment allows an early assessment of tumour response \ntypically after 2-4 cycles of chemotherapy. This evaluation is most commonly per-\nformed with PET/CT during therapy for high grade non-Hodgkin’s lymphoma. This \nreview presentation looks at the potential roles that CT, regional MRI and whole \nbody MRI do and could play in response evaluation from a radiology perspective. \nThe presenter is a radiologist who is clinical director of a medium volume PET/\nCT centre. The talk focuses on discrepancies between CT and PET findings in \ntumour response and on tumours or situations where CT is the primary modality \nto determine tumour response. Potential roles for whole body MRI in response \nevaluation and assessment of solid tumours by MRI are examined. At a general \nlevel, the role of the radiologist as part of the multidisciplinary oncology meeting \n(MDM), including when and where to use image-guided biopsy in response evalu-\nation and the use of RECIST versus PRECIST criteria is discussed. The aim of the \npresentation is to outline the role of CT in tumour response evaluation in the era \nof PET/CT and to explore potential roles particularly for whole body MRI in tumour \nassessment. The presenter hopes to encourage radiologists to get fully involved \nin MDM discussions regarding CT, MRI and PET/CT evaluation. \nLearning Objectives:\n1. To learn the standard method (tumour measurements) for the evaluation of \ntumour response to treatment.\n2. To understand the limits of international standard.\n3. To become familiar with methods that provide functional or structural \ninformation, like perfusion CTMR or DW-MRI.\nA‑057\t 16:23 \nEvaluation of tumour response to therapy: the role of nuclear medicine \nA. Chiti; Milan/IT (arturo.chiti@humanitas.it) \nThe high costs and possible side effects of chemotherapy and radiation therapy \ntreatments favour the use of effective ways to monitor the treatment efficacy in \noncology. Molecular imaging demonstrated to be effective in evaluating the response \nafter and during the course of therapy, in order to assess chemo-sensitivity and \nchemo-resistance of a particular neoplasm. The use of PET-CT in this setting can \nvary from very sophisticated and complex quantitative evaluation to simple qualita-\ntive analyses. In malignant lymphoma, international criteria for monitoring response \nto therapy have recently been revised, and FDG now plays a central role in defining \ntumour response. In a variety of solid tumours, studies have indicated that FDG \nPET-CT may provide early and accurate assessment of tumour response, suggest-\ning that it could play a significant role in personalising the treatment of malignant \ntumours. Performed during and after therapy for HL and aggressive NHL, FDG \nPET results have a high prognostic value and correlate with survival. FDG PET \nhas been incorporated into revised response criteria for aggressive lymphomas, \nand several ongoing trials are under way to investigate the value of treatment \nadaptation based on early FDG PET results for HL and aggressive NHL. Many \ntechnical aspects must be taken in consideration to avoid critical errors in evaluat-\ning response. From patient preparation to image acquisition a series of possible \npitfalls must be avoided. In the clinical practice, the most widely used parameter \nis the SUV, which can improve the accuracy of qualitative image assessment in \nmany clinical settings. \nLearning Objectives:\n1. To understand why PET-CT can be used to assess tumour viability.\n2. To become familiar with the principles of signal quantification and to discuss \nits advantages and limits.\n3. To learn about the incoming tracers that might enhance the role of PET-CT \nin the evaluation of tumour response.\nA‑058\t 16:41 \nAlzheimer’s disease: the role of radiology \nJ. Alvarez-Linera; Madrid/ES (jalinera@ruberinternacional.es) \nNeurobiological changes in Alzheimer’s disease (AD) occur in an stereotypical \npattern that begins in the medial temporal lobe (MTL) years before the clinical \nmanifestation (brain reserve). Brain atrophy is a marker of neurodegeneration that \nreflects the neurobiological disorder and is correlated with the neuropsychological \nchanges at all stages of the disease. Other imaging markers may reflect changes \nin microstructural (diffusion), functional (perfusion) or metabolic (MRS) domains \nthat would provide additional information but are awaiting wider validation. In the \nearly stages of AD, the most effective MRI markers are those that reveal atrophy \nin MTL, particularly the measures of the hippocampus. The MTL atrophy mea-\nthe required conditions in whom they may be successfully used, and how these \ntechniques could be implemented in the daily clinical practice. \nLearning Objectives:\n1. To review the different dose reduction techniques used on cardiac CT.\n2. To understand the clinical impact, if any, of dose reduction.\n3. To recognise when the dose is too low and the noise too high.\nA‑054\t 17:00 \nC. Cardiac post-processing: latest tricks \nB.J. Wintersperger; T oronto, ON/CA (Bernd.Wintersperger@uhn.on.ca) \nProper linking of the data acquisition to the patients ECG is among the crucial \nprerequisites for successful cardiac imaging. While cardiac CT data acquisition \nitself does not impose any effect on the patients’ ECG, inherent physical effects in \nthe MR environment does show impact on the ECG trace and may hamper proper \nR-peak delineation. In addition, patient-related factors such as arrhythmia might \naffect image quality (IQ). Dose saving strategies in cardiac CT limit the possibilities \nof retrospective IQ optimisation and as such more emphasis is recommended prior \nto data acquisition which is mainly related to patient selection/heart rate control. In \ncardiac MR a high amplitude ECG without influence of magnetic or scanning effects \nis of outmost importance. Arrhythmia also remains a challenge that might be over-\ncome by arrhythmia-rejection algorithms or real-time imaging. Suboptimal contrast \nenhancement ought to be avoided by proper planning and timing as the majority of \npost-processing algorithms is based on signal behaviour. In the unfortunate situation \nof suboptimal contrast enhancement often only the use of standard post-processing \ntools is possible while semi-automated tools for cardiac post-processing may fail or \nnecessitate substantial user interaction. The use of straight forward visualisation \ntechniques is recommended for diagnosis while complex visualisation tools may add \non confidentiality but are mainly suited for case presentations. Coronary evaluation \nis typically performed using centerline tools allowing for the easy assessment of \nCAD. While these tools potentially allow for estimation of the degree of diameter \nand area stenosis, accuracy though may still be limited. \nLearning Objectives:\n1. To learn how to reduce ECG trigger artefacts on CT and MR.\n2. To learn how to compensate for suboptimal contrast enhancement.\n3. To learn how to choose appropriate visualisation techniques.\n16:00 - 17:30 Room L/M \nProfessional Challenges Session\nPC 2 \nRadiology and nuclear medicine: really a joint \nventure \nModerators:\nÉ. Breatnach; Dublin/IE \nP. Bourguet; Rennes/FR\nA‑055\t 16:00 \nChairmen’s introduction \nÉ. Breatnach1, P. Bourguet2; 1Dublin/IE, 2Rennes/FR (ebreatnach@mater.ie) \nThis is the second session between ESR and EANM at each Society’s Annual \nCongress. Few would argue but that patient’s interests are best served by cross-\nfertilisation and open communication between specialties. This is particularly true \nfor radiology and nuclear medicine. This session elaborates on clinical scenarios \nwhere cross-fertilisation between both specialties is particularly important. The \nsession will elaborate the radiologist and nuclear medicine perspectives on two \ncommon clinical scenarios, i.e. tumour response to therapy and evaluation of \nAlzheimers disease. \nSession Objectives:\n1. To appreciate how nuclear medicine and radiology provide complementary \ninformation.\n2. To learn how each method can enhance the mutual performance of the \nradiologist and nuclear medicine physician.\n3. To learn about recent advances in the field of tumour evaluation and early \ndetection of Alzheimer’s disease.\n\nPostgraduate.Educational.Programme\nS20\n A B C D E F G H\nshown on MDCT-images in the axial, coronal, and sagittal plane. Variants of the nor-\nmal anatomy, which are important to describe and to know are also shown. Some of \nthese variants are also delineated on MR images. In the second part of the lecture, the \ndifferent expressions of congenital malformations of the external and middle ear will \nbe explained. The different findings of the severity of the malformations will be shown \nand their importance for further clinical-therapeutical procedures will be explained. \nLearning Objectives:\n1. To review the normal anatomy of the external auditory canal and middle ear.\n2. To become familiar with the most frequent malformations of the middle ear.\n3. To learn about imaging protocols.\nA‑061\t 16:30 \nB. Cholesteatoma and chronic infection \nF. Veillon; Strasbourg/FR (Francis.Veillon@chru‑strasbourg.fr) \nImaging investigation of cholesteatoma is required before surgery. If no surgery has \nbeen performed previously, CT will provide information about the location of the \nlesion (epi, pro, meso, retro, hypotympanum), the partial or total destruction of the \nossicles, and possible extension to the inner ear. If there is no doubt about any of \nthese factors CT is sufficient. In doubtful cases an MRI examination is performed \nto confirm or refute the presence of cholesteatoma using T1 sequences without IV \ncontrast medium, and diffusion weighted imaging with or without high resolution \nT2, depending on the age of the patient. In postoperative recurrent cholesteatoma, \nMRI is becoming the modality of first choice for detecting cholesteatomas, appear-\ning : low in signal on T1 sequences, high in signal on diffusion weighted imaging. \nHowever, care is required since performing diffusion weighted imaging without T1 \nmay lead to false positives. A granuloma with a slightly or markedly increased T1 \nsignal is often associated with a high signal on diffusion. Measurement of ADC is \nuseful for detecting cholesteatomas, infected cholesteatomas or abscess. Finally \nwhilst MRI is the first examination in the follow -up of postoperative patients, the \nuse of contrast medium is not necessary in most of the cases. \nLearning Objectives:\n1. To learn about different causes of hearing loss within the external auditory \ncanal and middle ear.\n2. To learn about a template for a structured report.\nA‑062\t 17:00 \nC. Implants and postoperative findings in the middle ear \nB. Verbist; Leiden and Nijmegen/NL \nMany conditions which affect the function of the middle ear may require surgical \nintervention. Postoperative imaging will be requested either to evaluate complete \nremoval of diseases (eg in cholesteatoma) or because of new, persisting or recurrent \ncomplaints of the patient (e.g. vertigo after stapes replacement). In this presenta-\ntion, different surgical procedures will be reviewed including the indications for a \ncertain surgical approach as well as the different types of prosthesis. The normal \npostoperative imaging appearance of the most common surgical techniques will be \nshown. It will be discussed whether CT or MRI should be performed to answer the \nclinical questions. An overview of possible failures and complications will be given. \nLearning Objectives:\n1. To become familiar with typical implants.\n2. To review expected and unexpected postoperative findings.\n3. To learn about a template for a structured report.\n16:00 - 17:30 Room P \nVascular \nRC 215 \nExtracranial vascular malformations: imaging \nstrategies prior to endovascular therapy \nModerator: \nJ.E. Jackson; London/UK \nA‑063\t 16:00 \nChairman’s introduction \nJ.E. Jackson; London/UK (james.jackson@imperial.nhs.uk) \nThe management of patients with vascular malformations is often suboptimal. The \nreasons for this are many but include confusion regarding classification, uncertainty \nabout the most appropriate imaging of the various forms of malformation and a \nsures are helping to propose new diagnostic criteria for AD, allowing a diagnosis \nof probable AD in predementia stages, when memory loss criteria are attached \nto Imaging criteria (MRI or PET) or measures of amyloid/tau in CSF. The use of \natrophy markers (global or MTL) increases the effectiveness in clinical trials (both by \nreducing the size of the sample and increasing the statistical power) and is therefore \ncontributing significantly to the development of new treatments. The association of \nmultiple markers of structural and functional imaging (MRI and PET) and the use \nof advanced computational analysis techniques will allow better management of \nAD but it needs a broader validation and know the most efficient combination of \nbiomarkers at each stage of the disease, including the preclinical period. \nLearning Objectives:\n1. To become familiar with the early signs that enable the detection of \nAlzheimer’s disease.\n2. To understand the specific role of MRI and to learn the appropriate protocols.\n3. To learn about the new developments in radiological detection of Alzheimer’s \ndisease.\nA‑059\t 16:59 \nAlzheimer’s disease: the role of nuclear medicine \nK. Tatsch; Karlsruhe/DE (Klaus.T atsch@klinikum‑karlsruhe.de) \nScientists, researchers and clinicians all benefit from molecular imaging in dementia \nproviding exciting new insights into their basic biology and pathophysiology. Tar-\ngeting specific aspects of neurotransmission, metabolism, inflammation or plaque \nformation - just to mention some of the current molecular approaches - increasingly \ngains impact on establishing the correct diagnosis, following the course of dementia \nor developing CNS drugs. This talk will highlight the molecular targets and major \nPET and SPECT tracers for application in dementia, and will update on the results \nof the clinical imaging studies published in recent years. Typical imaging patterns of \nAlzheimer‘s disease (AD) will be discussed, including also the diagnostic discrimi-\nnation from other types of neurodegenerative dementias such as frontotemporal \ndementias, Lewy body dementia, and others. Assessment of MCI patients and the \nprobability of transition in manifest dementia (predominantly AD) will be addressed \ntogether with its prognostic relevance. Furthermore, recent advances in analysing \ntools which further improved the high diagnostic accuracy already reached by visual \nassessments will be presented. Even though in competition with other modalities, \n‚standard FDG‘ PET has shown to be a robust and both, sensitive and specific \nmarker in the diagnostic work-up of dementia. FDG information will be markedly \nextended in clinical practice by specific amyloid imaging in the near future when \nthese tracers are approved and thus generally available. \nLearning Objectives:\n1. To become familiar with the nuclear medicine method that enables detection \nand evaluation of Alzheimer’s disease.\n2. To learn about the potential development of functional studies using nuclear \nmedicine.\n3. To understand how nuclear medicine and radiology can provide \ncomplementary information.\nPanel discussion: \nThe advantages of working together for nuclear  \nmedicine and radiology 17:17 \n16:00 - 17:30 Room N/O \nHead and Neck \nRC 208 \nAn insight into middle ear pathologies \nModerator: \nT.J. Vogl; Frankfurt a. Main/DE \nA‑060\t 16:00 \nA. Normal anatomy and congenital malformations of the middle ear \nC. Czerny; Vienna/AT (christian.czerny@meduniwien.ac.at) \nImaging of the middle ear is either performed by CT and/or MRI. As the normal middle \nand external ear consists mostly of bony structures and air, CT in the bone-window-level \nsetting is the method of choice to delineate the normal anatomic structures. Especially, \nhigh-resolution MDCT in bone-window-level setting excellently depicts even subtle \nnormal as well as abnormal osseous structures. However, pathologic conditions are \nalso well delineated such as those of inflammation or cholesteatoma. In this lecture, \nthe normal anatomic structures of the external and middle ear will be explained and \n\nThursday\nPostgraduate.Educational.Programme\nA\n S21\nCB D E F G H\nsymptoms may require explanation and reassurance only. Lesions with a mainly \ncutaneous element may be treated with laser. Deeper lesions are usually treated \nwith several episodes of sclerotherapy. Agents such as alcohol, polidocanol and \nSTD will be discussed and the relative advantages and issues explained. Informed \nconsent is vital, and the approach to this will be outlined. High flow lesions are fre-\nquently associated with severe cosmetic changes, invasion of surrounding tissues, \nhaemorrhage, and high output cardiac failure. Lesions may be life threatening. In \nthe extremities peripheral ischaemia and ulceration due to steal of blood by the \narteriovenous malformation is common. Informed consent will again be discussed, \nas potential for major complications is high. Key to endovascular management of \nthese lesions is an understanding of the nidus, arterial inflow and venous outflow. \nThe role of liquid and solid embolic agents and specifics of transarterial, venous \nand direct approaches will be discussed. \nLearning Objectives:\n1. To learn the principles of endovascular treatment including sclerosing and \nembolisation materials and catheterisation techniques.\n2. To discuss the hazards and complications of treatment.\n3. To discuss the endpoints of treatment.\nPanel discussion: \nWho should decide management? 17:14 \nAVMs pose a major problem regarding classification and treatment. A case report \ndiscussed by the panellists demonstrates how these patients should be ap -\nproached. The importance of establishing an interdisciplinary outpatient clinic is \nalso presented. The most important organisational steps for providing an efficient \nclinical service are given. In addition, the most common pitfalls and complications \nof treatment are illustrated. \n16:00 - 17:30 Room Q \nComputer Applications \nRC 205 \nComputer-aided detection/diagnosis \nModerator: \nE. Pietka; Gliwice/PL \nA‑067\t 16:00 \nChairman’s introduction \nE. Pietka; Gliwice/PL (epietka@polsl.pl) \nComputer-aided detection/diagnosis (CAD) is recognised as a workstation or a \nsystem developed in order to assist the radiologists (clinicians) in performing their \ndaily diagnostic tasks. Clinically implemented CADs are available at workstations \nand (if DICOM compliant) may serve as a plug-in to PACS. The three-layer CAD \nsystem includes: (1) image analysis procedures whose development requires \na medical and technical knowledge, (2) a database module that is managed by \nexperienced radiologists and IT professionals, and (3) graphical user interface \n(GUI) that enables a user-friendly access to the data, the processing tools, and \nthe results. A modern CAD development involves a multidisciplinary team whose \nmembers are experts in medical and technical fields. A close collaboration of all \nexperts is required at all stages of system life-cycle. At each stage the physicians \nknowledge and experience are indispensable. It includes medical analysis of the \ndiagnostic problem, data collection, image analysis evaluation, and clinical verifica-\ntion. Design, testing, and evaluation have to be successful in order to ensure CAD \nimplementation in a daily clinical routine. In this session three experts will share their \nexperiences in the area of the overall CAD architecture, its evaluation, validation \nand acceptance by clinicians, advantages and restrictions of solutions and clini -\ncal implementation in lung, breast and colon cancer. Reading paradigm (primary, \nconcurrent, second) in oncology as well as results of CAD clinical implementation \nwill be presented. Perspectives in clinical CAD implementation in diagnosis and \ntreatment will be discussed. \nSession Objectives:\n1. To understand what the radiologist should know about CAD.\n2. To understand the role of the radiologists in CAD development.\n3. To learn about the main challenges for CAD implementation.\n4. To understand the impact on radiological practice.\npoor understanding of the indications for intervention. This session will concen -\ntrate upon these important topics and will also address some technical aspects \nof endovascular therapy. \nA‑064\t 16:05 \nA. Pathology, correct anatomical classification and clinical work-up \nH. Kubiena; Vienna/AT (harald.kubiena@meduniwien.ac.at) \nPatients presenting with vascular malformations mostly are nomadic and hopeless \nindividuals looking for help. Finally having reached a “multidisciplinary specialist-\ngroup” after a sometimes long and misleading trip throughout the ocean of “single-\nplayers” of different specialities these patients do not ask for any more diagnostics \n- they strongly claim for therapy. Vascular malformations are congenital lesions, \nalthough merely seen at birth they become evident throughout the individuals \ngrowth. These developmental errors can affect all components of the vascular tree \nin any area of the body. The therapeutic goal must be defined rather as “control” \nthan “cure” of this disease. To make this point understandable for both patients and \ncollegues a fundamental understanding of the pathogenesis and natural course \nmust be created. In special cases of complex vascular malformations the precise \ndiagnosis and the information about all potential side-effects as well as risk-factors \nof progression enables these patients to manage their daily life. Therefore, indica-\ntions for treatment vary depending on the specific type of slow flow or high flow \nlesion, location, pain, functional and cosmetic impairments and general side-effects \nof each particular lesion, since no single specialist has enough knowledge to \ndiagnose or treat vascular anomalies beyond the border of his distinct speciality \nmultidisciplinary working-groups emerged at these interdisciplinary interfaces. Their \ncommon language in classifying and their overall understanding of pathogenesis, \nprognosis offer these mostly hopeless patients a custom-fit treatment addressing \ntheir symptoms. \nLearning Objectives:\n1. To understand the pathology of capillary, venous, lymphovenous and \narteriovenous malformations.\n2. To understand the haemodynamics of vascular malformations.\n3. To discuss the clinical symptoms and the indications for treatment.\nA‑065\t 16:28 \nB. Imaging of capillary, venous, lymphovenous and arteriovenous \nmalformations \nL. Schultze Kool; Nijmegen/NL (l.schultzekool@rad.umcn.nl) \nImaging of vascular malformations should be directed by clinical assessment of the \ntype of malformation to be expected, clinical symptoms and need for treatment. In \norder to make the proper decision of the required imaging modality or treatment, it \nis essential that the (interventional) radiologist is a member of a dedicated vascular \nmalformation team. Imaging needs to be tailored to the individual patient although \ngeneral rules can be applied. Duplex ultrasound together with a clinical assess-\nment is often sufficient to make a proper diagnosis. This is especially true for the \npaediatric population. If more information about the extent of the lesion is needed, \nMR is often used in case of low flow lesions (venous/lymphatic), and MRA or CTA \nin case of high flow lesions. Angiography is mandatory if an AVM is diagnosed \nand treatment is planned. High frame rate imaging and selective injections are the \nonly options for a proper evaluation of the nidus architecture of the AVM. There \nare exceptions that warrant deviating from the above general rules. In this lecture, \nboth the general rules and the exceptions will be discussed. \nLearning Objectives:\n1. To consolidate knowledge of the various imaging techniques including their \npotential for visualising the anatomy and haemodynamics.\n2. To learn criteria for classification of vascular malformations.\n3. To learn reporting standards for vascular malformations.\nA‑066\t 16:51 \nC. Technical aspects of endovascular treatment \nP.C. Rowlands; Liverpool/UK (peter.rowlands@rlbuht.nhs.uk) \nVascular malformations are uncommon conditions with a wide spectrum of ap-\npearance and symptoms. Incorrect diagnosis and management is common. Best \noutcomes are obtained in centres with a high caseload and multidisciplinary \nmanagement. The disciplines include interventional radiology, plastic surgery, \ndermatology, anaesthesiology, vascular surgery and others. Accurate diagnosis \nby clinical assessment and non-invasive imaging is key to procedural planning. \nLow flow and high flow lesions are managed very differently and are discussed \nseparately below. Low flow lesions may be associated with symptoms varying \nfrom trivial to significantly affecting quality of life. Patients with lesions with mild \n\nPostgraduate.Educational.Programme\nS22\n A B C D E F G H\nA‑070\t 16:51 \nC. CAD in oncology: from principles to clinical implementation \nE. Neri; Pisa/IT (neri@med.unipi.it) \nCAD has been developed to help radiologists in detecting pathology. In the era \nof screening radiologists are asked to read a large amount of x-ray, CT and MRI \nexaminations; readers fatigue increases the risk of interpretation errors; therefore, \nsystems that help radiologists in detecting pathology are welcome. CAD is the \nnatural solution; however, is it ready to be used in the clinical and especially in \nthe screening setting? How it works? CAD uses algorithms that identify specific \nshapes and densities into a DICOM image. The CAD compares this features with \nan internal database and through a learning curve reach a decision and marks \nthe pathological findings. Which are the oncological applications of CAD. Three \nfields actually seems to be well established and promising: detection of polyps in \nCT colonography, breast lesions in x-ray mammography, and nodules in CT of the \nlungs. These 3 oncological applications of CAD will be discussed in the presentation. \nLearning Objectives:\n1. To review the principles of current CAD systems in the detection of lung, \nbreast and colon cancer.\n2. To understand the reading paradigm (primary, concurrent, second) in \noncologic applications of CAD.\n3. To understand the results of CAD clinical implementation.\n4. To learn about future perspectives of CAD in oncology (which other \napplications?).\nPanel discussion: \nThe take-home points 17:14 \n1. Modern CAD system architecture\n2. Open source solutions: advantages and restrictions\n3. CAD clinical implementation\n4. Future perspectives of CAD \n18:30 - 18:50 Room A \nPlenary Session \nOL \nOpening Lecture \nPresiding:\nY. Menu; Paris/FR \nA‑071\t 18:30 \nWater: radiologists' best friend? \nD. Le Bihan; Gif‑sur‑Yvette/FR (denis.lebihan@gmail.com) \nAt the onset of the 21 st century humankind is focusing its attention on a very \nsmall molecule, as controlling CO 2 in the atmosphere is becoming a major goal, \neconomically, socially and politically. Yet, there is another small molecule which is \ngoing to play a more prominent role in the near future. H2O, especially in its liquid \nform, the ‘Blue Gold’, is just indispensable to our lives. Water makes 60 to 70% of \nthe human body weight and is crucial to the working of the biological machinery. \nStill, how such a tiny molecule with its 105° ‘magic’ angle could have been at the \norigin of life remains largely a mystery. Different organisms have adopted different \nstrategies in the way they get the most out of water, depending on their environ -\nment, and water contributes to the biodiversity. Faulty mechanisms in the use of \nwater by tissues may lead to severe diseases or death. Clearly, water deserves to \nbe seen as the prime ‘biological molecule’, and radiologists have long recognised \nits importance from the days of ‘dry’ (bone and air) radiology to the advent of CT \nwhich allowed contrast from ‘wet’ tissues to be explored. With MRI one went one \nstep further, as magnetisation of water is the sole source of contrast. Life has led \nto intelligence, and recent MRI studies have suggested that water may also actively \ncontribute to the mechanisms underlying brain function. Could the ‘molecule of life’ \nalso be the ‘molecule of the mind’? Clearly, water must be radiologists' best friend. \nLearning Objectives:\n1. To comprehend how the structure of the water molecule makes it important \nto life.\n2. To understand the importance of water in biological and cellular processes.\n3. To become familiar with the different ways water is responsible for image \ncontrast in radiology.\nA‑068\t 16:05 \nA. The role of CAD in modern-day imaging \nA. Todd-Pokropek; London/UK (A.T odd@ucl.ac.uk) \nThe use of CAD in medicine is an important and growing area of research. Firstly \ngood data must be acquired including not just images but associated information. \nThe first step in that of preprocessing, notably (but not only) noise reduction. The \ndata are then passed onto the segmentation step. Often this step is semi-automatic \nrequiring some manual intervention. Conventional edge detection methods are not \noften of value, but Active Shape and Appearance Models, the use of Markov Ran-\ndom Fields etc are commonly used. The next step is that of feature extraction both \nof shape and texture. These data are then submitted to one of several classifiers \nsuch as Artificial Neural Networks (including MTANNs) Support Vector Machines \n(SVM) and data reduction using Principle and Independent Component Analysis, \nand Multiple voting techniques such as ADABoost are also of value. The output \nmay simply be returned to the observer (clinician) or as further input for a decision \nsupport system. Examples considered will be in breast imaging (mammography), \nlung nodule detection, virtual colonoscopy and lumber spine. The use of the CAD \nsystem as a simultaneous assistant or as a second reader is important. The use \nof CAD in therapy is of increasing important. The assessment of such CAD system \n(evaluation and validation) is still controversial. The difficulty of bringing systems \nboth instrumentation and software for use in clinical practice in often underestimated \nand there have been some notable failures. Some example of ‘failures’ will be given. \nLearning Objectives:\n1. To review several current CAD systems and architecture from a general \npoint of view.\n2. To understand the problems of evaluation, validation and acceptance by \nclinicians.\n3. To learn about potential future applications such as assessment of therapy.\n4. To become familiar with the potential implications of advances such as the \nGrid.\nA‑069\t 16:28 \nB. Emergence of open-source software \nO. Ratib; Geneva/CH \nIn the recent years, open source software (OSS) has grown in numerous areas \nof software development including in highly specialised markets such as medical \napplications. This new paradigm in software development has proven to be cost \neffective and successful in many areas including medical imaging applications. It is \nparticularly promising in advanced image display and analysis applications where \nthe rapid increase in demand cannot be matched by traditional expensive com-\nmercial solutions. The evolution of radiology imaging modalities from 2D sectional \nacquisition to 3D volumetric acquisition and even higher dimensions with functional \ndata and the emergence of multimodality scanners such as PET/CT scanners calls \nfor new and innovative display and visualisation tools. By combining multiple new \ntechnologies and open-source projects it is possible to develop a new generation \nof high-performance 3D DICOM viewers that were traditionally only accessible \non expensive 3D workstations restricting their use to specialist radiologists. An \nexample of such open source project is the OSIRIX software for multimodality \nimage analysis and processing. It provides the necessary tools for navigating and \nprocessing very large datasets of multimodality imaging. It can be implemented \noutside radiology departments and provide a solution for increasing needs and \nrequirements of clinicians, surgeons and other specialists. Open source software \nplatform can provide cost-effective framework for the development and wide dis-\ntribution of advanced image processing and image analysis tools. It can ensure \nsustainability and large diffusion of specialised analysis tools that would otherwise \nbe very difficult to distribute and maintain outside its original development lab. \nLearning Objectives:\n1. To learn about the advantages and restrictions of open-source solutions.\n2. To understand how open-source solutions could be implemented.\n3. To learn about specific open-source tools.\n4. To understand the legal aspects of clinical applications of open-source \nsoftware.\n\nPostgraduate.Educational.Programme\nA\n S23\nCB D E F G H\nFriday,.March.4\n\nPostgraduate.Educational.Programme\nS24\n A B C D E F G H\n(CRC) screening. The reason was that the data from the major multicenter trials \nshowing benefits in CRC screening by the use of CTC are not applicable to the \naverage Medicare population because of the differences in age; and the older the \nage the larger the number of polyps with a consequent increase in colonoscopy \nreferral, leading to exam duplication. This is the same policy of almost all the pri-\nvate contractors in the US as well as the European countries, where both private \nand public payers are not covering CTC for CRC screening. Reason is that even \noptical colonoscopy is not considered a screening test in Europe, where authori -\nties recommend the use of faecal occult blood test (FOBT). In some European \ncountries, for example in Italy, CTC is integrated into mass screening projects \nperformed with FOBT as a substitute of barium oenema in the case of incomplete \noptical colonoscopy performed in individuals with a positive FOBT. The situation \nis different for other clinical conditions and, in particular, for those patients with a \nprevious incomplete optical colonoscopy, due to obstructing neoplasm, aberrant \nanatomy, previous surgery, etc., where CTC is fully reimbursed. And the same \noccurs in most countries when there is an absolute contraindication to invasive \ncolonoscopy or preoperative cancer staging and localisation is needed. \nLearning Objectives:\n1. To become familiar with differences in reimbursement for CTC within \nand outside Europe, and to detail how this differs for symptomatic and \nasymptomatic patients.\n2. To understand how differences in reimbursement impact on implementation \nof CTC.\n3. To understand broader political issues related to reimbursement, namely \nturf-battles with other health professionals.\n4. To become familiar with potentially imminent changes in reimbursement.\nA‑075\t 09:09 \nQuality, training and accreditation \nD. Burling; London/UK (burlingdavid@yahoo.co.uk) \nCT colonography has evolved rapidly and disseminated widely over the last decade. \nThe ability to provide an accurate whole colon examination with near perfect comple-\ntion rates, use of reduced laxative bowel preparations and extra-colonic organ review \nhas attracted very considerable interest amongst the wider radiological and gastro-\nenterological community. Inclusion of CT colonography in several core radiological \ntraining programmes confirms its evolution from super-specialist technique (performed \nin only a few centres) to mainstream. However, evidence supports highly variable \nperformance, which is perhaps unsurprising given the complexity of both technique \nand interpretation methods - both which require specific training. Notably, attendance \nat a training workshop generally represents the beginning of a radiologist’s experi-\nence of CT colonography. Indeed, most delegates rapidly progress from unconscious \nto conscious incompetence, acknowledging the need for a planned implementation \nstrategy prior to offering CT colonography in their routine clinical practice. Thankfully \na decade of intensive research and large volume clinical experience has equipped \nthe radiological community with knowledge and experience to inform successful CT \ncolonography implementation strategies. By combining this experience with training \nand accreditation practices developed for colonoscopy, the prospect of a robust quality \nassurance framework is realistic and necessary to reassure both service commissioners \nand the general public alike. Step one: the publication of international CT colonography \nstandards, co-authored by eminent radiologists from across Europe and beyond has \nbeen achieved. This talk will review the likely next steps. \nLearning Objectives:\n1. To learn about trial data that quantify the benefit of training individuals to \ninterpret CTC.\n2. To become familiar with a quality framework necessary for optimised CTC \ndata acquisition, interpretation, and patient satisfaction, with reference to the \nBSGAR/RCR/ESGAR guidelines.\n3. To learn how the above may be implemented practically.\n4. To learn about issues around potential accreditation for CTC, both practical \nand political.\nA‑076\t 09:27 \nCAD: friend or foe? \nS. Halligan; London/UK (s.halligan@ucl.ac.uk) \nComputer-assisted detection (CAD) for CT colonography is now widely available \nin Europe from a number of different vendors. This presentation will detail factors \nthat potential users will need to know in order to properly evaluate CAD systems, \nuse them in clinical practice, and evaluate their likely impact. The different ways in \nwhich the performance of CAD systems can be assessed will be discussed and the \ndifference between weak methodologies (e.g. internal validation) and more valid \nassessments (e.g. external validation) will be explained. The different possibilities \n08:30 - 10:00 Room A \nState of the Art Symposium \nSA 3 \nThe 3 P’s of CT colonography: polyps, protocols \nand politics \nModerator: \nS. Halligan; London/UK \nA‑072\t 08:30 \nChairman’s introduction \nS. Halligan; London/UK (s.halligan@ucl.ac.uk) \nNow that the diagnostic performance of CT colonography has been well-established, \nthis state-of-the-art symposium will deal with issues related to the implementation CT \ncolonography in day to day clinical practice. The lecturers will deal with the diagnostic \nperformance of CT colonography, the technical requirements necessary to obtain high \nquality diagnostic data, the factors that underpin a high-quality service (including reader \ntraining), how implementation differs across different countries, and the possible impact \nof new developments, including computer-assisted detection (CAD). \nSession Objectives:\n1. To review current technical prerequisites for acquisition of high-quality CTC \ndata and its visualisation.\n2. To learn about political and turf-battle issues surrounding implementation of \nCTC technology.\n3. To recognise the characteristics of a high-quality service, both for patients \nand doctors.\n4. To understand the benefit of CAD assistance for data interpretation.\nA‑073\t 08:33 \nCT colonography in 2011: how far has it come \nP. Lefere; Roeselare/BE (radiologie@skynet.be) \nTwo decades ago spiral CT technology initiated a new era in diagnostic imag-\ning with virtual colonoscopy or CT colonography (CTC) as a major innovation. \nIntroduced by David Vining in 1994, CTC was rapidly endorsed as a potential \ntool for colorectal cancer screening. After an initial pioneering period defining the \nbasic CTC principles, the advent of multi-slice CT significantly improved spatial \nand temporal resolution, allowing for isotropic image reconstruction with detailed \n3D rendering of the colonic wall and very short acquisition times, reducing motion \nartefacts. Furthermore, application and refinement of (ultra-) low dose technique \nalmost completely tackled the issue of radiation dose. These improvements have \nresulted in the perfect optical colonoscopy imitator with reliable fly through of the \ncolon in a timely manner. Consecutively, the primary 3D reading paradigm with 2D \nproblem-solving is getting more and more adepts, although in experienced hands \nprimary 2D-read with 3D-problem solving is a solid contender. To improve depiction \nof the colonic wall new 3D visualisation methods were developed. These technical \nimprovements with the application of state-of-the-art CTC technique have resulted \nin a very good performance of polyp detection. In three multi-centre studies, totalis-\ning 3775 patients, sensitivity ranged between 78-91% and 90-92% and specificity \nbetween 84-93% and 84-98% for lesions >  6 mm and >  10 mm, respectively. \nFinally, it may be expected that further refinements of CAD, laxative-free CTC with \nelectronic cleansing and dual energy CT will bring CTC to the next level and will \nenhance it as the reliable and cost-effective tool for colorectal cancer screening. \nLearning Objectives:\n1. To review the evolution of CT colonography since its introduction, with \na focus on data acquisition and methods of data visualisation and \ninterpretation.\n2. To review the currently achievable test characteristics of CTC (sensitivity, \nspecificity, accuracy) via reference to current trial data.\n3. To become familiar with imminent developments that may further enhance \nCTC test characteristics.\nA‑074\t 08:51 \nCurrent status of reimbursement \nA. Laghi; Latina/IT (andrea.laghi@uniroma1.it) \nCurrent status of reimbursement for CT colonography (CTC) is extremely het-\nerogeneous, both within and outside Europe. In the US, in 2009, the Centers for \nMedicare and Medicaid Services denied coverage for CTC for colorectal cancer \n\nFriday\nPostgraduate.Educational.Programme\nA\n S25\nCB D E F G H\nastinitis and extension of infection from adjacent spaces (neck, pharynx, pleura or \nretroperitoneum). Typical cases including the role of radiologic findings with respect \nto sensitivity and specificity, and important differential diagnosis will be discussed. \nThe distinction between a parapneumonic pleural effusion and an empyema based \non radiologic findings is often impossible. Features suggesting a “complicated” \ncourse requiring interventional or even surgical treatment at some point will be \ndiscussed. Features of empyema and lung abscess at CT will be illustrated as well \nas CT indices of severity of empyema and its effect on the underlying lung that allow \nsome prediction of functional outcome after surgical decortication. An empyema \nnecessitatis describes a chronic empyema that attempts to decompress through \nthe chest wall. Infectious agents include tuberculosis, actinomyces, staphylococcus \nand various types of fungi. It has to be differentiated from other mostly neoplastic \ndiseases that cross fascial planes such as lymphoma or Pancoast tumour. \nLearning Objectives:\n1. To review the most common conditions or infectious agents that cause non-\npulmonary thoracic infections.\n2. To learn about the role of various imaging techniques including ultrasound, \nCT and MRI for the assessment of chest wall, pleural or mediastinal \ninfections.\n3. To be aware of the differential diagnosis and to know about imaging features \nthat are helpful in this matter.\n08:30 - 10:00 Room C \nAbdominal and Gastrointestinal \nRC 301 \nAbdominal lymphoma \nModerator: \nA. Rahmouni;  Creteil/FR \nA‑079\t 08:30 \nA. Solid organs \nE. de Kerviler; Paris/FR (eric.de‑kerviler@sls.aphp.fr) \nMost lymphomas arise in lymph nodes or other lymphatic tissues. Extranodal \nlymphomas arise in tissues normally devoid of lymphoid tissue. Involvement of \nso-called extranodal organs is a common finding after staging investigation, how-\never, and a substantial part of NHL even arises in these sites. The latter form is \noften referred to as primary extranodal NHL. Splenic lymphoma is common in both \nHodgkin disease and non-Hodgkin lymphomas but it may be difficult to detect by \nimaging techniques because lymphoma nodules in the spleen are often smaller \nthan 1 cm. Splenic enlargement alone is not a good indicator of lymphomatous \ninvolvement. Primary hepatic lymphoma is rare compared with disseminated \ndiseases at both nodal and extranodal sites. Several forms of hepatic involve -\nment can be seen including mass lesions/nodules, diffuse infiltrative form and \nextrahepatic involvement of the hepatic ligament. Lymphomatous involvement of \nliver hilum nodes often infiltrates along the hepatic artery and portal vein toward \nthe head of the pancreas and produces an infiltrative bulky mass that involves the \nliver, pancreas and duodenum. Primary pancreatic lymphoma is very rare and can \nbe difficult to differentiate from pancreatic adenocarcinoma. Definitive pathological \ndiagnosis of lymphomas is often obtained using image-guided biopsy. This non-\ninvasive procedure is important as the prognosis and management of lymphomas \ndiffer greatly from that of adenocarcinoma or metastatic diseases. Staging (Ann \nArbor classification or modifications) and response to therapy is primarily by CT. \nIndications for 18 F-PET/CT include lymphomas that are routinely FDG avid, diffuse \nlarge B-cell lymphomas and Hodgkin disease. \nLearning Objectives:\n1. To review the pathways of spread in liver and spleen lymphoma.\n2. To learn the various imaging features of liver and spleen lymphoma and their \ndifferential diagnoses.\n3. To learn to identify the accuracy of each imaging modality to assess staging \nand response to therapy.\nA‑080\t 09:00 \nB. Hollow abdominal viscera \nR.M. Mendelson; Perth/AU (richard.mendelson@health.wa.gov.au) \nPrimary gastrointestinal lymphomas are nearly always NHLs, classified pathologi-\ncally by the REAL/WHO system. Correlation of radiological morphology with histol-\nogy is relatively poor, but characteristic subtypes are discussed. The key issue is \ndifferentiating indolent and aggressive lymphomas. Most gastric lymphomas are \nfor integrating the CAD system into day to day clinical workflow will be explained, \nparticularly second-read CAD and concurrent CAD. Finally, the clinical impact of \nCAD and the different reading paradigms will be quantified with reference to the \npeer-reviewed indexed literature. \nLearning Objectives:\n1. To understand what CAD is and how it is integrated into clinical interpretation \nof CTC.\n2. To review trial data that quantifies the benefit of CAD assistance to \nobservers tasked with interpreting CTC.\n3. To learn which observer groups may benefit most from CAD, and its impact \non training schedules.\nPanel discussion: \nIn 2011, should CTC now be the primary method of colorectal investigation \nin my hospital? 09:45 \nCTC is now established in clinical practice but other viable methods for colonic \ninvestigation remain; namely barium enema and colonoscopy. CTC has attracted \nmost attention as a screening method for colorectal cancer and adenomas, but \na role is also advocated for symptomatic patients, not only because it can detect \nsymptomatic cancer but because disease outside the colon may underpin symp-\ntoms. The panel will debate whether the barium enema should be abandoned \ncompletely and, if so, will discuss the relative positioning of CTC and colonoscopy \nfor investigation of symptomatic patients. \n08:30 - 10:00 Room B \nInteractive Teaching Session \nE³ 320a \nThoracic infections: what the radiologist must \nreport \nA‑077\t 08:30 \nA. Pulmonary infections \nT. Franquet; Barcelona/ES (tfranquet@santpau.es) \nCommunity acquired pneumonia (CAP) is a major health care problem because \nof their high morbidity and mortality rates. Patients exposed to non-hospital risks \nwho develop pneumonia have been traditionally categorised as having community-\nacquired pneumonia (CAP). Healthcare-associated pneumonia (HCAP) is a new \ndesignation for pneumonias affecting individuals residing in non-hospital health \ncare facilities, patients undergoing outpatient procedures or therapies, and patients \nwho have been recently discharged from the hospital setting. When the diagnosis \nof CAP or HCAP is suspected, imaging studies are mandatory for the evaluation \nof affected patients. A nosocomial pneumonia is defined as one not acquired in a \nhospital or a long-term care facility. It occurs most commonly among ICU patients, \npredominately in individuals requiring mechanical ventilation. Pulmonary infection \nis a major cause of morbidity and mortality in patients with impaired immune func-\ntion. Increasing numbers of patients are becoming immunosuppressed, because \nof solid organ and hematopoietic stem cell transplantation, the use of immunosup-\npressive agents for treating a host of inflammatory diseases, or congenital and \nacquired diseases such as acquired immune deficiency syndrome (AIDS). Mildy \nimpaired host immunity as it occurs in chronic debilitating illness, diabetes mellitus, \nmalnutrition, alcoholism, advanced age, prolonged corticosteroid administration \nand chronic obstructive lung disease have also been regarded as predisposing \nfactors of pulmonary infections. The rapid diagnosis and treatment of pulmonary \ninfections are essential. Combination of pattern recognition with knowledge of the \nclinical setting is the best approach to pulmonary infectious processes. \nLearning Objectives:\n1. To learn how to recognise pulmonary infections in immunocompetent and \nimmunodepressed patients.\n2. To learn how to recognise infections of the chest wall, pleura and \nmediastinum.\nA‑078\t 09:15 \nB. Non-pulmonary chest infections \nC. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nAcute mediastinitis is a potentially life threatening but fortunately rare condition that \nrequires prompt diagnosis and treatment. Spontaneous or iatrogenic oesophageal \nrupture is the by far most common cause. Other causes include post-surgical medi-\n\nPostgraduate.Educational.Programme\nS26\n A B C D E F G H\nask the patient for those information. At the time of MR imaging plain films and/\nor results of an ultrasound exam of the shoulder, if possible, should be available. \nHowever, only such prerequisites allow to run a tailored examination protocol and \nto support the orthopaedic colleague with the needed answers for further adequate \ntherapy. The patient has to be placed in the magnet in a pleasant situation to avoid \nartefacts due to patients movement, which usually cause motion artefacts. It is very \nimportant to explain to patients to keep quiet during the whole examination, because \nartefacts may need repetitions of sequences, and lead so to prolongation of total \nexamination time. Furthermore, they make diagnosis more difficult and eventually \nmore or less inaccurate. Lastly, sequence repetitions decrease patient throughput \nand therefore cost effectiveness. Imaging in three orientations (axial, paracoronal-\nparallel to the supraspinatus tendon, and parasagittal - parallel to the glenoid cavity) \nusing T1W (PDW) and/or T2W sequences have to be performed. In case of specific \nquestions regarding lesions of the labrum intraarticular administration of contrast \nagent (MR arthrography) should be considered, which is sometimes (different from \ncountry to country) possible after discussion with referring orthopaedic surgeon only. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑083\t 08:55 \nB. Normal variants and pitfalls \nM. Reijnierse; Leiden/NL (m.reijnierse@lumc.nl) \nMR arthrography is superior to other imaging techniques in the evaluation of the \nglenohumeral joint. Knowledge of normal anatomy on MR arthrography is essential \nto identify pathology. Three glenohumeral ligaments (GHL) have been described, the \nsuperior GHL, the middle GHL and the inferior GHL complex, formed by an anterior \nband, a posterior band and an axillary recess of the joint. The number of ligaments \nis variable in any person and their size varies considerably. The SGHL is present in \n90-97% of shoulder studies and is variable origin. The MGHL is present in 73-92%. \nThe IGHL is present in almost 100% of shoulder studies. The MGHL is the least \nconstant in size and it can be absent in up to 27% of individuals. A well-recognised \nvariant is the Buford complex, which represents a cordlike thickening of the MGHL, \nwith absence of the anterior superior portion of the labrum. This variant is seen in \nup to 6.5% of patients. Other normal variants that can be diagnostic pitfalls include \nthe anterosuperior sublabral foramen and hyaline cartilage under the labrum. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑084\t 09:20 \nC. Identifying and reporting abnormal findings \nS. Waldt; Munich/DE (Waldt@roe.med.tum.de) \nMR imaging (MRI) and MR arthrography are the primary diagnostic imaging modali-\nties applied to patients with degenerative, traumatic and sports-related shoulder le-\nsions. In this categorical course the characteristic MR imaging and MR arthrographic \nfeatures of articular pathologies of the shoulder, in particular, instability-associated \ninjuries, rotator cuff tears and biceps tendon lesions are discussed. Beside lesion \ndetection the radiological analysis comprises the understanding of the underlying \npathomechanism and recognition of possible interrelations between different type \nof lesions (for example, secondary impingement and associated lesions of the \nposterosuperior labrum). The use of classification systems for specific lesions is \nintroduced in order to improve the radiological report. A reasonable structure for \nwritten reports is discussed comprising a brief and clear description of pathological \nfindings with subsequent interpretation and categorisation of findings with a view \nof therapeutic decision making. \nLearning Objectives:\n1. To review imaging appearances of instability lesions, rotator cuff tears and \npathology of the biceps tendon.\n2. To understand the use of terminology and classification systems to describe \nand categorise these common abnormalities.\n3. To recognise underlying pathomechanisms and understand therapeutic \nconsequences.\nB-cell, MALT type. Radiological features depend on histological grade. Small intes-\ntine lymphoma patterns are categorised as multiple nodules, infiltrative, polypoid, \nendo-exoteric and mesenteric-invasive. Rare primary colonic lymphomas may \nbe focal or diffuse. Gastrointestinal lymphomas are great mimickers with a wide \ndifferential diagnosis including: in the stomach, Menetrier’s disease, hypertrophic \ngastritis and carcinoma; in the small intestine, Crohn's disease, mastocytosis and \nmetastatic disease (nodular form); inflammatory disease and carcinoid (infiltra-\ntive form); GISTs and serosal metastases (cavitating form); TB, Crohn's disease, \ncarcinoid and carcinoma (fistulation). However, ‘aneurysmal dilatation’ strongly \nindicates lymphoma. The ‘hamburger’ sign of mesenteric lymph node enlargement \nis characteristic. Staging (Ann Arbor classification or modifications) and response \nto therapy is primarily by CT. Indications for 18F -PET or PET/CT include lympho-\nmas that are routinely FDG avid, diffuse large B-cell and Mantle cell lymphomas. \nPET’s role in other NHLs is less clear. PET can show occult advanced disease, \nassess therapeutic response, detect relapse, and differentiate fibrosis/necrosis \nfrom tumour. Although there is no convincing evidence that baseline FDG uptake \nintensity is an independent prognostic factor, changes in uptake reflect chemo-\ntherapeutic response; post-therapy residual uptake correlates with poor prognosis. \nPost-therapy negative PET has high NPV for residual disease. Interim PET may \nbe more accurate that end-of-therapy PET for predicting progression-free survival. \nLearning Objectives:\n1. To know the various imaging features of gastrointestinal tract lymphoma.\n2. To recognise the differential diagnostic criteria from other diseases.\n3. To learn to identify the accuracy of each imaging modality to assess staging \nand response to therapy.\nA‑081\t 09:30 \nC. Genitourinary tract involvement \nJ.A. Spencer; Leeds/UK (johnaspencer50@hotmail.com) \nLymphoma can involve any part of the genitourinary (GU) tract. Manifestations \ninclude a focal mass, multifocal masses or a diffuse process. Lymphoma is one \nof the great mimics. When should one suspect a diagnosis of lymphoma? 1. With \nimmunocompromised patients, e.g. after organ transplantation from post-transplant \nlymphoproliferative disorder (PTLD) or with HIV infection. 2. In childhood and ado-\nlescence when lymphoma is relatively more common and, with multifocal masses in \nthe same organ, e.g. the testis or kidney. 3. Bland homogeneous masses. 4. Diffuse \nprocesses infilling whole anatomic spaces, e.g. the perinephric space. 5. Disease \ncrossing several tissue planes. 6. Bulky disease with few symptoms. The primary \nmodality for investigation will be determined by the symptoms or clinical signs which \nprompt medical attention. Obtaining a tissue diagnosis at the earliest possible op-\nportunity is key to planning therapy. The radiologist can do this by a variety of routes \nusing US or CT guidance and should alert the surgeon to the need for deep biopsies \nwhen a submucosal process seems likely. With prior lymphoma the likelihood that \nany new GU problem reflects disease recurrence is guided by expected behaviour of \nthe original disease. Comparison of the new specimen with material from the original \ndiagnosis is important. Relapse in extranodal sites such as the GU tract may indicate \ntransformation to a high grade lymphoma. Overall, diffuse large B-cell lymphoma \n(DLBCL) is the predominant diagnosis. CT is the mainstay of monitoring treatment \nresponse. CT-PET has a role for assessment of residual masses. \nLearning Objectives:\n1. To recognise the varied imaging features of genitourinary tract lymphoma.\n2. To understand the differential diagnostic criteria from other diseases.\n3. To learn to select appropriate imaging modalities in diagnosis, staging and \nassessment of response to therapy.\n08:30 - 10:00 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 316 \nThe shoulder \nModerator: \nA. Oktay; Izmir/TR \nA‑082\t 08:30 \nA. How I do it \nJ. Kramer; Linz/AT (kramer@ctmri.at) \nThe first step prior to the examination of an optimal evaluation of the shoulder by \nMR imaging consists of a sufficient recommendation with some information of the \npatients history and clinical complaints. Not rarely the radiologist himself has to \n\nFriday\nPostgraduate.Educational.Programme\nA\n S27\nCB D E F G H\nA‑087\t 08:58 \nState-of-the-art CT/MR/PET in the treated neck \nF.A. Pameijer; Utrecht/NL (f.a.pameijer@umcutrecht.nl) \nTissue changes in the treated neck by surgery and/or radiotherapy (RT) make the \ndetection of residual or recurrent tumour more difficult. Clinical evaluation of the \nneck is also hampered by these changes. Therefore, any (non-invasive) method \nhelping in the detection of recurrence is welcome. In order to evaluate the treated \nneck, radiologists should be familiar with expected post-RT findings. Histological \nchanges post-RT will be discussed in combination with imaging examples. This \nknowledge will enable radiologists to recognise non-expected findings post-RT. \nNon-expected post-RT findings can be caused either by tumour recurrence, or \nby complications of treatment (e.g. chondro-radionecrosis). Imaging examples \nwill be shown. Especially after surgery, including various types of neck dissection, \nlymphatic drainage patterns of the head and neck are altered. It is important that \nradiologists are aware of these changes. Imaging examples will be shown. CT \nand/or MR-findings in the treated neck may be inconclusive. In these cases, there \nmay be an additional role for metabolic (PET) imaging. At present, the position of \nmetabolic imaging in the imaging protocol for the treated neck is unclear. Information \nfrom the recent literature will be discussed. Also, examples from daily practice will \nbe shown, with emphasis on the importance of base-line imaging after treatment \nand the timing of such base-line scans. This knowledge will help in understanding \nthe current indications and limitations of post-treatment metabolic (PET) imaging \nof the head and neck. \nLearning Objectives:\n1. To become familiar with expected post-radiation CT/MR findings.\n2. To become familiar with patterns of lymphatic spread after surgery.\n3. To understand the indications and limitations of post-treatment metabolic \n(PET) imaging of the head and neck.\nA‑088\t 09:21 \nNew techniques and protocols: perfusion, diffusion, spectroscopy and \nnew PET tracers \nV. Vandecaveye; Leuven/BE (vincent.vandecaveye@uz.kuleuven.ac.be) \nComputed tomography (CT), magnetic resonance imaging (MRI), and [ 18F]fluo-\nrodeoxyglucose positron emission tomography (FDG-PET) are the main imaging \nmodalities in head and neck cancer. However, the dependency on morphological \nand size-related criteria of anatomical imaging and the limited spatial resolution and \nFDG-avidity of inflammation of metabolic imaging may reduce diagnostic accuracy. \nNew PET-tracers, including 11C-methionine, 18-fluorothymidine (FLT) and 18 F-\nmisonidazole (FMISO) that target more specific tumour binding sites compared to \nFDG, are developed in order to improve specificity in tumour detection or treatment \nfollow-up or to visualise specific prognostic tumour characteristics. While FMISO-\nPET may hold important prognostic information pre-treatment by depicting tumour \nhypoxia associated with treatment resistance, 11C-methionine and FLT may be used \nfor more specific tumour depiction and early response assessment. Functional MRI \nsequences are developed aiming to improve lesion characterisation, nodal staging \nand treatment follow-up. Most frequently used techniques are diffusion-weighted \nMRI (DWI), dynamic-contrast-enhanced MRI (DCE-MRI) and MRI-spectroscopy \n(MRS). Although MRS may have value in nodal staging and treatment assessment, \ncurrently its main disadvantage is the limited spatial resolution. DWI measures \ndifferences in water mobility between different tissue microstructures quantified \nby the apparent diffusion coefficient, while DCE-MRI measures tissue perfusion \nusing permeability measurements or semi-quantitative perfusion parameters. \nDWI is researched and gradually clinically implemented for locoregional staging, \ndifferentiation of tumour recurrence from post-treatment complication and early \ntreatment follow-up. DCE-MRI mainly shows additional value for early assessment \nof treatment response, but also as a prognostic imaging modality as pre-treatment \ntumour perfusion may correlate with hypoxic status of the tumour. \nLearning Objectives:\n1. To understand the physiological basis and rationale for use of the different \nand new functional imaging modalities and tracers in head and neck cancer.\n2. To have an overview of the currently possible clinical applications and \ncompare the advantages and disadvantages of the different modalities for \npre and post-treatment imaging.\n3. To have an overview of potential future applications for treatment prediction \nand early treatment follow-up.\n4. To recognise the potentially synergistic value between functional MRI \ntechniques and nuclear imaging techniques.\n08:30 - 10:00 Room D2 \nSpecial Focus Session \nSF 3d \nHead and neck oncology: the three musketeers (CT, \nMR, PET) \nModerator: \nA. Borges; Lisbon/PT \nA‑085\t 08:30 \nChairman’s introduction \nA. Borges; Lisbon/PT (borgalexandra@gmail.com) \nAn increasing number of functional and metabolic imaging options reflecting relevant \naspects of tumour biology have rapidly been incorporated into clinical trials and, pro-\ngressively, into clinical practice. While tumour staging according to the TNM system still \nrules most decisions regarding treatment choice in head and neck cancer, biological \ninformation from the tumour and its microenvironment has proven to have important \npredictive and prognostic value heading for a tailored and individualised patient’s \nmanagement. CT, MR and PET are the mainstay imaging modalities to access tumour \nextent, both of the primary tumour, lymphatic and distant metastases and for early \ndepiction of recurrence during patient’s follow-up. Hypoxia and angiogenesis, the \nmajor driving forces for tumour aggressiveness, long linked to chemo and irradiation \ntreatment failure, can now be imaged both by PET (18 F-MISO or 60Cu ATSM) or \nMRI (BOLD and PWI, respectively). This information is being used to define biological \ntumour volumes, to tailor conformational and intensity modulated radiation treatments \nand to select patients for specific treatments such as radiosensitizers, hypoxia selective \ncytotoxic and antiangiogenic drugs. Overexpression/amplification of EGFR (epidermal \ngrowth factor receptor) are common genetic abnormalities in SCC linked to increased \ncell proliferation and worse prognosis. Imaging techniques reflecting cell proliferation/\ndensity (18 F-FLT -desoxyfluorothymidine- and diffusion-weighted MRI) can be used \nto select patients for treatment with EGFR inhibitors. This special focus session will \nreview the use of these imaging modalities both prior, during and after treatment of \nhead and neck cancer focusing on their specific advantages and accuracies in these \ndifferent settings. \nSession Objectives:\n1. To become familiar with the premises behind the choice of CT, MR and PET \nin different anatomic areas of the head and neck.\n2. To understand the added value of each technique in the diagnosis, follow-up \nand prognostic prediction of head and neck cancer.\n3. To be able to tailor an imaging protocol taking into account risk-benefit and \ncost-effectiveness.\n4. To become familiar with the clinical application of hybrid imaging and new \nPET tracers.\nA‑086\t 08:35 \nState-of-the-art CT/MR/PET as baseline modalities \nS. Bisdas; Tübingen/DE (sotirios.bisdas@med.uni‑tuebingen.de) \nContrast-enhanced CT and MRI are routinely used in order to determine the precise \nlocalisation, size and anatomic extent of the primary lesion. On the other hand, \npositron emission tomography (PET) is the most sensitive and specific technique \nfor in vivo imaging of metabolic pathways and receptor-ligand interactions in the \ntissues. A common question is which of these techniques should be used in a \nparticular patient. The most widely used technique is CT, as it has a number of \nimportant advantages over MRI, like wide availability, relative low cost and short \nexamination time. However, CT also has a number of disadvantages compared to \nMRI: relative low soft tissue contrast resolution, severe image quality degradation \nby dental fillings or other metallic foreign objects, and radiation exposure. PET in \ncombination with CT and/or MRI has a good sensitivity and specificity for the de-\ntection of primary tumour and for nodal staging as well as for detection in a single \nexamination distant metastases, occult tumours, second synchronous tumours, and \nfor radiotherapy planning. By combining PET with CT and MRI studies, either se-\nquentially or synchronous performed, the diagnostic accuracy is significantly higher. \nLearning Objectives:\n1. To understand the advantages and shortcomings of each modality.\n2. To learn the state-of-the-art CT/MR/PET protocols for routine imaging work-\nup in head and neck.\n3. To be able to select the appropriate modality for staging of head and neck \ncancer according to the needs of the clinician and treatment planning.\n\nPostgraduate.Educational.Programme\nS28\n A B C D E F G H\nA‑091\t 09:30 \nC. Emergencies of non-gynaecologic origin \nD. Akata; Ankara/TR (dakata@hacettepe.edu.tr) \nDuring routine clinical practice, radiologist must often evaluate a wide range of cases \nwith acute abdominal and pelvic pain. Ultrasound (US) is the primary imaging modal-\nity of choice to evaluate pelvic pain in the female patient. Computed tomography \n(CT) is mostly performed if ultrasound findings are equivocal or if the abnormality \nextends beyond pelvis. Conditions such as appendicitis, diverticulitis, pyelonephritis \nand renal calculi may develop in women of childbearing age with clinical features \nthat mimic obstetric and gynaecologic emergencies. Pelvic pain is a diagnostic \nproblem especially in pregnant woman. Ultrasound scanning has certain limitations \nsecondary to increasing gestational age. CT is not appropriate due to radiation dose. \nIn those situations, it has been proven that magnetic resonance (MR) imaging is a \nvaluable adjunct to delineate the pathology. In non-pregnant woman the radiological \nevaluation is less difficult. Still, a multimodality approach may be needed in certain \ncases. In this lecture, radiological features of non-gynaecologic emergencies such \nas acute appendicitis, diverticulitis, renal calculi and pyelonephritis will be discussed. \nLearning Objectives:\n1. To understand the causes and imaging diagnosis of common non-\ngynaecologic emergencies.\n2. To recognise how these may mimic gynaecologic disease.\n3. To understand the use of a multimodality approach to solve the problem.\n08:30 - 10:00 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 320b \nGenitourinary problems: common daily practice \nModerator: \nV. Donoghue; Dublin/IE \nA‑092\t 08:30 \nA. Imaging strategy in urinary infections \nM. Riccabona; Graz/AT (michael.riccabona@medunigraz.at) \nThe purpose is to discuss the role of imaging and the potential of different methods \napplicable in childhood UTI - with a focus on US. The imaging task in UTI has changed, \nand new questions arouse for radiology. In addition, growing economical demands \npressurise radiology to restrict imaging to those conditions where an evident benefit \nhas been demonstrated. This efficacy-oriented approach is difficult in children due \nto the lack of evidence-based data. Thus, controversies exist on if, when and how \nto investigate childhood UTI, trying to minimise procedures and reduce burden on \nchildren and health budgets without missing important conditions that may pose a \nthreat to the kidney. Furthermore, modern imaging with new methods, applications and \npotential (e.g. contrast-enhanced voiding urosonography = ce-VUS) may influence \nthe imaging algorithm. Therefore, the clinical demand and the value of established as \nwell as new imaging for treatment have to be understood and balanced. Most of the \nproposed imaging algorithms heavily relay on modern US including Doppler options, \nrecommend scintigraphy for the assessment of renal function and scarring, and define \nthe indications for MCU (or ce-VUS) from these findings, additionally considering \npatient’s age, gender and presentation, with respect to the individual clinical context. \nImaging in childhood UTI has changed, some well-established methods and rules \npersist. Basically, detection of renal involvement is the centre point of acute imaging, \nwith extended exploration, e.g. by MCU or MRI, in those who have complications, \nscars/upper UTI, and other risk factors such as malformations. \nLearning Objectives:\n1. To learn about the role, the importance and the information obtained from \nultrasonography.\n2. To learn about the technique and indications of voiding cystourethrography, \nas well as the role and potential of nuclear medicine examinations.\n3. To learn about an imaging algorithm for the imaging approach based on \nexisting ESUR & ESPR recommendations.\nA‑093\t 09:00 \nB. Urinary tract dilatation: what should be done, to whom and when? \nF.E. Avni; Brussels/BE (Freddy.Avni@erasme.ulb.ac.be) \nThe in utero and post-natal follow -up of foetuses with urinary tract dilatation has \nprovided lots of information about the proper management of urinary tract malforma-\ntions. Nowadays, affected neonates are evaluated following standardised charts \nPanel discussion: \nThe three musketeers were actually FOUR 09:44 \nCT, MR and PET: how to choose between modalities in head and neck cancer \npatients. An increasing number of imaging modalities reflecting functional and \nmetabolic aspects of tumours have rapidly been incorporated into clinical practice. \nThese modalities provide additional information on tumour vascularisation/ angio-\ngenesis (CT and MR perfusion); on tumour metabolism, hypoxia and proliferation \n(PET using different radioactively labelled substances) and on tumour architecture \nand cellular density (DWI). Hybrid imaging, PET-CT and, in the near future PET-MR, \ncan provide morphologic, metabolic and functional information in a one-stop-shop \nexamination. The choice of the best modality  (ies) to answer specific questions \nin the diagnosis, follow -up and in the prediction of response to treatment and \nprognosis will be addressed. \n08:30 - 10:00 Room E1 \nGenitourinary \nRC 307 \nGynaecologic emergency and its mimics \nModerator: \nK. Kinkel; Chêne‑Bougeries/CH \nA‑089\t 08:30 \nA. Imaging of emergencies in pregnancy \nG. Masselli; Rome/IT (gabrielemasselli@libero.it) \nAcute abdominal and pelvic pain in pregnant women may be the manifestation of various \ngynaecological and non-gynaecological conditions. The correct diagnosis of the causes \nof acute pain during pregnancy is critical to minimise maternal-foetal morbidity and \nmortality. Although ultrasound (US) is the primary imaging investigation in the diagnostic \nevaluation of the pregnant patient, the role of magnetic resonance (MR) imaging in the \nevaluation of foetal and maternal diseases in pregnant patients continues to expand. \nMR imaging offers different potential advantages in comparison to US for evaluating \nacute abdominal and pelvic pain; these include multiplanar imaging capabilities, a \nhigher soft tissue contrast and the ability to detect and distinguish blood from other \nfluid collections. When US is equivocal or nondiagnostic, MR imaging is a valuable \ncomplement to determine the exact aetiology of acute abdominal pain. The intrinsic \nsafety and the accuracy of MRI in diagnosing abdominal and pelvic disease make it an \nexcellent choice for triage of pregnant patients with acute abdominal and pelvic pain. \nMR imaging provides important information that influences patient management, and it \nis important for the radiologist to recognise the MR imaging appearance of the common \ncauses of acute abdominal and pelvic pain during pregnancy. This lecture will discuss \nthe use of MR imaging for maternal diseases that cause acute abdominal and pelvic \npain during pregnancy. Moreover, this lecture will discuss the different MR imaging \ntechniques to use, and will show how to detect and to differentiate the gynaecologic \nand non-gynaecologic causes of pain during pregnancy. \nLearning Objectives:\n1. To learn the most common causes of gynaecologic pain in pregnancy.\n2. To understand how to diagnose non-gynaecologic causes of pain in \npregnancy.\nA‑090\t 09:00 \nB. Emergencies of gynaecologic origin \nA.G. Rockall; London/UK (andrea.rockall@bartsandthelondon.nhs.uk) \nIn this lecture, the role of imaging in the evaluation of gynaecologic emergencies \nwill be presented. A combined approach using both clinical findings and imaging \nfeatures is necessary. Accurate evaluation is important as failure to make a diagno-\nsis may lead to serious consequences. Presenting symptoms, such as pelvic pain \nor vaginal bleeding or discharge, may overlap with pregnancy-related emergencies \nand with non-gynaecologic abdominal emergencies. The range of conditions to be \nconsidered include ovarian cyst emergencies (cyst rupture, haemorrhage or torsion), \ninfective conditions (Bartholins’ or vulval abscess, pelvic inflammatory disease or \ntubo-ovarian abcess) and acute bleeding (from inflammation, neoplasm, or trauma). \nPain may be related to the menstrual cycle, as in endometriosis or ruptured corpus \nluteum, or may be unrelated, such as in fibroid or ovarian torsion or pelvic inflam-\nmatory disease. The imaging features of these acute abnormalities will be reviewed \nand discussed in the context of the differential diagnoses. \nLearning Objectives:\n1. To understand the causes of common gynaecologic emergencies.\n2. To understand the imaging diagnosis of common gynaecologic emergencies.\n\nFriday\nPostgraduate.Educational.Programme\nA\n S29\nCB D E F G H\nthe choice of b-factors on WB-MRI will all be analysed. Emerging applications of \nWB-MRI and of WB-DWI will be exposed, especially regarding onco-haematological \nmalignancies. WB-MRI can allow combination of morphologic and functional data \non a whole body scale. Optimisation of MR instrumentation, standardisation of MR \nprotocols and future studies on specific diseases are under way. \nLearning Objectives:\n1. To understand the technical specificities of whole body DWI.\n2. To know how to apply whole body DWI in the detection and functional \nassessment of tumours, including haematological malignancies.\n3. To learn about the developments of whole body DWI for tumour staging and \nresponse assessment.\nA‑096\t 09:00 \nB. Quality and quality control in DCE-MRI and DCE-CT \nV.J. Goh; Northwood/UK (gohmcglone@hotmail.com) \nDynamic contrast enhanced MRI and CT provide valuable information of the anti-\nvascular effect of anti-angiogenic and vascular disruptive agents. The quality of \nDCE-MRI or DCE-CT data is influenced by patient, acquisition and post-processing \nfactors. For example, patient habitus, scanner type, acquisition parameters, contrast \nagent and administration profile, signal to noise, input function, kinetic model, and \nprocessing software affect the accuracy of quantification. Multisite acquisition and \nprocessing provide challenges to multicentre implementation of DCE techniques \nwithin and outside the context of clinical trials: standardised acquisition and process-\ning on the same scanner and software platform, while ideal may not be possible. \nQuality control is essential to maintain accuracy and consistency of standards \nacross all sites. A consensus-based, practical approach to quality control of DCE-\nMRI and CT in early phase clinical trials will be presented. \nLearning Objectives:\n1. To understand the differences obtained with different imaging techniques.\n2. To understand the differences obtained with different processing software.\n3. To know the limitations of multi-site acquisition or processing.\nA‑097\t 09:30 \nC. Synthesis: functional imaging for tumour management \nV. Vilgrain; Clichy/FR (valerie.vilgrain@bjn.aphp.fr) \nThe major functional imaging tools for tumour management are obtained with \ndynamic contrast-enhanced imaging, diffusion-weighted MR imaging, and MR \nelastography. These acquisitions allow understanding of tumour angiogenesis \nand perfusion, and tumour architecture. Dynamic contrast material-enhanced \nimaging allows assessment of perfusion parameters. Diffusion-weighted MR \nimaging provides information that reflects tissue cellularity and the integrity of \ncellular membranes. MR elastography evaluates the mechanical properties of \ntissue such as stiffness and viscosity. To date, tumour detection is mainly based \non morphologic features. However, changes in perfusion parameters have been \nshown as early parameters of liver metastases detection in patient with colorectal \ncarcinoma or breast carcinoma. Tumour characterisation is usually based on mor-\nphologic features. Yet, perfusion parameters have been shown to correlate with \nmicrovascular density and tumour differentiation helping tumour characterisation. \nFurthermore, apparent coefficient diffusion (diffusion-weighted MR imaging) and \nstiffness and viscosity (MR elastography) are significantly different in benign and \nmalignant tumours. Despite these differences, these last parameters usually do \nnot allow definitive subtyping. Functional imaging starts playing a major role in \nnon-surgical treatment follow-up especially with targeted cancer therapy. Changes \nin perfusion parameters, apparent coefficient diffusion, and stiffness and viscosity \nare observed in responders. Interestingly, these changes appear promptly after \ntreatment initiation. These functional variables are not included in RECIST 1.1 but \nmight be part of response criteria in the next future. Many examples of functional \nimaging for tumour management will be provided. \nLearning Objectives:\n1. To understand the potential of functional imaging in tumour detection.\n2. To understand the potential of functional imaging in tumour characterisation.\n3. To learn about the future use of functional imaging in treatment planning and \nfollow-up.\n(among others, thanks to the ESUR-ESPR working group). At birth, a confirmatory \nultrasound is performed in order to evaluate the type and degree of the malforma-\ntion. Urinary tract dilatation are separated into mild, moderate and marked. Mild \nand moderate dilatation will be followed by US. Voiding cystogram and functional \nstudies will be performed only if the dilatation is significant or persists. The prog-\nnosis is usually good. Patients with marked dilatation would be managed more \n“aggressively”. Their work-up would be initiated as soon as diagnosed in order to \ndiagnose cases that need therapeutic manoeuvre. For them voiding cystogram, \nanatomical and functional studies cannot be skipped and are important for the \nprognosis. Long-term follow-up are needed to prevent further damage. \nLearning Objectives:\n1. To learn which infants with antenatal diagnosis of urinary tract dilatation \nrequire imaging and when.\n2. To become familiar with the most important differential diagnosis.\n3. To learn about the imaging strategies in these infants.\nA‑094\t 09:30 \nC. Renal and pararenal masses: basic rules \nP. Tomà; Rome/IT (paolo.toma@opbg.net) \nThe differential diagnosis of renal and pararenal masses firstly depends on the \nage of the child. Wilms tumour (nephroblastoma) is the most common abdominal \ntumour in 1-8 years old (80% of cases in children less than 5 years old - peak age \n3.6 years). Renal non-Wilms tumours represent a significant proportion of renal \ntumours in children, especially in children aged less than 6 months or greater than \n12 years. Neuroblastoma most commonly arises from the adrenal gland but can \narise anywhere along sympathetic chain; it is the most common tumour in children \nunder 2 years of age (90% of cases in children less than 5 years - mean age < 2 \nyears). Adrenal adenomas and carcinomas also occur in childhood. US is the initial \nimaging modality to investigate an abdominal mass in children. CT or MRI is used \nto confirm the US findings and not uncommonly add new, valuable information. \nConcerning Wilms tumour there is a very diverse approach to treatment according \nto geographical location. This variation in therapeutic attitude has consequences \nfor the choice of imaging modality at diagnosis. Neuroblastoma staging includes \nalso 123I-MIBG, and laboratory investigations (bilateral bone marrow aspirates with \nhistochemical tests and urine catecholamine level measurements). We focus on \nthe points under discussion: revision to the staging of neuroblastoma, the problems \ninherent in distinguishing nephrogenic rests from Wilms tumour and the approach \nregarding small lung nodules in children with Wilms tumour. \nLearning Objectives:\n1. To understand the imaging findings of paediatric renal and pararenal \nmasses.\n2. To learn how and when to use sonography, CT and MRI in investigation and \ndifferential diagnosis.\n3. To learn about the role of imaging in staging renal and pararenal \nmalignancies.\n08:30 - 10:00 Room F1 \nFunctional Imaging of Tumours: How to do it \nMC 322 \nFunctional and ultra structural MR \nModerator: \nL. Martí‑Bonmatí;  Valencia/ES \nA‑095\t 08:30 \nA. Diffusion imaging and whole body MRI \nA. Luciani, C. Lin, F. Pigneur, C. Haioun, E. Itti, A. Rahmouni; Creteil/FR \nIt is now well accepted that treatment strategies and patients prognosis rely in \nlarge part on initial tumour staging. Early response assessment in cancer patients \nfurther enables adapted treatment selection treatment response on imaging. Recent \ninstrumentation MR developments, including routine high field imaging, phased \narray coils and parallel imaging bring whole body MR imaging to clinical practice. \nMoreover, both optimised morphologic imaging and functional data previously \nobtained on specific dedicated examinations can be provided on a whole body \nscale. The aim of this lecture will be to review technical requirements of whole \nbody MR imaging, with special focus on dynamic contrast-enhanced MRI (DCE-\nMRI), diffusion weighted imaging on a whole body scale (WB-DWI), and MRI us-\ning continuous rolling platform. The combination of phased array coils, enabling \nparallel acquisitions, the selection of dynamic contrast enhanced sequences, and \n\nPostgraduate.Educational.Programme\nS30\n A B C D E F G H\nA‑100\t 08:58 \nDecreasing the number of BI-RADS 3 in clinical settings \nL.J. Pina Insausti; Pamplona/ES (ljpina@unav.es) \nIt is important to minimise the number of lesions classified as BI-RADS 3. In a clinical \nsetting we can support our diagnoses using more additional imaging techniques \nthan in a screening setting. The ways to decrease the BI-RADS 3 lesions are as \nfollows. 1. Careful review of previous imaging studies: if the lesion had a benign \nappearance and was seen on previous studies, it should be classified as BI-RADS \n2. 2. Palpation: the physical examination may be crucial to classify a lesion. 3. \nHistory of breast cancer and other clinical conditions: BI-RADS category 3 should \nbe avoided as much as possible for BRCA carriers, patients having a recently \ndiagnosed breast cancer or if pregnancy is planned. 4. Radiologist’s experience: \nunexperienced radiologists tend to use more of this category. 5. Complementary \nstudies: spot compressions and magnifications views can show suspicious signs \nthat were not detected on conventional views, upgrading to BI-RADS 4 or 5. US \ncan classify a mass as a cyst (category 2). Sonoelastography can also play a role. \nVery high spatial resolution breast MRI can be useful to evaluate the margins of \nthe lesion more accurately, upgrading the lesion to category 4 or 5. 6. Size of the \nlesion: an important requirement to choose follow-up for a probably benign lesion \nis to ensure that, in case of being a malignant lesion, it will be an early diagnosis.\nFinally, the patient’s age is important: the typical appearance of a benign lesion in \na young low-risk woman (< 30) can make unnecessary periodic follow-up. \nLearning Objectives:\n1. To appreciate the reasons for inconsistency of cancer incidence between \npublished studies.\n2. To understand the difficulties of using some of the specific descriptors and \ntheir current limitations.\n3. To become familiar with the way to integrate imaging modalities to reduce \nuncertainty.\n4. To recognise the influence of clinical data in the management of a BI-RADS \n3 lesion.\nA‑101\t 09:21 \nManagement of BI-RADS 3 lesions \nF. Sardanelli; Milan/IT (f.sardanelli@grupposandonato.it) \nThe principle of BI-RADS 3 imaging finding should be that of “quasi-benign” type, \ni.e. with a very low associated risk of malignancy (< 2%), opening the possibility of \na short-term imaging follow-up as an alternative to imaging-guided needle biopsy. \nHowever, a number of issues should be regarded as relevant to radiologists and \npatients. 1. BI-RADS 3 cancer prevalence is highly variable due to (1.1) different \nprevalence in the study population (symptomatic/asymptomatic, clinical/screening \nsetting; high-risk [BRCA1, BRCA2, family history, etc.], intermediate risk [dense \nbreasts; previous breast cancer or high-risk lesions], relatively low risk) and/or \n(1.2) radiologists' differences in classification. 2. When needle biopsy is optioned, \nvacuum-assisted biopsy under stereotactical guidance for mammographic only \nfindings (typically, microcalcifications) and core-biopsy for sonographic findings \nshould be used; fine needle aspiration cytology should be avoided due to the high \nprobability of benign lesions which need larger tissue samples. 3. When short-term \nfollow-up (typically, 6 months) is optioned, the same technique on which the BI-\nRADS 3 lesions was initially detected should be used. 4. In the screening setting, \nshort-term follow-up option is commonly not considered and the reader is forced to \ngive a dichotomic reading (recall/not recall). 5. The choice between the two options \nshould be clearly discussed with the patient, including the psychological cost of \nwaiting six months to get a conclusive report, and a really informed consent should \nbe obtained. 6. Till now, there is insufficient evidence for using tomosynthesis or \nMRI for evaluating mammographic or sonographic BI-RADS 3 findings. \nLearning Objectives:\n1. To learn about the management options of a BI-RADS 3 lesion.\n2. To appreciate the costs to the patient of different management options.\n3. To appreciate the costs to the organisation of different management options.\nPanel discussion: \nBI-RADS 3: biopsy or watch? 09:44 \nThe premise behind the BI-RADS 3 classification is to identify a group of low risk \nlesions that can be safely placed on follow -up rather than biopsy. In practice this \ncan be very difficult and is anachronistic to the principles of the European population \nscreening programmes where the radiology objective is to diagnose or discharge. \nThe panel will discuss these dilemmas. \n08:30 - 10:00 Room F2 \nSpecial Focus Session \nSF 3a \nThe BI-RADS 3 controversy \nModerator: \nM.G. Wallis; Cambridge/UK \nA‑098\t 08:30 \nChairman’s introduction \nM.G. Wallis; Cambridge/UK (matthewwallis492@btinternet.com) \nStarting in the late 1980s an American College of Radiologists task force developed \nthe concept of guidelines to standardise mammography reporting: breast imag-\ning reporting and data system (BI-RADS). There is evidence that over time there \nhave been improvements in consistency of use, sensitivity, specificity and positive \npredictive value. However, BI-RADS 3 ‘probably benign; short interval follow -up \nrecommended; less than 2% risk of malignancy’ has always been the most difficult \nand controversial, with the highest levels of discordance between classification and \nrecommendation, wide variation in both intra- and inter-observer agreement and \na 2007 literature review demonstrating PPV for malignancy of between 0 and 8%. \nManagement of breast disease has moved on a great deal since the 1990s. In \nthe main driven by increasing specialisation associated with population screening \nprogrammes. Nowadays a specialist breast radiologist works with a wide variety of \nneedle options at his hip to such an extent that the breast Multi-Disciplinary Team \nincreasingly feels that failure to obtain a non-operative diagnosis of discrete lesions \nis unacceptable. In this setting, and mindful of the medico legal consequences of \n‘delayed diagnosis’, is there still room to allow a patient to leave the one stop clinic \nwithout a definitive diagnosis? As the leaders of the diagnostic team we also have \nto take account of the emotional and psycho-social consequences for our patients \nas well as the financial costs to patient and the healthcare economy. \nSession Objectives:\n1. To consolidate knowledge of BI-RADS classification with respect to grade 3.\n2. To appreciate the potential variability in interpretation of BI-RADS 3.\n3. To appreciate the management options and their implications for both patient \nand organisation.\nA‑099\t 08:35 \nDefining lesions to follow-up \nP. Skaane; Oslo/NO (per.skaane@ulleval.no) \nBreast imaging reporting and data system (BI-RADS) was developed for standardis-\ning reporting and include mammography, ultrasound, and MRI. BI-RADS category 3 \n“probably benign finding - short-interval follow-up suggested” should have less than \n2% risk of malignancy. Category 4 has been subgrouped into 4 A, 4B, and 4C, and \nthis influence the classification of BI-RADS 3. Mammographic BI-RADS 3: three \nnonpalpable findings in this category include clusters of punctate microcalcifica -\ntions, well-circumscribed and noncalcified solitary masses, and benign-appearing \nasymmetric density. Digital mammography will increase detection of amorphous \nmicrocalcifications and the number of BI-RADS 3 (or 4 A) lesions. Intramammary \nlymph nodes and calcified fibroadenomas are BI-RADS 2 lesions. Ultrasonographic \nBI-RADS 3: a most important BI-RADS 3 lesion is a solid oval mass (“tumour”) \nwith gently lobulations, circumscribed margins, and parallel orientation. Using strict \ncriteria, the negative predictive value is approaching 99%. Two other lesions are \nnonpalpable “complicated cyst” and clustered microcysts. The “complex” cyst, i.e., \na mass with cystic and solid components, should be classified as BI-RADS 4. MRI \nBI-RADS 3: there is lack of evidence which MRI findings should be categorised \nBI-RADS 3. Nonmass-like enhancement (NMLE) and enhancement kinetics are \nunique to MRI. Lesions less than 5 mm (“foci”) need no assessment. A challenge is \nMRI-detected tumours < 10 mm as morphologic analysis is of limited value. Benign \nkinetic curves may justify short-term follow -up. In high-risk women, MRI-guided \nvacuum-assisted biopsy should be considered. In conclusion, BI-RADS 3 is justified \nin diagnostic settings but should be avoided or kept at a minimum in screening. \nLearning Objectives:\n1. To understand the mammography features of BI-RADS 3 classification.\n2. To understand the ultrasound features of BI-RADS 3 classification.\n3. To understand the MRI features of BI-RADS 3 classification.\n\nFriday\nPostgraduate.Educational.Programme\nA\n S31\nCB D E F G H\n08:30 - 10:00 Room G/H \nNew Horizons Session \nNH 3 \nQuantum leaps in MRI: teslas, pulses, tracers \nModerator: \nO. Clément; Paris/FR \nA‑102\t 08:30 \nChairman’s introduction \nO. Clément; Paris/FR (olivier.clement@inserm.fr) \nWhat will be the routine MR machine in 10 years? Which field strength? Which \ncoils? Which gradient design? Which contrast agents? Which combination will \nallow a gain in sensitivity to allow molecular imaging? Can hybrid imaging be a \nsolution? The goal of this session is to review the technical developments in field \nstrength, pulse, RF coils and contrast agents, and to discuss the necessary choices \nfor future MR scans. \nSession Objectives:\n1. To review the different perspectives of progress in MRI.\n2. To understand that the progress is both instrumental and chemical with new \nprobes.\n3. To envisage a scenario where MRI will offer molecular imaging capacities.\nA‑103\t 08:35 \nWhat will be the standard machine and field of the future? \nL. Darrasse; Orsay/FR (luc.darrasse@u‑psud.fr) \nImproving the sensitivity has still been an essential issue in MRI, because the signal \nfrom nuclear spins relies on extremely weak magnetic interactions dominated by thermal \nfluctuation. To push the signal-to-noise ratio upward, the basic routes have been (i) to \nincrease the field strength, (ii) to improve the signal detection with radiofrequency coils \nand (iii) to enhance the signal dynamically with contrast agents or alternative preparation \ntechniques. The first route is the most obvious one, driven by the trends in analytical \nMR spectroscopy and small-animal MRI. Going up to or even above 7 T represents a \nconsiderable challenge, both technically and in view to renew the MR equipment market. \nHowever, this way is limited by safety issues, radiofrequency penetration concerns \nand susceptibility artefacts. Alternatively, improving the radiofrequency system relies \non a complex electrodynamics background, where tissue conductivity and different \nsources of noise have to be considered. During the last half-period of MRI development, \nradiofrequency coil arrays have appeared as a powerful mean to improve the signal-\nto-noise and to accelerate the spatial encoding process, even able to overcome some \npitfalls with high-field MRI. Finally, the topics of an optimal field strength has always \nbeen highly controversial because the contrast mechanisms, on which the diagnostic \ninformation is mainly founded, are essentially field-dependent. Basically, the contrast \nmechanisms tend to be dominated, respectively, by macromolecular cross-relaxation \nat low field, and by susceptibility-weighted diffusion at high field. An emerging ques-\ntion is then to address different pathologies or organs with either general-purpose or \ndedicated MRI systems. \nLearning Objectives:\n1. To learn about the possibilities of gaining a jump in signal.\n2. To understand the respective strategies of field increase and coil \nimprovements.\n3. To consider the probable system in 2020.\nA‑104\t 08:58 \nWill new technologies allow a jump in sensitivity? \nJ. Hennig; Freiburg/DE (Juergen.Hennig@uniklinik‑freiburg.de) \nImaging technologies have made breathtaking progress for several decades and \nin all aspects of medical imaging - MR, CT, US and PET. Amongst the current \ndevelopments in MRI there are several areas which hold promise to redefine the \nboundaries of sensitivity. Ultrahighfield MRI with field strengths of 7 T and more \nstarts to reveal insights into tissue microstructure so far inaccessible to MR (or \nany other technique). This is still under intense technological development with \nsome key issues to resolve notably safety issues related to the high radiofrequency \npower. The unique contrast and resolution does hold promise for highly relevant \napplications such as neurodegenerative disease, small vessel disease, MS and \nothers - although definite clinical studies for a ‚killer application‘ are still lacking. \n13C-Hyperpolarisation of metabolites such as pyruvate, succinate, bicarbonate, \netc. lead to an increase in detection sensitivity by factors of 10-100,000. Finally, the \ndevelopment of targeted probes is progressing extremely rapidly and for all imaging \nmodalities. Most of this work is aimed at preclinical research, but the tremendous \nimpact of the new insight in translational research promises to be of high impact \nfor clinical application. Will these technologies allow a jump in sensitivity? Yes and \nno. Image quality, contrast and sensitivity will grow significantly. The biggest impact \nwill, however, lie in the combination of the new possibilities with other data - imag-\ning as well as non-imaging. A true change in paradigm will only be achieved if the \ncurrent parcellated knowledge about various aspects of the disease is unified into \na comprehensive picture. \nLearning Objectives:\n1. To review the recent developments in RF-coils and gradients.\n2. To learn about the new measurements technologies.\n3. To envision how these new tools will allow a huge gain in sensitivity.\nA‑105\t 09:21 \nWill new MR contrast probes compete with PET? \nS. Aime; Turin/IT (silvio.aime@unito.it) \nPurpose: Molecular imaging is a new science that will have a tremendous impact \nin the development of innovative diagnostic tools. In the first stage of its enrolment, \nit has relied massively on PET/SPECT and optical imaging technologies because of \nthe superior sensitivity of their probes. In the long-term, MRI/MRS approaches may \nrecover a central role, provided that further sensitivity improvements will be attained. \nMethods and Materials: High sensitivity MRI probes have been designed and \ntested for molecular imaging applications. In the case of paramagnetic based \nsystems they rely on improved design of the coordination cage as well as on the \nencapsulation/incorporation in proper nanocarriers. For multiple detection studies, \nCEST as well Hyperpolarized C-13 containing molecules have been considered. \nResults: As molecular imaging is the evolution of biologists’ in vitro work that \nhas revolutionized the way living cells and intact tissues were investigated, MRI \nmultiplex-visualization of biological processes appears to be a key task for the \nforthcoming years for an efficient translation of such outstanding achievements. \nThe search for frequency-encoding MRI contrast agents represented by CESTand \nHyperpolarized C-13 containing molecules have opened the interesting perspective \nof detecting more than one agent in the same anatomical region. This task is largely \nprecluded to nuclear probes. Moreover merging MRI and nanotechnology allows \nthe attainment of high sensitivity systems also with the classical relaxation agents. \nConclusion: Recent achievements in amplification procedures allow to tackle the \nintrinsic insensitivity of MRI probes to make them more competitive in the arena of \nmolecular imaging applications. \nLearning Objectives:\n1. To review the recent developments in MR contrast agents.\n2. To understand the principle of CEST agents.\n3. To understand the role of the new contrast probes in molecular imaging.\nPanel discussion: \nWhat is ready for our next machine? 09:44 \nMRI has experienced tremendous developments in the last 20 years to become an \nindispensable clinical tool. The success story still goes on with major developments \nin the design of new hardware and specific contrast probes, resulting in a potentially \nhuge gain in sensitivity and potentially competing with other imaging modalities like \nPET. Will all these technologies develop at the same pace? Will contrast probes be \nready when the machine can use them? Will the tendency for higher fields continue? \n08:30 - 10:00 Room I/K \nCardiac \nRC 303 \nSystematic approach to congenital heart disease \n(CHD) \nModerator: \nA.P. Parkar; Bergen/NO \nA‑106\t 08:30 \nA. Vascular rings and other congenital vascular things \nA.J.B.S. Madureira; Porto/PT (ajbmadureira@gmail.com) \nThe cardiac tube appears around the third week of embryonic development and \ndevelops into a structure with several segments (truncus arteriosus, bulbus cordis, \nventricle, atrium, and sinus venosus). The truncus arteriosus divides into the aorta \nand pulmonary trunk. Six paired aortic arches develop that terminate in dorsal aor-\n\nPostgraduate.Educational.Programme\nS32\n A B C D E F G H\nLearning Objectives:\n1. To learn how to examine CHD with MDCT.\n2. To compare the advantages and limitations of MDCT in comparison to MRI.\n3. To understand the role of CT in differentiating various types of CHD.\n4. To learn how to control radiation dose.\n08:30 - 10:00 Room L/M \nSpecial Focus Session \nSF 3c \nTumour response to treatment: RECIST, desist or \ninsist? \nModerator: \nR.H. Reznek; London/UK \nA‑109\t 08:30 \nChairman’s introduction \nR.H. Reznek; London/UK (r.h.reznek@qmul.ac.uk) \nThe use of imaging to monitor response to treatment has become central in the \ncare of patients with cancer. It is crucial therefore that radiologists involved in the \nmanagement of patients with cancer understand the place of imaging within the \nclinical context of the management of patients with cancer; that they are aware of \nthe criteria of the accepted current criteria for assessing response and are familiar \nnot only with new developments in imaging that act as a surrogate end-point for \nevaluating the success of treatment but are also aware of how imaging is used to \npredict the likely response early in the patient’s pathway. This session will concen-\ntrate on all these aspects on the use of cancer imaging in monitoring response to \ntreatment in patients with cancer. \nSession Objectives:\n1. To understand the clinical importance of monitoring the response to \ntreatment in patients with cancer.\n2. To appreciate the need for standard response criteria and how they have \nbeen derived.\n3. To become familiar with the range of morphological and functional imaging \ncriteria available to monitor response.\nA‑110\t 08:35 \nMonitoring response to treatment in patients with cancer: why and how. \nThe oncologist’s view \nP. Johnson; Southampton/UK (johnsonp@soton.ac.uk) \nWe are in the era of targeted cancer therapy, whether by small molecules derived \nfrom knowledge of the molecular pathogenesis of tumours, or from biological \ntherapies emerging from our understanding of immunology and cell biology. These \napproaches convey new challenges for the monitoring of response. Small molecule \ntherapeutics often stabilise tumours for significant periods without producing clear \nreduction of masses, and for these the assessment of surrogate endpoints takes \non increasing importance. The measurement of pharmacodynamics is central to \nearly phase trials in which confirmation of on-target effects is required to determine \nthe biologically effective dose, and in many cases this is best done by functional \nimaging. Biological therapeutics such as monoclonal antibodies and cellular im-\nmunotherapy also need novel approaches for the determination of their actions in \nvivo, particularly as they are frequently tested in the setting of low level disease. \nRandomised trials are underway to assess the contribution of functional imaging, \nin particular CT-PET as a means to guide therapy. The emerging data suggest \nthat there are broad variations in accuracy, both according to the disease in ques-\ntion and the context in which studies are performed, even before factors such as \nimaging quality control and standardised reporting are included. For the future, \nstandardisation of techniques and common quality control will play a vital part in \nadvancing our understanding in this rapidly evolving field. \nLearning Objectives:\n1. To learn how new anticancer treatments are being developed and applied in \nthe clinic.\n2. To understand how surrogate endpoints are assuming an increasing \nimportance in this process.\n3. To appreciate how imaging can contribute to this and how important it is to \nhave a reproducible system.\ntas. There is regression of portions of these arches, but several remnants normally \npersist. Any failure in this process can result in congenital anomalies of the aorta \nor pulmonary vessels. These anomalies can be categorised into aortopulmonary \nanomalies, systemic arterial anomalies, and pulmonary artery anomalies. The \naortopulmonary anomalies comprise truncus arteriosus, hemitruncus arteriosus, \naorticopulmonary window, patent ductus arteriosus, and transposition of the great \narteries. The systemic arterial anomalies include the anomalies of the aortic arch, \nof which the most common is a left aortic arch with aberrant right subclavian artery. \nDouble aortic arch is the most common cause of a vascular ring and is characterised \nby left and right aortic arches arising from the ascending aorta and encircling the \ntrachea and oesophagus. A right aortic arch can have three “subtypes”: aberrant \nleft subclavian artery, mirror image branching, or isolated subclavian artery. The first \ntype is the most common one and is the second most common cause of vascular \nring. Aortic coarctation, pseudocoarctation and interruption of the aortic arch are \nother systemic arterial anomalies. The most important pulmonary artery anomalies \nare idiopathic dilatation of the pulmonary trunk, absence or proximal interruption of \na pulmonary artery, pulmonary arterial stenosis, and pulmonary sling. \nLearning Objectives:\n1. To understand the embryology of the aortic arch.\n2. To review the imaging findings and clinical significance of vascular rings in \nthe chest.\n3. To learn how to diagnose the most common congenital anomalies of the \npulmonary arteries.\nA‑107\t 09:00 \nB. MRI: getting more specific \nA.M. Taylor; London/UK (a.taylor@ich.ucl.ac.uk) \nCardiovascular magnetic resonance (CMR) imaging has become integrated into \nthe assessment pathways for congenital heart disease in both paediatric and adult \npatients. CMR provides a powerful tool, giving anatomical and haemodynamic \ninformation that echocardiography and catheterisation alone do not provide. Extra-\ncardiac anatomy, including the great arteries, systemic and pulmonary veins, can be \ndelineated with high spatial resolution. Vascular and valvular flow can be assessed, \nshunts can be quantified, and myocardial function can be measured accurately \nand with high reproducibility, regardless of ventricular morphology. Finally, CMR \nsurpasses both catheterisation and echocardiography in providing high resolution, \nisotropic, three-dimensional (3D) datasets. This allows for reconstruction of data in \nany anatomical imaging plane, giving complete visualisation of complex congenital \ncardiac anomalies, without the use of ionising radiation. In the congenital heart \ndisease, CMR can be justified for any patient in whom clinical or echocardiographic \ndata are insufficient for monitoring, decision-making or surgical planning. Due to \nthe complexity of both the anatomy and physiology of congenital heart disease, it is \nessential to have a systematic approach for CMR when assessing these patients. \nLearning Objectives:\n1. To understand the advantages of MRI in CHD.\n2. To learn how to use dedicated MRI techniques (e.g. flow measurements) in \nCHD.\n3. To learn which MR parameters have a prognostic value in CHD.\nA‑108\t 09:30 \nC. MDCT: the expanding role \nA. Küttner; Frankfurt a. Main/DE (Kuettner@radiologen‑frankfurt.de) \nWith the development of novel CT scanners, especially the Dual Source CT, novel \nstrategies of examining congenital heart disease became possible. Especially \nnewborns and infants younger 3 years of age are difficult to examine, since compli-\nance cannot be expected. Also young children are especially susceptible to ionizing \nradiation and should be exposed as little as possible. In a first step the course will \nillustrate the underlying technical principle how to examine children in < 1 sec with \nsub mSv exposure. Also the course will teach how to avoid sedation in children \nof any age. In a second step the course will show how to apply contrast media in \nchildren of all ages and what strategy to use. In a third step the course will show \nhow to appropriately choose scanning parameters for the CT scan since the size \nand weight varies considerable in children as there are small to date newborns \nwith < 2 kg body weight up to adolescents with a body weight > 60 kg. Since little \ncomprehensive data is available how to examine with an optimal compromise \nbetween sufficient image quality and unnecessary radiation overexposure the \ndata of the Erlangen study will be presented and discussed. In a forth part typical \nindications for the exam are shown and how to interpret the exam. Also limits for \nthe exams are shown. In a final step a comparison with MRI is shown which method \nis used for which pathology. \n\nFriday\nPostgraduate.Educational.Programme\nA\n S33\nCB D E F G H\n08:30 - 10:00 Room P \nContrast Media \nRC 306 \nContrast media: always as safe as we wish? \nModerator: \nS.K. Morcos;  Sheffield/UK \nA‑113\t 08:30 \nChairman’s introduction \nS.K. Morcos; Sheffield/UK (sameh.morcos@sth.nhs.uk) \nExtracellular water soluble contrast media (CM) are either iodine (I) or gadolinium \n(Gd) based. They have similar pharmacokinetics and excreted mainly by the kidneys \nwith biological half life around 90  minutes. They do not cross intact blood brain \nbarrier, minimal cell penetration and are not metabolised inside the body. Iodin-\nated CM are classified into high-osmolar, low-osmolar and iso-osmolar contrast \nagents. Osmolality, iconicity and viscosity are important physicochemical factors \nwhich influence the safety of these agents. Gd-CM are either linear or macrocyclic \nand available as ionic or non-ionic preparations. The stability of the Gd-CA is an \nimportant safety feature of these agents particularly in patients with reduced renal \nfunction. The macrocyclic agents have high kinetic stability whereas the non-ionic \nlinear preparations have low kinetic and thermodynamic stability. Contrast media \nadverse effects can be divided into acute and delayed reactions. Acute reactions \nare allergic like and usually develop within one hour of CM administration. Delayed \nreactions develop after an hour and within a week of CM administration. Acute \nreduction in renal function referred to as contrast-induced nephropathy (CIN) \nmay develop after contrast administration in patients with pre-existing risk factors. \nPatients with advanced reduction in renal function may develop the complication \nof nephrogenic systemic fibrosis (NSF) after administration of low stability Gd-CM. \nIn this session contrast-induced nephropathy and nephrogenic systemic fibrosis \nwill be discussed. Measures to reduce the incidence these adverse effects will \nalso be presented. \nSession Objectives:\n1. To understand optimised and integrated approaches for management of \ncurrently available contrast agents.\n2. To review the advantages and disadvantages of different contrast media.\n3. To learn about the safety of patients and professionals.\nA‑114\t 08:35 \nA. Iodinated CM: whether CIN is a SIN, and how to avoid it \nR.W.F. Geenen; Alkmaar/NL (r.w.f.geenen@mca.nl) \nThe pathophysiology of CIN is complex and not well understood. Basically, a \nmisbalance between vasodilatation and vasoconstriction takes place inside the \nkidney after intra-arterial or intravenous CM administration. Furthermore, increased \noxygen demand of tubular cells due to increased reabsorbtion of sodium and water \nis a second mechanism, leading to transient medullar ischaemia. Identifying the \npatient at risk is the first step in prevention. Knowledge of the patient‘s medical \nrecord and a recent basic kidney function are mandatory. High-risk patients should \nreceive prevention. Two major topics in CIN prevention are the questions whether \niso-osmolar CM cause significantly less CIN than low-osmolar CM and whether \nhydration schedules with NaHCO3 give significantly less CIN than hydration sched-\nules with NaCl 0.9%. \nLearning Objectives:\n1. To understand the physiology of iodinated contrast media.\n2. To understand CIN mechanisms.\n3. To learn about pertinent safety issues.\nA‑115\t 08:58 \nB. MR contrast agents: rumble in the jungle \nG. Heinz-Peer; Vienna/AT (gertraud.heinz@meduniwien.ac.at) \nCurrently up to 50% of all MRI examinations worldwide are performed using contrast \nagents, either an extracellular agent or an organ-specific agent. The extracellular \nMRI contrast agents are chelates that contain the paramagnetic ion gadolinium \nwhich strongly affects the relaxation properties of water protons, leading to changes \nin tissue contrast. Gd-DTPA was the first extracellular agent to be introduced in \nclinical practice. Since the introduction of Gd-DTPA in 1988, various gadolinium \nchelates with different chemical properties became available for clinical use. \nFor many years, it was believed that gadolinium-based contrast agents (GBCA) \nA‑111\t 09:00 \nPrinciples in the use of conventional/anatomic imaging for response \nassessment \nL. Schwartz; New York, NY/US (lschwartz@columbia.edu) \nThe standard way to assess a patient’s response to chemotherapy is to use com-\nputed tomography (CT) to measure tumour size using uni-dimensional (RECIST) \nor bi-dimensional (WHO) criteria. This methodology has changed little in the past \n30 years despite the emergence of new therapies and advances in imaging tech-\nnology. Measuring the changes in the size of tumours in one or two dimensions \ndoes not always capture the effects of novel therapies on primary tumours and \nmetastases. Radiographic changes in the size of tumours treated, for instance, \nwith epidermal growth factor receptor tyrosine kinase inhibitors such as gefitinib \nor erlotinib or inhibitors of angiogenesis such as bevacizumab do not necessarily \noccur at the same magnitude or speed as observed in those individuals treated \nwith standard cytotoxic therapies. With these newer agents, tumours respond by \nundergoing cystic change, central necrosis, and density changes that may not be \ncaptured by conventional measurements of the largest lesion diameter. \nLearning Objectives:\n1. To understand and appreciate the use of conventional/anatomic imaging for \nresponse assessment in clinical practice as well as in clinical trials.\n2. To understand general and disease-specific challenges associated with \nresponse assessment at imaging.\n3. To recognise potential improvement in imaging and image post-processing \nfor response assessment.\nA‑112\t 09:25 \nPET in monitoring response \nW. Weber; Freiburg/DE \nPET imaging and specifically PET/CT with the glucose analogue fluorodeoxy -\nglucose (FDG) has been evaluated in a significant number of studies to monitor \ntumour response in patients undergoing chemotherapy, radiotherapy or targeted \ntherapies. The clinical value of for differentiation of residual or recurrent viable \ntumour and therapy-induced fibrosis or scar tissue has been established for ma-\nlignant lymphomas and various solid tumours. Furthermore, there are now several \nreports suggesting that quantitative assessment of therapy-induced changes in \ntumour FDG-uptake may allow prediction of tumour response to chemotherapy \nand targeted drugs very early in the course of therapy. In non-responding patients \ntreatment may be adjusted according to the individual phenotype of the tumour \ntissue. Current studies investigate whether FDG-PET can be used to “personalise” \ntreatment and to reduce the side effects and costs of ineffective therapy. In addi-\ntion to FDG, several other imaging probes are in clinical studies to monitor tumour \nresponse to therapy. These include among others [ 18F]fluorothymidine (FLT) for \nimaging of cellular proliferation, [18F]fluoromisonidazole for assessment of tumour \nhypoxia and radio-labelled RGD-peptides for angiogenesis imaging. Preclinical \nand early clinical trials with these imaging probes are encouraging, but need to be \nconfirmed in larger clinical trials. \nLearning Objectives:\n1. To understand how image acquisition and reconstruction influence visual \nand quantitative analysis of PET studies.\n2. To describe current criteria for assessing tumour response in lymphoma and \nsolid tumours and recognise the limitations of these criteria.\n3. To understand how differences between scanner models can influence \nresponse assessment by PET.\nPanel discussion: \nWhy does the radiologist need to understand the importance of monitoring \nresponse and how it is done? 09:45\nMonitoring the response to treatment has become a critical part of the management \nof patients with cancer. The markedly improved diagnostic performance of cross-\nsectional imaging in delineating the extent of malignancy has meant that imaging \nhas become increasingly important as a surrogate end-point. These two factors \nhave resulted in an increasing need for a standardisation of the criteria of response \nboth in therapeutic trials and in clinical practice. It is vital that all radiologists imaging \npatients with cancer are familiar with the limitations, pitfalls and strengths of these \nchanging criteria and also are aware of the possibility of using imaging to evaluate \nthe changing molecular make-up of the cancer. \n\nPostgraduate.Educational.Programme\nS34\n A B C D E F G H\nstent-grafts is steadily increasing. Therefore, knowledge of this treatment option is \nfundamental to provide basis for procedure planning and a meaningful radiological \nreporting. Imaging plays a crucial role in the assessment of patients with aortic \naneurysms. Eligibility for endovascular treatment depends very much on detailed \nanatomical knowledge of the aorta, its branches and vascular access through the \niliac arteries. We will review the role of imaging modalities: US, CT, MR for detection \nand evaluation of anatomy of thoracic and abdominal aneurysms. The strength and \nweakness of each modality will be reviewed and inclusion criteria for endovascular \naortic aneurysm repair will be presented. The precise sizing of the stentgraft obtained \nfrom the images is certainly one of the most critical points of the endovascular pro-\ncedure and a condition of its success. Although it is a minimally invasive treatment \nit is associated with complications. There is a strong need for general radiologists to \nknow about the most prevalent normal and abnormal findings of the post-treatment \naorta. The session will end with discussion addressing the central role of imaging in \npre- and post-treatment evaluation of the patients with aortic aneurysms. \nSession Objectives:\n1. To learn about the leading role of interventional radiology in management of \npatients with aortic aneurysms.\n2. To understand the importance of pre and post-procedural imaging.\n3. To understand the role of the radiologist in the management and follow-up \nprocess.\nA‑118\t 08:35 \nEndovascular treatment of thoracic aortic aneurysms \nJ.-P. Beregi; Lille/FR (jean‑paul.beregi@chru‑lille.fr) \nIndications for and experience with placement of endovascular stent grafts in the \nthoracic aorta are still evolving. Recent advances in imaging technologies have \ndrastically boosted the role of pre-procedural imaging. The accepted diagnostic gold \nstandard, digital subtraction angiography, is now being challenged by the state-of-\nthe-art computed tomography angiography (CTA), magnetic resonance angiography \n(MRA) and trans-oesophageal echocardiography (TEE). Among these, technological \nadvancements of multidetector computed tomography (MDCT) have propelled it to \nbeing the default modality used, optimising the balance between spatial and temporal \nresolutions and invasiveness. MDCT angiography allows the comprehensive evalu-\nation of thoracic lesions in terms of morphological features and extent, presence of \nthrombus, relationship with adjacent structures and branches as well as signs of \nimpending or acute rupture, and is routinely used in these settings. In this presentation, \nwe review the current state-of-the-art radiological imaging for thoracic endovascular \naneurysm repair (TEVAR), especially focusing on the role of MDCT angiography. \nAfter analysing the technical aspects for optimised imaging protocols for thoracic \naortic diseases, we will discuss pre-procedural determinants of candidacy, and how \nto formulate interventional plans based on cross-sectional imaging. \nLearning Objectives:\n1. To learn about etiology, clinical presentation and indications for treatment.\n2. To understand which imaging information is required for management of \nthoracic aortic aneurysms.\n3. To learn about the outcomes and drawbacks of stentgrafting.\nA‑119\t 08:58 \nEndovascular treatment of abdominal aortic aneurysms \nR. Morgan; London/UK (robert.morgan@stgeorges.nhs.uk) \nThe purpose is to present the essential principles of endovascular repair of abdominal \naortic aneurysms (EVAR). Abdominal aortic aneurysms (AAA) larger than 5.5 cm should \nbe treated. Inclusion criteria for EVAR include satisfactory aneurysm neck morphology \nand suitable access vessels. Preprocedural imaging involves CTA from the diaphragm \nto the femoral arteries. Several devices may be used to cover a wide range of anatomy. \nEVAR procedures are generally performed as combined procedures by teams of \nvasculr surgeons and interventional radiologists. Patients are followed up indefinitely \nby CTA (or ultrasound) and plain radiography. The periprocedural mortality is three \ntimes lower compared with surgery. Late mortality rates are similar between surgery \nand EVAR. Quality of life issues favour EVAR in the short and medium term. Early \npublished series reported high complication and reintervention rates for EVAR, although \nthese have reduced with increased experience and improved device technology. \nConclusion: EVAR has become a favoured alternative to open surgical repair of AAA in \nmany European centers. Further refinements to the technique and devices are ongoing. \nLearning Objectives:\n1. To learn about etiology, clinical presentation and indications for treatment.\n2. To understand which imaging information is required for management of AAA.\n3. To learn about the outcomes and drawbacks of stentgrafting.\nwere nearly a 100% safe which led to a liberal and off label use of these agents. \nNephrogenic systemic fibrosis (NSF) was first identified in 1997, but reported in \nthe peer-reviewed literature in 2000. The disease typically affects patients with end-\nstage renal disease, including those on regular dialysis treatment. First publications \nreporting an association between GBCA and NSF appeared in 2006. According \nto Medwatch, 589 people developed GBCA-associated NSF between 1997 and \n2007. Most of these cases were associated with the administration of linear chelate \nGBCA. The proposed trigger for NSF is transmetallation of the gadolinium chelate \nwhereby free gadolinium is released from the chelate in exchange for endogenous \nmetals such as zinc, copper, and calcium with subsequent binding to human tissue. \nThe exact pathogenesis is unclear, but it is likely that cofactors may be involved. \nLearning Objectives:\n1. To understand the spectrum and mechanisms of MR contrast agents.\n2. To understand the pathophysiology behind NSF.\n3. To learn about clinical safety issues to consider beyond NSF.\nA‑116\t 09:21 \nC. PET tracers: established tracers and those on the horizon \nF.C. Gärtner, M. Schwaiger; Munich/DE \nThere is a large number of PET radio-pharmaceuticals in research, but only a \nlimited number have reached clinical application. The success of clinical PET \ndepends primary on the use of 18F deoxyglucose (FDG), which was introduced as \nbrain tracer in the late 1970s. Since tumour tissue displays high glucose uptake, \nFDG became an important diagnostic and prognostic biomarker in cancer. Beyond \nFDG, tracers of various biologic processes in tumours are currently evaluated. The \nmost promising are FLT, FET, 18F Choline. 18F-labelled compounds are preferred \nbecause of the 2 hrs physical half-life, which allows distribution to sites without \ncyclotron. Experimental compounds address angiogenesis, hypoxia, apoptosis \nand extra-cellular matrix. With the introduction of 68Ga-generators, 68Ga -labelled \nreceptor ligands are being used for detection of neuro-endocrine tumours. In \ncardiology, PET tracers are available for perfusion, metabolism and innervations. \nGene-reporter imaging has been used to monitor cell-based therapies in neurol -\nogy. One of the most promising applications of molecular imaging principles is the \ntargeting of amyloid deposition in the patients with Alzheimer’s disease. It is hoped \nthat early diagnosis of the neurodegeneration may lead to better therapies. The \nadvent of hybrid-imaging will be associated with the need for multimodal contrast \nagents exploiting the imaging characteristics of the involved instrumentation for \nmore differentiated visualisation of structure, physiology, and biology. \nLearning Objectives:\n1. To understand the working mechanism and radiation of current clinical \ntracers.\n2. To become familiar with the potential clinical indications and applications.\n3. To learn about potential new tracers.\nPanel discussion: \nWhat specific precautions are mandatory in order to guarantee contrast \nmedia safety to patients and healthcare professionals? 09:44 \nCurrent contrast agents are safer than previous products. However there are still \nsafety aspects to consider, including patient’s kidney function, thyroid metabolism, \nallergy, radiation exposure, or specific medical history, and there is no such thing \nas total or complete safety. While these simple precautions may appear obsolete in \nthe era of sophisticated technical approaches, these issues are still quite complex \nand crucial in maintaining a high safety level. The discussion will give guidelines \nand tips for achieving a high level of safety when using contrast agents. \n08:30 - 10:00 Room Q \nSpecial Focus Session \nSF 3b \nThe ABC of EVAR \nModerator: \nM. Szczerbo‑Trojanowska; Lublin/PL \nA‑117\t 08:30 \nChairman’s introduction \nM. Szczerbo-Trojanowska; Lublin/PL (ewamak@MRI.am.lublin.pl) \nTreatment of aortic aneurysms have been revolutionised two decades ago by the \nintroduction of endovascular methods. They became a favoured alternative to open \nsurgical repair nowadays. The number of patients with aortic aneurysms treated with \n\nFriday\nPostgraduate.Educational.Programme\nA\n S35\nCB D E F G H\nSession Objectives:\n1. To learn how cutting edge research can translate into clinical application in \nthe field of neuroradiology.\n2. To understand imaging strategy in common diseases like demyelinating \ndiseases and stroke.\n3. To evaluate whether functional imaging of the brain can lead to potential \napplication for clinical practice in the near future.\nA‑122\t 10:35 \nWhite is white: a simple guide to demyelinating diseases \nV. Dousset; Bordeaux/FR (vincent.dousset@chu‑bordeaux.fr) \nMagnetic resonance imaging (MRI) is the best tool to explore white matter disorders \n(WMD), including the most common demyelinating disease: multiple sclerosis (MS). \nThe formation of demyelinating lesions is related to an “inflammatory attack”. New \ntechniques as diffusion tensor imaging (DTI), perfusion weighted imaging and \nUSPIO enhancing can explore earlier and more specifically lesions formation. \nAcute demyelinating lesions may resolve (remyelination) or persist as “chronic \nblack holes”. Chronic demyelinating lesions lead to axonal injury and Wallerian \ndegeneration. A diffuse neurodegenerative process leading to cerebral atrophy is \nactually a major landmark in MS. Conventional MRI sequences allows visualisation \nof white matter lesions (seen as hyper T2/FLAIR lesions, low signal T1 lesions and \npossible gadolinium contrast enhancement), presently the basis of MS diagnosis. \nMS follow-up is usually clinic but imaging could provide prognosis and therapeutic \nparameters (“surrogate markers”) even if disease progression and axonal loss are \nindependent from “lesion load”. MR spectroscopy, DTI or magnetization transfer \nimaging (MTI) provide measurement of diffuse tissue damage in clinical research, \nand may correlate to disease progression, as well as brain volume measurement. \nAfter exclusion of alternative diagnosis (MRI “red flags” as other WMD), MRI le-\nsions dissemination in space and time criteria are the main points in MS diagnosis. \nThe widely used revised McDonald criteria may be replaced by more simple and \nefficient MAGNIMS criteria. Such criteria could allow starting “modifying disease \ntreatments” as soon as the first “clinical isolated syndrome”. \nLearning Objectives:\n1. To understand the MRI-targeted biological landmarks in demyelinating diseases.\n2. To know how to classify the appropriate techniques for diagnosis, prognosis, \ntherapeutic evaluation and for clinical research.\n3. To understand the input of MRI in the diagnosis of multiple sclerosis. \nInterlude (1) 10:55\nA‑123\t 11:00 \nFunctional imaging: useful tool for the radiologist or crystal ball for the \npsychiatrist? \nA. Krainik; Grenoble/FR (akrainik@chu‑grenoble.fr) \nSince blood oxygenation level-dependent (BOLD) signal changes have been ob-\nserved using MRI and modulated using neuronal stimuli, functional MRI (fMRI) has \nquickly become the most popular non-invasive functional neuroimaging technique \nin clinical practice and cognitive neuroscience. Indeed, high-field MR scanners and \nBOLD-sensitive sequences are now widely accessible in both clinical and research \nsettings. BOLD signal that relies on deoxyhaemoglin concentration is detectable \nwithout injection of external contrast media. The colourful activation maps combined \nwith three-dimensional brain anatomy may have also made this imaging method as \nmuch attractive as controversial. Numerous applications of fMRI have been suggested \nin medicine. After a 15-year long history in clinical practice and thousands of scientific \npapers even in prestigious journals, the role of fMRI remains mostly dedicated to \nmap eloquent cortex before a neurosurgical procedure. In fact, BOLD fMRI is chal-\nlenging because the relationship between the neuronal response to a stimulus and \nthe activation blobs relies on neurovascular coupling, haemodynamic response, MR \nsignal detection, and complex time-series analyses. Besides an obvious and partially \nelucidated complexity, and several concerns on the interpretation of experimental \nparadigms in cognitive neuroscience, fMRI is based on a robust physiological and \nphysical framework. BOLD signal is reproducible across subjects and MR scanners. \nfMRI requires a rigorous methodology to acquire and analyse data, an advanced \nknowledge in sulcogyral and functional neuroanatomy to estimate spatial displace-\nment and reorganisation in patient with focal lesion, and a solid experience in BOLD \nimaging to distinguish artefacts and potential confounds from appropriate results. \nLearning Objectives:\n1. To know the key points of quality in fMRI.\n2. To know the main pitfalls in fMRI interpretation.\n3. To learn more about advances in fMRI of brain perfusion.\nInterlude (2) 11:20\nA‑120\t 09:21 \nThe role of imaging in follow-up \nK.A. Hausegger; Klagenfurt/AT (klaus.hausegger@lkh‑klu.at) \nThe goal of surveillance after EVAR is to prevent late rupture eurysm. High pressure \nELs (type I and type III EL) are risk factors for late rupture therefore have to be treated. \nType-II, IV and type V (endotension) ELs are low pressure ELs with a low rupture risk. \nThus, it is essential not only to detect ELs but also to classify ELs correctly. Until recently \nstent graft surveillance has been performed with contrast enhanced multislice CT \n(MSCT), typically 1, 3, 6 and 12 months after EVAR and thereafter in yearly intervals. \nHowever, although MSCT proved to be a very effective in FU cumulative radiation \nexposure, repetitive contrast medium load and increasing work load have to be seen \ncritically. Therefore, alternative surveillance protocols especially including ultrasound \nhave been evaluated. Several studies have shown that a risk-adjusted follow-up regime \nmight be most efficient. Patients with low risk of aneurysm-related mortality after EVAR \nhave a normal 1- and 6-month MSCT scan and sack shrinkage at 12 months. In these \npatients regular contrast enhanced US in yearly intervals have been proven to be safe \nfor further FU. A one yearly non-enhanced low-dose CT or a plain film may be recom-\nmended to detect distortion or migration of the stent-graft. Patients with a persistent \ntype II EL after one year need to be followed more closely and imaging modality is \nchosen depending on the character of the EL. In most cases EL classification can be \nmade correctly by MSCT or US; however, sometimes DSA may be needed. \nLearning Objectives:\n1. To learn about the follow-up imaging strategy.\n2. To compare the advantages and limitations of US and CT.\n3. To understand the role of MRI.\nPanel discussion: \nThe key role of imaging in endovascular aortic aneurysm repair 09:44 \nMany patients with aortic aneurysms are currently treated endovascularly. Therefore \nthe number of patients imaged pre and post-procedurally is increasing. Radiologists \nevaluating aortic aneurysms with different modalities should know the key imaging \nfeatures to look for in pre-treatment as well as follow-up examinations. \n10:30 - 12:00 Room A \nESR meets France \nEM 1 \nFrom neurosciences to clinical practice \nPresiding:\nY. Menu; Paris/FR \nJ.‑P. Pruvo; Lille/FR \nA‑121\t 10:30 \nIntroduction \nJ.-P. Pruvo; Lille/FR (jppruvo@chru‑lille.fr) \nNeuroimaging is one of the fields of radiology with the most exciting recent ad-\nvances. Moreover, these advances show dramatically important clinical applica -\ntions. Some are useful for the specialised neuroradiologist, but most are critical \nfor the general radiologist as well. In this session, we will try to address some of \nthe most relevant issues: white matter disorders are common diseases. Expertise \nof the radiologist is important in detecting the disease, and in the evaluation of the \nactivity after treatment. With this respect, standardisation of criteria is desirable \nfor appropriate medical decisions. Functional Imaging is a fascinating insight into \nthe human brain. It opens new horizons and has found many applications in the \nevaluation of psychiatric diseases, and in the planning before treatment of brain \nlesions, among other potential applications. Although it is obvious that we ignore \nmuch more than we know, this field is already one of the most exciting topics in \nneuroradiology. Although these methods are still in the field of specialists, everybody \nshould be aware of the possibilities of functional imaging of the brain and its recent \ndevelopments. Stroke is by excellence a clinically relevant problem. Because it is \nan emergency situation, time really matters, and we have more than one imaging \ntool to explore these patients, it is mandatory to provide strong recommendations \nand guidelines for the radiologist, in accordance with the clinical situation and \nwith the treatment options. At the end of this session, the attendees will be aware \nof important advances in the domain of neuroradiology, and will take home very \nimportant landmarks for their own clinical practice.\n\nPostgraduate.Educational.Programme\nS36\n A B C D E F G H\nLearning Objectives:\n1. To learn about the common causes of abdominal pain in children.\n2. To understand the importance of ultrasonography and to learn when CT or \nMRI might be required.\n3. To learn about issues relating to radiation dose in the paediatric abdominal \nand pelvic CT.\nA‑126\t 11:00 \nB. Jaundice in children: common causes and imaging strategy \nD. Pariente; Le Kremlin‑Bicêtre/FR (daniele.pariente@bct.aphp.fr) \nJaundice is rare in children but imaging has a major role to establish the cause \nwhich differs according to age. In the neonatal period the leading cause is biliary \natresia (BA) which consists of the obliteration of the extrahaepatic bile duct (BD) \nwithout dilatation of intrahaepatic BD and requires urgent surgical treatment to \nreduce the need for liver transplantation. BA must be considered when there are \npersistent white acholic stools and firm hepatomegaly. US shows the absence of \ndilated BD and in a few cases a cyst at the porta hepatis or findings of the splenic \nmalformation syndrome, but often it is not conclusive. MRCP has not yet proved \nto be reliable for the diagnosis of BA. Other neonatal cholestases include medical \nintrahepatic causes which can be identified by biological tests or histological find-\nings and rare causes of extrahepatic obstruction with dilated BD such as lithiasis, \ncholedochal cyst or spontaneous perforation of BD. In childhood, US easily identi-\nfies all causes of extrahepatic obstruction by showing dilated BD; the main causes \ninclude choledochal cyst (the most frequent congenital malformation, defined by \nan abnormally long common bilio-pancreatic channel), cholelithiasis, tumoural \ncompression, sclerosing cholangitis, portal vein obstruction, postsurgical or post-\ntraumatic stenosis… In all these cases, in our experience, MRCP has become \nthe modality of choice and has replaced invasive procedures which are nowadays \nreserved for treatment. MDCT may be useful in rare instances, for example, to \ndifferentiate calculi and aerobilia after surgery. Imaging protocols and illustrative \ncases will be presented. \nLearning Objectives:\n1. To learn the common causes of jaundice in the various paediatric age \ngroups.\n2. To learn about the imaging strategies.\n3. To become aware of complications following therapy and their investigation.\nA‑127\t 11:30 \nC. Neonatal bowel obstruction: the role of the radiologist \nS. Ryan; Dublin/IE (stephanie.ryan@cuh.ie) \nNeonatal bowel obstruction generally presents within hours of birth. The diagnosis \nof bowel obstruction is clinical but imaging is vital to determine the cause. The plain \nradiograph will distinguish upper from lower intestinal obstruction. The radiograph \nalone is diagnostic in duodenal atresia and jejunal atresia and the baby may be \ntaken directly to surgery. If the radiograph shows multiple dilated loops of bowel, \nmore than 4 loops, then the obstruction is distal ileal or colonic. The radiograph \nmay give some clues as to the possible cause, such as a large fluid level in the \ndilated loop proximal to an atresia. Contrast enema, usually with low osmolar water \nsoluble contrast, is used in most cases, however, to determine the cause of lower \nintestinal obstruction because the management of this is different for different \ncauses of obstruction. Meconium ileus and ileal atresia are the commonest ileal \ncauses of obstruction and Hirschprung’s disease and meconium plug syndrome \nare the commonest colonic causes of obstruction. Colonic atresia is rare and \nimperforate anus is a clinical diagnosis. Radiologically guided reduction is used \nto treat meconium ileus. Intestinal obstruction in the older neonate may be due \nto volvulous, pyloric stenosis, duodenal stenosis or omphalomesenteric band. In \nthe baby born prematurely, obstruction may be caused by stricture secondary \nto necrotising enterocolitis. Radiographs and contrast studies are also used to \nevaluate these conditions. \nLearning Objectives:\n1. To learn about the most common causes of neonatal obstruction.\n2. To understand the role of plain radiography in establishing the diagnosis.\n3. To know when upper and lower GI contrast studies are indicated and the \ncontrast medium used.\nA‑124\t 11:25 \nStroke around the clock: will the challenger (CT perfusion) beat the \nchampion (diffusion MRI)? \nX. Leclerc; Lille/FR (xleclerc@chru‑lille.fr) \nIn patients admitted for a suspected stroke, time management is the most important \ncriterion for therapeutic decisions. Less than four hours and a half, all patients \nadmitted in emergency for an acute neurological deficit without impairment of \nconsciousness (NIH < 25) and presented with a brain ischaemia of less than one \nthird of the territory of the middle cerebral artery should receive IV thrombolysis. \nBrain imaging must exclude bleeding and quantify the extent of ischaemic damages. \nBetween 4.5 and 6 hours after onset of symptoms, intravenous thrombolysis and/\nor intraarterial mechanical or chemical thrombolysis may be indicated in selected \ncases. The assessment of ischaemic penumbra and vessel permeability is par-\nticularly important for the therapeutic decision. This may be evaluated either by \nMRI or CT. MRI is the technique of choice that should be used whenever possible \nbecause of the absence of irradiation and iodine-related side effects, the optimal \nanatomical coverage, the detection of lacunar infarct and its sensitivity for evalu -\nating ischaemic brain damages of the posterior fossa. Imaging protocol should \ninclude FLAIR (fluid attenuated inversion recovery), T2*, diffusion/perfusion and \nMR angiographic sequences. In case of unstable patient or if MRI is not available, \na non-contrast CT scan must be performed and completed by perfusion CT and \nCT angiography. The main advantages of this technique are the short time of data \nacquisition and the absolute quantification of perfusion due to the linear relation \nbetween attenuation and concentration. \nLearning Objectives:\n1. To understand the medical challenges in patients with stroke, and why and \nwhen imaging should be performed to decide on a specific treatment.\n2. To understand the appropriate protocols for CT and MRI in patients with \nstroke and to recognise the main results.\n3. To learn about the respective possibilities and limits of CT and MRI, their \ncomplementarities or concurrence, and to learn whether imaging strategy \ncan be tuned to machine availability.\nPanel discussion 11:45 \n10:30 - 12:00 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 420 \nCommon digestive problems in children: the \nradiologist as a key player \nModerator: \nA. Paterson; Belfast/UK \nA‑125\t 10:30 \nA. Abdominal and pelvic pain: a practical approach \nS.G.F. Robben; Maastricht/NL (s.robben@mumc.nl) \nMany paediatric abdominal emergencies present with abdominal or pelvic pain. Any \ndelay in diagnosis and treatment may result in death or severe morbidity. These \ndiseases are highly age-dependent. Newborn infants may have congenital diseases \nas Hirschsprung‘s disease or meconium ileus or may develop necrotising entero-\ncolitis, incarcerated inguinal herniation and midgut volvulus. Infants and preschool \nchildren have intussusceptions, urinary tract infections and (rare) haemolytic uremic \nsyndrome. Children and adolescents have appendicitis, genito-urinary infections, \novarian torsion and Henoch Schonlein purpura. Considering radiation dose in chil-\ndren and the excess value of ultrasonography (US) in small individuals, US plays \nan important role as initial diagnostic modality in paediatric patients with abdominal \npain. Sensitivity and specificity for US in diagnosing intussuception, midgut volvulus, \nurinary tract abnormalities and appendicitis is over 90%. Conventional abdominal \nradiographs or fluoroscopy is valuable in Hirschsprung‘s disease, meconium ileus, \nmalrotation and necrotising enterocolitis. I consider CT as an additional technique \nwhen the initial techniques (US and conventional radiography) are inconclusive. \nMRI is seldom indicated in paediatric patients with abdominal emergencies because \nof motion artefacts in anxious children and sometimes limited MR capacity. Delay \nin diagnosis of the above-mentioned diseases may be devastating, ranging from \nlife-long disability to death. Therefore, it is important to consider these diagnoses \nand to initiate prompt adequate diagnostic work-up. \n\nFriday\nPostgraduate.Educational.Programme\nA\n S37\nCB D E F G H\nA‑130\t 14:30 \nB. Unresolving pneumonia: when and how to image, and clinical \nconsequences \nK. Foster; Birmingham/UK (katharine.foster@bch.nhs.uk) \nPneumonia is a common cause of attendance to hospital. Chest infections in \nchildren are usually viral and self limiting, but sometimes chest infections can be \nprolonged or repeated. There are many underlying causes for this, for example, \ncongenital anatomical causes, underlying patient susceptibility, inhaled foreign \nbodies and unusual organisms. One of the more common causes seen in hospital \nis when pneumonia has become complicated by empyema. Very rarely other con-\nditions such as Kawasaki’s disease or tumours can masquerade as pneumonia. \nThis session will review these conditions together with the benefits and limitations \nof plain radiography. It will also consider times when other imaging modalities such \nas CT and ultrasound can help to guide diagnosis and treatment. \nLearning Objectives:\n1. To learn about the role of plain radiography.\n2. To learn about the value of ultrasonography and to outline the instances \nwhen CT is helpful.\n3. To be aware of the complications and how the radiologist can contribute to \nmanagement.\nA‑131\t 15:00 \nC. Common cardiac disorders in children: the basic role of imaging \nC.J. Kellenberger; Zurich/CH (christian.kellenberger@kispi.uzh.ch) \nIn children, congenital heart disease (CHD) is more frequent than acquired heart \ndisease. Diagnosis and subsequent management of patients with CHD relies \nheavily on different and often multiple complementary imaging modalities. Serial \nassessment of the morphology and function of the heart and thoracic vessels is \nneeded at various stages of care. Although chest radiography is frequently used for \nmonitoring the cardiorespiratory status and complications that may arise during clini-\ncal care or intervention, it rarely provides a complete diagnosis. Echocardiography, \nas first line imaging modality, often provides all information required for diagnosis \nand follow-up, especially in small children with good acoustic windows. Contrast-\nenhanced computed tomography (CT) and magnetic resonance (MR) imaging are \nvaluable for detailed three-dimensional evaluation of the extracardiac vasculature \nand cardiac anatomy. In addition to being radiation free, MR has the advantage \nto provide both morphologic and functional information with the use of different \ntechniques including ECG gated gradient-echo cine imaging, gadolinium-enhanced \nangiography and velocity-encoded phase-contrast imaging. A comprehensive MR \nevaluation including quantitative measurements of ventricular volumes and function \nas well as blood flow in vessels and across valves can give important information \non long-term sequelae of the underlying cardiac defect, the significance of residual \nlesions, and potential complications of surgery. It is also valuable for planning \nand timing of future interventions. Today, CT and MR have become the next line \nof investigation when echocardiography does not provide sufficient information, \nwhile catheter angiography is reserved for the assessment of coronary arteries, \nmeasurements of pulmonary vascular resistance and interventional procedures. \nLearning Objectives:\n1. To learn whether plain radiography still plays a role in diagnosis.\n2. To become familiar with the technique of cardiac CT and when best to use it.\n3. To learn when MRI should be used and the sequences required.\n14:00 - 15:00 Room Z \nThe Beauty of Basic Knowledge: Interpretation of the Chest \nRadiograph \nMC 21B \nLobar collapse \nA‑132\t 14:00 \nLobar collapse \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nIt is important to recognise lobar collapse in the chest radiograph, because it is \noften caused by bronchogenic carcinoma. A hilar mass and lobar collapse are \nfindings strongly suggestive of a primary tumour. The most common signs of loss \nof volume of a lobe are increased opacity of the affected lung, displacement of \nfissures, displacement of the hilum and elevation of diaphragm. Imaging findings \nvary depending of the affected lobe. \n12:15 - 12:45 Room A \nPlenary Session \nHL 1 \nJosef Lissner - Honorary Lecture \nPresiding: \nY. Menu ; Paris/FR \nA‑128\t 12:15 \nThe chest radiograph: a perfect design \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nOver the past years, diagnostic imaging has witnessed a veritable explosion in \nthe modalities available for studying patients. When applied to the study of the \nthorax, they contribute to earlier detection of abnormalities and greater diagnostic \naccuracy. Yet, the conventional radiographic examination of the chest continues to \nbe the most commonly performed imaging study and, when properly interpreted, \ncontinues to demonstrate a wealth of information. For a correct interpretation of \nthe chest radiograph, several premises should be met by the radiologist: a proper \nknowledge of the anatomy and semiology of the thorax, stressing the need for a \nlateral projection, understand the importance of reviewing previous studies and \ntry to avoid unnecessary cross-sectional studies. \nLearning Objectives:\n1. To understand how to re-evaluate the role of the chest radiograph in \ndiagnostic imaging.\n2. To review basic principles of interpretation.\n3. To understand the importance of the lateral projection and of previous \nstudies.\n14:00 - 15:30 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 520 \nThoracic diseases: common, important and \npotentially devastating \nModerator: \nC.E. de Lange; Oslo/NO \nA‑129\t 14:00 \nA. Investigating a child with a “cough”: a pragmatic approach \nC.M. Owens, S. Cacaci; London/UK (owensc@gosh.nhs.uk) \nThis lecture will address the radiological approach to imaging children of all age \ngroups presenting with cough. This is a common symptom with very diverse \ncauses, from acute viral infection to complex vascular and intrinsic congenital \ntracheal anomalies and can be the presenting symptom of acute (rapidly fatal \nif not managed adequately) and chronic effects of foreign body aspiration. The \nvarious causes of cough vary with age and whether cough is acute, sub-acute \nor chronic. This has effects on radiological investigations deployed, and thence \non subsequent clinical management. We will present a pragmatic approach to \nradiological investigations in this diverse set of patients, using simple algorithms \nand illustrate the more important (and often rarer) causes of cough with discussion \naround deployment of examinations that are fit for purpose using ALARA principles. \nGuidance on imaging algorithms and CT technique will be given to children with \nthis important presenting symptom of myriad diverse pathological processes. The \nattendee will learn the value and optimal use of imaging with tips on optimising \nCT technique as fit for purpose. \nLearning Objectives:\n1. To learn about the differential diagnoses in the very young child and in older \nchildren.\n2. To learn which imaging modalities best help to determine the final diagnosis \nin the various age groups.\n3. To understand radiation protection requirements in chest CT examinations.\n\nPostgraduate.Educational.Programme\nS38\n A B C D E F G H\nA‑135\t 16:28 \nClinical examples of dual energy CT \nL.S. Guimarães; Viseu/PT (luis.s.guimaraes@gmail.com) \nDual energy (DE) computed tomography (CT) allows the discrimination of different \nmaterials, which has several clinical applications. The ability to differentiate calcium \nfrom uric acid renal stones allows the identification of patients that will benefit from \ndrugs that alkalinise urine. A musculoskeletal application of the same technique \nis in tophaceous gout, where the crystals can be differentiated from bone. Post-\nprocessing of CT angiography images can be facilitated using DE techniques to \nidentify and remove the calcium signal. Such an approach removes both bones and \ncalcified plaques. “Virtual non-contrast” images can be obtained by identifying and \nremoving the iodine-containing voxels of contrast-enhanced CT images, simulating \nnon-contrast images and potentially eliminating the need for some non-contrast \nacquisitions, but it should be realised that small misclassifications could result in \nmissing tiny caliceal tip stones, for example. DECT also allows the utilisation of \nlow energies without the prejudice of unacceptable noise. Since iodine signal is \nsignificantly higher at low energies, disease conspicuity can be improved. This is \nparticularly beneficial in the liver (for hepatocellular carcinoma identification), in the \npancreas (for visualisation of hypo- and hypervascular lesions), and in enterography \n(to increase the identification of hyperenhancement). The approach for displaying \nthe enhanced iodine signal may be one of blending information from the two ener-\ngies (into a single grey-scale image), or via an iodine-only view. Further validation \nof dual energy techniques and their limitations is needed to understand the patient \npopulations in which such techniques can be utilised and where conclusions based \non dual energy data can be trusted. \nLearning Objectives:\n1. To learn about the clinical applications of dual energy CT imaging.\n2. To learn about the value of clinical applications in diagnosis.\n3. To better understand the clinical situations where dual energy CT should be \nused.\nA‑136\t 16:51 \nCT contrast perfusion \nK.A. Miles1, V.J. Goh2; 1Brighton/UK, 2Northwood/UK \n(gohmcglone@hotmail.com) \nCT perfusion imaging is a quantitative technique that employs rapid sequences of \nCT images after bolus administration of intravenous contrast material to measure \na range of physiological processes related to the microvasculature of tissues. CT \nperfusion parameters can provide surrogates for tissue hypoxia as well as the \nphysiological processes such as vasodilatation that represent vascular responses \nto hypoxia. Although the basic techniques for DCE-CT have been available for \ndecades, more recently a range of technological advances have contributed to the \ngreater applicability of perfusion CT in the clinical environment including wider CT \ndetectors, shorter gantry rotation times, ‘table-toggling’, radiation dose reduction and \nsoftware corrections for image mis-registration due to respiratory or other patient \nmotion. Consensus guidelines are now available for the acquisition and processing \nof CT perfusion studies for the brain and body. To date, the main applications of \nCT perfusion imaging in stroke have been the confirmation of stroke diagnosis and \nextent, identification of penumbra and selection of patients for thrombolysis. The \nmain applications in oncology have been in lesion characterisation, risk-stratification \nand assessment of treatment response. \nLearning Objectives:\n1. To learn about how CT contrast perfusion is performed technically.\n2. To better understand the clinical data the perfusion provides.\n3. To have a good understanding of the most important applications of CT \nperfusion.\nPanel discussion: \nWill CT surprise us again? 17:14\nWhat clinical situations benefit from dual energy or contrast perfusion imaging?  \nCan contrast perfusion imaging benefit from dual energy techniques? \nWhat are the three most important clinical applications of DE and CT perfusion \nimaging? \nLearning Objectives:\n1. To learn the signs that identify lobar collapse.\n2. To learn specific signs applied to different lobes.\n3. To understand the significance of lobar collapse in the adult.\n16:00 - 17:30 Room A \nNew Horizons Session \nNH 6 \nNot just Hounsfield numbers: CT aimed at the fifth \ndimension? \nModerator: \nJ.M. Boone; Sacramento,  CA/US \nA‑133\t 16:00 \nChairman’s introduction \nJ.M. Boone; Sacramento, CA/US (jmboone@ucdavis.edu) \nComputed tomography (CT) systems have provided three-dimensional (x, y, z) data \nsince their clinical introduction in the 1970s. This session will address the extension \nof CT imaging into the fourth and fifth dimensions. The rapid acquisition capabilities \nof modern CT scanners open the door to the fourth dimension - time - where a \ntime-course CT scan can provide clinical information about blood flow, perfusion \nand other physiological measures regarding organ function. The door to the fifth \ndimension - energy - is opened by dual energy image acquisition techniques, which \nare made possible by dual source CT scanners or rapidly switching x-ray source \nCT scanners. Dual energy CT images can be manipulated to provide quantitative \ninformation with regard to the elemental composition of tissues, which, in turn, \ncan be used to differentiate between bone and iodine contrast, with many other \napplications possible as well. Modern CT scanners now provide multidimensional \ndata sets characterised as I (x, y, z, t, E), and the additional information provided \nby these five-dimensional data sets provide genuinely useful clinical information \nwhich add to the diagnostic potential of computed tomography. \nSession Objectives:\n1. To learn about CT capabilities beyond just imaging.\n2. To better understand dual energy CT capabilities.\n3. To better understand the potential of CT perfusion.\nA‑134\t 16:05 \nBasic principles of dual energy CT \nW.A. Kalender; Erlangen/DE (willi.kalender@imp.uni‑erlangen.de) \nX-ray computed tomography (CT) usually measures the attenuation of the patient \nor object cross-section in question at a fixed chosen voltage value; the result is \npresented as the linear attenuation coefficient µ expressed in Hounsfield units \n(HU). Dual energy CT (DECT) acquires data at two different mean energies and \nevaluates the differences in attenuation. Dual energy CT imaging has been a topic \nsince the 1970s. The acquisition modes have changed over the years from two \nseparate scans at different voltages to single scans with rapid kV-switching, and \ndual source CT operating with different voltages and pre-filtrations. These concepts \nwill be explained in detail including future options of energy-discriminating detec-\ntors. The basic physics principles remain the same for all acquisition schemes. \nThe two independent measurements allow separating two tissue characteristics \ncontributing to attenuation. For example, low and high effective atomic number \nmaterial densities can be determined in the so-called basis material decomposition. \nArbitrary combinations such as monoenergetic or electron density and effective \natomic number images can then be provided. These will be illustrated and explained \nby examples such as differentiation between plaque and contrast agent or virtual \nunenhanced abdominal organ imaging. DECT meanwhile offers quite a number of \naccepted clinical applications which will be covered in a separate talk. \nLearning Objectives:\n1. To learn the basic principles of dual energy imaging.\n2. To learn the acquisition modes of dual energy imaging in CT.\n3. To better understand the dose consequences of dual energy CT.\n\nFriday\nPostgraduate.Educational.Programme\nA\n S39\nCB D E F G H\nous lesions (adenomas) and curable early-stage cancer, screening for CRC has \nhigh potential for reducing incidence and mortality of the disease. Nevertheless, \nthe benefit of population-based CRC screening needs to be weighed against \npotential risks, psychological distress and required resources since only a minor-\nity of the population develops the disease and may thus benefit from screening. \nSeveral industrialised countries offer faecal occult blood testing as a primary \nscreening tool, with positive test results being followed up by colonoscopy. Some \ncountries, such as the United States and Germany, also offer colonoscopy as a \nprimary screening tool. While the results of randomised controlled trials regarding \nscreening colonoscopy are still outstanding, there is evidence from observational \nstudies that support its effectiveness in population-based CRC screening. Recent \nevidence suggests that colonoscopy, when performed in the community setting, \nis more effective in protecting from neoplasms in the left colon and rectum than \nin the right colon. Decision-analytic models support the (cost)-effectiveness of \nscreening colonoscopy but results vary, among others, according to compliance, \n(country-specific) cost estimates and screening schedules. \nLearning Objectives:\n1. To learn about the incidence and prevalence of colorectal cancer and its \nprecursors in the target population of screening.\n2. To understand the rationale for colorectal cancer screening.\n3. To become familiar with estimated (cost) effectiveness of colorectal cancer \nscreening when using optical colonoscopy as a primary screening tool.\nA‑140\t 16:23 \nFacts from the statistician (true for once?): how accurate is CT \ncolonography \nA. Laghi; Latina/IT (andrea.laghi@uniroma1.it) \nThe issue of diagnostic accuracy of CTC for CRC and polyps has been debated \nfor a long time, because of the conflicting results published in the literature. Those \nresults led researchers to design three important studies: two large, multicenter \ntrials testing the performance of CTC in comparison with CC in asymptomatic \nindividuals (ACRIN and IMPACT) and one randomised, double-arm trial (SIGGAR) \nconducted on symptomatic patients with the aim to detect CRC. Both the ACRIN \nand IMPACT reported per-patient sensitivity of 90% for polyps > 10 mm and 78-84% \nfor polyps larger than 6 mm; per-patient specificity was extremely high, over 85%, \nindependent of lesion size. The major drawback of the ACRIN was represented \nby the poor positive predictive value (PPV) (23% for polyps ≥10 mm); a definitely \nbetter PPV was documented in the IMPACT trial (62% for lesions larger than 6 mm) \nas well as in studies obtained in high-experienced centers. However, the negative \npredictive value in both the ACRIN and the IMPACT was rather high, approaching \n100%; this is extremely important in order to reassure negative patients about the \nsignificance of the examination. Excellent results were also obtained in the Munich \nColorectal Cancer Prevention Trial, a single-center study where around 300 as-\nymptomatic subjects underwent low-dose CTC in comparison with other screening \ntests (CC, sigmoidoscopy and FOBT). Despite the good results there are still some \nopen issues: the significance of diminutive (<  6 mm) polyps, the management of \nintermediate (6-9 mm) lesions and the detection rate for non-polypoid, flat lesions. \nLearning Objectives:\n1. To learn data from meta-analysis on VC accuracy.\n2. To become familiar with the results of recent multi-centre trials.\n3. To understand the performances of VC on the identification of small polyps \nand non-polypoid lesions.\nA‑141\t 16:41 \nWhen optical beats virtual \nJ.F. Riemann; Ludwigshafen/DE (riemannj@garps.de) \nOptical colonoscopy is the gold standard in detecting and removing precancerous \nlesions and early colon and rectal cancer. Sensitivity and specificity of the pro-\ncedure are over 95% up to 100%. The new HD-TV colonoscopes with additional \nvirtual chromoendoscopic techniques such as NBI, FICE or iSCAN significantly \nhave improved the precise diagnosis prior to histology. These improvements not \nonly enable the gastroenterologist to completely excise lesions with sophisticated \nnew resection techniques (EMR, ESR) but also let him predict the final pathology \naccording to internationally accepted classifications (i.e. Kudo´s classification for \npolyps). Limitations of optical colonoscopy are due to “blind” regions of the colon \n(both flexures), poor bowel cleansing and unexperienced examiners. Withdrawal \ntime and adenoma detection rates are further quality markers for a sufficient \ncolonoscopy. The acceptance rate of the screening colonoscopy is limited due \nto several reasons one of the most important being the opportunistic way of the \ninvitation. Interval cancers play an important role if one ore more of the described \nquality parameters fail. Further technical improvements like broadening of the field \n16:00 - 17:30 Room B \nInteractive Teaching Session \nE³ 620a \nCancer of the uterus and cervix: what the \nradiologist must report \nA‑137\t 16:00 \nCancer of the uterus and cervix: what the radiologist must report \nB. Hamm1, H. Hricak2; 1Berlin/DE, 2New York, NY/US (bernd.hamm@charite.de) \nMR imaging is the method of choice for staging uterine malignancies. The main \ncriterion for local staging of endometrial cancer is the depth of myometrial invasion. \nDiagnostic accuracy can be improved by performing a dynamic contrast-enhanced \nstudy in addition to T2-weighted imaging. Staging of cervical cancer is based on \nhigh-spatial-resolution axial and sagittal T2-weighted imaging, on which invasion \nof the parametrium can be assessed with a high degree of accuracy. Especially for \ncervical cancer, MR imaging can replace numerous other diagnostic tests and allow \nmore accurate pre-treatment staging while reducing costs. In addition, MR imaging \nis used in planning radiotherapy and in post-radiotherapy follow-up. Lymph node \nstaging on MR lymphography remains unreliable and may potentially be improved \nby the addition of diffusion-weighted imaging. \nLearning Objectives:\n1. To become familiar with imaging features in staging cervical and uterine \ncancer.\n2. To understand the impact of imaging on modern patient treatment.\n3. To understand the imaging findings on follow-up.\n16:00 - 17:30 Room C \nESR meets Gastroenterologists \nEM 2 \nOptical and virtual colonography: friends or \nenemies? \nPresiding:\nR. Hultcrantz; Stockholm/SE \nY. Menu; Paris/FR \nA‑138\t 16:00 \nChairmen’s introduction \nR. Hultcrantz1, Y. Menu2; 1Stockholm/SE, 2Paris/FR (Rolf.Hultcrantz@ki.se) \nColonoscopy is a very useful and important method to examine the colon. In recent \nyears virtual colonoscopy has become a popular alternative to optical colonoscopy. \nDisorder of the colon includes colorectal cancer, which is one of the most common \ncancers worldwide and presents a threat to life since the mortality is almost 50%. \nColorectal cancer screening has been shown to be an efficient method to find early \nforms of colorectal cancer and also to reduce mortality in this disease. In this ses-\nsion we will discuss the various methods used to examine the colon, how useful \nthey are and the economy behind using them.\nSession Objectives:\n1. To understand the respective roles of OC and VC in colorectal diseases.\n2. To become familiar with technical innovations and new diagnostic \nopportunities offered by OC.\n3. To understand the clinical value of VC.\nA‑139\t 16:05 \nFacts from the statistician (true for once?): incidence, prevalence, \nrationale for screening, standard results of optical colonoscopy \nU. Haug; Heidelberg/DE (u.haug@Dkfz‑Heidelberg.de) \nFacts from the epidemiologist: Incidence, prevalence, rationale for screening, \nstandard results of optical colonoscopy. Colorectal cancer (CRC) is the third most \ncommon cancer in the world, with about 1 million new cases and more than 500.000 \ndeaths per year. Incidence of CRC strongly increases by age and is higher in men \nthan in women. The lifetime risk differs between countries and is about 7% in the \nUnited States. Because most cases of CRC develop from removable precancer -\n\nPostgraduate.Educational.Programme\nS40\n A B C D E F G H\nstabilisation complex system a dual echo T2/DP sequence could be performed in \na sagittal-oblique plane drawing an imaginary line which on an axial image used as \nreference plane, is done perpendicular to popliteous tendon. Gradient echo (GE) \nsequences are useful in cartilage and traumatic pathology. T2-weighted sequences \nunderstimate cartilage thickness since cortex and cartilage have the same signal. \nPD sequences may have the similar signal for cartilage and adjacent joint fluid, \nobscuring defects; fat suppression solves this. If available, acquisitions performed \nin orthostatism could give further information in the assessment of meniscal and \npatello-femural pathology. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑144\t 16:25 \nB. Normal variants and pitfalls \nS.J. Eustace; Dublin/IE (seustace@iol.ie) \nThis talk will review appearances of normal anatomic variants identified at MRI \nof the knee including discoid meniscus, transverse meniscal ligaments meniscal \nflounce, ossicles, and pseudotears. Subsequently the talk will focus on diagnostic \npitfalls reflecting both imaging technique and variations in anatomy such as the \neffect of motion, imaging plane and anatomic variations in patella shape. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑145\t 16:50 \nC. Identifying and reporting abnormal findings \nM. Maas; Amsterdam/NL (m.maas@amc.uva.nl) \nMRI of the knee is one of the most frequent performed investigations, thus indicating \nthat common abnormalities need to be familiar to the general radiologist. A simple \nand straightforward method of enabling assessment of clinically relevant anatomical \nentities is based upon a (pre)structured radiology report. Use of speech recognition \nfacilitates implementation of pre-structured reporting in a KISS manner. Since one \nnow is enabled to structure the report, using digital tools, terminology used should \nbe discussed between the reporting radiology department and the clinical partners. \nIt is mandatory that the important message, the clinical relevance of the information \nthat radiologists put in their report, is understood by the referring clinician in the \nsame manner as it was meant to be. We should consider the background of our \nreferring physician, and tailor our report, both in chosen terminology as well as \ndetailed information. When working in a centre in which both specialised orthopaedic \nsurgeons as well as general practitioners (GPs) or sports physicians are referring \nfor MRI, each of the three needs a tailored report, especially considering advise \nfor secondary referral: GPs and sports physicians will need different approach, \ncompared to medical specialists. Also, the knowledge of terminology used should \nbe considered. The presentation focuses on common encountered pathologies, \nconsidering common abnormalities. Emphasis is given to common abnormalities, \nand pitfalls that should be dealt with. Some sports specific entities are discussed. \nImplication of clinical correlation is stressed. The presentation will include case-\nbased clinical illustrations. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\nof view and the “Third Eye” colonoscope are under investigation. At the moment, \nhowever, the combination of both, exact diagnostic and sufficient therapeutic action \nat the same time, is the reason why optical beats virtual in this particular indication. \nLearning Objectives:\n1. To learn about the precise diagnostic and therapeutic options concerning \nearly colorectal cancer and its precursor lesions.\n2. To understand the technical progress of the newest generation of \ncolonoscopes.\n3. To become familiar with the few limitations of the procedure.\n4. To consolidate knowledge of the most important diseases of the large bowel.\nA‑142\t 16:59 \nWhen virtual beats optical \nS.A. Taylor; London/UK (csytaylor@yahoo.co.uk) \nSince its evolution CT colonography has been advocated as a safe well tolerated \nalternative to colonoscopy, particularly in the context of colorectal cancer screening. \nNotably perforation rates are lower than those of colonoscopy and cardiovascular \neffects are less. However, patient preference studies have produced mixed results \nand it is not clear if standard CTC will increase compliance with screening. Fur-\nthermore, issues over apparent inferior sensitivity for polyp detection compared to \ncolonoscopy, need for prolonged radiologist education and radiation dose exposure \nhave been cited as barriers to widespread implementation in a screening context. \nTechnical developments in recent years are beginning to address these issues. \nUse of reduced laxative regimes supplemented with faecal tagging have shown \ngood results with superior patient acceptability. Software developments have also \nspeeded up dataset analysis -notably panoramic or “virtual pathology” 3D views \nreducing or eliminating hidden areas within the colon. Furthermore, computer-aided \ndetection software is increasingly fit for purpose and good data show a positive ef-\nfect on radiologist performance both in the research setting and day to day clinical \npractice. This presentation will review the data on patient preference and safety \nand highlight developments in those areas in which CTC holds advantages over \nconventional endoscopic techniques. Discussion will focus not only on colon cancer \nscreening but also the on data supporting CTC in older symptomatic patients who \nare at higher risk of adverse events during colonoscopy. \nLearning Objectives:\n1. To review the patient safety of CT colonography and conventional \ncolonoscopy.\n2. To review advanced computer techniques for maximising visualisation of \nthe colon during CT colongraphy including 3D visualisation methods and \ncomputer aided detection.\n3. To review the data on CT performance with particular emphasis on patient-\nfriendly reduced laxative regimens.\n4. To consider patient preference data.\nPanel discussion: \nIntegrated strategy? What about the outsiders (capsule, DNA, PET , …) 17:17 \n16:00 - 17:30 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 616 \nThe knee \nModerator: \nJ. Labuscagne; Bunbury, WA/AU \nA‑143\t 16:00 \nA. How I do it \nA. Barile; L’Aquila/IT (antonio.barile@cc.univaq.it) \nMRI of the knee has to be performed with patient in supine position with knee in \nsemiflexion (15-20°). The use of a dedicated coil is mandatory. Standard exam \ninclude: (a) spin echo (SE) T1 or proton density (PD)-weighted sequence in \nsagittal plane to evaluate menisci and cruciate ligaments; (b) SE T1-weighted \nsequence in coronal plane to evaluate marrow and anatomy; (c) dual-echo T2/\nDP in axial plane to evaluate lateral and medial supporting structures, patella and \nthe location of fluid collections; (d) a fat-suppressed sequence short tau inversion \nrecovery (STIR) or fast spin echo (FSE) T2-weighted in a coronal plane to easily \ndetect marrow oedema. For the evaluation of anterior cruciate ligament (ACL) a \nPD sequence with or without fat saturation could be performed in a sagittal-oblique \nplane parallel to the orientation of ACL. For the evaluation of the postero-lateral \n\nFriday\nPostgraduate.Educational.Programme\nA\n S41\nCB D E F G H\nrequires chest tube drain in less than 10% of cases. Sustained complete tumour \nresponse has been reported in about 85-90% of the target lesions; lesion size \nrepresents the most important risk factor for tumour local recurrence. Data regard-\ning long-term survival are now being published, reporting promising outcomes. \nAccording to the RAPTURE study, the 2-year cancer-specific survival was 73% \nin patients with NSCLC, 68% in patients with colorectal metastases, and 67% in \npatients with other metastases, with corresponding overall survival rates of 48%, \n66% and 64%, respectively. The use of RFA in combination with systemic chemo-\ntherapy for lung metastasis is now under investigation. Initial results report about \n30% 5-year survival rate in patients with colorectal metastasis. The association \nbetween RFA and radiotherapy should also be considered in selected patients. \nLearning Objectives:\n1. To learn about indications and patient selection.\n2. To understand the technique and complications.\n3. To review the results of RF ablation to date.\n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 610 \nMetabolic bone diseases \nModerator: \nJ. Freyschmidt; Bremen/DE \nA‑149\t 16:00 \nA. Metabolic bone disease for the practicing radiologist \nM. Sundaram; Cleveland, OH/US (sundarm@ccf.org) \nOsteoporosis, osteomalacia, hyperparathyroidism and Paget’s disease have con-\nventionally been considered the disease entities that comprise metabolic bone dis-\nease. The lecture will follow this convention and discuss the imaging characteristics \nthat suggest osteoporosis in the elderly or anorexia nervosa in younger patients by \nthe distribution of fractures and marrow changes as well as the role of bone mineral \ndensity evaluations in osteoporosis. Oncogenic osteomalacia will be discussed in \nthe context of appropriate imaging for detecting the tumour and emphasise the \nbasic biochemical abnormality that most radiologists should be familiar with that \nleads to the diagnosis. Radiologists most frequently encounter hyperparathyroid-\nism in renal osteodystrophy with over a million patients worldwide kept alive by \ndialysis. Dialysis-induced imaging changes such as amyloid and the spectrum of \nfindings from long-term dialysis will be shown and demonstrated. Paget’s disease \nis on the decline. Its distinctive MRI signal characteristics in uncomplicated cases, \nin contrary to most bone lesions encountered in clinical practice, will be explained. \nLearning Objectives:\n1. To get an overview of the entities that are considered in the realm of \nmetabolic bone disease.\n2. To understand common, less common and rare findings.\n3. To learn about some imaging findings that occur as a consequence of \ntreatment.\nA‑150\t 16:30 \nB. Latest advance in osteoporosis \nC.R. Krestan; Vienna/AT (christian.krestan@meduniwien.ac.at) \nOsteoporosis is of great socioeconomic impact, as approximately 30% of all \npostmenopausal women have osteoporosis in developed countries. Ageing of \npopulations worldwide will be responsible for a major increase of the incidence \nof osteoporosis in postmenopausal women. In 1994, the WHO Working Group \ndefined osteoporosis according to measurements of bone mineral density (BMD) \nusing dual energy x-ray absorptiometry (DXA) as a bone density T score at or \nbelow 2.5 standard deviations (T score) below normal peak values for young \nadults. The relative risk of a fracture is between 1.3 and 1.6 for each unit decline \nin spine or total hip T score. Due to limitations of the T-score concept a 10-year \nrisk calculating tool has been developed by the WHO to determine intervention \nthresholds. Fragility fractures are, however, not only related to bone mineral density \n(BMD). Trabecular bone microarchitecture is a significant determinant of the bone’s \nmechanical properties and is thus of major clinical relevance in predicting fracture \nrisk. Trabecular bone structure analysis can be based on images from multide -\ntector computed tomography, high-resolution peripheral computed tomography, \nhighresolution MRI and projection radiography. Advantages and disadvantages \nof the different methods depend on radiation, costs, availability and a reasonable \ntime for in vivo scanning. Grading of vertebral fractures can be done using a visual \n16:00 - 17:30 Room D2 \nInterventional Radiology \nRC 609 \nRF ablation beyond the liver \nModerator: \nA. Adam; London/UK \nA‑146\t 16:00 \nA. RF ablation in bone \nA.D. Kelekis; Athens/GR (akelekis@med.uoa.gr) \nThe purpose of this refresher course is to demonstrate bone ablation. The main \naim of thermal tumour ablation is to destroy the tumour using ionic movement to \nkill the malignant cells without damaging adjacent vital structures. Multiple sources \nof energy have been used to induce cell death. RF energy is an electromagnetic \none. Radio waves emanate from the non-insulated distal portion of the electrode. \nHeat is produced by resistive forces (i.e., ionic agitation) surrounding the electrode \nas the radio waves attempt to find their ground. Other type of ablations (using dif-\nferent wave lengths) include microwave, electoporosis, laser and radiofrequency \nablation is still seeking its place among bone interventional techniques. This \npresentation is an overview, in an area of non-vascular interventions in the spine \nand the appendicular skeleton. It will explain the patient selection, indication and \npossible approaches to a bone lesion. Available material will be discussed, as \nwell as possible combinations of them in order to yield maximum results, while \nreducing possible drawbacks. \nLearning Objectives:\n1. To learn about indications, patient selection and preprocedural imaging.\n2. To understand the technique.\n3. To review the results and complications.\nA‑147\t 16:30 \nB. RF ablation in the kidney \nM.A. Farrell; Waterford/IE (michaela.farrell@hse.ie) \nOver the last two decades, open nephron sparing surgery has become the pre-\nferred surgical alternative to nephrectomy for treatment of patients with a single, \nsmall (< 5 cm) localised renal mass and a normal contralateral kidney. Because \n25-49% of newly diagnosed small renal masses are identified incidentally on cross-\nsectional imaging, often in elderly patients, less invasive surgical nephron sparing \nalternatives have been advocated, including laproscopic partial nephrectomy and \nlaproscopic cryoablation, for select tumours in an effort to reduce surgical mortality \nand morbidity while preserving renal function. Percutaneous image-guided abla -\ntion offers potential advantages over surgical methods including the minimally \ninvasive nature of the procedure, less mortality and morbidity than surgery, shorter \nhospital stay, and quicker recovery. Local tumour control rates of up to 95% have \nbeen reported for small tumours. Central tumours and tumours greater than 3 cm \nin diameter are more difficult to successfully treat with local tumour progression \noccurring 25% of central tumours. Tumours larger than 3 cm in diameter typically \nrequire overlapping ablations and incomplete treatment can result from residual \ntumour at the ablation interfaces. While in some reports, local tumour progression \noccurred in up to 20% of tumours larger than 3 cm, in contrast, others have shown \nthat all exophytic tumours, despite their size, can successfully be treated using \nmultiple overlapping ablations and complete treatment may require more than one \nablation session. The most clinically relevant and potentially avoidable complica-\ntion is ureteral injury with resultant obstruction of the intrarenal collecting system. \nLearning Objectives:\n1. To learn about indications and patient selection.\n2. To become familiar with currently available therapeutic alternatives.\n3. To review the results of RF ablation compared with other treatments.\nA‑148\t 17:00 \nC. RF ablation in the chest \nI. Bargellini; Pisa/IT (irenebargellini@hotmail.com) \nPercutaneous image-guided radiofrequency ablation (RFA) represents as a safe \nand effective minimally invasive procedure in selected patients with unresectable or \nmedically inoperable lung malignancies. When adequately performed, in selected \npatients, the procedure is associated with over 95% immediate technical success \nrate and relatively low incidence of major (8-15%) and minor complications (20-\n40%). Pneumothorax represents the most frequent complication (up to 60%) but \n\nPostgraduate.Educational.Programme\nS42\n A B C D E F G H\npresentation, the worse the outcome in adulthood. AVN is a significant complica-\ntion. CT/MR assists orthopaedic planning. Imaging strategy: plain radiographs. \nSmall children localise pain poorly. Whole limb radiographs may be needed. US \ndetects hip effusions but cannot differentiate pus from effusion. Nuclear medicine \nmay need sedation for scanning phase. A full bladder may obscure the pelvis. \nMR is sensitive for soft tissue pathology and marrow disease included in the area \nimaged. Radiographs are needed before MR, which is insensitive for bone detail. \nOther causes: spinal problems - discitis, avulsions of muscle origins, trauma - tod-\ndler's fracture, diffuse bone disease, localised bone disease; blind areas: spine, \npelvis/sacroiliac joints. \nLearning Objectives:\n1. To learn about the imaging approach to the child with suspected \ndevelopmental hip dysplasia.\n2. To become familiar with the differential diagnosis in the older child with a limp.\n3. To learn which imaging modalities best help to arrive at a diagnosis.\nA‑153\t 16:30 \nB. Non-accidental injury: a radiologist’s nightmare \nP.K. Kleinman; Boston, MA/US (Paul.Kleinman@childrens.harvard.edu) \nSkeletal injuries are the most common findings noted on imaging studies in cases \nof child abuse. In infants, certain lesions, such as the classic metaphyseal lesion \nand posteromedial rib fractures are sufficiently characteristic to point strongly to \nthe diagnosis of inflicted trauma. Other fractures are less specific for abuse, but \nwhen correlated with other imaging findings and clinical information, their pres-\nence may add strong support for the diagnosis. Many of the most specific injuries \nproduce subtle radiographic alterations, and meticulous technique, adhering to a \nstrict imaging protocol, is vital in providing optimal detection of the fractures. In \nrecent years, increasing attention has been given to those conditions that may \nsimulate inflicted injury. A variety of normal variants, naturally occurring diseases \nand accidental injuries may be confused with the findings of child abuse. Other \nconditions, real or hypothetical, may be suggested by consultants in medico-legal \nproceedings. To be credible, a witness must be prepared to counter reckless and \nirresponsible testimony given by uninformed or biased medical „experts“. To ensure \nthat investigators and finders of fact are provided with testimony that is clear, con-\ncise and accurate, the radiologist must be fully informed and prepared to address \nthe radiologic alterations and their significance to a reasonable medical certainty. \nLearning Objectives:\n1. To learn in detail the investigation of a child with suspected non-accidental \ninjury.\n2. To learn about the typical skeletal injuries seen on plain radiography and the \ndifferential diagnosis.\n3. To understand when further imaging is required and which imaging modality \nis best.\nA‑154\t 17:00 \nC. Bone and joint infection and inflammation: pearls and pitfalls \nM. Alison, B. Tilea, R. Azoulay, G.-H. Sebag; Paris/FR \n(guy.sebag@rdb.ap‑hop‑paris.fr) \nAcute osteomyelitis and septic arthritis are diagnostic and therapeutic emergency \nin children. Diagnosis remains challenging because of their variable expression \n(acute, subacute, chronic stages, causative agents and hosts). Imaging strategy \nrelies on a multimodality approach including radiographs and ultrasonography as \nfirst line examinations with a complementary role for bone scintigraphy and MRI. \nMRI is especially useful for misleading challenging presentations (such as axial \nskeleton, pelvis and calcaneus osteomyelitis) and for detection of reversible os-\nteocartilaginous ischaemia requiring urgent surgical drainage. Juvenile idiopathic \narthritis (JIA) is an heterogeneous group of chronic inflammatory disorders that are \nclassified on their mode of onset (systematic, pauci and polyarticular diseases). It is \na diagnosis of exclusion and imaging plays a major role in the differential diagnosis. \nRadiographic scoring systems of JIA are different from adult scoring systems with \nless emphasis on joint space narrowing. Doppler-ultrasonography and MRI play an \nincreasing role in a the assessment of disease activity and response to treatment. \nLearning Objectives:\n1. To learn about the imaging approach to a child with suspected osteomyelitis \nand septic arthritis and to outline the classical features.\n2. To learn how best to investigate a child with suspected arthropathy and the \nspecific findings.\n3. To understand the differential diagnoses of bone and joint infections.\nsemiquantitative scoring method. Vertebral morphometry is based on radiographs \nor scans from DXA-machines calculating ratios of vertebral heights with normal \nvalues to identify vertebral fractures. \nLearning Objectives:\n1. To become familiar with what the radiologist ought to know about the WHO \ndefinition of osteoporosis and vertebral fracture risk.\n2. To understand the standard techniques and newer diagnostic techniques \nthat provide insights into the structure of trabecular bone.\n3. To analyse the pros and cons of these techniques.\n4. To describe methods of grading and quantitative morphometric assessment.\nA‑151\t 17:00 \nC. Rickets, osteomalacia, hyperparathyroidism and renal osteodystrophy \nJ.E. Adams; Manchester/UK (judith.adams@manchester.ac.uk) \nDiagnostic imaging features of rickets relate to defective osteoid mineralisation & \ninclude widened growth plates, splayed/poorly mineralised metaphyses (rachitic \nrosary) with bone softening (tri-radiate pelvis, deformity of long bones [bow legs, \nknock knees, varus/valgus deformity femoral neck]). In adults diagnostic feature \nis Looser’s zone (linear radiolucency, perpendicular to cortex, sclerotic margins), \nwhich occur most commonly: medial femoral neck, pubic rami, lateral scapular \nborders & ribs. If cause of rickets/osteomalcia is vitamin D deficiency (nutritional, \nlack of sunlight, malabsorption, chronic liver/renal disease) or low calcium intake, \nlow serum calcium stimulates secondary hyperparathyroidism (2HPT)(check for \nsub periosteal cortical erosions lateral margins middle phalanges 2nd & 3rd fingers). \nOther causes (hypophophosphataemia, ‘oncogenic’, low alkaline phosphatase \n[hypophosphatasia] and severe acidosis) will not have 2HPT. Primary HPT (third \nmost common endocrine disorder after thyroid disease & diabetes): 80% due to \nPTH adenoma, 15% to genetically-determined multiple endocrine abnormalities \n[MEA] syndromes & 5% PTH carcinoma. Imaging features include bone cysts \n[brown ‘tumours’], chondrocalcinosis, nephrocalcinosis, renal calculi & superiosteal \nerosions. As diagnosis often made on raised serum calcium with asymptomatic/\nmild disease there may not be any diagnostic imaging features present. Chronic \nkidney disease (CKD) results in azotaemic osteodystrophy (AZO), a complex \nbone disorder. The active metabolite 1.25 (OH)2 vitamin D is not formed in kidney \nso serum calcium falls; this stimulates 2HPT. Phosphate is retained & calcium x \nphosphate ratio raised, resulting in metastatic calcification in arteries & soft tis-\nsues, often related to bursae adjacent to large joints. There may be bone sclerosis \n(‘rugger jersey spine’) or osteopenia. \nLearning Objectives:\n1. To recognise the imaging features of rickets, osteomalacia, \nhyperparathyroidism and renal osteodystrophy.\n2. To learn the various causes of vitamin D deficiency and other disorders that \nresult in rickets and osteomalacia.\n3. To appreciate the role of imaging in renal osteodystrophy.\n16:00 - 17:30 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 620b \nCommon musculoskeletal disorders: how to avoid \nthe traps! \nModerator: \nA.C. Offiah; Sheffield/UK \nA‑152\t 16:00 \nA. Imaging a child with a limp \nA. Sprigg; Sheffield/UK (alan.sprigg@sch.nhs.uk) \nLimping is due to many causes. Clinical assessment determines imaging strategy. \nSepsis and obscured trauma are easily missed, later presenting hip dislocation \n< 3years. Despite clinical diagnosis and neonatal US scanning some children \npresent late with a limp (Trendelenburg gait). Do not be reassured by a 'normal' \nneonatal US report. Plain radiographs are the best modality. Arthrogram and CT \nassist surgical management of late presenting DDH. AVN - Perthes aged 3-11. Initial \nradiographs may be normal. Best diagnostic film - frog view both hips. Nuclear \nmedicine or MR help detect early cases. Management aims to keep the femoral \nhead covered by the acetabulum. Slipped capital femoral epiphysis age > 11 yrs. \nClinical misdiagnosis is common - referred pain between hip and knee. Early signs \nof SCFE are subtle on a true AP view - a frog view is best. The greater the slip at \n\nFriday\nPostgraduate.Educational.Programme\nA\n S43\nCB D E F G H\ngreat need for early, accurate and reliable imaging indicators of tumour response \nto anti-angiogenic drugs which is ultimately defined by overall survival rate, but is \nmostly based on changes in number and size of measurable tumour “targets”, i.e. \nblood vessels. Thanks to its characteristics of high temporal and spatial resolution in \nlimited fields and lack of ionising radiation and side effects (i.e. easy repeatability), \ncontrast-enhanced US (CEUS) is currently the simplest and also most reliable imaging \nmodality for detection, analysis and quantification of intratumoural macro- and micro-\nvascularity (up to 40 μm in diameter). Even minimal changes can be easily detected \nand quantified with CEUS during anti-angiogenic treatments: early disappearance \n(or severe reduction) of tumoural vascularisation is highly predictive of complete (or \nsignificant) response even before tumour volume decreases. Initial clinical studies \nwere conducted on hypervascular hepatic metastases (e.g. metastases from GISTs), \nbut recently also hypovascular hepatic metastases and primary cancers of differ-\nent organs are being assessed. For the quantitative analysis of tumour vascularity \nchanges several parameters (peak intensity, time-to-peak intensity, area under the \ncurve, etc). are currently being investigated and specific perfusion software connected \nto working stations are being developed and clinically tested. \nLearning Objectives:\n1. To know the advantages of DCE-US.\n2. To learn how to extract the parameters on true cases.\n3. To learn useful tricks for performing and processing good quality \nexaminations.\n16:00 - 17:30 Room F2 \nBreast \nRC 602 \nBreast MRI today \nModerator: \nW.A. Kaiser; Jena/DE \nA‑158\t 16:00 \nChairman’s introduction \nW.A. Kaiser; Jena/DE (Werner.Kaiser@med.uni‑jena.de) \nThe clinical application of MR-mammography (MRM) in the last 26 years has \nshown that this imaging tool has had significant diagnostic advantages in the \nfield of breast diagnosis, e.g. the proof of small breast cancers, the differentiation \nbetween scar and recurrent tumours, the detection of multifocality/multicentricity, \nthe search for primary tumours, the delineation of implants, etc. The clinical use \nof MR-mammography is steadily increasing. However, many still describe a “high \nsensitivity but a low specificity”, which is wrong. Achieving a high quality is not an \neasy task; a lot of teachers have to be learned and considered. This refresher \ncourse is focussing on high quality concerning technical and diagnostic aspects, \nespecially focussing the question of improving specificity. \nA‑159\t 16:05 \nA. How to set up a high quality breast MRI unit \nC.S. Balleyguier, S. Canale, E. Zareski, F. Bidault, B. Boulet, S. Delaloge, \nG. Aboud, B. Boyer, C. Dromain; Villejuif/FR (balleyguier@igr.fr) \nBreast MRI has become a key examination in the strategy of breast imaging. \nThe input of breast MRI is its great sensitivity to detect breast malignant tumours, \nnevertheless false positives are still common. Quality of acquisition parameters is \nmandatory to obtain high quality images and to avoid artifacts. The key points are as \nfollows: 1. Indications for the examinations should be precisely defined i.e. staging \nof known cancer, screening of high risk patients, etc. Training of the officers who \norganize appointments is of utmost importance. 2. Appropriate patient positioning. \nMany pitfalls are related to inappropriate basic technique; training for technicians \nis mandatory. 3. Reliable protocol includes examination of both breasts with T1w \nand T2w sequences with and or without fat suppression, dynamic acquisition after \ncontrast injection should provide as the best compromise between spatial and \ntemporal resolution. The role of new sequences such diffusion-weighted imaging \nsequences has to be defined. 4. Standardisation of image interpretation should be \nhomogenously shared within the imaging team. Reports should be established ac-\ncording to the BI-RADS principles. The role of CAD should be precisely defined as \nan adjunct and not as a substitute to expert reading. 5. Quality control includes the \ncombination of technical checking: double reading and cooperation with clinicians \nin order to provide an adequate number of radiologic and pathologic correlation. \nBecause breast MRI is a continuous process, all the key points should be concur-\nrently optimized. Any failure would jeopardize the whole procedure. \n16:00 - 17:30 Room F1 \nFunctional Imaging of Tumours: How to do it \nMC 622 \nDynamic contrast-enhanced (DCE) imaging \nModerator: \nA. Ba‑Ssalamah;  Vienna/AT \nA‑155\t 16:00 \nA. DCE-CT \nJ. Votrubová1, H. Mírka2; 1Prague/CZ, 2Plzen/CZ (jana.votrubova@homolka.cz) \nDynamic contrast enhanced computed tomography (DCE-CT) is a noninvasive \nmethod showing haemodynamic changes in living tissue in various oncologic and \nnon-oncologic applications. Recently, it has gained an increased popularity for \nstudying malignant tumour blood supply and formation of new vessels, also known \nas angiogenesis, that plays a critical role in the growth of cancer. Technical remarks: \nRepeated rapid CT scans are acquired at the same location to allow determination \nof time-attenuation curves (TAC). Several quantitative parameters are assessed: \ntumour blood flow (TBF) (ml/min/100  g), tumour blood volume (TBV) (ml/100  g), \npermeability surface product (PSP) (ml/min/100 g) and mean transit time (MTT) (s) \nare calculated using dedicated perfusion software. Indication: Perfusion CT may be \nused by the distinction of benign from malignant lesions when conventional methods \nare unreliable, may improve staging by demonstrating occult hepatic metastases, \nmay guide biopsy to the tumour region most likely to be of highest grade. Several \ntumours with higher perfusion are more sensitive to the chemoradiation than that \nwith lower perfusion. Findings at DCE-CT images after chemoradiotherapy are \na significant predictor of early tumour response and overall survival. Its applica -\ntions have been stimulated by the development of anti-angiogenesis therapy for \nmonitoring the effects of therapy and additionally may be used as a noninvasive \ntool in detection of hepatic toxicity of chemotherapy. In the future, new prognostic \ninformation could impact clinical management. Studying the response of cancers by \nmeasuring changes in their blood flow may provide useful information on oncologic \npatients for managing cancers in the future. \nLearning Objectives:\n1. To know the advantages of DCE-CT.\n2. To learn how to extract the parameters on true cases.\n3. To learn useful tricks for performing and processing good quality \nexaminations.\nA‑156\t 16:30 \nB. DCE-MR \nA.R. Padhani; Northwood/UK (anwar.padhani@stricklandscanner.org.uk) \nBefore undertaking DCE-MRI examinations in the therapy assessment setting it is \nimportant to know the time of expected maximal antivascular effects, demonstrating \nrecovery and additive effects if applicable. Identification of potential confounding \nvariables that could alter DCE-MRI kinetics irrespective of treatment effects need to \nbe identified. The choice of suitable lesions in important and robust data acquisition \nprotocols that are able to deal effectively with physiological motions are needed. \nConsideration on the use of an appropriate input function is vital. Successful QA \nand QC steps should ensure that failed examination rates are minimal. Data analy-\nsis requires validated, fit for purpose software that incorporates data traceability. \nKinetic parameters measures must be clinical meaningful and if possible closely \nlinked to underlying physiological processes. Measurement error and causes of \nvariability should be known. \nLearning Objectives:\n1. To know the advantages of DCE-MRI.\n2. To learn how to extract the parameters on true cases.\n3. To learn useful tricks for performing and processing good quality \nexaminations.\nA‑157\t 17:00 \nC. DCE-US \nL. Solbiati; Busto Arsizio/IT (lusolbia@tin.it) \nNeoangiogenesis is a key stage in the development of malignant tumours and their \ninvasive potential is strongly linked to their vascularisation. Modern chemotherapy \nis largely based on anti-angiogenic substances: new target drugs and treatment \nprotocols are continuously introduced in clinical practice, often with severe prob -\nlems related to modalities of use, costs and side effects. Consequently, there is a \n\nPostgraduate.Educational.Programme\nS44\n A B C D E F G H\n16:00 - 17:30 Room G/H \nState of the Art Symposium \nSA 6 \nBrain tumour: imaging and response \nModerator:\nM. Stajgis; Poznan/PL \nA‑162\t 16:00 \nChairman’s introduction \nM. Stajgis; Poznan/PL (stajgis@o2.pl) \nOver the last years, novel therapies for patients with brain tumours are being \ninplemented worldwide. One can observe a shift in imaging from merely anatomi-\ncal details information towards providing tumour physiology data. Number of new \nMRI techniques have been developed and are currently used in advanced brain \ntumour imaging, monitoring and prediction of treatment response. Where and when \nto use them? In which order? \nSession Objectives:\n1. To become familiar with the role of different MR techniques in advanced \nbrain tumour imaging.\n2. To consolidate knowledge of monitoring and prediction of treatment \nresponse in patients with brain neoplasms.\n3. To learn how to differentiate necrosis, pseudo-progression and true recurrent \nbrain tumour with advanced MR imaging.\nA‑163\t 16:05 \nAdvanced brain tumour imaging: complete imaging protocol \nM. Law; Los Angeles, CA/US (meng.law@usc.edu) \nAdvanced imaging is now widely utilised in the research and clinical settings. In \nthe clinical setting, qualitative, semi-quantitative and quantitative approaches \nsuch as review of colour-coded maps to ROI analysis and analysis of signal \nintensity curves are being applied in practice. We will also compare the relative \nadvantages for T1 DCE MRI with T2* DSC MRI in the estimation of perfusion \nand permeability metrics in the clinic as well as some more automated histogram \nanalysis methods. The role of advanced imaging in the characterisation of tumour \nbiology and different pathologies will be reviewed. Differentiating between recur-\nrent tumour and therapeutic necrosis is often a challenge. We will review the role \nof advanced imaging and also the effects of anti-angiogenic therapies on tumour \nmicrovasculature/microenvironment resulting in changes in diffusion, perfusion \nand MRS. Pseudophenomenon has made conventional imaging with gadolinium \ncontrast agent almost obsolete necessitating mechanistic techniques to differenti-\nate entities such as pseudoprogression which is seen more commonly as a result \nof therapy with temozolomide and radiation for high grade gliomas as well as \npseudo-response and pseudo-pseudoprogression. Lastly to combine and apply \nthese different imaging techniques in a multi-parametric algorithmic fashion in the \nclinical setting can be shown to increase our diagnostic specificity and confidence. \nLearning Objectives:\n1. To become familiar with different advanced MR techniques used in brain \ntumour imaging.\n2. To learn the role of permeability, perfusion, diffusion imaging and MR \nspectroscopy in characterising brain tumour biology and differential \ndiagnostics.\n3. To become familiar with a complete imaging protocol, which can be \nimplemented in a multi-parametric algorithm fashion in brain tumour \ndiagnosis.\nA‑164\t 16:28 \nMonitoring and prediction of treatment response \nP.C. Maly Sundgren; Lund/SE (Pia.Sundgren@med.lu.se) \nHigh-grade gliomas have a poor survival rate despite improvements in surgery, \nradiation and chemotherapy. A contributing factor to the poor survival is the inability \nof currently available imaging techniques to accurately delineate the tumour which \nresults that targeted focal treatment my not be effective. Conventional imaging is \nnot able to give an early assessment of the effectiveness of radiation and/or che-\nmotherapy. Early identification of patients with a poor treatment response or who \nsuffer from tumour recurrence can be of great advantage: it provides the opportunity \nto adjust individual more rapidly, and sparing patients unnecessary morbidity, and \nLearning Objectives:\n1. To review the techniques and interpretation criteria.\n2. To discuss the use of contrast agents and CAD in breast MRI.\n3. To know the advantages and limitations of 3T MRI for breast imaging.\nA‑160\t 16:28 \nB. Evidence-based controversies \nF. Sardanelli; Milan/IT (f.sardanelli@grupposandonato.it) \nAn evidence-based consensus on indications to breast MRI was recently reached \nby an interdisciplinary working group promoted by the European Society of Breast \nCancer Specialists (EUSOMA). There was a general agreement on MRI for screen-\ning high-risk women, evaluating the response to adjuvant chemotherapy, evaluating \nsuspected implant rupture, searching for occult primary cancer, evaluating sus-\npected recurrence when conventional imaging is inconclusive. A limited consensus \nwas obtained for the use of preoperative MRI in women with invasive lobular cancer, \nat high risk, with mammography/ultrasonography discrepancy in tumour size, and \nin patients candidate to partial breast irradiation. The debate on preoperative MRI \nhas been fuelled by the publication of the results of the COMICE study, a large \nrandomised study which showed a non-significant impact of MRI on re-excision \nrate (19% in both arms). Thus, we have now a large evidence for a superior MRI \nability for ipsilateral and contralateral staging and for impact on surgical treatment \non about 15-20% of patients (with potential overdiagnosis and overtreatment), \nwithout a demonstration of a positive impact on patient outcome. In this context, \nrecommendations for preoperative MRI include: clear patient information; high-\nquality studies; mandatory verification/localisation of MRI additional findings with \nimpact on patient treatment using targeted sonography or MR-guidance; treatment \ndelay no longer than 1 month; decision on changes of treatment planning by a \nmultidisciplinary team; attention paid to methods for translating MRI 3D information \non disease extent to the operating theatre. \nLearning Objectives:\n1. T o become familiar with current controversies in clinical applications of breast MRI.\n2. To review literature on the role of MRI in breast cancer staging and \nscreening in high risk patients.\n3. To evaluate the potential impact of overdiagnosis in breast MRI.\nA‑161\t 16:51 \nC. How to improve the specificity of breast MRI \nJ. Veltman; Nijmegen/NL (j.veltman@zgt.nl) \nBreast MRI has shown diagnostic sensitivities of 94-99% for invasive breast cancer; \nhowever, specificities have been reported significantly lower with values between 37% \nand 86%. The specificity of breast MRI is in a routine clinical setting based on the evalu-\nation of morphologic features and relative “slow” dynamic characteristics of enhancing \nlesions. The only moderate specificity that is achieved using these characteristics can \nresult in a significant number of false positive findings during, for instance, screening \nor pre-operative imaging. These findings will often require short-term follow-up, target \nultrasound with biopsy or even MRI-guided biopsy. Fast dynamic imaging, spectroscopy \nand diffusion weighted imaging (DWI) have been described to have potential for improv-\ning the specificity of breast MRI. The use of fast dynamic imaging sequences result \nin a more accurate evaluation of the initial enhancement of the lesion. In combination \nwith pharmacokinetic modelling this can result in a more quantitative evaluation of \nenhancement. In proton-MR spectroscopy (MRS) the presence of a choline signal, a \ncell-membrane precursor, in breast lesions can be used to differentiate benign from \nmalignant lesions. The specificity of MRS varies between 67 and 100% in literature \n(average 87%). DWI has also shown potential in differentiating between benign an \nmalignant lesions, but, like with other techniques, varying specificity values are reported \nranging between 46% and 93%. In this presentation the value of these techniques for \nimproving the performance of breast MRI will be discussed. \nLearning Objectives:\n1. To become familiar with literature on MRI specificity.\n2. To understand the value of ultrafast sequences.\n3. To appreciate the value of spectroscopy and diffusion-weighted imaging.\nPanel discussion: \nDo we find too many cancers with MRI? 17:14 \nPreoperative staging of breast cancer has become one of the main indications of \nbreast MRI. Studies have shown that MRI changes management in a significant \npercentage of patients, leading to a higher number of mastectomies. This has \ncaused concern, especially in the surgical community. The debate is on the pos-\nsibility and potential harms of overdiagnosis as well as cost effectiveness and \npatient selection issues in preoperative staging. \n\nFriday\nPostgraduate.Educational.Programme\nA\n S45\nCB D E F G H\n16:00 - 17:30 Room I/K \nChest \nRC 604 \nBedside chest imaging \nModerator: \nH. Prosch; Vienna/AT \nA‑166\t 16:00 \nA. Bedside chest radiography: technical aspects and correct interpretation \nE. Eisenhuber; Vienna/AT (eisenhuber@gmail.com) \nAlthough bedside chest radiograph is one of the less elaborate imaging examina-\ntions in our diagnostic armamentarium, it remains the most frequent radiologic \nprocedure performed in intensive care patients. Despite its limitations chest imag-\ning is an important tool in the management of the critically ill patient. Though the \nadvent of digital radiography has vastly contributed to improved image quality of \nthe bedside radiographs, optimal positioning and technique remain a real challenge \nfor the performing technologist. In addition, the interpretation of chest radiography \nin the critically ill patient poses a challenge for the radiologist, because findings are \nfrequently unspecific and lung opacifications have similar appearances in a variety \nof different cardiopulmonary pathologies. Clinical information and an interdisciplinary \napproach are therefore crucial for optimal interpretation of these chest radiographs. \nThe American College of Radiology has established expert recommendations for the \nuse of bedside chest radiography. Current recommendations suggest that routine \ndaily chest radiographs should be reserved for patients with acute cardiopulmonary \nproblems and in patients receiving mechanical ventilation. Acquisition of a portable \nchest radiograph is recommended after insertion of endotracheal tubes, central \nvenous catheters, pulmonary artery catheters, chest tubes, and nasogastric tubes. \nTherefore, knowledge of correct positioning of catheters, tubes, and monitoring \ndevices and of various malpositions and associated complications is essential for \nthe interpreting radiologist. \nLearning Objectives:\n1. To learn about the technical requirements of portable chest units.\n2. To understand key imaging findings in different clinical settings.\n3. To understand potential limitations of bedside chest radiography and how to \navoid common pitfalls.\nA‑167\t 16:30 \nB. Bedside thoracic ultrasonography: how far can it go? \nK. Vidmar Kocijancic; Ljubljana/SI (ksenija.vidmar@sb‑izola.si) \nChest ultrasonography (CHUS) is a useful imaging tool in patients at intensive \ncare units, because of its simplicity and reproducibility. However, there are some \nlimitations such as low specificity of some crucial sonographic signs and limited \nsearching area (soft tissues, pleural cavity and lung consolidations). The ICU patient \ncan be examined in supine or sometimes in lateral or partly lateral position using \nintercostal spaces as an acoustic window. Supine analysis of the anterior chest wall \nrules out pneumothorax, while lateral approach detects clinically relevant pleural \neffusion and parenchymal consolidations. CHUS is a method of choice in detec-\ntion as well as in characterisation and volume estimation of free and/or loculated \npleural fluid. With CHUS we can explore and characterise lung consolidations from \nthe moment they reach the visceral pleura. They can be in contact with pleural \nline or can be observed through an effusion. However, in case of subcutaneous \nemphysema and/or diffuse oedema of soft tissues the lung parenchyma can not \nbe reliably assessed. Also, in the question of pulmonary embolisms in critically ill \npatient, CHUS could be contributive. Sometimes small pleural effusion can be vis-\nible with some peripheral lung tissue consolidations indicating minute pulmonary \ninfarction. Typical pulmonary infarction is triangular tissue consolidation with air \nbronchogram and absence of Doppler blood flow signals within consolidated lungs \nbut CECT for confirmation is mandatory. CHUS exploration of the diaphragm can \nreliably evaluate respiratory movements since pleural effusion even substantial \ndoes not affect the amplitude of diaphragmatic excursion. \nLearning Objectives:\n1. To understand the advantages and limitations of bedside thoracic \nultrasonography.\n2. To learn about the US findings of pleural and parenchymal diseases suitable \nfor bedside ultrasonography.\n3. To review current guidelines for estimation of pleural effusion volume.\ndelay in initiation of other maybe more effective treatment. In recent years, different \nfunctional imaging approaches such as dynamic contrast-enhanced (DCE) and \ndynamic susceptibility-weighted contrast (DSC) MRI, diffusion-weighted imaging \nand spectroscopy have been complementary used for diagnosis and treatment \nresponse. In this lecture different advance MR and CT imaging methods as well as \nthe traditional way of monitoring to assess treatment response will be discussed. \nIn addition, a novel recently published promising technique will be described - the \nparametric response mapping (PRM), a novel voxel-wise analytical method of \nmonitoring physiological and environmental changes in a tumour volume during \ntreatment will be presented and compared to the traditional methods used. Finally, \nthe aim of the lecture is to consolidate the present knowledge and novel ideas in \nbrain tumour imaging for future monitoring of treatment response and the possibility \nand limitations for future individualisation of cancer therapy. \nLearning Objectives:\n1. To gain an understanding of the present traditional model for the treatment \ncycle for brain tumours and how they are monitored.\n2. To learn about different imaging biomarkers for early assessment of brain \ntumour treatment response that might result in individualisation of cancer \ntherapy.\n3. To consolidate present knowledge and ideas in brain tumour imaging for \nfuture brain tumour therapy and monitoring of response.\nA‑165\t 16:51 \nRadiation necrosis and pseudo-progression vs recurrent tumour \nM. Essig; Heidelberg/DE (m.essig@dkfz‑heidelberg.de) \nPseudophenomenon has made conventional imaging with gadolinium contrast \nagent almost obsolete necessitating mechanistic techniques to differentiate \nentities such as pseudoprogression which is seen more commonly as a result of \nadvanced multimodal therapeutic concepts. Advanced, non-enhanced and contrast \nenhanced MR imaging techniques include MR-spectroscopy, perfusion MR imaging, \ndynamic contrast enhanced MRI and diffusion tensor MR. In the presentation we \nwill analyse the application of those techniques in brain tumour assessment with \nfocus on the post-therapeutic brain to differentiate therapy induced from tumour-\ninduced changes. The results of the available studies in literature, all with relatively \nlimited patient numbers, indicate that the combination of functional MRI proved to \nbe useful in the post-therapeutic workup of gliomas, lymphomas and metastatic \ndisesease. The typical patterns of tumour recurrence and the different therapy-\ninduced effects will be presented. In perfusion (DSC-MRI) and dynamic contrast \nenhanced magnetic resonance imaging (DCE-MRI) the signal intensity measure-\nments of the tumour reflect a composite of tumour perfusion, vessel permeability, \nand the extravascular-extracellular space. In contrast to conventional enhanced \nMRI, which simply presents a snapshot of enhancement at one time point, both \ntechniques permits a fuller depiction of the wash-in and wash-out contrast kinetics \nwithin tumours, and this provides insight into the nature of the bulk tissue proper-\nties on its microvascular level. With the strong demand in drug development the \nidentification of biomarkers that can assess tumour microvascular properties non-\ninvasive dynamic MRI is the method of choice to assess tumour response and to \nidentify atypical tumour response findings. \nLearning Objectives:\n1. To identify the different aspects of therapy-induced MRI findings.\n2. To differentiate therapy-induced changes from tumour recurrence by the use \nof modern MRI techniques.\n3. To identify technical aspects of functional MRI techniques in brain tumour \nimaging.\nPanel discussion: \nTry to understand the clinical question and you will know which imaging is \nappropriate 17:14 \nWe are witnessing a change in brain tumour imaging from merely providing anatomi-\ncal details toward the characterisation of tumour biology and physiology. A number \nof advanced MRI techniques serve as powerful tools in therapeutic decisions and \nprognosis. How and when should we use them? In which sequence? All of them? \nTo answer these questions, the understanding of clinician questions and value of \nparticular MRI studies is essential. \n\nPostgraduate.Educational.Programme\nS46\n A B C D E F G H\nthe pelvic floor muscles should relax and the pelvic floor descends normally less \nthan 3 cm below the PCL. Based on the static and dynamic MR imaging sequences \na vast array of morphologic and functional pelvic floor disorders can be depicted. \nLearning Objectives:\n1. To review the technique and imaging protocols of dynamic pelvic MRI.\n2. To understand relevant anatomical structures and classification systems for \ndefining normal and abnormal findings.\n3. To review normal findings in asymptomatic volunteers.\nA‑171\t 16:28 \nIndications and spectrum of pathological findings \nF. Maccioni; Rome/IT (francesca.maccioni@uniroma1.it) \nFunctional abnormalities of the pelvic floor represent a significant health-care \nproblem, as they affect approximately 15% of older multiparous women. Moreover, \nnearly 300.000 surgeries in United States are annually performed to correct those \ndisorders. The success of medical and surgical therapies relies on the correct \nclassification of dysfunction and identification of the pelvic compartments involved. \nClinical classifications of pelvic floor abnormalities are primarily topographic, rather \nthan functional. However, as the pelvic floor muscles tend to act as a unique func-\ntional entity, their dysfunction usually leads to dysfunction of more than one organ \nsystem (genitourinary or gastrointestinal), resulting in a wide spectrum of symptoms \nvariably associated, including dysuria, urinary incontinence, uterine prolapse, anal or \npelvic pain, obstructed defaecation, rectal prolapse or faecal incontinence. Because \nof the variability of symptoms and complexity of physio-pathological mechanisms, \ndiagnosis of pelvic floor disorders is usually achieved by combining different diag-\nnostic tools. Dynamic MRI of the pelvic floor has emerged as an alternative and \neffective modality for assessing and understanding of these disorders. It currently \noffers a complete morphological and functional evaluation of all three compartments \nat the same time. Constipation and pelvic organ prolapse are the most common \nindications for a dynamic MRI. The physio-pathological features of the main pelvic \nfloor disorders and their MRI findings will be shown in detail. MR images and mov-\nies, with particular regard to posterior pelvic floor abnormalities, such as rectocele, \nrectal invagination and prolapse, enterocele, descending perineal syndrome and \nspastic pelvic floor syndrome, will be illustrated and discussed. \nLearning Objectives:\n1. To review the current indications of dynamic pelvic floor imaging.\n2. To understand the spectrum of pathological findings.\n3. To understand the clinical relevance of abnormal findings.\nA‑172\t 16:51 \nDynamic imaging of the pelvic floor: MR imaging or conventional \ntechnique? \nS. Halligan; London/UK (s.halligan@ucl.ac.uk) \nThe ability to perform and interpret dynamic pelvic floor imaging is essential for the \nmodern gastrointestinal (and indeed urogynaecological) radiologist. The other speak-\ners in this session will be reviewing indications, pathologic findings, clinical relevance, \nand MR technique. Although I will detail the MR and fluoroscopic techniques used \nat my institution, I will focus on the specific technical and diagnostic advantages and \ndisadvantages of both dynamic pelvic MR and conventional fluoroscopic evacuation \nproctography (defecography). Many practitioners wising to initiate this type of imaging \nwill wish to know what modality to chose and existing practitioners using fluoroscopy \nwill possibly be interested in migrating their practice to MR. I will illustrate what imaging \nfindings are best imaged by each technique, continually referencing this to whether the \nfinding is ultimately important to the referring clinician or not. Using examples from our \nown research programme and clinical practice, I will illustrate why we have migrated \nour practice exclusively to dynamic MR. \nLearning Objectives:\n1. To review the current role of MR imaging and conventional techniques in \ndynamic pelvic imaging.\n2. To appreciate the advantages and limitations of both techniques.\n3. To learn which technique is useful for which clinical situation.\nPanel discussion: \nDoes dynamic pelvic MR imaging replace conventional \ndefecography? 17:14 \nAlthough dynamic pelvic MR imaging is increasingly used for imaging pelvic floor \ndisorders, the crucial question is whether the technique can completely replace \nconventional techniques. Although MR imaging provides excellent soft-tissue \ncontrast which is a particular advantage when imaging the pelvis, it has to be \nacknowledged, that the examination is performed in supine position and not in \nphysiological sitting position. \nA‑168\t 17:00 \nC. Radiologic-guided bedside interventions of the thorax \nF. Gleeson; Oxford/UK (fgleeson@mac.com) \nThis presentation will review the ultrasound appearances of pleural disease in ward \nand ITU-based patients, and will discuss the indications for pleural procedures \nand the complications associated with them. The use of colour Doppler to aid the \ndiagnosis of effusions will be discussed, as will the identification of septations and \nthe need for intrapleural fibrinolytic therapy. The advantages of guided versus \nblind drain insertion will be presented, and the benefits of large versus small bore \ndrains will also be discussed. \nLearning Objectives:\n1. To review current clinical indications for ultrasound-guided intervention of the \nthorax.\n2. To learn how to perform bedside intervention of the thorax.\n3. To review potential complications of thoracic bedside interventions.\n16:00 - 17:30 Room L/M \nSpecial Focus Session \nSF 6 \nDynamic MR imaging of the pelvic floor: easy and \nuseful \nModerator: \nD. Weishaupt; Zurich/CH \nA‑169\t 16:00 \nChairman‘s introduction \nD. Weishaupt; Zurich/CH (dominik.weishaupt@triemli.stzh.ch) \nPelvic floor function and structure is complex. Imaging has a key role in guiding the \nclinician in managing patients with incontinence, constipation, difficult rectal evacuation \nand pelvic organ prolapse. Dynamic imaging is of particular interest for assessment of \nthe pelvic floor since this kind of imaging gives a near physiological data set of what is \nhappening and gives us a better understanding of the multifactorial causes of pelvic \nfloor dysfunction. Whereas conventional evacuation proctography was over years \nstandard of reference for dynamic imaging of the pelvic floor, dynamic MR imaging \nof the pelvic floor is gaining increasing acceptance among radiologists and clinicians. \nHowever, dynamic MR imaging of the pelvic floor is (due to the architecture of most \nthe clinically MR magnets) usually performed in supine position which does exclude \nthe axial load on the pelvic floor. The lack of a physiological patient positioning during \ndynamic pelvic floor MR imaging is still brought into discussion if dynamic MR imaging \nof the pelvic floor can replace conventional techniques or not. \nSession Objectives:\n1. To review the current status and technique of dynamic pelvic imaging.\n2. To learn about indications and imaging findings of dynamic pelvic imaging.\n3. To understand the role of dynamic pelvic imaging in the light of conventional \ntechniques.\nA‑170\t 16:05 \nHow I do it \nC.S. Reiner; Zurich/CH (caecilia.reiner@usz.ch) \nThe pelvic floor is a complex anatomic and functional unit. In clinical routine a simple \nanatomic concept of the female pelvic floor has gained acceptance. Especially for \ntreatment planning, the female pelvic floor may be separated into three functional \ncompartments: the anterior compartment (bladder and urethra), the middle compart-\nment (vagina, cervix, uterus, and adnexa), and the posterior compartment (anus \nand rectum). Intact structure of the pelvic floor is a basic prerequisite for a normal \nmechanism of defecation and continence. Over the last years, MR imaging has \ngained increasing acceptance as imaging modality for evaluation of the pelvic floor, \nwhich enables a global and integrated approach to the pelvic floor. Using static T2-\nweighted sequences the morphology of the pelvic floor can be visualised in great \ndetail. A rapid half-Fourier T2-weighted, balanced steady state free precession \n(bSSFP), or gradient-recalled echo (GRE) sequence are used to obtain sagittal \nimages while the patient is at rest, during pelvic squeeze, during pelvic strain and \nto document the evacuation process. On these images the radiologist identifies \nthe pubococcygeal line (PCL) (which represents the level of the pelvic floor). In \nnormal findings, the base of the anterior and the middle compartment are above \nthe PCL at rest, and the pelvic floor elevates during contraction. During straining, \n\nFriday\nPostgraduate.Educational.Programme\nA\n S47\nCB D E F G H\nA‑175\t 17:00 \nC. Oncology \nM.G. Pomper; Baltimore, MD/US (mpomper@jhmi.edu) \nAlthough most clinical diagnostic imaging studies employ anatomic techniques \nsuch as computed tomography (CT) and magnetic resonance (MR) imaging, much \nof radiology research currently focuses on adapting these conventional methods \nto physiologic imaging as well as on introducing new techniques and agents for \nstudying processes at the cellular and molecular levels in vivo, i.e. molecular \nimaging. Molecular imaging promises to provide new methods for the detection \nof minimal changes in diseased tissue and support for personalised therapy. \nAlthough molecular imaging has been practiced for over 20 years in the context \nof nuclear medicine, other imaging modalities have only recently been applied to \nthe noninvasive assessment of physiology and molecular events. Nevertheless, \nthere has been sufficient experience with specifically targeted contrast agents and \nhigh-resolution techniques for MR imaging and other modalities that we must begin \nmoving these new technologies from the laboratory to the clinic. Several projects \nrelevant to oncology will be discussed with emphasis on how they were/will be \nmoved from the bench to the clinic. \nLearning Objectives:\n1. To understand the rationale of probes for oncology.\n2. To understand how these probes can be used in visualisation of neoplastic \ndiseases.\n3. To understand the potential clinical value of these probes.\n16:00 - 17:30 Room P \nVascular \nRC 615 \nNon-traumatic acute aortic dissection and \nmalperfusion syndromes \nModerator: \nA.‑M. Belli;  London/UK \nA‑176\t 16:00 \nChairman’s introduction \nA.-M. Belli; London/UK (Anna.Belli@stgeorges.nhs.uk) \nAortic dissection is increasingly managed by endovascular means. It is important \nfor all radiologists to understand the benefits and disadvantages of varying imaging \nmodalities in the differential diagnosis and the fundamental anatomical requirements \nfor assessing suitability for endovascular repair. The causes, detection, classifica-\ntion and complications of aortic dissection will be discussed followed by a panel \ndiscussion of imaging strategies which give the best information for diagnostic \nwork-up, endograft planning and monitoring of patients during and after treatment. \nA‑177\t 16:05 \nA. Predisposing factors for developing non-traumatic acute aortic \ndissections \nV. Bérczi; Budapest/HU (Berczi@hotmail.com) \nAortic dissection, a highly lethal disease, is defined as longitudinal cleavage of \nthe aortic media by a dissecting column of blood. The mortality rate of untreated \naortic dissection is 1-2% per hour for the first 24-48 hours, or 75% within the first \n2 weeks, and 90% at 1 year. Predisposing factors include hypertension, inherited \narteriopathies characterised by cystic medial necrosis, pre-existing aortic aneu -\nrysm, a bicuspid aortic valve, aortic coarctation, different vasculitides, the use of \ncocaine (due to its effect on aortic connective tissue and also by producing severe \nhypertension). Hereditary diseases include Marfan’s syndrome (dedifferentiation \nof vascular smooth muscle cells, enhanced elastolysis of aortic wall components, \ndefective fibrillin in the extracellular matrix), Ehlers-Danlos syndrome (hereditable \nconnective tissue disorders leading to tissue fragility), annuloaortic ectasia and \nfamilial aortic dissection (elastolysis, deposits of mucopolysaccharid-like materi-\nals, cyctic medial degeneration). Acquired conditions, such as hypertension, alter \narterial wall composition in numerous ways, causing smooth muscle cell necrosis \nand fibrosis of elastic structures, leading to stiffness and vulnerability to pulsatile \nforces, thereby creating a substrate for aneurysms and dissections. Other acquired \nconditions include inflammation and autoimmune processes, causing nutrient \ndeficiency and destroying the medial layers of the aortic wall. Pregnancy-related \ndissection is extremely rare. Beside discussion of the predisposing factors, a brief \n16:00 - 17:30 Room N/O \nMolecular Imaging \nRC 606 \nClinical potential of molecular imaging: between \ndream and reality \nModerator: \nG. Frija; Paris/FR \nA‑173\t 16:00 \nA. Molecular imaging from bench to bedside \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nWith the introduction of targeted therapeutics and personalised therapy regimen \nthere is increasing need to improve diagnosis of diseases in a way that insight into \npathophysiological and molecular regulation is provided. In this context, molecular \nimaging can be of tremendous help in basic research, drug development and the \nclinics. Many interesting approaches of molecular imaging have been tried in small \nanimal models. New methods and tools have been identified, which are easy \nenough to handle, aceptable in its costs and, most importantly, reliable enough to \nbe translated to clinical practice. Unfortunatenly, as soon as they have entered the \nclinics they are often not classified as molecular imaging anymore. Among those are \nMR-spectroscopy, SPIO/USPIO enhanced liver and RES imaging but also contrast \nagents like Gd-EOB-DTPA and most applications for PET/SPECT. Other interesting \napplications such as targeted ultrasound imaging are already established tools in \npreclinical research and very close to first clinical use. Near infrared optical imaging \nis another example of a rapidly developing technology and first clinical devices and \ndyes (e.g. to detect arthritic lesions) are availibe now. It can be expected that with \nthe availability of targeted and activatable probes the acceptance and the use of \noptical imaging methods will further rise. Most proably, this will initially happen in \ncontext with intraoperative diagnosis and endoscopy. In summary, it is the aim of \nthis talk to give a realistic overview on the available molecular imaging tools and \non their potential for preclinical research and patient use. \nLearning Objectives:\n1. To understand the principles of molecular imaging research.\n2. To understand how probes are tailored towards clinical applications.\n3. To appreciate the required steps for clinical development and approval.\nA‑174\t 16:30 \nB. Cardiovascular disease \nL. Hofstra; Utrecht/NL (leonard.hofstra@gmail.com) \nCardiovascular diseases remain the number one cause of morbidity and mortality, \nboth in the developed and developing countries, and in men and women alike. It is \nexpected that these numbers will continue to increase in the coming decades due \nto escalating proportions of obesity and the aging population. Atherosclerosis is the \nmajor cause for cardiovascular disease. Since in about 50% of cases a stroke or \nacute myocardial infarction is the first symptom of atherosclerosis, it is of paramount \nimportance to identify patient at high risk. A first step in the identification is the use of \nclinical risk profiling, such as the Framingham Risk score, which has an area under \nthe curve (AUC) of about 0.8 using ROC analysis. However, clinical risk profiling \nalone is not sufficient to identify individual patients at imminent risk to develop a \ncardiovascular event in the near future. A next step in a more precise identification \nof the patient at risk is the development of serum biomarkers for atherosclerotic \ndisease. However, so far serum biomarkers have failed to contribute substantially \nto improve the AUC in the prediction of cardiovascular events using ROC analysis. \nA major step forward in risk stratification is provided by the rapid development of \ncardiac computed tomography, which offers a rapid visual access to the coronary \ntree, at low radiation dose and in a patient friendly manner. However, for the iden-\ntification of the vulnerable plaque we need to go beyond anatomical imaging, and \nuse molecular imaging tools. In the lecture I will discuss the different targets for \nmolecular imaging within the vulnerable plaque, such as inflammation, apoptosis \nand angionenesis. Imaging of these substrates of plaque vulnerability may offer \nopportunities for a precise identification of the patient at risk, at the individual level. \nLearning Objectives:\n1. To understand potential mechanisms for cardiovascular disease.\n2. To understand how these probes can be used in visualisation of \ncardiovascular disease.\n3. To learn about the potential clinical value of these probes.\n\nPostgraduate.Educational.Programme\nS48\n A B C D E F G H\n16:00 - 17:30 Room Q \nRTF - Radiology Trainees Forum \nTF 1 \nHighlighted Lectures \nModerators: \nD. Bulja; Sarajevo/BA \nP.R. Kornaat; Leiden/NL \nA‑180\t 16:00 \nMusculoskeletal trauma in children \nI. Boric; Zagreb/HR (igor.boric1@zg.t‑com.hr) \nThe aim of the lecture is to familiarise the audience with the specific paediatric \nconditions in trauma radiology. It will be described the major pathophysiologic \ndifferences in childhood and the consecutive altered injury pattern. The standard \nradiological imaging protocol for various involved body regions and different trauma \nsettings/varying queries will be described, with suggestion for standardised diag-\nnostic algorithams in some typical settings. Special regard will be given to radiation \nprotection and the potential of imaging modalities such as ultrasound, multi-detector \nCT as well as MRI in paediatric trauma patients. The roll of the lecture is to provide \nsome basic guidelines for young radiologists and general radiologists who less \noften have to deal with paediatric patients. \nLearning Objectives:\n1. To become familiar with the major pathophysiologic differences in childhood \ntrauma\n2. To standardised diagnostic algorithm in some typical settings in field of \npediatric trauma.\nA‑181\t 16:30 \nBasic principles in the interpretation of signal intensities on T1- and T2-\nweighted images \nG. Wilms; Leuven/BE (Guido.Wilms@uz.kuleuven.ac.be) \nThe signal intensities of normal structures and pathological findings on conven -\ntional T1- and T2-weighted MR images depend on many factors. The amount of \nwater, proton density, chemical structure and/or binding, presence or absence \nof flow (of blood or CSF), calcification, fat, blood degradation products, melanin, \nmucine and even air are all factors that influence the signal characteristics. T1- and \nT2-lenghtening is the rule in most tumoural, vascular and infectious lesions and \ntherefore is rather unspecific. T1- and T2-shortening can be due to the presence of \nfat (lipoma), melanin (melanoma and metastasis of melanoma), mucine (metastasis \nof sigmoid carcinoma), colloid material (colloid cyst, Rathke cleft cyst) and even \ncalcification (falx!). T1-shortening with T2-lengthening can be due to cholesterine \n(cholesterol granuloma, craniopharyngioma), high protein content (tumoural \ncysts), and methaemoglobin (late haemorrhage, thrombus). T1-lengthening and \nT2-shortening is almost exclusively due to deoxyhaemoglobin. Acute haemor -\nrhage and meningioma can be iso-intense on T1-weighted images, while some \nmeningiomas and micrometastases can be iso-intense on T2-weighted images. \nAbsence of signal can be due to high-velocity flowing blood (aneurysm, AVM, hy-\npervascular tumours), high velocity flowing CSF (normal pressure hydrocephalus, \ncortical bone or extensive calcification, air and a large amount of iron (coils, clips). \nIt is concluded that the simple use of a combination of T1- and T2-signal intensities \non conventional MR images can be used to arrive at the diagnosis and differential \ndiagnosis of brain lesions. \nLearning Objectives:\n1. To learn the types of the different signal intensities on conventional T1- and \nT2-weighted MR images.\n2. To correlate the signal intensities with biochemical and pathological findings, \nwith the implications of specific MR effects and artifacts.\n3. To use the combination of T1- and T2-signal intensities to arrive at the \ndiagnosis and differential diagnosis of brain lesions.\ndescription of variant anatomy (aortic spindle, ductus diverticulum) and structures \ncausing diagnostic dilemma (pericardial recess, left inferior pulmonary vein, left \nsuperior intercostal vein and right atrial appendage) will be given. \nLearning Objectives:\n1. To learn how to determine the incidence and mortality.\n2. To analyse the clinical and pathologic changes of aortic dissection.\n3. To understand the natural history.\nA‑178\t 16:28 \nB. Acute aortic dissections: detection and classification \nJ. Lammer; Vienna/AT (johannes.lammer@akhwien.at) \nThe most commonly used classification is the Stanford classification: in type A dis-\nsections the ascending aorta is involved, in type B dissection the ascending aorta \nis not involved. The De Bakey classification subdivides the dissection in a type I \ndissection which involves the entire aorta, a type II dissection which involves the \nascending aorta, and a type III dissection of the descending aorta only. In 2001, \nErbel et al. published (European Heart Journal; 22: 1642-1681) a new classification. \nClass 1: classical aortic dissection with an intimal flap between true and false lumen. \nClass 2: intramural haematoma. Class 3: discrete dissection without haematoma, \neccentric bulge at tear site. Class 4: penetrating aortic ulcer, Class 5: iatrogenic and \ntraumatic dissection. Clinical symptoms: the typical patient with aortic dissection is \nmale, in his 1960s with a history of hypertension who suffers with abrupt onset of a \nsharp, ripping chest pain. Malperfusion of organs: compression of the true lumen \nmay cause malperfusion of the coronary and cerebral arteries, the spinal cord, all \nabdominal organs and the limbs. This malperfusion may change the symptoms. \nImaging: contrast-enhanced CT is the imaging modality of choice. The report has \nto describe the classification, the entry site, the grade of true lumen compression, \norgan malperfusion, pericardial and pleura effusions, and false lumen ectasia. \nHowever, aortic valve insufficiency which can be a complication of type A dissec-\ntions are demonstrated by echocardiography, transesophageal ultrasound or MRI. \nLearning Objectives:\n1. To learn how to diagnose aortic dissection.\n2. To understand the pros and cons of different imaging modalities.\n3. To learn the classification.\nA‑179\t 16:51 \nC. Acute aortic dissections: imaging of complications \nM.H.K. Hoffmann, A.-C. Fischer; Ulm/DE (martin.hoffmann@uniklinik‑ulm.de) \nComplications occurring after acute aortic dissections should be separated into \nthose related to the disease per se and those related to post-treatment conditions. \nLife-threatening complications related to the disease should be familiar as immedi-\nate consequences for treatment may ensue. Most of these are either located in the \naortic root or related to mal-perfusion syndromes. The aortic root with very thin walled \nstructures of the sinus of valsalva is located within the pericardial sac. The structure \nis prone to rupture and may produce life-threatening pericardial tamponade or pres-\nent clinically as sudden onset of severe aortic regurgitation. All imaging modalities \nsuitable for diagnostic workup in such conditions have to be rapidly accessible and \nperformable. This precludes lengthy MR imaging procedures and renders ultrasound \nand CT as the mostly used modalities. The condition that has to be recognised as \nthe most important inductor of malperfusion syndromes in the descending aorta is \nthe progression of dissection into aortic branches and the true lumen collapse. Both \nconditions are easily discernible with CT imaging. Complications related to treatment \nshould be sub-classified into those after pure surgical treatment and those related \nto endograft repair. The acute surgical complication with most deleterious effects is \nrelated to spinal cord ischaemia. The condition also applies to endograft repair. It is \ntherefore beneficial for the radiologist involved either in pre-surgical imaging or inter-\nventional treatment to acquire thorough knowledge of the spinal cord blood supply. \nEndograft complications of interest encompass endoleak formations, stent migrations \nand endoluminal stent collapse. \nLearning Objectives:\n1. To learn the most common complications.\n2. To learn the most appropriate imaging strategy for diagnosis.\n3. To understand the clinical significance of the most common complications.\nPanel discussion: \nWhich imaging modality is best for endovascular management? 17:14\nThe various imaging modalities for establishing the diagnosis of acute non-traumatic \ndissections will be discussed. The panellists will present recommendations for \ndiagnostic work-up with special respect to differential diagnosis such as acute \nmyocardial infarction and acute pulmonary embolism. Also, the problem of sizing \nthe endograft and planning the procedure will be addressed. The panellists will \ndiscuss strategies for detection of complications and for monitoring patients fol-\nlowing treatment. \n\nFriday\nPostgraduate.Educational.Programme\nA\n S49\nCB D E F G H\nA‑182\t 17:00 \nPlain film criteria: quality of the x-rays \nH. Bosmans; Leuven/BE (hilde.bosmans@uz.kuleuven.ac.be) \nThe quality of radiographs is determined by many parameters from both techni-\ncal and clinical origin. During the presentation, we will make an overview of the \nparticular features of x-ray tubes and plain films that affect the quality of the radio-\nlogical image. The training session will start from very simple x-ray tubes and film, \nand gradually introduce more sophisticated, state-of-the-art technology. We will \nbriefly explain concepts such as focal spot, heel effect, beam quality, filters, grid, \nfilm sensitivity, automatic exposure control, etc. from a practical point of view. The \nEuropean Commission and selected research groups have developed criteria to \njudge the quality of the images and we will show how they can be used to improve \nthe daily practice. A more technical evaluation of quality is possible with images \nof test objects, some of which are very straightforward and interesting if problems \nhave to be retrieved. X-ray quality should be at a high level every day. Therefore \nquality control procedures have a role. One example evaluates the stability of the \nimaging chain by means of acquisitions of homogeneous blocks of PMMA. We \nwill illustrate typical findings with repercussions on the radiological practice, and \nshow that the fight against artefacts is a never ending process. Both with film and \ndigital detectors, radiologists should be aware that quality management and quality \ncontrol procedures are needed. Quality has to be organized, and quality control \nprocedures have to be automated and included in the routine practice. \nLearning Objectives:\n1. To become familiar with the basic principles of x-ray imaging, from the tube \nto the film.\n2. To understand the technical quality of a radiograph and how technology and \nits proper use influence the radiological quality.\n3. To illustrate the role of quality control procedures in the daily practice.\n\nPostgraduate.Educational.Programme\nS50\n A B C D E F G H\n\n\nPostgraduate.Educational.Programme\nA\n S51\nCB D E F G H\nSaturday,.March.5\n\nPostgraduate.Educational.Programme\nS52\n A B C D E F G H\nA‑186\t 09:21 \nChest \nC. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nThere are diverse underlying causes for “diagnostic mistakes”. Missed lesions due \nto inadequate technique, “satisfaction of search” or lack of perception have to be \ndifferentiated from interpretative mistakes of lesions that have well been seen but \nerroneously interpreted due to the lack of experience, misconception or overlap of \nfindings that complicates the differential diagnosis. Each of these underlying reasons \nrequire a different approach to avoid them or reduce their risk of occurrence. The first \ntype of mistake arises more often when interpreting chest radiographs and refers to \nthe detection of mostly small focal parenchymal densities but also to the interpretation \nof mediastinal and hilar contours. By analysing typical cases, visual “tricks”, helpful \ndisplay techniques and strategies for systematic review and analysis will be outlined \nthat are thought to be helpful in reducing the risk of “missing” a lesion. The second type \nof mistake mostly represents a problem of interpreting parenchymal abnormalities seen \non CT. Since the lung has limited means to “react” against an injury, many radiologic \nfindings are aspecific. Interpretation of pathology of parenchymal changes is based \non pattern analysis, the knowledge of disease distribution and additional findings of \npleura and mediastinum. In many cases, an interdisciplinary approach of radiologists \nand clinicians is essential for correct interpretation. Cases will be analysed to illustrate \ndifficult differential diagnosis occuring in daily routine (e.g., infectious pneumonia versus \norganising pneumonia) and key features helping in going into the right interpretative \ndirection will be outlined. Emphasis will lie on focal lung disease rather on the inter-\npretation of diffuse interstitial lung diseases. \nLearning Objectives:\n1. To learn about visual tricks and strategies to overcome typical perception \nerrors in chest radiography.\n2. To become familiar with overlaps of morphologic findings of focal \nparenchymal lesions frequently occuring in daily routine when interpreting \nthoracic CT.\n3. To recognise those additional findings that represent the “helpful clue” for \ncorrectly narrowing the differential diagnosis.\nPanel discussion: \nWhat have we learned from our mistakes? 09:44\nInterpreting the results of imaging studies is more and more challenging and time \nconsuming due to the large volume of data to evaluate, compare and post-process. \nMoreover, errors in the interpretation of imaging studies can have significant effects \non patient care, particularly in acute medicine and oncology. So the question is how \nto be aware of the potential pitfalls that may be encountered in the realisation and \nthe interpretation of imaging studies and how to avoid them or to learn from them. \n08:30 - 10:00 Room B \nOrgans from A to Z: Pancreas \nMC 719 \nImaging inflammation and function \nModerator: \nO. Akhan; Ankara/TR \nA‑187\t 08:30 \nA. Acute pancreatitis \nP.R. Ros; Cleveland, OH/US (Pablo.Ros@UHhospitals.org) \nAcute pancreatitis remains a potentially life threatening condition with an overall \nmortality rate of 5%. Its outcome is strongly related to a precise and timely diagnosis, \na correct estimate of severity and subsequent appropriate treatment. Radiologic \nimaging, particularly CT, plays a key role in staging the severity and therefore helps \nguiding therapeutic decisions. Management of interstitial or edematous pancreatitis \nis supportive while severe or necrotising pancreatitis requires intense monitoring and \nspecific therapies. The latter has a higher mortality and guarded prognosis, since \nit may lead to organ failure, infection, pseudocyst formation and extrapancreatic \nparenchymal and vascular complications. A number of severity indices have been \nestablished to determine the prognosis of acute pancreatitis, based both on clinical \nand imaging criteria. A CT-based severity index has become the main prognostic \nmethod to predict outcomes. This course reviews relevant imaging findings of \nvarious stages of acute pancreatitis and its complications by CT, including special \nconditions such as groove pancreatitis and autoimmune pancreatitis. Currently \nestablished and modified severity indices are reviewed to learn how to estimate \nprognosis and guide therapy. \n08:30 - 10:00 Room A \nSpecial Focus Session \nSF 7 \nMy ‘most beautiful’ mistakes \nModerator: \nM. Zins; Paris/FR \nA‑183\t 08:30 \nChairman’s introduction \nM. Zins; Paris/FR (mzins@hpsj.fr) \nInterpreting the results of imaging studies is more and more challenging and time \nconsuming due to the large volume of data to evaluate, compare and post-process. \nRadiology errors are inevitable, affect all radiologists and may be defined as a \nmistake that has management implications for the patient. Errors can be broadly \nclassified into technical errors, active errors (errors in perception, judgment or \nknowledge) and errors of communication. The majority of errors are false-negative \ninterpretations and occur during interpretation of CT examinations. Good communi-\ncation between the referring physician and the radiologist is essential. Unfortunately, \nonly a small minority of radiologists keep a personal record of their errors. Patient \nsafety should benefit from the repeat organisation of “error meetings” through the \nact of collective learning. Radiologists and radiology departments must continue \nto improve the process of recording and addressing errors. \nSession Objectives:\n1. To understand the potential pitfalls that may be encountered in interpreting \nimaging exams with emphasis on acute medicine and oncology.\n2. To recognise the different types of errors: technical errors (latent or system \nrelated) or active errors (errors in perception, judgment or knowledge).\n3. To learn about methods to facilitate identification of errors in order to \nminimise their occurrence.\nA‑184\t 08:35 \nAbdomen \nA.H. Freeman; Cambridge/UK (a.h.freeman@talk21.com) \nMaking a mistake in radiology may result in catastrophic effects for the patient. It \nis therefore crucial that as radiologists we are honest with ourselves, prepared to \nreview our mistakes and errors with an open mind, and thus pass this knowledge \nonto future generations of radiologists. Mistakes may come about through techni-\ncal, observational and deductive errors and these will be reviewed utilising two \nseparate cases. \nLearning Objectives:\n1. To understand the potential pitfalls that may be encountered in interpreting \nabdominal imaging exams.\n2. To become familiar with technical errors in the realisation of abdominal \nimaging exams that contribute to misinterpretation.\n3. To be aware of the spectrum of factors that contribute to active errors \n(detection, characterisation) in interpretation of abdominal imaging exams.\nA‑185\t 08:58 \nGU \nL.E. Derchi; Genoa/IT (derchi@unige.it) \nRadiologists do make mistakes, diagnostic errors can be the cause of severe \nconsequences to patients or, luckily, in many cases, they can be corrected. Learn-\ning from mistakes is quite important since understanding why a mistake has been \nmade help to avoid it in the future. During this lecture a series of mistakes made \nin the field of GU will be presented and causes which have lead to each of them \nwill be analysed. \nLearning Objectives:\n1. To understand the potential pitfalls that may be encountered in interpreting \nGU imaging exams.\n2. To become familiar with technical errors in the realisation of GU imaging \nexams that contribute to misinterpretation.\n3. To be aware of the spectrum of factors that contribute to active errors \n(detection, characterisation) in interpretation of GU imaging exams.\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S53\nCB D E F G H\n08:30 - 10:00 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 718 \nDyspnea \nModerator: \nM. Rémy‑Jardin;  Lille/FR \nA‑190\t 08:30 \nA. Clinical considerations \nJ. Neuwirth; Prague/CZ (neuwirthj@gmail.com) \nDyspnoea is defined as an awareness of difficulty in breathing. Individual sensation is \ndescribed as “shortness of breath”, “breathlessness” or tightness in the chest. Clinical and \ndiagnostic approach differs according to severity and speed of onset. It can be chronic, \nacute or hyperacute = life threatening. Hyperacute dyspnoea can be caused by pulmonary \nembolism, tension pneumothorax, severe metabolic acidosis, florid pulmonary oedema, \nstatus asthmaticus, severe upper airway obstruction and ARDS. Dyspnoea is the most \ncommon complaint of patients with cardiopulmonary diseases and 60% of dyspnoea is \ncaused by cardiac, pulmonary or mixed cardiopulmonary aetiology. Clinical differential \ndiagnosis list is long. The pulmonary causes are airway mass including angio-oedema, \nepiglottitis, laryngeal obstruction, asthma, bronchitis, chest wall trauma, effusion, emphy-\nsema, metastatic disease, pneumonia, pneumothorax, pulmonary embolism, pulmonary \nhypertension and restrictive lung dinase. The cardiovascular aetiology includes: ar-\nrhythmia, coronary artery disease, intracardiac shunt, left ventricular failure, myxoma, \npericardial and valvular disease. Less frequent aetiology includes drug-induced, neuro-\npsychogenic or haematological diseases or by increase of abdominal pressure. Rare \ncauses are: neuromuscular, CNS disorders, myopathy, neuropathy, phrenic nerve and \ndiaphragmatic disorders, spinal cord disorders, altitude, anaemia, metabolic problems, \nanaphylaxis and sepsis. The priority diagnoses include COPD, heart failure, pneumonia \nand pulmonary embolism. The imaging methods are most decisive and conclusive in the \nlast two. The plain chest film is requested just after check-out of vital signs, consciousness, \npulse dimetry, oxygen mask and arterial blood gas in life threatening dyspnoea. CT and \nCT angiography are more frequently used in acute setting as well. \nLearning Objectives:\n1. To learn more about the clinical conditions causing shortness of breath.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑191\t 09:00 \nB. Imaging techniques and typical findings \nH. Prosch; Vienna/AT (helmut.prosch@meduniwien.ac.at) \nDyspnoea is a common symptom in patients presenting to the emergency room. \nIn almost two-thirds of all cases, dyspnoea is caused by either a pulmonary or a \ncardiovascular disorder. Imaging in patients with dyspnoea depends mainly on \nthe clinical presentation and the medical history of the patient. Chest radiographs \nare a cost-effective and rapid test for the evaluation of patients with dyspnoea, \nwith a fair sensitivity and specificity. For this reason, chest radiographs are usually \nperformed early in the diagnostic evaluation of patients with acute and chronic dys-\npnoea. Chest radiographs enable the diagnosis of frequent causes of dyspnoea of \npulmonary origin, such as pneumonia, pneumothorax, pleural effusions, interstitial \nlung diseases, and emphysema. The diagnosis of cardiovascular disorders, such \nas pulmonary venous hypertension, cardiomyopathy, as well as valvular diseases, \nis also facilitated by chest radiographs. If chest radiographs, clinical studies, and \nlaboratory tests, however, are non-diagnostic or equivocal, CT is indicated. CT \noffers high sensitivity and specificity for the evaluation of pulmonary embolism \nand for diseases of the pulmonary parenchyma and the airways. High-resolution \nCT represents the method of choice for the evaluation of suspected diffuse lung \ndisease. Additional expiratory scans are useful for the evaluation of mosaic perfu-\nsion and air-trapping. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof dyspnea patients.\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\nLearning Objectives:\n1. To review the clinical and imaging classification of acute pancreatitis and its \nimplications for patient management.\n2. To understand the role of cross-sectional techniques and how to provide \nprognostic information.\n3. To understand the role of imaging in clinical decisions regarding \ncomplications.\nA‑188\t 08:55 \nB. Chronic pancreatitis \nG. Morana; Treviso/IT (gmorana@ulss.tv.it) \nChronic pancreatitis (CP) is an inflammatory disease of the pancreas, with irrevers-\nible morphologic changes and fibrotic replacement of the gland, which progressively \nresult in loss of exocrine and endocrine function. CP is morphologically character-\nised by irregular sclerosis associated with destruction and permanent loss of the \nexocrine parenchyma which may be either focal, segmental or diffuse. The primary \nsymptoms of CP are abdominal pain and maldigestion, which may be physically \nand socially debilitating, although it is acknowledged that chronic pancreatitis can \noccasionally be painless. A classification based on the causes of CP is useful \nin order to better define the therapeutic interventions. However, morphological \nchanges of the pancreatic ducts are the main rule of thumb for the classification \nin order to better compare the results of the treatment. Imaging techniques have \na role both on the diagnosis - especially in the early phases of the disease - and \non the classification of CP, either for the grading of the disease, to explain the \naetiology - even for rare forms - and to differentiate the focal mass from ductal \nadenocarcinoma. CT, MRI and ERCP have a specific role in the assessment of \nCP, due to the different capacity of the techniques to explore the pancreatic gland. \nHowever, thanks to heavily T2w sequences, MRI has a competitive role with ERCP , \nwhich actually has more an interventional role in case of obstructive CP. Finally, \nMRI thanks to secretin test and DWI sequences is able to give a non-invasive \nassessment of pancreatic exocrine function. \nLearning Objectives:\n1. To review the imaging findings and classification of chronic pancreatitis.\n2. To understand the pros and cons of imaging techniques including ECRP.\n3. To learn about the rare forms of CP such as auto-immune and groove \npancreatitis.\n4. To pick up clues on how to differentiate from adenocarcinoma.\n5. To learn how to measure exocrine pancreatic function.\nA‑189\t 09:20 \nC. Management of complications of pancreatitis \nC.D. Becker; Geneva/CH (Christoph.Becker@hcuge.ch) \nComplications of pancreatitis may include fluid collections and pseudocysts, vas-\ncular complications such as arterial pseudoaneurysm or thrombosis of the portal \nvenous system, and stenosis of common bile duct and pancreatic duct. Inflammatory \nfluid collections in the context of acute pancreatitis often resolve spontaneously. \nDrainage may become necessary in the presence of clinical complications such \nas abdominal pain, compression of adjacent organs by large pseudocysts, or if \nsuperinfection of a pseudocyst occurs. Depending on clinical, morphologic, or tech-\nnical factors, drainage may be accomplished with image- guided external catheter \nplacement, by endoscopic internal (transgastric) drainage or by internal surgical \ndrainage. Arterial pseudoaneurysm carries the risk of acute intra- or extraperitoneal \nbleeding, and transarterial embolisation is usually indicated when pseudoaneurym \nis detected. Strictures of the common bile duct secondary to chronic pancreatitis \nmay require percutaneous or endoscopic retrograde intervention. \nLearning Objectives:\n1. To review interventional techniques that are used to manage fluid collections \nin the setting of pancreatitis.\n2. To compare the results with those obtained by surgical and/or endoscopic \napproach.\n3. To learn about algorithms used for clinical decision making, and for \ntreatment evaluation and follow-up.\n4. To understand major shortcomings and complications and how to avoid \nthem.\nDiscussion 09:45 \n\nPostgraduate.Educational.Programme\nS54\n A B C D E F G H\nants include the presence of accessory muscles, a low-lying peroneus brevis muscle \nbelly, pseudosubluxation of the peroneus brevis tendon, and a bifurcated or mildly \ncrescentic peroneus brevis tendon. Accessory muscles in the ankle area include in \nthe lateral aspect the peroneal tertius and peroneal quartus, in the medial aspect the \nflexor digitorum accessorius longus, and posteriorly the peroneocalcaneus internus, \ntibiocalcaneus internus and accessory soleus. As variations are commonly seen in \nasymptomatic ankles, matching with clinical symptoms is important. Pitfalls include \npseudoloose bodies in the ankle joint, pseudolipomas, and artefacts such as the „magic \nangle“ effect, chemical shift, susceptibility, motion, „ghost“ and partial volume averaging. \nKnowledge of normal anatomy, pitfalls and variants, aids radiologists in making the \nprecise diagnosis of various disorders. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑195\t 09:20 \nC. Identifying and reporting abnormal findings \nA. Cotten; Lille/FR (anne.cotten@chru‑lille.fr) \nAnkle and foot disorders are common and can affect a wide variety of patients and \nmany different anatomical structures. A precise and complete analysis of all these \nstructures is therefore required, and an appropriate terminology of the pathological \nfeatures has to be used in the report. This lecture will review the MR appearances \nof the most common disorders (traumas, microtraumas, infection, rheumatisms, \ntumours, etc.) affecting the bones, joints and soft tissues of the ankle and foot. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\n08:30 - 10:00 Room D2 \nGenitourinary \nRC 707 \nCTU and MRU: urinary tract imaging \nModerator: \nR. Manfredi; Verona/IT \nA‑196\t 08:30 \nA. CTU/MRU in acute obstruction \nT. Meindl; Munich/DE (thomas.meindl@med.uni‑muenchen.de) \nA variety of pathological processes that involve the upper urinary tract (UUT) may cause \nacute urinary obstruction: impacted calculi, neoplasms, intra- and extraluminal ureter \ncompression, coagulopathy, fibrosis and surgery. Clinically acute obstruction leads to \nsignificant flank pain and renal colic that urges the clinician to immediate diagnostic \nwork-up and appropriate treatment. Radiological imaging procedures include ultraso-\nnography, intravenous urography, computed tomography (CT) and magnetic resonance \n(MR) imaging. Among the cross-sectional examinations, multi-detector CT is the mo-\ndality of choice for clarifying the underlying cause of acute obstruction. Unenhanced \n(low-dose) CT is the new imaging standard for detection of calculi. Contrast-enhanced \nCT allows diagnosis of virtually all pathologies leading to obstructive nephropathy. \nAfter intravenous contrast media application, several contrast-phases can be imaged \nincluding the excretory phase for depiction of the UUT. Since radiation dose is a major \ndrawback, imaging protocols have to be optimised and must be tailored to the clinical \nquestion. Magnetic resonance urography reveals the possibility of imaging the urinary \ntract without the need for contrast media by means of heavily T2-weighted sequences. \nThese static urograms provide information about the grade and site of obstruction, \nindependent of the excretory function of the kidneys. After injection of gadolinium \nchelates, one or more urograms can be acquired during contrast media excretion. In \nthe context of acute obstruction, MR urography is preferred in paediatric, young and \npregnant patients. Patients with renal impairment are examined with T2-weighted \nsequences without the need for contrast media. Magnetic resonance urography is \ncomplementary to CT in challenging cases. \nLearning Objectives:\n1. To learn the technical tips for MRU and CTU in acute obstruction.\n2. To understand the value of cross-sectional urography compared to IVP.\n3. To review the appearance of major diseases like urinary stones, clots, etc.\n4. To understand the drawbacks of each method and which one should be \nused first.\nA‑192\t 09:30 \nC. Interactive case discussion \nJ. Andreu; Barcelona/ES (jandreus@gmail.com) \nThe aetiology of dyspnoea is varied. It may be due to pulmonary or pleural disease, \ncardiac pathology or extrathoracic causes. Imaging is an useful adjunct in the diag-\nnosis of majority of cases of dyspnoea. In this lecture we will present selected cases \nwhich will demonstrate the usefulness of different imaging modalities, emphasising \nwhen cross-sectional imaging is indicated. \nLearning Objectives:\n1. To review typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of dyspnea cases.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n08:30 - 10:00 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 716 \nThe ankle and foot \nModerator: \nM. Shahabpour;  Brussels/BE \nA‑193\t 08:30 \nA. How I do it \nM. Zanetti; Zurich/CH (marco.zanetti@balgrist.ch) \nWe use two various standard MR imaging protocols for the evaluation of foot and \nankle abnormalities. For hindfoot abnormalities, MR imaging is performed with the \nfoot in neutral position and the patient is supine. T1-weighted spin-echo images are \nobtained in the coronal plane and in the transverse oblique plane (45° between the \ncoronal and transverse planes). T2-weighted fast spin-echo images are obtained in \nthe coronal plane and in the transverse plane. A fast spin-echo short tau inversion \nrecovery (STIR) sequence is obtained in the sagittal plane. The protocol is modi-\nfied when patients are referred specifically for flexor tendon abnormalities. Such \npatients are prone positioned to avoid magic angle artefacts. Alternatively to the \nprone body position, the foot can be plantarflexed in supine body position. In our \nexperience this position is less comfortable and results in more motion artefacts \nthan the well tolerated prone body position. For forefoot abnormalities, MR imag-\ning is performed in the prone body position with plantarflexed foot. The reason \nfor prone patient positioning is the higher conspicuity of Mortons Neuroma in the \nprone position compared to the supine position. The protocol consists of a sagittal \nT1-weighted spin-echo sequence, a transverse (perpendicular to the metatarsals) \nT1-weighted spin-echo MR sequence, and a transverse T2-weighted turbo spin-\necho sequence. A coronal short inversion time inversion recovery (STIR) images \nis used as a screening sequence for bony lesions. Contrast enhanced T1-weighted \nfat-suppressed spin-echo MR images are obtained for rheumatic diseases. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑194\t 08:55 \nB. Normal variants and pitfalls \nA.H. Karantanas; Iraklion/GR (akarantanas@gmail.com) \nMR imaging is recognised as the modality of choice in the diagnosis of many diseases \nof the ankle and foot. In order to better depict pathology, detailed knowledge of the \nnormal anatomy is important. The proper depiction of normal anatomy requires recogni-\ntion of the anatomic variants. Osseous variants include a flat or convex retromalleolar \nfibular groove, hypertrophy of the peroneal tubercle and retrotrochlear eminence, \npresence of various accessory bones such as the os naviculare and os peroneum \nand variation of the calcaneal apophysis ossification. Variants of the subtalar joints \ninclude a missing anterior facet, fusion of the anterior and middle facets and articula-\ntion between talar head and cuboid bone. At the posterior talocalcaneal articulation, \nvariations exist regarding the curvature of the medial side of the joint. Soft tissue vari-\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S55\nCB D E F G H\n08:30 - 10:00 Room E1 \nMusculoskeletal \nRC 710 \nBone marrow oedema and bone marrow oedema-\nlike lesions \nModerator: \nB. Vande Berg; Brussels/BE \nA‑199\t 08:30 \nChairman’s introduction \nB. Vande Berg; Brussels/BE (bruno.vandeberg@uclouvain.be) \nThe term bone marrow oedema was introduced to describe ill-defined bone marrow \nhypointensity on T1Wi and hyperintensity on T2Wi and water sensitive sequences. \nBone marrow edema can be found in many similar unrelated disorders, such as \nbone contusions, osteonecrosis, inflammatory or degenerative disease, being a \nnon-specific MRI abnormality representing a diagnostic challenge for radiologist. \nRecently has been demonstrated that bone marrow oedema might be a prognosis \nmarker for OA (osteoarthritis) and inflammatory disease, and could be used as a \npowerful predictive tool for treatment options. Therefore our role as radiologist is to \ntry to increase specificity to help patient management and decrease progression. \nThe aim of this refresher course is to describe MR imaging features of bone marrow \nedema in different important and frequent disorders: osteoarthritis, inflammatory \ndiseases and trauma. \nA‑200\t 08:35 \nA. BME and osteoarthritis \nF.W. Roemer; Augsburg/DE (f.w.roemer@gmx.de) \nSubchondral bone marrow lesions (BMLs) are a hallmark of osteoarthritis (OA) on \nMRI. Radiologically, BMLs in OA are understood as non-cystic subchondral areas \nof ill-defined hyperintensity on T2w images and of hypointensity on T1w images, \nbut only water-sensitive fat-suppressed sequences depict the lesions to their maxi-\nmum extent. BMLs are observed regularly in conjunction with adjacent cartilage \nalterations. Higher grades of cartilage loss are associated with higher prevalence \nand greater volume of concomitant BMLs. As the disease progresses, an increase \nin BML volume is seen in the same region subchondrally in many patients, which \nis positively correlated with an increase in cartilage loss and radiographic joint \nspace narrowing. Cysts are strongly associated with BMLs in the same subregion \nand develop within non-cystic BMLs. The published data on the natural history of \nBMLs are ambiguous but recent reports showed that the majority of subchondral \nBMLs may regress or resolve completely. Note that progression and regression of \nBMLs may be observed within the same knee simultaneously. Histologic correlation \nstudies showed that the lesions consisted of a mixture of different tissue patterns \nwith only little oedema. Specific changes in bone mineralisation and remodelling \nin areas of BMLs have been shown, and they appear sclerotic compared to unaf-\nfected regions from the same individual. Differential diagnoses of OA-related BMLs \ninclude traumatic bone contusions and fractures with or without disruption of the \narticular surface. Osteonecrosis, inflammation, idiopathic BMLs, red marrow and \npost-surgical alterations should also be considered. \nLearning Objectives:\n1. To learn about the basic physiopathology of OA and its relation with BME.\n2. To analyse the distribution and natural history of BME in OA.\n3. To understand the differential diagnosis and relevance of BME in staging OA \nand as a marker of prognosis.\nA‑201\t 08:58 \nB. BME and early inflammatory disease \nA.J. Grainger; Leeds/UK (andrew.grainger@leedsth.nhs.uk) \nMarrow oedema is identified as a feature of many forms of inflammatory and \nmechanical arthritis, but has been most studied in the inflammatory arthritides \nand particular in rheumatoid arthritis. It was first reported as a feature of RA as \nfar back as 1986. Work has been undertaken both using human specimens and \nspecimens from animal models which suggest that marrow oedema seen on MRI \nin RA corresponds to areas of inflammation been associated with invading pannus, \nlymphocytic aggregates and hypervascularity. There is also evidence that the mar-\nrow lesions seen on MRI in ankylosing spondylitis correspond to histopathological \ninflammatory change. Marrow oedema has been shown to be an important predictor \nA‑197\t 09:00 \nB. Chronic/intermittent obstruction \nM.-F. Bellin; Le Kremlin‑Bicêtre/FR (marie‑france.bellin@bct.aphp.fr) \nThe recent technological advances of CTU and MRU have had an exceptional \nimpact on the assessment of chronic/intermittent obstruction. Imaging studies \nshould help answer the clinical questions raised concerning the presence, level, \nand cause of obstruction. In this session, the recommended techniques of CTU \nand MRU will be described and their relative merits and limitations reviewed. 3D \nCT images should be used as an adjunct to the transverse images, instead of a \nreplacement, because volume-rendered images best depict the lumen and not the \nwall of the urinary tract. Thin-section reformatted CT images likely are as sensi-\ntive as transverse images in the detection of urinary tract abnormalities. MRU is \nbeing increasingly used because it provides excellent anatomic and functional \nimaging in a single setting. It has proved particularly valuable in pregnant women \nand children. The relative advantages of static-fluid MRU and excretory MRU \nwill be discussed. The main aetiologies of chronic/intermittent obstruction will be \nillustrated, including intraluminal diseases (stones, clots, etc.), wall abnormalities \n(transitional cell carcinomas, tuberculosis, etc.) and extraluminal diseases (pelvic \nand retroperitoneal tumours, retroperitoneal fibrosis, GI tract diseases, etc.) UPJ \nsyndrome is the most common site of urinary tract obstruction in children. Vessels \ncrossing a ureteropelvic junction obstruction contribute to the degree of hydrone-\nphrosis in up to 46% of these patients. Demonstration of these vessels and their \nlocation anterior or posterior to the obstruction facilitates surgical planning. At the \nend of the lecture, attendees will become familiar with moderate or severe urinary \nobstruction and their various features and causes. \nLearning Objectives:\n1. To learn the technical tips for MRU and CTU in chronic obstruction.\n2. To review the appearance of major diseases like PU junction, prostate \nmasses, chronic inflammation and extrinsic compression.\n3. To understand the advantages and disadvantages of each method.\nA‑198\t 09:30 \nC. Tumours: CTU/MRU \nN.C. Cowan; Oxford/UK (nigel.cowan@nds.ox.ac.uk) \n1. Technological advances in both computed tomography (CT) and magnetic \nresonance (MR) imaging have improved the diagnostic imaging of the urinary \ntract, surpassing ultrasound and the intravenous urogram. Multidetector computed \ntomography urography (CTU) is defined as CT examination of the kidneys, ureters \nand bladder with at least one imaging series acquired during the excretory phase \nof contrast enhancement. MR urography (MRU) can be performed using heavily \nT2-weighted sequences without contrast material or T1 spoiled gradient - recalled \necho sequences during the excretory phase after administration of gadolinium-\nbased contrast material. In adults, CTU or MRU is now the preferred examination. \nTechnical aspects of image acquisition and processing will be explored and technical \ntips relating to protocol design given. 2. The typical and atypical appearances of \nupper urinary tract urothelial tumours and bladder cancers will be demonstrated. \nA method of fluoroscopic biopsy of upper tract tumours is described for validation \nof the imaging diagnosis. 3. Early and accurate diagnosis of urinary tract tumours \nhelps optimise prognosis but conventional investigative pathways are complicated \nand lengthy, utilising multiple imaging tests and many diagnostic algorithms exist \nwithout rigorous evaluation. CTU offers a single imaging test of high diagnostic \naccuracy with the potential to replace multiple alternative imaging tests in the \ndiagnostic pathway, improve patient experience, improve diagnostic performance \nand accelerate diagnosis. MRU is a promising technique that may be used for \nthe initial evaluation of patients at high risk for developing upper-tract urothelial \ncarcinoma when CTU or intravenous urography is contraindicated. \nLearning Objectives:\n1. To learn the technical tips for MRU and CTU in the detection of urothelial \ntumours.\n2. To review the typical and atypical appearance of urothelial tumours.\n3. To understand why CTU/MRU are complementary tools to other imaging \nmethods.\n\nPostgraduate.Educational.Programme\nS56\n A B C D E F G H\nrhage and periventricular echodensities. The posterior fontanelle approach improves \nthe detection of grade II haemorrhage in 30% more cases than the anterior fonta-\nnelle, and the mastoid fontanelle approach is essential for diagnosing cerebellar \nhaemorrhage. Ventricular dilatation is the main complication of intraventricular \nhaemorrhage and resolves spontaneously in approximately 65% of cases. The main \nchallenge with periventricular echodensities is to differentiate them from classical \nperiventricular leukomalacia. When cysts appear during follow -up, the diagnosis \nis straightforward. MRI is considered to be more sensitive than US for evaluating \nwhite-matter damage. Congenital brain malformations including ventricular dilatation \nof diverse aetiologies, corpus callosus agenesis and posterior fossa malformations \nare usually diagnosed prenatally. MRI complements US for this purpose. Acquired \nabnormalities arise mainly from infections and hypoxic-ischaemic injury. Although \nMR is considered the gold standard, US still plays an important role in the study of \nhypoxic-ischaemic lesions when used to its full capacity. Depending on the duration \nand severity of the hypoxic insult, patterns different from those seen in premature \ninfants may be observed. \nLearning Objectives:\n1. To learn about the technique of neonatal neurosonography and outline its \nlimitations.\n2. To become familiar with the common abnormalities seen in the premature \ninfant.\n3. To learn about the common congenital and acquired abnormalities in the \nterm infant.\nA‑204\t 09:00 \nB. Common congenital cerebral abnormalities \nA. Rossi; Genoa/IT (andrearossi@ospedale‑gaslini.ge.it) \nBrain malformations are conditions where the brain has not formed properly during \npregnancy. These problems in brain structure are almost often (with some excep-\ntions) associated with neurological and developmental problems. Often, brain \nmalformations are part of syndromic complexes that require a multidisciplinary \napproach. Malformations may be caused by inherited genetic defects, spontane-\nous mutations within the genes of the embryo, or effects on the embryo due to \nthe mother’s infection, trauma, or drug use. Classification schemes are currently \nshifting from a morphological to a genetic approach. The most frequent congenital \nbrain abnormalities may be categorised into anomalies of the corpus callosum and \ntelencephalic commissures, holoprosencephalies and related entities, malforma-\ntions of the cerebral cortex, and malformations of the cerebellum. These congenital \nbrain defects are diagnosed either from direct physical examination or from imaging \nstudies including CT and MRI. Prenatal MRI offers a viable method to improve \ndetection and characterisation of these entities in utero. \nLearning Objectives:\n1. To learn about the common supra- and infratentorial congenital \nabnormalities.\n2. To learn when MRI is required and the appropriate imaging protocol.\n3. To learn if and when CT is still useful in the investigation of congenital \nanomalies.\nA‑205\t 09:30 \nC. CNS infection and inflammation: signs you should not miss \nM.I. Argyropoulou; Ioannina/GR (margyrop@cc.uoi.gr) \nDifferent neuroimaging patterns of CNS infection may be found in neonates and \nyoung children. In the neonatal period parenchymal calcifications with or without \nventriculomegaly are suggestive of intrauterine infection. Cytomegalovirus causes \nadditionally striatal vasculopathy and gyral abnormalities and herpes simplex en-\ncephalomalacia. Herpetic infection in older children involves the orbital surface of the \nfrontal lobes, the temporal lobes and the insula and causes haemorrhagic lesions. \nIschaemic or haemorrhagic infarcts may be suggestive of varicella zoster infection. \nInvolvement of the pontine tegmentum, the anterior horns and the ventral roots of \nthe spinal cord is observed after enterovirus infection. HIV infection may appear as \nbasal ganglia and deep white matter atrophy, as diffuse brain atrophy or even as \nnecrotising encephalopathy. Brain abscess may appear as mass lesion presenting \nperipheral enhancement and restricted diffusion. Diffuse meningeal enhancement \nmay be suggestive of viral or bacterial meningitis, while basal cistern enhancement \nis suggestive of tuberculous meningitis. Acute disseminated encephalomyelitis is a \nparainfectious condition appearing with multiple peripheral ill-defined simultaneously \nenhancing white matter lesions. Involvement of the basal ganglia, the thalami and \nthe cortex may also be seen. Spinal cord lesions appear as longitudinal swelling \nover more than three vertebral segments. Multiple sclerosis (MS) presents with \nmultiple lesions perpendicular to the long axis of the lateral ventricles. Larger le-\nsions with open ring enhancement are suggestive of tumefactive MS. Spinal cord \nof future joint damage in patients with rheumatoid arthritis. In addition to predicting \nbone destruction for erosion, marrow oedema is independently predictive of joint \nspace loss and therefore cartilage destruction. It also correlates well with other \nmeasures of disease activity. We have applied dynamic contrast enhancement \ntechniques to show that treatment with anti-TNF therapy brings about a reduction \nin contrast uptake in areas of marrow oedema in patients with RA. In the serone-\ngative arthritides marrow oedema in the spine in ankylosing spondylitis has been \nshown to be predictive of future changes and of response to treatment. Diffusion \nweighted imaging of marrow lesions in ankylosing spondylitis can also be used to \nshow a treatment response, seen as a change in the apparent diffusion coefficient. \nLearning Objectives:\n1. To become familiar with the imaging pattern of seronegative and rheumatoid \narthritis distribution.\n2. To understand the relationship between BME and early diagnosis of \ninflammatory disease.\n3. To analyse whether BME helps in patient management, diagnosis and \nfollow-up.\nA‑202\t 09:21 \nC. BME and trauma \nO. Hauger; Bordeaux/FR (olivier.hauger@chu‑bordeaux.fr) \nBone marrow oedema, also referred as bone contusion or bone bruise, is frequently \nidentified at magnetic resonance imaging after an injury to the musculoskeletal \nsystem. It may result from a direct blow to the bone, compressive forces from \nadjacent bones impacting one another, or from traction forces that occur during \nan avulsion injury. Its location reflects the mechanism of injury, which allows for a \nfocused search for predictable patterns of associated internal derangements. It is \nseen in any joint but are particularly common in the knee reflecting mechanisms \nsuch as pivot shift, hyperextension, contrecoup or dashboard injuries, as well as \nlateral patellar dislocation. In a context of trauma, bone marrow oedema, identified \nat MR imaging as areas of poorly marginated signal intensity alteration (best seen \non fat-suppressed sequences) in the cancellous bone and marrow, represents \nareas of oedema and haemorrhage secondary to trabecular injury. It can be seen \nas soon as one hour after trauma and usually resolves in the following six to eight \nmonths, except in case of subsequent chondral lesion. \nLearning Objectives:\n1. To learn about BHE physiopathology in trauma scenario, direct and indirect \nmechanism.\n2. To recognise BME as a footprint that allows other soft tissue injuries to be \nruled out.\n3. To analyse whether BME can be a value tool for follow-up.\nPanel discussion: \nCan we still use the term BME or should we be more specific? 09:44\nThe term bone marrow oedema was introduced to describe ill-defined bone marrow \nhyperintensity on T2 weighted images. Since then many studies have demonstrated \nthat it can be found in many similar unrelated disorders, such as bone contusions, \nosteonecrosis, inflammatory or degenerative disease, and that it is a non-specific \nMRI abnormality. It has been demonstrated that bone marrow oedema might be \na prognosis marker for OA (osteoarthritis) and inflammatory disease, and could \nbe used as a powerful predictive tool for treatment options. Therefore our role is \nto increase specificity to help patient management and decrease progression. \n08:30 - 10:00 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 720 \nPaediatric neuroimaging: let’s make it simple! \nModerator: \nJ.F. Schneider; Basle/CH \nA‑203\t 08:30 \nA. Neurosonography in the neonate: rules of thumb \nG. Enriquez; Barcelona/ES (genriquez@vhebron.net) \nSonography is an essential tool for studying the neonatal brain. Brain scans are \nusually performed via the anterior fontanelle; however, a more complete assess-\nment of the brain can be achieved using the posterior and mastoid fontanelles, \nhigh-resolution linear array transducers and colour or power Doppler. The most \ncommon lesions in premature infants are intraventricular/periventricular haemor -\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S57\nCB D E F G H\nA‑208\t 08:58 \nB. CT and MRI perfusion \nF. Berger; Munich/DE (Frank.Berger@med.uni‑muenchen.de) \nAt initiation, tumours in a pre-vascular phase are supplied by oxygen and nutrients \nthat diffuse from pre-existing normal vessels. When the tumour reaches a critical \nsize of approximately 1-4 mm diameter, the resultant ischaemia leads to secretion \nof angiogenic factors. These factors, such as vascular endothelial growth factor \n(VEGF), recruit and maintain tumour vessels. “New” vessels (neovasculature) \nexhibit increased blood volume and permeability compared with normal vessels. \nVarious new specific therapies in oncology target tumour vasculature or tumour neo-\nangiogenesis. It is not uncommon that these targeted therapies have pronounced \ncytostatic and not predominantly cytotoxic effects. This limits the usefulness of \nsize-based morphological tumour response assessments. Of newer magnetic \nresonance imaging (MRI) modalities, perfusion MRI has emerged as a valid marker \nof tumour-induced blood vessels and their function. MRI perfusion measures the \nvascularity within a tumour, as well as its component heterogeneous parts. Of \nparameters which can be measured to date, blood volume and permeability are \ncommonly applied in patient studies. Blood volume measures the aggregate size \nof the vascular space, while the permeability function informs about the integrity \nof vessels and their ‚leakiness‘ to contrast agents. We will describe the use of MR \nperfusion to monitor such new therapies and discuss its specific advantages and \nlimitations in comparison to CT perfusion protocols. PET-based strategies for tar-\ngeted treatment-monitoring in oncology will be briefly mentioned, with prospect on \nthe significance of combined vascular and metabolic imaging for further optimising \nnon-invasive response assessment in specific anticancer therapies. \nLearning Objectives:\n1. To learn about established morphological-based strategies for tumour \nresponse monitoring: RECIST and WHO criteria with their limitations in \ntargeted treatment surveillance.\n2. To learn about the latest antiangiogenic/antivascular treatment strategies in \noncology.\n3. To learn about perfusion imaging protocols, specific advantages and \ntechnical challenges when utilising CT or MRI.\n4. To learn about the significance of CT or MR perfusion imaging in oncology, \ntypical applications and future strategies for improvement of non-invasive \ntreatment monitoring in oncology.\nA‑209\t 09:21 \nC. MR diffusion and PET/CT \nC. Della Pina; Pisa/IT (mclotilde@virgilio.it) \nAfter a brief review of physical and technical principles of diffusion-weighted MR \nimaging and PET-CT, the lecture describes the ability of these techniques in evalu-\nating functional parameters in tumour tissue. Diffusion-weighted sequences have \nbeen used in an attempt to further increase the diagnostic capability of baseline \nand dynamic MR study by providing functional information. Diffusion-weighted \nMR imaging is based on the random microscopic movement of molecules that \ncan be quantified by means of apparent diffusion coefficient (ADC). In the early \npost-treatment period after loco-regional therapies, tumours may not change in \nsize. Recent studies demonstrated that water diffusion can be used to differentiate \nviable and cellular regions from necrotic area in the tumour, regardless morphologic \nor dimensional changes. Moreover, new classes of antitumour therapy have been \ndeveloped that have an antiproliferative effect, inducing a delay in tumour shrink-\nage. Diffusion MR imaging can be promising in this clinical setting as a biomarker \nto predict early response to systemic chemotherapy. On the other hand, PET/CT, \ncombining the functional and the structural imaging approach, was shown to be su-\nperior regarding conventional imaging modalities in the identification of intrahepatic \nand extrahepatic metastases. Less experience and less publications are available \nfor PET-CT in monitoring tumour response after interventional therapies, but the \nability of PET-CT to measure early metabolic changes could make this technique \nuseful in the development of novel anticancer drugs. \nLearning Objectives:\n1. To become familiar with the physical and technical principles of DWI and \nPET/CT in tumours.\n2. To recognise the qualitative and quantitative information of the different \nmodalities.\n3. To review imaging findings after percutaneous and intra-arterial treatments \nof liver malignancies.\n4. To appreciate the clinical role of these techniques in monitoring tumour \nresponse.\ninvolvement is characterised by lesions well or ill-defined lesions extending over \nless than one vertebral segment. \nLearning Objectives:\n1. To recognise how best to image the child with suspected CNS infection or \ninflammation.\n2. To understand the imaging findings and the main differential diagnoses.\n3. To learn about the complications and their investigation.\n08:30 - 10:00 Room F1 \nAbdominal and Gastrointestinal \nRC 701 \nTumour evaluation: beyond morphology \nModerator: \nO. Lucidarme; Paris/FR  \nA‑206\t 08:30 \nChairman’s introduction \nO. Lucidarme; Paris/FR (olivier.lucidarme@psl.ap‑hop‑paris.fr) \nUntil now, in oncology, only the RECIST criteria based on anatomical measurement \nof the tumour size are used for drug trials or in clinical practice because this is a \nstandardised way to assess the tumour response that allows the calculation of the \nprogression-free survival (PFS) or the time to progression (Ttp) that are usually ac-\ncepted as surrogate end point for overall survival. However, tumour follow-up evaluation \nusing only morphology is usually delayed and with the emergence of new numerous \nand very expensive targeted therapies there is now a need to move beyond morphol-\nogy to find new ways to assess tumour responses or progression not only for clinical \ntrials but also in clinical practice to maintain or to change quickly a treatment. This is \nthe aim of the functional imaging using ultrasound, CT, MRI or PET. The ultimate goal \nof these technique is to find biomarkers able to predict the likely course of disease, \nirrespective of treatment (prognostic biomarkers) or able to forecast the likely response \nto treatment (predictive biomarkers); before (baseline values of a parameter) or during \nthe treatment (dynamic variation of the parameter during the follow-up). During this \nsession the presenters will discuss the technical issues and the results obtained today \nusing ultrasound with share-waves or microbubbles, functional CT, dynamic contrast \nenhanced MRI, diffusion weighted MRI and PET-CT. The candidate biomarkers will \nbe presented as well as the limits and the problems that are still to be overcome. \nA‑207\t 08:35 \nA. US and CEUS \nM. Claudon; Vandoeuvre‑les‑Nancy/FR (m.claudon@chu‑nancy.fr) \nFor tumour evaluation, the main advantages of ultrasound (US) associate a high \nframe rate and a large range of data and parameters potentially extracted from \nthe signal backscattered from tissues. Beyond morphology, elastography is a first \nmodality, based on in vivo estimation of the mechanical properties of tissues. Data \non displacement or strain of tissues and lesions can be obtained by manual exter-\nnal compression, but shear wave generation techniques allow for a quantitative \nand more precise estimation of their visco-elastic properties. In oncology, clinical \nevaluation included first breast. Contrast-enhanced US (CEUS) is obtained after \nintravenous administration of microbubbles which are pure blood pool contrast \nagents. CEUS is capable for detection, characterisation and follow -up of tumour \nlesions, based on enhancement profiles during bolus, destruction-replenishment, \nor contrast burst depletion imaging. Quantification of perfusion in normal tissues \nand lesions may be obtained by extracting various blood flow and blood volume-\nrelated parameters from time-intensity curves. Protocols have entered validation \nprocesses to improve reproducibility. As a predictive technique, CEUS is a promis-\ning tool for monitoring changes of haemodynamic parameters and evaluating the \nearly response during chemotherapy or antiangiogenic treatment. It is helpful in \nthe guidance and follow-up of lesions treated by radiofrequency or cryoablation. \nRecent advances of US and CEUS include 3D/4D real-time imaging with matrix \ntechnology, and the evaluation of targeted agents, to be released on site after \nbubble destruction by the US beam. \nLearning Objectives:\n1. To learn about enhancement characteristics of the liver and the various focal \nliver lesions.\n2. To understand in which situations US and CEUS are expected to be \nappropriate.\n3. To understand the role of US and CEUS in comparison to CT and MRI.\n\nPostgraduate.Educational.Programme\nS58\n A B C D E F G H\nLearning Objectives:\n1. To learn about the differences in training in IR and methods of training \nharmonisation in Europe.\n2. To learn about a syllabus for European IR training.\n3. To understand the optimum timing and methodology for delivering IR \ntraining.\nA‑212\t 08:58 \nTurf battles facing IR \nJ.A. Reekers; Amsterdam/NL (J.A.Reekers@amc.uva.nl) \nInterventional radiology, being part of general radiology, has traditionally always \nbeen a medical specialty to support clinicians. It is about 15 years ago that IR \nprocedures were gradually changing from an extension of a clinicians treatment, \nto become stand-alone treatments replacing traditional surgical techniques. \nInterventional radiologists moved more towards the clinical site, not only making \nthe diagnosis but also controlling the indications for treatment. This became very \nclear at the turning of the century as one of the pillars of vascular surgery, being \naneurysm surgery, became the new playing ground for interventional radiologists. \nA major turf battle was born. Next to this well know turf battle there are many oth-\ners emerging at the horizon. Gynaecologist wanting to perform UFE, GE-doctors \nperforming biliary interventions, cardiologist doing renal stenting, but also urologist, \ntrauma physicians and many others are moving towards image-guided minimal \ninvasive treatment. Is the consequence of all these battles that IR by interventional \nradiologists should/will disappear? Not at all, at least when we stop fighting these \nbattles. Recognition of IR as an independent clinical medical speciality, with his \nown needs, training and certification, is the most important way forward. Being the \nbest equipped, best trained, image-guided treatment specialist is essential. Making \nservice and financial alliances with other more traditional medical specialties is also \nimportant. The old adagio, if you cannot beat them, join them, is still valid. But join \nthem on equal terms from the strong position as well trained clinical interventionalist. \nLearning Objectives:\n1. To understand reasons for turf battles.\n2. To learn how to resolve conflict with other specialities.\n3. To learn about conflicts with diagnostic radiology.\nA‑213\t 09:21 \nFuture directions in IR \nM.J. Lee; Dublin/IE (mlee@rcsi.ie) \nThe dramatic growth of interventional radiology (IR) over the last 15 years and \nits increasing impact on patient care have made IR a vital component of modern \nhealthcare. IR is in a strong place; however, there are vital areas that require nur-\nturing. Clinical practice in interventional radiology is a must for IR to continue to \ngrow and fulfil its potential. Outpatient clinics, day case and inpatient beds should \nall be part of IR work plans. Teaching is an important part of any clinical discipline \nand interventional radiologists need to ensure that IR plays a prominent role in \nthe undergraduate and postgraduate curricula of medical schools. Research is \nalso important and has been gathering momentum and critical mass over the last \n10 years. In Europe, IR remains strong under the stewardship of CIRSE. CIRSE \nholds the largest IR meeting, with an attendance of over 5000 delegates, annu -\nally. Recently, IR has been recognised as a sub-speciality under the umbrella of \ndiagnostic radiology at UEMS. This is an important milestone with great potential. \nIn fact, CIRSE have recently run the first sub-certification examination (European \nBoard of Interventional Radiology-EBIR) in Interventional Radiology in Europe in \nOctober 2010. Importantly, the examination was endorsed by ESR and by the IR \nDivision of UEMS. I believe EBIR is an incredibly important examination which \nwill supercede national boundaries and give IR a more secure footing in Europe. \nInterventional radiology is emerging into the light, I believe it has a bright future. \nLearning Objectives:\n1. To learn about ways to guide IR in a safe direction.\n2. To learn about subcertification in IR.\n3. To understand the importance of recognition by UEMS.\n4. To understand the issue of working in multidisciplinary teams.\nPanel discussion: \nWhat does an interventional radiologist need to know? 09:44\nSome years ago, interventional radiologists (IRs) could have been seen as skilled \nphysicians interested in the performance of complex vascular procedures. This is not \nthe case anymore and now IRs are (or should be) fully involved in the multidisciplinary \nmanagement of patients. This new scenario needs specific training, recognition \namong other specialists and institutional boards as well as specific subcertification. \nPanel discussion: \nHow can you easily implement some functional imaging into your \npractice? 09:44\nThrough clinical cases the speakers will discuss or debate the best use of the \navailable functional imaging techniques, pitfalls and limitations and how they can \nbe optimally used in combination with correlative anatomic imaging modalities ac-\ncording to the clinical questions (staging, restaging, assessment of response and \nprediction of patient prognosis before and after neoadjuvant therapy). \n08:30 - 10:00 Room F2 \nProfessional Challenges Session \nPC 7 \nProfessional issues in interventional radiology: \neducation, training and standards \nModerators: \nJ.I. Bilbao; Pamplona/ES \nJ.H. Peregrin; Prague/CZ \nA‑210\t 08:30 \nChairmen’s introduction \nJ.I. Bilbao1, J.H. Peregrin2; 1Pamplona/ES, 2Prague/CZ (jibilbao@unav.es) \nInterventional radiology (IR) is the part of clinical radiology based on the per -\ncutaneous or endoluminal treatment of widespread conditions. The procedures \nperformed by the interventional radiologists require a deep level of knowledge of \nclinical imaging and specific training in patient management and care. Technical \nskills are also needed because complex devices and materials are used in some \nprocedures. Therefore, specific training programmes are required to address the \ntraining needs for the interventional radiologist. A multidisciplinary approach is \nrequired (based on team work) with defined levels in patient care. IR procedures \nhave become the treatment of choice for many conditions as an alternative for \nsome surgical procedures. Even for some conditions without a defined treatment \nare now being treated by IR. Thus, it is a discipline with a great deal of interaction \nwith other clinical specialities that requires a clear definition. IR specialists have to \nreceive recognition in the patient care process and their activity has to be known by \nthe medical community. The recognition of IR as a subspecialty of clinical radiology \nby the UEMS will contribute to the development of specific training programmes in \nthe European community and will promote training centres with certified specialists. \nSession Objectives:\n1. To know more about the specific training needed for interventional radiology \n(IR).\n2. To learn about the interaction between IR and other specialties.\n3. To understand the relevance of the recognition of IR as a UEMS division \nwithin the section of Radiology.\nA‑211\t 08:35 \nEducation and training in IR \nA.-M. Belli; London/UK (Anna.Belli@stgeorges.nhs.uk) \nInterventional radiology (IR) procedures are complex and require specific training \nto ensure good results. In the UK, a curriculum for subspecialty training was es-\ntablished in 1998 specifying the required knowledge, training and core procedures \nexpected of trainees. This curriculum has undergone several reforms since that \ntime. However, training is not uniform throughout Europe and this stimulated the \ndevelopment of a Europe wide IR training document to ensure similar training in \nall countries as a way of ensuring good medical practice. Radiology training is \nbased on 3 years of common radiology training and 2 years of subspecialty train-\ning with an option for further specialist training in the 6 th year. Regular appraisals \nand assessments of trainees’ performance should guide progress at local train-\ning institutions with the aim that competence is assessed formally at the end of \ntraining by a European Board examination. This qualification will be recognised \nthoughout Europe and ensures that the required proficiency in IR procedures has \nbeen attained. Competence in the core skills for IR occurs during the first 3 years \nof training. In the next 2 years, trainees undertake modular training depending on \ntheir areas of interest and ultimate goals. The majority of this training is practical, \nsupervised training in interventional suites and theatres, with clinical exposure. \nSimulators play a role alongside the more traditional training methods and allow \nearly training in a more forgiving environment away from the patient. Development \nand validation of such simulation models is progressing. \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S59\nCB D E F G H\ndiscrimination of individual x-ray quanta, i.e. the detectors can ‘see’ the colour of \nthe x-rays. Different materials attenuate the energy spectrum in their own charac-\nteristic way. By comparing the measured spectra with the spectrum emitted from \nthe x-ray tube the penetrated material can be characterised. Colour x-ray imaging \ncan be used in breast imaging to detect, for example the uptake of an iodinated \ncontrast agent to show the vasculature of a tumour while reducing the impact of the \nstructures from the surrounding tissue. It can also be used to estimate the breast \ndensity and as a material decomposition technique to separate the digital mam-\nmogram into compositional images, showing different material types separately. \nColour x-ray imaging can, for example be realised with pulse height discrimination \nin a photon counting detector, multiple exposures with different x-ray tube settings \nor filtering the x-ray beam before or after the object. The most simple form of colour \nx-ray is dual energy where two images are acquired at different x-ray energies.\nLearning Objectives:\n1. To learn the benefits of colour x-ray imaging.\n2. To get an overview of available methods for colour x-ray imaging and their \nrespective advantages and drawbacks.\n08:30 - 10:00 Room I/K \nChest \nRC 704 \nNon-small cell lung cancer \nModerator: \nJ. Vilar; Valencia/ES \nA‑217\t 08:30 \nA. Update in TNM classification \nS. Diederich; Düsseldorf/DE (s.diederich@marien‑hospital.de) \nLung cancer staging is based on imaging techniques in combination with tissue \ndiagnosis and surgical exploration. The TNM staging system describes the local \ntumour extent (T1-T4), presence or absence of lymph node metastases (N0-N3) \nand distant metastases (M0/M1). Different combinations of T-, N- and M-factors \ntranslate into tumour stages (stages IA-IV). Therapeutic decisions and assessment \nof prognosis are based on these tumour stages. Recently, the TNM system has \nbeen modified: tumour size is now used more precisely for T staging: tumours \n<= 2 cm: T1a, > 2-3 cm: T1b, > 3-5 cm: T2a, > 5-7 cm: T2b, > 7 cm: T3. Satellite \ntumour nodules in the same lobe are now classified as T3 (previously T4) and in a \ndifferent lobe of the ipsilateral lung as T4 (previously M1). Satellite nodules in the \ncontralateral lung (previously M1) and pleural or pericardial metastases (previously \nT4) are now classified as M1a, whereas distant metastases outside the chest are \nclassified as M1b (previously M1). Also, the TNM staging system should now be \napplied not only to non-small cell lung cancer (NSCLC) but also to small cell lung \ncancer (SCLC). During this refresher course the different T-, N- and M-stages will \nbe presented including the recent changes and examples will be presented and \ndiscussed with the audience. Therapeutic strategies in different tumour stages \nwill be described and key decisions highlighted. The accuracy of different imaging \nprocedures and findings will be presented and the role of biopsy in specific clinical \nscenarios will be discussed. \nLearning Objectives:\n1. To understand the principles of TNM classification for lung cancer.\n2. To understand the relationships between tumour stage, prognosis, and \ntherapeutic strategies.\n3. To become familiar with the recent changes of TNM classification for lung \ncancer.\nA‑218\t 09:00 \nB. PET/CT in lung cancer \nN. Howarth; Chêne‑Bougeries/CH (nigel.howarth@grangettes.ch) \nIntegrated PET/CT imaging has an established role in the management of cancer \npatients and is now recommended for all patients with curative non-small cell \nlung cancer. PET/CT provides information essential for staging and prognosis, \nfor choice of management and monitoring of treatment and for the detection of \nrecurrence. Recent technical developments in PET/CT permit rapid examinations \nwith improved resolution. Compared with standard CT or stand-alone PET, the \nadded value of fused imaging is uncontested. The clinical influence of preoperative \nPET/CT is currently undergoing extensive evaluation. Radiologists should benefit \nfrom an understanding of important aspects of molecular imaging to improve their \ncontribution to patient management. With the increasing use of PET/CT in the \n08:30 - 10:00 Room G/H \nEFOMP Workshop \nNew technology in diagnostic radiology:  \nadvances in breast imaging \nEF 1 \nAdvances in technology for breast imaging \nModerators: \nS. Christofides;  Nicosia/CY \nA. Del Guerra; Pisa/IT \nWelcome address \t 08:30\nS. Christofides;  Nicosia/CY \nY. Menu; Paris/FR \nA‑214\t 08:40 \nBreast tomosynthesis \nP.R. Bakic; Philadelphia, PA/US (Predrag.Bakic@uphs.upenn.edu) \nDigital breast tomosynthesis (DBT) is an imaging modality which allows for three dimen-\nsional visualisation of breast tissue based upon the tomographic reconstruction using \na limited number of x-ray projections. Early clinical studies indicated higher specificity \nand sensitivity compared to mammography, thus suggesting DBT as a candidate for \nreplace mammography for early cancer screening. There are still several open issues \nin DBT, as, e.g. visualisation of microcalcifications, breast density estimation, use of \ncontrast-enhanced DBT, and optimisation of DBT acquisition and reconstruction. This \nlecture will review published results of DBT clinical trials and discuss the open ques-\ntions related to the use of DBT in quantitative imaging. In addition, we will discuss the \nuse of simulation in DBT optimisation and validation. Validation of DBT is a challenging \ntask due to its technological complexity. Clinical trials represent the gold standard for \nvalidation. They are, however, long, costly, and involve repeated exposure of women \nto radiation. Pre-clinical DBT validation may be performed using simulation of breast \nanatomy and image acquisition. Such approach offers ground truth about simulated \ntissues and flexibility to vary anatomy and/or acquisition parameters. The use of simula-\ntion in DBT validation will be illustrated by the examples of DBT geometric accuracy \nestimation and optimisation of DBT reconstruction parameters. \nLearning Objectives:\n1. To become familiar with the current research topics in digital breast \ntomosynthesis.\n2. To compare the performance of digital breast tomosynthesis with \nmammography in terms of early cancer screening.\n3. To learn about the use of breast anthropomorphic computer phantoms and \nacquisition simulation in validation of digital breast tomosynthesis.\nA‑215\t 09:05 \nBreast CT \nW.A. Kalender; Erlangen/DE (willi.kalender@imp.uni‑erlangen.de) \nX-ray computed tomography (CT) has been proposed and evaluated recently as a \npotential alternative method for breast imaging. Efforts so far showed success with \nrespect to contrast-enhanced dynamic imaging, but suffered from limited spatial \nresolution. Respective efforts and clinical results will be reviewed. The new concept \npresented here builds upon micro-CT scanning approaches and aims at providing \nboth high spatial resolution at around 100 µm for micro-calcification imaging and \nadvanced dynamic scan capabilities with continuous acquisition and scan times of \nabout 10 seconds for differential diagnosis of lesions. To achieve this, spiral scan \nmodes, slipring technology, high-resolution detectors and high-power micro-focus \nx-ray tubes are demanded. The concept has been evaluated and confirmed by simu-\nlations and basic experiments; feasibility studies are expected by the end of 2011. \nLearning Objectives:\n1. To review the state of the art in CT of the breast.\n2. To inform about concepts for dedicated CT scanners of the breast.\nA‑216\t 09:30 \nX-ray colour in breast imaging \nC. Ullberg; Danderyd/SE (christer.ullberg@xcounter.se) \nColour x-ray imaging can best be described as the x-ray analogy to optical colour \nimaging. In optical imaging the wavelength - the energy - of the light gives the dif-\nferent colours that we see. Emerging x-ray detector technologies enable energy \n\nPostgraduate.Educational.Programme\nS60\n A B C D E F G H\nmaintenance of confidentiality of patient information. In contrast, more hierarchi -\ncal cultures often defer to elders for decision-making whereas communal cultures \nmay involve community leaders in a shared decision-making process. Gender \nand religious issues can also affect the provision of high-quality procedures with \nsame gender care being a requirement within some cultural groups and gowning \nprocedures that maintain cultural values frequently being an expectation. In addi-\ntion, in many countries in the developing world, radiation still has mystique and fear \nassociated with it, affecting participation in screening programs and recruitment to \nmedical radiation technology educational programs. This presentation will present \nfindings from a variety of countries and cultures that will help to contextualise these \nissues through a cross-cultural imaging lens. \nLearning Objectives:\n1. To understand the concept of culture in relation to healthcare delivery from a \ntechnologist’s and patient’s perspective.\n2. To understand the impact of culture on patient health outcomes.\n3. To understand the knowledge, skills and attitudes needed by a culturally \ncompetent health practitioner.\n4. To consider the impact of global differences in ethical codes, scopes of \npractice, educational and professional practice expectations.\nA‑221\t 09:15 \nB. Basic technique for image interpretation \nC. Patrick; Poole/UK (Cheryl.Patrick@poole.nhs.uk) \nFirst line image interpretation is now commonly used in the United Kingdom. For \nmany years radiographers have used a system commonly known as “Red Dot” in \norder to identify to the referring clinician that an abnormality has been recognised \non a radiographic image. This has more recently evolved into radiographer com-\nment where the radiographers’ experience in recognising abnormalities can help \nreferring clinicians. Junior doctors are often inexperienced at image interpretation, \nthus this system can assist in ensuring that a higher percentage of fractures and \ninjuries are observed and the appropriate treatment obtained. This presentation \nwill demonstrate the fundamentals of basic image interpretation of the cervical, \nthoracic and lumbar spine in a trauma situation. It will include basic anatomy, \nmechanism of injury, common fractures and soft tissue signs. Using these principles \nthis will encourage radiographers to use the comment system, both developing the \nradiographer’s role and helping to improve patient care. \nLearning Objectives:\n1. To be familiar with the principles of image interpretation.\n2. To gain knowledge of common abnormalities and injuries of the C/T and L \nspine.\n3. To appreciate the role of the radiographer in image interpretation.\n4. To consolidate knowledge of normal and abnormal radiographic \nappearances of the spine.\n08:30 - 10:00 Room N/O \nHead and Neck \nRC 708 \nSuprahyoid neck \nModerator: \nD. Pereira Coutinho; Lisbon/PT \nA‑222\t 08:30 \nA. Anatomy-guided differential diagnoses \nC.R. Habermann; Hamburg/DE (c.habermann@uke.uni‑hamburg.de) \nTwo fasciae cross the suprahyoid neck: the superficial cervical fascia (SCF) and \nthe deep cervical fascia (DCF). The latter can be divided into three parts and \nthese layers define different fascial spaces or compartments. The descriptions of \nthese compartiments in the literature vary almost as much as those of the fasciae \nthemselves. In addition, the names of the formed compartiments vary within the \nliterature. Despite these controversies, the knowledge of these compartiments is \ninestimable for correct differential diagnosis of pathologies that arise in the su-\nprahyoid neck. With the utilisation of cross-sectional imaging, it has been noticed \nthat growth of some tumours appears restricted by fasciae and knowledge of the \nanatomy of these fasciae allows not only prediction of growth patterns. By allocation \nof a tumour to a certain compartiment the number of differential diagnosis drop \ndramatically due to the fact that in different compartiments different types of tissue \noccur. In addition, the exact localisation of infectious disease of the suprahyoid neck \nmay predict further intracranial or mediastinal spread. Even though the number \nmanagement of cancer patients, imaging pitfalls must be recognised to avoid both \nfalse-positive and false-negative interpretation. The principles and good practices \nof PET/CT will be explained. Normal distribution of FDG, pitfalls and normal vari-\nants will be presented. Specific examples will be discussed to demonstrate how \nthe combined information of images of human anatomy upon which biological \ninformation within body structures is added improves delineation of disease, can \nguide surgical and radiation planning and biopsy. Advances in technology result in \nnew training requirements for radiologists who should promote close collaboration \nwith nuclear medicine specialists. \nLearning Objectives:\n1. To review clinical indications and limitations of PET/CT for lung cancer \nstaging and management.\n2. To learn about future developments of PET/CT in lung cancer staging.\n3. To understand the need for a complete integration of the nuclear medicine \nspecialist and the radiologist in PET/CT examinations.\nA‑219\t 09:30 \nC. Radiofrequency ablation of NSCLC: current status \nF. Deschamps; Villejuif/FR (Frederic.Deschamps@igr.fr) \nPercutaneous radiofrequency ablation (RFA) is a safe and effective treatment \nfor patients with small non-small cell lung cancer (NSCLC). The low morbidity, \nincluding pneumothorax requiring chest tube drainage (10%), breathing impair -\nment pain and hospital stay make it possible in patients who have comorbidities \nthat make them not surgical candidate anymore or in single lung patients. A series \nof 75 primary NSCLC (75% stage IA and 25% stage IB) patients demonstrated a \nmedian survival of 29 months with a 1, 3, and 5 years overall survival of 78%, 36%, \nand 27%. Median survival for stage IA was 30 months and 25 months for stage \nIB. Better survival was reported for tumours 3  cm or smaller with a survival rate \nclose to 50% at 5 years. This is probably because the maximal ablation diameter \nis slightly larger than 40 mm with the electrode needles available now. Compared \nwith RFA, larger and more circular zones of thermal necrosis with faster growth \nof the ablation zone can be achieved with microwave ablation (MWA) in a swine \nlung model. Early trials have demonstrated promising results for MWA and gives \nhope for better rate of complete ablation for larger tumour. Follow -up imaging of \nthe ablation volume on CT is essentially based on morphologic evaluation. This \nmethod of evaluation has some drawbacks, namely late discovery of incomplete \ntreatment. PET-CT appears promising to provide early evaluation of treatment \nresponse. Sensitivity and specificity of PET has been reported superior to CT in \nearly detection of incomplete ablation. \nLearning Objectives:\n1. To be able to define the best candidates for lung radiofrequency ablation.\n2. To understand the results of radiofrequency ablation for primary tumours and \nlung metastases.\n3. To review different imaging patterns of ablated lesions in the lung.\n08:30 - 10:00 Room L/M \nRadiographers \nRC 714 \nRadiography as a profession and a science \nModerators: \nN. Kinsman; Poole/UK \nC. van Kuijk; Amsterdam/NL \nA‑220\t 08:30 \nA. Cultural competence in the practice of radiography: international \nimplications \nC. Cowling1, L. Boyd2, M.D. Ward3; 1Rockhampton/AU, \n2T oronto, ON/CA, 3St. Louis, MO/US \nAt its core, radiography is the acquisition of radiographic images to help diag -\nnose and treat patients within clinical practice. There are, however, many factors \nwhich impact on the success of procedures and resultant quality of images. The \noperator-client relationship is often influenced by cultural values and norms which \ncan vary considerably. Optimal images are dependent both on operator skill and \nclient compliance which comes with a sense of trust critical to the fiduciary relation-\nship. This can be difficult to achieve within the physical environment of a radiology \ndepartment and can also be impeded by cultural expectations and cultural conflict. \nWestern societies that stress individual rights tend to focus on health practices that \nare embedded in this worldview such as the requirement for informed consent and \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S61\nCB D E F G H\n08:30 - 10:00 Room P \nVascular \nRC 715 \nVascular imaging: diabetes and vascular occlusive \ndisease \nModerator: \nM. Sapoval; Paris/FR \nA‑225\t 08:30 \nA. Metabolic syndrome, diabetes and vascular disease: what do we need \nto know? \nE. Minar; Vienna/AT (erich.minar@meduniwien.ac.at) \nThe metabolic syndrome refers to the clustering of cardiovascular risk factors includ-\ning diabetes, obesity, dyslipidaemia and hypertension. The association between \nmetabolic syndrome and cardiovascular diseases raises important questions about \nthe underlying pathological processes. Insulin resistance and visceral obesity have \nbeen recognised as the most important pathogenic factors. Metabolic syndrome \ngenerally precedes and is often associated with type 2 diabetes. Cardiovascular \nrisk reduction in individuals with metabolic syndrome should include (1) control of \nobesity, diet and physical activity and (2) control of the individual components of \nmetabolic syndrome, especially atherogenic dyslipidaemia, hypertension, hypergly-\ncaemia and prothrombotic state. Appropriate management of metabolic syndrome \nshould be able to prevent the progression from impaired glucose tolerance to frank \ndiabetes and thus to prevent the increasing prevalence of type 2 diabetes and \nvascular diseases. Each 1% increase in HbA1c is associated with a 28% increase \nin risk of incident PAD. Diabetes is also highly associated with progression of PAD \nand especially with the development of critical limb ischemia. Rigorous control of \nblood glucose prevents the microvascular complications of diabetes, although \nsimilar benefits on the macrocirculation have not been ascertained. Patients with \ndiabetes and PAD should have an aggressive control of blood glucose levels with \na HbA1c goal of < 7.0% or as close to 6% as possible. In the new TASC paper this \nrecommendation is graded as C, meaning that it is based on evidence obtained \nfrom expert committee reports or opinions and/or clinical experiences of respected \nauthorities, while there are no applicable studies of good quality. \nLearning Objectives:\n1. To learn the principles of metabolic syndrome and diabetes.\n2. To understand how both diseases affect the vascular system.\n3. To learn which vascular territories are primarily affected.\nA‑226\t 09:00 \nB. Imaging strategies in the diabetic foot syndrome \nR. Iezzi; Rome/IT (r.iezzi@rad.unich.it) \nPeripheral arterial disease (PAD) is a common cardiovascular complication in patients \nwith diabetes. In contrast to non-diabetic PAD, it is more prevalent and, because of the \ndistal territory of vessel involvement and its association with peripheral neuropathy, \nit is more commonly asymptomatic. Diabetic PAD thus may present later with more \nsevere disease and have a greater risk of amputation. The pervasive influence of \ndiabetes on the atherothrombotic milieu of the peripheral vasculature is unique. The \nabnormal metabolic state accompanying diabetes results in changes in the arterial \nstructure and function. The proatherogenic changes include increases in vascular \ninflammation and derangements in the vascular cellular components, alterations in \nblood cells and haemostatic factors. These changes are associated with an increased \nrisk for accelerated atherogenesis as well as poor outcomes. In contrast to the focal \nand proximal atherosclerotic lesions of non-diabetic PAD, in diabetic patients the \nlesions are more likely to be more heavily calcified, diffuse, and distal, sparing the \nproximal vessels and mainly affecting the more distal arteries in the calf and, in a \nlater stage, the foot. By identifying a patient with subclinical disease and instituting \npreventative measures, it may be possible to avoid acute, limb-threatening ischaemia. \nThe primary imaging modality to be used should be duplex ultrasound, due to its \nnon-invasive nature, lower risks and costs. CT-angiography and MR-angiography \nare now replacing DSA as standard imaging methods, providing a non-invasive \nassessment of the localisation and extension of a vascular lesion and allowing an \naccurate planning of endovascular and/or surgical treatment. \nLearning Objectives:\n1. To review the typical lesions encountered in the diabetic foot syndrome.\n2. To understand the underlying pathophysiology.\n3. To learn imaging strategies for the evaluation of the diabetic foot syndrome.\nof spaces in the literature varies from seven to fourteen, the use of seven spaces \nor compartiments seems to be helpful for a sufficient diagnostic approach using \ncross-sectional imaging. Anatomic landmarks and the radiologic appearance in a \nnon-pathologic suprahyoid neck and a pathologic involvement of the suprahyoid \ncompartiments will be reviewed extensively in a coherent manner. \nLearning Objectives:\n1. To identify CT and MR imaging landmarks of the neck spaces.\n2. To recognise the CT and MR imaging findings of normal anatomical \nstructures in each space.\n3. To understand the use of neck spaces as a basis for the differential \ndiagnosis of pathologic conditions in the neck.\nA‑223\t 09:00 \nB. Suprahyoid neck lesions in daily clinical practice \nV. Chong; Singapore/SG (dnrcfhv@nus.edu.sg) \nThe anatomy of the suprahyoid neck is complex and the spectrum of diseases \nis wide. To improve studies of the neck, radiologists should become increasingly \nmore familiar with the anatomy and expected pathology in the various spaces. \nThis familiarity provides crucial information required for the selection of treatment \noptions and therapeutic planning. In addition, radiologists should be aware of \nsituations when diagnostic inaccuracies may lead to serious consequences and \ncomplications. For example, surgical approach to a deep lobe parotid tumour as \nthough it is a parapharyngeal lesion will in all likelihood result in facial nerve injury. \nMRI artefacts such as complex flow-induced increase in signals may be mistaken \nas a lesion prompting an unnecessary operation. An awareness of such pitfalls \nhelps to improve the quality of imaging studies. This presentation highlights some \npertinent anatomical knowledge that may help to improve the diagnostic accuracy \nof neck studies and at the same time explain the existence of pitfalls that may ruin \nimaging studies. \nLearning Objectives:\n1. To learn the anatomic basis of imaging abnormalities.\n2. To understand the pathological basis of image interpretation.\n3. To learn the potential pitfalls of radiological diagnosis.\nA‑224\t 09:30 \nC. Tips and tricks for suprahyoid neck lesions \nA. Trojanowska; Lublin/PL (agnieszka30@yahoo.com) \nThree layers of the deep cervical fascia define the suprahyoid neck compartments, \nwhich include: prevertebral, retropharyngeal, carotid, masticator, parapharyngeal \nand pharyngeal mucosal space. Knowledge of the structures inherent to these \nspaces will provide the radiologist with an accurate basis for differential diagnosis. \nAlso, expanding lesions will distort or displace adjacent structures and fascia in \npredictable fashion, which is crucial in defining the site of origin. Both MRI and \nCT are frequently used in the imaging of suprahyoid neck lesions. The introduc -\ntion of functional imaging has also given some benefits. Primary and secondary, \nbenign and malignant processes occupying major suprahyoid neck spaces will be \ndiscussed, with regard to crucial findings necessary for appropriate treatment selec-\ntion and treatment planning. Since correct diagnosis requires close collaboration \nwith ENT surgeons, clinical findings will also be discussed, together with practical \ninformation needed for surgery. \nLearning Objectives:\n1. To become familiar with the most frequent pathologies in the suprahyoid neck.\n2. To review the proper imaging technique.\n3. To learn how to differentiate between benign and malignant lesions.\n4. To learn about a template for the ‘perfect’ report.\n\nPostgraduate.Educational.Programme\nS62\n A B C D E F G H\nA‑229\t 09:00 \nB. MR spectroscopy \nL. Astrakas; Ioannina/GR (astrakas@cs.uoi.gr) \nIn vivo proton MR spectroscopy is a non-invasive MR technique that is routinely used \nto assess a number of paediatric neurologic conditions. It is based on the fact that \nprotons belonging to different metabolites resonate at slightly different frequencies \n(chemical shift). Using water suppression and volume localisation techniques we \ncan obtain a spectrum (single voxel) or spectra (SI) containing metabolite peaks \ncorresponding to predetermined anatomical site(s). In paediatrics the majority of \nspectroscopy is performed in the brain and the metabolites detected usually are: \nN-acetyl aspartate, N-acetyl aspartyl glutamate, creatine and phosphocreatine, \nCholine containing compounds (free choline, acetylcholine, phosphocholine, \ncytidine diphosphate choline and glycerophosphocholine), myoinositol, myoino -\nsitol monophosphate and glycine, aminoacids (glutamine, glutamate and GABA), \nlactate, lipids and macromolecules. These metabolites participate in fundamental \nmetabolic pathways and their levels are being disturbed by various pathologies. \nThus, MR spectroscopy has a vast field of application including paediatric tumours, \ninfarction, hypoxia, ischaemia, infection, inflammation, metabolic disorders neuro-\nlogical disorders and trauma. In many cases, it can redirect or narrow differential \ndiagnoses; in selected instances, it may provide the key finding that points to a \nfinal diagnosis. However, MR spectroscopy alone is usually not specific, but can be \nvery helpful especially in combination with other clinical, diagnostic and other MR \nmethods. Finally, particular caution is needed in data evaluation because spectral \nappearance and concentrations of the most prominent metabolites are affected by \n(a) experimental and preprocessing factors and (b) brain development. \nLearning Objectives:\n1. To become familiar with the basic principles of proton MR spectroscopy.\n2. To understand what proton MR spectroscopy can offer to the diagnosis and \nmonitoring of various paediatric diseases.\n3. To understand how MR spectroscopy combines with other MR techniques.\nA‑230\t 09:30 \nC. Vascular diseases: the role of CTA, MRA, angiography (DSA) \nN. Girard, X. Combaz; Marseille/FR (nadine.girard@ap‑hm.fr) \nStroke in children is most often of ischaemic origin and thrombophlebitis is the \nsecond cause of stroke in children. Stroke is considered as rare compared to \nthe adult population. However, numerous aetiologies impose to look for a cause \nthrough series biological investigations. The goal of brain imaging is to confirm \nthe diagnosis of stroke, to evaluate the extension of ischaemia and mostly to \nparticipate in the search of a cause for the stroke. Prognostic is mostly related to \nthe aetiology. A lot of cases are performed under general anaesthesia leading to \nlimited indications of MRA in the acute phase compared to adult. The role of CTA \nat the acute phase is mostly to confirm thrombophlebitis and is the primary method \nto assess intracranial vessels at the acute phase of haemorrhage of arterial or \nvenous origin. It is also the primary method to assess arterial vessels at the neck \nlevel (especially when dissection is suspected). CTA permits to confirm or rule out \narterial lesion that was suspected on MR: indeed, cases with pitfalls are numerous \nwith MR angiography. The role of MRA, also always performed in the acute phase \nor follow-up of vascular diseases, is not as clear as CTA role because of artefacts \nespecially in young children. The role of angiography (DSA) is finally limited to \nprove vasculitis when the other methods are not contributive and in cases of arte-\nrial or arterio-venous malformation to plan the treatment (endovascular procedure \nversus surgery or radiosurgery). \nLearning Objectives:\n1. To become familiar with the specific presentation of cerebral vascular \ndiseases in children.\n2. To compare and appreciate specific indications for CTA, MRA and DSA.\n3. To understand the best imaging approach depending on clinical \npresentation.\nA‑227\t 09:30 \nC. Imaging prior to revascularisation: CTA, MRA or DSA? \nS.O. Schönberg; Mannheim/DE (Baerbel.Reichhard@umm.de) \nThe choice of the appropriate modality for imaging of the peripheral vascular \nsystem strongly depends on the type of disease. In the acute setting of lower leg \nischaemia caused by embolism or thrombosis on top of a pre-existing high-grade \nstenosis CT angiography frequently is the imaging modality of choice due to its \n24-hour availability and robustness with reasonable accuracy in the upper leg \nexceeding 90%. With the introduction of dual energy CT, visualisation of lower leg \narteries and highly calcified areas has improved. For elective patients, contrast-\nenhanced MR-angiography (CE-MRA) is the technique of choice, in patients with \nrenal insufficiency preferably at 3 Tesla with a single dose of macrocyclic contrast \nagents. Recent continuous table-movement techniques have substantially reduced \ncomplexity and scan time and extended the spectrum to the emergency stetting. \nTime-resolved CE-MRA improves the detection of small arteries in the lower leg \nand reduces artefacts from venous overlay. Accuracy of state-of-the-art CE-MRA \nexceeds 95% compared to digital subtraction angiography (DSA). New fast spin-\necho and steady-state free precession MRA techniques without contrast media are \npromising, particularly in areas without motion. DSA should be restricted to the \ndisplay of the target lesion, inflow and run-off during the interventional procedure \nas well as to the in-detail visualisation of the anastomosis site prior to surgical \nrevascularisation particularly in the lower calf. \nLearning Objectives:\n1. To learn the anatomy of the arterial system of the lower leg and its variants.\n2. To review appropriate imaging protocols for each modality.\n3. To review the pros and cons of MRA, CTA and DSA in the diabetic foot \nsyndrome prior to revascularisation.\n08:30 - 10:00 Room Q \nPaediatric \nRC 712 \nAdvanced brain imaging \nModerator: \nC. Venstermans; Edegem/BE \nA‑228\t 08:30 \nA. Diffusion tensor MRI \nA. Righini; Milan/IT (neurorad@icp.mi.it) \nDiffusion tensor imaging (DTI) studies demonstrate progressive apparent diffusion \ncoefficient (ADC) decrease within grey and white matter areas starting from foetal \nlife as sign of brain maturation; meanwhile, fractional anisotropy (FA) increases in \nsome white matter structures. Changes in FA and ADC, together with radial and \naxial diffusivity values, during cell proliferation-migration and during myelination, \nwell correlate with modifications known from developmental histologic studies. \nAcute ADC decrease (i.e. ischaemia) can be detected already in foetal stroke and \nits measure is pivotal in monitoring neonatal hypoxic-ischaemic encephalopathy. \nADC calculation allows also to assess acute osmotic and metabolic anomalies in \nneonate (i.e. hypernatremia, hypoglycaemia, etc.). Early FA decrease, with radial \nand axial diffusivity changes, is observed in white matter areas as sign or early \nwallerian degeneration after acute brain damage. Chronic regional white matter \nFA reduction is detectable in sequelae of periventricular leukomalacia or adjacent \nto malformative cortex. Also, in children with neurodevelopmental delay (autism, \nADHD, dyslexia, etc.). FA reduction and radial or axial diffusivity changes have been \ndemonstrated, but in these conditions not on a single case basis rather in cohort \nquantitative studies. Finally, building fiber tracking and colour coded (RGB) maps \nfrom DTI data may help in better characterising suspected structural anomalies \non a single case basis (i.e. corpus callosum, hippocampal fornix, optic radiation, \ncerebellar peduncles malformations, etc.). However, the potentials of fiber tracking \napplications still need to be fully exploited, especially in view of future higher spatial \nresolution image acquisitions. \nLearning Objectives:\n1. To understand the relationship of ADC-FA values with the structural \ncharacteristics of the normal developing brain.\n2. To understand ADC-FA value changes in paediatric CNS diseases.\n3. To learn about the potential impact of fibre tracking in clinical paediatric \nneuroradiological practice.\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S63\nCB D E F G H\nLearning Objectives:\n1. To become familiar with the characteristic high-resolution CT manifestations \nof granulomatous pulmonary infections.\n2. To learn about the most helpful findings in distinguishing South American \nblastomycosis (paracoccidioidomycosis) from tuberculosis and other \ngranulomatous and non-granulomatous pulmonary infections.\nInterlude: The world is in love with Brazil 11:20\nA‑234\t 11:25 \nCongenital lung disease in children: state-of-the-art imaging \nP.A. Daltro; Rio de Janeiro/BR (daltro.pedro@gmail.com) \nCongenital pulmonary malformations may involve the lung parenchyma, bronchi, \narterial supply, and venous drainage. The pulmonary developmental abnormali -\nties that most commonly result in clinically significant complications in neonates \nand children are hypogenetic lung syndrome, bronchopulmonary sequestration \n(BPS), congenital lobar emphysema (CLE), bronchial atresia, congenital cystic \nadenomatoid malformation (CCAM), and bronchopulmonary foregut cysts. It \nshould be noted that there is often considerable overlap between these conditions \nand that multiple lesions may be identified in the same patient either separately \nor as hybrid lesions. The aim of this presentation is to illustrate the characteristic \nimaging manifestations of the most important congenital lung diseases and their \nmain differential diagnosis. Emphasis will be given to pre-natal diagnosis using \nultrasound or magnetic resonance imaging (MRI) and post-natal diagnosis using \nMRI or low dose CT in multidetector scanners. \nLearning Objectives:\n1. To review the characteristic imaging manifestations of the most important \ncongenital lung diseases in children and their main differential diagnosis.\n2. To understand the role of ultrasound and magnetic resonance imaging (MRI) \nin the pre-natal diagnosis of congenital lung diseases.\nPanel discussion 11:45\n10:30 - 12:00 Room E2 \nFoundation Course: Paediatric Radiology \nE³ 820 \nWhat should we know about antenatal imaging? \nModerator: \nC. Adamsbaum; Paris/FR \nA‑235\t 10:30 \nA. Foetal imaging: current practice and evidence base \nC. Garel; Paris/FR (catherine.garel@trs.aphp.fr) \nUltrasonography (US) is the primary screening modality in prenatal imaging. Its \ndiagnostic accuracy is usually very high so that the indications for foetal MRI should \nbe very rare. In some countries, because US is considered of secondary importance \nand is not exploited as much as it could be, there is a progressive shift from US to \nMRI as a prenatal imaging modality. Consequently, there are many discrepancies \nregarding the relative contributions of foetal US and MRI in the prenatal literature. \nThe main indications for foetal MRI will be discussed, with emphasis on the central \nnervous system, which remains the main field of application. In daily practice, the \ntechnique of foetal MRI has not changed during the last decade and most diagnoses \ncan be assessed using T1, T2 and T2* sequences. The basic technique and patient \npreparation will be described. New techniques, based on a functional or a metabolic \napproach, have been developing during the past few years but their impact on \ndaily practice is still very limited. Many studies have underlined the high diagnostic \ncontribution of foetal MRI compared with US. However, the diagnostic accuracy of \nMRI has not been studied in large series. Comparison between pre- and postnatal \ndata or between foetal MRI and pathological findings make it possible to define the \nmain limits of foetal MRI. Regarding the brain, migration or cortical development \ndisorders are often overlooked or underdiagnosed. A tight collaboration between \ncolleagues practicing prenatal US and MRI should increase diagnostic accuracy, \nboth modalities being complementary. \nLearning Objectives:\n1. To learn when MRI is recommended for the assessment of foetal \nabnormalities.\n2. To become familiar with patient preparation, the technique and the value of \nthe various sequences used.\n3. To understand the main limits of MRI in imaging of the foetus.\n10:30 - 12:00 Room B \nESR meets Brazil \nEM 3 \nThoracic imaging: a Brazilian approach \nPresiding: \nM.A. Gomes da Silva;  Sao Paulo/BR \nY. Menu; Paris/FR \nA‑231\t 10:30 \nIntroduction \nS.C.M. Tramontin1, M.A. Gomes da Silva2; 1Ponta Grossa/BR, 2Sao Paulo/BR \n(clinicamanoel@ig.com.br) \nFounded on September 15, 1948, the Brazilian College of Radiology comprises \n23 Regional Societies and ten thousand associates. The college is a branch of the \nBrazilian Medical Association (AMB) acting as its Scientific Department of Radiol-\nogy, Imaging Diagnosis and Radiotherapy. It collects, under the same umbrella \nmedical professionals and legal entities in the field of diagnosis and treatment using \nimaging methods and/or ionising radiation. \nSession Objectives:\n1. To get an introduction to the practice of radiology in Brazil.\n2. To understand the importance of radiology as a method for diagnosing \ndiseases in Brazil.\n3. To become familiar with the great technological advances of radiology in \nrecent years in Brazil.\nA‑232\t 10:35 \nGranulomatous interstitial lung disease: HRCT path correlation \nC.I.S. Silva; Salvador/BR (c.isabela.silva@gmail.com) \nGranulomatous interstitial lung diseases are a group of lung diseases in which \ngranulomas are an important component of the histologic findings. The most com-\nmon conditions are hypersensitivity pneumonitis and sarcoidosis. Hypersensitivity \npneumonitis is very common in Brazil because of the warm and humid climate in \nmost regions and a large number of birds. The prevalence of sarcoidosis in Brazil \nseems to be lower than that in North America and Europe. Other ubiquitous causes \nof granulomatous interstitial lung disease include intravenous talcosis, drug reac-\ntions, and some forms of vasculitis (e.g. Churg-Strauss syndrome). The aim of \nthis presentation is to illustrate the characteristic high-resolution CT and histologic \nmanifestations of the most common granulomatous interstitial lung diseases and \nto summarise the main differential diagnosis based on the pattern and distribution \nof abnormalities seen on high-resolution CT. \nLearning Objectives:\n1. To become familiar with the characteristic high-resolution CT and histologic \nfindings of the most common granulomatous interstitial lung diseases \n(hypersensitivity pneumonitis and sarcoidosis).\n2. To learn about the most helpful features in distinguishing the granulomatous \ninterstitial diseases from other parenchymal lung diseases.\nInterlude: Brazilian masterminds 10:55\nA‑233\t 11:00 \nGranulomatous pulmonary infections \nA.S. Souza Jr.; São José do Rio Preto/BR (asouzajr@gmail.com) \nThe most common granulomatous lung diseases are fungal infections and tuber-\nculosis. These infections are particularly prevalent in Brazil, the most common \nfungal infection being paracoccidioidomycosis (South American blastomycosis). \nHistoplasmosis and coccidioidomycosis may occur but they are uncommon. \nParacoccidioidomycosis is the most frequent endemic systemic mycosis in Latin \nAmerica, being seen particularly in Brazil, Argentina, Colombia, and Venezuela. \nThe lungs are the main target organ of P. Brasiliensis organisms, and infection of \nthe lungs is the leading cause of morbidity and mortality in these patients. Fungal \ninfections need to be considered not only in patients living in endemic regions \nbut also in patients who have travelled to these areas. Although the prevalence \nof pulmonary tuberculosis has decreased in Brazil in recent years it remains one \nof the most important causes of pulmonary morbidity and mortality. The aim of \nthis presentation is to discuss the radiologic manifestations of the granulomatous \npulmonary infections with emphasis in paracoccidioidomycosis and tuberculosis \nand to summarise the main differential diagnosis. \n\nPostgraduate.Educational.Programme\nS64\n A B C D E F G H\n10:30 - 12:00 Room G/H \nEFOMP Workshop \nNew technology in diagnostic radiology:  \nadvances in breast imaging \nEF 2 \nScreening and diagnostic breast imaging \nModerators: \nK. Faulkner; Wallsend/UK \nJ. Vassileva; Sofia/BG \nA‑238\t 10:30 \nQA, image quality and dose in screening with digital mammography \nH. Bosmans; Leuven/BE (hilde.bosmans@uz.kuleuven.ac.be) \nThe European Commission states in its council recommendation of 2 December \n2003 that mammography screening in women aged 50-69 is justified if performed \nin accordance with the European Guidelines on Quality Assurance (QA). This \nrecommendation and the Directive 97/43/Euratom on medical exposures made QA \nan important part of screening programmes. Physico-technical aspects of digital \nmammography are to be included in QA programmes. As with film-screen systems, \nboth acceptance tests, (half) yearly tests and constancy tests are necessary. Ac-\nceptance tests and yearly tests evaluate the performance of the system and the \ndose settings from blocks of PMMA. Special attention is given to the spatial char-\nacteristics of the (digital) detector, the noise properties and the signal-difference-\nto-noise-ratio. In the European guidelines, performance is ultimately assessed from \ncontrast threshold values for a series of disk diameters. We discuss the use of the \nCDMAM phantom along with alternative approaches such as detectability indices \nd’ (Monnin, Verdun, Marshall et al.) for systems in our QA network. The automatic \nexposure controller should ultimately be tested in real cases. Patient dose inves-\ntigations are more important than before. In digital mammography, and especially \nwith direct digital detectors, patient dose surveys can be automated. Constancy \nchecks have to guarantee an optimal quality every day. We will illustrate typical \nartefacts that occur with digital detectors and viewing stations. Daily homogeneity \ntests of the detector along with an automatic evaluation of DICOM tags allow both \nthe detection of sudden problems as well as a long-term follow-up of performance. \nLearning Objectives:\n1. To learn about the particular aspects of QA in digital mammography.\n2. To learn about contrast-detail analysis and alternative tests to assess system \nperformance.\n3. To learn about the implementation, the results and the added-value of \npatient dose surveys in digital mammography.\nA‑239\t 11:00 \nMRI diagnostic breast imaging \nK. Gilhuijs; Utrecht/NL (k.g.a.gilhuijs@umcutrecht.nl) \nMagnetic resonance imaging (MRI) is a highly sensitive technique that provides \ncomplementary information to conventional breast imaging (i.e. mammography and \nultrasonography) for the detection of multinodular disease and for the assessment \nof primary tumour extent. The use of MR breast imaging has increased consider-\nably in the past decade. Although its use is well established for some indications, \ne.g. detection of unknown primary and assessment of uncertain disease extent, \nbreast MRI is still under investigation for other applications such as preoperative \nassessment in patients eligible for breast conserving therapy on the basis of con-\nventional imaging and clinical examination. Despite its superior ability to visualise \ndisease spread, recent studies have shown increased rates of mastectomy without \nreduction in positive surgical margins or local recurrence rates. Nonetheless, a \nshift in paradigm is occurring, focusing on the use of breast MRI to reduce involve-\nment of healthy tissue in breast-conserving therapy. This paradigm involves new \nmethodology to optimise the transfer of information to the surgeons and radiation \noncologists. New technological developments, such as diffusion-weighted imag-\ning (DWI) and magnetic resonance spectroscopy (MRS) provide new insights to \nestablish a link with underlying biology of the tumour. Contrast-enhanced MRI, DWI \nand MRS are examined for their ability to extract prognostically relevant information \nto individualise therapy to individual patients and tumours. This overview aims to \nsummarise the current status of breast MR imaging and new developments geared \ntowards providing therapists with patient-tailored information for treatment decision, \ntreatment guidance and therapy response.\nA‑236\t 11:00 \nB. Ventricular enlargement and beyond \nE.H. Whitby; Sheffield/UK (e.whitby@sheffield.ac.uk) \nThis talk will review the current literature and clinical use of foetal MRI in cases with \nventriculomegaly. The initial part will discuss antenatal ultrasound in the detection, \ncategorisation and diagnosis at the 20-week anomaly scan. The role of foetal MRI \nwill be discussed including which cases may benefit most from foetal MRI when \nthe resource is limited. The timing of the foetal MR with relation to gestational \nage and the value of further foetal MR scans at a later gestational age will also \nbe discussed. This is still a controversial and debated area especially when the \nresource is limited or there are financial constraints. The current literature will be \ndiscussed on the issues around foetal MRI in cases with ventriculomegaly both \nisolated ventriculomegaly and ventriculomegaly associated with other abnormalities. \nFinally, this section will conclude by looking at the common associated abnormali-\nties seen in cases referred with ventriculomegaly. The final section will discuss \nthe role of foetal MR in imaging the posterior fossa, an area often difficult with \nultrasound especially in the later stages of pregnancy. Again the current literature \nwill be discussed and the use of foetal MR in clinical practice. The concluding time \nwill be used to summarise the referral pathway used by local centre in the UK. This \nwill differ with other UK centres and centres worldwide. Hopefully, time will allow \nan open discussion on this at the end of the session. \nLearning Objectives:\n1. To learn about the differential diagnoses of ventriculomegaly identified on \nfoetal ultrasonography.\n2. To learn when MR should be performed and its value when compared to \nultrasonography.\n3. To understand the value of MRI in assessing posterior fossa abnormalities.\nA‑237\t 11:30 \nC. Common chest and abdominal problems \nA. Darnell1, C. Martín2; 1Barcelona/ES, 2Sabadell/ES (andarnel@clinic.ub.es) \nPrenatal diagnosis involves obtaining genetic, anatomic, biochemical and physi-\nological information about the foetus and analysing whether there are any altera-\ntions that might have repercussions during the foetal period or after birth. Magnetic \nresonance imaging (MRI) has been useful in the diagnosis of foetal anomalies for \nmany years. Thoracic abnormalities play an important role in infant morbidity and \nmortality. Survival after birth depends largely on adequate lung development dur-\ning gestation, and various pulmonary problems can affect foetuses. Heart defects \nare present in 8 of 1000 live births, and up to 25% of these are associated with \nother malformations. Other thoracic anomalies (tracheoesophageal malformations, \nchest wall defects, and tumours, amongst others) can also cause morbimortality. \nCongenital abdominal anomalies can affect many organs. It is essential to determine \nthe location and morphological characteristics of the lesion to ensure an accurate \ndiagnosis. MRI‘s excellent contrast resolution between tissues is very useful in the \ndiagnosis of these conditions. Prenatal diagnosis also makes it possible to detect \nanomalies that can be difficult to recognise clinically in newborns but require early \ntreatment to minimise possible complications.This presentation stresses the im-\nportance of diagnosing chest and abdominal problems before birth and analyses \nthe usefulness of MRI in this context. \nLearning Objectives:\n1. To learn about the MR protocol when investigating the foetal chest.\n2. To recognise the situations in which MRI is helpful in assessing chest \nabnormalities.\n3. To understand the value of MRI when compared to ultrasonography in \nassessing congenital renal and gastrointestinal abnormalities.\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S65\nCB D E F G H\nA‑243\t 11:30 \nStructured reporting: improving the quality of radiology reports \nC.E. Kahn; Milwaukee, WI/US (kahn@mcw.edu) \nThe radiology report communicates the results of an imaging procedure and \nprovides the enduring legal record of the procedure. Structured reporting uses \nstandardised language and predefined formats to create reports. Structured reports \ncan integrate information collected during the imaging procedure, such as clini -\ncal data, technical parameters, measurements, annotations, and key images. In \nthis presentation, well defined structured reporting describes its advantages and \ndisadvantages, and identifies the motivations for its adoption. This session will \ndiscuss how structured reporting can make it easier to retrieve reported informa-\ntion, evaluate the appropriateness of exams, and aggregate data across health \ncare enterprises. Structured reporting can support radiology quality improvement, \nresearch, and education, and has the potential to improve the quality of commu-\nnication between radiologists and their referring colleagues. \nLearning Objectives:\n1. To define structured reporting and its potential role in radiology.\n2. To become familiar with current efforts to promote structured reporting of \nimaging procedures.\n3. To learn how structured reporting can improve the quality of radiology \nreports.\n12:15 - 12:45 Room A \nPlenary Session \nHL 2 \nPierre et Marie Curie - Honorary Lecture \nPresiding: \nY. Menu ; Paris/FR \nA‑244\t  \nBeyond morphology and into physiology: newer spine imaging techniques\nM.M. Thurnher; Vienna/AT \nThere are major challenges to imaging the spinal cord. A number of technical is-\nsues needed to be resolved before the advanced techniques could be used as an \nadjunct to the clinical evaluation. Small size of the cord, macroscopic motion related \nto physiological CSF pulsations, breathing and swallowing, and local field inhomo-\ngeneities lead to reduction of the image resolution and cause disturbing artifacts. \nDespite these challenges there are a number of potential solutions that have been \nintroduced in the last decade. Diffusion weighted imaging (DWI), diffusion tensor \nimaging (DTI), fiber tractography (FT) and functional BOLD (fMRI) of the spinal \ncord has seen progressive translation from the laboratory to the clinic. The results \nof recent studies show that significant changes in DTI metrics are present in the \ncervical spinal cord of patients with demyelinating diseases and other myelopathies, \nin the absence of spinal cord signal abnormality at conventional MR examinations. \nThere is no doubt that in the future advanced techniques will provide an excellent \nset of biomarkers for understanding neuroplasticity of the spinal cord and response \nto therapies. This lecture will focus on evolution of spinal cord imaging and update \nyou on the clinical applications of advanced techniques in imaging the spinal cord.\n12:30 - 13:30 Room Z \nThe Beauty of Basic Knowledge: Interpretation of the Chest \nRadiograph \nMC 21C \nAir-space disease \nA‑245\t 12:30 \nAir-space disease \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nAir-space disease is secondary to occupation of the acini and alveoli by oedema, \nexudates or malignant cells. It presents in the chest radiograph as ill-defined densi-\nties which tend to coalesce. The presence of an air bronchogram is pathognomonic. \nWhen the disease is widespread it shows the typical “butterfly” appearance. Air-\nLearning Objectives:\n1. To learn about the current status, indications and new developments in \nbreast MRI.\n2. To learn about processing, analysis and transfer of information from MRI to \nclinical decision making.\n3. To understand the limitations and current opportunities for breast MRI.\nA‑240\t 11:30 \nIs there a future for radioisotope breast imaging? \nS. Ziegler; Munich/DE (sibylle.ziegler@tum.de) \nNo abstract available \n10:30 - 12:00 Room Z \nStandards and Audit \nHow to write better reports \nModerator: \nE.J. Adam; London/UK \nA‑241\t 10:30 \nHow to write a good radiological report \nL.P. Lawler; Dublin/IE (llawler@mater.ie) \nThe pixel data set of modern imaging is transformed into a life altering insight \nfor the individual patient through the radiologic report. A good report is patient \nand service centred, and forms the basis of the reciprocal relationship between \nradiologist and referring clinician. It is a creative process with serious scientific \npurpose and becomes part of the permanent record in a person’s life. Its primary \nrole is communication of diagnostic and procedure-related imaging information \nbut it has many vital adjunct roles in quality service delivery. In current practice \nof multidisciplinary care the report content must be of value to all the stakehold -\ners beyond radiology. Structured reports must have uniformity where possible to \npermit data-mining and audit whilst preserving the individual radiologist practice \nand style and the individual nature of each patient’s health. Report design has \na particular role in modern alerting and safety-net systems when unexpected or \ncritical imaging findings are discovered. The properly written report can be vital in \nmedico-legal defence to reflect good practice. Ultimately guidelines and standards \non reporting must be meaningful to the users and appropriate to local resources, \nsystems and needs. \nLearning Objectives:\n1. To comprehend the role of the modern radiological report.\n2. To understand the role of the report in communication and patient safety.\n3. To become familiar with structured report formulations.\nA‑242\t 11:00 \nStructured reporting: European perspective \nR. Silverio; Grosseto/IT (rsilverio@sirm.org) \nIn the last decade, we observe an increasing interest in structured report (SR). This \nis a part of the DICOM standard, where the technical and clinical information are \norganised in a standard format so that it can be retrieved and reused for clinical, \nstatistical and research scopes. Structured reports have three important features: \na “structured” format, with fixed paragraphs, heading and subheading in which \nto describe technical data and clinical findings, impressions and conclusions; a \nconsistent, “itemised” organisation, leading to a better way of reporting, even with \nautomated speech recognition systems; and the possibility, or rather the need, \nof a common, shared language. When defined terms from a standard lexicon \nare associated with imaging reports, the information in the report becomes more \naccessible and reusable. Moreover, SR allows the interoperability between the \nDICOM world and the complex sphere of the e-health (electronic patient record, \npatient care, etc). It is possible to convert a radiological report created as SR in a \nCDA2 (Clinical Document Architecture) document. This clinical document will be \nused in every computerised healthcare application, as well in the several regional \ne-health projects (EPSOS, ELGA, Calliope, Renewing Health, etc). promoted by \nEuropean Community. Integrating the Healthcare Enterprise (IHE) initiative is as \na key partner in fostering the adoption of structured report. In short, question of \nwhether SR will be adopted by radiologists is now a question of “when”, not “if.” \nLearning Objectives:\n1. To become familiar with structured report.\n2. To keep up to date on the developments of e-health projects in Europe.\n\nPostgraduate.Educational.Programme\nS66\n A B C D E F G H\nLearning Objectives:\n1. To learn the different causes of ischaemic abdominal emergencies and \nprinciples for treatment by interventional radiology.\n2. To learn the causes and the optimal imaging strategy for preparing \ntreatment.\n3. To understand the principles, techniques and results of interventional \nradiology for the treatment of acute abdominal bleeding.\nA‑248\t 16:30 \nB. The black bowel \nP. Rogalla; T oronto, ON/CA (Patrik.Rogalla@uhn.on.ca) \nIschaemic bowel disease represents a life threatening disease that requires im-\nmediate clinical attention once diagnosed. Expansion of cardiac surgery, surgical \ninterventions in elderly and high-risk patients has created an increasing demand \nfor early diagnostic workup if bowel ischaemia is clinically suspected. Multi-row \ndetector CT with multiplanar reformations including further projection techniques \nplays a leading role in early detection of bowel ischaemia if blood work and clinical \npresentation are equivocal or contradictory. Optimal sequencing of intravenous \ncontrast media injection and the scanning delay represents a prerequisite for reli-\nable diagnostic outcomes. Knowledge of typical patterns of the disease, early and \nlate signs of ischaemic bowel disease is mandatory for radiologist in charge. The \ncourse will help to understand physiological principles and causes of ischaemic \nbowel disease. Diagnostic performance of current imaging tests and how to integrate \nthem into clinical practice will be discussed. \nLearning Objectives:\n1. To understand the underlying physiological principles and causes of \nischaemic bowel disease.\n2. To become familiar with typical signs of bowel ischaemia and how to use \nthem.\n3. To understand the diagnostic performance of current imaging tests and how \nto integrate them into clinical practice.\nA‑249\t 17:00 \nC. Clinical management: what you need to know \nD.E. Malone; Dublin/IE (dmalone@ucd.ie) \nAcute mesenteric insufficiency (AMI) is due to arterial or venous occlusion. Arterial \nAMI is an emergency. The typical patient is elderly, may have atrial fibrillation and \nhas recent onset intense visceral pain disproportionate to clinical signs. CT is the \nmainstay of diagnosis and may be supplemented by CT angiography (CTA). Waste \nno time if arterial AMI is suspected. Average mortality rates of 71% (59-93%) have \nbeen reported and symptom duration before therapy is an independent predictor \nof mortality. Age > 70 years, metabolic acidosis and renal failure are other danger \nsigns. Interrupt routine CT lists; ensure that these patients are scanned as soon as \npossible - neutral oral contrast and high-dose IV contrast are essential. CT appear-\nances should be correlated with serum lactate as acute arterial occlusion without \nreperfusion may produce falsely 'normal' bowel wall thickness. Early diagnosis and \naggressive surgical intervention combining bowel resection with revascularisation \noffer the best prognosis. Venous AMI may present with a more chronic, intermittent \ncourse of pain, fever, abdominal tenderness and ascites. Therapy is bowel resection \nand anticoagulation. Ischaemic colitis occurs in elderly patients with atherosclerosis \nspontaneously or after aortic aneurysm repair. There are fewer systemic manifesta-\ntions, bloody diarrhoea predominates; it may spontaneously resolve. CT or contrast \nenema is established imaging options. Chronic mesenteric ischaemia presents with \n'intestinal angina' and weight loss. Doppler US, CTA/MRA are diagnostic. Surgical \nor interventional therapy is feasible; the correct choice varies with individual patient \nanatomic and co-morbidity considerations. Endovascular therapy may have higher \nre-intervention rates, reducing cost-effectiveness. \nLearning Objectives:\n1. To review the clinical signs of ischaemic bowel disease.\n2. To analyse the clinical management of patients with suspected bowel \nischaemia with focus on workflow.\n3. To analyse cost-effectiveness and clinical outcome of early diagnosis and \ninterventional treatment options.\nspace disease may be divided into acute or chronic. The most common causes of \nacute disease are pneumonia, pulmonary infarct and pulmonary edema. Among \nthe chronic causes are alveolar cell carcinoma, tuberculosis, sarcoidosis and other \nsystemic diseases. \nLearning Objectives:\n1. To learn to recognise air-space disease.\n2. To learn about a differential diagnosis of the most common conditions.\n3. To evaluate imaging management of air-space disease.\n13:30 - 14:00 Room A \nPlenary Session \nGL \nGuest Lecture\nPresiding: \nY. Menu ; Paris/FR \nA‑246\t 13:30 \nSlicing through Antiques & Works of Art \nM. Ghysels; Brussels/BE (marc.ghysels@skynet.be) \nThis invited lecture explores the groundbreaking use of CT for studying antiquities \nand artworks from a wide range of cultures, irrespective of their age or material. \nDr. Marc Ghysels, a former interventional radiologist, comes from a family of art-\nists and collectors. About ten years ago he set up a private radiology practice in \nBrussels where he analyses antiquities and artworks. Over the years he has built \nan international reputation among collectors and art dealers as well as museum \ncurators and experts working in auction rooms. Art specialists call on his radiologi-\ncal skills and knowledge to authenticate antiquities, and more specifically to show: \nwhat methods were used to make the works, what damage they have suffered over \nthe years, how much restoration has been done, and to expose the many tricks \nused by forgers to deceive not only the discerning eye of the collector but also the \nmethods of scientific analysis more commonly used than CT scans. His presentation \nwill highlight the prominent role of CT as a nondestructive test to explore selected \nartworks made in wood, terracotta, stone, and ivory. \n16:00 - 17:30 Room A \nRadiology in Abdominal Emergencies \nCC 1017 \nMissing perfusion: abdominal ischaemic disease \nModerator: \nO. Chan; London/UK \nA‑247\t 16:00 \nA. Mesenteric angiography: diagnostic and therapeutic approach \nJ. Lammer; Vienna/AT (johannes.lammer@akhwien.at) \nAcute abdominal organ ischaemia may be caused by hypovolaemic shock, spasm \n(ergotism), embolisation and aortic dissection. Embolisation is the most common \ncause. It occurs typically in elderly patients with atrial fibrillation, after myocardial \ninfarction or due to a thoracic aortic aneurysm (TAA). The primary diagnosis is \nmade by CT with contrast enhancement which can also demonstrate cardiac \nthrombi or a TAA. Interventional treatment can be performed with a thrombectomy \ndevice or fibrinolysis with recombinant tissue plasminogen activator (rt-PA; 10 mg \nloading dose, 5 mg/hr infusion dose). Acute aortic dissection may cause dynamic \ncompression of the true lumen with occlusion of the ostium of the visceral arteries \n(floating visceral sign). The primary diagnosis is made by CT. Occlusion of the \nprimary entry tear with a thoracic aortic stentgraft may decompress the false lumen \nfollowed by reexpansion of the true aortic lumen followed by reperfusion of the \nvisceral arteries. Chronic abdominal ischaemia in younger patients may be due to \nfibromuscular dysplasia, Takayasu arteritis or neurofibromatosis. In the elderly it is \nusually caused by arteriosclerosis. The patient may have post-prandial abdominal \npain (angina abdominalis), diarrhoea and/or weight loss. Due to the collateral circu-\nlation, symptoms usually occur only if more than one of the major arteries (celiac \ntrunk, superior and inferior mesenteric artery) is narrowed. The diagnosis can be \nmade by color Doppler ultrasound (CDUS), CT and MR with contrast enhancement. \nEndovascular treatment is done by PTA and stent placement. \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S67\nCB D E F G H\n3. To learn what to include in the report of CNS infections for the treatment \nplanning.\n4. To learn how to report follow-ups and treatment monitoring of CNS \ninfections.\n16:00 - 17:30 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 1018 \nPalpable abdominal mass \nModerator: \nF. Caseiro‑Alves; Coimbra/PT \nA‑252\t 16:00 \nA. Clinical considerations \nD. Akata; Ankara/TR (dakata@hacettepe.edu.tr) \nFinding of a palpable mass in the abdomen always raises the possibility of an im-\nportant clinical problem. A potentially life-threatening process, especially malignancy \nis the major concern. The list of differential diagnosis of “abdominal mass” is a very \nlong one. In the process of differential diagnosis the most common approach is to \nevaluate the patient according to the gender, age, patient history and co-existing \nclinical and laboratory findings. The accompanying symptoms and signs and the \nlocation of the abdominal mass are the key indicators in the clinician’s way of think-\ning in the process of differential diagnosis. For instance, a palpable mass with acute \nabdomen or intestinal obstruction will be assessed differently than a mass found \nincidentally. Imaging is commonly required to confirm or ascertain the diagnosis. \nCross-sectional imaging is required to accurately evaluate a palpable abdominal \nmass in most situations. Ultrasound and computed tomography have each been \nused successfully in evaluating patients with palpable abdominal mass. Although \neach modality is appropriate in most situations, the advantages and disadvantages \nof each modality in certain situations will be addressed and the appropriateness \ncriteria will be reviewed in this lecture. Knowledge of a detailed clinical history is as \nimportant to the radiologist as to the clinician. Its impact on the diagnostic accuracy \nin the interpretation of the images will also be addressed. \nLearning Objectives:\n1. To learn more about the clinical conditions causing abdominal space \noccupying lesions.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑253\t 16:30 \nB. Imaging techniques and typical findings \nM. Prokop; Nijmegen/NL (M.Prokop@rad.umcn.nl) \nA palpable abdominal mass has a long list of benign and malignant differential \ndiagnoses. These diagnoses may be as different as a hydatid cyst of the liver, a \nvolvolus, an aneurysm, or a giant renal cell carcinoma. The diagnostic approach is \nbased on two major steps: first, the affected organ must be indentified. Second, the \ndifferential diagnosis must be established based on imaging characteristics. The \nchoice of ultrasound, CT or MRI should be based on location and size of the mass. \nDespite the fact that ultrasound is frequently used as a first step, the overview and \nanatomic orientation in large masses may be hampered, making ultrasound a better \ntechnique for image-guided biopsy than for primary diagnosis. In the vast majority \nof cases, multidetector CT is the first technique of choice. A thin-section protocol \nshould be used to allow for high-quality multiplanar imaging. A pre-contrast scan is \nusually not required but can be helpful in suspected hemorrhage. For most upper \nand middle abdominal masses, biphasic imaging in the arterial and portal phase is \nrecommended in order to establish the relation of the mass to the vasculature and \nto assess vascularity. In the small pelvis, MR is the superior imaging technique. \nOtherwise, MRI is mainly used for problem-solving. This course will discuss how to \nuse the various imaging tool efficiently to narrow the differential diagnosis, decide \nabout the need for biopsy and establish a suitable therapy. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof patients with a palpable abdominal mass.\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\n16:00 - 17:30 Room B \nInteractive Teaching Session \nE³ 1020 \nInfections of the central nervous system: what the \nradiologist must report \nA‑250\t 16:00 \nA. “Dangerous” viral and prion infections \nG. Wilms; Leuven/BE (Guido.Wilms@uz.kuleuven.ac.be) \nThe most common viral infection of the brain is herpes encephalitis (HSV1). It is a \nnecrotising encephalitis with a a mortality of more than 50%. On imaging studies \nlesions will be seen in the “limbic system”, i.e. the temporal lobes, hippocampi, \ninsular cortex and cingulate gyrus. They appear as hypodensity on CT, T2- and \nFLAIR hyperintensity on MRI, possibly with haemorrhagic transformation. Diffu-\nsion is restricted in the early phase. Enhancement occurs at a later stage. Hu-\nman immunodeficiency virus (HIV) infection is a multifocal giant-cell encephalitis \neventually leading to a progressive leuco-encephalopathy. On MR atypical focal \nor diffuse symmetrical signal abnormalities are seen neither with mass-effect nor \nwith enhancement and typically sparing the U-fibers. Spectroscopy can show an \nincrease of myo-inositol. Progressive multifocal leuco-encephalopathy (PML) is \ndue to reactivation of the JC polyomavirus in immunocompromised patients, 10% \nof which are HIV positive. On MRI “scalloped” multifocal asymmetrical lesions are \nseen with minimal mass-effect and without enhancement. New treatments of HIV, \nespecially highly active antiretroviral therapy (HAART) can lead to a paradoxical \nworsening of patients due to the immune reconstitution inflammatory syndrome \n(IRIS). On MRI mass lesions are seen with diffuse patchy enhancement. Cerebral \ntoxoplamosis appears as multiple enhancing lesions with marked perilesional \noedema. Calcification is possible. Prion diseases are caused by a proteinaceous \ninfectious particle leading to Creutzfeld-Jacob disease in humans. Diffusion \nweighted MR-images show high signal intensities in the cortex and the basal \nganglia. Abnormalities on T2-weighted images and FLAIR occur at a later stage \nwhere atrophy is mostly prominent. \nLearning Objectives:\n1. To be familiar with the imaging pattern of most common viral and prion CNS \ninfections.\n2. To learn how recognise and differentiate between the different viral and prion \nCNS infections.\n3. To learn how to report detected viral and prion CNS infections.\n4. To have knowledge about follow-ups and treatment monitoring of viral and \nprion infections.\nA‑251\t 16:45 \nB. Bacterial and parasitic infections \nE.T. Tali; Ankara/TR (turgut.tali@gmail.com) \nMost of the CNS infections can be treated successfully as long as they are detected \nearly. Radiological evaluations play important role in the diagnosis, subsequent \ntreatment and treatment monitoring. Bacteria, fungi and parasites may cause \nCNS infections. Infections in newborn and infants differ from the adults. MRI is \nthe modality of choice. Radiological findings may vary according to the causing \nagent, location and the stage of the infections (for cerebritis; surrounding oedema, \nmass effect, capsule (thicker rim border near cortex, thinner near ependyma) \nhypointense on T2WI, hyperintense on T1WI) with central necrotic area, satellite \nlesions, daughter rings, petechial haemorrhage, heterogeneous enhancement of \nthe rim. DWI shows high signal intensity while ADC maps show low signal. MRS \nshows lactate and amino acids. Reports should include comments for differential \ndiagnosis among the radiological findings for the infections. Treatment can also \nbe monitored by MRI (for cerebritis: decrease in oedema; decrease in mass ef-\nfect; decrease in degree of enhancement, shrinking cavity, gliosis; decrease in \nDWI high intensity and increase in ADC low signal and also turning of lactate and \namino acids to normal at MRS). Reports should include comments for the success \nor failure of the treatment. \nLearning Objectives:\n1. To learn how to report detected and recognised bacterial and parasitic CNS \ninfections basically.\n2. To learn how to assist clinicians for the diagnosis and differential diagnosis \nof bacterial and parasitic CNS infections.\n\nPostgraduate.Educational.Programme\nS68\n A B C D E F G H\nsusceptibility effects, increased radiofrequency (RF) field inhomogeneity and more \npronounced magnetic shielding effects. In the mean time, many investigators have \nproposed strategies to optimise imaging protocols and to decrease SAR levels \nand to reduce artefacts including optimised coil and hardware design, in combina-\ntion with parallel imaging and modulation of refocusing flip angles. Many clinical \napplications in neurology and angiography for high field MRI that were recently \nbeing investigated showed benefits over 1.5 T. However, as of to date, virtually no \nprospective comparative studies have been performed and published that could \nhelp to estimate whether or not there would be any clinical benefit of 3.0 T MSK over \n1.5 T. Although many authors described the improved SNR of MSK imaging at 3.0 \nT allowing for higher spatial resolution this has not been prospectively investigated \nwith comparison to 1.5 T. Further studies have to show whether the improvement \nin speed and resolution will also translate into increased patient throughput and \nearlier depiction of disease in MSK applications at 3.0 T. \nLearning Objectives:\n1. To become familiar with artefacts and pitfalls of MSK MRI at 3 T.\n2. To recognise and address MR safety issues at 3 T.\n3. To identify where 3 T is of most benefit in MSK imaging.\nA‑257\t 17:00 \nC. New techniques and applications \nS. Trattnig; Vienna/AT (siegfried.trattnig@meduniwien.ac.at) \nMRI of MSK structures has significantly improved in recent years due to the develop-\nment of clinical high-field MR systems operating at 3 Tesla with high signal-to-noise \nratios. Further improvement was achieved by higher gradient strengths and the \napplication of dedicated coils. This allows high resolution isotropic 3D imaging which \nprovides identical resolution when reformatting in all planes. This isotropic imaging \ncan be used in visualisation of cartilage lesions and repair, ACL reconstructions, \ncomplex meniscal tears and labral tears in the shoulder and hip. In addition to the \nevaluation of gross cartilage morphology by MRI, there is growing interest in the \nvisualisation of ultra structural components of cartilage and other structures such as \nmenisci by MRI. Several MR techniques were developed, which allow detection of \nbiochemical changes that precede the morphological degeneration in cartilage. For \nvisualising the loss of glycosaminoglycans delayed gadolinium-enhanced MRI of \ncartilage (dGEMRIC) can be used. For the quantification of collagen matrix content \nand organisation cartilage T2 mapping has become useful. Further new biochemi-\ncal MR techniques comprise diffusion-weighted imaging, magnetisation-transfer \nand a variant: chemical exchange saturation transfer (CEST) methods. All of these \ntechniques benefit from the higher SNR and higher resolution capabilities at 3  T. \nNew developments are ultrashort-TE techniques at 3 T which help to visualise MSK \nstructures, which based on their inherent low T2 relaxation times did not provide \nsignal such as cortical bone and tendons. \nLearning Objectives:\n1. To learn the role of 3 T in the application of new techniques in MSK imaging.\n2. To appreciate future clinical applications of new MSK techniques at 3 T.\n3. To learn how to apply new techniques in routine practice.\n16:00 - 17:30 Room D2 \nGenitourinary \nRC 1007 \nImaging of the scrotum and penis \nModerator: \nS. Özbek; Izmir/TR \nA‑258\t 16:00 \nA. Acute scrotum \nB. Brkljacic; Zagreb/HR (boris.brkljacic@zg.htnet.hr) \nUltrasound is the best imaging modality for evaluation of acute scrotal conditions. \nMRI is used only rarely, when US findings are equivocal and in cases of suspected \ninfarction. CT is used exceptionally, for example, to detect air in the scrotal wall. \nHigh-frequency transducers with modern software like compound imaging and \nnative harmonic, and very good colour sensitivity for low flow in small vessels \nprovide excellent insight into testicular morphology and vascularisation. It is very \nimportant to distinguish testicular torsion from the acute inflammation, as it has \nimportant therapeutic and even medicolegal consequences. In testicular torsion \nrapid diagnosis is vital, and salvage rate is directly related to timely operation. \nTorsion is more common in younger patients and orchiepididymitis is more com-\nmon in adults. Infection usually starts at the epididymis and then spreads to testis \nA‑254\t 17:00 \nC. Interactive case discussion \nA.H. Freeman; Cambridge/UK (a.h.freeman@talk21.com) \nThe patient presenting with an abdominal mass represents a common clinical \nproblem. Clearly, the differential diagnosis is large and obviously will depend on \nthe age and sex of the patient as well as location of the mass. Of course history \nand clinical examination are mandatory, but formal diagnosis will usually rest on \nradiological interpretation. Contrast examinations have now been replaced by \ncross-sectional imaging and endoscopy and it behoves the clinical radiologist to \nbe aware of the advantages and limitations of these methods in order to reach a \ndiagnosis. Particular difficulty may be encountered when the mass is so large that \nit is difficult to determine the organ of origin. The purpose of this interactive case \ndiscussion is to explore the relative merits of ultrasound, CT, MR and endoscopy \nin establishing a diagnosis in two different cases. The cases concerned are: 1. \nA 21-year-old man who presents with a right iliac fossa mass, but is otherwise \nasymptomatic. 2. A 54-year-old woman who presents with anaemia and a large \nupper abdominal mass. Active audience participation will be encouraged by means \nof key pads in order to respond to issues raised during the debate. \nLearning Objectives:\n1. To introduce typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of palpable abdominal mass cases.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n16:00 - 17:30 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 1016 \nThe basics of MSK MRI at 3 T \nModerator: \nA. Baur‑Melnyk; Munich/DE \nA‑255\t 16:00 \nA. Optimising protocols \nC. Glaser; Munich/DE (christian.glaser@nyumc.org) \nThe most straightforward expectation from 3 T MRI scanners is a gain in SNR that \ncould be translated in improving spatial resolution and/or reducing imaging time at \nan at least constant CNR. Together with field strength, susceptibility effects, chemi-\ncal shift and T1 increase and T2 and T2* decrease. Also, relaxation properties of \ncontrast agents are modulated. RF power deposition is higher at 3 T and is often \na limiting factor in sequence parameter optimisation. Hence, the need to optimise \nMRI sequence protocol parameters at 3  T. For cartilage, muscle, synovial fluid \nand fat, T1 increases by between 14% and 22%, T2 decreases by between 10% \nand 37% and R1 of Gd Chelates decrease by 5% to 10% when B0 increases from \n1.5 T to 3 T. In most applications reduced T2 and increased T1 work synergistically \ntowards a reduced SNR. Since the change in relaxation times is not linear for the \ndifferent tissues, CNR varies with field strength, too. A relatively straight forward \napproach is to lengthen TR in order to compensate for longer T1 and to shorten \nTE to compensate for shorter T2 (*). In non-fat-sat images bandwidth needs to be \nincreased to control chemical shift effects. Because of the better fat and water peak \nseparation, 3 T often helps improve frequency-based fat saturation but may also \nbe greatly impaired by field inhomogeneities in the presence of metallic materials. \nField strength (B0) and appropriate dedicated multi-element coils are the hardware \nprerequisites to bring high resolution (HR) isotropic imaging into clinical routine. \nLearning Objectives:\n1. To understand the physical differences of MSK MRI at 1.5 T and 3 T.\n2. To learn how to optimise MSK sequence parameters at 3 T.\n3. To recognise the value of high-resolution and isotropic imaging at 3 T.\nA‑256\t 16:30 \nB. Pitfalls, strengths and weaknesses \nT.C. Mamisch; Berne/CH (mamisch@bwh.harvard.edu) \nMRI (3.0 T) has gained increasing acceptance for whole-body imaging. Since \nthe introduction of 3.0 T MR systems to clinical human imaging, several difficul-\nties have been described beyond a simple SNR gain including increased energy \ndeposition (as denoted by the specific absorption rate (SAR)), increased magnetic \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S69\nCB D E F G H\n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 1010 \nHip through the ages \nModerator: \nE.C. Kavanagh; Dublin/IE \nA‑261\t 16:00 \nA. The paediatric hip \nD.J. Wilson; Oxford/UK (david.wilson@noc.anglox.nhs.uk) \nDepending on the age of the child, hip symptoms may predict a variety of diseases. \nIn the infant, developmental dysplasia and infection should be considered. After \nthe age of 4, irritable hip most commonly due to transient synovitis is the common-\nest disease but infection is the more worrying condition. Perthes disease affects \nsome and this condition overlaps into those over 8 who may have a slipped upper \nfemoral epiphysis. Fractures and rare cases of osteonecrosis and chondrolysis are \na concern in the adolescent. In the young and indeed in most cases, ultrasound \nprovides a useful first line test. Aspiration of effusion may be both diagnostic and \ntherapeutic. In the older child and, especially when SUFE is a risk, conventional \nradiographs with an external rotated “frog leg” view is very important. Despite \nthe logistics problems in children, there is an important role for MRI especially in \ncases where the initial imaging does not explain the symptoms. I will review the \nimaging pathways and provide examples of common diseases. I will also discuss \nhow to manage the difficult case and show recent audit data on detection rates \nand clinical management. \nLearning Objectives:\n1. To understand the age-specific diseases of the hip in children.\n2. To appreciate the strengths and weaknesses of each imaging method.\n3. To understand how imaging is used in the management of children’s hip \nproblems.\nA‑262\t 16:30 \nB. The hip in the young athlete \nC.W.A. Pfirrmann; Zurich/CH \nFemoroacetabular impingement (FAI) is a common condition in the young athlete. \nFAI refers to a conflict between the proximal femur and the acetabulum. Both an \nabnormal shape of the proximal femur (FAI of the „Cam-Type“: Aspheric femoral \nhead with a laterally increasing radius and/or a waist deficiency of the femoral neck) \nand the acetabulum (FAI of the „Pincer-Type“: Acetabular retroversion or a deep \nacetabulum) or a combination of the two may be present. For a long period the FAI \nmay be asymptomatic and the only clinical finding will be an impaired internal rota-\ntion of the hip joint. Later as the disease progresses, cartilage damage (outside-in \nabrasion of the acetabular cartilage/cartilage delamination) and labral tears occur. \nLabral tears are most common in the anterosuperior aspect of the acetabulum. \nA typical labral tear is an incomplete detachment with a tear located at the base \nof the labrum. Anatomic variants such as a sulcus may be present and should be \ndistinguished from tears. A sulcus is common at the junction of the labrum with the \ntransverse ligament and is generally located beyond the equator of the hip joint. \nInsufficiency fractures about the hip commonly occur in the region of the femoral \nneck. Another site vulnerable to overuse is the symphysis pubis. Often, a bone \nmarrow oedema pattern around the symphysis pubis is observed. A characteristic \nfinding is the „Secondary cleft sign“, which reflects a partial tear of the adductor \ntendon aponeurosis at the symphysis pubis. \nLearning Objectives:\n1. To understand the mechanisms of injury of the hip.\n2. To recognise the imaging pattern of abnormalities of the hip.\n3. To become familiar with femoroacetabular impingement.\n4. To learn about the typical injuries to tendon attachments around the hip.\nA‑263\t 17:00 \nC. The ageing hip \nA.H. Karantanas; Iraklion/GR (akarantanas@gmail.com) \nUnderstanding age-related changes is essential for interpretation of imaging \nstudies. Age is a risk factor strongly correlated with osteoarthritis (OA) which is \nthe most common hip joint disease seen in adults. The diagnosis of OA is based \non a combination of radiographic findings and characteristic subjective symptoms. \nThe lack of a radiographic consensus definition has resulted in a variation of the \nthat is painful and hypervascularised on colour Doppler imaging. In cases of \ntorsion B-mode findings are non-specific, while on colour Doppler flow is absent \nin complete torsion, but may be present and diminished in incomplete torsion, \nor increased in intermittent torsion. In cases of trauma ultrasound is important \nto diagnose haematoma, haematocele to evaluate integrity of testis and assess \nwhether the testicular fracture is present or if the surgery is needed in cases of \ntesticular rupture. Imaging is helpful in cases of rare causes of the acute scrotum, \nsuch as Fournier gangrene, testicular appendage torsion, vasculitis, and also in \nevaluation non-scrotal causes of symptoms, like in cases of renal colic, abdominal \ninflammatory and traumatic conditions, etc. \nLearning Objectives:\n1. To learn the imaging signs of testicular torsion.\n2. To review the appearance of acute and subacute orchiepididymitis.\n3. To understand the role of imaging, especially ultrasound, in testicular \ntrauma.\nA‑259\t 16:30 \nB. Scrotal tumours \nL.E. Derchi; Genoa/IT (derchi@unige.it) \nA scrotal mass is an important clinical problem and a source of anxiety to the \npatient. Radiologists play an important role in the management of these cases, \nsince imaging is required to provide information about precise anatomical location \nof the lesion, its size and extension and, possibly, to elucidate the nature of the \ndisease. The US and MRI findings of the many different scrotal tumours will be \npresented in this lecture. Special attention will be given to two topics. The first are \nthe possibilities offered by imaging to differentiate among the different pathologies, \nespecially to differentiate between benign and malignant lesions. The second will \nbe the problem of the small, non-palpable, indeterminate testicular mass. Such \nlesions have been shown to be relatively frequent. Prevalence of malignancy varies \nwidely in the literature, and orchidectomy seems not justified in all cases. The use \nof contrast-enhanced MRI and of advanced US techniques (contrast-enhanced \nUS and elastography) may help to narrow the differential. Furthermore, the use of \nintraoperative US to guide removal of non-palpable testicular nodules can help to \nperform conservative surgery in lesions with no malignant potential. \nLearning Objectives:\n1. To understand the typical imaging appearance of benign and malignant \nscrotal tumours.\n2. To review differential diagnosis of intra and extratesticular scrotal tumours \nand the impact of imaging.\nA‑260\t 17:00 \nC. Imaging of the penis \nM. Bertolotto; Trieste/IT (bertolot@univ.trieste.it) \nUltrasonography (US) is the first-line imaging modality in patients with penile dis-\nease. Using high-end equipment after pharmacologically induced erection penile \nanatomy is well defined and virtually all clinically significant penile vessels can be \nevaluated in normal and in impotent men. The superior soft-tissue contrast resolu-\ntion afforded by MR imaging provides an opportunity to advance imaging evaluation \nof the penis in selected cases. In the clinical practice, erectile dysfunction is the most \nfrequent penile abnormality which is investigated with Doppler US. The clinical role \nof this evaluation, however, reduced after the introduction of oral medications for \nimpotence. Differentiation among different forms of erectile dysfunction is mainly \nbased on evaluation of Doppler waveform changes in the cavernosal arteries. \nPeyronie’s disease is the most frequent cause of penile induration. Imaging is often \nrequired to evaluate the extension of the plaques, involvement of the penile septum, \nand relationship between the plaques and penile vasculature. In patients with penile \ntraumas, imaging allows accurate evaluation of albugineal tears, extra-albugineal \nand cavernosal haematomas, vascular lesions producing high flow priapism and \nother pathological changes. Compared with US, MR imaging has some advantages \nin identification of small albugineal tears, and is more accurate in identification of \nurethral or spongiosal involvement. Other situations in which penile imaging can \nbe required are circumscribed or diffuse cavernosal fibrosis, tumours, priapism, \nsevere inflammation, and evaluation of postsurgical complications. Most of these \nconditions are first investigated with US; MR imaging is optimal for tumour staging. \nLearning Objectives:\n1. To learn the most frequent penile diseases that can be diagnosed by \nimaging.\n2. To understand the respective roles of US and MRI and the technical \nchallenges of imaging.\n3. To know how imaging influences treatment and follow-up.\n\nPostgraduate.Educational.Programme\nS70\n A B C D E F G H\nA‑265\t 16:25 \nB. Endocrine and other solid pancreatic tumours \nC.J. Zech; Munich/DE (Christoph.Zech@med.uni‑muenchen.de) \nEndocrine tumours of the pancreas are derived form the APUD cell system. They \noften show early clinical sign related to the hormones produced by these tumours. \nThe usually very specific symptoms raise the suspicion of an endocrine tumour of \nthe gastro-entero-pancreactic tract and initiate imaging studies for tumour detection. \nIn this setting usually the pancreas is among the most frequent tumour sites. Since \nendocrine active tumours of the pancreas usually show a strong vascularisation, \nthey can be differentiated from other solid tumours of the pancreas - including ad-\nenocarcinoma of the pancreas. Metastases in the pancreas are very rare - however, \nthey represent a potential differential diagnosis either for non-functioning neuro -\nendocrine tumours or for adenocarcinoma of the pancreas. Since the evaluation \nof the whole pancreas is crucial, transabdominal ultrasound plays an only limited \nrole for the detection of endocrine pancreatic tumours. Usually MRI and CT - alone \nor in combination with specific nuclear medicine tracers in PET - are needed for \naccurate diagnosis and staging of these tumours. \nLearning Objectives:\n1. To understand the clinical manifestations, pathology and imaging findings of \nfunctioning and non-functioning endocrine tumours.\n2. To learn about imaging protocols and to address management options of \nthese tumours.\n3. To review prognostic information.\n4. To learn about other causes of solid pancreatic tumours, including \nmetastases, and the role of imaging in management.\nA‑266\t 16:50 \nC. Congenital and developmental anomalies \nM. Karcaaltincaba; Ankara/TR (musturayk@yahoo.com) \nPancreas develops from ventral and dorsal buds during embryologic development. \nRadiologic imaging plays an important role in the diagnosis of congenital and \ndevelopmental anomalies of pancreas, which can involve either pancreatic duct \nor pancreas parenchyma. The spectrum of congenital pancreatic duct anomalies \ninclude the failure of fusion of ventral and dorsal pancreatic ducts, so-called pan-\ncreatic divisum, which can be complete or partial. Parenchymal anomalies and \nvariants include cystic dystrophy of duodenum, annular and ectopic pancreas, \ndorsal (distal) pancreas agenesis, circumportal pancreas, short pancreas, bifid tail \nof pancreas, fusion of pancreas and spleen. These can cause symptoms (groove \npancreatitis and duodenal obstruction) or can be asymptomatic. Dependent stomach \nand dependent intestine signs can allow diagnosis of dorsal pancreas agenesis. \nVariations in the fat accumulation of pancreas can cause diagnostic problems and \nknowing embryology of pancreas can help in diagnosis. The role of ultrasonography, \nCT, MRI and MRCP in the diagnosis of anomalies of pancreas will be illustrated. \nA variety of pancreas anomalies can be diagnosed with CT and MRI and this ap-\nproach can obviate invasive diagnostic procedures. \nLearning Objectives:\n1. To review the elements of pancreatic embryology that are necessary to \nunderstand abnormalities and variants of the pancreas.\n2. To learn about the most common variants in the pancreatic ducts, like \ncomplete or partial pancreas divisum, and abnormal localisations of \npancreatic tissues like cystic dystrophy of the duodenum, annular and \naberrant pancreas.\n3. To learn about the role of these abnormalities in determining diseases.\n4. To learn how imaging should be used to derive the appropriate diagnosis.\nDiscussion 17:15 \npublished incidences and prevalence of OA. The progression of OA traditionally \nhas been measured using radiographic joint space width (JSW). Weight-bearing \nradiographs centered on the hip are the most reproducible and reliable ones. The \nsequence of degeneration includes the following radiographic findings: joint space \nnarrowing, osteophyte formation, subchondral sclerosis, and cyst formation. Cur-\nrent definitions of radiological OA based on reduced JSW and osteophytes display \npredictive validity for clinical hip OA. Radiographs are also useful for assessing \ndevelopmental dysplasia and other congenital disorders which may lead to early \nOA. There are cases though, that radiographs show minor changes and the clini-\ncal suspicion of early disease can be confirmed with more sophisticated imaging \nmethods, such as CT and MRI. CT is helpful for additional measurements such \nas femoral and acetabular abnormal version which might lead to OA. Femoroac-\netabular impingement has been shown to cause labral and chondral lesions and \nleads to OA. Prompt recognition of abnormal head-neck junction on radiographs \nenables proper conservative or surgical treatment planning. MR arthrography is \nthe method of choice for assessing the labra whereas CT arthrography might be \nused as an alternative for articular cartilage assessment. \nLearning Objectives:\n1. To become familiar with the radiographic assessment of the ageing hip.\n2. To understand the MRI findings of degenerative hip disease.\n3. To review the various disorders which predispose for early osteoarthritis.\n4. To recognise the advantages and disadvantages of CT and MR arthrography \nof the ageing hip.\n16:00 - 17:30 Room E2 \nOrgans from A to Z: Pancreas \nMC 1019 \nCystic tumours, endocrine neoplasms and \ncongenital anomalies \nModerator: \nI. Lupescu; Bucharest/RO \nA‑264\t 16:00 \nA. Cystic tumours \nR. Pozzi-Mucelli; Verona/IT (roberto.pozzimucelli@univr.it) \nCystic tumours of the pancreas include a variety of masses which can be classified \ninto cystic tumours of the exocrine pancreas, cystic tumours of the endocrine pan-\ncreas, cystic tumour-like lesions of the exocrine pancreas. In order to simplify the \napproach only the relatively common cystic tumours - the intrapapillary mucinous \ntumours (IPMT), the serous cystoadenoma (SC) and the mucinous cystoadenoma \n(MC) - will be considered. IPMT are characterised by ductal dilatation. Imaging \ncharacteristics of IPMT are best displayed at MR-cholangiopancreatography. On \nthe basis of the extent, these tumours can be divided into IPMT of the main duct \n(or central), IPMT of the secondary ducts (or peripheral) and mixed IPMT. Central \nand mixed IPMT have a malignant behaviour and therefore need to be treated \nsurgically, while peripheral IPMT have a benign behaviour and, in general, need \nonly follow-up. SC are characterised by a microcystic architecture in most cases. \nImaging features are typical in cases of microcystic appearance and consist of \nsmall amounts of fluids interspersed within multiple septae of a “sponge like” mass. \nThe differential diagnosis with a mucinous cystoadenoma is difficult in cases with \na oligo-macrocystic appearance. MC appears as a uni-oligolocular cystic mass, \nwith a simil-ovaric stroma in the tail of the pancreas. Imaging features include a \ncystic mass with a definite wall and inner septae. When calcifications and enhanc-\ning nodules are present, a mucinous cystoadenocarcinoma has to be suspected. \nTherefore, a careful evaluation of imaging features of pancreatic cystic tumours is \nneeded to differentiate benign form malignant masses. \nLearning Objectives:\n1. To understand the classification and management of cystic pancreatic \ntumours using rad/path correlation.\n2. To learn how to provide a differential diagnosis and how, when and why \nimaging techniques should be used.\n3. To review pathological and imaging findings of intra-ductal cystic tumours.\n4. To learn how to deal with the incidental pancreatic cyst.\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S71\nCB D E F G H\ncancer death in women, indicating that there is room and need! for improvement. \nMagnetic resonance imaging (MRI) of the breast has been introduced a decade \nago. Over recent years, it has become increasingly evident that breast MRI by far \nthe most powerful breast imaging technique that is currently available. Across all \ndifferent clinical and screening scenarios, MRI has been shown to be superior to \nmammography - be it for diagnosing primary or recurrent, invasive or intraductal, \nfamilial or sporadic breast cancer, irrespective of a woman‘s breast density. And yet \nis the technique only slowly adopted in clinical practice. Arguments against the use \nof breast MRI include costs, frequency of false positive diagnoses, lack of trained \nradiologists, lack of minimally invasive biopsy capabilities, lack of evidence by \nrandomised controlled clinical trials, and, last, fear of overtreatment. In this lecture, \nthese concerns are reviewed, discussed and weighted against the advantages of \nscreening and diagnostic applications of breast MRI. \nLearning Objectives:\n1. To learn about results of breast cancer screening studies involving breast MRI.\n2. To learn current indications for MRI screening.\n3. To understand technical MR imaging strategies for screening.\nA‑270\t 16:51 \nThe evolving role of the radiologist \nP. Brader; Vienna/AT (peter@brader.md) \nIn the past two decades, enormous strides have been made in medical imag-\ning and many new technologies and agents are now available for breast cancer \nresearch, clinical trials and patient care. Advances in experimental and clinical \nbreast imaging are likely to improve our knowledge of how breast cancer arises at \nthe cellular level, which will help not only to identify and locate tumours but also to \nassess the activity of biological processes within these tumours. This recent and \nconcomitant progress, in imaging in general, and in breast imaging in particular, has \nbeen facilitated by the convergence of molecular cell biology, pathology, chemistry, \nphysics and engineering in a multimodality and multidisciplinary way. The challenge \nfor radiology is to begin thinking at the molecular level. It is, therefore, important \nthat the next generation of radiologists become more involved in multidisciplinary \nresearch and clinical work, and that younger radiologists receive special training \nin diagnostic imaging and nuclear medicine, as well as a solid understanding of \nphysics, radiochemistry, pathology and biology. Applying this approach to breast \ncancer patients should allow earlier detection, stratification of patients for treatment, \nand objective evaluation of new therapies. The outcome will be considerably better \nmanagement and care of those with breast cancer. \nLearning Objectives:\n1. To learn about novel developments in the field of breast imaging, especially \nthose aimed at treating and characterising.\n2. To understand what is happening functionally and structurally at the \nmolecular level for breast cancer imaging.\n3. To learn about design and development of molecular imaging probes for \nbreast cancer imaging.\nPanel discussion: \nBreast imaging 2025: blood test or still imaging? 17:14\nBreast cancer is the leading cause of cancer death among women worldwide. \nImaging plays a key role in the early detection of breast cancer. Mammography is \nan accepted screening modality with some limitations such as over-treatment. To \novercome these limitations research is going on to characterise breast cancer more \naccurately. Currently researchers are working on different strategies spanning the \nspectrum from tomography- based systems to MRI and even molecular imaging. \nThis panel discussion will focus on these different strategies. The auditorium will \nlearn if in 2025 imaging still plays a major role in breast cancer detection or whether \na simple blood test will eventually solve the problem. \n16:00 - 17:30 Room F1 \nNew Horizons Session \nNH 10 \nBreast imaging in 2025 \nModerator: \nT.H. Helbich; Vienna/AT \nA‑267\t 16:00 \nChairman’s introduction \nT.H. Helbich; Vienna/AT (Thomas.Helbich@meduniwien.ac.at) \nBreast cancer is the leading cause of cancer death among women world wide. \nImaging plays a key role in the early detection of breast cancer. Mammography is \nan accepted screening modality with some limitations such as over treatment. To \novercome this limitations, research is going on to characterise breast cancer more \naccurately. Currently researchers are working on different strategies spanning the \nspectrum from tomography-based systems to MRI and even more molecular imag-\ning. This panel discussion will focus on these different strategies. The auditorium \nwill learn if in 2025 imaging still plays a major role in breast cancer detection or a \nsimple blood test will eventually solve the problem. \nSession Objectives:\n1. To learn about new breast imaging modalities for 2025.\n2. To learn whether these imaging modalities can influence breast cancer \nscreening in 2025.\n3. To understand whether today’s polemics will remain true in 2025.\nA‑268\t 16:05 \nIs mammography still an accepted modality for breast cancer imaging in \n2025? \nM.J. Yaffe; T oronto, ON/CA (martin.yaffe@sunnybrook.ca) \nX-ray mammography is currently the only imaging modality that when used in routine \nscreening has been demonstrated to contribute to reduced mortality in women in \nthe age range 40-74. But, the accuracy of mammography is limited with respect \nto both sensitivity and specificity. Digital mammography has provided increased \nsensitivity in women with dense breasts and three-dimensional methods such \nas digital breast tomosynthesis or dedicated breast CT promise to yield further \nimprovement. However, these techniques are dependent on detecting rather \ngross physical changes as masses, microcalcifications or architectural distortions \ndevelop and, therefore, their ultimate potential is limited. It is likely that before 2025, \ndetection tools that are more specifically targeted to molecular characteristics or \nearly functional changes associated with cancer will be clinically available. These \nmay be either in the form of an imaging test, based on a specific biomarker for the \ncancer or possibly an innocuous test designed to sense a circulating biomarker \nin the blood or urine. In the latter case, a positive test would be followed by an \nimaging study to provide localisation for therapy. Such tests could not only detect \nthe presence of disease but would also provide prognostic information to guide \nthe type and aggressiveness of therapy so that overtreatment could be avoided. \nPromising imaging techniques based on targeted imaging with ultrasound, x-ray \ncontrast agents, MR and radio-labelled agents are already under investigation. \nBy exploiting new molecular or functional signals one of these is almost certain to \nreplace mammography before 2025. \nLearning Objectives:\n1. To understand the current performance of mammography, including its \nbenefits, strengths and limitations.\n2. To become familiar with the potential for improvement in breast cancer \nimaging.\n3. To examine possible strategies for evolution of the paradigm for screening \nand imaging in breast cancer management.\nA‑269\t 16:28 \nBreast cancer screening with MR imaging and nothing else \nC.K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \nRegarding the early diagnosis of breast cancer, population-based mammographic \nscreening has been shown to help reduce breast cancer mortality. Mammographic \nscreening, reduced post-menopausal hormone intake and the development of \nnew, targeted therapies all contributed to the reduction of breast cancer mortality \nthat has been observed in the last couple of years. Still breast cancer is one of \nthe most frequent cancers overall, and it continues to be the leading cause of \n\nPostgraduate.Educational.Programme\nS72\n A B C D E F G H\nLearning Objectives:\n1. To review frequently used response evaluation criteria in solid tumours (e.g. \nRECIST).\n2. To evaluate the development and optimisation of new imaging parameters \nas biomarkers of treatment response and optimised monitoring of tumour \ntherapy in multi-center EORTC clinical trials.\n3. To present an innovative medicine initiative as a roadmap for future \ncollaboration between EORTC and ESR, combining different imaging \nmodalities.\nA‑273\t 16:24 \nCan we assess cell density of tumours with imaging techniques? \nD.-M. Koh; Sutton/UK \nImaging is increasingly used to define endpoints of clinical trials in oncology. Tumour \ncellular density may be inferred by diffusion-weighted MR imaging (DW-MRI) and \nmeasurement of the T2 relaxation time. DW-MRI is unique as the mechanism of \ncontrast is based on differences in the mobility of water between tissues, which can \nbe quantified by the apparent diffusion co-efficient (ADC). Tumours are frequently \nmore cellular compared with their tissue of origin which impedes water diffusion, \nresulting in increased conspicuity on DW-MRI and lower ADC values. Studies have \nshown negative correlations between histopathologically determined cell density \nand ADC in several tumour types, including prostate cancer, soft tissue sarcomas \nand cerebral tumours. DW-MRI is sensitive for tumour detection, especially for \ndisseminated peritoneal disease, liver and bone metastases. Whole body DW-MRI \nwith background suppression (DWIBS) is an emerging technique that has shown \nsubstantial promising for staging of lung cancer, prostate cancer, lymphoma and \nmultiple myeloma. Effective treatment results in reduction in cell density due to cell \nlysis, apoptosis and necrosis, leading to a rise in ADC value. ADC increase has \nbeen observed within 30 days of anti-tumour treatment (including chemotherapy \nand radiotherapy); and as early as one to two weeks after treatment. Quantitative \nADC measurements may also be prognostic as tumours with higher pre-treatment \nADC have been shown to respond poorer to chemotherapy and radiotherapy. \nNevertheless, a number of challenges still have to be overcome to qualify ADC \nas a response and prognostic biomarkers in a multi-centre setting across different \nimaging platforms. \nLearning Objectives:\n1. To show that MRI-derived parameters (e.g. apparent diffusion coefficient, T2 \nrelaxation time) are good indicators of tumour cell density.\n2. To evaluate the role of diffusion-weighted imaging to assess tumour growth \nand metastases (whole body imaging).\n3. To show the prognostic role of imaging parameters with regard to potential \nmetastatic activity and tumour aggressiveness.\n4. To demonstrate that diffusion imaging can be used to monitor cytotoxic \ntreatment response.\nA‑274\t 16:42 \nWhich imaging techniques are useful to evaluate tumour angiogenesis? \nD. Sahani; Boston, MA/US (dsahani@partners.org) \nAngiogenesis is an essential process whereby tumours derive vascular supply from \nadjacent tissue, to sustain tumour growth and metastatic spread. Newer targeted \nantiangiogenic therapies differ significantly from current cytotoxic therapies for \ncancer. The methods of dose selection are either invasive, such as biopsy and \nhistology, or time consuming, such as tumour shrinkage and time to disease pro-\ngression, both of which take months to assess and fraught with other limitations. \nMoreover, cancer is a very variable disease, which means that some patients will \nrespond to a particular therapy while others will not. There is, therefore, a great need \nto establish surrogate markers for drug response that are both rapid and reliable, \nnot only for clinical trials of new drugs but also to aid in the selection of optimal \ntreatment for individual patients. Although functional imaging has been a domain \nof nuclear medicine (PET), dynamic CT and MRI using a kinetic model can derive \ntumour vascular characteristics. It has been demonstrated that tumour contrast \nuptake characteristics correlate with recognised marker of tumour angiogenesis. \nBy capturing temporal changes in contrast enhancement reflecting the tumour \nvasculature, functional imaging techniques can facilitate diagnosis, risk-stratification \nand therapeutic monitoring. Various imaging technique and protocols have been \nused with each having its own advantages and limitations. Similarly, various post-\nprocessing methods such as semi-quantitative or quantitative analysis can be used \nto produce functional maps. Other novel imaging techniques such as multi-energy \nCT, diffusion MR and MR spectroscopy also have potential in assessing tumour \nbiology and response. \n16:00 - 17:30 Room F2 \nProfessional Challenges Session \nPC 10 \nImaging as the number one tool for oncology trials \nModerators: \nF. Meunier; Brussels/BE\nP.M. Parizel; Antwerp/BE \nA‑271\t 16:00 \nChairmen’s introduction \nF. Meunier1, P.M. Parizel2; 1Brussels/BE, 2Antwerp/BE \n(francoise.meunier@eortc.be) \nMultiparametric imaging techniques provide a non-invasive insight into tumour \ncell density, vascularisation, and biochemistry. Imaging data have the potential to \nprovide information on disease profiling pertaining to diagnosis, prognosis, selection \nof therapy, monitoring of response to therapy, and pharmacokinetic information of \ndrugs. Undoubtedly, these methods hold great promise, but how can we stan-\ndardise these techniques, in terms of acquisition parameters and image analysis \n(post-processing), and validate imaging parameters as biomarkers in multicenter \ninternational cancer trials. Beginning with a review of the frequently used response \nevaluation criteria in solid tumours (RECIST), the development and optimisation \nof new imaging parameters as biomarkers of treatment response and optimised \nmonitoring of tumour therapy in multicenter EORTC clinical trials will be presented. \nDW-MRI is sensitive for tumour detection; ADC is affected by the different cellular \ndensity of a tumour. Still, a number of challenges need to be overcome to qualify \nADC as a response and prognostic biomarker in a multicenter setting. The large \nvariety in primary tumours and imaging methods, as well as the large variety and \ncontinual evolution of imaging equipment, point towards the need for a concerted \ndesign of imaging protocols in order to assure that these protocols are applicable \nto multicenter trials. Furthermore, reliable evaluation of imaging data requires \nimagers experienced in the area of the definite cancer targeted in this trial and in \nthe use of imaging tools for lesion quantification. From this session, a roadmap \nfor future collaboration between EORTC and ESR combining different imaging \nmodalities will emerge. \nSession Objectives:\n1. To prove that advanced multiparametric imaging techniques play a crucial \nrole in the diagnosis, staging, treatment monitoring and follow-up of \noncological patients.\n2. To explore avenues for future collaboration between EORTC and ECR.\n3. To suggest input of radiologists in the design and implementation of multi-\ncenter trials.\nA‑272\t 16:06 \nThe EORTC Imaging Group: vision and strategy on cancer imaging \nS. Stroobants; Antwerp/BE (Sigrid.Stroobants@ua.ac.be) \nResponse to cancer treatment is evaluated by subsequent assessments of target \nlesions and is defined as a significant decrease in measurable tumour dimensions \n(WHO, RECIST). The new targeted therapeutics which cause cytostasis rather \nthan cytotoxicity have challenged volume-based response criteria and tumour \nregression is increasingly recognised as an unreliable end point. New imaging \nmodalities looking at tumour biology, like positron emission tomography (PET) or \ndiffusion weighted (DW) and dynamic contrast enhanced (DCE) magnetic reso-\nnance imaging (MRI) or increasingly used to identify subpopulation of patients most \nlikely to respond. Recently, new response criteria were introduced that incorporate \nFDG-PET (RECIST 1.1 for solid tumours and new Cheson criteria for lymphomas). \nSince imaging is becoming increasingly important in novel trial design, the EORTC \ndecided to invest in an imaging platform. EORTC has established a medical im-\naging exchange infrastructure allowing to store imaging data linked to the clinical \ndatabases. A functional imaging expert group is set up to review protocols, organise \ncentral review and develop specific initiatives for imaging biomarker validation. \nEORTC is part of the QuicCONCEPT consortium that within the EU innovative \nmedicine initiative (IMI) will try to validate the use of novel PET probes and DW-MRI \nas biomarkers for apoptosis and proliferation. Functional imaging techniques can \nonly evolve successfully into biomarkers that are clinically valuable and important \nfor drug development, when there is agreement on the standards for measure -\nment and analysis and working groups are set up in collaboration with the different \nprofessional organisations (ESR, EIBIR, EANM) to set up imaging guidelines. \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S73\nCB D E F G H\nconditions such as TTTS in twin pregnancies and foetal demise. The living foetus \ncan also suffer from abnormal blood supply to the CNS, and thus showing small \nor even large hemispheric infarcts. Other diffusion technique, DTI is also used to \ndemonstrate the white matter formation of the foetal brain. MRS is also used in the \nevaluation of the foetal brain. The values of the NAA, Choline and the existence of \nlactate are different than the values in the paediatric and adult brain. \nLearning Objectives:\n1. To explore the new imaging techniques for the study of the foetal brain.\n2. To understand the use of diffusion-weighted imaging in the foetal brain.\n3. To become familiar with the accurate use of T1-weighted sequences in the \nfoetal brain.\n4. To understand the possibilities of tractography in the fetal brain.\nA‑277\t 16:30 \nB. Normal findings and pitfalls in paediatric neuroimaging \nA. Rossi; Genoa/IT (andrearossi@ospedale‑gaslini.ge.it) \nThe paediatric central nervous system is a complex structure undergoing rapid \ndevelopment. As such, there is a rapid, continuous modification of what is “normal” \nin relation with age and the stage of development. Knowledge of the normal patterns \nof brain development in the clinically relevant ages from 0 to 18 years is necessary \nto interpret neuroimaging findings correctly. Knowledge of embryology and normal \nvariants is also greatly helpful. MR imaging equipment and parameters need to \nbe adjusted and optimisation for paediatric studies. Pitfalls often occur from the \nmisunderstanding of normal conditions that are perceived as abnormal based on \na comparison with the appearance of the normal brain in adults. This includes, for \ninstance, the evaluation of the brain in the first 2-3 years of life during the course \nof the process of myelination. A summary of the most frequent conditions that may \nlead to misinterpretation of findings will be provided here. \nLearning Objectives:\n1. To understand a different approach to neuroimaging in the developing \npaediatric brain and spine.\n2. To appreciate that, despite the wide and potentially complex spectrum \nof diseases seen in neuropaediatrics, most interpretations can be made \nthrough the thoughtful application of basic neuroradiological analytical \ntechniques.\n3. To be aware of certain areas where common pitfalls, myths and \nmisunderstandings occur.\nA‑278\t 17:00 \nC. Neuroimaging in the acutely ill child \nE. Vázquez; Barcelona/ES (evazquez@vhebron.net) \nThe ability to develop more aggressive treatments of acute neurological disorders \nin children is nowadays improving; however, infants and children are often unco-\noperative, clinical signs are not always easily localised, and diagnosis and therapy \nmay be both delayed. Effective imaging of the central nervous system assumes \nan increasingly important role in the evaluation of these critically ill children. This \nlecture will review the main indications to perform a neuroimaging procedure in \nchildren with a neurological emergency. With didactic purposes, acute conditions \nwill be classified in traumatic and non-traumatic (ischaemic and haemorrhagic \nstroke, infection and acute metabolic disorders). Differential diagnosis will be \ndiscussed based on representative cases selected from the daily routine in a \npaediatric tertiary hospital. The varied neurological complications that can occur \nin the child admitted at the intensive care unit will also be presented in a didactic \nmanner, including PRES (posterior reversible encephalopathy syndrome), acute \nliver failure, osmotic demyelination syndrome, hypoglycaemic encephalopathy or \ninduced neurotoxicity. Eventually, some peculiarities in oncologic and immunosu-\npressed children, particularly opportunistic infections, will be highlighted. Practical \nalgorithms with the preferential use of either CT or MRI will be developed for each \nsection. CT continues being the primary modality for trauma, although it should \nbe better used in cases of non-available MRI in the other acute conditions to save \nradiation in children. MR imaging is nowadays better for imaging these children \nowing to the new techniques that can be used, such as diffusion imaging (DI), \nspectroscopy, arterial spin labelling (ASL) or susceptibility-weighted imaging (SWI). \nLearning Objectives:\n1. To learn the characteristic neuroimaging findings that may be useful in \nestablishing differential diagnoses.\n2. To understand the various neurological complications that can occur in the \nintensive care unit and to become familiar with their most typical imaging \npatterns.\n3. To consolidate knowledge of the best neuroimaging protocols for the acutely \nill child and establish the main indications for the use of MR imaging, \nparticularly diffusion and spectroscopy.\nLearning Objectives:\n1. To prove that modern imaging techniques, such as perfusion MRI, can be \nused to measure tumour angiogenesis and vascular permeability.\n2. To show that imaging parameters can be directly correlated with molecular \nmarkers such as vascular endothelial growth factor (VEGF).\n3. To correlate tumour perfusion with histopathologic changes (e.g. \nhypercellularity, pleomorphism, vascular endothelial proliferation, mitotic \nactivity, and necrosis).\nA‑275\t 17:00 \nChallenges for morphologic imaging in oncology trials: reproducibility and \nreading \nF.E. Lecouvet; Brussels/BE (frederic.lecouvet@uclouvain.be) \nBeside clinical endpoints and biological or molecular parameters, beside emerg-\ning perfusion or diffusion imaging techniques, morphologic imaging remains the \ncornerstone of the evaluation of treatment response in the majority of primary or \nmetastatic tumours. The large variety in cancers and imaging methods, as well \nas the large variety and permanent evolution in imaging equipments, raises the \nneed for a concerted design of imaging protocols to guarantee transposability of \nthese protocols to multiple centers. The reliable evaluation of imaging studies \nobtained in trials requires readers experienced in the area of the definite cancer \ntargeted in this trial, and in the use of imaging tools for lesion quantification. The \nimaging group of the EORTC targets this optimisation of imaging protocols. First, \nthe different “organ groups” of the EORTC will benefit from the availability of expert \nradiologists in the different fields of oncology, involved in the choice and tuning of \nadequate and generalisable imaging tools from the beginning of trials design. The \ndesign of CT or MRI studies should target acquisition parameters transposable in a \nlarge number of centers; there is no need for “cutting edge” protocols for a reliable \nassessment of response in a majority of cancer patients. Second, the central review \nof imaging studies will be possible based on the involvement of expert radiologists, \nand on a robust imaging platform that guarantees availability, quality control, and \n“side by side” evaluation of baseline and follow -up examinations. Principles and \nlimits of response evaluation by morphologic imaging in oncology will be illustrated. \nLearning Objectives:\n1. To illustrate the setting up of an independent image analysis platform in the \nEORTC Imaging Group.\n2. To underline the need for defining imaging protocols reproducible and \ntransposable to multiple centre trials, facing technical and manufacturer \ndependent variability.\n3. To illustrate how “simple” protocols may guarantee robust imaging \nmonitoring of cancer (compared to some advanced and multiparametric \nprotocols).\nPanel discussion: \nCan we use imaging parameters as biomarkers in multicentre trials and \npredict tumour response? 17:18\n16:00 - 17:30 Room G/H \nNeuro \nRC 1011 \nCommon disorders of the paediatric brain \nModerator: \nO. Flodmark; Stockholm/SE \nA‑276\t 16:00 \nA. Foetal MR imaging: more than just T2-weighted images \nC. Hoffmann; T el Hashomer/IL (chen.hoffmann@sheba.health.gov.il) \nThe objective of this talk is to introduce other techniques than SS FSE T2 in use \nwhen scanning the foetal brain. The most frequent indications for MRI are ven-\ntriculomegaly, asymmetry of the ventricular system, brain malformations, infection \nand others. Most of the MR scan is done with Single Shot FSE T2 (SSFSET2), \nthis is a sequence allowing the acquisition of slice by slice of the brain, and thus \nminimising the effect of foetal movement on the scan. Today, fast FRFSET2 are \navailable, this is a very short T2 sequence in which the white and gray matter junc-\ntion is visualised very well. T1 or FSPGR is used with limitations due to the foetal \nmovements. It is necessary to perform T1 to demonstrate the myelination. DWI is \na very important tool in understanding the ischaemic changes in the adult brain, \nallowing the diagnosis of acute infarcts. Ischaemic insult can occur in foetuses with \n\nPostgraduate.Educational.Programme\nS74\n A B C D E F G H\nA‑281\t 16:28 \nB. From pattern recognition to disease diagnosis: a practical approach \n(part 1) \nM.-L. Storto; Chieti/IT (ml.storto@radiol.unich.it) \nA practical approach to HRCT of the chest for diagnosis of diffuse lung diseases \nincludes: recognition of the abnormalities, definition of their distribution within the \nsecondary lobule or the lung, identification of associated findings. When combined \nwith the patient clinical history, these 3 steps allow to shorten the list of differential \ndiagnoses and may sometimes lead to a specific diagnosis. A reticular pattern \nconsists of multiple lines as the result of interlobular septal thickening, intralobular \nlines or cystic walls of honeycombing. When present as a predominant abnormality, \nthickening of interlobular septa has a limited differential diagnosis which includes \npulmonary oedema/haemorrhage, lymphangitic spread of cancer, sarcoidosis and \nalveolar proteinosis. Honeycombing represents destroyed and fibrotic lung tissue \ncontaining numerous cystic airspaces with fibrous walls and is considered a CT \nfeature of established pulmonary fibrosis. When honeycombing is present, UIP is \nlikely the histologic pattern and IPF is the most likely diagnosis, in the absence of \na known disease. A nodular pattern consists of multiple rounded opacities 2-10 mm \nin size. The distribution of nodules is the most important factor in making an ac-\ncurate diagnosis. A centrilobular predominance of nodules that typically spare \npleural surfaces is a frequent sign of bronchiolitis and airway disease. A perilym-\nphatic distribution is most frequently seen in patients with sarcoidosis, silicosis and \nlymphangitic spread of cancer. A random distribution with nodules diffusely and \nuniformly distributed can be the result of infection, haematogenous metastases \nand other rare diseases such as Langerhans cell histiocytosis. \nLearning Objectives:\n1. To understand the different patterns on HRCT scans of the chest.\n2. To learn about a systematic approach to differential diagnosis of diffuse lung \ndiseases.\n3. To review key imaging findings.\nA‑282\t 16:51 \nC. From pattern recognition to disease diagnosis: a practical approach \n(part 2) \nT. Franquet; Barcelona/ES (tfranquet@santpau.es) \nThe diffuse interstitial lung diseases (DILDs) are a heterogeneous group of disorders \nwhich principally affect the lung parenchyma. Basic HRCT patterns are common to \nmany disease processes and are usually non-specific. However, their distribution \nand their temporal evolution are often characteristic enough for diagnostic purposes. \nIncreased lung opacity: air-space consolidation, by definition, occurs when alveolar \nair is replaced by fluid, cells, or other material. On HRCT, consolidation results in \nan increase in lung opacity associated with obscuration of underlying vessels. \nConversely, ground-glass opacity is defined as: “... hazy increased attenuation \nof lung with preservation of bronchial and vascular margins\". The significance \nof ground-glass opacity depends on the clinical scenario. Cysts and decreased \nlung opacity: a cyst appears as a round parenchymal lucency or low-attenuating \narea with a well-defined interface with normal lung. Lung diseases characterised \nby cysts include Langerhan´s cell histiocytosis, lymphangioleiomyomatosis, LIP, \npostinfectious pneumatoceles, and amyloidosis. Recently, lung cysts have been \nreported in association with extrinsic allergic alveolitis. Honeycombing is a process \ncharacterised by the presence of cystic spaces.The determination of the presence or \nabsence of honeycombing on HRCT in patients with idiopathic interstitial pneumonia \nis of great importance. Honeycombing may have an atypical distribution particularly \nin asbestosis, sarcoidosis, non-specific interstitial pneumonia (NSIP), drug-related \nfibrosis and hypersensitivity pneumonitis. HRCT is now an integral component of \nthe clinical investigation of patients with suspected and established interstitial lung \ndisease. A knowledge of the close relationship between histopathological changes \nand CT appearances. \nLearning Objectives:\n1. To understand the different patterns on HRCT scans of the chest.\n2. To learn about a systematic approach to differential diagnosis of diffuse lung \ndiseases.\n3. To review key imaging findings.\nPanel discussion: \nHow do we report CT of the chest? 17:14\nThe radiology report is often the primary method of communicating imaging findings \nto the referring physician. Practical guidelines on how to report CT scans of the \nchest for diffuse infiltrative lung diseases will be provided by the panel. Emphasis \nwill be placed on both report content and style in order to provide the clinician a \ntool for good patient care. \n16:00 - 17:30 Room I/K \nChest \nRC 1004 \nDiffuse lung diseases: what the radiologist should \nknow \nModerator: \nC. Schaefer‑Prokop; Amersfoort/NL \nA‑279\t 16:00 \nChairman’s introduction \nC. Schaefer-Prokop; Amersfoort/NL (cornelia.schaeferprokop@gmail.com) \nWith the advent of volumetric data acquisition and with increasing knowledge of \npatho-radiological correlations, HRCT has further matured over the last decade \nand provides the radiologist with an excellent tool for accurately demonstrating \ngross lung anatomy and precisely analysing abnormal findings. The radiologic \ndiagnosis of many pulmonary abnormalities is based on an assessment of their \npattern and distribution. While the pathologist has the advantage of being able to \nevaluate specimens microscopically, the radiologist is confined to the assessment \nof more gross disease. However, the radiologist is able to examine the entire lung \nproviding him with information about the distribution of disease and about additional \ndiagnostic clues in mediastinum and pleura. Both together, characterisation of the \ngross findings and knowledge of their distribution represent the key features for \narriving at a confident diagnosis. \nSession Objectives:\n1. To become familiar with the standardized and internationally accepted \nterminology for describing and analysing HRCT findings.\n2. To learn how a structured analysis of the predominant pattern and its \ndistribution represent the key for making a specific diagnosis in the best \ncase scenario or to understand how it helps to narrow the differential \ndiagnosis.\n3. To promote the understanding how the variability of manifestations of some \ndiseases can cause an overlap of findings being responsible for difficulties \nthe radiologist encounters when categorizing diffuse diseases of the lung \nparenchyma.\nA‑280\t 16:05 \nA. The glossary of terms for thoracic imaging: old and new definitions \nJ.A. Verschakelen, W. De Wever, J. Coolen; Leuven/BE \n(johny.verschakelen@uz.kuleuven.ac.be) \nMost radiological reports consist of a ‚descriptive part‘ in which the radiologist \ndescribes the findings and a short ‚conclusion part‘ containing the interpretation \nof what is seen. Both parts are filled with ‚jargon‘. Some terms are typical radio -\nlogical ‚language‘ while others refer to terminology also used by clinicians and \npathologists. Some terms are purely descriptive but others may contain already \nsome interpretation of what is seen and hence narrow the differential diagnosis. \nThe meaning of a term may also change over time. It is very important that both \nradiologists and the readers of their reports speak the same language and know and \nunderstand the meaning and full content of each term. This is especially important \nwhen radiological findings in patients with diffuse lung diseases are described \nand interpreted. Diagnosis of diffuse lung disease is indeed largely based on the \nrecognition and description of the appearance pattern of the disease because this \noften allows developing an appropriate list of differential diagnosis. Members of \nthe Fleischner Society have introduced a glossary of terms for thoracic imaging. \nThis presentation will emphasise on the importance of such a glossary for both \ndescribing and interpreting chest images. Special attention will be given to the \nterms used to describe the different patterns in diffuse lung diseases: (1) reticular \nand short linear opacities, (2) nodular opacities, (3) increased lung opacity and (4) \ncysts and decreased lung opacity. \nLearning Objectives:\n1. To understand the importance of a glossary of terms for thoracic imaging.\n2. To become familiar with the new definitions introduced in the last glossary of \nterms proposed by members of the Fleischner Society.\n\nSaturday\nPostgraduate.Educational.Programme\nA\n S75\nCB D E F G H\nA‑285\t 17:00 \nC. Ethical problems in diagnostic radiology in terms of radiation protection \nK. Paalimäki-Paakki; Oulu/FI (karoliina.paalimaki‑paakki@oamk.fi) \nThe purpose is to describe ethical dilemmas related to the use of radiation in Finn-\nish radiographer’s work in diagnostic imaging. The data were collected during the \nspring and summer of 2008, and it consisted of thematic interviews of diagnostic \nradiographers (N=8) whose working experience varied from 4 to 31 years. The data \nwere analysed by the method of data-oriented qualitative inductive content analysis. \nEthical dilemmas related to the use of radiation were found to concern justification \nand optimisation principles, which were found to be inadequately implemented by \nradiographers. The background factors of these dilemmas were found to be both \ndependent on and independent of the employee, resulting in worsened well-being at \nwork and in seeking for change. The current processing methods of dilemmas were \nfound to be insufficient, and suggestions for better processing methods were made. \nThe results suggest that there may be shortcomings in radiographers’ knowledge of \nradiation usage. Attitudinal problems within the work community seem to maintain \nethical shortcomings. Instead of ethically inadequate routines and passing the \nbaton to other professionals, radiographers should be encouraged in committing \nthemselves into responsibility and safety culture. Respondents repeatedly described \npowerlessness and inability to intervene in ethical problems. \nLearning Objectives:\n1. To consolidate knowledge of basic radiation protection principles.\n2. To become familiar with ethical dilemmas in radiographers work.\n3. To gain knowledge about ethical dilemmas in the implementation of \njustification and optimisation principles in diagnostic radiographer’s work.\n4. To consider and learn to recognise ethical dilemmas in the use of radiation.\n16:00 - 17:30 Room N/O \nHead and Neck \nRC 1008 \nRunny and stuffy noses: paranasal sinus imaging \nModerator: \nM.G. Mack; Frankfurt a. Main/DE \nA‑286\t 16:00 \nChairman’s introduction \nM.G. Mack; Frankfurt a. Main/DE (m.mack@em.uni‑frankfurt.de) \nThe common cold is one of the most frequent illnesses in Europe and the United \nStates. Although most cold are mild and resolve within a short time period, colds \ncost billions of dollars per year, mostly due to lost time at work and school. The \ncommon cold is a group of symptoms caused by one of a large number of viruses. \nRhinoviruses cause the greatest number of colds; there are more than 100 dif-\nferent varieties of rhinovirus. The average adult experiences two to three colds \nper year, while children average 8-12 colds per year. In most cases, colds do not \ncause serious illness. Most colds last for 3-7 days, although many people continue \nto have symptoms (coughing, sneezing and congestion) for up to 2 weeks. Some \nviruses that cause the common cold can also depress the immune system or cause \nswelling in the lining of the nose or airways; this can lead to bacterial infection. \nOne of the more common complications is sinusitis, which is usually caused by \nviruses and rarely (about 2% of the time) by bacteria. However, it can be difficult \nto distinguish bacterial sinusitis from sinusitis caused by a cold because the signs \nand symptoms can be similar. However, due to the fact that a runny nose can also \nresult from inflammation, trauma, foreign body and other abnormal processes, \nincluding tumours, an excellent diagnostic workup is necessary. \nSession Objectives:\n1. To discuss the epidemiology of runny and stuffy noses.\n2. To discuss the pathophysiology of runny and stuffy noses.\n3. To become familiar with facts concerning the economic aspects of runny and \nstuffy noses.\nA‑287\t 16:05 \nA. Functional anatomy and anatomic variants \nS. Robinson; Vienna/AT (s.robinson@dzu.at) \nThe paranasal sinuses develop in pairs from the nasal cavity and grow from early \npregnancy to late puberty. They humidify and warm inspired air, increase the \nsurface area for olfaction, are thought to regulate intranasal pressure, lighten the \nskull, provide resonance and absorb shock. They are all lined by ciliated columnar \n16:00 - 17:30 Room L/M \nRadiographers \nRC 1014 \nRadiography as an ethical practice \nModerators: \nB.T. Andersson; Lund/SE \nA.L. Baert; Kessel‑Lo/BE \nA‑283\t 16:00 \nA. The relationship between man and technology in radiographic practice: \na narrative approach \nB.R. Mussmann; Odense/DK (borm@ucl.dk) \nThe purpose is to examine the relationship between man and technology within \nradiography without considering man and technology as separate entities. The \nstudy is designed as an observational study which took place in a Danish radiologi-\ncal department. It involved 20 examinations followed up by three semi-structured \ninterviews. Through emergent narratives radiographers construct a practice in which \nthe relationship between man and technology is marked by a struggle of domina-\ntion of one over the other. The struggle expresses itself through two competing \nplots: a diagnostic plot with a prevailing, but not merely chronological structure \nmostly composed of events tied to pathology. The life story, in opposition, plots \nthe examination as a significant experience in the patient‘s life, transforming it \ninto events stretching towards a future yet unknown. Most often the radiographers \ncontributed to the domination of man over technology through active engagement \nof their narrative alertness. Errors and failure to keep the time schedule can, how-\never, lead the radiographers to a change of perspective that makes them displace \nman from the scene of radiography by playing on the premises of technology. In \nseveral stories technology can be labelled ‚setting‘ while the patient plays the main \nrole. The radiographers act with the patient as point of origin, but they reason with \ntechnological arguments. Hence, the human aspects of radiography constitutes \nan underground practice, which is not explicitly articulated valuable. This creates a \nfield of tension between man and technology, with risk of technological dominance. \nLearning Objectives:\n1. To gain knowledge about narrative analysis in a radiographic context.\n2. To appreciate humanistic aspects of radiography.\n3. To consolidate knowledge of ethics in radiographic practice.\n4. To understand how perspectives of illness and disease influences the \npatients experience.\nA‑284\t 16:30 \nB. Ethical codes across Europe \nD.S. Oreti; Monfalcone/IT (graig@virgilio.it) \nThe private life of everyone of us as well as the everyday practice of our profession \nis deeply embedded in ethical/deontological aspects which play a critical role into: \nour profession, the relationship with our patients, with our colleagues, with the \nhealth care team we work with, and with ourselves. The radiographer’s everyday \npractice has to take this aspects into account. Ethics finds its origins in the fusion \nof three different sources, as if it were a compromise between: the species we \nbelong to, the society we live in, and ourselves. Yet, we are not obliged to abide \nto these three elements. It is through our actions that we decide how to behave in \ncertain situations. And this is the reason why every single action towards the others \ngathers importance, the simple rites when individuals meet play a pivotal role in \nthe creation of a relationship with the others. Shaking hands, greeting and using \npolite forms of speech, all these actions are ethically important, they allow us to \ncatch the benevolence of our interlocutor and to discourage any possible hostility. \nWhat would happen if our professional identity were perceived and acknowledged \nthrough the way we can interact and relate to others? In this case, the work no \nlonger ennobles the man, but it is the man, through his actions, who ennobles his \nprofession. Behaving ethically towards one’s own profession, towards the others \nand towards ourselves, is it, or could this be the common ground of European \nprofessional ethics? \nLearning Objectives:\n1. To gain knowledge about the border between philosophical, ethical and \npersonal application in the professional field.\n2. To understand the ethical aspect of daily practice, starting from simple actions.\n3. To appreciate how the ethic can exploit the profession of the radiographer.\n4. To consolidate knowledge of the role of the ethic within the profession of the \nradiographer in Europe.\n\nPostgraduate.Educational.Programme\nS76\n A B C D E F G H\ncystic carcinoma, mucoepidermoid carcinoma, haemangiopericytoma, melanoma, \nolfactory neuroblastoma, osteogenic sarcoma, chondrosarcoma, rhabdomyosar -\ncoma, lymphoma, extramedullary plasmacytoma, and metastatic tumours. Benign \ntumours are: papillomas, osteomas, fibrous dysplasia, juvenile angiofibroma, \nschwannomas and neurofibromas. Till date, the TNM classification is used only \nfor maxillary sinus carcinoma. \nLearning Objectives:\n1. To understand the value of different imaging techniques.\n2. To review imaging findings in benign and malignant disease.\n3. To become familiar with TNM staging of sinonasal neoplasms.\n4. To learn about a template for a “structured report”.\nPanel discussion: \nDiagnostic considerations in runny and stuffy noses 17:14\nA runny or stuffy nose can be due to colds, allergies, sinus infections or the flu and \nsometimes the nose is stuffed by a tumour. Do we need imaging at all in runny \nand stuffy noses? When should imaging be performed? Which type of imaging \nis indicated? \n16:00 - 17:30 Room P \nPhysics in Radiology \nRC 1013 \nDiagnostic radiology and pregnancy \nModerators: \nR. Padovani; Udine/IT \nH. Ringertz; Linköping/SE \nA‑290\t 16:00 \nA. Conceptus doses and risks from maternal diagnostic x-ray \nexaminations \nJ. Damilakis; Iraklion/GR (damilaki@med.uoc.gr) \nWhenever a diagnostic x-ray examination of a pregnant patient is considered to be \nnecessary, conceptus dose estimation is an important step in assessing the risks \nto the unborn child. Accurate estimation of conceptus dose is also needed after \ninadvertent irradiation of a pregnant patient from a diagnostic x-ray procedure. \nSeveral methods have been developed to estimate conceptus dose from radiologic \nexaminations. When the uterus is remote from the directly exposed tissues, the \nconceptus is exposed to scattered radiation and its dose is negligible (<  1 mGy). \nExaminations involving the abdomen-pelvis may deliver higher dose to the child. \nVariations in maternal body size and uterus position should be taken into account \nto obtain accurate conceptus dose estimation. Multidetector CT (MDCT) scanners \nhave replaced conventional CT technology. Conceptus doses from abdominal \nMDCT range from about 13 to about 31  mGy during the first post-conception \nweeks for a scan acquired at 120 kVp, 200 mAs with a pitch of 1.0, depending on \nmaternal body size and uterine position. Multi-phase abdominal CT examinations \nmay deliver relatively high doses to the unborn child. Doses to the conceptus below \n100 mGy should not be considered a reason for termination of pregnancy. The risk \nto the embryo/foetus for stochastic effects is assessed on the basis of dose using \nappropriate risk factors. Although these risks from a single diagnostic procedure \nare low for the majority of diagnostic x-ray examinations, it is important to ensure \nthat doses are kept as low as reasonably achievable. \nLearning Objectives:\n1. To learn how to manage and counsel pregnant patients in case of (a) \nintentional and (b) accidental exposure.\n2. To learn how to estimate conceptus radiation dose from diagnostic x-ray \nexaminations.\n3. To learn how to assess the radiogenic risks to the embryo/foetus from \ndiagnostic x-ray examinations.\nepithelial cells. The mucociliary transport drains each sinus in a specific pattern \nthrough its ostium to the nasal cavity and ensures a constant flow of mucus contain-\ning bacteria and particulate matter. Functional endoscopic sinus surgery (FESS) \naims to enlarge the preformed ostia to allow physiologic drainage. Preoperatively, \nanatomic variants have to be ruled out or shown by CT to avoid injury. Special \nemphasis lies on the ostiomeatal unit, a complex anatomic region at crossroads of \nmucociliary drainage from frontal, anterior ethmoid and maxillary sinuses (uncinate \nprocess, Haller, Agger and frontoethmoidal cells, inverse turbinate). Description \nof the level of the cribriforme plate in relation to the roof of the ethmoid is another \nkey element in a report to avoid skull base injury (Keros I-III). Preoperative iden -\ntification of variations in the location of the optic nerve and the cavernous portion \nof the internal carotid artery is also mandatory. Furthermore, the close proximity \nof the sinuses to neighbouring structures and their thin bony walls predispose to \ncertain pathways of spread. \nLearning Objectives:\n1. To become familiar with the normal anatomy and surgically relevant \nanatomic variants.\n2. To learn about the functional anatomy and patterns of disease.\nA‑288\t 16:28 \nB. Sinusitis: imaging findings before and after treatment \nD. Farina; Brescia/IT (nappaje@yahoo.it) \nRunny and stuffy noses may be due to a long list of pathologic conditions, which \nrequire distinct imaging strategies and treatment options. Acute rhinosinusitis, for \nexample, is normally managed by GPs without any imaging study. Occasionally, \nsigns and symptoms suggest orbital or intracranial complications: in such cases \nMSCT allows a prompt diagnosis and is preferred to MRI for wider availability and \nfaster acquisition. Persistence of signs/symptoms for longer than 12 weeks clas-\nsifies rhinosinusitis as chronic (CRS); the condition may or may not be associated \nwith the presence of nasal polyps. In patients affected by CRS cross-sectional \nimaging aims at precisely depicting bone structures and air conduits. In detail, \nimaging shows the anatomic arrangement of sinus drainage pathways and their \npatency, maps anatomic variants that may facilitate CRS or increase surgical risk, \ndepicts bone changes induced by CRS or by the mechanical pressure exerted \nby polyps. These tasks are better accomplished by CT, even more so after the \nadvent of multislice technology allowed multiplanar reconstructions along oblique \nplanes. After surgery, imaging is required when signs/symptoms recur - to asses \npresence and extension of CRS or nasal polyps - or when late complications are \nsuspected - such as mucosal synechiae impairing mucus drainage or mucocele. \nMRI plays a limited role in sinusitis because it fails to demonstrate thin bone \nstructures; nonetheless, its use is advocated in aggressive inflammatory diseases \n(such as invasive mycoses and Wegener’s granulomatosis) to demonstrate the \ninvolvement of deep spaces of the face and of the skull base. \nLearning Objectives:\n1. To understand the value of different imaging techniques.\n2. To review imaging findings in acute infections and chronic inflammatory \ndisease.\n3. To become familiar with postoperative changes.\n4. To learn about a template for a structured report.\nA‑289\t 16:51 \nC. Sinonasal tumours \nH.B. Eggesbø; Oslo/NO (h.b.eggesbo@medisin.uio.no) \nSinonasal tumours are rare and comprise only 1% of all malignancies. The clinical \nand radiological challenge is to differentiate malignancy from benign or inflamma-\ntory changes. Most malignant tumours present at advanced stages. Malignant \ntumours are most common in the 5th-7th decades and have a male preponderance. \nSquamous cell carcinomas are the most prevalent (80%) followed by adenocarci-\nnomas. Squamous cell carcinomas are most common in the maxillary sinus, next \nthe nasal cavity and ethmoid sinuses, while adenocarcinomas are most often \nseen in the ethmoid sinuses, and commonly caused by occupational exposures, \ne.g. nickel and hardwood workers. Inverting papilloma is one of the most common \nbenign tumours and have been associated with human papillomavirus. CT should \nbe the first modality in paranasal sinus imaging, while complementary MRI before \nand after gadolinium i.v. is mandatory to differentiate tumour from inflammatory \ndisease. A general rule is that tumours more often have unilateral extension and \nthat malignant tumours usually erode the bone. However, malignancy may mimic \nbenign tumours with thickening or remodelling of the adjacent bone. While CT is \nsuperior to demonstrate changes in the bone, MRI can differentiate tumour from \ninflammatory changes and demonstrate tumour invasion and perineural spread. \nMalignant tumours are: squamous cell carcinoma, adenocarcinoma, adenoid \n\nSaturday\nPostgraduate.Educational.Programme\nA\n S77\nCB D E F G H\nA‑291\t 16:30 \nB. X-ray imaging and pregnancy: justification and optimisation of \nexposure \nP. Vock; Berne/CH (peter.vock@insel.ch) \nAs outside pregnancy, justification and optimisation are the main steps to be \ndone when an imaging examination using ionising radiation is considered during \npregnancy. However, the risk concerns the embryo/foetus in addition to the mother \nwhich means that justification has to be more critical whenever the uterine dose \nis not neglectable. The practical approach to an examination in any woman of \nchild-bearing age starts by ruling out pregnancy, whether by taking history or by \na laboratory test. When pregnancy cannot be ruled out, further steps will depend \non the type of examination needed and the urgency of diagnostic clarification. \nUltrasound is the alternative to be preferred when it can answer the clinical ques-\ntion. But even among x-ray examinations, the uterine dose is varying widely which \nasks for a careful selection, optimisation and, maybe, for postponing the test. Once \npregnancy is confirmed, the major question is whether the specific type of diagnostic \nexamination will include the uterus in the primary radiation field. Examinations not \ninvolving the uterus by direct radiation - despite a potentially significant exposure by \nscattered radiation - can usually be performed without a relevant risk to the embryo/\nfoetus. The situation is more critical when the uterus is within the examination field \nand when therapeutic interventions are considered. The presentation will discuss \nthe practical approach to these different situations, the influence of the stage of \npregnancy, optimisation methods and the choice between alternative methods in \nsome frequent clinical situations. \nLearning Objectives:\n1. To become familiar with the radiologist’s practical approach to justification \nduring pregnancy.\n2. To learn how to optimise imaging protocols for x-ray examinations performed \non pregnant patients.\n3. To present the role of imaging modalities in the evaluation of pregnant \npatients.\nA‑292\t 17:00 \nC. Pregnancy and MRI: risks to the unborn child \nJ. De Wilde; Edinburgh/UK (jdewilde@staffmail.ed.ac.uk) \nThis paper explores the risks to the foetus when magnetic resonance imaging \n(MRI) is used. MRI uses three main components to produce images from inside the \nbody: a static magnetic field; a pulsed radio-frequency (RF) fields and time-varying \ngradient electromagnetic fields. The exact frequencies of these fields depend on \nthe MRI system purchased, for example; a 0.5T scanner uses 21  MHz RF, a 1.5 \nT system uses 63 MHz and a 3 T system uses 127 MHz RF. There is also a wide \nrange of options for gradient strengths and slew rates to be considered as well. \nThe overall exposure for the foetus depends ultimately on the imaging sequence \nused and the area being scanned. This paper will discuss particular hazards that \nneed to be addressed for pregnant women including biological effects of the static \nand time-varying magnetic fields, heating effects of the RF pulses and acoustic \nnoise generated by the spatial encoding gradients. The circumstances for foetal \nexposure in MRI will also be discussed including the following situations: the pa-\ntient may not be aware that she is pregnant, likely to be in the first trimester; the \nmother is referred for direct foetal imaging after ultrasound (normally second or \nthird trimester); the expectant mother may need diagnosis; research on pregnant \nvolunteers. The exposure for pregnant staff working in MRI is also an essential \nconsideration. Finally, how to minimise the exposure for the foetus during MR \nimaging will be discussed. \nLearning Objectives:\n1. To understand the risks to the foetus in MRI from static and time-varying \nmagnetic fields, with particular reference to the radiofrequency field.\n2. To consider the exposure of the foetus to noise during MRI.\n3. To understand how to minimise the exposure of the foetus during MR \nimaging.\n\nPostgraduate.Educational.Programme\nS78\n A B C D E F G H\n\n\nSunday\nPostgraduate.Educational.Programme\nA\n S79\nCB D E F G H\nSunday,.March.6\n\nPostgraduate.Educational.Programme\nS80\n A B C D E F G H\nin terms of cerebral perfusion (rCBF, rCBV, MTT and TTP) and cell metabolism \n(cytotoxic versus vasogenic oedema, diffusion restriction). The fundamental goals \nof stroke imaging in the acute phase are: 1. to rule out intracranial haemorrhage, \nand other non-stroke causes of the patient‘s symptoms; 2. to show occlusion of a \nmajor blood vessel, e.g. by CT or MR angiography; 3. to demonstrate ischaemic \nbrain tissue (cytotoxic oedema), e.g. by diffusion-weighted MRI; 4. to reveal tissue \nblood flow and to identify areas of salvageable brain tissue („penumbra“), e.g. by \nperfusion CT or MRI; 5. to select candidates for thrombolytic therapy within the \ncritical 3 to 6 hour time window. The purpose of this presentation is to review how \nnew developments in neuroimaging improve our understanding of the pathophysiol-\nogy of acute stroke and to demonstrate that multiparametric techniques now play \na crucial role in the rapid diagnosis, clinical management, therapy and outcome \nprediction of patients with an acute stroke. \nLearning Objectives:\n1. To illustrate the objectives of neuroimaging in patients admitted with an \nacute neurologic deficit.\n2. To show that perfusion imaging is useful to differentiate the infarct core from \nthe penumbra.\n3. To discuss the role of CT versus MRI in the management of acute stroke \npatients.\nA‑296\t 09:21 \nC. Intervention in stroke \nM. Leonardi; Bologna/IT (marco.leonardi@centauro.it) \nOrganisation is crucial to the practice of dethrombosis. The first step is to grasp \nthe fact that ischaemic stroke is an emergency. Stroke victims require an organi-\nsation similar to that provided for heart attack patients. Patients must be taken to \nhospital in an ambulance manned by a specifically trained crew. Ideally equipped \nwith a mini CT scanner recently made available. This device provides an immedi-\nate morphological scan and CT angiogram to be sent by satellite to the reference \nhospital so that the problem will be clear and the medical team ready on the patient’s \narrival. Clinical and neurological assessment of the patient must be undertaken \nimmediately along the lines of UK practice implementing a simple, clear and rapid \nprocedure. If the clinical, CT and CT angiography findings indicate intra-arterial \ntreatment, responsibility shifts to the neuroradiology team, organised to work a 24 \nhour shift, at the hospital or at least on call. Dedicated imaging systems must be \navailable: a multi-layer CT device (CT angiography and perfusion studies). Dedi-\ncated angiography suite is essential. A flat panel system would be ideal. There is \ngrowing evidence supporting the availability of an MR system. This device would \ncertainly enhance the possibilities of a stroke unit but it is not essential in the initial \nstages. A stroke unit should be based on a dedicated facility, with emergency ac-\ncess separate from the general emergency room, dedicated equipment, dedicated \nambulances and appropriate links including a dedicated ward and a rehabilitation \nunit essential to the success of the project. \nLearning Objectives:\n1. To learn about the benefits and risks in stroke intervention.\n2. To consolidate knowledge of different methods of intervention in stroke \ntherapy.\n3. To learn about the different imaging methods used to decide on and perform \nstroke intervention.\nPanel discussion: \nWhere do we stand in stroke therapy today? 09:44\nStroke is a common health problem with high socio-economic costs. In recent \nyears much effort has been focused on finding ways to ensure early intervention \nas well as new methods not only for early detection but for early treatment. The \ndiscussion will focus on where we stand today and whether we think stroke imaging \nand treatment will advance further. \n08:30 - 10:00 Room A \nNeuro \nRC 1111 \nImaging stroke \nModerator: \nR. Siemund; Lund/SE  \nA‑293\t 08:30 \nChairman’s introduction \nR. Siemund; Lund/SE (roger.siemund@skane.se) \nDuring the last decade imaging of stroke has developed from a minor field dealing \nwith a barely treatable disease to one of the most dynamic parts of neuroradiology. \nThe routinely treatment with intra-venous thrombolysis within the 4.5 hour time win-\ndow and the continuously expanding treatment of severe strokes with intra-arterial \nthrombectomy have lead to increasing requests from clinicians and interventional \nneuroradiologists to provide imaging information for treatment guidance. All radi-\nologists involved in the management of stroke are facing mainly three demands: \nfirst, to have good knowledge of the causes and the pathophysiology of ischaemic \nstroke and a proper understanding of the current models for infarct development, \nas a prerequisite for rational decision making and efficient communication with the \nclinicians. Second, to be able to choose and to use appropriate imaging modalities \nfor the acute work up of patients with stroke and to be aware of the benefits and \ndrawbacks of CT and MRI. Finally, is good knowledge about the therapy options \nmandatory in order to be able to support the clinicians in the time critical treatment \ndecision. This session will try to cover these three demands in order to give an \noverview on the current status and the opportunity to discus future perspectives. \nA‑294\t 08:35 \nA. Aetiology and pathophysiology of stroke \nR. von Kummer; Dresden/DE (ruediger.vonkummer@uniklinikum‑dresden.de) \n„Stroke“ is the commonly used diagnosis for disturbances of brain blood supply due \nto ischaemia, haemorrhage, or venous obstruction. It is evident that „disturbances \nof blood supply“ in stroke patients do not represent a useful concept in order to \ndevelop effective treatment. It is the radiologist‘s task to describe the acute brain \npathology, its conditions (pathophysiology), and its aetiology to give directions \nfor specific treatment and prophylaxis. The approach is vascular and brain tissue \nimaging. Brain ischaemia is the cause of stroke in about 85% of patients, intracra-\nnial haemorrhage in 15% of patients. Arterial obstruction causing brain ischaemia \nis thrombotic or embolic. It can as well be caused by arterial wall dissection or \ninflammation. Arterial wall diseases and heart diseases including a patent foramen \novale are sources for brain embolism. The obstruction of a brain supplying artery \ncauses brain tissue ischaemia of various degrees depending on the capacity of \ncollaterals supplying the same arterial territory. The chances for collateral compen-\nsation depend on the site of obstruction and the development of collateral vessels. \nNeurons cannot tolerate low cerebral blood flow (CBF) below 10  ml/100 g x min \nfor more than 20 minutes and develop first cellular then irreversible ionic oedema. \nThey survive, but do not function with low CBF between 10 and 20 ml/100 g x min. \nEnhancement of CBF in such regions, e.g. by arterial recanalisation can mean \nfunctional recovery. The imaging diagnosis of damaged brain is therefore the first \naim in acute ischaemic stroke patients. \nLearning Objectives:\n1. To comprehend the etiology and pathophysiology of stroke.\n2. To learn to differentiate between different types of stroke.\n3. To consolidate knowledge of the key imaging findings in different types of \nstroke.\nA‑295\t 08:58 \nB. Stroke imaging in the acute phase or in critically ill patients \nP.M. Parizel, C. Venstermans, F. De Belder, J.W. Van Goethem, \nL. Van den Hauwe, T. Van der Zijden, M. Voormolen; Antwerp/BE \nAcute stroke is the most common non-traumatic neurological emergency. Clinical \nhistory and physical examination do not provide reliable information regarding the \nextent and localisation, vascular distribution territory, and aetiology of the stroke. The \nrole of stroke imaging has changed dramatically in recent years, thanks to the arrival \nof aggressive new therapies aimed at re-establishing blood flow, reducing infarct \nsize and protecting the brain at risk. Multiparametric neuroimaging, involving CT, \nMRI or both, has opened new insights to determine the pathophysiology of stroke, \n\nSunday\nPostgraduate.Educational.Programme\nA\n S81\nCB D E F G H\n08:30 - 10:00 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 1118 \nSurprise in the liver \nModerator: \nC. Bartolozzi; Pisa/IT \nA‑299\t 08:30 \nA. Clinical considerations \nA. Palkó; Szeged/HU (palkoand@gmail.com) \nFocal liver lesions are part of our everyday practice because radiologists perform-\ning various types of examinations may encounter them without being aware of \nany clinical condition rising the suspicion of these changes. In a situation like this \nseveral important decisions are to be made by the radiologists, like: is the lesion \nclinically significant, is the lesion benign or malignant, are additional imaging ex-\naminations necessary, does it require medical, surgical or interventional radiologi-\ncal action, should it be, and if yes, how frequently followed up, etc. For providing \na well-established answer to these questions the reporting radiologist has to be \nfamiliar with medical history and results of former examinations (physical, laboratory, \nimaging, etc.); consider the age, gender, physical condition, eating and drinking \nhabits, potential drug abuse of the patient; bearing in mind the prevalence and \nstatistical probabilities of different pathologic conditions. With all this information \nat hand the thorough analysis of images obtained by different modalities will allow \na rather reliable differential diagnosis and a well-established planning of therapy \nof the incidentally detected lesions. \nLearning Objectives:\n1. To learn more about the clinical conditions that may result in the appearance \nof focal liver lesions.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑300\t 09:00 \nB. Imaging techniques and typical findings \nC.J. Zech; Munich/DE (Christoph.Zech@med.uni‑muenchen.de) \nThe spectrum of differential diagnoses is broad in the liver. Therefore, incidentally \ndiscovered liver lesions represent a challenging clinical situation. Fortunately, there \nare specific imaging features for the most common benign and malignant liver le-\nsions (such as, e.g. hemangioma, FNH, cysts, vascular pseudolesions, HCC and \nmetastases) so that a minimal-invasive diagnosis with a biopsy is not needed in \na lot of cases. In ultrasound, the echogenity and recently also the contrast agent \nbehaviour are used for liver lesions characterisation. In CT, attenuation and also \ncontrast agent behaviour are used for characterisation. MR imaging offers several \noptions including T1- and T2-weighted images, use of chemical shift imaging, \nGRE sequences with long echos and diffusion weighted images, so that tissue \ncomponents such as fat, water, glycogen, iron, etc. can be evaluated already in the \npre-contrast examination. Beside the evaluation of dynamic signal characteristics \nin the early dynamic phase after contrast agent application, MR can utilize also \ntissue-specific contrast agents dedicated to the RES or to the hepatocytes. Other \nmodalities such as angiography, PET or other nuclear medicine methods usually \nonly play a minor role nowadays in the evaluation of incidental liver lesions in non-\noncological patients. In oncological patients the clinical consequences and also the \nrange of diagnoses and pre-test probabilities are different from the non-oncological \ngroup; therefore, the demands to imaging are even higher. In case of atypical pre-\nsentation of otherwise benign liver lesions such as sclerosed hemangioma close \nfollow-up or even biopsy can be necessary in such a setting. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof patients with incidentally detected focal liver lesions.\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\n08:30 - 10:00 Room B \nInteractive Teaching Session \nE³ 1120 \nCommon radiological problems: palpable lower \nneck mass - thyroid or not? \nA‑297\t 08:30 \nA. Thyroid nodule \nH. van Overhagen; Den Haag/NL (h.voverhagen@hagaziekenhuis.nl) \nThyroid nodules are common. In 4-8% of adults nodules can be palpated and \nat ultrasonographic examination nodules are seen in 10-41%. Most nodules are \nbenign, the eventual diagnosis in patients with a palpable nodule is carcinoma in \nonly 5% of cases. The incidence of thyroid carcinoma is low. Papillary carcinoma \nis the most common type and is found in 75-80% of thyroid cancer. Lymph node \nmetastases in thyroid carcinoma are primary to the paratracheal and prelaryngeal \nnodes (Level VI), and the upper (Level III) and lower (Level IV) jugular nodes. \nMalignancy should be suspected when there is rapid growth, a firm or fixated \nmass, when enlarged lymph nodes are present or in case of vocal cord paralysis. \nIn patients with multiple thyroid nodules the cancer risk per patient is not altered. \nUltrasound is the primary imaging technique in patients with a palpable thyroid \nnodule. It is best performed with the patient supine, the neck slightly extended and \nusing a high frequency linear-array transducer. Several ultrasonographic features \nare more often associated with benign or malignant nodules. However, while some \nultrasonographic features may strongly suggest malignancy it may be very difficult \nto rule out malignancy by means of these features alone. Ultrasound-guided fine \nneedle biopsy can be performed in an attempt to differentiate between benign and \nmalignant nodules. Unfortunately, even with ultrasound guidance, an important \nnumber of cytological examinations will be non-diagnostic. In addition, in follicular \nlesions it is usually impossible to differentiate cytologically between benign and \nmalignant follicular nodules. \nLearning Objectives:\n1. To learn about the optimal settings for US examination of the thyroid.\n2. To identify morphologic characteristics of benign and malignant thyroid \nnodules.\n3. To identify the most common pathways of lymph node metastases in the thyroid.\n4. To learn about the role of US-guided fine needle aspiration cytology in the \nthyroid.\nA‑298\t 09:15 \nB. Outside the thyroid \nN.J.M. Freling; Amsterdam/NL (n.j.freling@amc.uva.nl) \nThe neck is host to a large variety of benign and malignant diseases ranging from \nsimple cysts to acute inflammation with complications to highly malignant sarcomas \nand imaging plays an important role to assess the nature and the extention of \ndisease. Patient history and clinical findings will decide which imaging technique \nis best suited to resolve the diagnostic dilemma. Ultrasound is recommended to \ndifferentiate between a cystic or solid lesion, to guide FNA, being quick and ac-\ncurate. Pathologic flow within or around a lesion can be assessed adding Doppler \ntechnique. In acute illnesses with anticipated complications, such as a deep neck \nabscess, contrast-enhanced CT is required to evaluate local extention and demon-\nstrate spread from the neck deep to the mediastinum. MRI is indicated to assess \nnon-inflammatory, subacute or chronic diseases, such as vascular malformations, \nbranchial cleft cysts, benign and malignant soft tissue tumours, brachial plexus \npathology and neurologic diseases. Vascular malformations are easily depicted \nwith MRI using T2 sequences in different image planes. Persistent fistulas of the \nbranchial system can also be depicted by MRI running from the anterior border of \nthe sternocleidomastoid muscle to the lateral pharyngeal wall. Assessing the origin \nof a soft tissue tumour has major implications for surgery. Staging a malignant soft \ntissue tumour must comprise the skull base and upper mediastinum including local \nextention, pathologic neck nodes and perineural spread. Follow-up during chemo-\ntherapy and postoperative monitoring of malignant disease are important indications \nfor (MR) imaging, the more so in young patients, diminishing ionising radiation. \nLearning Objectives:\n1. To identify different compartments in the neck.\n2. To be able to choose the optimal imaging technique relating to request.\n3. To become familiar with the most common pathology in adults and children.\n4. To be able to address a short list of differential diagnoses.\n\nPostgraduate.Educational.Programme\nS82\n A B C D E F G H\npatients (92%) and by ultrasound in 95 patients (93%). The activity of the disease \nwas assessed correctly in 91% patients by ultrasound, compared to 74% patients \nby enteroclysis. There was no statistically significant difference. Bowel US is a use-\nful investigation for the diagnosis and follow-up of patients with Crohn´s disease. \nLearning Objectives:\n1. To learn about US techniques used in the assessment of patients with \ninflammatory bowel disease.\n2. To learn tips for interpretation of US in the diagnosis and follow-up of \npatients with inflammatory bowel disease.\n3. To understand the pros and cons of using US, including CEUS, in the \ndiagnosis and follow-up of patients with inflammatory bowel disease, \nincluding assessment of disease activity.\n4. To appreciate the accuracy, reproducibility and usefulness of US compared \nwith other imaging techniques in assessing patients with inflammatory bowel \ndisease.\nA‑304\t 08:58 \nB. Role of CT in diagnosis and follow-up \nS. Romano; Naples/IT (stefromano@libero.it) \nThe use of computed tomography (CT) in the diagnostic imaging of patients affected \nby inflammatory bowel disease (IBD) has a long standing history. CT techniques \nsuch as CT-enteroclysis and CT-enterography have been reported as efficient \ntools for a radiological assessment of disease. The state-of-the art methods will \nbe reported and their potentialities in diagnostic accuracy discussed in different \nclinical type of IBD. The acute setting of unknown IBD could be demanded as well \nto CT examination performed in emergency without endoluminal contrast medium \nadministration. The CT appearance of the intestinal wall of the segments involved \nby an active disease could be not correctly interpreted if the knowledge of basic \nand classic typical findings of IBD is not combined to consider different pathologic \nentities that could affect the intestine, offering similar but not even equal signs. \nThe entire abdominal background needs to be evaluated according to the clinical \nsymptoms, signs, laboratory parameters and history of the patient. CT examination \ncould be an efficient tool to determine the degree of disease activity in patient with \nknown IBD as well as to assess the presence of an acute inflammatory disease of \nthe intestine in patients with unknown IBD affection. The actual role of CT in the \nearly diagnosis of IBD, in disease staging and detection of complications as well \nas monitoring therapy in follow-up will also be considered and discussed. \nLearning Objectives:\n1. To learn about state-of-the-art CT techniques for the assessment of patients \nwith inflammatory bowel disease.\n2. To learn tips for interpretation in terms of diagnosis and differential diagnosis \nof inflammatory bowel disease.\n3. To discuss the value of CT in determining disease activity and monitoring \ntherapy.\nA‑305\t 09:21 \nC. CT versus MRI \nM.A. Patak; Zurich/CH (michael.patak@usz.ch) \nThe aim of this lecture is to give an overview of the techniques and typical find-\nings for imaging Crohn’s disease (CD) with either multidetector row computed \ntomography (MDCT) or with magnetic resonance imaging (MRI) and compare \nthe two different modalities. Optimal imaging of CD begins with the preparation \nphase. The small bowel has to be distended for a concise examination. This can \nbe done either invasively, i.e. enteroclysis or orally, which is named enterography. \nThere is much debate on which of these two preparation methods is better. For \nthe administered intraluminal contrast, best is water with some additives, which \nare neutral in CT and biphasic in MR. Imaging in MDCT is done 40 sec and 70 \nsec after IV administration of iodinated contrast with a thin collimation. All image \ndata are reconstructed in axial, coronal and sagittal planes. The aim of imaging \nin CD should be to establish the following: (1) presence, severity, and extent of \nthe disease; (2) its activity; and 3) extra-intestinal complications. Both modalities \nhave proven to be a good tool to evaluate the extent, the activity of the disease \nand the presence of extraluminal complications. Both are also able to identify the \ntype of the disease, being either the active/inflammatory, the fistulising/perforating, \nthe fibrostenosing or the reparative/regenerative type. The challenge for MRI is \nmostly the in-plane resolution of the image data whereas radiation dose is for CT. \nLearning Objectives:\n1. To consolidate knowledge of MR techniques and results in the assessment \nof inflammatory bowel disease.\n2. To consider the pros and cons of CT and MRI in inflammatory bowel \ndisease.\nA‑301\t 09:30 \nC. Interactive case discussion \nG. Brancatelli; Palermo/IT (gbranca@yahoo.com) \nIncidental lesions are frequently discovered during routine radiographic evaluations. \nCorrelation with clinical history and additional confirmatory imaging is essential to \nthe development of an accurate, focused differential diagnosis and for appropriate \nmanagement. The objective of this presentation is to describe the imaging findings \nassociated with incidentally found liver lesions and to review those clinical and \nradiologic features, which should be considered in development of an ordered and \naccurate differential diagnosis. \nLearning Objectives:\n1. To introduce typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of unexpected liver lesion cases.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n08:30 - 10:00 Room D1 \nAbdominal and Gastrointestinal \nRC 1101 \nInflammatory bowel disease: which test and when? \nModerator: \nZ. Tarján; Budapest/HU \nA‑302\t 08:30 \nChairman’s introduction \nZ. Tarján; Budapest/HU (ztarjan@gmail.com) \nThe diagnosis of IBD is based on complex evaluation of clinical signs, endoscopic \nappearance, radiological imaging, laboratory tests and histology. Besides Crohn's \ndisease (CD) and ulcerative colitis (UC) the modern classification advises to use \nthe term IBDU (IBD unclassified) colitis to those 10% of cases, where the distinction \nbetween CD and UC is impossible based on the results of multiple exams. These \ncases are usually clinically more severe, with humbler therapeutic results. The \nnew classification of CD types includes besides the phenotype (B1: inflammatory \nnon stenosing non penetrating, B2: stenosing, B3: penetrating) the age (A1: ≤16 y, \nA2: 17-40 y, A3: > 40 y) the location (L1: ileum, L2: colon, L3: ileocolic, L4: upper \nGI tract) and P perianal involvement. In UC the most important clinical factors are \nextent, type and severity. The classification includes length and clinical types as \nacute, relapse-remission and chronic continuum. The radiological imaging in CD is \nneeded for lesions not reachable by the endoscope, for categorising, for follow-up \nand detecting complications. Different modalities fit best for these different tasks. \nThe goal of imaging in UC is rather to help differential diagnosis and detection of \ncomplications. While in UC there are good correlation between laboratory and \nendoscopic signs of activity and severity so there is not much need for radiological \nactivity indices, in CD the clinical activity does not correlate with the histological \nchanges. Although CDAI is widely used for clinical studies, it includes several \nsubjective factors, thus radiological activity indices may be of help. \nA‑303\t 08:35 \nA. Role of US in diagnosis and follow-up \nV. Válek; Brno/CZ (vlvalek@med.muni.cz) \nCrohn’s disease is more likely a systemic disease governed by a shift in the immune \nresponse, thus affecting the whole MALT system. Bowel ultrasound is a quick, \nsimple and effective investigation. The method is simple and requires no bowel \npreparation. We use both - convex (C 5-1 - overview, anatomical orientation) as well \nas linear transducer (L 12-5 - preferred, incl. CEUS, L 17-5 -children and very slim \npatients, L 9-3 - TDPs, deep structures). We examine patients in supine position, \nfirst small bowel, than mesentery and large bowel. Finally, we examine the terminal \nileum and cecum or the areas of anastomoses. We assess folds, hastrum, wall \nthickness, vascularity, echogenity of the surrounding fat, the presence of nodes \nand peristalsis. In some cases we use intravenous contrast (CEUS). At least four \nstudies have prospectively compared the diagnostic accuracy of US with radiological \nstudies, endoscopy or surgery in those with suspected Crohn’s disease. In these \nstudies, the sensitivity of US ranged between 84% and 90% and its specificity \nreached 98% and 100%. In our prospective study we investigated patients by \nultrasound and enteroclysis. We established the diagnosis by enteroclysis in 94 \n\nSunday\nPostgraduate.Educational.Programme\nA\n S83\nCB D E F G H\nA‑308\t 09:30 \nC. Central venous occlusions \nP. Haage1, C. Hohl2; 1Wuppertal/DE, 2Siegburg/DE \nThe central venous vasculature and particularly the upper venous system may \nbe obstructed by either benign or malignant lesions. Malignant central venous \nobstructions are mainly due to bronchial carcinoma, mediastinal metastasis, \nmesothelioma or lymphoma. The most common cause for benign central venous \nobstruction is haemodialysis related; other benign reasons are rather uncommon \nbut increasing due to the omnipresent use of permanent central venous access \ncatheters as well as implantable cardiac rhythm management devices. The inci-\ndence of haemodialysis-related central venous obstruction resulting in angioplasty is \ndescribed to be more than 10 times higher compared to, for example, pace-maker-\ninduced stenosis. In any case, early detection and treatment of complications are \nessential to provide adequate care. Contrast venography for many years has been \nthe standard of reference; yet this procedure has its shortcomings. Sonography is \nnot consistently reliable for detection of central pathologies, owing to difficult access \nto these vessels. Today contrast enhanced CT is employed to define the site of the \nobstruction and the presence of possible thrombosis and reveal surrounding soft \ntissue alterations. MRI is of comparative or even higher sensitivity and specificity in \nevaluating the patency of the central veins. The efficacy and safety of stent place-\nment in central venous occlusion of benign and malignant origin lead to rapid relief. \nStenting provides fast symptomatic help. Repetitive percutaneous intervention can \nprolong the cumulative patency. Thrombolysis may be required to improve the final \nresult, should, however, not be employed as a sole means for revascularisation. \nLearning Objectives:\n1. To review imaging modalities for SVC, IVC, hepatic and portal venous \nocclusions.\n2. To learn about interventional radiological treatment options.\n3. To learn about different indications and routes of treatment.\n08:30 - 10:00 Room E1 \nMusculoskeletal \nRC 1110 \nSports injuries: US or MRI? \nModerator: \nG.M. Allen; Oxford/UK \nA‑309\t 08:30 \nChairman’s introduction \nG.M. Allen; Oxford/UK (georgina.allen@gtc.ox.ac.uk) \nUS and MR are excellent imaging techniques for studying tendons and muscles. \nDuring this integrated session we will review the advantages and disadvantages \nof US and MR for the diagnosis and follow -up of sports injuries. Tricks of both \ntechniques will be addressed, together with some useful guidelines for specific \nsports injuries. Ultrasound is being used at the pitch side and in sports medicine \npractice as an adjunct to clinical practice. With this in mind there are a number of \nquestions that will be answered in these talks. 1. When US and MRI are the primary \nimaging and when they are complimentary. 2. What advances have there been \nin US and MRI imaging to help advance our use of these techniques in tendon \nand muscle injury. 3. Should we be aspirating haematomas and using autologous \nblood injections or PRP to treat tendon or muscle disease. 4. Can we predict the \nathletes return to sport? \nA‑310\t 08:35 \nA. Muscle and US \nC. Martinoli; Genoa/IT (carlo.martinoli@libero.it) \nMuscle imaging is inherently complex and presents unique morphologic challenges \nand continuing integration of dynamic, physiologic and functional capabilities. In \nsports medicine, ultrasound (US) has proved to be an excellent tool to evaluate \nmuscle strain and contusion injuries in athletes providing good correlation with \nclinical findings. In the acute phase, US has nearly equal sensitivity to MR imaging \nto diagnose muscle strains, except in the first few hours after the injury, when fresh \nhaemorrhage and oedema have similar echogenicity to normal muscle and strains \nmay go unnoticed. Later in the process, US has been shown to be a useful tool in \nassessing the sequential stages of muscle repair, showing progressive resolution \nof blood fluid products, decrease in oedema and formation of scar tissue, thus \naiding rehabilitation planning. Dynamic US during muscle contraction can be valu-\n3. To compare the diagnostic accuracy of CT versus MRI in Crohn’s disease.\n4. To learn about a strategy for the use of CT and MRI in the radiological work-\nup of patients with inflammatory bowel disease.\nPanel discussion: \nFive good reasons for the radiologist to be at the forefront 09:44\nThe chairman and speakers will debate the optimum imaging paradigms according \nto (1) the clinical indication, (2) assessment of those with suspected but as-yet-\nundiagnosed disease, (3) staging of the small bowel in those with newly diagnosed \nCrohn disease, (4) evaluation of response to therapy and (5) assessment of those \nwith long standing disease. The optimum approach to assessing and monitoring \ndisease activity will be discussed. \n08:30 - 10:00 Room D2 \nInterventional Radiology \nRC 1109 \nVenous intervention \nModerator: \nL. Lonn; Copenhagen/DK \nA‑306\t 08:30 \nA. DVT and prevention of pulmonary emboli \nC. Binkert; Winterthur/CH (christoph.binkert@ksw.ch) \nDeep vein thrombosis (DVT) is a common condition which can lead to possible life-\nthreatening pulmonary embolism (PE). The primary imaging modality nowadays is \nDuplex ultrasound. In cases where the pelvic veins and/or the vena cava is involved, \na venous-phase CT is helpful to determine the exact extend of the clot burden. \nStandard therapy for DVT is anticoagulation. However, if there is a contraindication \nor a complication (bleeding) to anticoagulation a vena cava filter is a good option \nto prevent PE. A filter should also be considered if a catheter directed thrombolysis \nis performed. With the new optional filters the filtration can be terminated either \nby removing the filter or by converting the filter into a stent. One problem which \nwas observed with these optional filters is that (too) many of them are left in place. \nDespite a low complication rate of filters, a filter may cause an increased risk of \nfurther DVT, or a caval occlusion and in rare cases even a migration or penetration \nis possible. Therefore, patients with optional filters should be followed and filters \nshould be retrieved when clinically no longer needed. \nLearning Objectives:\n1. To learn about optimal examination and imaging.\n2. To understand the role of IVC filters in the management of DVT.\n3. To learn about filter concepts.\nA‑307\t 09:00 \nB. Endovascular treatment of varicose veins \nD.J. West; Stoke‑on‑Trent/UK (david.west@uhns.nhs.uk) \nVaricose veins are an early manifestation of venous insufficiency of the lower limbs \nwhich can also lead to skin changes including extensive ulceration. It is a very com-\nmon problem affecting up to 30% of adults in Europe. Patients presenting with venous \ninsufficiency must first be assessed by a history and clinical examination to determine \nthe presence and extent of the disease. A duplex ultrasound examination is essential \nto determine the cause from which an appropriate treatment plan can be decided. \nDepending on the patients wishes and their funding options it is perfectly reasonable \nto treat all stages of the disease even if just cosmetic. Treatment aims to eliminate the \nreflux in all contributing veins starting proximally and moving distally. Surgery used to \nbe the commonest treatment offered to patients but this has been largely superceded \nby endovenous methods which have significant advantages including: no general \nanaesthesia, outpatient based, no cuts, no scars, low recurrence, rapid convalesence. \nThere are several endovenous methods using laser, RF, foam sclerotherapy and most \nrecently steam heating and a combined mechanical/sclerosant system (ClariVein (R)). \nLaser and RF give almost identical results and 95% permanent truncal vein closure is \nto be expected. Foam sclerotherapy is cheaper and quicker but long-term results are \npoorer and patients often have to return for repeat procedures. Having ablated the main \ntruncal veins using laser or RF at least 50% of patients require additional treatments \nfor residual varicosities, e.g. microavulsions or foam sclerotherapy. \nLearning Objectives:\n1. To learn about diagnostic strategies and options.\n2. To know the principles of treatment and discuss the indications.\n3. To review the short term and long term results.\n\nPostgraduate.Educational.Programme\nS84\n A B C D E F G H\nPanel discussion: \nWhat is the best imaging modality for diagnosing sports injuries? 09:44\nUS and MR are excellent imaging techniques to study tendons and muscles. During \nthis integrated session we will review advantages and disadvantages of US and \nMR for the diagnosis and follow -up of sports injuries. Tricks of both techniques \nwill be addressed, together with some useful guidelines for specific sports injuries. \n08:30 - 10:00 Room E2 \nOrgans from A to Z: Pancreas \nMC 1119 \nImaging adenocarcinoma \nModerator: \nT.K. Helmberger; Munich/DE \nA‑313\t 08:30 \nA. MDCT: how to diagnose, how to stage \nW. Schima; Vienna/AT (Wolfgang.Schima@khgh.at) \nAdenocarcinoma is the most common pancreatic malignancy, affecting the head in \n60-70%. MDCT is very effective in detection and staging of adenocarcinoma, with a \nsensitivity of up to 90% for detection and accuracy of 80-90% for staging, but it has \nlimitations (detection of small cancers, characterisation). MRI is a problem-solving \ntool in equivocal CT to depict small cancers. MRI with MRCP helps to differentiate \nbetween adenocarcinoma and focal pancreatitis. The “duct penetrating sign” at \nMRCP is indicative of an inflammatory mass. Examination protocols for MDCT \ninclude oral administration of 1-1.5 l of water (“hydro-CT”), IV contrast administration \nof 2 ml/kg b.w. (app. 140-150 ml), a flow rate of 4-5  ml/s, and a biphasic scan in \nparenchyma and venous phases. MRI protocol should include non-fatsat and fat-sat \nT1w GRE, T2w TSE, DWI, MRCP , and contrast-enhanced sequences. Gadolinium-\nenhanced T1w 3D-GRE are helpful for assessment of vessel infiltration and cystic \ntumours, whereas mangafodipir-enhanced sequences improve delineation of small \ntumours. In patients with locally advanced tumours, neoadjuvant chemoradiation \nmay be used for tumour downsizing to make it amenable to radical surgery. How-\never, pancreatic cancer often does not shrink after tumour response, which renders \nMDCT or MRI unreliable for tumour assessment in this setting. PET/CT may play \na role in this indication. In conclusion, CE hydro-MDCT is an excellent and robust \ntool for pancreatic cancer detection and staging. MDCT in combination with MRI or \nEUS provides high accuracy for characterisation of tumours. Further improvement \nis needed to assess tumour response after neoadjuvant chemoradiation. \nLearning Objectives:\n1. To understand the main pathologic features of pancreatic adenocarcinoma \nand how it governs imaging findings.\n2. To learn how to set up imaging protocols for detection and staging purposes \nincluding contrast media considerations.\n3. To learn about the current role of endosonography and PET/CT.\n4. To understand the role of image-guided biopsy.\n5. To review current trends in tumour management, including the role of \npreoperative neoadjuvant therapy.\nA‑314\t 08:55 \nB. MR imaging: a main course or just a side dish? \nM. Zins; Paris/FR (mzins@hpsj.fr) \nCT is the established imaging technique for evaluation of pancreatic adenocarcinoma. \nMRI, however, can play a major role in this disease. Technical advances of MRI includ-\ning parallel imaging techniques, multichannel receive coils of the abdomen, dynamic \ngadolinium-enhanced T1-weighted fat sat 3D GRE sequences, 3D MRCP sequences, \nmangafodipir-enhanced MRI and diffusion weighted imaging (DWI) have greatly im-\nproved the results of MRI in the assessment of pancreatic tumours. Standard imaging \nsequences include T1-weighted GRE with fat saturation, in-phase and opposed phased \nT1-weighted, axial single-shot turbo spin-echo (TSE) and coronal/oblique 2D and/or 3D \nMR cholangio-pancreatography (MRCP) pulse sequences, post-gadolinium-enhanced \n3D T1-weighted fat sat sequence and DWI with multiple b values. MR imaging may be \nuseful as subsequent examination for: (1) detection of small non-contour-deforming \ntumours with isoattenuated appearance at CT, (2) evaluation of local extension and \nvascular encasement, (3) detection of the presence of lymph node and peritoneal \nmetastases, and (4) detection and characterisation of associated liver lesions and liver \nmetastases. Diffusion-weighted imaging may be helpful as a complementary imaging \nmethod in the differentiation between mass-forming focal pancreatitis and pancreatic \nadenocarcinoma. Due to its superior soft-tissue contrast compared with CT, MRI ap-\nable to monitor the healing process. Local complications, such as vein thrombosis, \nirritation of adjacent neurovascular bundles, chronic haematoma and myositic \nossificans can be demonstrated with this technique as well. However, US tends \nto underestimate the extent of injury and the abnormalities seen disappear more \nquickly when compared with MR imaging. At least in elite athletes, MR imaging \nseems, therefore, to play a more significant role in management of muscle injury, \nparticularly when decisions regarding the time at which the patient can return to play \nare needed. By contrast, US is more accessible, and cheaper than MR imaging. \nIn most clinical settings, US should be regarded as the first-line imaging choice \nfor assessing skeletal muscle injury. \nLearning Objectives:\n1. To understand the mechanism of injury of muscles in athletes.\n2. To understand the role of US in the diagnosis of muscles injuries.\n3. To recognise the imaging pattern of abnormalities in athletes.\n4. To understand how US might be used in the management of sports muscle \nfor diagnosis and follow-up.\nA‑311\t 08:58 \nB. Tendon and US \nA. Klauser; Innsbruck/AT (andrea.klauser@i‑med.ac.at) \nSports activity can affect tendons due to chronic overuse or acute injury. Both can \nresult in complete tendon rupture. US is helpful in precise assessment of rupture \nseverity and extend, but enables alsofor assessment of tendon degeneration, where \nrupture of individual collagen fibres stimulates a chronic cycle of reparative response \ncaused due to repetitive microtrauma. In chronic tendinopathy histopathological \nchanges, such as hypoxic, mucoid, calcifying, or lipoid degenerations are present. US \nenables for differentiation of partial tears, tendinosis, tenosynovitis or paratendinosis, \nbecause of active and passive dynamic examination possibilities, and high-resolution \ncapability when using high frequency probes. US developments as power Doppler \nUS, sonoelastography and contrast enhanced US allow further for new insights into \ntendinopathy. With the use of US, tendon changes can be diagnosed before they \nbecome symptomatic and a reduction of tendon load and initiation of treatment before \nthe condition becomes chronic seem to gain important place in therapeutic regimes. \nFurthermore, US-guided therapies are advisable over blinded-guided injections to \nminimise side effects and to allow an accurate targeted therapeutic approach. \nLearning Objectives:\n1. To understand the mechanism of injury of tendons in athletes.\n2. To understand the role of US in the diagnosis of tendon injuries.\n3. To recognise imaging patterns abnormality in athletes.\n4. To discuss how US might be useful in the management of tendon injuries for \ndiagnosis and follow-up.\nA‑312\t 09:21 \nC. Muscle and tendon by MRI \nU. Aydingoz; Ankara/TR (uaydingo@hacettepe.edu.tr) \nAlthough diagnosis of acute muscle injuries in athletes is usually clinical, magnetic \nresonance imaging (MRI) is a very helpful adjunct tool in this setting, showing the \nlocation, extent and severity of the injury and thereby streamlining the manage -\nment of the patient. Portability of ultrasonography (US) on the playfield in the acute \nsetting is not matched by MRI, which nevertheless has distinct patterns of grade \n1-3 muscle strains; however, it is usually with nonacute and deeper injuries of the \nmuscles that MRI is especially helpful. Presence of bone contusion, stress reac-\ntion, or stress fracture is readily displayed by MRI and this is practically beyond \nthe limits of US. Evolving haematomas, fibrosis, scarring, and myositis ossificans \nare sequelae of direct or indirect muscle injury which are usually outlined in a \nsingle field of view by MRI. Delayed onset muscle soreness and chronic exertional \ncompartment syndrome, as well as acute and chronic stages of muscle denerva-\ntion changes, are readily diagnosed with MRI. By providing an understanding of \ndistinct muscular denervation changes, MRI may actually noninvasively point to \nthe entrapped or involved nerve and guide medical or surgical intervention. Foci \nof mucoid degeneration within the muscle, myotendinous junction, or tendon itself \nare readily shown by MRI, which thereby displays potential sites of failure during \nsport activities. Diffusion tensor imaging may have a role in displaying the subtle \narchitectural disruptions of directly or indirectly injured muscles. \nLearning Objectives:\n1. To understand the specific role of MRI in the evaluation of muscle and \ntendon injuries in athletes.\n2. To recognise imaging patterns of tendon abnormalities in athletes: acute and \nover-use injuries.\n3. To review different mechanisms of muscle injuries: direct and indirect.\n4. To understand how MRI might be used in the management of athletes.\n\nSunday\nPostgraduate.Educational.Programme\nA\n S85\nCB D E F G H\nbe as much familiar as the referring physician with plain film appearances of many \ntypes of abdominal pathology and established roentgen signs. The purpose of the \npresentation is to review remaining indications for abdominal plain films and to \nrevisit common imaging findings. \nLearning Objectives:\n1. To review the most common causes of hollow organ perforation.\n2. To know the optimal technique for plain film of the abdomen in the \nemergency setting, signs of perforation.\n3. To know if there are still indications for plain film of the abdomen in the era \nof US and CT.\nA‑317\t 09:00 \nB. Defining the role of US \nJ.B.C.M. Puylaert; The Hague/NL (dr.jbcmpuylaert@wxs.nl) \nWhen a defect occurs in the bowel wall, air will appear within the peritoneal cavity, \nmost frequently due to perforated peptic ulcer and perforated sigmoid diverticulitis. \nIn most perforating gastrointestinal conditions however, the -imminent- perforation is \nwalled-off by neighbouring bowel loops, mesentery and especially by the omentum, \nnick-named “policeman of the belly”. If this walling-off process occurs timely and \neffectively, no or only minimal free air will appear. The most important causes of \nwalled-off gastrointestinal perforation are appendicitis, peptic ulcer disease, sigmoid \ndiverticulitis, bowel malignancy, Crohn disease and -often underdiagnosed- acci-\ndently ingested sharp foreign bodies, as toothpicks, fish bones, chicken bones, etc. \nThe extent to which the perforation is walled-off, determines the eventual course of \nthe disease. The US hallmark of -imminent- perforation is inflamed fat around the \ninvolved bowel structure. Inflamed fat on US corresponds to what is often called \n“dirty fat” on CT scan: hypodense fat is interspersed with hyperdense streaks. This \nrepresents oedema or cellular infiltration of the fatty mesentery and omentum, which \nhave migrated towards the site of the imminent perforation in an attempt to seal \nit off. On US inflamed fat is recognised as hyperechoic, non-compressible fatty \ntissue often interspersed with hypoechoic streaks. If fluid collections occur within \nthe inflamed fat, this implies abscess formation. Inflamed fat is an important and \nvaluable sign in perforating gastrointestinal conditions. If found in the absence of \nbowel pathology, the diagnosis is usually epiploic appendagitis or omental infarction. \nLearning Objectives:\n1. To understand the strength of US as the primary imaging modality.\n2. To know typical signs of bowel perforation.\n3. To be aware of the limitations and pitfalls of US.\nA‑318\t 09:30 \nC. In search of the hole: CT \nA. Laghi; Latina/IT (andrea.laghi@uniroma1.it) \nMDCT is an extremely powerful tool when the search for a GI perforation is required. \nThe high spatial and contrast resolutions make MDCT the most accurate imaging \nmethod to identify even small amount of free intraperitoneal air. There is general \nconsensus about the acquisition of a contrast-enhanced scan acquired during the \nportal venous phase of enhancement (delay of around 60-70 sec). Controversies \nare still present in the literature about the utility of a pre-contrast scan as well as \nthe need for a preliminary administration of an oral soluble iodinated CM or for \nan enema or gaseous distention of the distal GI tract. Image reviewing needs the \nuse of a workstation because multiplanar reformations have been demonstrated \nto improve the detection of small amount of free air. An appropriate window setting \nis mandatory and it makes MDCT 100% accurate for identification of free air and \nalmost 90% accurate in the identification of the precise site of perforation. The aim \nof the examination is not only to assess the presence of free air but also to detect \nthe site of perforation: this is an extremely useful clinical information especially if \nsurgeons decide to perform a laparoscopic repair. Several CT signs have been \ndescribed, able to guide the diagnosis and to differentiate between a perforation \noriginating in the upper GI tract (stomach and duodenum), in the small bowel or \nin the colon. \nLearning Objectives:\n1. To learn the appropriate imaging protocols in patients with suspected bowel \nperforation.\n2. To learn useful signs for the detection and localisation of perforation.\n3. To become familiar with imaging strategies in case of clinical suspicion of \nbowel perforation.\npears to be particularly useful for characterisation of small liver metastases and for \ndirect visualisation of small pancreatic tumours. \nLearning Objectives:\n1. To learn how to set up a useful protocol for pancreatic evaluation for different \nhigh field equipments.\n2. To understand the current role of diffusion-weighted imaging and ADC values.\n3. To review the role of organ-oriented contrast media.\n4. T o understand the technique and role of diffusion-weighted imaging of the pancreas.\nA‑315\t 09:20 \nC. Detection and staging: multimodality comparison \nD.E. Malone; Dublin/IE (dmalone@ucd.ie) \nEvidence-based radiology’ (EBR) is based on best current evidence, traditionally \nacquired radiological expertise, the ALARA principle and the values of referring \ndoctors and patients. Any appropriately trained radiologist can formulate an answer-\nable question, search the literature, appraise the retrieved evidence, apply their \nfindings to local practice and evaluate the results. This presentation will describe \nand illustrate the ‘EBR’ process. Patients with chronic pancreatitis (CP) may pres-\nent with features resembling pancreatic carcinoma, for which CP is a risk factor \nwith an incidence of 5.9% after 20 yrs. EBR methods were applied to the problem \nof differentiating mass-forming CP from pancreatic adenocarcinoma. A focused \nquestion and literature search found no secondary literature or imaging guidelines. \nPrimary literature searching found 53 relevant papers, 9 comprised current best \nevidence. For CT, time-attenuation curve characteristics had a sensitivity of 94% \nand a specificity of 83% for carcinoma. For MR, dynamic time intensity curve \ncharacteristics were only reported in a descriptive study but the Duct Penetrat-\ning Sign (MRCP) had a sensitivity of 85% and a specificity of 96%. For PET/CT, \n18F-FDG had a sensitivity for carcinoma between 86% and 96% with specificity \nof 87%-100%. For EUS/FNA, the sensitivity for carcinoma in pre-existing CP was \nconsistently low (54-74%), but the specificity was 100%. Simple Bayesian analysis \nwas used to establish the best order in which to apply these studies in practice. An \nalgorithmic approach will be presented. The presentation will also consider other \n‘grey areas’ in the field of pancreatic adenocarcinoma imaging using EBR methods. \nLearning Objectives:\n1. To learn about evidence-based methods of literature searching and \nappraisal.\n2. To understand how these methods can be used to produce diagnostic \nalgorithms using the differentiation of pancreatic adenocarcinoma from \nmass-forming chronic pancreatitis as an example.\n3. To learn about diagnostic algorithms based on different clinical scenarios \n(local and distant staging, advance versus early disease) involving multiple \nimaging techniques.\nDiscussion 09:45\n08:30 - 10:00 Room F1 \nRadiology in Abdominal Emergencies \nCC 1117 \nThe hole in the guts \nModerator: \nG. Mathis; Rankweil/DE \nA‑316\t 08:30 \nA. Wasting time with plain radiography? \nM. Laniado; Dresden/DE (michael.laniado@uniklinikum‑dresden.de) \nIn recent years, continuing trends in radiology have diminished the importance of \nplain films of the abdomen significantly. Ultrasonography and MDCT are applied \nwith enormous success to the investigation of many abdominal conditions in the \nemergency setting. In the eyes of the radiologist, plain films, therefore, seem irrel-\nevant in the presence of such powerful imaging procedures. Surprisingly, referring \nphysicians, mostly surgeons, gastroenterologists and urologists, still request plain \nfilms although the potential of MDCT is obvious to them as well. In their perception, \nthe plain film is either a definitive examination before initiation of treatment (e.g. \nstone at the ureteropelvic junction in US proven hydronephrosis) or a preliminary \nstudy prior to MDCT or surgery (exclusion of pneumoperitoneum or ileus). In the \npresent climate of cost and radiation consciousness this trend may continue. \nMoreover, many surgeons, gastroenterologists, urologists, etc. have greater skills \nin reading plain films than in understanding MDCT. Therefore, the radiologist should \n\nPostgraduate.Educational.Programme\nS86\n A B C D E F G H\nporation. All these techniques remain investigational at this time for the treatment \nof breast cancer. The limitations of and challenges associated with each ablation \ntechnique and the issues raised by early pilot studies, which have so far prevented \nthese techniques from replacing standard surgical techniques, will be discussed. \nLearning Objectives:\n1. To learn about current therapeutic interventional procedures for malignant \nlesions.\n2. To learn about current therapeutic interventional procedures for benign \nlesions.\n3. To learn about the possible role of therapeutic interventions in the future.\n08:30 - 10:00 Room G/H \nSpecial Focus Session \nSF 11 \nCan we predict premature ageing? \nModerator: \nG. Guglielmi;  Foggia/IT \nA‑322\t 08:30 \nChairman’s introduction \nG. Guglielmi; Foggia/IT (g.guglielmi@unifg.it) \nIn the elderly the co-existence of several diseases, the prevalence of involutional \nand degenerative aspects, together with physical and cognitive problems represent \n‘the norm’. It is therefore important to know how to distinguish the healthy elderly \nfrom those in need of treatment to avoid overdiagnosis and overtreatment. So the \nquestion is how to be aware of the potential and limits of diagnostic imaging and \nits applications in geriatric patients. \nSession Objectives:\n1. To recognise the coexistence of several diseases in the elderly.\n2. To distinguish the healthy elderly from those in need of treatment.\n3. To be aware of the potential and limits of imaging in geriatric patients.\nA‑323\t 08:35 \nBrain ageing/dementia \nF. Barkhof; Amsterdam/NL (f.barkhof@vumc.nl) \nBrain development occurs rapidly during the last trimester of pregnancy and \ncontinues at a rapid pace in the first two years of life. More subtle maturation, for \nexample in the white mater, occurs well into the third decade of life, as evidenced \nby diffusion tensor imaging (DTI). Evidence of brain degeneration is occurring soon \nafterwards and includes mild brain volume los, reductions in white mater integrity \non DTI, widening of Virchow-Robin spaces and accumulation of incidental white \nmatter lesions (WML). Severe WML and incidental cerebral microbleeds (MBs) are \nassociated with know cardiovascular risk factors and while the concurrent impact \nmay be subtle in terms of cognition, they carry a poor prognosis in the long run. The \nsame is true for silent cerebral infarcts, which increase the risk of dementia. Neu-\nrodegenerative (general brain volume loss, ventricular dilatation and hippocampal \natrophy) changes also occur well before the onset of clinical signs of dementia. In \ngenetically predisposed subjects (e.g. APOE4 carriers) abnormal (compensatory) \nbrain activity on functional MRI and increased (compensatory) cerebral metabolism \non FDG-PET have been observed that predict subsequent cognitive decline. More \nrecently, PET studies employing amyloid tracers have shown abnormal binding in \na significant proportion of cognitively elderly, suggesting that these subjects are at \nrisk to develop Alzheimer’s disease - the pace of which is currently undetermined. \nLearning Objectives:\n1. To learn which structural brain changes occur with normal ageing.\n2. To understand imaging biomarkers that predict premature ageing.\n3. To learn how to diagnose dementia as early as possible using MRI and PET.\nA‑324\t 08:58 \nBone and joint ageing \nA. Cotten; Lille/FR (anne.cotten@chru‑lille.fr) \nMusculoskeletal disorders are frequent in the elderly population. The loss of mobility \nand physical independence resulting from fractures, osteoarthritis, and osteopo -\nrosis can be devastating, both physically and psychologically. A current increase \nin geriatric imaging is likely to persist into the near future and requires radiologists \nto be more aware of musculoskeletal complaints and conditions pertaining to the \ngeriatric population. The aim of the lecture is to review the main musculoskeletal \n08:30 - 10:00 Room F2 \nBreast \nRC 1102 \nInterventional: from diagnosis to treatment \nModerator: \nG. Acunas; Istanbul/TR \nA‑319\t 08:30 \nA. Practical tips for a successful needle biopsy procedure \nM.T.G. Gaskarth; Cambridge/UK (matthew.gaskarth@addenbrookes.nhs.uk) \nThe objective of percutaneous needle biopsy of the breast is to obtain an accurate \npreoperative diagnosis with a low upgrade rate post-surgery. Indications arise in both \nsymptomatic and screen-detected lesions. A range of biopsy needle designs are \navailable and their selection depends on being aware of the range of needle design \ntypes, their advantages and limitations. Cutting needles, guns, vacuum systems and \nMR compatible devices will be discussed. Guidance technique for ultrasound, x-ray \nstereotaxis and MR-guided procedures is extremely important, beginning with patient \npositioning and anaesthesia prior to commencing the procedure. Accurate needle \nplacement under direct vision using high frequency ultrasound probes, x-ray stereo-\ntaxis with digital systems and MR guided - with the option of using a CAD system for \ndistance calculation - will be presented. Typical imaging signs and potential pitfalls of \neach technique, both anatomical and technical, will be highlighted. Methods to increase \naccuracy including the use of meticulous technique, adequate sampling and correlation \nof specimen pathology with imaging findings at multidisciplinary meetings are essential. \nLearning Objectives:\n1. To consolidate knowledge of needle selection for successful biopsy.\n2. To consolidate knowledge of guidance technique for successful biopsy.\n3. To learn about possible solutions to increase accuracy in needle biopsies.\nA‑320\t 09:00 \nB. Underestimation of disease in needle biopsies \nI. Schreer; Kiel/DE (ischreer@email.uni‑kiel.de) \nThere is always the possibility of a false negative biopsy results in any type of \npercutaneous image-guided needle biopsy (FNAC, core biopsy, vacuum-assisted \nbiopsy). The risk depends upon the quality of the harvested cytologic or histologic \nmaterial. The quality is closely related to the amount of material collected and the \naccurate targeting of a lesion. Some lesions are at a higher risk of underestima -\ntion (sizes < 5 mm, architectural distortions, microcalcifications, stellate lesions) \nthan others (i.e. focal lesions). The false-negative rates for microcalfications using \nvacuum-assisted biopsy were reported to be 1.2%, for mass lesions 0.8%. Using \nultrasound-guided 14 g-core needle biopsy the false-negative rates were reported \nto be in the range of 2.5%. Radiologic-histologic correlation plays a key role in the \ndefinite and correct judgement of the diagnostic result. In case of imaging-histologic \ndiscordance re-biopsy, possibly using larger needle diameters, or even open biopsy \nshould be considered. The European Guidelines for Quality Assurance of Breast \nCancer Screening and Diagnosis define outcome parameter for breast biopsies. \nGuidelines from the European Society of Breast Imaging published in 2007 define \nthe standards and skills necessary to perform these procedures. Documentation \nstandards should be used (B1-B5) to allow continuous yearly evaluation of the \nindividual institution results and quality improvement. The aim of any needle biopsy \nis to get as much, i.e. representative material as possible. Nevertheless, a certain \namount of underestimation, caused by lesion type (ADH, DCIS, LIN, papilloma, \nfor example) will remain and has to be reflected. \nLearning Objectives:\n1. To realise the risk of a false negative result in needle biopsies.\n2. To understand the performance standards needed to minimise the risk of \nunderestimation.\n3. To evaluate the importance of radiologic-pathologic correlation before \ndefinite diagnosis.\nA‑321\t 09:30 \nC. New developments: therapeutic interventional procedures \nB.D. Fornage; Houston, TX/US \nThe various modalities currently available to ablate breast masses include ther-\nmotherapy using radiofrequency current, laser irradiation, microwave irradiation, \nor insonation with high-intensity focused ultrasound (HIFU) waves, cryotherapy, \nwhich freezes tissues through the use of refrigerant gases, and irreversible electro-\n\nSunday\nPostgraduate.Educational.Programme\nA\n S87\nCB D E F G H\nspecific, reliable diagnostic tests are needed. CT angiography (CTA) is reported to \nhave more frequent inconclusive results (up to 20%) in pregnant and postpartum \npatients, mainly because of poor opacification. Suboptimal opacification is explained \nby physiological changes during pregnancy and persisting in postpartum such \nas the increase in blood volume, which reaches 50% by the 36 th week. Shallow \nbreathing during CTA acquisition is better than suspended full inspiration to avoid \nmassive return of non-opacified blood from the inferior vena cava. The amount \nof contrast medium must also be adapted to the weight. Using standard CTA pro-\ntocols, mean maternal radiation dose is roughly 8 times that of lung scintigraphy. \nReduced kilovoltage or bismuth shielding are different options to reduce skin entry \ndose to the breast, the main radiosensitive organ. Dedicated studies using Monte \nCarlo simulations have shown foetal dose is less for CTA than for V-Q scan, both \nbeing negligible. CTA allows identifying an alternate diagnosis in 12% to 27% of \nthe pregnant and postpartum patients with negative results for VTE. In postpartum \npatients, CT venography following CTA leads to an absolute increase in the VTE \ndetection rate of 12%, by allowing detection of iliac or ovarian vein thrombosis. \nLearning Objectives:\n1. To understand the role of CTA in the diagnosis of acute PE during pregnancy \nand post-partum.\n2. To learn how to optimise CTA protocols for PE during pregnancy and post-\npartum.\n3. To review key imaging findings.\nA‑327\t 09:00 \nB. CT angiography of large vessel vasculitis \nA.A. Bankier; Boston, MA/US (abankier@bidmc.harvard.edu) \nThe presentation will discuss the role of large vessel arteritis within the spectrum \nof thoracic vascular diseases. It will detail the pathological entities and their mor-\nphological, functional, and clinical characteristics. It will present typical CT and \nMRI findings and discuss key elements to the differential diagnosis. It will finally \ndiscuss the clinical relevance of this diseases, with a special emphasis on overall \nevolving importance of thoracic vascular disorders. \nLearning Objectives:\n1. To understand the role of CTA in the diagnosis of large vessel vasculitis.\n2. To learn how to optimise CTA protocols in patients with known or suspected \nlarge vessel vasculitis.\n3. To consolidate knowledge of typical imaging findings in patients with large \nvessel vasculitis.\nA‑328\t 09:30 \nC. CT angiography for severe haemoptysis \nA.R. Larici; Rome/IT (anna.larici@rm.unicatt.it) \nSevere haemoptysis can occur in about 5% of patients. It is associated with high \nmortality due to asphyxiation, if not treated, and needs urgent and comprehensive \nevaluation of the lung parenchyma, airways, and thoracic vasculature. Multi-\ndetector row CT angiography is a very useful noninvasive imaging modality for \ninitial assessment of haemoptysis in stable patients. It can accurately identify the \nsource and the most common predisposing causes of haemoptysis (bronchiec -\ntasis, chronic bronchitis, lung malignancy, tuberculosis and fungal infection) and \nthe effects of haemorrhage on the lungs and airways. Moreover, the combined \nuse of thin-section axial and complex reformatted images allows clear depiction \nof the origins and trajectories of abnormally dilated systemic arteries that may be \nresponsible for the bleeding in over 90% of cases requiring intervention with arterial \nembolisation or surgery. Nonbronchial arteries may also represent an important \ncause of haemoptysis. The road maps of dilated bronchial and nonbronchial arteries \nprovided by CT angiography represent a useful guide for endovascular treatment. \nCT angiography is a quick and noninvasive tool that is helpful in the diagnosis and \nmanagement of haemoptysis. \nLearning Objectives:\n1. To understand the role of CTA in the clinical management of patients with \nhemoptysis.\n2. To learn how to optimise CTA protocols for evaluating patients with \nhemoptysis.\n3. To consolidate knowledge of typical imaging findings in patients with \nhemoptysis from different etiologies.\ndisorders that affect the elderly population. Some misleading radiological presenta-\ntions typically occurring in this population will be also presented. \nLearning Objectives:\n1. To recognise the increased incidence of trauma, degeneration and \nmalignancy in ageing.\n2. To understand that the loss of mobility and physical independence resulting \nfrom fracture, arthritis and osteoporosis affect both the physical and \npsychological quality of life.\n3. To be more aware of musculoskeletal complaints and conditions pertaining \nto the geriatric population.\nA‑325\t 09:21 \nCardiovascular ageing \nT. Saam; Munich/DE (T obias.Saam@med.uni‑muenchen.de) \nCardiovascular ageing is a universal phenomenon associated with an increased \nlikelihood of the development of cardiovascular diseases and of adverse outcomes \nonce disease does develop. In fact, most complications of cardiovascular disease, \nincluding myocardial infarction, stroke, congestive heart failure, atrial fibrillation, and \ncardiovascular death, occur in the increasing number and proportion of our popula-\ntion that is 65 years of age and older. Traditionally, imaging techniques that have \nbeen used to assess the vasculature have focused on depicting the arterial lumen. \nHowever, luminal narrowing occurs late in the atherosclerotic disease process and it \nis commonly accepted that knowing the degree of luminal stenosis alone is insufficient \nto determine the vulnerability of atherosclerotic lesions. Thus, a number of imaging \nmethods, such as ultrasound, PET/CT and high-resolution black-blood MRI have \nemerged that are able to assess the composition and morphology of atherosclerotic \nplaques. IMT measurements of the carotid arteries and calcification in the coronary \narteries are well validated imaging markers that are associated with adverse outcomes \nindependent of other traditional cardiovascular risk factors. Recent studies suggest \nthat several other imaging markers, such as arterial FDG-uptake as assessed by \nPET/CT or intraplaque haemorrhage and fibrous cap thickness as assessed by MRI \nare associated with an increased risk of future cardio- or cerebrovascular events. \nIt still remains a hotly debated topic whether atherosclerosis is reversible. This talk \nwill also provide an update of the latest imaging studies which examined the effects \nof anti-atherosclerotic drugs on plaque regression and progression. \nLearning Objectives:\n1. To consolidate knowledge of the underlying pathophysiology of \ncardiovascular ageing.\n2. To learn about different imaging strategies to assess cardiovascular ageing.\n3. To become familiar with imaging features that might be able to predict \npremature ageing.\n4. To learn about imaging studies that examine the effects of drugs on the \nregression/progression of the ‘cardiovascular age’.\nPanel discussion: \nWhat specific knowledge do you need to be able to interpret and \nunderstand the radiological scenarios in geriatric patients? 09:44\nIn the elderly the coexistence of several diseases, the prevalence of involutional \nand degenerative aspects, together with physical and cognitive problems represent \n‘the norm’. It is therefore important to know how to distinguish the healthy elderly \nfrom those in need of treatment to avoid overdiagnosis and overtreatment. So the \nquestion is how to be aware of the potential and limits of diagnostic imaging and \nits applications in geriatric patients. \n08:30 - 10:00 Room I/K \nChest \nRC 1104 \nCT angiography of the chest beyond aorta \nModerator: \nC. Engelke; Göttingen/DE \nA‑326\t 08:30 \nA. CT angiography for PE diagnosis during pregnancy and post-partum \nM.-P. Revel; Paris/FR (marie‑pierre.revel@egp.aphp.fr) \nThe risk of venous thromboembolism (VTE) is increased by a factor of four to five \nduring pregnancy and in the postpartum period owing to factors such as the higher \nconcentration of procoagulant factors and venous stasis. In developed countries, \nPE is the leading cause of maternal death. Because clinical symptoms are non-\n\nPostgraduate.Educational.Programme\nS88\n A B C D E F G H\nA‑331\t 09:30 \nC. Radiation dose optimisation and the radiographer’s role \nA. Henner; Oulu/FI (anja.henner@oamk.fi) \nFast development in the area of imagining modalities demands a lot of work in dose \nand image quality optimisation and management. Deterministic harms have been \nreported both in interventional and diagnostic radiology. There are also some special \ngroups (e.g. children) which need a lot of attention and especially tight indications for \nx-ray examinations. Radiation dose and image quality optimisation can be applied \nwith small steps in everyday clinical work as a part of self assessment, if the safety \nculture is agreed by all professionals. The vendors put the settings high in order to \nreach the best image quality. After installation the settings must be re-evaluated \nbefore starting clinical use of the equipment. Also, the sensitivity of AEC (automatic \nexposure control) must be turned according the detector. Using the air gap (30 cm) \ninstead of grid, e.g. in hip axio-lateral project or scoliosis, dose decrease can be \neven two thirds. The role of radiographer is expanding to new areas. Quality assur-\nance and dose and image optimisation could be parts of the expanded role. The \nnew technical solutions in imaging offer a lot of possibilities for dose reduction, if \nwe want, but there is also danger of dose creeping if the doses are not followed up \nfrequently. The management and legislation offer the basics but the work must be \ndone among those who are working in radiological departments. Commitment to the \nsafety culture on all levels in medical radiation offers better care and procedures with \nlower doses to the patients. \nLearning Objectives:\n1. To understand the importance of radiation dose optimisation.\n2. To become familiar with procedures to optimise the radiation dose.\n3. To consolidate knowledge of the radiographer’s role in radiation dose \noptimisation.\n08:30 - 10:00 Room N/O \nJoint Course of ESR and RSNA  \n(Radiological Society of North America) \nMC 1125 \nEssentials in oncologic imaging:  \nwhat radiologists need to know (part 1) \nModerator: \nD.M. Panicek; New York, NY/US\nA‑332\t 08:30 \nA. Principles of oncologic imaging and reporting \nD.M. Panicek; New York, NY/US \nLearning Objectives:\n1. To review general principles of oncologic imaging.\n2. To understand the critical importance of clinical context during interpretation \nof oncologic exams.\n3. To evaluate ways to ensure that our reports provide added value and reflect \nthe radiologist’s role as consultant.\nA‑333\t 08:50 \nB. Lung cancers (primary, metastases) \nC.J. Herold; Vienna/AT \nLearning Objectives:\n1. To review the strengths and limitations of radiologic techniques suitable for \ndetecting and characterising primary and metastatic lesions in the lungs.\n2. To understand the imaging findings relevant for lung cancer T, N and M \nstaging, and appraise the implications of the new IASLC lung cancer staging \nsystem.\n3. To evaluate the imaging findings used to assess response to conventional \nand new therapies for lung cancers.\n08:30 - 10:00 Room L/M \nRadiographers \nRC 1114 \nRadiation protection and optimisation of \nradiological procedures \nModerators: \nK. Åhlström Riklund;  Umeå/SE \nD. Katsifarakis; Athens/GR \nA‑329\t 08:30 \nA. Diagnostic quality and patient dose management in digital radiography \nsystems \nL.J.O.C. Lanca; Lisbon/PT (luis.lanca@estesl.ipl.pt) \nSeveral digital systems are currently available for projection radiography. Digital \nsystems are traditionally split into two broadly defined categories: computed radiog-\nraphy (CR) and digital radiography (DR). CR systems use storage-phosphor image \nplates with a separate image readout process and DR technology converts x-rays \ninto electrical charges by means of a direct readout process using TFT arrays. DR \nsystems can be further divided into direct and indirect x-ray conversion systems. \nDigital detectors offer several advantages when compared to analogue detectors \nsuch as wide dynamic range, adjustable image processing, better image quality, \nrapid image acquisition and image access at remote locations. The management \nof diagnostic quality and patient dose is a very important issue to be considered \nby radiographers when working with digital systems. Exposure has a direct influ-\nence in image quality representation and dose delivered to the patient could be \ninappropriate for diagnostic purpose. Diagnostic accuracy could be affected by \ninadequate exposure and thus an appropriate exposure level should be achieved. \nDigital detector technologies have the potential to reduce patient exposure while \nmaintaining diagnostic quality using appropriate methods of process optimisation. \nLearning Objectives:\n1. To get a global overview of digital radiography systems (both CR and DR).\n2. To gain knowledge about advantages when using digital radiography \ntechnologies.\n3. To learn about strategies for the management of diagnostic quality and \npatient dose.\nA‑330\t 09:00 \nB. The radiographer’s position in the initial optimisation procedure \nD. Pekarovic; Ljubljana/SI (dean.pekarovic@kclj.si) \nRadiological procedures are performed because of medical benefits to patients, \nbut they also cause some harm because of the dose. If medical benefit overweighs \ndetriment the procedure is justified. The purpose of the optimisation is then to adjust \nthe procedure in a way to maximise the ratio of benefit over harm. Question is who \nis responsible to do it and how it can be done. Who should participate: we believe \nthere is a major role of radiographer as she/he is present at each and every radio-\nlogical procedure performed. But it is absolutely mandatory for them to understand \nbenefits of the procedure and understand harm (dose). Radiographer’s position \nis the connection between radiologist, medical physicist and vendor’s engineers. \nRadiologists usually do not have in depth knowledge of technology and dose \nand physicists and engineers on the other hand do not understand in depth the \nmedical aspects of procedure. Radiographers must also understand operational \npossibilities of every x-ray machine. To get to know them they should be there at \nthe acceptance of the x-ray machine and talk to service engineers and applicators. \nThey should also talk to physicist when he/she is doing tests. And finally simula -\ntion of procedure(s) using different phantoms is the best way to understand how \nmachine parameters are affecting image quality and dose. In presentation, some \nexamples for different modalities will be given. \nLearning Objectives:\n1. To gain knowledge about how to start with optimisation of radiological \nprocedures.\n2. To understand the basics of quality control (QA) for radiographic modalities \nand how to use experience acquired from QA in daily work.\n3. To become familiar with guidelines and applications for good radiological \npractice and how to implement them in the optimisation process.\n4. To consolidate knowledge of technology of radiographic modalities and the \nuse of materials in daily practice according to guidelines, and to be familiar \nwith the radiographers responsibility in the field of radiation protection.\n\nSunday\nPostgraduate.Educational.Programme\nA\n S89\nCB D E F G H\nmentations the phase and magnitude relations are even varied during RF pulses. \nIn combination with equally dynamic gradient waveforms such fully individual \ncontrol permits particularly fast spatially tailored RF pulses (Transmit SENSE). \nArray transmission entails a generalisation of RF pulse design, for which a range \nof efficient mathematical methods have been developed. One important challenge \nthat remains, however, is the need to calibrate array transmitters in terms of the \nindividual channels‘ RF field contributions, both magnetic and electric. The latter, \nin particular, underlie power deposition in the tissue and hence need to be closely \ncontrolled to enforce strict SAR limits. \nLearning Objectives:\n1. To learn about the need to control radio-frequency fields, particularly at high \nB0.\n2. To understand the principles of doing so by multiple-channel transmission.\n3. To become acquainted with the methods of obtaining uniform and tailored \nexcitation within SAR limits.\nA‑337\t 09:30 \nC. Is 7T ready for clinical use? \nR.W. Bowtell; Nottingham/UK (richard.bowtell@nottingham.ac.uk) \nThe availability of magnetic resonance (MR) scanners operating at 7 T and above \nhas already proved beneficial for MR imaging and spectroscopy of the human brain \nand promises similar benefits in the human body. These advantages result from \nthe increases with the magnetic field of the intrinsic signal-to-noise ratio, blood \noxygenation level dependent (BOLD) contrast, which forms the basis of the vast \nmajority of functional MR imaging (MRI) experiments, and chemical shift dispersion. \nThese gains can be exploited in improving the spatial and/or temporal resolution of \nanatomical and functional MRI experiments and in increasing the spectral resolu-\ntion in volume selective spectroscopy or chemical shift imaging. Operation at the \nincreased magnetic field also offers easier access to T 2\n*-contrast and improved \nimplementation of susceptibility-weighted imaging (SWI) in which the phase of \ngradient echo images provides information about local variation of magnetic sus-\nceptibility. In the brain, such variation appears to be dominated by differences in \niron concentration and myelin content, so that high-field SWI may provide useful \ninformation about the progression of neurodegenerative disease. The elevated T1 \nrelaxation times at 7 T also offer benefits for arterial spin labelling and time of flight \nangiography. Current and potential future applications of high-field MRI in clinical \nand pre-clinical studies in a number of areas and will be discussed in this presen-\ntation, along with the barriers to wider usage of 7 T systems for clinical studies. \nLearning Objectives:\n1. To become familiar with the advantages that 7T provides for magnetic \nresonance imaging and spectroscopy.\n2. To recognise the areas of clinical application where 7T already offers \nsignificant benefits over lower fields.\n3. To understand the barriers to clinical usage of 7T.\n4. To recognise the technical developments that will help to overcome these \nbarriers and allow wider clinical usage of 7T.\n08:30 - 10:00 Room Q \nPaediatric \nRC 1112 \nAbdominal emergencies in children \nModerator: \nM. Haliloglu;  Ankara/TR \nA‑338\t 08:30 \nA. Non-traumatic acute abdomen \nC. Veyrac; Montpellier/FR (c‑veyrac@chu‑montpellier.fr) \nThe purpose is to present and discuss the role of imaging in non-traumatic acute \nabdomen, with particular focus on ultrasound (US). The neonatal GI tract emer-\ngencies, associated with specific disorders and imaging strategies, are excluded. \nAcute abdomen in children refers to a wide variety of conditions ranging from benign \ndisorders, such as gastroenteritis, to threatening disease, such as midgut volvulus \nor intussusception. The recognition of a surgical emergency requires usually, after \na competent clinical evaluation, an imaging investigation in order to avoid nega -\ntive or unnecessary surgery. Abdominal plain film is known as poorly sensitive in \nmost situations, except bowel occlusion. Ultrasound requires experience and a \nthorough examination but has demonstrated a high sensitivity and specificity for \ndiagnosing bowel obstruction, midgut volvulus, intussusception, acute appendicitis, \nA‑334\t 09:25 \nC. Colon cancer \nR.M. Gore; Highland Park, IL/US \nLearning Objectives:\n1. To get an overview of current recommendations for the diagnosis of \ncolorectal cancer.\n2. To understand the specific role of MDCT, MR imaging, endoscopic \nultrasound, and PET/CT in the staging of colorectal cancer in optimising \npatient management.\n3. To learn the utility of imaging in assessing tumour response to therapy and \nin the general follow-up of patients with colorectal cancer.\nQuestions 09:50\n08:30 - 10:00 Room P \nPhysics in Radiology \nRC 1113 \nHigh field MRI: Beyond 3 T \nModerators: \nM. Tosetti; Pisa/IT \nA.J. van der Molen;  Leiden/NL \nA‑335\t 08:30 \nA. Challenges of high field MR \nM. Bock; Heidelberg/DE \nOver the recent years the clinical MRI field strengths have gradually been increased \nto 3 Tesla; however, whole body MRI systems with higher fields of up to 9.4 Tesla \nhave become available in experimental settings. Compared to clinical field strengths, \nMRI at very high magnetic fields has several advantages but also some unique \nchallenges. With increasing field strength the signal-to-noise ratio increases, which \ncan be used to either increase the spatial resolution in the images, or to acquire \nthe images more rapidly. Unfortunately, the energy deposited in the human body \nvia the RF excitation scales quadratically with the field strength. Thus, the specific \nabsorption rate (SAR) is a critical factor in all rapid imaging protocols, and requires \nthe design of RF pulses with low SAR, (e.g. VERSE pulses). Inhomogeneities of the \nRF field which are induced by standing wave phenomena have to be compensated, \nand make the design of efficient spin echo pulse sequences very difficult. At higher \nfield also the field inhomogeneities become larger and stronger imaging gradients \nare required to overcome the susceptibility-induced image distortion. Stronger \ngradient systems are difficult to manufacture, and the usable gradient slew rate \nis limited by peripheral nerve stimulation thresholds. Furthermore, stronger and \nfaster gradients become very loud at high fields, and special measures for sound \nprotection are required. Despite these limitations, high-field MRI offers image with \nvery high resolution, it provides unique contrasts, a better spectral separation of \nthe resonance lines and high signal for non-proton applications. \nLearning Objectives:\n1. To understand how the increased field strength affects exposure and image \nquality characteristics.\n2. To learn about MR imaging protocols developed for ultra-high field MRI.\n3. To become familiar with technology for specific absorption rate reduction.\nA‑336\t 09:00 \nB. A complicated solution to a complicated problem: transmit array \nK.P. Pruessmann; Zurich/CH (pruessmann@biomed.ee.ethz.ch) \nClinical MRI usually aims to depict anatomic regions of interest with uniform \ncoverage and contrast behaviour. To this end it is essential to use suitably homo-\ngeneous radiofrequency (RF) magnetic fields for spin excitation, refocusing, and \nsaturation. Traditionally, such uniform transmit fields are generated by volume \nresonators based on quasi-stationary electrodynamics, which, however, gradually \ncease to apply as clinical MRI explores high field strengths of 3 T and beyond. The \nconcomitant increase in operating frequency entails shorter RF wavelength and \nincreasing tissue interactions, which render the tailoring of RF fields substantially \nmore complex and patient-dependent. One promising response to this challenge \nis to depart from volume resonators and perform RF transmission by multiple, \nindividually fed transmitter elements. With such transmit arrays the effective RF \nfield can be tailored on a per-patient and per-scan basis by adjusting the relative \nmagnitude and phase of driving the elements (RF shimming). In advanced imple-\n\nPostgraduate.Educational.Programme\nS90\n A B C D E F G H\n08:30 - 10:00 Room Z \nENCITE Session\nVisualisation of cell therapy meets clinical \napplication \nModerator: \nG.P. Krestin; Rotterdam/NL \nA‑341\t 08:30 \nENCITE - a translational approach for novel cell therapy applications \nS. Aime; Turin/IT \nENCITE (European Network for Cell Imaging and Tracking Expertise) is an EU \nintegrated project aiming at developing tools and procedures for an efficient in vivo \nimage-guidance for cell therapy. It relies on a large interdisciplinary consortium \nthat includes chemists, biologists, physicians and imaging scientists. It consists \nof six sub-projects devoted to: 1. Novel imaging technologies; 2. Novel imaging \nreporter probes; 3. Novel tools for cell labelling; 4. Pre-clinical validation; 5. Trans-\nlaction towards clinical applications; 6. Dissemination and training. The research \nwork carried out in the project is providing important contributions to get a better \nunderstanding of the mechanisms by which cell therapy works. The availability of \ndedicated methods and probes will allow an improved in vivo spatio-temporal track-\ning of labelled cells thus providing the clinicians with the possibility of monitoring \ninnovative cell therapies to cure major diseases. \nA‑342\t 08:50 \nVisualising transplanted neural stem cells and tissue regeneration by MRI \nM. Modo; London/UK \nNeural stem cells are in the process of finding their translation into the clinic. However, it \nis well-known that the cells by themselves do not regrow lost tissue. To this end, neural \nstem cells need further support and guidance. Tissue engineering is using biomaterials \nto provide a structural support for cells, but can also incorporate the release of factors \nthat guide the fate of transplanted cells. Ideally, an in vivo imaging approach would \nencompass all these processes. We here demonstratethe use of a 19 F MRI contrast \nagent to detect clinical-grade human neural stem cells non-invasively over 7 days within \na tissue cavity formed by stroke. T o provide structural support for these transplanted cells \nwithin the tissue cavity, cells were mixed with an engineered de-cellularisedextracellular \nmatrix (ECM). Using diffusion MRI, we were able to detect the presence of the ECM \nwithin the stroke cavity. This approach hence provides a novel approach as to how we \ncan study transplanted cells and tissue regeneration in vivo by MRI. \nA‑343\t 09:10 \nImaging dendritic cell vaccinations in melanoma patients \nM. Srinivas, E.H.J.G. Aarntzen, F. Bonetto, A. Heerschap, W.J. Oyen, \nO.C. Boerman, C.J.A. Punt, C.G. Figdor, I.J.M. de Vries; Nijmegen/NL \nOur lab has been among the first to exploit dendritic cell (DC) therapy to treat \nmelanoma patients. Over the past years, immunological responses are increasingly \nreported and clinical responses have consistently been observed. Moreover, DC \ntherapy often has much milder side effects than standard chemotherapy. A key \nhurdle in the development of the DC therapy is accurate delivery of the cells to \nlymph nodes (LNs), or their successful migration from the site of injection to LNs. \nIn particular, tools for measuring cell migration in vivo are necessary. Ideally, we \nwould be able to quantify the number of DCs at the relevant site, with high resolution \nanatomical context to allow differentiation of LNs and the possibility of longitudinal \ndata acquisition. Furthermore, functional data on the ensuing immune response is \nalso required. Towards these ends, we have been working on developing imaging \ntechniques to study DCs in vivo, for example with scintigraphy on 111In-labeled \nDCs, and magnetic resonance imaging (MRI) on iron-labelled DCs. Scintigraphy is \nquantitative, but it is restricted to the relatively short half-life of the radioisotope and \nis unable to resolve individual LNs. MRI allows high resolution anatomic localisation, \nbut the use of contrast agents such as iron oxide is not quantitative. Our recent \nwork has focused on imaging the functionality of these DCs using positron emis-\nsion tomography (PET) to study LN activation. Finally, we have also developed in \nvitro assays that closely mimic in vivo DC migration in 3D scaffolds imaged using \nquantitative 19F MRI, as a substitute for in vivo optimization. We plan on applying \n19F MRI to the tracking of DCs in vivo, as the technique allows both quantification \nand high-resolution anatomic detail. \nhypertrophic pyloric stenosis, etc. It enables some differential diagnosis such as \ninfectious ileocolitis, ischaemic colitis, Henoch Schonlein purpura, complicated \nMeckel diverticulum or duplication, etc. or even pyelonephritis. It can provide \nsome findings suggesting mesenteric adenolymphitis, viral gastroenteritis, etc. The \nUS findings will be described as well as the potentialities and limitations of US in \neach of these conditions. The accurate knowledge of the clinical findings together \nwith the results of US will guide the need for another imaging modality: enhanced \nCT in case of suspected appendicitis with inconclusive US, upper GI series in an \ninfant with bilious vomiting and impossibility to display the mesenteric vessels, etc.  \nAt last, some aspects of pancreatic and biliary tract emergencies will be shown. \nLearning Objectives:\n1. To understand the role of sonography in acute digestive disease.\n2. To become familiar with the specific imaging findings of intussusception and \nappendicitis.\n3. To learn about the acute pathology of the liver, biliary tract and pancreas.\nA‑339\t 09:00 \nB. GU emergencies in children: kidney, ovary, testis \nM. Riccabona; Graz/AT (michael.riccabona@medunigraz.at) \nThe purpose is to discuss the role of emergency imaging in acute paediatric GU \nconditions, with particular focus on the potential of ultrasound (US). Besides GU \ntract trauma conditions such as urosepsis, renal failure, renal colics, ovarian or \ntesticular torsion with all the respective relevant differential diagnoses have to be \nconsidered and urgently addressed adequately. Particularly with respect to radia-\ntion protection (ALARA-principle) and due to the superb US potential in childhood, \nUS is often used as the primary imaging tool. In many conditions US will reveal \nall treatment relevant information and no additional imaging is necessary in the \nacute setting. However, in other conditions such as severe (multiple) trauma CT \nremains the best primary imaging tool, however, only by using age-adapted CT \nprotocols. The work-up and follow -up may also require imaging, usually achiev -\nable by US and partially by MRI, scintigraphy and/or cystography. All these lead \nto imaging algorithms that differ from adults. The most important conditions, their \nimaging appearance, the potential pitfalls and some important methodical details \nwill be presented, also discussing the recommended dedicated paediatric imaging \nalgorithms. In most paediatric acute GU conditions US is adequate as the first and \noften sufficient imaging modality. Rarely other imaging is necessary particularly in \nthe acute setting - except for CT in severe (multiple) trauma. All imaging should \nbe indicated with respect to therapeutic consequences and the ALARA principle, \nand proper paediatric protocols as well as methododical skills (e.g., dedicated \npaediatric US) should be provided 24 hours throughout the year. \nLearning Objectives:\n1. To learn about the diagnostic imaging approach in acute urinary tract disease.\n2. To recognise the sonographic aspects of ovarian emergencies.\n3. To understand the role of sonography in acute scrotum diseases.\nA‑340\t 09:30 \nC. Abdominal trauma in children \nM.P. García-Peña; Barcelona/ES (pilagarcia@vhebron.net) \nTrauma is a leading cause of morbidity and mortality in children. The clinical \nevaluation of children with potential blunt abdominal injury presents a difficult and \nchallenging task. Therefore, diagnostic imaging plays an important role in the \nevaluation of injured children. The most common indication for abdominal imaging \nfollowing trauma in children is haematuria. The majority of children with haematuria \ndo not have urinary tract injury. Certain clinical variables have been associated \nwith a higher risk of abdominal injury. These include gross haematuria, abdominal \ntenderness, ecchymoses, and a low trauma score. Lap belt ecchymoses represent \nan important high-risk marker for injury. They are associated with complex of injury. \nSonography has limited utility in the assessment of paediatric abdominal trauma. \nComputed tomography (CT) is the imaging method of choice in the evaluation of \nabdominal injury after blunt trauma in haemodynamically stable children. An un-\nstable patient needs to be stabilised prior to CT or to proceed directly to surgery. \nEvaluation with CT allows for accurate detection and quantification of injury to solid \nand hollow viscera, and can also identifies an active haemorrhage. CT can help \nprioritise optimal management by diagnosing the major or most life-threatening \nsite of haemorrhage or injury. CT can also demonstrate associated bony injury \nto ribs, spine, and pelvis. A normal CT examination may prevent other unneces -\nsary explorations. The decision for operative intervention in the small percentage \nof children who require surgical haemostasis is primary made based on clinical \ncriteria and not on CT findings. \nLearning Objectives:\n1. To learn about traumatic lesions of the abdomen in children.\n2. To learn the diagnostic strategy after abdominal trauma.\n3. To discuss the diagnosis improvement with the new technology.\n\nSunday\nPostgraduate.Educational.Programme\nA\n S91\nCB D E F G H\nA‑346\t 10:40 \nHow to start interventional radiology \nH. Ghanaati; T eheran/IR (ghanaati@yahoo.com) \nInterventional techniques deeply changed approach to treatment of diseases. In each \ncountry, interventional radiology practice establishment varies according to local fac-\ntors, but following a standard strategy seems better to set up this facility. According \nto above-mentioned points, I decided to establish this specialty in our hospital since \n1996 as the pioneer center in interventional radiology Iran. At first the procedures \nincluded percutaneous laser disc decompensation (PLDD), and vertebroplasty fol-\nlowed by vascular procedures such as UAE in later years. Now, we are performing all \ninterventional procedures in our country including aortic stent and all neurointervention \nprocedures. The following items will be discussed: 1. Prepare step by step strategies \nfor establishing intervention. 2. Solving issues regarding interventions procedures. 3. \nModified techniques for lowering costs to cover interventions in poor people. 4. Setting \nof fellowship courses. 5. Co-operation with dedicated and pioneer international centers \nsuch as using neocrylate for treatment of brain aneurysms in conjunction with UCSD \nfor the first time on human. When presenting our experience we want to review how \nwe should start interventional radiology in developing countries. \nLearning Objectives:\n1. To understand why interventional radiology is a mandatory resource.\n2. To learn about the milestones of a strategy for building an interventional suite.\n3. To understand what the priorities are.\nA‑347\t 10:55 \nUterine artery embolisation for treatment of symptomatic fibroids \nK. Firouznia; T ehran/IR (k_firouznia@yahoo.com) \nFibroids are the most common benign tumours of the uterus during female re-\nproductive age. Uterine artery embolisation (UAE) is a procedure in which using \nembolic particles (PVA, Gelfoam, etc.) we block blood supply to uterine fibroids. It \nhas been reported as a relatively safe, effective, and durable nonsurgical alternative \nmethod diminishing fibroid-related symptoms. UAE is typically performed in both \nuterine arteries by an experienced interventional radiologist. After UAE, reduction \nin menorrhagia has been reported as 80-93% and the mean decrease in fibroid \nsize varies from 50% to 78% in the literature. Complications including amenorrhoea \nare frequency ranging from 1% to 7% in the literature. UAE may be followed by \nmenopause in 1% of the cases. Nevertheless, it is usually encountered in women \nin their late 40s. It seems that the future of UAE depends on optimal selection of \npatients based on the prediction of volume-shrinkage, the outcome of fertility, and \nthe long-term efficacy. Although pregnancy is possible after embolisation, neither \nfertility preservation nor its improvement can be definitely guaranteed. Women \nwho desire to become pregnant should definitely be cautioned about potential \ncomplications during pregnancy. In this presentation we are going to review the \nposition of UAE in Iran and to present our experience about the efficacy, and safety \nof UAE. Besides, we will discuss some methods of dose reduction during UAE and \nthe effects of UAE on fertility and pregnancy outcome. \nLearning Objectives:\n1. To understand the technique of uterine artery embolisation.\n2. To learn about the results and complications through literature and \nexperience.\n3. To learn about the future of this technique, including clinical benefit and \ncomparison with other strategies.\nA‑348\t 11:10 \nInterlude (I): Persian physicians' contribution to the evolution of medicine \nK. Vessal; Shiraz/IR \nA‑349\t 11:15 \nInterventional procedures in liver transplantation \nA. Rasekhi; Shiraz/IR (DrRasekhi@yahoo.com) \nAdvances in immunosuppressive therapy, the early diagnosis of complications \nand treatment by interventional methods have all led to prolonged survival of liver \ntransplantation. Interventional radiologist is always a part of transplantation team \nand has a very important role to face with complications. During 2001 to 2010, \n846 patients with end stage liver disease underwent liver transplantation in Shiraz \nUniversity of medical science. Among the complications 13 HA, 6 HO and 39 \nbiliary structures treated by interventional endovascular methods. HA thrombosis \nwas treated mostly by direct thrombolytic injection in the clot. The patients treated \nby ballooning the site of strictures and putting an internal-external drainage. 8 HV \nstrictures treated by endovascular stenting and ballooning. 11 of 13 patients with \nA‑344\t 09:30 \nMonitoring of transplanted pancreatic islets in humans by MRI \nM. Hájek, D. Jirák, M. Dezortová, V. Herynek, P. Girman, J. Kříž, F. Saudek; \nPrague/CZ \nPurpose:  Labelling pancreatic islets (PI) with superparamagnetic mark -\ners enables their detection as hypointense spots on magnetic resonance \n(MR) images. We tracked PI transplanted into the liver and quantified \ntheir signal loss in liver tissue using MR imaging over a six-month period. \nMethods and Materials:  PI were labelled with ferucarbotran 5  μl/ml for 6-44 \nhours and transplanted into the portal vein in 8 C-peptide negative recipients \n(12 infusions). The liver was examined prior to transplantation and subsequently \n1 day and 1, 2, 4 and 24 weeks after transplantation using a 3  T MR scanner. \nResults: In all recipients significant C-peptide levels and near-normal HbA1c values \nwere achieved with 50-80% insulin dose reduction. No side-effects related to the \nlabelling procedure were documented. A significant decrease in the number of islet \nspots was detected at 1 week post-transplantation (on average 60%) with a subse-\nquent only slight decrease for up to 24 weeks. In two subjects with a labelling period \nof less than 6 and 10 hours respectively only a few islet spots were detected corre-\nsponding to poor islet visualization in phantoms labelled for the same period of time. \nConclusion: PI visualization was successful in all recipients but was less efficient \nif the labelling period was less than 16 hours. A significant decrease in islet spots \noccurred at 1 week post-transplantation suggesting early islet destruction or im-\npaired engraftment. Then, the decrease in islet spot numbers slowed and islets \nwere still detected at 24 weeks post-transplantation. Data shows that MR detection \nof ferucarbotran-labelled islets correlates with sustained C-peptide production. \nDiscussion and exchange 09:50\n10:30 - 12:00 Room B \nESR meets Iran \nEM 4 \nInterventional radiology: from scratch to innovation \nPresiding: \nY. Menu; Paris/FR \nA. Sedaghat; Tehran/IR \nA‑345\t 10:30 \nWelcome and introduction \nA. Sedaghat; T ehran/IR (radiologysociety@gmail.com) \nIran, is one of the largest countries in the Middle East, with the population of over 75 \nmillion people. Iran has always had special geographic, social, cultural, and economic \nsituations. Iran is the cradle of civilisation and home to great people like Cyrus the \nGreat, who mentioned the human rights as Cyrus Cylinder and Ibn Sina the author of \nQanun, one of the most reliable text books in past medicine. At the present time, there \nare 17 medical schools that are training more than 300 radiologist assistants, and over \n1600 radiology practitioners are working in IRAN. The Iranian Journal of Radiology, \nthe scientific organ of the Iranian Society of Radiology is published in English and \nhas passed seven years of publication. During the past decade, the Iranian Society \nof Radiology has expanded its overseas-activities. Besides local societies and their \ncongresses, ISR has established a close and appropriate connection to the European \nSociety of Radiology (ESR) justified as the large attendance of Iranian radiologists in \nECR, the submission of numerous articles to ESR, the membership of Iranian radiolo-\ngists in ESR as corresponding members, the significant presence of European radiolo-\ngists in the Iranian annual congress of radiology (ICR). Interventional radiology has \ndeveloped in Iran at the same place as in other countries, so that we can offer most of \nthe interventional services, such as vertebroplasty, chemoembolisation, various stent \nplacements, aneurysm treatment and uterine fibroid embolisation in Iranian radiology \ncenters by Iranian radiologists. \nSession Objectives:\n1. To learn about prominent clinical situations in which interventional radiology \nplays an important role in the treatment of patients.\n2. To understand how interventional radiology can be created and organised \nfrom the beginning.\n3. To learn about the Iranian strategy for the development of interventional \nradiology.\n\nPostgraduate.Educational.Programme\nS92\n A B C D E F G H\nareolar complex), the presence of other imaging findings (extension to the skin, \ninflammatory cancers) and the status of regional lymph nodes. This information \ninfluences the type of treatment given to the patient and it is very important to \ngather as much information as possible in order to obtain a one-step surgical \nexcision with free margins at pathology. On the basis of this information and on \ndiscussions held in multidisciplinary meetings, markers will be placed wherever \nneeded in order to locate the exact distribution of the tumour(s). The different parts \nof a structured report (clinical data relevant to the report, technical description of \nthe diagnostic or the interventional modality, pitfalls during the exam, description \nof breast composition, description of lesions, categories and overall assessment) \nshould always be included in order to guarantee that all the important information \nis there. Breast imaging, like other subspecialties in radiology, is a multimodality \narea of knowledge where it is vital to integrate the information obtained through \ndiagnostic and interventional procedures in order to supply the clinician with a body \nof data that is useful and straightforward. \nLearning Objectives:\n1. To know the pertinent information the clinicians need in a breast cancer patient.\n2. To learn the different parts of a structured report using the BI-RADS system.\n3. To learn how to integrate the information from various modalities in a report.\n10:30 - 12:00 Room N/O \nJoint Course of ESR and RSNA \n(Radiological Society of North America)\nMC 1225 \nEssentials in oncologic imaging: \nwhat radiologists need to know (part 2) \nModerator: \nD.M. Panicek; New York, NY/US\nA‑353\t 10:30 \nA. Pancreatic cancer \nF. Caseiro-Alves; Coimbra/PT \nLearning Objectives:\n1. To understand current pathologic concepts for the classification of pancreatic \ntumours.\n2. To learn about imaging findings used for tumour detection, staging, and \nrestaging after adjuvant therapy.\n3. To understand the role of functional and molecular information provided by \nPET/CT, DWI and perfusion imaging when assessing pancreatic tumours.\nA‑354\t 10:55 \nB. Kidney cancer \nE.K. Fishman; Baltimore, MD/US \nLearning Objectives:\n1. To understand the diagnostic implications of minimally invasive treatments \nof renal cancer.\n2. To review the genetic causes of renal cancer and the radiologic appearances \nof specific histologic subtypes.\n3. To review the potential role of molecular imaging in the management of \nadvanced renal cancer.\nA‑355\t 11:20 \nC. Ovarian cancer \nH. Hricak; New York, NY/US \nLearning Objectives:\n1. To get an overview of the essential imaging findings in characterisation and \nstaging of ovarian cancer.\n2. To learn the key imaging findings that affect management of ovarian cancer.\n3. To understand the changes in imaging armamentarium in ovarian cancer, \nand learn the best practice in proper image utilisation. \nQuestions 11:50\nhepatic artery thrombosis treated by direct intra-vascular injection of streptokinase, \nflow is again restarted. 2 patients underwent surgery because of right stenosis and \norganised clot. Among 39 biliary strictures 32 strictures were at the site of anasto-\nmosis, and 3 patients had changes infavour of sclerosing cholangitis and 4 patients \nhad multiple stones and casts. All 8 patients with hepatic vein stricture stended \nsuccessfully. In conclusion, a close working relationship between radiologist and \nliver transplantation team has always been and continues to remain an essential \ncomponent of a successful liver transplantation program. \nLearning Objectives:\n1. To understand the main clinical situations in which intervention is necessary \nin patients with a transplanted liver.\n2. To become familiar with illustrative cases of the most important procedure.\n3. To learn about the role of imaging work-up in the planning of intervention.\nA‑350\t 11:30 \nInterlude (II): Persian physicians' contribution to the evolution of medicine \nK. Vessal; Shiraz/IR (k_vessal@yahoo.com) \nA‑351\t 11:35 \nRadiochemoembolisation of hepatic metastases \nS. Akhlaghpoor, M. Fatehi, A. Aziz Ahari, M. Amoui, S. Tolooee, H. Poorbeigi, \nS. Sheibani; T ehran/IR \nLiver metastases are of the most difficult therapeutic challenges in oncologic man-\nagements. Surgery is frequently impossible due to disease extent and systemic \nchemotherapy usually fails. In other body parts, the combination of radiotherapy and \nsystemic chemotherapy is used for several types of malignancies. We successfully \nadopted a novel image-guided form of this combination for such masses referred \nto as radiochemoembolisation, which substantially intensifies the treatment locally. \nPatients underwent transarterial radiochemoembolisation with chemotherapy \nprotocol of mitomycin, doxorubicin, and cisplatin and embolisation with radioiso -\ntope particles of 32P. The effectiveness of method was determined by comparing \ncontrast-enhanced CT images, pre- and post-intervention. Treatment response \nwas evaluated using RECIST criteria. We also used some arbitrary criteria such as \ntumoural mean density and enhancement pattern. For stable and partial-response \ncases, the procedure was repeated. We did not repeat the treatment for progressive \ndiseases. Complete-response cases were only followed. After completing treatment \nsessions, regardless of the tumour source, considerable amount of patients showed \nsubstantial response. In terms of RECIST criteria, a significant portion of patients \ngained at least a “Partial Response”. But the decrease in tumour density and the \nappearance of non-enhancing tissues were more promising. Radiochemoembolisa-\ntion is an effective method for the treatment of patients with unresectable hepatic \nmetastases. Although this study lacks a control group, it shows the effectiveness \nof the treatment. Literature review showed the response to treatment with regard \nto RECIST criteria had been better in our study comparing with studies only used \nchemoembolisation or radioembolisation. \nLearning Objectives:\n1. To understand the technique of radiochemoembolisation and the necessity \nof multidisciplinary cooperation.\n2. To learn about the possibilities and limits of radiochemoembolisation.\n3. To understand the potential role of radiochemoembolisation in the treatment \nstrategy of hepatic metastases.\nPanel discussion 11:50\n10:30 - 12:00 Room C \nInteractive Teaching Session \nE³ 1220 \nBreast cancer: what the radiologist must report \nA‑352\t 10:30 \nBreast cancer: what the radiologist must report \nA. Tardivon1, J. Camps Herrero2; 1Paris/FR, 2Valencia/ES \n(anne.tardivon@curie.net) \nIn a patient with a recently diagnosed breast cancer, the clinicians (oncologist, \nsurgeon and radiotherapist) need information relative to the location of the can-\ncer, its size, the relationship with adjacent structures, its distribution (multifocal, \nextensive intraductal component, multicentric, bilateral, extension to the nipple-\n\nSunday\nPostgraduate.Educational.Programme\nA\n S93\nCB D E F G H\nA‑358\t 11:10 \nSecondary evidence for interventional radiology \nD. Vorwerk; Ingolstadt/DE \nA search on PubMed/EMBASE using 12 terms identifying imaging modalities and \ntheir explosions was performed to retrieve secondary studies (systematic reviews/\nmeta-analyses, cost-effective analyses, guidelines, and position papers) on imag-\ning-guided interventional therapeutic procedures (ITPs) published from January \n2000 to May 2010. A total of 1,902 abstracts were initially found and evaluated. \nExcluding congress abstracts, non-secondary studies, and those not imaging-\nrelated, secondary studies concerning diagnostic imaging procedures as well as \nthose concerning imaging-guided needle biopsy procedures, 203 papers concerning \nITPs were found, published with a rate of 19.6/year. Of these 203 studies, 45 (22%) \nwere studies concerning ITPs performed by radiologists (R-ITPs=4.4/year), while \n158 (78%) were studies concerning ITPs also performed by non-radiologists (NR-\nITPs=15.3/year). The overall R-ITPs/NR-ITPs resulted 0.29. The mean number of \nstudies/year per body district was as follows: neuro/head-neck, 1.8 (R-ITPs) and \n0.4 (NR-ITPs); gastrointestinal/abdominal, 1.3 and 5.9; cardiovascular, 0.5 and \n7.2; musculoskeletal 0.5 and 0.5; thoracic, 0.0 and 0.3; pediatric, 0.0, and 0.1; \nurogenital, 0.3 and 0.6; maternal/fetal, 0.0 and 0.2, respectively. For seven out \nof eight body districts (neuro/head-neck being the only exception), the number \nof studies for NR-ITPs is equal or greater than the number of studies for R-ITPs. \nThese data show the under-representation of interventional radiology in terms of \nsecondary evidence. To analyze whether this is due to the lack of primary studies \nor to the lack of systematic reviews and meta-analyses of existing primary studies \nis one of the aims of the EBR working group promoted by EuroAIM. \nA‑359\t 11:30 \nThe American College of Radiology Imaging Network (ACRIN): twelve \nyears of conducting trials of medical imaging \nB.J. Hillman; Charlottesville, VA/US \nThe American College of Radiology Imaging Network (ACRIN) is a U.S.-based, \nNational Cancer Institute (NCI)-funded network of institutions and individuals \ncollaborating in the design, conduct, and analysis of scientifically rigorous clini -\ncal trials of diagnostic imaging and image-guided therapy. Since its inception in \n1999, ACRIN has conducted over 40 trials focused on all applications of imaging: \nscreening and early detection, diagnosis and staging, image-guided treatment, and \nresponse to treatment. An important early focus was the design of large screen-\ning trials that have had an important impact on medical practice. These include: \nthe Digital Mammographic Imaging Screening Trial (DMIST), which showed the \nsuperiority of digital mammography for younger and perimenopausal women, as \nwell as those with dense breasts; the National CT Colonography Trial (NCTCT), \ndemonstrating the equivalence of CTC with colonoscopy; and the National Lung \nScreening Trial (NLST) which has preliminarily reported a 20% decrease in lung \ncancer- specific mortality associated with annual CT screening. ACRIN’s current \nfocuses include the assessment of emerging imaging biomarkers for the prediction \nof and monitoring of response to treatment and the extension of its activities to \ndisease processes beyond cancer. \nDiscussion 11:50\n12:15 - 12:45 Room A \nPlenary Session \nHL 3 \nWilhelm Conrad Röntgen - Honorary Lecture \nPresiding: \nY. Menu ; Paris/FR \nA‑360\t 12:15 \nDetecting liver tumours: the search for the Holy Grail \nR.L. Baron; Chicago, IL/US (rbaron@uchicago.edu) \nFor decades, abdominal imagers have focused on liver tumour detection and \ncharacterisation as their holy grail. Most general abdominal CT techniques aim to \noptimise liver mass lesion detection/characterisation, recognising it as (1) prevalent \ndisease yet difficult to optimise and (2) one of few areas in abdomen where contrast \nmaterial volumes and timing of scanning is critical. Despite being one of the most \ncommon topics of publication over the last 30 years in radiology, there is not con-\ncurrence among the radiology community or with clinical colleagues as to the best \n10:30 - 12:00 Room Z \nEuroAIM Session \nEvidence-based radiology: why is evidence-based \nradiology crucial? \nModerators: \nG.P. Krestin; Rotterdam/NL \nF. Sardanelli; Milan/IT \nA‑356\t 10:30 \nApplying EBM to radiology - the EuroAIM project \nF. Sardanelli; Milan/IT \nDuring ECR 2010, the EuroAIM initiative promoted a European working group for \nEvidence-Based Radiology. A search on PubMed and EMBASE database using \n12 terms identifying imaging modalities and their explosions was performed to \nretrieve secondary studies (systematic reviews/meta-analyses, cost-effective \nanalyses, guidelines, and position papers) on both diagnostic imaging proce -\ndures (DIPs) and interventional therapeutic procedures (ITPs) published from \nJanuary 2000 to May 2010. Imaging-guided needle biopsy procedures were \nincluded in DIPs. A total of 3,147 abstracts were initially found and evaluated. \nPrimary studies, papers not concerning imaging procedures, and congress ab-\nstracts were discarded (n=1,699). The remaining 1,448 papers were classified as \nsecondary studies on: DIPs performed by radiology/nuclear medicine specialists \n(R-DIPS=807; 56%); ITPs performed by radiologists (R-ITPs=45; 3%); the effect \nof a treatment using a DIP as an end-point (Treat-DIPs=195, 13%); DIPs also \nperformed by non-radiology/nuclear medicine specialists (NR-DIPs=243; 17%); \nITPs also performed by non-radiologists (NR-ITPs=158; 11%). The following ratios \nwere calculated: (R-DIPs+R-ITPs)/(NR-DIPs+NR-ITPs)=852/401=2.12; R-DIPs/\nNR-DIPs=807/243=3.32; R-ITPs/NR-ITPs=45/158=0.28. From 2000 to 2005, the \nmean number of published secondary studies per year was 28.5 R-DIPs, 1.5 R-\nITPs, 7.7 Treat-DIPs, 10.4 NR-DIPs, and 5.1 NR-ITPs; from 2006 to 2010, 41.7, \n2.0, 10.5, 12.4, and 9.8, respectively. Secondary studies on R-DIPs and R-ITPs \nare relatively underrepresented in comparison with those concerning NR-DIPs \nand especially NR-ITPs. A delay of production of radiological secondary evidence \nnegatively impacts on the challenge of an evidence-based demonstration of the \nclinical role of our discipline. The EuroAIM and the European EBR working group \nshould make radiologists fully aware of this gap. \nA‑357\t 10:50 \nSecondary evidence for diagnostic imaging \nL.M. Sconfienza; Milan/IT \nA search on PubMed/EMBASE using 12 terms identifying imaging modalities and \ntheir explosions was performed to retrieve secondary studies (systematic reviews/\nmeta-analyses, cost-effective analyses, guidelines, and position papers) pub -\nlished from January 2000 to May 2010 on diagnostic imaging procedures (DIPs), \nincluding imaging-guided needle biopsy procedures. A total of 2,944 abstracts \nwere initially found and evaluated. Excluding congress abstracts, non-secondary \nstudies and those not imaging-related, 1,245 papers, published with a rate of \n120.5/year, were classified as studies on: DIPs performed by radiology/nuclear \nmedicine specialists (R-DIPs=78.1/year), evaluation of a treatment using a DIP \nas an end-point (Treat-DIPs=18.9/year), DIPs also performed by non-radiology/\nnuclear medicine specialists (NR-DIPs=23.5/year). For the R-DIPs group, the \nmean number of studies/year according the subspecialty was as follows: neuro/\nhead-neck 19.5; gastrointestinal/abdominal 11.7; cardiovascular 10.9; breast 9.8; \nmusculoskeletal 6.9; thoracic 5.7; pediatric 4.8; oncology (general) 4.2; urogenital \n2.3; maternal/fetal 0.7; other 1.5; for Treat-DIPs, 5.3, 2.2, 1.5, 0.8, 3.1, 1.6, 0.9, 0.7, \n0.2, 0.2, 2.4; for the NR-DIPs group, 9.1, 0.9, 6.7, 0.0, 0.1, 0.2, 0.7, 0.2, 1.1, 4.4, \n0.3, respectively. One subspecialty (neuro/head-neck) has more than 20 studies/\nyear, five have more than 10. About 20% of all studies concerns NR-DIPs, 23% \nexcluding Treat-DIPs. Moreover, the role/number of radiologists in the authorship of \nradiological secondary studies as well as the publishing journal (general medicine, \nclinical specialty, imaging) should be considered. The EuroAIM EBR working group \nshould encourage the diffusion of EBR culture and practice in order to fill the gap \nidentified with this preliminary analysis. \n\nPostgraduate.Educational.Programme\nS94\n A B C D E F G H\npulse sequences with low and high b-values improves lesion detection. Administra-\ntion of a contrast agent is mandatory in liver MRI, because many focal lesion are \nonly highlighted by enhanced pulse sequences. Dynamic gadolinium-enhanced \nT1-w GRE pulse (preferably 3D interpolated) sequences are versatile and useful \nfor lesion detection and characterisation as well assessment of the vasculature \n(i.e., hepatic artery aneurysms, Budd-Chiari-S., portal vein thrombosis, etc). Liver-\nspecific contrast agents render excellent results for detection and differentiation \nbetween metastasis and haemangioma or FNH. Manganese- or superparamagnetic \niron oxide liver-specific contrast agents can be administered in patients with renal \ninsufficiency. The choice of contrast material should be based on availability, the \nspecific clinical question, and renal function of the patient. \nLearning Objectives:\n1. To learn about the standard basic pulse sequences for liver imaging and the \ncritical technical parameters.\n2. To appreciate the diagnostic value of non-specific gadolinium chelates \nand different liver-specific contrast agents as well as optional sequences, \ndepending on the clinical question.\n3. To learn how to optimise pulse sequences and use advanced protocols \nincluding ‘knife-edge’ sequences and functional/structural imaging.\nA‑363\t 14:30 \nB. Small bowel and colon \nN. Papanikolaou; Iraklion/GR (nickolas.papanikolaou@gmail.com) \nThe advent of powerful gradient systems resulted in substantial improvement of \nimage quality in ultrafast magnetic resonance (MR) imaging and therefore novel \nclinical applications emerged including gastrointestinal tract imaging. Within this \ncontext, MR enteroclysis and MR colonography were developed, providing luminal, \ntransmural and extramural diagnostic information at the same imaging session. Two \ndifferent protocols have been developed for imaging the small bowel with MR. These \ninclude MR follow-through and MR enteroclysis. MR follow-through is based on the \noral ingestion of an adequate amount of contrast agent and acquisition of consecu-\ntive sequences. In a clinical setting, sufficient luminal distention that guarantees \naccurate individual lesion detection can be achieved by MR enteroclysis. Two MR \ncolonography protocols have been proposed. According to the first, termed as ‚bright \nlumen MRC‘, a gadolinium-spiked water solution is administered endorectally to \nthe patient who has previously undergone colonic cleansing to distend the colon, \nresulting in a homogeneous high-signal intensity on heavily T1-weighted 3D gradient \necho images. Polyps are demonstrated as filling defects while air bubbles can be \ndifferentiated by performing the examination in both supine and prone positions. \nAccording to the second approach, termed as ‚dark lumen MRC‘, dense barium or \ntapped water is used to distend the colon in conjunction with post-gadolinium 3D \ngradient echo with fat-saturation sequences. The colonic wall and the correspond-\ning polyps exhibit high signal intensity as a result of gadolinium uptake while the \ncolonic lumen presents with low signal intensity. \nLearning Objectives:\n1. To review the basic technical aspects of MR enteroclysis and MR \ncolonography.\n2. To review MR enteroclysis imaging features of Crohn’s disease.\n3. To understand the use of optional sequences depending on the clinical \nquestion in patients with Crohn’s disease.\n4. To recognise the potential of MR colonography in the era of CT \ncolonography and propose advanced imaging protocols.\nA‑364\t 15:00 \nC. Pancreas and bile ducts \nC. Matos; Brussels/BE (cmatos@ulb.ac.be) \nMR imaging of the pancreas and bile ducts relies upon a combination of T2-w and T1-w \nstrategies in order to safely acquire anatomic, cross-sectional and functional information.\nTissue-imaging strategies include free breathing T2-w imaging (obtained with echo-train \nspin-echo sequences with or without fat saturation) and breath-hold 3D-gradient echo \nT1-w imaging (obtained with fat saturation) without gadolinium and in the capillary phase \nand in the interstitial phase post-gadolinium. This combination is valuable in the assess-\nment of the full spectrum of pancreatic diseases and malignant bile duct obstruction. \nHardware improvements (gradients) and the advent of more sophisticated phased-array \ncoils and parallel imaging capabilities in modern MR scanners allowed to increase the \nspatial and temporal resolution of “conventional” T2-w and T1-w sequences. Furthermore, \nit provided the possibility of adding high-b-value diffusion weighted imaging (DWI) to our \nroutine protocol in order to increase the sensitivity of MRI in detecting malignant and \ninflammatory diseases. T o obtain conventional MRCP imaging thick-slab heavily T2-w \nTSE sequences or 3D heavily T2-w TSE sequences may be used. Advantages and \nlimitations of both sequences will be underlined. Functional bile duct imaging is obtained \nimaging modality or technique for this problem. Increasing technological capabilities \nand knowledge of how to optimise CT/MR contrast utilisation provides better ways \nto characterise tumours than ever before such that key clinical specialties outside \nof radiology now recommend nonbiopsy imaging diagnosis of HCC to triage patient \ntreatment. Radiologists must work extra diligently to learn the clinical issues, triage \npoints and implications that are associated with specific clinical presentations and \nimaging findings. The perfect test that does not require cognitive interpretation of \nthe constellation of imaging findings with integration of the patient clinical presen-\ntation to optimise patient care is not in our near future. This lecture emphasises \nhistorical advances in liver imaging and how data in the literature impacted patient \ncare decisions in ways that may be different than expected from radiologists. An \nemphasis on pathologic-imaging correlation will be used to put apparent disparate \npublished results in proper perspective to allow radiologists to meaningfully interact \nwith clinical colleagues in determining optimal patient treatment. \nLearning Objectives:\n1. To understand the pathologic changes and imaging correlates in cirrhosis \nthat lead to neoplastic development.\n2. To gain an awareness of the key role of diagnostic imaging in triaging \npatients with cirrhosis and hepatocellular carcinoma among treatment \noptions.\n3. To better understand apparent disparate published results to allow \nradiologists to meaningfully interact with clinical colleagues in determining \noptimal patient treatment.\n12:30 - 13:30 Room Z \nThe Beauty of Basic Knowledge: Interpretation of the Chest \nRadiograph \nMC 21D \nRounded lesion(s) \nA‑361\t 12:30 \nRounded lesion(s) \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nRounded lesions of the lung may be solitary or multiple. It is important to separate \npulmonary from extra-pulmonary nodules, because the significance is different. \nMultiple pulmonary nodules are usually due to metastatic disease. In managing \nthe solitary pulmonary nodule it is imperative to exclude pseudonodules due to skin \nor rib lesions and it is of the utmost importance comparing with previous studies. \nLearning Objectives:\n1. To understand the importance of rounded opacities.\n2. To review the most frequent causes of rounded lesions.\n3. To learn current imaging management of the solitary nodule.\n14:00 - 15:30 Room A \nAbdominal and Gastrointestinal \nRC 1301 \nAbdominal MRI: protocols that work \nModerator: \nS. Yarmenitis; Iraklion/GR \nA‑362\t 14:00 \nA. Liver \nW. Schima; Vienna/AT (Wolfgang.Schima@khgh.at) \nLiver MRI is undertaken to assess the liver parenchyma, vasculature, and biliary \nsystem. It is necessary to use a variety of unenhanced and contrast-enhanced MR \npulse sequences to achieve lesion detection and characterisation. A set of T1-, T2-w \nand DWI sequences is now standard for lesion delineation and assessment of liver \nfat and iron content. In-phase and opposed-phase T1-w GRE images show focal or \ndiffuse fatty infiltration and focal sparing. A fat-suppressed T2-w TSE sequence is \nrobust and provides high tumour contrast, with 3.0 T units now allowing acquisition \nof isotropic 3D-TSE sequences. The quite popular T2-w half-Fourier single-shot \nTSE (e.g., HASTE) pulse sequences show anatomic detail (including bile ducts), but \nlack lesion contrast. In case of suspected iron overload (i.e., haemosiderosis and \nhaemochromatosis) an additional T2*-w GRE is recommended. Acquisition of DWI \n\nSunday\nPostgraduate.Educational.Programme\nA\n S95\nCB D E F G H\n14:00 - 15:30 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 1318 \nFever of unknown origin \nModerator: \nP.A. Grenier; Paris/FR \nA‑367\t 14:00 \nA. Clinical considerations \nC.P. Heussel; Heidelberg/DE (heussel@uni‑heidelberg.de) \nPatient transport into the radiology department, contact to other potentially infec-\ntious persons, and things such as breath-holding are reasonable burdens and \ndangers to immunocompromised patients. When searching the focus of fever, \nimaging should help to identify an affected organ system in order to eventually \nguide invasive procedures to identify underlying micro-organism or non-infectious \ndisease. Equally relevant is the exclusion of its involvement with a reasonable \nspecificity. Depending on local epidemiology, organ system, and the clinical signs \nand symptoms, suspected differential diagnosis can be derived from image pat-\nterns. Some of these diagnoses might be exclusion diagnosis, others might require \ninvasive procedures including time consuming and costly analysis to be verified. \nInvasive procedures, however, require adequate hemostasis, which is usually not \navailable for a substantial duration due to pancytopenia in patients who underwent \nchemotherapy. If imaging fails to derive the underlying disease confident and \nconclusively in a fast way, clinicians might need to treat on an empirical basis. \nEmpirical treatment plays a major role in immunocompromised or severely ill \npatients at risk, because mortality rises within hours of untreated disease. On the \nother hand, empiric treatment causes relevant toxicity and substantial costs, while \nimaging might become cost-effective. \nLearning Objectives:\n1. To learn more about the clinical conditions causing fever without an apparent \norigin.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑368\t 14:30 \nB. Imaging techniques and typical findings \nG.R. Ferretti; Grenoble/FR (GFerretti@chu‑grenoble.fr) \nDiagnosis of fever of unknown origin (FUO) is a major challenge for internists. \nThe spectrum of disease includes infections (28%), inflammatory diseases (21%), \nmalignancies (17%), and “no diagnosis” (19%). Deep vein thrombosis (3%) and \ntemporal arteritis in the elderly (16%-17%) are important considerations. Investi-\ngation of patients with FUO usually includes clinical and standard biological tests \nwhich give numerous clues. Imaging procedures depend on objectives and various \nimaging investigations should be organised in strategies. Early identification of the \nbest tissue to be the site of biopsy is one of the most decisive procedures. First \nline imaging studies usually include chest radiography, abdomen ultrasonography \nand contrast enhanced CT of the thorax abdomen pelvis in order to disclose com-\nmon etiologies such as infections (tuberculosis, Pneumocystis carinii pneumonia, \nabdomen abscesses and pelvic abscesses), malignancies (lymphoma, metastatic \ncancers, renal cell carcinoma and pancreatic carcinoma), autoimmune conditions \n(Behçet’s disease) and miscellaneous (sarcoidosis). Vein sonography is useful for \ndetecting deep venous thrombosis. Nevertheless, there is a need for more complex \ntechniques if this strategy fails. Second line techniques include MRI and 18-FDG \nPET scan as (18)F-FDG accumulates in malignant tissues, at the sites of infection \nand inflammation and in autoimmune and granulomatous diseases. In some stud-\nies, the PET scan contributed to the final diagnosis in 25%-69% of the patients. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof patients with fever of unknown origin.\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\nusing contrast agents that are taken up by hepatocytes and excreted through the biliary \nsystem in combination with volumetric T1-w sequences. We use this technique in post-\noperative complications and to elucidate complex biliary anatomy. Functional imaging \nof the pancreas is obtained by combining MRCP along with hormonal stimulation with \nsecretin. In addition, secretin improves anatomic delineation and allows MRI quantifica-\ntion of fluid production by the exocrine pancreas. \nLearning Objectives:\n1. To understand the basic sequences (with technical details) for MRI/MRCP of \nthe pancreas and bile ducts.\n2. To learn about the use of optional sequences related to special clinical \nsituations.\n3. To learn about advanced imaging protocols for MRI/MRCP of the pancreas \nand bile ducts concerning functional/structural imaging.\n14:00 - 15:30 Room B \nInteractive Teaching Session \nE³ 1320 \nCommon radiological problems: cardiovascular \nA‑365\t 14:00 \nA. Looking at the heart in chest x-rays \nJ. Andreu; Barcelona/ES (jandreus@gmail.com) \nDespite the advance of cross-sectional techniques, the chest radiograph remains \na basic tool for the initial approach to heart diseases. In this lecture we will present \nour current approach to evaluate cardiac pathology in conventional radiography \nillustrating it with selected cases. The basic approach consists of seven steps, \nevaluating the size and shape of the cardiac silhouette, cardiac calcifications, \npulmonary circulation and lung changes, great vessels and implanted devices, all \nof them correlated with the clinical findings. \nLearning Objectives:\n1. To learn how to detect and characterise cardiac abnormalities in the chest \nradiograph.\n2. To learn how to detect and characterise cardiac abnormalities on chest CT.\n3. To learn the limitations of the interpretation of cardiac abnormalities on un-\ngated chest CT.\n4. To learn when further evaluation is required.\nA‑366\t 14:45 \nB. Looking at the heart in chest CT \nF. Laurent; Pessac/FR (francois.laurent@chu‑bordeaux.fr) \nLooking at the heart on a chest film may be considered at a first glance as wasting \ntime since, today, many other techniques are available today to offer an impressive \nluxury details of the morphological and functional evaluation of heart. Neverthe -\nless, the chest film remains often the first modality performed in many situations \nin which symptoms can be both from pulmonary or cardiac origin and then, careful \nanalysis of heart may avoid rough mistakes in patient management. Acquired and \ncongenital pericardial or cardiac abnormalities may be responsible for a deformity \nof the cardiac silhouette and lead to explore the patient by a chest CT. CT with \nfast scanning capabilities can acquire images of the thorax with reduced cardiac \nmotion artefacts, improving the evaluation of the heart in the course of a thoracic \nCT. Unexpected findings of cardiac structures on both unenhanced and enhanced \nacquisition can dramatically influence the patient’s clinical management. In many \nsituations, a chest CT is performed without cardiac gating and it may be necessary \nto complement the initial examination by a gated acquisition to provide a more dedi-\ncated analysis. The normal appearance of cardiac structures and the most common \ncardiac abnormalities should be known by all the radiologists. Various conditions \nsuch as idiopathic and acquired cardiomyopathy, ischaemic heart disease, valvular \ndysfunction can be identified even on non-gated scans. Pulmonary diseases may \nalso involve pericardium and cardiac structures and this should be clearly identified. \nLearning Objectives:\n1. To learn how to detect and characterise cardiac abnormalities in the chest \nradiograph.\n2. To learn how to detect and characterise cardiac abnormalities on chest CT.\n3. To learn the limitations of the interpretation of cardiac abnormalities on un-\ngated chest CT.\n4. To learn when further evaluation is required.\n\nPostgraduate.Educational.Programme\nS96\n A B C D E F G H\nnal in discs and vertebrae to the adult shape and signal pattern will be reviewed. \nThe normal pattern of unfused bony segments and apophyses in the child and \nfusion to the mature adult form will be reviewed. Normal variants such as persis-\ntent segmentation/non-union leading to limbus vertebrae and dysraphism will be \nreviewed. Intervertebral discs, vertebral body endplates, posterior elements and \nbone marrow show a wide degree of variation and the borderland of normal variant \nversus pathological abnormality is often difficult to navigate. Common borderland \nfindings such as Schmorl’s nodes versus Scheuermann’s disease will be discussed. \nTransitional vertebrae as such are normal but incomplete transitional changes are \nassociated with clinical symptoms. Even without associated pathological changes \nthe terminology of transitional vertebrae is a common pitfall. Simple coping strate-\ngies will be reviewed. Various imaging artefacts can have an influence on image \ninterpretation though lumbar spine MR imaging is more resistant to these than \nimaging of the cervical and thoracic spine. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑372\t 14:50 \nC. Identifying and reporting abnormal findings \nA. Stäbler; Munich/DE (info@radiologie‑muenchen‑harlaching.de) \nMost frequent pathologies encountered on lumbar spine examinations are \ncaused by degenerative disc disease and include: Disc herniation with nerve root \nentrappement, activated erosive intervertebral osteochondrosis from instability, \nspinal canal stenosis, recess stenosis and neuroforamen stenosis. Disc hernia -\ntion is defined as dislocation of nucleus pulposus material through a defect of the \nannulus fibrous (annular tear) beyond the outer part of the annulus fibrosus. The \nconcept of contained disc versus non-contained disc describes whether there is \ndisc material dislocated into the epidural space or not. The terms intradiscal disc \nhernia, bulging or protrusion of disc material have to be differentiated. Segmental \ninstability plays a causative role in the development of activated erosive interver-\ntebral osteochondrosis, which is accompanied by band-like/hemispherical bone \nedema in the adjacent vertebrae and/or band-like vascularity in the disc space at \nthe disco-vertebral junction. Bony changes and spurs at the endplates are absent \nor only moderately developed. Spinal stenosis may be congenital or acquired by \ndegenerative constriction of the spinal canal leading to spinal cord, nerve root or \ncauda equina compression. Measurement of the bony spinal does not help in the \ndetermination of clinical significance of spinal stenosis. The required space of the \nnerve roots to pass unaffected through the spinal canal increases when ascending \nthe lumbar spine levels. Severity of spinal canal stenosis is related to the residual \nsubarachnoid space, which is present on axial T2w images. Imaging findings that \ncorrelate with the severity and clinical relevance of spinal canal stenosis are cauda \nredundancy and swelling/edema of nerve roots. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\n14:00 - 15:30 Room D2 \nInterventional Radiology \nRC 1309 \nInfection and percutaneous drainage \nModerator: \nM. Bezzi; Rome/IT \nA‑373\t 14:00 \nA. Empyema \nA. Keeling; Dublin/IE (aoifekeeling@hotmail.com) \nAt the end of this presentation one should be familiar with the: (1) appearances \nof empyema on each imaging modality, (2) clinical indications for percutaneous \ndrainage, (3) technique and image guidance methods employed for percutaneous \nchest catheter insertion, (4) potential procedure-related complications and their \nmanagement, (5) role of urokinase/TPA and (6) existing literature on image-guided \nchest drainage success rates. Empyema represents a common medical problem \nwith a mortality of up to 20%. Difficulty in differentiating empyema from simple pleural \neffusion with imaging alone often occurs. Needle aspiration with or without formal \nchest drainage may be necessary in many circumstances. Traditionally, large bore \nA‑369\t 15:00 \nC. Interactive case discussion \nW. Curati-Alasonatti1, G.H. Mostbeck2; 1Stanmore/UK, 2Vienna/AT \nThe cases presented during this part of the session illustrate the three principles the \nclinician and the radiologist should be guided by: 1. Starting with a clinical problem, \nchoose the best imaging modality as part of the investigative process to establish \na differential diagnosis. 2. Study the imaging documents acquired and identify the \nrelevant findings leading to the diagnosis or further investigations. 3. Avoid perform-\ning multiple imaging modalities, comply with ALARA directives and keep the cost \nto a minimum: a variation of ALARA. We will illustrate the compliance with these \nprinciples as, in the clinical context of a FUO, strategy, individual knowledge and \nmultidisciplinary team-work are critical to the success of the algorithmic approach. \nThirty years ago a seminal textbook appeared in the radiological literature: “Critical \nDiagnostic Pathways in Radiology - An Algorithmic Approach”, edited by Ronald \nEisenberg and John Amberg and published by J.B. Lippincott (1981). This textbook \nwas published at a time when a spectrum of imaging modalities was becoming well \nestablished and critical guidance for their use - and not abuse - was desperately \nneeded by the radiologists of my generation. \nLearning Objectives:\n1. To introduce typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of patients with fever of unknown origin.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n14:00 - 15:30 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 1316 \nThe lumbar spine \nModerator: \nM. Epermane; Riga/LV \nA‑370\t 14:00 \nA. How I do it \nP. Richards; Stoke‑on‑Trent/UK (paula.richards@uhns.nhs.uk) \n1. Always report in the same logical manner for each examination, which imprints \nnormal pathology ‘jumps out at one’. 2. Evaluate all images before looking at the \nclinical information to prevent bias and satisfaction of search. 3. Review every scout \nimage. Scoliosis transitional vertebrae and pseudoarthrosis become more obvious \non coronals. Single kidneys, hydronephrosis and renal tumours may explain ‘back \npain’, especially if there are mets. 4. Review any x-rays or old IVUs, remembering \nthat abdominal x-rays show the spine. 5. Indications; summarise the reason for the \nscan. Think of the differential diagnosis to exclude. 6. Technique; allows one to check \nthe levels scanned. Be sure there has been no area missed between 2 studies. 7. \nReport vertebral alignment and disc height. 8. MRI just like an x-ray, i.e. there is \nnormal alignment from D10 to S3. 9. Start at the far sagittals and look at the nerve \nroots in the ‘key hole’, the pars and facets. 10. Determine the worst abnormality \non the axials and report the most significant findings first. Check the facets at each \nlevel. 11. Have a checklist of normals at the end; ‘the bone marrow, cord and CSF \nreturn normal signal. The conus ends normally with no pars or metastasis’. 12. \nOpinion: explain what you think is causing the patient’s symptoms. Assume this \nis the only part read, so if there is only one kidney reiterate here. The lecture will \nillustrate additional information on scout images and benefits of coronal images. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑371\t 14:25 \nB. Normal variants and pitfalls \nB. Tins; Oswestry/UK (Bernhard.Tins@rjah.nhs.uk) \nThe lumbar spine undergoes morphological changes with age. Normal appearances \nand relevant normal variants will be discussed. In particular, the morphological \nchange from an almost round intervertebral disc in newborns with high water sig-\n\nSunday\nPostgraduate.Educational.Programme\nA\n S97\nCB D E F G H\n14:00 - 15:30 Room E1 \nMusculoskeletal \nRC 1310 \nPostoperative imaging of the lower extremity \nModerator: \nF. Aparisi; Valencia/ES \nA‑376\t 14:00 \nA. Hip \nS.J. Eustace; Dublin/IE (seustace@iol.ie) \nThis talk will review an approach to imaging complications of total hip replacements. \nThe talk will briefly review surgical techniques and types of prostheses. The talk \nwill subsequently review early and late complications of prostheses and focus on \nthe integrated use of all modalities including radiographs, aspiration arthrography, \nscintigraphy and MRI in achieving a diagnosis. \nLearning Objectives:\n1. To understand the principles of basic surgical techniques.\n2. To review technical aspects of different modalities for imaging post-surgical \npatients.\n3. To recognise normal imaging findings after surgery and how to differentiate \nthem from pathological ones.\n4. To become familiar with the main complications after hip surgery.\nA‑377\t 14:30 \nB. Knee \nK. Verstraete; Gent/BE (koenraad.verstraete@ugent.be) \nThere are many surgical techniques to repair meniscal tear, focal cartilage defect, \ncruciate ligament tear, malalignment, fracture, osteoarthrosis, etc. Conventional \nradiography, CT-scan, CT-arthrography and MRI play an important role in evalua-\ntion of the knee after surgery or arthroscopy. Indications for postoperative imaging \nare infection, persistent pain and dysfunction. Every radiologist should be familiar \nwith “normal” imaging findings after arthroscopy, osteosynthesis, ligament recon-\nstruction, osteotomy, knee prosthesis and meniscal or (osteo)chondral repair, \nbut also recognise the main complications after knee surgery or arthroscopy. \nOrthopaedic hardware is usually evaluated on plain radiography or CT, and only \na relative contraindication for MRI. Microscopic metal artefacts and fibrotic scar-\nring are frequently seen along the course of the instrumentation tract. After partial \nmeniscectomy, an obtuse angle at the apex of the meniscus and increased signal \nintensity of the remnant part of the meniscus are normal findings, whereas fibrilla-\ntion and recurrent tear may explain the complaints of the patient. Various intra- and \nextra-articular reconstructive procedures exist for anterior and posterior cruciate \nligament reconstruction. Besides the neoligament, an osseous tunnel, screws and \nmetal artefacts are also visible. Postoperative findings of the extensor apparatus \ninclude a thickened patellar tendon, focal myxoid degeneration, fibrosis and focal \ndefects, e.g. after harvesting tendon tissue for ACL reconstruction or after release of \nthe lateral patellar retinaculum for ‘unstable’ patella. Accelerated osteoarthritis may \nbe a late postoperative finding. MRI very well depicts incorporation and alignment \nof osteochondral auto- or allografts, and the position, morphology and integrity of \nthe meniscus after repair or transplantation. \nLearning Objectives:\n1. To understand the principles of basic surgical techniques.\n2. To review technical aspects of different modalities for imaging post-surgical \npatients.\n3. To recognise normal imaging findings after surgery and how to differentiate \nthem from pathological ones.\n4. To become familiar with the main complications after knee surgery.\nA‑378\t 15:00 \nC. Ankle \nC. Masciocchi; L’Aquila/IT (carlo.masciocchi@cc.univaq.it) \nTo evaluate postsurgical patients it is important to know the primary clinical diagno-\nsis, the surgical treatment, the interval since surgery, and patients’ current clinical \nsymptoms. Radiography is the most common imaging modality to evaluate the \npostoperative ankle, particularly in traumatic cases; after reduction and fixation of \na fracture or dislocation it is generally carried out as routine. Ultrasonography is \nhighly sensitive and specific in postoperative tendon assessment, thanks to the \nsuperb resolution, and the opportunity for dynamic evaluation of tendon integrity. \nchest drains (28-30 Fr) with underwater seals achieved decompression of pleural \nfluid collections. Recent literature suggests small bore drains may be adequate, with \nimage guidance playing an important role. Pleural space anatomy, including fissural \nlocations will be revised. Aetiology of transudates, exudates and empyemas, along \nwith typical clinical presenting features are outlined. Various examples of plain film, \nultrasound, multi-detector computed tomography and MRI appearances of pleural \ncollections and their aetiologies are presented. Selection of patients, image guidance \nmethods, catheter size, insertion technique, pitfalls and procedure complications \nare discussed. Importance of physician-radiologist liaison with respect to catheter \nmanagement and catheter dwell times is emphasised. Pleural space fluid collections \nare common clinical entities that radiologists can accurately diagnose as well as \nsuccessfully treat. Overview of aetiology, radiological appearances and method of \nimage-guided drainage of infected pleural fluid collections is provided. \nLearning Objectives:\n1. To learn about imaging strategies and indications for drainage.\n2. To review technical aspects of catheter drainage.\n3. To understand the use of urokinase.\n4. To appreciate the results of percutaneous drainage.\nA‑374\t 14:30 \nB. Abdominal abscess \nV. Válek; Brno/CZ (vlvalek@med.muni.cz) \nWith new antimicrobial agents, advances in diagnostic imaging and imaging-guided \npercutaneous procedures, the management of pyogenic liver abscess has significantly \nimproved. The advantages of the percutaneous approach include a marked decrease \nin the invasiveness and cost of abscess drainage. The classic triad of fever, upper right \nquadrant pain or fullness, and jaundice is rarely seen nowadays. Possible image-based \nexclusionary criteria for drainage include abscess size of less than 3 cm in diameter, \nfluid attenuation of more than 40 HU, absence of contrast material-enhanced margins, \nabsence of trapped air in a fluid collection, absence of free intraperitoneal air, and \npresence of air without fluid in the abscess cavity. The most important is the size of \nless than 3 cm. Possible clinical exclusionary criteria include normal white blood cell \ncount, normal temperature, normal blood pressure, absence of peritoneal signs, lack of \nrelevant medical history and a do-not-resuscitate code status. Indications for tacking a \npercutaneous approach to abdominal abscess drainage are the signs of inflammation \nand fluid collection (abscess) larger than 3 cm. Contraindications are today only relative. \nPercutaneous needle aspiration or catheter drainage guided by CT or sonography has \nbecome the first line treatment for abdominal abscess. \nLearning Objectives:\n1. To understand imaging strategies and indications for drainage.\n2. To learn about image guidance, route planning and catheter placement.\n3. To review follow-up strategies and results.\nA‑375\t 15:00 \nC. Pelvic abscess \nM.A. Funovics; Vienna/AT (martin.funovics@meduniwien.ac.at) \nPelvic abscess drainage may employ more difficult access routes due to anatomic \nrestrictions. The procedure may carry a higher risk of complications compared to \nsimple abdominal drainage. To optimise patient preparation, correction of coagula-\ntion deficits, optimisation of antibiotic treatment, and sedation or anesthesia may \nbe needed. The usual access routes for deep pelvic abscesses are the anterolat-\neral and the posterior transgluteal approach. In selected cases, a transvaginal or \ntransrectal approach may be the safer and more efficient option. Depending on \nthe viscosity of the drained fluid, the presence of necrotic solid tissue and gas, dif-\nferent sizes of drainage material may be needed. Do not hesitate to employ large \ndrainage catheters if indicated. An overview of the available material will be given. \nIntestinal laceration is a major complication which can be managed percutaneously \nin selected circumstances. Often, the weakest part of percutaneous drainage is the \npostinterventional management. It is advocated that the management is actively \nguided by the interventionalist who ensures that the drainage is properly handled, \nrinsed, and cleaned, that follow-up imaging is performed at the right intervals, and \nwho is also responsible for indicating drain removal. \nLearning Objectives:\n1. To understand imaging strategies and indications for drainage.\n2. To learn about transgluteal, endocavitary and other routes of drainage.\n3. To review results and follow-up strategies.\n\nPostgraduate.Educational.Programme\nS98\n A B C D E F G H\nLearning Objectives:\n1. To appreciate the importance of looking at the heart on CT scans of the chest.\n2. To review the normal appearance of cardiac structures that can be easily \nidentified on CT scans of the chest.\n3. To understand key imaging findings.\nA‑381\t 14:28 \nB. Incidental findings and their clinical relevance \nA. de Roos; Leiden/NL (A.de_Roos@lumc.nl) \nChest CT and MRI are commonly performed to evaluate patients with acute chest \npain. A number of imaging techniques are available that may cover the entire \nchest, including the cardiovascular system. The radiologist will encounter more \nand more cardiovascular disease that was not visible with ungated CT and MRI \ntechniques. The differential diagnosis of acute chest pain may include over 30 \npossible diagnoses, a substantial number related to cardiovascular disease. It is \nimportant to recognise chronic and acute coronary disease, myocardial infarction \nand its complications, left ventricular function, pericardial disease, atrial disease \nand large vessel disease. Case material will be presented and discussed using \nboth CT and MRI techniques to illustrate the spectrum of usual and more unusual \ncardiovascular pathology that should be considered in the differential diagnosis \nof unexplained chest pain. \nLearning Objectives:\n1. To become familiar with cardiac anomalies that can be identified on CT \nscans of the chest.\n2. To understand the clinical value of cardiac anomalies incidentally detected \non CT scans of the chest.\n3. To learn how to manage and report incidental cardiac findings to the \nreferring clinician.\nA‑382\t 14:51 \nC. Pulmonary hypertension and right ventricle function \nM. Rémy-Jardin, F. Pontana, A.-L. Hachulla, J. Rémy; Lille/FR \n(martine.remy@chru‑lille.fr) \nPulmonary hypertension (PHT) remains a disease difficult to diagnose because \nthe clinical findings are nonspecific, often leading to a delayed diagnosis. Once \nrecognised, it is necessary to determine the underlying cause and to estimate the \nseverity of pulmonary hypertension. Among the noninvasive methods of assessment \nof PHT, CT angiography (CTA) now plays an important role in the diagnosis and \npost-therapeutic management of PHT. Numerous recent technological advances \nof multidetector-row CT technology (MDCT) have reinforced the clinical impact \nof this technology by introducing new tools for the morphological evaluation of \nsmall-sized pulmonary arteries and pulmonary capillaries, the latter being acces-\nsible with dual energy CT and often referred to as pulmonary “perfusion”. The role \nof CT now also includes the possibility to investigate the presence of PHT on the \nbasis of functional parameters, such as the distensibility of the pulmonary arterial \nwall, and to integrate cardiac functional information, with great interest towards \nright ventricular function. The major clinical impact of these new scanning modes \nis that morphology and function can be obtained from the same data set, with \nno restriction on the diagnostic performance of high-resolution CT angiographic \nimages. The purpose of this lecture is to review these new trends in imaging of \nPHT and estimating right ventricular function through practical clinical situations, \nincluding the most common causes of PHT. \nLearning Objectives:\n1. To review the normal appearance of pulmonary vessels and right ventricle \non CT scans of the chest.\n2. To learn about CT findings indicative of pulmonary hypertension in \ncomparison with other imaging modalities.\n3. To understand how to evaluate the right ventricle function.\nPanel discussion: \nReady for routine reporting of cardiovascular findings on CT scans of the \nchest? 15:14\nCT scans of the chest are usually performed and reported as if the lungs were the \nonly organs in the thoracic cage. However, the heart and pulmonary arteries can \nshow significant abnormalities either as associated findings of the parenchymal \ndisease or as incidental findings. So the recommendation is: do not forget the heart \nand pulmonary vessels when reporting a CT scan of the chest. \nMRI has rapidly become important in post-operative assessment of the ankle, \nbecause it provides high soft-tissue contrast, multiplanar capability and osseous \nstructures visualisation. It shows signal changes of ligaments and tendons, hypoin-\ntense subchondral sclerosis, subchondral bone marrow oedema, joint effusion, \ncapsular thickening, fibrosis, and synovitis. MRI has also an important role in the \nevaluation of post-surgery ankle pain due to impingement syndrome and in the \nhindfoot chronic instability related to postoperated sinus tarsi syndrome; it demon-\nstrates the anatomy of sinus tarsi, chronic synovitis and nonspecific inflammatory \nchanges, synovial cysts, fibrosis and subtalar joint effusion. It is important also in \nthe follow-up of tumours and tumour-like conditions of bone and soft tissues after \nsurgery. Computed tomography is the most valuable method to define the osseous \nanatomy of the postoperative ankle, so it is important in the follow-up of the oper-\nated osteochondral lesions of the talus. CT allows the evaluation of irregularities \nor degenerative changes, and progressive degenerative arthritis; however, CT \nusually fails to evaluate soft tissue’s ankle lesion. \nLearning Objectives:\n1. To understand the principles of basic surgical techniques.\n2. To review technical aspects of different modalities for imaging post-surgical \npatients.\n3. To recognise normal imaging findings after surgery and how to differentiate \nthem from pathological ones.\n4. To become familiar with the main complications after ankle surgery.\n14:00 - 15:30 Room E2 \nChest \nRC 1304 \nWhen CT sees both the heart and the lungs \nModerator: \nL. Bonomo; Rome/IT  \nA‑379\t 14:00 \nChairman’s introduction \nL. Bonomo; Rome/IT (lbonomo@rm.unicatt.it) \nThe development of subsecond MDCT scanners with high temporal and spatial \nresolution has significantly reduced scanning times and now it is possible to have \nvery good quality images of the heart during routine chest CT examinations. There-\nfore, the importance of looking at the heart and pulmonary vessels on a CT scan \nperformed for non-cardiac reasons will be emphasised. Anatomic cardiac details that \nevery radiologist should know will be discussed in the first talk; the presentation is \naimed mainly at the non-cardiac radiologist. It will review normal cardiac anatomic \ndetails, as routinely encountered on modern multi-detector CT studies. It is now \npossible to delineate much of the intracardiac anatomy on a contrast enhanced \nstudy and significant pathology may also be evident on non-enhanced CT exami-\nnations. Important incidental findings and their clinical relevance will be discussed \nin the second talk. Unexpectedly, cardiac abnormalities may be diagnosed when \nlung disease is clinically suspected and vice versa; the focus of this presentation \nwill be the comprehensive evaluation of lung and heart/large vessels diseases.The \nstrong correlation existing between pressure in the pulmonary artery system and \ndilatation of the pulmonary trunk and central branches will be discussed in the last \ntalk. CT is considered more useful than echocardiography because it can depict \nthe cardiac structures in all patients including those with extensive parenchymal \nabnormalities. At the end of the presentations we should try to answer the question \nabout the routine reporting of cardiovascular findings on CT scan of the chest. \nA‑380\t 14:05 \nA. Anatomic cardiac details that every radiologist should know \nS.P.G. Padley; London/UK (s.padley@ic.ac.uk) \nThis presentation is aimed at the non-cardiac radiologist. It will review normal cardiac \nanatomic detail, as routinely encountered on modern multi-detector CT studies. \nIt is now possible to delineate much of the intracardiac anatomy on a contrast \nenhanced study, and significant pathology may also be evident on non-enhanced \nCT examinations. This study will primarily review normal cardiac anatomy, including \ncardiac chambers, valves and coronary vessels. The typical radiological appear -\nances of innocent incidental intra-pericardial abnormalities will then be reviewed. \nImportant incidental pathology will be discussed in the next talk. \n\nSunday\nPostgraduate.Educational.Programme\nA\n S99\nCB D E F G H\nA‑385\t 14:32 \nQuantification of liver inflammation \nJ.F.L. Cobbold; London/UK (j.cobbold@imperial.ac.uk) \nLiver inflammation, or hepatitis, may be acute or chronic and occurs as a result \nof one or more hepatocellular insults (including viral, metabolic and toxic causes) \nleading to a pro-inflammatory cytokine response, oxidative stress, hepatocellular \ndamage, necrosis, apoptosis and inflammatory cell infiltration. Hepatic stellate cell \nactivation and net deposition of disordered extracellular matrix (fibrosis) may occur \nin chronic liver disease. Histological scoring systems for the assessment of chronic \nliver disease include the assessment of inflammation, while in acute hepatitis, liver \nbiopsy is rarely indicated. Histological scoring systems rely on identification of \nfeatures producing scores which are categorical in nature and cannot be consid -\nered truly quantitative. Serum aminotransferase values are conventionally used \nfor the routine assessment of hepatic inflammation with limitations. Conventional \nultrasound demonstrates characteristic appearances in acute and chronic hepa -\ntitis, but is unable to quantify inflammation. When considering the non-invasive \nassessment of chronic liver disease, interpretation of aminotransferase values \nis less clear and conventional imaging techniques (MRI, CT and ultrasound) are \npoor discriminators of hepatic inflammation. Liver stiffness, measured by transient \nelastography, is predominantly influenced by fibrosis, but the effect of inflammation \nmay substantially affect values, with implications for clinical practice. Predominantly \nresearch-based techniques show promise, including contrast-enhanced ultrasound, \nproton and phosphorus-31 MR spectroscopy and diffusion-weighted imaging. Serum \naminotransferase values are a useful and sensitive tool in clinical practice with well-\ndescribed limitations. Radiological-pathological correlations have demonstrated that \ninflammatory processes affect the output from a number of techniques, yet the chal-\nlenge remains to find clinically relevant and specific markers of liver inflammation. \nLearning Objectives:\n1. To review clinical, histological, and pathogenic features of liver inflammation.\n2. To review conventional techniques for detecting and qualitatively assessing \nliver inflammation.\n3. To consolidate knowledge of advanced techniques for quantifying liver \ninflammation.\n4. To be aware of current gaps in knowledge about non-invasive quantification \nof liver inflammation and learn about future directions.\nA‑386\t 14:54 \nQuantification of liver fibrosis \nB. Van Beers; Clichy/FR (bernard.van‑beers@bjn.aphp.fr) \nFibrosis is a non-specific healing process that occurs in all chronic insults of the liver. \nFibrosis staging is based on semi-quantitative histopathological scores obtained at \nliver biopsy. However, biopsy is invasive and the results are limited by sampling. \nNon-invasive assessment of liver fibrosis can be based on serum biomarkers or \nliver imaging. Composite scores of biomarkers, such as the fibrotest, have a reason-\nable accuracy for detecting liver cirrhosis but are unable to discriminate between \nintermediate stages of fibrosis. Dynamic elastography is a quantitative functional \nimaging method that measures the visco-elastic parameters of tissues by analysing \nthe propagation of transmitted mechanical waves elasticity of the liver is observed \nin liver fibrosis. Transient ultrasound elastography is increasingly used as first-line \nexamination to stage liver fibrosis. However, this method remains limited for staging \nintermediate fibrosis, and often fails in obese patients and patients with ascites. It \nhas been shown that more robust, reproducible and accurate assessment of liver \nfibrosis can be obtained with MR elastography. MR elastography holds the promise \nof complementing ultrasound elastography and serum biomarkers for quantifying \nliver fibrosis and monitoring the response to treatment. However, elastography is not \na specific method for assessing liver fibrosis because it measures liver stiffness that \nis influenced by other abnormalities including oedema, inflammation, cholestasis, \ncongestion and activation of the stellate cells. The precise role of other functional \nimaging methods, including perfusion imaging in cirrhosis and diffusion MRI in liver \nfibrosis remains to be determined. \nLearning Objectives:\n1. To review clinical, histological, and pathogenic features of liver fibrosis.\n2. To review conventional techniques for detecting and qualitatively assessing \nliver fibrosis.\n3. To consolidate knowledge of advanced techniques for quantifying liver \nfibrosis.\n4. To be aware of current gaps in knowledge about non-invasive quantification \nof liver fibrosis and learn about future directions.\n14:00 - 15:30 Room F1 \nSpecial Focus Session \nSF 13 \nQuantifying liver fat, inflammation and fibrosis: \nroutine or research? \nModerator: \nC.B. Sirlin; San Diego, CA/US \nA‑383\t 14:00 \nChairman’s introduction \nC.B. Sirlin; San Diego, CA/US (csirlin@ucsd.edu) \nLiver fat, inflammation, and fibrosis are important pathological features in patients \nwith diffuse liver disease. The clinical gold standard for assessing these features is \nliver biopsy. Due to its invasiveness and sampling variability, however, liver biopsy \nis suboptimal for screening, monitoring, and clinical research. There is, therefore, a \nneed to develop biomarkers to assess liver fat, inflammation, and fibrosis non-inva-\nsively. In recent years, many quantitative imaging techniques have been developed, \nrefined, tested, and made available. The question becomes: are these techniques \nready for routine clinical use or are they most appropriate for research? In this \nspecial focus question, we will begin with a brief overview of diffuse liver disease \nand discuss basic concepts of biomarker validation and qualification. Dr. Reeder \nthen will discuss conventional and state-of-the-art imaging-based biomarkers of liver \nfat. Dr. Cobbold will discuss the current status of non-invasive biomarkers for liver \ninflammation. Dr. Van Beers will discuss ultrasound- and MR-based biomarkers of \nliver fibrosis, with emphasis on techniques such as transient elastography and MR \nelastography that measure visco-elastic properties of liver tissue. We will conclude \nwith a panel discussion asking the question: are the repeatability, reproducibility, \nand robustness of the non-invasive biomarkers presented in this session adequate \nfor routine clinical implementation? \nSession Objectives:\n1. To review the clinical importance of diffuse liver disease.\n2. To understand that key features of diffuse liver disease include fat \naccumulation, inflammation, and fibrosis.\n3. To understand the need for non-invasive biomarkers to assess fat, \ninflammation, and fibrosis.\n4. To review basic concepts in biomarker validation and qualification.\nA‑384\t 14:10 \nQuantification of liver fat \nS.B. Reeder; Madison, WI/US (sreeder@wisc.edu) \nIntracellular deposition of fat within hepatocytes (steatosis) is a common condi -\ntion of the liver. Fat is the histological hallmark of non-alcoholic fatty liver disease \n(NAFLD) but also may occur with alcohol abuse, viral hepatitis, HIV and genetic \nlipodystrophies, and chemotherapy. NAFLD alone afflicts an estimated 20-80 million \nin the US and is a rapidly growing condition in other Western societies, paralleling \nthe expanding epidemics of obesity and diabetes type II. This talk will review the \nclinical, pathogenic and histological features of liver fat, including an overview of \nfatty liver disease and diseases where fat is an important disease feature. Next, \nit will review the current use and limitations of non-targeted biopsy in diffuse liver \ndisease, and why quantitative non-invasive biomarkers of liver fat and iron would \nbe beneficial. Currently available conventional magnetic resonance imaging tech-\nniques that attempt to detect and quantify liver fat will then be discussed, as well \nas known confounding factors that corrupt the ability of conventional methods to \nquantify fat. This lecture will then describe emerging quantitative imaging methods \nfor accurate and precise quantification of liver fat, and the advantages offered by \nthese methods address in comparison with conventional methods. Finally, remain-\ning challenges and unsolved problems for quantifying liver fat will be discussed. \nLearning Objectives:\n1. To review clinical, histological, and pathogenic features of liver fat.\n2. To review conventional techniques for detecting and qualitatively assessing \nliver fat.\n3. To consolidate knowledge of advanced techniques for quantifying liver fat.\n4. To be aware of current gaps in knowledge about quantification of liver fat \nand learn about future directions.\n\nPostgraduate.Educational.Programme\nS100\n A B C D E F G H\nLearning Objectives:\n1. To understand the advantages and limitations of BI-RADS in clinical practice.\n2. To appreciate the potential of an automated analysis of the descriptors.\n3. To trace continuous modifications required by technological advancements.\n4. To review BI-RADS categorisation with case illustrations.\nA‑389\t 15:00 \nC. MRI \nC.K. Kuhl; Aachen/DE (ckuhl@ukaachen.de) \nThe breast imaging reporting and data system (BI-RADS) for MRI has been the \nfirst effort to standardise terminology in breast MRI. The system lists a number \nof descriptors for all sorts of breast MR imaging findings. Its main feature is that \nit distinguishes between “type of enhancement”: mass-like and non-mass-like \nenhancement. This distinction is important because it marks a crossroad of dif-\nferential diagnosis: whereas the descriptors for mass-like enhancement serve to \nhelp distinguish benign and malignant solid tumours, e.g. fibroadenomas from \nbreast cancer, the descriptors for non-mass-like enhancement can be used to \ndistinguish DCIS or diffusely infiltration cancer from benign changes such as \nadenosis, hormonal stimulation, mastitis. So far, the PPV and NPV of the different \ndescriptors are not yet established, such that the current BI-RADS lexicon helps \ndescribe, but not necessarily interpret breast MR images. The lecture is meant to \nhelp fill this gap by presenting the newest revisions and amendments of the BI-\nRADS MRI lexicon, and by a systematic review of BI-RADS descriptors in benign \nand malignant breast lesions. \nLearning Objectives:\n1. To review BI-RADS descriptors for MRI.\n2. To understand the differences in the final version of BI-RADS.\n3. To review BI-RADS categorisation with case illustrations.\n14:00 - 15:30 Room G/H \nNeuro \nRC 1311 \nFocal brain lesions \nModerator: \nM. Golebiowski;  Warsaw/PL \nA‑390\t 14:00 \nA. Differential diagnosis of T2 hyperintense lesions \nA. Rovira-Cañellas; Barcelona/ES (alex.rovira@idi‑cat.org) \nConventional MRI techniques, such as T2W and gadolinium-enhanced T1W \nsequences, which are highly sensitive for detecting demyelinating plaques, are \nrecognised as the most important paraclinical tool for diagnosing multiple sclerosis \n(MS). However, the changes seen on MRI in patients with MS are not disease-\nspecific, as focal white matter T2 hyperintense lesions (THL) are also commonly \nobserved not only in the elderly but also in middle age and young patients, and in \na large list of different disorders such as hypoxic-ischaemic vasculopathies (ath-\nerosclerotic and hypertensive small vessel disease, CADASIL, Fabry’s disease \nand Susac’s syndrome), CNS vasculitis, sarcoidosis, adult forms of leucoencepha-\nlopathies, trauma and radio chemotherapy, and acquired metabolic conditions \n(hepatic encephalopathy, alcoholism), among others. While it is recognised that \na combination of findings from clinical history, physical examination and labora -\ntory tests is commonly required to correctly establish a firm and clear aetiological \ndiagnosis of THLs, a detailed analysis of different MRI features should also be \nconsidered essential, e.g. lesions shape, size, and distribution; contrast-uptake; \nand associated structural lesions (microbleeds, infarcts, spinal cord, brainstem and \ncerebellar involvement, …). In addition to these conventional MRI-based features, \nnon-conventional MR techniques (diffusion, MRS and perfusion) may also provide \nin some cases useful diagnostic information. Knowledge of these features will assist \nthe diagnostic work-up of patients presenting with THLs, and should be considered \na first step to take full advantage of the potential of MRI, and in doing so should \nresult in a reduced chance of misdiagnoses and facilitate the correct diagnosis of \nsometimes treatable disorders. \nLearning Objectives:\n1. To be aware of the limited specificity of brain multifocal T2 abnormalities.\n2. To learn about recognition patterns that might be helpful in suggesting the \nmost likely etiology of brain multifocal T2 lesions.\n3. To learn about the role of spinal cord imaging and advanced neuroimaging \ntechniques for the differential diagnosis of brain T2 hyperintense lesions.\n4. To be able to establish a neuroimaging diagnostic strategy in patients with \nmultiple brain T2 lesions of unknown origin.\nSummary of presentations 15:16\nC.B. Sirlin; San Diego, CA/US \nPanel discussion: \nRoutine or research? 15:21\nIs non-invasive image-based quantification of liver fat, inflammation, and fibrosis \nready for routine clinical use? Validation of biomarkers requires demonstration \nnot only of accuracy but also of repeatability, reproducibility, and robustness. For \nemerging technology, initial research usually focuses on accuracy but not on the \nother parameters. So the question is: are the repeatability, reproducibility, and \nrobustness of the non-invasive biomarkers presented in this session adequate for \nroutine clinical implementation? \n14:00 - 15:30 Room F2 \nBreast \nRC 1302 \nUpdate in BI-RADS \nModerator: \nG. Forrai; Budapest/HU \nA‑387\t 14:00 \nA. Mammography \nE. Aribal; Istanbul/TR (earibal@marmara.edu.tr) \nBreast imaging reporting and data system (BI-RADS) was developed by American \nCollege of Radiology in order to set standards for mammography reporting, common \nterminology and data collection. BI-RADS is being used widely for over a decade \nand many studies have assessed the validity of the system. An important compo-\nnent of BI-RADS is the lexicon which gives descriptors of specific imaging features \nthat facilitate image interpretation and unify the reports. Two main titles for these \ndescriptors are about masses and calcifications. An asymmetry is called a mass \nwhen it is seen in two projections. A mass is defined with its shape, margin and \ndensity. Definition of a mass with these three modifiers would help the radiologist to \ndetermine the type of the mass and probability of its malignancy. Calcifications are \ndivided into three categories by their shapes and another descriptor is defined for \ntheir distribution. The first category is for typically benign calcifications. The other \ntwo are for probably malign calcifications where biopsy should be suggested. The \ndistribution modifiers for calcifications can also play an important role in assessing \nthe probability of malignancy. BI-RADS defines 7 assessment categories from 0 to \n6 for the final report that facilitate data management for yearly audits. Category 3 \nis the transition zone between malignant and benign lesions where the suspicion \nfor malignancy should be less than 2% and requires short-term follow -up. BI-\nRADS morphology and distribution descriptors are effective in assessing the risk \nof malignancy with a reasonable positive predictive value. \nLearning Objectives:\n1. To review the outline of BI-RADS mammography and its updates.\n2. To review literature on the applicability of BI-RADS.\n3. To review BI-RADS categorisation with case illustrations.\nA‑388\t 14:30 \nB. US \nG. Rizzatto; Udine/IT (grizzatto@libero.it) \nThe breast imaging reporting and data system (BI-RADS®) for ultrasound (US) was \ndeveloped by the American College of Radiology (ACR) and published in 2003. \nAlthough this lexicon was created to achieve a consensus among radiologists when \ndescribing breast abnormalities, clinical practice shows substantial intraobserver \nagreement but only moderate interobserver agreement. Most problems are reported \nfor descriptors related to shape (when trying to classify abnormalities containing \nlobulations and/or elliptical with not-parallel orientation), echo pattern and margin. \nEspecially mass margin is a critical feature for determining whether a lesion should \nbe biopsied or not. Other problems are related to the final assessment, including \ndifficulties in applying the subcategories and the relatively high percentage of \nfalse negative cases for lesions interpreted as category 3. Many computer-aided \ndiagnosis software have shown the potential to improve performance amongst less \nexperienced readers and decrease interobserver variability; still they do not solve \nall the problems. The BI-RADS® lexicon is actually under advanced revision by an \ninternational panel and Ellen B. Mendelson chairs the US subcommittee. Revision \nis reviewing both descriptors and categories; it will include also new parameters \nlinked to the evolution of US technology as colour flow mapping and elastography. \n\nSunday\nPostgraduate.Educational.Programme\nA\n S101\nCB D E F G H\ntroubles. Characterisation of AML is possible, based on identification of its fatty \ncontent mainly using CT. When microscopic, this component may be missed and \nbiopsy is required with immunostaining. MR imaging may be helpful using chemical-\nshift sequences but thresholds, to rule-out clear cell carcinoma, have to be better \ndefined. Presence of necrosis or calcifications rules-out diagnosis of AML. AMLs \nmust be treated if haemorrhagic, painful or if diameter exceeds 4cm. Embolisa -\ntion is the main nonsurgical method, using microparticles, alcohol and/or coils but \npostembolisation syndrome must be prevented. Volume regression may require \nall agents whereas aneurysm occlusion requires coiling. The effect on volume \nand on haemorrhagic risk is substantial making surgery as an alternative method \nfor nephron sparing purposes. Secondary surgery is required in less than 10% of \nembolisation. RF ablation is also possible but its efficacy is still under evaluation. \nLearning Objectives:\n1. To learn the high frequency of angiomyolipoma, and the possibility of \ncomplication.\n2. To review the imaging appearance of typical and atypical angiomyolipoma.\n3. To understand the higher incidence of angiomyolipoma in certain \nphakomatoses.\n4. To learn about the possibilities of intervention and to discuss the indications \nand results.\nA‑394\t 14:30 \nB. The (not so) rare malignant tumours of the kidney \nP. Hallscheidt; Heidelberg/DE (Peter.Hallscheidt@med.uni‑heidelberg.de) \nToday, an increasing number of renal cell carcinomas is detected in a very early \nstage. These incidentally detected carcinomas must be differentiated from benign \ntumour. The role of the radiologist is to differentiate renal lesions and to diagnose \nmalign tumours in adults and children. With the individual therapy for each tumour \nand patient, a better knowledge of different gradings and entities is demanded. \nModern imaging modalities such as CT and MRI have the capability to differenti-\nate renal tumours because of different attributes. Besides the benign tumours, the \nmalign tumours such as renal cell carcinoma, complex cysts, metastasis of other \nmalignomas and lymphomas of the kidneys have to be differentiated. Whereas CT \nremains the standard tool for staging RCC, the differentiation of different tumours \nis a field increasingly pre-operatively worked up by MRI with dynamic and diffusion \nimaging. The most common and not so common renal tumours are demonstrated \nand typical findings are discussed. \nLearning Objectives:\n1. To know the rare malignant tumours of the kidney: Bellini duct carcinoma, \nchromophobe renal cell carcinoma, lymphoma, sarcoma, renal medullary \ncarcinoma and metastases.\n2. To learn capabilities and limitations of MRI and CT.\nA‑395\t 15:00 \nC. Radiofrequency and cryotherapy of renal tumours: techniques, results \nand complications \nJ.-M. Correas; Paris/FR (jean‑michel.correas@nck.aphp.fr) \nThe number of small renal tumours is increasing due to the large amount of imag-\ning examinations of the kidneys performed with various modalities and the true \nincreasing incidence of renal cancer. Conservative therapy of small renal tumours \nis now widely recognised as the reference technique for the treatment of these \nsmall lesions. The increasing rate of chronic renal failure in the elderly and the \nefficacy of conservative therapy to treat cancer as demonstrated by the urolo -\ngists performing partial nephrectomy and tumourectomy emphasise the role of \npercutanaeous minimally invasive ablative procedures, particularly in patients with \nsurgical contraindications. Radiofrequency ablation and cryotherapy are the two \nmost developed techniques, but new technical approaches are under development \nsuch as microwave ablation, electroporation, etc. The evaluation of the success \nof the procedure relies on imaging techniques showing the lack of enhancement \nwithin the lesion and the size and shape of the necrotic covering the entire tumour \narea. The techniques, indications, results, and complications of both radiofrequency \nablation and cryotherapy will be discussed. \nLearning Objectives:\n1. To learn the technique and results of radiofrequency ablation of renal \ntumours.\n2. To learn principles, indications and results of cryotherapy, microwave \nablation and high-intensity focused US (HIFU).\nA‑391\t 14:30 \nB. Neoplasm or non-neoplasm \nZ. Rumboldt; Charleston, SC/US (rumbolz@musc.edu) \nA variety of diseases including neoplasms, but also infectious, inflammatory, \nvascular and traumatic processes, may present as focal intracranial mass le -\nsions. Modern neuroimaging, primarily with MRI, enables differentiation of these \nentities allowing for accurate diagnosis in almost all cases. The requirements are \nappropriate image acquisition and detailed analysis of imaging findings, while \npertinent clinical information may be very helpful in certain cases. The distinction \nis frequently broad, between different disease processes, such as with tumefac-\ntive demyelination versus neoplasm, which is often sufficient for clinical decision \nmaking and patient management; at times this may be more specific, approaching \nhistological diagnosis, such as with pilocytic astrocytoma versus medulloblastoma. \nThis presentation will go briefly over the imaging techniques and various disease \nprocesses, while heavily concentrating on the differentiating features of intra-\naxial primarily non-haemorrhagic mass lesions. The emphasis will be on the key \ndistinguishing imaging features, such as presence or absence of mass effect or \nvasogenic oedema, signal intensity characteristics, presence and pattern of con-\ntrast enhancement, as well as diffusion and perfusion features. Decision making \nprocess will be discussed. A number of cases with intracranial masses will then \nbe reviewed and analysed, using a step by step approach, accentuating the most \nreliable distinguishing findings. \nLearning Objectives:\n1. To list various pathologic processes that present as focal brain masses.\n2. To define the differentiating imaging and clinical features of those processes.\n3. To recapitulate the role of imaging techniques for differentiation of brain \nmass lesions.\nA‑392\t 15:00 \nC. Adult glioma: advanced neuroimaging for treatment planning \nC. Calli; Izmir/TR (cem.calli@gmail.com) \nThe role of MR imaging in adult gliomas consists of many steps. (1) Is there a \nlesion in the brain? (2) Is the lesion a tumour? (3) Is the tumour a glioma? (4) Is \nit a high- or low-grade glioma? (5) If there is a suspicion and a biopsy is planned, \nwhich part of the tumour should be targeted at biopsy. (6) How the surgery should \nbe performed to avoid injury to functional areas of the brain (e.g. motor cortex). (7) \nIf there is need for adjunctive radiotherapy, how the extent of the tumour should \nbe defined? (8) After radiotherapy, if a new enhancing lesion occurs, is it a recur-\nrent neoplasm or radiation necrosis? Conventional anatomical MR imaging is not \nalways powerful enough to answer these questions. However, with advanced MR \nimaging techniques such as diffusion MR (including tractography), perfusion MR, \nMR spectroscopy and functional MRI (fMRI) we can answer the above questions \nreliably in most cases. \nLearning Objectives:\n1. To recognise different treatment protocols for different types of adult gliomas.\n2. To get an overview of the advanced neuroimaging techniques that may aid \nin the pre-operative characterisation of adult gliomas.\n3. To discuss the roles of various advanced neuroimaging techniques for \nglioma treatment planning.\n14:00 - 15:30 Room I/K \nGenitourinary \nRC 1307 \nKidney: imaging and intervention \nModerator: \nM.N. Özmen; Ankara/TR \nA‑393\t 14:00 \nA. Angiomyolipoma: a review \nN. Grenier; Bordeaux/FR (nicolas.grenier@chu‑bordeaux.fr) \nAngiomyolipomas (AML) are benign tumours derived from the perivascular epi-\nthelioid cell (PEC) characterised at pathological examination by the expression \nthe of melanocytic marker HBM-45. They contain various proportions of the three \ncomponents: vascular, fatty and muscular. An epithelioid variant with a malignant \npotential is exceptional. 80% are sporadic and 20% integrated to tuberous sclerosis. \nThe association with a lymphangioleiomyomatosis is always possible: chest CT \nwill be performed in TS and sporadic AML if large or associated with respiratory \n\nPostgraduate.Educational.Programme\nS102\n A B C D E F G H\nLearning Objectives:\n1. To understand the necessity of imaging in the delivery of external \nradiotherapy.\n2. To be familiar with the technology of image-guided radiation therapy (IGRT).\n3. To gain knowledge about the implementation of 3D IGRT.\nA‑398\t 15:00 \nC. Bridges between radiotherapy and radiography from a European \nperspective \nK. Sjövall; Lund/SE (Katarina.sjovall@skane.se) \nRadiotherapy is an area with a rapidly improving development of new techniques \nand improved possibilities for accuracy. This lecture aims to illustrate and discuss \npoints of contact and the need for collaboration between radiotherapy and radi-\nography. European educational programmes and working fields for radiotherapy \nnurses and radiotherapy technicians are compared. Radiotherapy nurses and \nradiotherapy technicians are responsible for the administration of radiotherapy \nto cancer patients and for the clinical care related to the treatment. Apart from \nprevention and treatment of side effects and psychosocial support during the treat-\nment, it encompasses preparations, delivery and verification of the radiation dose. \nEducational programmes differ in terms of academical level and target groups, \nwhether it is nurses or technicians in radiology or radiotherapy exclusively. Areas \nin the radiotherapy process where competences from radiography are needed \nare discussed, considering both technical development and research progresses. \nLearning Objectives:\n1. To gain knowledge about the differences and similarities between the \nareas of education and profession in radiography and radiotherapy from a \nhistorical perspective.\n2. To gain knowledge about national differences and similarities from a \nEuropean perspective.\n3. To consolidate knowledge about what competences are needed in the area \nof radiotherapy, and to define common ground with radiography.\n4. To consolidate knowledge about present and future needs of research and \ndevelopment in radiotherapy, how radiotherapy can apply competences from \nradiography.\n14:00 - 15:30 Room N/O \nJoint Course of ESR and RSNA \n(Radiological Society of North America) \nMC 1325 \nEssentials in oncologic imaging: \nwhat radiologists need to know (part 3)\nModerator:\nH.‑U. Kauczor; Heidelberg/DE  \nA‑399\t 14:00 \nA. Oncologic imaging: terminology, definitions and buzzwords \nY. Menu; Paris/FR \nLearning Objectives:\n1. To get an overview and precise explanation of current cancer-related \nterminology, definitions and \"buzz\" words used in everyday practice.\n2. To understand why and how this terminology should ensure and simplify \ncommunication with all specialists involved in cancer management, including \nclinicians, researchers as well as other radiologists.\n3. To learn common tricks and traps in providing a radiology report, illustrated \nwith clinical cases.\nA‑400\t 14:20 \nB. Liver cancers (primary, metastases) \nR.L. Baron; Chicago, IL/US \nLearning Objectives:\n1. To get an overview of the AASLD/EASL imaging criteria for noninvasive \ndiagnosis of hepatocellular carcinoma.\n2. To learn about best practice CT/MR/US imaging techniques that optimise \ncharacterisation, detection and staging of primary and metastatic liver \ntumours.\n3. To understand the key role specific findings reported by radiologists have in \ndetermining patient treatment options for hepatocellular carcinoma.\n14:00 - 15:30 Room L/M \nRadiographers \nRC 1314 \nRadiotherapy and integration with a diagnostic-\ntherapeutic path \nModerators: \nS. Geers‑van Gemeren;  Utrecht/NL \nC. Hohl; Siegburg/DE \nA‑396\t 14:00 \nA. Electronic portal imaging used for the development and improvements \nin radiation therapy for prostate cancer \nA. Thorolfsdottir, A. Einarsdóttir, G. Mýrdal; Reykjavik/IS (agnest@landspitali.is) \nThe purpose is to gain numerical information of accuracy in the treatment of localised \nprostate cancer and calculate the necessary size of the safety margin around the clini-\ncal target volume (CTV-PTV). In addition, the purpose was to evaluate the accuracy \nin treatment set up with patients with high BMI to find out whether patients with high \nBMI need a larger safety margin. Portal imaging was used to measure off-line random \nset-up error from bony structure. The sample size was 40, i.e. all the patients who \nreceived radiation treatment for localised prostate cancer in Landspítali - University \nHospital (LSH) 2006. A total of 3032 portal images were acquired. In 2010, the task \nwas repeated for 38 patients having gold fiducial markers in the prostate. The calcu-\nlated 3-D IMRT safety margins in LSH 2006 was to be 15.8 mm. Correlation is with \nhigh BMI and set-up errors in medio lateralis (M-L) direction (r=0.21). This indicates \nthat a patient with an increased pelvic circumference has a tendency to have more \nset-up errors. Reformed procedural workflow resulted in more acceptable calculated \nmargins in 2010. When corrected on line 3 times per week the margin is to be 7.2 mm \nand 3.0 mm if corrected 5 times per week. In conclusion, for delivery of 76-78 Gy \nto the prostate with IMRT and spare surrounding healthy tissue effort is needed to \nsecure the accuracy in the overall procedure of treatment planning and delivery. \nLearning Objectives:\n1. To gain knowledge on how to improve the target accuracy in treating \nprostate cancer with radiation therapy using Electronic Portal Imaging.\n2. To understand the importance of gaining numerical information of accuracy \nin the treatment of clinically localised prostate cancer and how to use the \ninformation to calculate the necessary size of the safety margin around the \nclinical target volume.\n3. To become familiar with the preparation needed before starting treatment \nwith IMRT and be aware that there is a need to look at all the treatment \nelements including the technical side, quality, education, staff and patients.\n4. To consolidate knowledge of radiation therapy for prostate cancer and the \nmeaning of giving high dose to the target while minimising radiation dose to \nhealthy tissue.\nA‑397\t 14:30 \nB. Image-guided radiation therapy: when imaging meets therapy \nA. Sarchosoglou; Athens/GR (anastasia71@hotmail.com) \nThe aim of this presentation is: to understand the necessity of imaging in the delivery \nof external radiotherapy; to be familiar with the technology of image-guided radiation \ntherapy and to to gain knowledge about the implementation of 3D IGRT. The aim of \nradiotherapy is to deliver high dose to target volume while minimising the dose to \nsurrounding healthy tissues. However, during treatment delivery many uncertainties \nmay arise that can result in higher toxicity and poor local control. Thus, it is crucial to \nmonitor and adjust if necessary, the actual treatment. Image-guided radiation therapy \nis the process where images are taken immediately prior or during a course of radia-\ntion treatment, to assess and improve the accuracy of therapy. Manufactures have \ndeveloped a number of systems to perform IGRT providing the options of ionising \nradiation images/non-ionising imaging technology and gantry mounted/room mounted \nequipment. 3D IGRT can be performed by acquiring computed tomography images on \nthe treatment unit. These images are matched with reference images from planning \nCT and potential discrepancies are recognised, calculated and corrected by couch \nshifts giving optimal results. Such advanced technologies require quality assurance \nsystems to be in place and high trained personnel. When properly implemented, \nIGRT meets the aim of radiation therapy. Imaging provides confidence to radiation \ntherapy to be aggressive, to fight cancer. Imaging promises radiation therapy a great \nfuture with improvements in clinical outcomes and patient survival! \n\nSunday\nPostgraduate.Educational.Programme\nA\n S103\nCB D E F G H\nA‑404\t 15:00 \nC. Hospital perspective on clinical audit \nP. Gilligan; Dublin/IE (PGilligan@materprivate.ie) \nThe demand from the public for greater accountability and standards has increased \nthe importance of audit and accreditation in modern healthcare delivery. Specifically \nradiology departments participate in audit and accreditation by a number of enti-\nties. These include: 1. National bodies concerned with improving radiation safety \nparticularly originating from EU 97/43 directives. 2. Hospital wide accreditation \nsurveys from state and private accrediting organisations. 3. Auditing of standards \nfrom within professional bodies. 4. Following from investigation of specific inci-\ndents such as misdiagnosis or radiation concerns. 5. Modality-specific standards. \nAlthough the specific requirements of the accrediting or auditing body may differ, \nthe processes and practical aspects in demonstrating compliance with standards \nand quality improvement are generally similar. Mechanisms such as outcomes, \nquality cycles, and performance indicators are critical in the success of any ac-\ncreditation or audit program. In addition to fulfilling basic regulatory requirements, \nthe medical physicist is playing an increasing role in developing performance indices \nparticularly in radiation safety, clinical image quality and equipment management. \nThe increasing role of the medical physicist in audit underpins the requirement for \ninclusion of audit and accreditation as part of their education. Recent experience \nof setting up and participating in EU 97/43 directive-based clinical audit in Ireland \nhighlighted the critical need for clarity of roles and ownerships of processes to be \ncommunicated to those who are carrying out audit and those who are being audited \nin hospitals and dental practices. \nLearning Objectives:\n1. To understand practical aspects of complying with standards and undergoing \naudit.\n2. To understand the outcomes of the audit.\n3. To understand how to implement the results of the clinical audit.\n14:00 - 15:30 Room Q \nPaediatric \nRC 1312 \nSafety first \nModerator: \nR. Fotter; Graz/AT \nA‑405\t 14:00 \nA. Security and dose with conventional radiology \nJ.-F. Chateil; Bordeaux/FR (jean‑francois.chateil@chu‑bordeaux.fr) \nPerforming imaging studies in a child requires basic knowledge. The first point is \nto reassure and to avoid stressful/painful procedure. Training of radiographer and \nradiologist is fundamental. Explanations, presence of a parent (if not pregnant…), \nare preferable. Specific devices may be useful for immobilisation and to avoid \nrepeated exposures. Antalgic drugs (traumatic circumstances) or sedative nitrous \noxide inhalation (MCUG) may be useful. X-rays exposition in relation with conven-\ntional radiology is lower than the one encountered with CT. But dose depends on \ntype of examination and also on imaging equipment. New devices, such digital \nfluoroscopy with x-rays pulsed emission, flat-panel detector, slot-scanning x-ray \nimager need less ionising radiation than conventional screen-films devices or even \nphotostimulable phosphor imaging plates. The scale between the higher and the \nlower dose for the same examination can be from ten to one. Common principles \nof protection that apply to all x-ray imaging procedures, known as ALARA concept \n(as low as reasonably achievable), have to be used daily. Act in accordance of the \nmedical justification of the examination, without any non-ionising alternative method, \nremains the first step. The second one is the optimisation of each procedure, the \nlimitation of expositions, with control of the x-ray beam adjusted to optimise the \ncritical balance between image quality and exposure to the child. Measure of the \ndose is mandatory to demonstrate appropriate levels on child exposure and to \nbe sure in the future that very low radiation doses received during conventional \nimaging procedures will not produce adverse effects. \nLearning Objectives:\n1. To learn about management of children in the radiology unit.\n2. To understand how technology affects dose delivery.\n3. To recognise the necessity for the application of the ALARA principles in \npaediatric radiology.\nA‑401\t 14:55 \nC. Prostate cancer \nJ.O. Barentsz; Nijmegen/NL \nLearning Objectives:\n1. To learn the key clinical indications for MR imaging in prostate cancer.\n2. To get an overview of essential MR imaging techniques in detection, \ncharacterisation, localisation and staging of prostate cancer.\n3. To understand how MR imaging influences therapeutic decisions and how \nbest to provide a value added MR report.\nQuestions 15:20 \n14:00 - 15:30 Room P \nPhysics in Radiology \nRC 1313 \nClinical audit, accreditation and the role of the \nmedical physicist \nModerators: \nW.J.M. van der Putten; Galway/IE \nM. Wucherer; Nürnberg/DE \nA‑402\t 14:00 \nA. European-wide perspective on clinical audit \nH. Jarvinen; Helsinki/FI (hannu.jarvinen@stuk.fi) \nThe Council Directive 97/43/EURATOM introduced the concept of clinical audit \nto medical radiological (diagnostic radiology, nuclear medicine and radiotherapy) \nprocedures. Clinical audit is a systematic review of the procedures in order to \nimprove the quality and the outcome of patient care. According to the directive, \nclinical audits shall be implemented in accordance with national procedures. The \nreview of its implementation in Europe has revealed a high variation of approaches \nand many practical problems. Therefore, the European Commission has published \nfurther guidelines on clinical audits in its report Radiation Protection No. 159 (2009). \nThe purpose is to improve the implementation of clinical audits and to enable the \nMember States to adopt the model of clinical audit with respect to their national \nlegislation and administrative provisions. The guideline points out the importance \nof both internal and external assessments for clinical audit. It deals with all types \nand levels of clinical audit and gives practical guidance for application. It defines \nthe list of topics which should be covered, while the actual criteria of good practice \nare discussed on generic levels only. The borderline between clinical audit and \nother quality assessments (accreditations, certifications, peer reviews) and regula-\ntory inspections is also discussed. The guideline is addressed to all professional \ngroups, hospital management, auditing organisations and regulatory bodies. It is \nimportant to recognise that the guideline is not a legal requirement. This refresher \ncourse lecture will give a summary of the EC guidelines and discuss briefly the \nimplementation of clinical audits in Europe. \nLearning Objectives:\n1. To understand the purpose and essential contents of the European \ncommission guideline on clinical audit.\n2. To learn about a review of clinical audits in Europe.\nA‑403\t 14:30 \nB. National perspective: clinical audit inspections \nS. Ebdon-Jackson; Didcot/UK (steve.ebdon‑jackson@hpa.org.uk) \nEuropean Council Directive 97/43/Euratom requires under Article 6 (4) that “clinical \naudits are carried out in accordance with national procedures”. Implementation \nof this requirement across Europe has been varied. This paper will reflect on the \nexperience in the UK and will consider examples of the various initiatives under -\ntaken in the UK by professional bodies and organisations. This will be contrasted \nwith the role of the regulator and the aims of the inspection process with regard to \ncompliance with the specific regulation addressing clinical audit and the remaining \nregulations addressing justification, optimisation, etc. Examples will be provided \nof the type of audits undertaken within UK hospitals. A UK perspective of EC and \nIAEA initiatives in clinical audit will be provided. \nLearning Objectives:\n1. To understand the approach taken by a national body towards performing \nclinical audit.\n2. To understand practical aspects of clinical audit inspections.\n3. To understand the lessons learned from inspection and suggestions for \nimprovement.\n\nPostgraduate.Educational.Programme\nS104\n A B C D E F G H\n16:00 - 17:30 Room A \nAbdominal and Gastrointestinal \nRC 1401 \nCT colonography: the big picture \nModerator: \nS.A. Taylor; London/UK \nA‑408\t 16:00 \nA. Optimised techniques for best results \nD. Regge; Turin/IT (daniele.regge@ircc.it) \nMulticentre trials have shown that CT colonography is ready for widespread clinical \nuse. However, these studies have also highlighted the inconsistent performances \nof CT colonography, with divergent results being recorded in different centres and \nbetween readers. Inter-observer and inter-centre variability may be related to reader \nexperience but it is also affected by how CT colonography is performed. While faecal \ntagging has been accepted universally as the proper way to prepare patients for CT \ncolonography, there is no consensus on which tagging agent is better, on the timing \nof contrast agent administration and on whether laxatives should be administered \nand in what dosage. In a similar way it is not yet clear which is the best way to \nobtain colon distension, whether by administering spasmolytic agents routinely or \nby changing patient’s decubitus. Standardising bowel preparation and technique \nis one of the most important goals that need to be achieved for CT colonography \nto be universally accepted and this presentation will attempt to deal with the issue \nusing an evidence-based approach. \nLearning Objectives:\n1. To review bowel preparation techniques for CT colonography.\n2. To learn about the possible options in terms of technique used (method of \ncolonic distention, use of spasmolytic agents, use of IV contrast material, \ndual positioning etc).\n3. To learn about optimal data acquisition parameters for CT colonography.\n4. To become familiar with published results with emphasis on techniques \nused.\nA‑409\t 16:30 \nB. Guide to interpretation and generating a useful report \nT. Mang; Vienna/AT (thomas.mang@meduniwien.ac.at) \nThe evaluation of CT colonography (CTC) studies is based on detection, interpre-\ntation and reporting of colonic findings. It is performed on a computer workstation \nequipped with dedicated CTC software by a primary 2D or a primary 3D approach. \nIn either case, the alternative viewing technique must be available for rapid correla-\ntion and characterisation of suspicious findings. Primary 2D evaluation is based on \n“lumen tracking” by interactively scrolling through the axial slices and multiplanar \nreformatted images, focusing only on the air-distended colonic lumen from one end \nto the other one. Primary 2D evaluation provides information about the attenuation \nof findings during the search process and is time-efficient. Primary 3D evaluation \nis based on 3D virtual endoscopy in an antegrade and retrograde fashion and in-\ncreases both, the conspicuity, especially of small and medium-sized polyps, and the \nduration of visualisation. The use of advanced 3D displays like virtual dissection or \nunfolding techniques may reduce the interpretation time for primary 3D evaluation. \nComputer-aided detection (CAD) algorithms used as a 2nd reader were shown to \nreduce the number of perceptual errors by pointing out possible abnormalities that \nmight otherwise be missed. Colonic findings are characterised by their morphology, \ntheir attenuation characteristics, and by their mobility. Knowledge of CTC imaging \nfeatures of common colonic lesions and artefacts is necessary for characterisation \nof findings and differentiation between definite colonic lesions and pseudo-lesions. \nStandardisation of CTC reporting facilitates classification and communication of \nfindings and the comparison with previous studies, thereby better assisting physi-\ncians in making appropriate management decisions. \nLearning Objectives:\n1. To understand what the radiologist needs to know to accurately interpret CT \ncolonography examinations.\n2. To recognise the relative merits of different interpretation techniques.\n3. To learn about a standardised method for generating a CT colonography \nreport.\n4. To briefly summarise the current status of CAD and its potential use in CT \ncolonography.\nA‑406\t 14:30 \nB. CT in children: dose reduction strategies \nR.A.J. Nievelstein; Utrecht/NL (R.A.J.Nievelstein@umcutrecht.nl) \nThe revolutionary development in multidetector CT (MDCT) technology during the \npast decade has contributed to a substantial increase in its diagnostic applications \nand accuracy in children. A major drawback of MDCT is the use of ionising radiation \nwith the risks of radiation-induced side effects, of which the induction of secondary \ncancer is the most important. Therefore, justification and optimisation of paediatric \nMDCT is of great importance in order to reduce these risks as much as possible \n(‚as low as reasonably achievable‘ principle). Optimisation of paediatric MDCT \nstarts with a solid understanding of all technical aspects of CT, including the most \nrelevant scan parameters, dose reduction techniques and technique of IV contrast \nmaterial administration. Furthermore, due to the smaller size and lack of visceral fat \nin young children the interaction and absorption of radiation will be different which \nwill influence the choice of the various technique and scan parameters. Although all \nthese issues are pivotal for a successful CT examination, it may become worthless \nif the importance of pre-scan issues such as justification and patient preparation \nare ignored. After a short overview concerning the current knowledge on radiation-\nrelated risks in children, this lecture will focus on several aspects relevant for MDCT \noptimisation in children. Issues such as justification, patient preparation, technique \nand scan parameters will be addressed. Finally, some guidelines for radiation dose \nlevel-based CT protocols will be given. \nLearning Objectives:\n1. To get an overview of current knowledge on radiation risks in children.\n2. To understand the CT scan and technique parameters that influence \nradiation dose.\n3. To learn about dose reduction strategies in order to optimise CT in children.\nA‑407\t 15:00 \nC. Ensuring safety for infants undergoing MRI \nT.G. Maris; Iraklion/GR (tmaris@med.uoc.gr) \nThe purpose is to present an overview of the safety hazards and safety protocols \nrelated to infants undergoing MRI examinations. MRI infrastructure-dependent \nsafety hazards originating from: (a) static and fringe magnetic fields, (b) gradient \nsubsystems, (c) radiofrequency subsystems and (d) acoustic noise sound pressure \nwill be reviewed and discussed. Safety hazards related to upcoming technological \nissues and future trends concerning MRI will be presented. The current status of \nthe organisations responsible to the problems of MR safety will be reviewed. Which \nauthority is responsible and where the responsibility is addressed to (Directives, \nLegislation policies, etc). An optimised protocol related to a variety of clinical MR \nsequences in reference to temperature measurements, EMF measurements, SAR \nand acoustic noise figures using basic commercially available infrastructure will be \npresented. 2D/3D TSE sequences with different ETL’s, 2D/3D GRE, 2D/3D SSFP \nand SE/GRE EPI sequences with multi-(b) diffusion gradients and 3D TOF MR \nangiography sequences will be examined. In vitro measurements of SNR, spatial \nresolution and scan times will be performed for each clinical MR sequence. A com-\nprehensive MRI equipment operational policy (optima: (ETL, TR, TE, b-value, EPI \nfactor etc).) for a safety protocol for infants undergoing MRI is proposed. Recom-\nmendations for safe infant MRI examinations will be summarised and presented. \nConclusion: MRI equipment can operate safely for infant imaging but require policies \nand procedures beyond those required for standard diagnostic MRI examinations. \nLearning Objectives:\n1. To get an overview of the three basic safety hazards related to infants \nundergoing MRI examinations.\n2. To become familiar with safety hazards related to upcoming technological \nissues and future trends.\n3. To learn about a safety protocol that could be applied in MRI examinations \nfor infants.\n\nSunday\nPostgraduate.Educational.Programme\nA\n S105\nCB D E F G H\nperfusion imaging. New possibilities arise in MRI almost every day. Imaging algorithms \nare to provide the correct diagnosis in the shortest time with the lowest expenses and \nharm to the patient. MRI is the first method of choice in neurological diseases with two \nexceptions: acute stroke and acute trauma, CT providing the necessary information, \nmore available and with easier patient care. Adequate imaging protocols optimally \nvisualise the anatomical region of interest and pathological processes, optimise the \ncomparison between serial examinations and provide the information in reasonable \nexamination time. Appropriate and well understood clinical information is indispensable \n(neuroradiology means good clinical knowledge combined with expertise in imaging \nmethods and their evaluation). Complicated protocols are superfluous without com-\npetent clinical background but adequate information must be provided to experienced \nclinicians. Basic protocols help to gather important information but do not exclude \nadditional necessary methods. Examples to be demonstrated are MRI protocol for the \npituitary, epilepsy, multiple sclerosis and spine. The up-to-date concepts of image evalu-\nation and interpretation will be demonstrated for brain CT, brain MRI and spinal MRI, \nincluding the importance of follow-up. The body and conclusion part of the structured \nneuroradiological report will be discussed. Consultation with other neuroradiologists and \nwith clinicians is the final tool to reach the goal: to help in recovering the patients’ health. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof patients with a focal neurological disorders.\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\nA‑413\t 17:00 \nC. Interactive case discussion \nG. Krumina; Riga/LV (gaida.krumina@apollo.lv) \nTen authentic and original typical clinical cases illustrating the importance of im-\naging modalities in the differential diagnosis of focal neurological symptoms from \nheadache to epilepsy will be presented while respecting the privacy of the patient. \nThe spectrum of pathologies includes vascular, inflammation, metabolic, degen -\nerative diseases, congenital malformations and neoplasms of the central nervous \nsystem. Each case story will be described shortly in a standard form followed by \ndemonstration of typical CT and/or MRI images. In some cases, conventional \nMRI will be supplemented by multi-voxel MR spectroscopy, DTI, MR tractography \nimages, and morphological pictures. Follow -up images will be presented where \nappropriate. Several diagnostic options will be offered for attendants. The audience \nwill be asked to participate in the diagnostic process by the use of voting pads. \nAfter highlighting of final diagnosis the basic differential diagnostic considerations \nwill be briefly summarised and emphasised from the clinical and imaging point of \nview for each presented case. \nLearning Objectives:\n1. To introduce typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of focal neurological symptoms.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n16:00 - 17:30 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 1416 \nSoft tissue extremity masses \nModerator: \nA.R. Mester; Budapest/HU \nA‑414\t 16:00 \nA. How I do it \nJ.C. Vilanova; Girona/ES (kvilanova@comg.cat) \nDiagnostic quality MRI of soft tissue masses can be performed using a variety of \nmagnetic equipments and a variety of field strengths. Regardless of system design, \nefforts should be made to maximise signal-to-noise ratios (SNR) using the most \nappropriate coil to include the lesion and associated oedema. FOV should be \ntailored to the size of the patient and the size of the mass. It is important to obtain \nimages in at least two planes through the lesion. Slice thickness vary depending \non the size of the lesion and interslice should be not more than one-half of the slice \nwidth. Imaging matrix should be balanced to in-plane spatial resolution. Parallel \nA‑410\t 17:00 \nC. Dose, risk and relevance in a screening population \nA. Graser; Munich/DE (Anno.Graser@med.uni‑muenchen.de) \nWhile CTC has achieved excellent results in average risk individuals with regard to \ndetection of clinically relevant polyps, it has not yet been implemented on a large \nscale in colorectal cancer (CRC) screening programmes. This is mainly due to the \nfact that it uses ionising radiation. There is uncertainty about adequate screening \nstrategies and the risk of radiation-induced malignancy. This presentation will sum-\nmarise recent results of CTC in a screening setting, will look at the dose associated \nwith CTC, and summarise calculations of radiation-associated risk of malignancy. \nThe key question is whether low doses from CTC will cause relevant negative \neffects in the screening population. The lecture will also feature a comparison \nbetween CT and MR colonography, an imaging test that might be able to provide \nhigh sensitivity CRC screening without ionising radiation. \nLearning Objectives:\n1. To understand the radiation dose imparted to patients undergoing CT \ncolonography.\n2. To understand the use of dose reducing techniques and their effect on \ndiagnostic performance.\n3. To consider the risk of radiation-induced malignancy versus potential benefits of \nCT colonography in the context of population screening for colorectal cancer.\n16:00 - 17:30 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 1418 \nFocal neurological disorders \nModerator: \nM. Sasiadek; Wroclaw/PL \nA‑411\t 16:00 \nA. Clinical considerations \nD. Balériaux; Brussels/BE (dbaleri@ulb.ac.be) \nFrom headache to epilepsy… or from “normal”, physiological “headache” to life \nthreatening pathological conditions. When do we need “neuroimaging” and what \nis the optimal diagnostic work-up? The radiologist must and should remain first of \nall a Medical Doctor: he/she should keep close contact with the clinical world and \nalways keep an active dialogue with the referring clinician. Indeed, medical Imaging \nhas become more and more sophisticated but also more expensive. Imaging is \nnot a “screening procedure” in brain pathology but should be performed in order to \nconfirm a clinical, suspected diagnosis keeping still in mind that differential diagnosis \nmust be considered as well. Imaging plays also a unique role in lesion evaluation \nand treatment monitoring. The radiologist must answer precise questions about the \npatient’s suspected pathological condition and if necessary, discuss the Imaging \nfindings with the clinician in order to narrow the differential diagnosis. Each MRI \nor CT must be performed with a clear knowledge of the clinical question and the \nsuspected pathology. Therefore, the radiologist will make the proper choices of \nimaging techniques especially with MRI where imaging sequences have become \nnumerous. Headaches and seizures are symptoms only and may be present \nin multiple and very diverse pathological conditions as infectious, neoplastic, \nhaemorrhagic, vascular diseases: by knowing the clinical history a good “clinically \nconscious” radiologist will undoubtedly be of greater “added value”! \nLearning Objectives:\n1. To learn more about the clinical conditions causing focal neurological \nsymptoms.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑412\t 16:30 \nB. Imaging techniques and typical findings \nP. Barsi; Budapest/HU (barsipeterdr@gmail.com) \nNeuroradiology has a continuously changing and developing array of modalities. Con-\nventional radiography has lost its importance. Angiographic practice has shifted from \ndiagnostics to therapy. MS-MD CT scanners provide high-quality CT angiography and \n\nPostgraduate.Educational.Programme\nS106\n A B C D E F G H\n16:00 - 17:30 Room D2 \nInterventional Radiology \nRC 1409 \nOncologic interventions in the liver \nModerator: \nM. Glynos; Athens/GR \nA‑417\t 16:00 \nA. RF ablation \nF. Deschamps; Villejuif/FR (Frederic.Deschamps@igr.fr) \nPercutaneous radiofrequency ablation (RFA) is a safe and effective treatment \nfor well selected patient with hepatic tumours such as hepatocellular carcinoma \n(HCC) and liver colorectal metastases (LCM). An appropriate selection is crucial. \nIt is based on clinical and technical arguments. Clinically, surgical resection of the \nhaepatic tumours remains the gold standard. Indeed, survival data following RFA \nare not as good as surgical resection. The only exception seems to be the RFA of \nthe very early HCC (≤3.0 cm) in cirrhosis that is not candidate for liver transplanta-\ntion. Most often, the RFA offers an alternative for patients with medical comorbidi-\nties, poor liver function or prior hepatectomy. Technically, there are three decisive \npoints for complete ablation. The first point is the good visualisation of the tumour \neither under ultrasound or un-enhanced computed-tomography (CT) examination. \nMetallic coil placement, lipiodol tattoo and virtual CT sonography with magnetic \nnavigation are technical tricks that allow the RF ablation of \"invisible\" tumour. The \nsecond point is the tumour size: in most series, a diameter less than 25-35 mm is \ncommonly admitted as a prognostic factor. This is probably because the maximal \nablation diameter is slightly larger than 40  mm with the electrode needles avail -\nable now. Micro-waves ablation might improve the local control by increasing the \nablation diameter. The last point is the \"heat-sink effect\" that requires a temporary \nocclusion of a large vessel close to the tumour. The quality of follow-up imaging is \na key factor for evaluation of tumour destruction. \nLearning Objectives:\n1. To understand indications for RF ablation.\n2. To learn about the technique and devices for RF ablation.\n3. To understand results and follow-up strategies.\nA‑418\t 16:30 \nB. Portal embolisation \nO.M. van Delden; Amsterdam/NL (o.m.vandelden@amc.uva.nl) \nPartial hepatectomy for liver metastases or primary liver tumours can only be \nperformed when the future remnant liver volume (FRLV) is considered large \nenough to avoid the risk of post-operative liver failure. In normal livers a FRLV of \n25-30% is considered safe whereas in compromised livers a FRLV of at least 40% \nis required. In patients whom the FLRV is considered to small, PVE may be per-\nformed pre-operatively to increase the FRLV. PVE involves percutaneous selective \nembolisation of the portal venous (PV) system, usually of the right liver lobe, which \nleads to atrophy of the embolised lobe. This, in turn, leads to hypertrophy of the \nFRLV. Because of the dual vascular supply to the liver (arterial and portal venous), \nnecrosis of the embolised lobe does not occur. This compensatory hypertrophy \nof the left lobe facilitates resection in patients in whom the FRLV would otherwise \nhave been to small to allow resection. PVE is most often performed percutaneously \nunder conscious sedation and local anaesthesia through an ipsilateral approach, \nusing a combination of particles, such as polyvinyl-alcohol (PVA) and embolisation \ncoils. Potential complications of PVE include thrombosis of the contralateral PV, \nliver abscess formation or cholangitis and are rare. Most of the hypertrophy occurs \nin the first 3-4 weeks after PVE and increase in volume of the FRLV averages 12% \nafter this time period. CT-volumetry should be performed both before PVE and after \n3-4 weeks to measure increase in FRLV. \nLearning Objectives:\n1. To learn about imaging strategies and indications for embolisation.\n2. To learn about embolisation methods.\n3. To learn about complications, results and follow-up strategies.\nimaging techniques allow to reduce scan time or improve SNR. Fat suppression \ntechniques are mandatory, and Dixon or STIR techniques should be used for \nlow-field systems. Spin and gradient echo sequences should be used including \nat least T1 and T2 WI. Intravenous gadolinium may be helpful especially using \nmultiphase dynamic contrast on fast gradient echo sequence depending on medi-\ncal appropriateness. Emerging MR imaging techniques may be useful, including \ndiffusion-WI and spectroscopy. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑415\t 16:25 \nB. Normal variants and pitfalls \nF.M.H.M. Vanhoenacker; Antwerp/BE (filip.vanhoenacker@pandora.be) \nMimickers of the soft tissue tumours belong to a large and heterogeneous group of \ndisorders, varying from normal anatomic variants, and other pitfalls such as inflam-\nmatory and infectious lesions, post-traumatic lesions, skin lesions, nonneoplastic \nvascular lesions, metabolic disorders (crystal deposition disease, amyloidosis) \nand miscellaneous disorders (Geyser phenomenon in longstanding rotator cuff \ndisease, Baker’s cyst, elastofibroma dorsi, pseudohypetrophy of the lower leg due \nto neurogenic compression…). Classification of these pseudotumours remains still \na matter of debate. Many of these lesions are reactive or self-limiting without the \nneed for further investigation or significant intervention. The imaging approach \nis often very similar to the approach of “true” soft tissue tumoural counterparts. \nKnowledge of the normal anatomy and existence and common presentation of \nthese diseases, in combination with the relevant clinical findings (clinical history, \nlocation, skin changes), enables the correct diagnosis in most cases, thereby limiting \nthe need for invasive procedures. Biopsy should be performed in doubtful cases. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\nA‑416\t 16:50 \nC. Identifying and reporting abnormal findings \nJ.L.M.A. Gielen; Edegem/BE (jan.gielen@uza.be) \nAccurate identification and reporting on soft tissue extremity masses is essential \nfor correct diagnosis and optimal treatment planning. This lecture focuses on \nthe MRI signs to stage and grade-characterise soft tissue mass lesions. These \ntwo objectives are the major structural components of the MRI report and fit the \nrequest of the referring clinician. This implies an accurate description of these \nsigns with appropriate terminology in the report. Local staging is essential for the \npreoperative work up. Important staging parameters are size, compartmental loca-\ntion, skip lesions and relationship to neurovascular structures and joints, as well as \ndistance to the nearest joint space. Grading and characterisation is complex and \nmultifactorial and classifies the lesions as „certainly benign“ (no biopsy needed) \nand „possibly „ or „certainly malignant“ (biopsy needed). Grading parameters are \nhomogeneity, (changing) signal intensities in multiple acquisition techniques and \nstatic and dynamic gadolinium enhancement pattern. These are used to define the \ncomposition of the lesion, i.e. fat, met-Hb, hemosiderin, myxoid tissue, collagen, \nviable, cystic or necrotic components. Other important grading and parameters \nare lesion margin, shape, perilesional invasion or destruction, multiplicity, specific \nlocation and associated findings but also age and gender of the patient. Benign \nlesions often have characteristic presentations. This is the case in arthrosynovial \ncysts, myxomas, lipomas, giant cell tumour of tendon sheat, hamartoma of nerve, \nelastofibroma dorsi, fibromatosis, neurinoma, etc. In the suspicion of tumour recur-\nrence, a comparison of these grading parameters with the primary tumour result in \na high specificity. Typical examples are used to illustrate „state-of-the-art“ reporting. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\n\nSunday\nPostgraduate.Educational.Programme\nA\n S107\nCB D E F G H\nT2W-MRI to localise PZ-Zone PCa. In the T-Zone, stromal nodules commonly have a \nlow ADC value simulating PCa. Significant differences in tumour ADC values existed \nbetween patients with low-risk, and those with higher risk localised P-Zone PCa. With \nS-MRI, the best accuracy for diagnosing PCa is obtained by combining a positive \nT2W-MRI and a choline+creatine/citrate ratio > 0.75. In the T-Zone, S-MRI has the \nsame limitations than DCE and DW-MRI. Multiparametric functional MRI accuracy of \nMRI to detect PCa can be improved by combining different functional sequences. At \nthe moment, it seems that the most widespread used protocol is a combination of DW \nand DCE-MRI for detection of P-Zone tumours. Performance of functional MRI to detect \nT-Zone PCa is less well established. Multiparametric MRI can now be used to perform \nstereotaxic TRUS-guided biopsies after TRUS-MRI image fusion. \nLearning Objectives:\n1. To understand the role of MRI in diagnosis of prostatic cancer.\n2. To understand the key MRI findings in prostatic cancer.\n3. To learn about the role of MR spectroscopy in diagnosis of prostatic cancer.\nA‑422\t 16:28 \nB. MRI in the post-treatment follow-up \nA.T. Turgut; Ankara/TR (ahmettuncayturgut@yahoo.com) \nThe role of imaging in patients with increased PSA level after radical prostatectomy \nor radiation therapy is to aid in differentiating locally recurrent disease which can \nbe managed with local therapy from distant metastatic disease requiring systemic \ntherapy. Although the majority of local recurrences in post-surgical patients can be \ndetected by MRI in the perianastomotic region which can also be evaluated with \nTRUS and TRUS-guided biopsy, some recurrences can occur at pelvic sites that \nare beyond the range of TRUS; MRI has a role of labelling these sites for TRUS-\nguided biopsy. The combination of an external phased-array coil and endorectal \ncoil is recommended for detecting local recurrent cancer. Current protocols involve \nT2-weighted MRI combined with functional techniques such as dynamic contrast-\nenhanced MRI (DCE-MRI), magnetic resonance spectroscopy and diffusion-\nweighted MRI. In the post-prostatectomy bed, recurrences present as lobulated \nmasses having low to intermediate signal intensity on T2-weighted images and \nshowing early, nodular enhancement with early washout of gadolinium on DCE-MRI. \nThe predominant finding after radiotherapy is a diffusely low signal intensity with \nan indistinct zonal anatomy where the contrast between a hypointense recurrence \nand benign irradiated tissue decreases. On DCE-MRI, peripheral zone enhance-\nment is lower after radiotherapy and any focal enhancement should be regarded \nas suspicious. The overall diagnostic efficacy of DCE-MRI for detecting recurrent \nprostate cancer is better than T2-weighted MRI alone. On MRI, bone metastases \nhave low and high signal intensity on T1- and T2-weighted images, respectively, \nand enhance after intravenous gadolinium administration. \nLearning Objectives:\n1. To understand the role of MRI in the follow-up of the patients with prostate \ncancer after radical prostatectomy or radiotherapy.\n2. To learn about the MRI findings for local or distant metastasis in the post-\ntreatment follow-up of prostate cancer.\n3. To learn about the post-radiotherapy signal intensity changes on the \ndetectability of recurrent prostate cancer after radiotherapy.\nA‑423\t 16:51 \nC. New frontiers in imaging of the prostate \nJ.O. Barentsz; Nijmegen/NL (J.Barentsz@rad.umcn.nl) \nIn this presentation new techniques with potential clinical value will be described \nwith a focus on prostate cancer multi-modality MR imaging. Techniques such as \nT2W, DWI, DCE and MRSI will be addressed, and their role in screening, deter-\nmination of tumour aggression and localisation, MR-guided biopsy, MR-guided \nminimal invasive focal therapy (laser, cryo, HiFu), and MR-guided radiotherapy \nwill be discussed. Examples will be shown. \nLearning Objectives:\n1. To become familiar with new developments in MRI of prostate cancer.\n2. To understand the future clinical needs, and how MRI can solve them.\nPanel discussion: \nWhat is the most appropriate radiological approach in patients with rising \nPSA levels, and when? 17:14\nThe major area of debate is how to approach patients with increased PSA levels. \nThe discussion has two parts: one is the patient who has not had a prior cancer \ndiagnosis and the other one is the patient who has already been treated for pros-\ntate cancer. What is the role of MR (as well as MRS, DW MR and dynamic MR) \nin precluding the need for multiple biopsies? When should we stop in cases with \nhigh or increasing levels of PSA despite consecutive negative biopsy outcomes? \nA‑419\t 17:00 \nC. Future directions \nJ. Kettenbach; Berne/CH (joachim.kettenbach@insel.ch) \nImage guidance and imaging fusion techniques represent an integral element in \noncologic interventions and liver surgery. In addition, several liver planning tech-\nniques such as the virtual liver surgery planer enhance simulation of a proposed \nliver resection. Using roboter-assistance or navigational guidance combined \nwith thermal ablation techniques such as radiofrequency ablation, significantly \nenhances accuracy of ablation probe placement and efficacy of ablation necrosis. \nFurthermore, the local recurrence rate can be considerably reduced, and the \namount of complete tumour ablation is significantly more likely. Integrating magnetic \nresonance imaging, and focused ultrasound to deliver and activate nano-capsules \ncarrying anti-cancer drugs to effectively target tumours will be another task. This \nwill involve drugs being injected into the body in the form of tiny capsules, which \nare harmless until they are activated by a concentrated focused ultrasound `blast’. \nThe MRI scanner will then be used to track the passage of the drugs, visualise the \ntarget and monitor the delivery of the drug treatment. \nLearning Objectives:\n1. To review new ablation modalities.\n2. To review research on targeted embolotherapy.\n3. To understand the use of combined therapies.\n16:00 - 17:30 Room E1 \nGenitourinary \nRC 1407 \nMRI in prostate cancer \nModerator: \nJ. Venancio; Lisbon/PT \nA‑420\t 16:00 \nChairman’s introduction \nJ. Venancio; Lisbon/PT (josevenancio@netcabo.pt) \nMRI is used in the detection of prostate cancer (PCa) in several circunstances highlight-\ning: A. Patients with previous series of negative ultrasound-guided biopsies and clinical \nor biochemical suspicion of PCa. B. Patients already treated for PCa, with rising PSA. \nFunctional multiparametric MRI including: dynamic contrast enhanced MRI (DCE-\nMRI), diffusion-weighted MRI (DW-MRI), and spectroscopic MRI (S-MRI) is useful \nto detect suspect areas, mainly in peripheral zone and direct TRUS or MRI-guided \nbiopsies. Nowadays 3 T MRI can improve PCa detection due to higher multiparamet-\nric capabilities and more precise staging. It is very important precise localisation of \ntumour in some kind of patients indicated for focal treatment: HIFU, brachytherapy, \ncryotherapy… In the follow-up after treatment, with a biological or clinical suspiction of \nrelapsing, it is very important to detect peri-anastomotic or pelvic recurrences, and MRI \n(combining the use of endorectal and pelvic phased array coils) is better than US or \nCT. Particular conditions concerning this matter will be discussed. Present and future \nclinical needs on imaging PCa. New developments in MRI of PCa will be presented, \nemphasising local staging, recurrences perianastomotic and the evaluation of lymph \nnodes (Fe-nanoparticles?). \nSession Objectives:\n1. To review and compare the most important MRI developments.\n2. To evaluate prostate after treatment for cancer, and signal intensity changes \nto detect local recurrences.\n3. To learn about future trends of MRI in prostate cancer, answering future \nclinical needs, namely in the evaluation of lymph nodes.\nA‑421\t 16:05 \nA. MRI in detection of prostatic cancer \nF. Cornud; Paris/FR (francois.cornud@imagerie‑tourville.com) \nMRI is more and more used for PCa detection in patients with a negative series of \nTRUS-guided biopsies and a persistent biological suspicion of PCa. Functional MRI \nincreases the accuracy of T2W-Imaging to localise PCa. It includes dynamic contrast \nenhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI) and spectroscopic MRI \n(S-MRI). Sensitivity and specificity of DCE-MRI are significantly higher than that of \nT2W-MRI to detect P-Zone cancers with a tumour volume > 0.2-0.5 cc. Limitations of \nDCE-MRI include the frequent enhancement of benign P-Zone sextants and T-Zone \nBPH nodules. With DW-MRI, PCa shows a significantly lower apparent diffusion coef-\nficient (ADC) value than that of benign prostate tissue which increases the accuracy of \n\nPostgraduate.Educational.Programme\nS108\n A B C D E F G H\noccult injuries of the large vessels, heart, tracheobronchial tree, diaphragm or spine. \nDespite significant merits of MDCT the chest x-ray together with ultrasound still \nserves as a tool for fast orientation and detection of traumatic changes requiring \nurgent intervention (e.g. tension pneumothorax, large haemothorax and pericardial \ntamponade). MDCT is currently accessible in practically all trauma centers and it \nis considered to be the gold standard of the imaging of trauma. This fact results \nin a tendency to perform MDCT in patients with high-energy injury as a routine \nexamination without selection according to the clinical and x-ray finding. The dis-\nadvantages of this approach are increased costs and higher radiation exposure, \nbut on the other hand it increases the number of relevant additional findings (in \n7-40%) leading to the modification of the therapeutic strategy. \nLearning Objectives:\n1. To learn about imaging algorithm in chest trauma: the value of CT.\n2. To understand the benefits of MDCT.\n3. To learn about examination protocols.\n4. To learn about post-processing methods.\n5. To learn about imaging findings focused on merits of MDCT.\nA‑427\t 16:51 \nRadiation in emergency thoracic CT: can it be reduced? \nS. Leschka; St. Gallen/CH (sebastian.leschka@kssg.ch) \nThe risks associated with radiation exposure in CT is of concern to radiologists, \nmedical physicists, government regulators, and the media. Thoracic CT is a techni-\ncally robust, non-invasive imaging technique for the evaluation of several traumatic \nand non-traumatic thoracic emergencies. Technical advances in the past years \nhave resulted in improvements in image acquisition speed, spatial resolution, and \nthe temporal resolution. Consequently, thoracic CT can now be performed rapidly \nin emergency conditions without substantial delay in treatment. State-of-the-art \nCT systems are now capable of imaging the entire thorax within a few seconds. \nHowever, radiation exposure associated with thoracic CT have been increased \nwith the advantages of modern CT systems particularly in the evaluation of chest \npain syndrome. Thoracic aortic CT angiography with cardiac gating may now be \nconsidered the preferred technique for the evaluation of chest pain syndrome in \nselected patients but is associated with a substantial higher radiation dose than \nroutine non-gated thoracic CT. Several effective strategies have been developed to \nlimit the radiation exposure in cardiac gated thoracic CT including prospective ECG \ngating techniques, anatomy and ECG-based tube current modulation, high pitch \nacquisition, and adaptation of the CT scanning parameters to the body habitus. In \naddition, several techniques are available to reduce the radiation exposure in non-\ngated thoracic CT depending on the patient’s body habitus and the clinical indication. \nLearning Objectives:\n1. To become familiar with radiation dose values associated with current CT \nprotocols used in thoracic emergencies.\n2. To learn which factors influence the radiation dose in thoracic CT.\n3. To learn how radiation dose can be reduced in clinical practice.\nPanel discussion: \nIncreasing use of MDCT in emergency radiology of the chest: is it \nappropriate? Can we stop it? Do we want to? 17:14\nIn many countries imaging in the emergency department is only partly based on \nappropriateness but also on defensive medicine, finances or politics. The number of \nprocedures increases with decreasing positive rates. Furthermore, especially with \nthe use of MDCT, radiation exposure is increasing. If radiologists want to reduce \ninappropriate use of MDCT, the questions arise of whether we are able to do it and \nhow it can be achieved. Are there alternative diagnostic strategies? \n16:00 - 17:30 Room F1 \nRadiology in Abdominal Emergencies \nCC 1417 \nInflammation and oedema \nModerator: \nN. Elmas; Izmir/TR \nA‑428\t 16:00 \nA. The three musketeers: appendicitis, diverticulitis, colitis \nJ. Stoker; Amsterdam/NL (j.stoker@amc.uva.nl) \nAppendicitis, diverticulitis and colitis are frequent causes of acute inflammatory \nbowel emergencies. In many patients, suspected for these conditions the diagnosis \nis not clear upfront. Imaging plays an important role in identifying the underlying \n16:00 - 17:30 Room E2 \nSpecial Focus Session \nSF 14 \nThoracic emergencies: triage with MDCT \nModerator: \nD.R. Kool; Nijmegen/NL \nA‑424\t 16:00 \nChairman‘s introduction \nD.R. Kool; Nijmegen/NL (dignakool@gmail.com) \nBecause of advancing technical developments and increasing diagnostic utility of \nMDCT in emergency care, its use has expanded significantly and has changed \npatient care, especially in chest emergencies. However, MDCT has important \ndrawbacks in cost and radiation exposure. The first presentation will discuss MDCT \nin acute chest pain (ACP). Scan techniques in different scanners will be addressed. \nThe reasons why CTA/CTCA can be a viable application for ACP and the current \nevidence for CTA in ACP will be discussed followed by an update on indications. \nThe next presentation will address MDCT in chest trauma. Its significance, the \nutility of this imaging method and its advantage compared to other modalities will \nbe discussed. The examination protocol and the role of post-processing methods \nwill be addressed. The interpretation of MDCT, findings, benefits, limitations and \npitfalls will be shown. The utility of chest x-ray and ultrasound as primary examina-\ntions and the indication for MDCT, routine or selective, will be discussed. Our last \nspeaker will familiarise us with procedures to measure radiation dose in thoracic \nMDCT, followed by an update of radiation exposure associated with the protocols \nfor the different clinical indications. Finally, available techniques for radiation dose \nreduction in ECG-gated and non-gated MDCT and their effectiveness in radiation \ndose reduction will be demonstrated. However, the best way to reduce radiation \nis to perform MDCT only when there is an appropriate indication and this will be \nthe focus of the concluding panel discussion of this session. \nSession Objectives:\n1. To learn about the benefits of MDCT in traumatic and non-traumatic \nemergencies of the chest.\n2. To learn about the disadvantages of MDCT in emergency care.\n3. To learn about ways to reduce the disadvantages of MDCT and improve \nappropriate use of MDCT.\nA‑425\t 16:05 \nMDCT in acute chest pain \nF. Cademartiri, E. Maffei; Parma/IT (filippocademartiri@hotmail.com) \nMDCT in acute chest pain has been performed for several years. However, one of the \nmajor missing pieces of the puzzle in this field was the heart and the coronary arteries. \nMajor life-threatening causes of chest pain such as acute aortic dissection and pulmo-\nnary embolism are part of our daily practice in emergency radiology care. Coronary \narteries and cardiac assessment are, instead, a new and challenging application. CT \nscan technique has several and demanding requirements as well as training for proper \nreporting. Current state-of-the-art CT scanner can perform a complete chest CT with \nECG synchronisation in few seconds with a reasonable, if not low, radiation dose. \nT echnique has to be optimised depending on patients’ features, and clinical indications. \nLearning Objectives:\n1. To become familiar with the CT scan technique for non-traumatic thoracic \nemergencies.\n2. To learn about the rationale of triple rule-out with CT.\n3. To learn about the indications of CT in settings of acute chest pain.\nA‑426\t 16:28 \nMDCT in chest trauma: indications, technique and interpretation \nH. Mirka; Plzen/CZ (mirka@fnplzen.cz) \nChest trauma is, particularly in younger population, a significant cause of morbidity \nand mortality. It is directly responsible for 20-25% of trauma-related deaths and in \nother 50% of deaths it is an important contributing factor. Imaging methods play \nthe key role in management of this group of patients. Introduction of MDCT in the \nlast decade of the 20th century markedly changed the diagnostic approach to the \nthoracic trauma. Fast data acquisition and increased resolution in the z-axis enabled \nreliable assessment of all chest anatomical components (often together with other \nparts of the body) in one examination. Compared to x-ray MDCT defines more \naccurately the extent and severity of traumatic changes and may detect serious \n\nSunday\nPostgraduate.Educational.Programme\nA\n S109\nCB D E F G H\nLearning Objectives:\n1. To learn epidemiology and clinical outcome of patients with pancreatitis.\n2. To understand typical findings and diagnostic pitfalls.\n3. To know the role of radiology in patients with acute and chronic pancreatitis.\n16:00 - 17:30 Room F2 \nBreast \nRC 1402 \nEvaluation of the treated breast and follow-up \nModerator: \nA. Tardivon; Paris/FR \nA‑431\t 16:00 \nChairman’s introduction \nA. Tardivon; Paris/FR (anne.tardivon@curie.net) \nThe topics of this refresher course cover very interesting fields in patients with \na breast cancer. How to evaluate residual disease after surgical biopsy? How to \nevaluate tumour response to neoadjuvant therapies and what about surveillance \nafter treatment? In all these fields, many questions remain without clear answers \nand univocal recommendations especially about the timing of imaging after surgery, \nunder treatment and during follow-up. If MRI is the most sensitive imaging technique \nfor detecting cancer (residual disease, new cancer event and local relapse), we \nhave to keep in mind that it is not perfect (calcifications, low grade DCIS detection) \nand that radiation therapy and systemic treatments play a major role for curing \nminimal residual disease. For evaluating and predicting response to neo-adjuvant \ntreatments, the major question is the debate between morphology (size and volume) \nand function (perfusion, spectroscopy and diffusion). For follow-up after treatment, \nconsidering the number of women concerned, cost benefit analyses are mandatory \nto offer the most efficient imaging strategies based not only on defined subgroups \n(risk factors of local relapse) but also over time. One of the first take home mes-\nsages of this course is the multidisciplinary approach of this disease or in another \nway: we do not treat images but patients! \nA‑432\t 16:05 \nA. Evaluation of residual disease after excisional biopsy \nC. Boetes; Maastricht/NL (c.boetes@mumc.nl) \nMammography can have an additional value in evaluating if microcalcifications are left \nbehind in the case of DCIS and irradical operation. Ultrasonography has proven to have \nno additional value in evaluating the postoperative breast, because of haematoma and \nscar tissue. MR imaging of the breast can of all imaging techniques predict residual \ndisease in the most accurate way. However, false positive results can exist because \nof enhancing scar tissue. Also, false-negative results exist, especially owing to residual \nlow and intermediate grade DCIS. It is recommended to perform postoperative breast \nMRI in premenopausal women in the right time of the menstrual cycle, that means \nbetween the 5th and 12th day after the start of the menstrual cycle. Unclear is how soon \nafter the operation one should perform breast MRI. If a large mass of residual disease \nis suspected, MRI is an excellent tool to confirm this fact. But, if a mastectomy is con-\nsidered, pathological confirmation before the re-operation is recommended. Another \nimaging technique is TC-99m-MIBI scintimammography. This seems a promising \ntechnique with a high sensitivity and specificity. \nLearning Objectives:\n1. To review indications for imaging after excisional biopsy.\n2. To understand imaging findings in the treated breast.\n3. To understand the role of MRI in detection of residual disease.\nA‑433\t 16:28 \nB. Evaluation of response to neoadjuvant chemotherapy \nP.A.T. Baltzer, M. Dietzel, W.A. Kaiser; \nJena/DE (pascal.baltzer@med.uni‑jena.de) \nNeoadjuvant chemotherapy is regularly used for downstaging of locally advanced \nbreast cancer. While it is equivalent to adjuvant therapy regarding overall survival and \noccurrence of distant metastasis, more patients are eligible for surgical treatment by \nless aggressive breast conservative therapy. Neoplastic growth depends on blood \nsupply with nutrients and oxygen. Hypoxia-induced angiogenesis is an early step in \ntumour progression. MRI is the imaging modality providing highest sensitivity for detec-\ntion of breast cancer, highlighting tumour vascularisation by injection of T1-shortening \ncontrast agents. Characteristic differences between benign and malignant lesions are \ncause. Ultrasound (US) and computed tomography (CT) are readily available and \nwidely used imaging techniques for this work up. US comprises an examination of \nthe abdomen with the graded compression technique. A transducer should be used \noptimised for the visualisation of the bowel. The CT protocol includes the use of \nintravenous contrast medium, while oral contrast medium will not be routine in many \ninstitutions. Findings are bowel wall thickening (or enlarged appendiceal diameter), \nfat infiltration, free air and fluid collections. The present evidence on the role of \nimaging in appendicitis and diverticulitis is substantial and has been summarised \nin systematic reviews. Although US is accurate in diagnosing appendicitis and \ndiverticulitis, CT is more accurate than US. Further advantages of CT are better \nidentification of alternative diagnoses and better comparison between consecutive \nexaminations. Thereby, CT is more helpful in communicating the diagnosis to the \nreferring physician. Cost effectiveness of CT in acute appendicitis has been dem-\nonstrated as well as the positive impact on management. For colitis, the evidence \nis more limited and imaging has more limitations here. Drawback of CT is ionising \nradiation exposure. An imaging strategy with initial US and CT only in inconclusive \nof negative US cases results in the highest sensitivity, reduces ionising radiation \nexposure and is cost effective. \nLearning Objectives:\n1. To know the pros and cons of ultrasound and computer tomography in \nappendicitis, diverticulitis and colitis.\n2. To understand the imaging findings and results in appendicitis, diverticulitis \nand colitis.\n3. To learn the role of imaging in acute inflammatory bowel emergencies.\nA‑429\t 16:30 \nB. Liver and biliary tree \nJ.A. Soto; Boston, MA/US (jorgeasoto@aol.com) \nAccurate and rapid diagnostic imaging is essential for the appropriate manage -\nment of acute biliary tract disorders. Ultrasonography (US) continues to be the \nfirst and often the only test needed to confirm suspected diagnoses affecting the \nducts and gallbladder. However, there has been an increase in the overall use of \ncomputed tomography (CT) in the emergency room setting, mostly because for \nits widespread availability and the relative speed, ease and uniformity with which \nevaluations can be performed. Thus, CT may be the first imaging examination \nperformed on patients presenting with signs and symptoms that are less specific \nfor biliary diseases. Magnetic resonance (MR) imaging has similarly robust potential \nas CT, although its integration into the acute care setting requires greater technical \nand logistical effort. Improved MR imaging sequences, advances in coil technol -\nogy, streamlined imaging protocols, and increased technical and professional \nfamiliarity with the modality make it an increasingly attractive option when there is \nconcern about patient radiation exposure or allergy to iodinated contrast material, \nas in pregnant patients with acute abdominal symptoms. MR can also be used \nas a problem-solving modality. In this presentation, the common and uncommon \nimaging appearances on US, CT and MR of acute diseases of the biliary tract and \ngallbladder will be reviewed. Potential pitfalls to be avoided with the three modali-\nties are also illustrated. \nLearning Objectives:\n1. To learn the etiology and clinical presentation of acute inflammatory liver \ndiseases.\n2. To understand imaging strategies using US, CT and MRI.\n3. To know typical findings and the spectrum of differential diagnoses.\nA‑430\t 17:00 \nC. Pancreatitis: common and critical \nP.R. Ros; Cleveland, OH/US (Pablo.Ros@UHhospitals.org) \nPancreatitis is an abdominal condition potentially life threatening. Imaging plays a \nkey role not only in the diagnosis but also in the staging and patient management \nof acute and chronic pancreatitis. Pancreatic inflammation and necrosis can be \neasily identified by imaging methods and has prognostic implications. The clinical \nprognostic criteria in acute pancreatitis are currently coupled with imaging crite-\nria. CT plays a central role in the evaluation of patients with known or suspected \npancreatitis. A CT-based severity index is the main prognostic method to predict \noutcomes. In addition, MRI and MRCP play increasingly important roles in pancre-\natitis evaluation. Integrity of the pancreatic duct can be easily evaluated by this last \nmethod, particularly if enhanced with the use of secretin. Imaging appropriateness \ncriteria determine the value of distinct imaging modalities with regard to the stage \nof disease. We review the modern imaging criteria for the diagnoses, staging and \npatient management in acute and chronic pancreatitis. We also discuss current \nseverity indices and imaging appropriateness criteria. \n\nPostgraduate.Educational.Programme\nS110\n A B C D E F G H\n16:00 - 17:30 Room G/H \nNeuro \nRC 1411 \nUpdate on brain aneurysms \nModerator: \nS. Bracard; Nancy/FR \nA‑435\t 16:00 \nIntroduction to brain aneurysms \nS. Bracard; Nancy/FR (s.bracard@chu‑nancy.fr) \nCerebral aneurysm is a challenging problem. Subarachnoid haemorrhage (SAH) remains \na devastating accident. The incidence of SAH is around 6 per 100000 patient-years, higher \nin Finland and account for around 5% of all strokes. The diagnosis may be difficult on \nCT or MR but is essential. Complications are frequent and precocious: hydrocephalus, \nvasospasm and the most important, rebleeding. In the first day, up to 15% of patients \nhave a rebleeding and after the first day, the risk of rebleeding is more-or-less constant \nat a rate of 1 to 2% per day during the next 4 weeks with a poor prognosis. After rebleed-\ning, 80% of patients died or remain disabled. Ruptured aneurysms are the cause of \nSAH in 85% of patients, whereas 5-10% fit into the pattern of so-called non-aneurysmal \nperimesencephalic haemorrhage. The remaining are caused by various causes. Both \nCTA and MRA may be proposed as a first-choice, non-invasive examination, The aver-\nage sensitivity of CTA for the detection of intracranial aneurysms reaches 90%, but the \nnegative predictive value is poor, and therefore digital subtraction angiography (DSA) \nis mandatory for all SAH cases with negative CTA or MRA. During the past decade, \nendovascular occlusion by means of detachable coils (coiling) of aneurysms has largely \nreplaced surgical occlusion as the intervention of choice for the prevention of rebleeding. \nOn the other hand, more and more unruptured aneurysms are fortuitously discovered \nand the question to treat or not to treat is also a challenging issue. \nA‑436\t 16:05 \nA. Subarachnoid haemorrhage \nL. van den Hauwe1, C. Venstermans2, M. Voormolen2, T. van der Zijden2, \nF. De Belder2, J.W. Van Goethem2, P.M. Parizel2; 1Brasschaat/BE, 2Antwerp/BE \n(lucvdhauwe@mac.com) \nIn 85% of nontraumatic cases, subarachnoid haemorrhage (SAH) is the result of \naneurysmal rupture. Other causes of SAH include perimesencephalic SAH (10%) \nand other disorders (5%) such as arteriovenous malformation (AVM), vertebrobasilar \nartery dissection, dural AV-fistula, cortical vein thrombosis, amyloid angiopathy, … \nSAH represents an emergency situation and diagnosis should be established ASAP . \nPlane computed tomography (CT) is the initial diagnostic test of choice (wide avail-\nability, easy accessibility, high sensitivity and specificity). If CT is negative, lumbar \npuncture and/or MRI of the brain (including FLAIR images) and spine should be \nperformed. 3D TOF MR angiography (MRA) sequences have high sensitivity and \nspecificity in detecting cerebral aneurysms; but because of their lower spatial reso-\nlution are insufficient to analyse in detail aneurysm morphology. This in contrast \nwith CTA. Both CTA and MRA may be proposed as a first-choice, noninvasive \nexamination, but the negative predictive value is poor, and therefore digital subtrac-\ntion angiography (DSA) is mandatory for all SAH cases with negative CTA or MRA. \nCatheter angiography remains the golden standard in the detection and evaluation \nof cerebral aneurysms (size, relationship between neck and adjacent vessels, etc). \nIncreased attenuation (CT) and hyperintense signal (FLAIR) within the basal cisterns \nand sulci are a characteristic finding of SAH; however, it is aspecific. Pattern and \nlocation of the blood may help to locate the ruptured aneurysm; sometimes helpful \nwhen multiple aneurysms are found. Pseudo-SAH may be a potential imaging pitfall \nbecause it may be observed in other acute neurological conditions (cerebral edema, \nbacterial meningitis, etc). \nLearning Objectives:\n1. To review the different causes of subarachnoid haemorrhage.\n2. To learn about the basic imaging strategies in the diagnostic work-up of \nsubarachnoid haemorrhage.\n3. To learn how to recognise the early CT and MR signs of subarachnoid \nhaemorrhage.\nbest identified by dynamic repetitive T1w imaging which is referred to as DCE-MRI. \nChemotherapeutic treatment leads to characteristic tissue changes affecting both \nvascularisation, tumour microstructure, i.e. extracellular space and chemistry, e.g. \ncholine metabolites. While the first is assessed by DCE-MRI, further MRI techniques \nsuch as diffusion weighted imaging (DWI) and MR-spectroscopy (MRS) provide means \nto measure changes in tumour microstructure and chemistry due to neoadjuvant che-\nmotherapy. This talk will introduce and discuss different MRI concepts for monitoring \nof neoadjuvant chemotherapy using MRI. Furthermore, accuracy and limitations of \nMRI for prediction of response will be discussed. \nLearning Objectives:\n1. To understand principal mechanisms of tumour vascularisation and \nmicrostructure.\n2. To understand changes in tumour vascularisation and microstructure due to \nneoadjuvant chemotherapy.\n3. To understand the accuracy and limitations of response monitoring using \nbreast MRI.\nA‑434\t 16:51 \nC. Surveillance for and detection of recurrent disease after therapy \nF.J. Gilbert; Aberdeen/UK (f.j.gilbert@abdn.ac.uk) \nRecurrent disease following treatment for primary breast cancer can occur in the same \nbreast following conservation surgery, ipsilateral breast tumour recurrence (IBTR) or in \nthe contralateral breast, metachronous contralateral breast cancer (MCBC). Estimations \nfor the rate of recurrence are between 04 and 0.8% each year. The rate of recurrence \nis higher than breast cancer incidence in the general population. Risk factors for recur-\nrence are young age (< 50), high grade disease, incomplete tumour excision and no \nradiotherapy. Due to the large numbers of women who develop and survive breast cancer \nthe cost and resource required to follow-up these women is considerable. There are vari-\nable guidelines in Europe for the surveillance of women but most regimes include clinical \nfollow-up and mammography. Variations concern the frequency of mammography, the \nlength of follow-up required, and whether clinical examination is required. The clinical \neffectiveness and cost-effectiveness of different surveillance mammography regimens \nafter the treatment of primary breast cancer will be reviewed together with the results \nof systematic reviews. Modelling of two data registries was undertaken to ascertain the \nsurvival benefit. Alternative methods of surveillance will be considered such as MRI with \nthe diagnostic accuracy of the various imaging techniques considered. A summary of \nthe economic evaluation will be presented to demonstrate the assumptions that require \nto be made in this complex area where there is a paucity of evidence. \nLearning Objectives:\n1. To understand the risk of recurrent disease and second primary following the \ntreatment of breast cancer.\n2. To review literature on surveillance mammography and other imaging \nmethods for detection.\n3. To appreciate the range of recommendations for surveillance mammography \nand clinical follow-up with cost benefit analysis.\nPanel discussion: \nThe new challenge in breast cancer: evaluation of response 17:14\nEvaluation of the treated breast is one of the major challenges in breast imaging. \nThere is especially much debate on the evaluation of response to therapy. The \nbest imaging modality, the best imaging criteria, timing, accuracy and limitations of \nimaging are currently being investigated. Whether it is time to reach conclusions \nregarding these aspects is the issue of this panel discussion. \n\nSunday\nPostgraduate.Educational.Programme\nA\n S111\nCB D E F G H\n16:00 - 17:30 Room I/K \nCardiac \nRC 1403 \nMRI and CT before cardiac interventions or surgery \nModerator: \nG.P. Krestin; Rotterdam/NL \nA‑439\t 16:00 \nChairman’s introduction \nG.P. Krestin; Rotterdam/NL (g.p.krestin@erasmusmc.nl) \nAdvancements in CT and MRI technology have lead to an increasing use of these \nmodalities in the non-invasive assessment of coronary arteries, myocardial perfu-\nsion, and cardiac function. While their role in detecting coronary artery disease and \nfunctional disorders has been widely accepted, it is still unclear whether they could \nbe adopted in triaging patients for the best therapeutic approach. Large studies \nhave already suggested that indication for surgery and percutaneous interventions \ncannot be solely based on the demonstration of morphologic alterations and that \nsuch “cosmetic” interventions are not always leading to the expected outcomes. \nTherefore, non-invasive imaging techniques have to offer more then just the detec-\ntion of grades of coronary artery stenosis, of areas of infarcted myocardium, or of \nvalvular alterations. Adjustment of imaging protocols for additional evaluation of \ncoronary flow reserve, of myocardial perfusion and contractility and of valve size, \nposition and damage with subsequent quantification of degree of stenosis and/\nor regurgitation are necessary in order to allow to choose the most appropriate \ntherapeutic approach and thus become the “gold standard” for prognosis and \npretherapeutic diagnosis of cardiac diseases. \nA‑440\t 16:05 \nA. Can CT predict the outcome of percutaneous intervention? \nC. Loewe; Vienna/AT (christian.loewe@meduniwien.ac.at) \nThe outcome of coronary revascularisation is not only defined by primary technical \nsuccess but also by improvement of symptoms and quality of life. Thus, despite \nthe individual comorbidities, the outcome and thus the potential benefit of coronary \nrevascularisation depends on many different factors, including morphology, distribu-\ntion and severity of coronary lesions, myocardial viability, and ventricular function. \nConsequently, the detection of coronary stenosis is not sufficient for planning an \noptimised treatment. It should be evaluated if the myocardial territory supported by \nthe diseased artery is still vital. In addition, lesions at risk for plaque rupture (culprit \nlesions) should be identified and treated to avoid major coronary events. Cardiac \nCT allows for the exact assessment of coronary morphology including length, \ncalcification and severity of lesions. Based on this morphological information, suc-\ncess of a percutaneous revascularisation procedure can be anticipated with high \nprognostic accuracy. In addition, the possibility of identification of culprit lesion by \nmeans of coronary CT has been described recently. By this, dedicated treatment \nof only the relevant stenosis should become possible avoiding multiple, potentially \nunneeded, stents. Finally, even the assessment of myocardial viability by means \nof CT becomes possible. Using all the possibilities of cardiac CT optimised treat-\nment plan can be established, and outcome can be estimated. This presentation \nshould give an overview about potential applications of cardiac CT for optimised \ntreatment decisions and planning. Recent literature should be introduced based on \nclinical examples. Potentially useful algorithms for appropriate treatment selection \nshould be provided allowing for improving the outcome of coronary interventions. \nLearning Objectives:\n1. To understand the role of CT coronary angiography in the assessment of \npatients prior to percutaneous intervention.\n2. To appreciate the role of CT findings regarding the myocardium in patients \nprior to cardiac interventions.\n3. To understand the positive and negative predictive value of CT in the \nassessment of potential candidates for cardiac interventions.\nA‑437\t 16:28 \nB. CTA/MRA in aneurysm diagnosis \nZ. Merhemic; Sarajevo/BA (merhemic.zulejha@gmail.com) \nIntracranial aneurysms are abnormal dilatations of the arteries, and will be found \nin 1% to 14% in general population. In 90% cerebral aneurysms are saccular and \ndevelop from the arteries of the circle of Willis or its major branches. Aneurysms typi-\ncally become symptomatic between the age of 40 and 60 years, with subarachnoid \nhaemorrhage (SAH) or intracerebral haematomas. Less common are giant aneu-\nrysms usually found in middle-aged women presenting with signs more indicative \nof a mass lesion. CT angiography (CTA) has been proven to be an excellent tool \nto visualise intracranial arteries. The average sensitivity of CTA for the detection \nof intracranial aneurysms reaches 90%. Post-processing allows assessment of \nthe aneurysm with maximum intensity projections (MIP) and surface-rendered 3D \nprojections in multiple plains. MR angiography (MRA) is a practical and noninva -\nsive tool for screening of high-risk individuals for aneurysms. DSA is diagnostic \nmethod of choice for assessment of intracranial aneurysms and was considered to \nbe a ‘gold standard’ for evaluation of cerebral vessels. A clear shift from invasive \nto noninvasive imaging of cerebral vessels has been noticed in the last decade. \nThis lecture will discuss advantages and disadvantages of CTA, MRA and DSA in \ndetection, assessment, and post-treatment evaluation of intracranial aneurysms. \nLearning Objectives:\n1. To understand the imaging findings on CTA and MRA of brain aneurysm.\n2. To recognise the key features of an imaging protocol for patients with \nsuspected aneurysm.\n3. To understand the optimal CTA and MRA protocol for diagnosing brain \naneurysm.\nA‑438\t 16:51 \nC. Treatment of aneurysms 2011 \nP. Vilela; Almada/PT (ferrovilela@sapo.pt) \nIntracranial aneurysms have a multifactorial origin. A heterogeneous and complex \ngroup of pathogenic mechanisms including luminal, mural and extramural factors \ninteract for the development and growth of aneurysms. There are several types of \nintracranial aneurysms, being the saccular the most common type. The aneurismal \ntreatment is dependent on its type and needs a multidisciplinary approach including \nendovascular and microsurgical teams. Endovascular treatment is recognised as \nthe first-line treatment for most of the ruptured saccular intracranial aneurysms. \nThere has been an enormous improvement in the endovascular technology and \ntechniques offering a wide spectrum of treatment possibilities that broadened the \nvariety of aneurysms that can be treated. The treatment options include the use \nof coils with/without the help of balloon-remodelling and/or stenting. Other options \ninclude the use of covered stents, of “flow-diverter” stents, of liquid embolics, or the \nparent vessel occlusion. The multislice computer tomography angiography (MSCTA) \nis a reliable method for pretreatment evaluation of intracranial aneurysms. For the \nposttreatment evaluation, magnetic resonance angiography (MRA) can be used for \nthe follow-up of embolised aneurysms; and MSCTA may be used for the follow-up of \nsurgically treated aneurysms. There are several challenges remaining in aneurysm \nmanagement. In the diagnostic field, improvement of the non-invasive techniques \nfor the diagnosis, for the morphological and haemodynamic characterisation and \nfor the posttreatment follow-up of aneurysms is expected. In the endovascular field, \ntechnological breakthroughs to improve the occlusion rate, to increase the treatment \ndurability, and to promote the vessel wall healing are desired. \nLearning Objectives:\n1. To learn about present treatment of brain aneurysms.\n2. To understand the strategies for multimodal CT and MR aneurysm imaging \npre and post-treatment.\n3. To present the challenges for neuroimaging in the field in the near future.\nPanel discussion: \nWhere do we stand in brain aneurysm treatment today? 17:14\nThere is a significant difference in the management of patients with ruptured versus \nun-ruptured brain aneurysms. This panel discussion will focus on the management \nof patients with brain aneurysms and will with simple case presentations show the \nmanagement in ruptured and un-ruptured aneurysms and discuss the involvement \nof the neurosurgeon in more complex cases. \n\nPostgraduate.Educational.Programme\nS112\n A B C D E F G H\n16:00 - 17:30 Room L/M \nRadiographers \nRC 1414 \nRadiography in the operating theatre \nModerators: \nR. Passariello; Rome/IT \nA. Yule; Cardiff/UK \nA‑443\t 16:00 \nA. Cone-beam CT imaging in the operating room during endovascular \naortic repair (EVAR) \nK.R. Eide, A. Ødegård, H.O. Myhre, S. Hatlinghus, O. Haraldseth; \nTrondheim/NO (kari.eide@hist.no) \nCone beam CT (CBCT) is a method for obtaining CT-like images using a C-arm \nsystem. Our aim was to investigate the accuracy of these images compared with \nmulti-detector CT (MDCT) as a gold standard in radiological imaging of abdominal \naortic aneurysms (AAA). 40 patients with AAA referred for elective EVAR were \nincluded in a pre-therapy protocol (20 patients) and in a post-therapy protocol (20 \npatients). All were exposed to standard MDCT and one additional CBCT. Image data \nwere evaluated by two radiologists and statistically compared using a linear mixed \nmodel. First, 6 predefined arterial measurements were performed, then 9 predefined \nanatomical areas were assessed and scored for visibility on a scale from 1 to 4. All \nmeasurements were chosen to be relevant for evaluating of AAA before and after \nEVAR. For the arterial measurements no significant differences were found between \nMDCT and CBCT. Visibility for the anatomical areas was significantly better for \nMDCT; however, most of the CBCT readings were above lowest acceptable level. \nVisualisation of the iliac arteries was suboptimal. We think that our results support \nthe start of clinical trials that scientifically can test the outcome without the use of \nMDCT immediately before and after EVAR. The problem with poor visualisation \nof the distal iliac arteries might be solved with newer technology. In conclusion, \nthe result indicates that CBCT in the operation room gives sufficient image-based \ninformation to support EVAR in a pre- and post-therapy setting. \nLearning Objectives:\n1. To gain knowledge about visualisation of high- and low contrast structures \nusing cone-beam CT.\n2. To appreciate some strengths and limitations using intraoperative cone-\nbeam CT.\n3. To become familiar with doses of radiation needed to plan and carry out \nEVAR.\nA‑444\t 16:45 \nB. Key radiographic skills in the operating theatre \nK.G. Holmes; Lancaster/UK (ken.holmes@cumbria.ac.uk) \nUndertaking theatre radiography can appear a daunting task for the radiographers \nlacking in confidence in their ability but others (like all expert practitioners) make \nit look easy and uncomplicated. Theatre radiography requires all the knowledge, \nskills and abilities of a competent radiographer together with assertiveness, re-\nflection and the ability to modify your technique at a moment’s notice. There are \na multitude of ‘traits’ which distinguish the expert from the novice. These include \nproduction of optimum images, effective use of the equipment, radiation protection, \ninfection control, effective communication and teamworking. There is also a clear \ndepth of knowledge together with a multitude of skills and abilities. The key to a \nstress-free experience is preparation. It is essential that there is a mechanism for \ntheatre staff and the radiology department to communicate effectively and give the \nradiographer prior notice of all cases requiring their attendance. It is also desirable \nto be in the theatre when the patient arrives for their examination to enable you to \ncheck the patient’s identity, pregnancy status and ensure the patient is positioned \ncorrectly to facilitate screening. There are few excuses to give the surgeon if you \ncannot screen the area of interest because of poor positioning of the patient and \nequipment. This paper will discuss the knowledge, skills and abilities required to \nundertake theatre radiography in a safe and proficient manner without feeling \nthreatened by the experience. \nLearning Objectives:\n1. To understand the key skills required to undertake radiographic procedures \nin the operating theatre.\n2. To gain an insight into the interpersonal skill required for effective \nradiographic practice in the operating theatre.\nA‑441\t 16:28 \nB. Can MRI predict the outcome of coronary revascularisation? \nM. Francone; Rome/IT (marco.francone@uniroma1.it) \nPrediction of coronary revascularisation outcome represents a major clinical question \nbecause a large number of medical and surgical options have become available for \nischaemic cardiomyopathy with need to identify more rigorous criteria for patient’s \nselection. The combination in a single examination of function, stress-perfusion and \ntissue characterisation with T2-weighted ‘oedema-sensitive’ and late-gadolinium en-\nhancement (LGE) techniques supported the role of cardiac MR (CMR) as an important \ntechnique for the evaluation of patients candidates to revascularisation. Besides more \n“traditional” indicators such as ejection fraction, end-diastolic wall thickness or end-\nsystolic volumes, extent and distribution of myocardial scar depicted with LGE has been \nidentified as one of the most important predictors of post-revascularisation outcome \nwith direct influence on functional recovery and on major adverse cardiovascular events \n(MACE) due to the potential induction of arrhythmias from the scar. LGE technique \nhas been shown to be superior to nuclear medicine for the assessment of myocardial \nviability due to the higher spatial resolution (up to 60-fold greater than SPECT) and \nan intrinsic high contrast resolution. A further technique that could be adopted before \nrevascularisation is stress imaging. Myocardial ischaemia detected by either CMR ad-\nenosine first-pass perfusion or dobutamine-induced wall motion abnormalities has been \nshown to predict subsequent cardiac death whereas normal stress perfusion showed \na high negative predictive value for MACE. In conclusions, although as a relatively \nnew diagnostic modality prognostic evidence is predominantly derived from single-\ncenter studies, CMR is increasingly becoming an important tool for risk stratification \nof patients before revascularisation, offering indications about outcome and mortality. \nLearning Objectives:\n1. To review the scientific evidence of MRI in CAD.\n2. To understand the important prognostic factors that MR is able to provide.\n3. To learn about the advantages of performing cardiac MR prior to coronary \nrevascularisation.\nA‑442\t 16:51 \nC. The value of CT before percutaneous aortic valve replacement \nR. Salgado; Antwerp/BE (rodrigo.salgado@uza.be) \nCardiac valve diseases are an important public health problem, strongly linked to \nthe general increasing age of the Western population. The most frequent valve \ndisease is aortic stenosis, for which percutaneous aortic valve replacement (PAVR) \nis currently evolving to a feasible alternative therapy for the classical surgical ap-\nproach in high-risk patients. Nevertheless, careful evaluation of all aspects of this \nnew approach is still required to avoid uncontrolled diffusion. Imaging plays a key \nrole in selecting patients who may be eligible for PAVR, focusing on the evaluation \nof leaflet anatomy, severity of valve dysfunction, haemodynamic consequences \nand potential problems in the access route. While echocardiography is commonly \nused for both the anatomical and functional evaluation, multidetector CT (MDCT) \nhas important intrinsic advantages providing state-of-the-art 3D imaging with a \nhigh spatial resolution over a large anatomic coverage. During this course, we will \ndiscuss the advantages and disadvantages of MDCT compared to other imaging \nmodalities. The relevant anatomy of the aortic valve and annulus will be reviewed, \nwith emphasis on correct alignment of the imaging planes, and its implications for \ncorrect reporting of the necessary measurements targeted at the clinicians need. \nFurthermore, MDCT scan protocol design will be reviewed, focusing not only on \noptimal implementation of common scan parameters but also on the need of \nECG-triggering and its consequences. Finally, we will present the current status \nof evidence on using MDCT in PAVR procedures, and discuss future challenges \nand perspectives. \nLearning Objectives:\n1. To understand how to optimise the imaging protocol for aortic valve imaging.\n2. To learn how to report the findings and what to include in the report.\n3. To understand the impact of this approach on patient management.\nPanel discussion: \nImprove your interaction with your colleagues 17:14\nMR and CT are increasingly being used as the modalities of choice in the evalu -\nation of patients prior to cardiac interventions or surgery. It is very important to \nunderstand the specific clinical question that prompted the clinician to order the \nexam and to answer it in the best possible way. The radiologist has to make clear \nstatements and should know the therapeutic implications of his report and findings. \n\nSunday\nPostgraduate.Educational.Programme\nA\n S113\nCB D E F G H\n16:00 - 17:30 Room P \nPhysics in Radiology \nRC 1413 \nVisualisation, perception and image processing \nModerators: \nA.A. Lammertsma;  Amsterdam/NL \nB. Wein; Aachen/DE \nA‑448\t 16:00 \nA. Visualisation and perception \nA.G. Gale; Loughborough/UK (a.g.gale@lboro.ac.uk) \nRadiological interpretation always incurs some degree of error due to the nature of \ndisease presentation coupled with the difficulty in diagnosis, especially where early \nsigns of disease need to be identified such as in medical screening. Early research \nstudies of radiologists’ performance concentrated upon the chest radiograph but \nmore recent work has studied breast screening extensively, as well as MRI and CT. \nAs radiology is now almost fully digital then research has also examined observer \nbehaviour with a range of digital images, viewing conditions, and image display \npresentations. It is possible that radiological interpretation will never be accom-\nplished without some errors occurring; however, it is important that steps are taken \nto minimise any causes of errors as far as possible. The reported error rates found \nin numerous investigations across different radiological domains will be reviewed \nand the reasons for these will be elucidated. Appropriate reporting conditions will \nbe highlighted for different image viewing scenarios. A theoretical framework for \nunderstanding error causation, especially where abnormalities are missed will be \ndetailed. Furthermore, the underlying visual, perceptual and cognitive processes \nwhich lead to errors will be detailed and approaches to minimise error occurrence \nwill then be proposed. The relationship between human perceptual and cognitive \nskills and computer imaging processing will be discussed and the usefulness of \nCAD systems outlined as how they can best aid the radiologist from the human \nperformance viewpoint. \nLearning Objectives:\n1. To review the basic principles of perception, detection and detectability.\n2. To learn about specifics of perception in medical imaging.\n3. To learn how image processing can help us with the perception process.\nA‑449\t 16:30 \nB. Image processing and perception \nB.M. ter Haar Romeny; Eindhoven/NL (B.M.terHaarRomeny@tue.nl) \nThe need for quantitative image analysis in radiology is universal: computer-aided \ndetection, segmentation for 3D volume visualisation, image enhancement, pattern \nrecognition, etc. All need effective, robust and preferably generic (not ‘ad hoc’) \nalgorithms for the computer. How to design such algorithms? A good inspiration \nsource is the functionality of the visual system, the best investigated brain struc-\nture today. In this talk we will explain how we think the brain calculates features in \nimages, why the retina measures at a wide range of resolutions and how we can \nexploit this. The visual system is strongly adaptive and self-learning. New optical \nrecording techniques have given new insight in how the cells in the visual cortex are \nfunctioning. We will go through these functionalities step-by-step. What we discover \nis quite amazing. We recognise huge amounts of filter banks in the first stages of \nvision: many filters analyse each pixel of the incoming image at a range of scales, \norientations, derivative order, for each colour, and also as a function of time. Ex-\ntensive feedback loops take care of optimal settings locally. We programmed these \nfilters into the computer, and were able to build many interesting applications for \ncomputer-aided diagnosis: detection of catheters at seriously reduced levels of x-ray \nradiation dose, automatic polyp detection, quantitative analysis of ischaemic heart \nventricle deformation, breast cancer CAD, pulmonary emboli CAD and analysis \nof in vivo microscopy images now so abundant in modern life-sciences research. \nLearning Objectives:\n1. To gain insight into modern computer vision techniques for computer-aided \ndiagnosis.\n2. To learn how the first stages of human visual perception process information.\n3. To learn a range of application areas of image processing techniques for \nmedical imaging.\n3. To appreciate effective methods for reducing radiation dose to patients and \nstaff during radiographic procedures in operating theatres.\n4. To learn how to improve radiographic techniques in theatre to ensure \noptimum images are produced during procedures.\n16:00 - 17:30 Room N/O \nJoint Course of ESR and RSNA \n(Radiological Society of North America)\nMC 1425 \nEssentials in oncologic imaging: \nwhat radiologists need to know (part 4)\nModerator:\nH.‑U. Kauczor; Heidelberg/DE\nA‑445\t 16:00 \nA. Lymphoma \nM.P. Federle; Stanford, CA/US \nLearning Objectives:\n1. To get a practical, clinically relevant summary of key imaging issues in \nHodgkin and non-Hodgkin lymphoma.\n2. To learn how imaging, especially PET and PET-CT can optimally assess \nand measure tumour treatment response, providing a value-added radiology \nreport.\nA‑446\t 16:30 \nB. Musculoskeletal neoplasms \nM.F. Reiser; Munich/DE \nLearning Objectives:\n1. To review imaging features of common malignant musculoskeletal \nneoplasms.\n2. To learn about key imaging findings required for staging of bone and soft \ntissue tumours, as well as associated imaging pitfalls.\n3. To learn about criteria for conventional imaging, perfusion MR imaging \nand diffusion-weighted MR imaging and PET/CT in assessing response to \ntreatment in musculoskeletal neoplasms.\nA‑447\t 16:55 \nC. Chemo- and radiation therapy-induced toxicity \nH.-U. Kauczor; Heidelberg/DE \nLearning Objectives:\n1. To get an overview of organ-specific toxicity and other adverse effects of \nchemo- and radiotherapy.\n2. To review the key imaging findings of therapy-induced organ toxicity and \nadverse effects.\n3. To understand how to differentiate inflammatory, infectious, fibrotic, and \nnecrotic changes from tumour recurrence.\nQuestions 17:20\n\nPostgraduate.Educational.Programme\nS114\n A B C D E F G H\ning using Graf’s method led to higher treatment and follow-up rates than that based \non NHI alone, i.e. 3-5% vs. 0.4-1.5% and 10-20% vs. 6-7%, respectively. However, \nimproved examination techniques and a better understanding of the findings have \nled to a more tailored approach, and an extensive meta-analysis performed in 2000, \nincluding 534 papers, could not find any differences in treatment rates due to different \nultrasound techniques. In this lecture I will present a crude status for US techniques \nused and also give recommendations for a worth while screening strategy based on \npresent knowledge, and on work performed within the ESPR’s DDH T ask Force group. \nLearning Objectives:\n1. To learn about the different approaches of hip sonography in neonates.\n2. To understand the need for a systematic study.\n3. To learn about proposed standardisation for examination and reporting.\nA‑453\t 17:00 \nC. Whole body imaging: PET/CT vs MRI \nP.D. Humphries; London/UK \nWith technological advances in recent years, paediatric whole body imaging is now \na clinically feasible and increasingly accessible technique. The two principle modali-\nties available are PET, with or without co-registered CT images, and whole body \nMRI (WB-MRI), both of which can be utilised to evaluate widespread disease states \nefficiently. The main application of these techniques has hitherto been oncological; \nhowever, as these techniques become more accepted, their use is becoming more \nvaried. PET provides functional assessment, utilising a radiotracer, most commonly \nFDG-18, to assess metabolic activity within tissues, with areas of greater metabolic \nactivity depicted as increased tracer uptake. The use of combined CT-PET enables \naccurate specific uptake values (SUV) to be determined, via attenuation correction, \nand anatomical co-registration which reduces perceptual errors. WB-MRI primarily \nprovides an anatomical assessment, using tissue contrast to identify pathology. \nThis typically uses water sensitive sequences to provide high sensitivity. “Physi-\nologic” MRI sequences, such as diffusion weighted imaging (DWI) can also be \nemployed to obtain functional MRI data, either qualitatively or quantitatively. There \nare advantages and disadvantages to both techniques, including ionising radiation \nexposure, acquisition times, movement and other artefacts, and reproducibility, \nwhich all need to be considered when choosing a particular technique for whole \nbody assessment in any given paediatric patient, with the disease process being \ninvestigated also influencing the technique used. The relative merits, clinical ap-\nplications and evidence base for the use of PET/CT and WB-MRI in paediatrics will \nbe discussed. Near future developments, such as PET-MRI will be touched upon. \nLearning Objectives:\n1. To get an overview of PET/CT and whole body MRI.\n2. To learn about advantages and limitations of each technique.\n3. To learn about examples of benign and malignant diseases.\nA‑450\t 17:00 \nC. Clinical application of image processing \nA. Persson; Linköping/SE (anders.persson@cmiv.liu.se) \nThe practice of medical image diagnosis is currently undergoing a fast transforma-\ntion. Vast amounts of data can be generated in standard examinations and focus \nis shifting from improving the collection of relevant data for diagnosis to develop-\nment of effective methods to analyse, visualise, navigate and interact with medical \ninformation. It is now becoming generally accepted in the medical community that \none of the most important keys to manage the increasing information work load is \nthe use of 3D and 4D applications. This talk will take its starting point in state-of-\nthe-art medical visualisation and then discuss the need for a research agenda that \nfocuses on the development of the next generation of medical visualisation tools, \nemphasising the fact that these tools must be based on medical user requirement \nand work flow studies as well as on new technical developments. \nLearning Objectives:\n1. To learn how to use adequate reconstructions/image sequences in CT/MR.\n2. To learn when to use transverse, sagittal and coronal displays.\n3. To learn when to use 3D displays.\n16:00 - 17:30 Room Q \nPaediatric \nRC 1412 \nChildren’s bones and joints \nModerator: \nM. Rasero; Madrid/ES \nA‑451\t 16:00 \nA. Imaging findings in childhood osteomyelitis \nR.R. van Rijn; Amsterdam/NL (r.r.vanrijn@amc.uva.nl) \nChildhood osteomyelitis is a relatively rare finding in childhood with an estimated annual \nincidence of 1 per 5000 and is predominantly seen in young children (< 5 years). It can \nbe caused by via haematogenous spread, contiguously from local areas of infection \nor from penetrating trauma or surgery. Usually it is caused by bacterial infections, but \noccasionally fungi, viruses or parasites are causative agents. Clinical findings can \nrange from mild to severe and depends on many factors such as age, site of infection, \nacute versus chronic osteomyelitis, and causative agent. The CRP and sedimentation \nrate are usually elevated; however, this is not always the case. Given the variability \nin clinical presentation radiology plays a crucial role in the detection of osteomyelitis. \nAlthough conventional radiography (CR) has a limited sensitivity and specificity for the \ndiagnosis of osteomyelitis, its wide availability makes it the first diagnostic technique \nof choice in children. For further analysis both MRI and radionuclide bone scintigraphy \n(RBS) have shown to have a high sensitivity for the detection of osteomyelitis. The \nadvantages and disadvantages of both the techniques will be addressed. CT mostly \nplays a role in the diagnosis of chronic osteomyelitis or in the pre-surgical work-up. \nThe use of radiology also allows for a differential diagnosis of osteomyelitis, based on \nclinical cases, an overview of this differential diagnosis will be given. The aim of this \nlecture is to present an evidence-based diagnostic strategy for childhood osteomyelitis. \nLearning Objectives:\n1. T o get an overview of current imaging practices in the evaluation of osteomyelitis.\n2. To learn about patterns of skeletal lesions found in osteomyelitis.\n3. To understand findings that point to alternative diagnoses.\nA‑452\t 16:30 \nB. Hip dysplasia: US techniques and recommendations \nK. Rosendahl; Bergen/NO (karen.rosendahl@helse‑bergen.no) \nDevelopmental dysplasia of the hip (DDH) is the most common musculoskeletal \ndisorder in childhood, with a reported prevalence of 1-4% according to method \nof ascertainment and definitions used. Ultrasound has enabled a detailed view of \nboth neonatal hip stability (NHI) and morphology, and two different schools have \ndeveloped; one arguing that NHI alone is the major pathology warranting splinting, \nthe other including acetabular dysplasia as an important feature. Both static (Graf, \nMorin) and dynamic (Harcke) ultrasound techniques, as well as a combination of \nthe two (modified Graf (Rosendahl)), have been described and are currently used. \nIn Europe, Graf’s ultrasound technique or a modification of this is commonly used \nwithin the German speaking countries and areas, in parts of Scandinavia, the UK, \nItaly, France, Hungary and the Netherlands. Others use a modified Morin’s method \nwhile Harcke’s method is used only occasionally. Initially, universal ultrasound screen-\n\nMonday\nPostgraduate.Educational.Programme\nA\n S115\nCB D E F G H\nMonday,.March.7\n\nPostgraduate.Educational.Programme\nS116\n A B C D E F G H\nthe GI tract are leading causes but any tumour involving the abdominal cavity or \nhaematological malignancy may be implicated. During treatment with chemotherapy \nor radiotherapy acute abdominal symptoms are common as a consequence of \ndirect toxicity. Imaging must be used as an adjunct to clinical assessment. Pat-\nterns of abdominal involvement are often modified in the later phases of disease. \nGI tract obstruction may be due to progression or the mechanical consequences \nof prior surgery and is more commonly at multiple levels. Perforation or fistulation \nmay occur with either progressive disease or tumour lysis in response to therapy. \nCancer does not protect against the common inflammatory conditions but poor host \nresponse and the use of steroids may mask signs leading to extensive abnormal-\nity at diagnosis. Bone marrow suppression increases susceptibility to infection \nincluding neutropenic enterocolitis and haemorrhage. Bone marrow transplantation \nand consequent graft versus host disease is a potent cause of acute abdominal \nsymptoms. CT is the major imaging technique although MR has an increasing \nrole particularly in the assessment of the female pelvis. Major determinants when \nconsidering the differential diagnosis include; the nature and initial stage of the \nprimary, any prior anatomical modification (surgery), the nature and relationship \nto current treatment and the bone marrow status. \nLearning Objectives:\n1. To be able to list neoplastic diseases that may potentially lead to acute \nabdominal symptoms.\n2. To appreciate the differences in causes and findings of the acute abdomen \nbetween the initial presentation with neoplasia and when undergoing \ntreatment.\n3. To understand typical CT findings and pitfalls, and the potential role of MRI.\n08:30 - 10:00 Room B \nInteractive Teaching Session \nE³ 1520 \nProstate cancer: what the radiologist must report \nA‑457\t 08:30 \nProstate cancer: what the radiologist must report \nA.R. Padhani1, H.-P. Schlemmer2; 1Northwood/UK, \n2Heidelberg/DE (anwar.padhani@stricklandscanner.org.uk) \nThis workshop will begin by describing the current limitations of MRI in evaluating \nprostate cancer patients and will show how to overcome these with advanced \nimaging techniques including diffusion weighted MRI (DW-MRI), MR spectroscopic \nimaging (1H-MRSI) and dynamic contrast enhanced MRI (DCE-MRI). The emphasis \nwill be on the use of processing tools that are readily available for clinical practice. \nWe will describe how to analyse images and provide a scheme for reporting findings \nback to surgeons/oncologists. We will show that using more than one MRI tool \nimproves imaging performance and that the relative importance of each technique \nremains unresolved. We will demonstrate new indications for advanced MRI in \nprostate cancer patients. \nLearning Objectives:\n1. To understand the current crisis in prostate cancer diagnosis and patient care.\n2. To appreciate that limitations of morphological imaging methods can be \novercome by functional techniques such as diffusion MRI, dynamic contrast \nenhancement and spectroscopy.\n3. To get to know the biological basis for observations, data acquisition and \nanalysis methods, validation, interpretation of data of these technique.\n4. To learn methods for reporting findings back to surgeons/oncologists.\n5. To appreciate that advanced MRI tools will enable us to tackle new \nindications in prostate cancer diagnosis.\n08:30 - 10:00 Room A \nRadiology in Abdominal Emergencies \nCC 1517 \nThe acute abdomen \nModerator: \nJ.‑M. Bruel; Montpellier/FR \nA‑454\t 08:30 \nA. Abdominal hernias \nG. Brancatelli; Palermo/IT (gbranca@yahoo.com) \nAbdominal hernias are common in daily practice and can be divided into: external \nor abdominal wall hernias, internal hernias and diaphragmatic hernias. External \nhernias typically involve protrusion of abdominal contents through a defect in the \nabdominal wall. Internal hernias involve protrusion of viscera through congenital \nor acquired defects in the mesentery or the peritoneum. Diaphragmatic hernias \ninvolve protrusion of abdominal contents into the chest. Among these conditions, \nthe diagnosis of internal hernia is the most challenging. Bariatric surgery and liver \ntransplantation with biliary-enteric anastomosis, with the Roux-en-Y loop placed \nin a retrocolic position, are recognised predisposing factors for internal hernia \ndevelopment. Symptoms of hernia are nonspecific and vague, and clinical and \nradiologic diagnosis can sometimes be challenging. Immediate diagnosis is man-\ndatory because misdiagnosis can be complicated by bowel obstruction, volvulus, \nstrangulation, incarceration, or trauma. MDCT with its multiplanar capabilities is \nwidely believed to facilitate this diagnosis, because it is able to delineate hernia \ntype, location, size, and shape and is particularly useful to diagnose unsuspected \nhernias. It also allows distinguishing hernias from masses of the abdominal wall, \nsuch as tumours, haematomas and abscesses. As a result, knowledge of the CT \nfindings of abdominal hernias may allow early and more accurate diagnosis, with \na resultant decrease in the mortality rate. \nLearning Objectives:\n1. To understand the predisposing factors, clinical presentation and \ncomplications of abdominal hernias.\n2. To be able to recognise abdominal hernias on imaging through multiple \nexamples with an emphasis on MDCT.\n3. To illustrate the postsurgical anatomy underlying internal hernias.\nA‑455\t 09:00 \nB. The wrong twist: mesenteric and omental torsion \nS.C. Efremidis; Ioannina/GR (sefremid@cc.uoi.gr) \nThe title of this talk limits the discussion of torsion to the mesentery and omentum. \nIt has to be mentioned, however, that an abnormal twist (torsion) can involve any \nperitoneal reflection of those suspending and fixating hollow viscera, (e.g. stomach, \nsmall bowel, cecum, sigmoid and gallbladder), solid organs, (e.g. spleen, ovaries), \nor even extraperitonel (extraabdominal) organs such as the testicles, leading to the \npathologic entity of volvulus or torsion of the corresponding viscous with its associ-\nated (different) imaging findings, prognosis and treatment. Moreover, twisting of the \nmesentery and volvulus can occur secondary to a variety of conditions including \ncongenital anomalies of intestinal rotation with variable prognosis. Finally, torsion \nof the omentum can be either primary or secondary, also associated with different \npathology, imaging findings and treatment. Consequently, a broad spectrum of \nabnormalities ensues related to the pathophysiology of torsion which requires a \ndetailed classification, an accurate description and the use of correct terminology \nmaking it impossible to be covered within the time limits of a presentation. There-\nfore, focusing the discussion on to abnormal twist of small bowel mesentery and \nomentum will simplify the approach to avoid overlaps and confusion. \nLearning Objectives:\n1. To understand the pathophysiology of mesenteric and omental torsion.\n2. To know the typical presentation on cross-sectional imaging modalities.\n3. To learn imaging strategies with focus on MDCT.\nA‑456\t 09:30 \nC. Acute stages in neoplastic diseases \nJ.A. Guthrie; Leeds/UK (Ashley.Guthrie@leedsth.nhs.uk) \nAfter the initial presentation, a patient with cancer enters a phase of active treat-\nment (surgery, chemotherapy or radiotherapy), and then remission/cure or palliative \nphases. An „acute abdomen“ may complicate any phase. The principle causes are \nobstruction, perforation, haemorrhage, ischaemia and sepsis. Tumours arising from \n\nMonday\nPostgraduate.Educational.Programme\nA\n S117\nCB D E F G H\n2. To become familiar with the technical imaging considerations and the proper \ndiagnostic algorithm.\n3. To know more about the typical imaging findings.\nA‑460\t 09:30 \nC. Interactive case discussion \nA.G. Rockall; London/UK (andrea.rockall@bartsandthelondon.nhs.uk) \nThis case-based lecture will present typical clinical cases of pelvic pain as well as \nsome unusual but important causes. Cases of acute and of chronic pelvic pain, and \nbenign as well as malignant disease will be included. The audience will have the \nopportunity to participate in case discussion by the use of interactive voting pads. \nThe selection of imaging modality for each clinical presentation and the importance \nof knowing the clinical findings at the time of the radiological interpretation will be dis-\ncussed. For each case, the key radiological features will be illustrated. The essential \nelements of the radiology report and the key information required by the clinician will \nbe discussed. In each case, the differential diagnosis and the need for follow-up imag-\ning will be considered. The key teaching points for each diagnosis will be reviewed. \nLearning Objectives:\n1. To introduce typical cases illustrating the role of imaging modalities in the \ndifferential diagnosis of pelvic pain in female patients.\n2. To motivate the audience by the use of voting pads to be involved in the \ndiagnostic process.\n3. To highlight the conclusion that may be drawn on the basis of the discussed \ncases.\n08:30 - 10:00 Room D1 \nKISS (Keep It Simple and Straightforward): Musculoskeletal MRI \nCC 1516 \nThe hip \nModerator: \nC.W.A. Pfirrmann; Zurich/CH \nA‑461\t 08:30 \nA. How I do it \nA. Kassarjian; Majadahonda/ES \nMR imaging of the hip and pelvis can be challenging given the complex anatomy, \nmultiple potential sites of injury, lack of dedicated hip coils, the deep location of the hip \njoint, and the tightly opposed intra-articular structures. Optimisation of patient position-\ning, scan parameters, and use of contrast can vastly improve diagnostic accuracy in \nassessing both intra- and extra-articular lesions that may result in hip and groin pain. \nLearning Objectives:\n1. To understand the influences of patient positioning, scan parameters and \nmagnet/coil technology on image quality.\n2. To learn how to optimise scan protocols to maximise patient throughput \nwithout compromising diagnostic quality.\n3. To recognise how and when to modify scan protocols to answer specific \nclinical questions.\nA‑462\t 08:55 \nB. Normal variants and pitfalls \nU. Studler; Basle/CH (studleru@uhbs.ch) \nThis lecture provides a practical approach to the fundamentals of normal cross-sectional \nanatomy of the hip. Basic knowledge necessary to identify the different portions and \ncontents of the joint anatomy is provided. A special emphasis is on cartilaginous struc-\ntures, the acetabular fossa, and capsular fibers and ligaments. Functional anatomy \nof muscles and tendons about the hip is reviewed. The location of bursae and their \nassociation with adjacent structures is discussed. In the second part of the lecture \nattendees will learn how to avoid commonly seen pitfalls about the hip. A special \nfocus on anatomic variants of the acetabular labrum simulating disease is given. \nOsseous variants including acetabular ossicles and the superior acetabular notch will \nbe explained and explored. Debates about the role of herniation pits referred to as a \nnormal variant are reviewed. The lecture offers an overview of muscular and tendinous \nvariations around the hip joint. \nLearning Objectives:\n1. To become familiar with the normal anatomy.\n2. To be able to identify normal variants.\n3. To appreciate the range of pitfalls that may simulate pathology.\n08:30 - 10:00 Room C \nCLICK (Clinical Lessons for Imaging Core Knowledge): Common \nClinical Cases \nCC 1518 \nFemale pelvic pain \nModerator: \nA.J.M. Maubon;  Limoges/FR \nA‑458\t 08:30 \nA. Clinical considerations \nG. Restaino, V. Chiantera; Campobasso/IT (gennares@hotmail.com) \nPelvic pain is an important part of clinical practice for any clinician who provides health \ncare for women. Pelvic pain may be acute, recurrent or chronic. Acute pelvic pain (APP) \nrarely lasts more than one month without crisis, resolution, or cure. Pain of more than \n1 or 3 or 6 months of duration is considered as chronic pelvic pain (CPP) and in many \nsettings may be considered and treated as an illness itself. Women who present with \nAPP frequently exhibit nonspecific signs and symptoms. Diagnostic considerations \nencompass multiple organ systems, including obstetric, gynaecologic, urologic, gastro-\nintestinal, and vascular aetiologies. As the first priority, urgent life-threatening conditions \n(e.g. ectopic pregnancy, appendicitis and ruptured ovarian cyst) and fertility-threatening \nconditions (e.g. pelvic inflammatory disease and ovarian torsion) must be considered. \nAdolescents and pregnant and postpartum women require unique considerations. \nCCP is a common and significant disorder of women, with a prevalence of 3.8-12%. \nMany disorders of the reproductive tract, gastrointestinal system, urological organs, \nmusculoskeletal system, and psychoneurological system may be associated with \nCCP , the most common being endometriosis, adhesions, irritable bowel syndrome \nand interstitial cystitis. Ultrasonography should be the initial imaging test because of \nits sensitivities across most aetiologies and its lack of radiation exposure. Computed \ntomography (CT) serves an important role in patients with nonlocalizing symptoms, \nan indeterminate US evaluation, or in patients who require a wider search beyond the \nfield of view available with US. Magnetic resonance imaging is an extremely useful \nsecond-line modality for problem solving after US or CT. \nLearning Objectives:\n1. To learn more about the clinical conditions causing pain in the female pelvis \nwithout an apparent origin.\n2. To be informed about the clinician’s way of thinking in the process of \ndifferential diagnosis.\n3. To become familiar with the potential role of imaging in the establishment of \nthe final diagnosis and planning of therapy.\nA‑459\t 09:00 \nB. Imaging techniques and typical findings \nB. Brkljacic; Zagreb/HR (boris.brkljacic@zg.htnet.hr) \nMany gynaecologic and nongynaecologic conditions causing pelvic pain are grouped \naccording to the anatomic origin; after determining whether the patient is pregnant \nimaging work-up is tailored to establish potential causes within and outside of pelvis. \nTransabdominal and transvaginal ultrasound (TVUS) with color duplex-Doppler are \nfirst imaging modalities. Examination technique will be discussed. Most patients \nwith pelvic pain and normal US findings have improvement or resolution of symp-\ntoms; normal TVUS has negative predictive value of 92%. US findings are often \ninconclusive, some diseases are hard to diagnose, and appearance of benign and \nmalignant conditions may overlap. CT is performed when US and/or clinical findings \nare equivocal or indicate pelvic abscess, haematoma, postpartum complications, \ncomplications of pelvic inflammatory disease, and when GI or urinary diseases need \nto be excluded. Advantage is availability in emergency, but CT lacks precise defini-\ntion of pelvic structures and includes exposure to ionising radiation, problematic in \nyoung or pregnant women. Examination technique and protocols will be presented. \nMRI has the highest accuracy. Fast MRI considerably shortened imaging time. \nFat-suppression sequences help to establish fat-containing lesions and increase \nthe conspicuity of inflammatory lesions. Different sequences will be discussed. MR \nis rated below US and CT for evaluation of acute pelvic conditions, but is excellent \nalternative when administration of iodinated contrast media or radiation exposure is \nundesirable, especially in young or pregnant patients. Long imaging times, limited \naccess and cost are major drawbacks of MRI. Imaging findings of various gynaeco-\nlogic and nongynaecologic conditions causing female pelvic pain will be presented. \nLearning Objectives:\n1. To learn about the available imaging modalities to be used for the evaluation \nof female patients with pelvic pain.\n\nPostgraduate.Educational.Programme\nS118\n A B C D E F G H\nA‑466\t 08:58 \nB. Vertebroplasty and kyphoplasty \nT. Sabharwal; London/UK (T arun.Sabharwal@gstt.sthames.nhs.uk) \nBone filling with cement aims to treat and prevent pathological fractures and relieve \npain in patients with osteoporosis and bone metastases. Several advances have \noccurred with new mechanical devices for effective restoration of vertebral height, \nas well as the introduction of osteoconductive and osteoinductive cements that will \npromote more physiological bone healing. \nLearning Objectives:\n1. To learn about indications to treat.\n2. To learn about how to treat non-surgically.\n3. To review the results. Is there evidence that it works on a long term or \nplacebo treatment?\nA‑467\t 09:21 \nC. Interventional management of painful osseous metastases \nA.G. Ryan; Waterford City/IE (jackoriain@yahoo.ca) \nAn overview of the interventional radiology management of painful osseus metas-\ntases will be presented. Consideration will be given to patient, lesion and treatment \nmodality selection (including radiofrequency ablation, cryoablation, microwave \nablation, laser ablation, ethanol ablation, MR focused ultrasound ablation, cement \nosteoplasty, transarterial embolisation and combinations therein, e.g. combined \nradiofrequency ablation and cement osteoplasty). The evidence supporting these \ntechniques and patient outcomes will be reviewed. \nLearning Objectives:\n1. To review the typical hierarchy of pain relief methods used in the treatment \nof painful osseous lesions.\n2. To review the technical and anatomic appropriateness of individual \ntreatments and their combinations.\n3. To review the evidence supporting the use of these techniques and their \nimpact on patients’ pain outcome.\nPanel discussion: \nExperience-based vs evidence-based practice in spinal \nintervention 09:44\nExperience/sense/empirical/economic vs evidence-based practice in spinal and \nextremity intervention. Who needs treatment and which modality (RFA, Cryo, os-\nteoplasty, embolisation, coblation) is best, alone or in combination? Which modality \nshould be recommended for management of painful osseous lytic or sclerotic le-\nsions in the spine or extremities? What are the interventional limitations and which \npatients should not be offered treatment by IR? \n08:30 - 10:00 Room E1 \nSpecial Focus Session \nSF 15a \nMolecular imaging made easy \nModerator: \nF.M.A. Kiessling;  Aachen/DE \nA‑468\t 08:30 \nChairman’s introduction \nF.M.A. Kiessling; Aachen/DE (fkiessling@ukaachen.de) \nMolecular imaging - defined as the non-invasive assessment of biological mecha-\nnisms at molecular and cellular level - will play a major role in future disease \ndiagnosis and treatment planning. In this context, the aim of this session is to \nintroduce in simple terms several major research areas in molecular imaging and \nto discuss their future potential for clinical radiology. \nSession Objectives:\n1. To learn about important applications for molecular imaging in drug \ndevelopment and in the clinics.\n2. To understand the main challenges and research tasks for molecular \nimaging.\n3. To become familiar with the areas where the profound knowledge of a \nradiologist is required.\n4. To identify areas in which radiologist’s interested in molecular imaging \nshould be trained.\nA‑463\t 09:20 \nC. Identifying and reporting abnormal findings \nP.M. Cunningham; Navan/IE \nThe differential diagnosis of hip pain is broad and includes intra-articular pathology, \nextra-articular pathology including referred pain from the spine, and mimickers \nincluding groin pain and pain from the joints of the pelvic ring. The diagnosis of all \ncauses of hip pain/pathology has improved with greater use of magnetic resonance \nimaging (MRI) to complement traditional investigations. In this session pathology \ninvolving the hip and groin will be reviewed in a systematic way which will outline an \napproach to the hip that will allow the reader to maximise their diagnostic ability. The \nreview will include evaluation of bone marrow disorders such as avascular necrosis \nand transient osteoporosis and intra-articular pathology including labral tears and \nfemoroacetabular impingement (arthritis and traumatic fractures will not be reviewed). \nExtra-articular diagnoses such as bursitis, groin pain (osteitis pubis and adductor/\ngracilis dysfunction) and common muscle and tendon injuries will then be reviewed. \nLearning Objectives:\n1. To review the imaging appearances of common abnormalities.\n2. To understand the use of terminology to describe pathological findings.\n3. To learn how to structure a radiological report to ensure clarity and brevity.\n08:30 - 10:00 Room D2 \nInterventional Radiology \nRC 1509 \nMusculoskeletal interventions \nModerator:\nA. Gangi; Strasbourg/FR \nA‑464\t 08:30 \nChairman’s introduction \nA. Gangi; Strasbourg/FR (gangi@rad6.u‑strasbg.fr) \nToday, many procedures of bone and joint are performed under imaging control. \nMinimally invasive procedures require less resources, time, recovery, and cost, and \noften offer reduced morbidity and mortality, compared to other modalities. Many \npercutaneous techniques are available. Some aim to treat pain and consolidate \nbone (cementoplasty). Others ablate or reduce the tumour (chemical and thermal \nablation techniques). The interventional radiologist with an efficient imaging-guided \ntechnique (flat panel fluoroscopy, CT, and MRI) can increase the precision of the \nabove-described procedures allowing an improvement of the results and reduc-\ntion of the complications. Furthermore, the presented interventions are carried out \neither on an outpatient basis or with 24 hours hospitalisation which contributes \nto the reduction of overall costs and presents a major advantage for patients of \nworking age. Some of these minimally invasive procedures can be considered \nas alternatives to surgery without excluding further surgical options if necessary. \nA‑465\t 08:35 \nA. Guidelines for spinal infiltrations and nerve blocks \nS. Masala; Rome/IT (salva.masala@tiscali.it) \nBack pain is one of the most common complaints, it is estimated that almost 50% of \nworking adults will experience it in any given year. Diseases of peripheral skeleton \nmay produce painful symptomatology as well. Some of the algogenic structures \nof the spine and peripheral skeleton are lumbar intervertebral discs, facet joints \nand atlanto-axial/occipital joints, sacroiliac joints, nerve root dura, periosteum, \nligaments, fascia. Among several aetiologies which can involve these structures, \nspine degenerative pathology plays the leading role. Nowadays, several different \ninterventional techniques are available, each one with its specific target of action. \nWith the right indication each of them has been proved to be effective as painkill-\ning modality. Herein, we present an up to date comprehensive overview on the \ninterventional techniques available with their own indications. \nLearning Objectives:\n1. To learn about examination methods and indications to treat.\n2. To learn about treatment modalities.\n3. To review results.\n\nMonday\nPostgraduate.Educational.Programme\nA\n S119\nCB D E F G H\nare explained. Principle requirements for clinical translations of MR-based molecular \nimaging strategies are discussed. \nLearning Objectives:\n1. To get an overview on clinical studies on USPIO-based lymph node imaging \nand cell tracking.\n2. To learn about different designs for molecular MR-probes.\n3. To understand the principle of activatable MR-contrast agents.\n4. To identify areas for clinical translation.\nPanel discussion: \nWhich role can radiologists easily play in molecular imaging? 09:44\nA.K. Dixon; Cambridge/UK \nDisease stage, aggressiveness, and therapy response are not sufficiently charac-\nterised by morphologic features. Therefore, imaging should assess disease-specific \npathophysiology down to the cellular and molecular level. Multimodal imaging and \nexperts with profound knowledge about imaging modalities and diagnostic agents \nare required. However, knowledge about the molecular biology of pathologies is \nalso needed. Mostly interdisciplinary teams will drive this innovative field forward, \nin which the role of radiologist will be discussed. \n08:30 - 10:00 Room E2 \nSpecial Focus Session \nSF 15b \nCT of small airways: elementary images for disease \nclassification \nModerator: \nJ.A. Verschakelen;  Leuven/BE \nA‑472\t 08:30 \nChairman’s introduction \nJ.A. Verschakelen; Leuven/BE (johny.verschakelen@uz.kuleuven.ac.be) \nSmall airways and small airways diseases (SAD) have attracted a lot of interest that \nhas resulted in a large number of publications since the early 1970s. Despite the \nseveral histopathological and clinical subtypes that have been described diagnosis \nis not always obvious. The introduction of thin section CT and the fact that this CT \ntechnique is able to depict signs of SAD has not only renewed interest but has \nalso improved insights in these disorders. In this session the direct and indirect \nCT signs of SAD will be presented and the CT techniques that can improve their \ndetection will be explained. Correlations between pathological findings and the \npresence of these CT signs will be made and diseases that can mimic these CT \nfindings will be discussed. Schemes of classification of SAD based on clinical and \npathological findings will be discussed briefly, but most attention will be given to the \nradiological classification, which is based on the recognition of the direct and indirect \nsigns of SAD. Algorithms that help to identify the cause of SAD will be presented. \nFinally, the use of CT and also of MR as a tool to examine the structure-function \nrelationship in SAD will be discussed. It will be shown how careful interpretation \nand software tools can help to generate data about disease extent and global and \nregional lung function. \nSession Objectives:\n1. To become familiar with the direct and indirect CT signs that indicate the \npresence of small airway disease (SAD).\n2. To understand how these signs can be helpful in classifying and diagnosing \nthe different types of SAD.\n3. To learn about the use of CT and other imaging methods to determine \ndisease extent and disease activity, and to predict pulmonary function \ndeterioration.\nA‑473\t 08:35 \nBasic signs in small airways disease \nD.M. Hansell; London/UK (davidhansell@rbht.nhs.uk) \nThe ability to recognise direct and indirect signs of small airways disease on \nHRCT has led to renewed interest in these elusive disorders. The “purest” of these \ndiseases is constrictive obliterative bronchiolitis which is manifested on HRCT by \nthe indirect sign of a mosaic attenuation pattern; the differential diagnosis for mo-\nsaicism and an algorithm that helps to identify the correct cause of small airways \ndisease will be presented. The necessity for routine expiratory HRCT to make the \ndiagnosis of obliterative bronchiolitis is controversial and will be discussed jointly \nA‑469\t 08:35 \nProbes and targets in optical imaging \nC.W.G.M. Löwik; Leiden/NL (c.w.g.m.lowik@lumc.nl) \nWhole body fluorescent imaging and bioluminescent imaging are now widely ap-\nplied in small animals to study all kinds of biological and molecular processes like \ni.e. gene expression, tumour progression and metastasis, apoptosis, inflammation, \nangiogenesis, proteolysis and to follow trafficking, differentiation and fate of cells \n(i.e. stem-, immune- and tumour cells). This has been done mainly by using gene \nreporters expressing fluorescent proteins or luciferases. Recently new mutated \nred shifted fluorescent proteins (with better light penetration and less absorption \nand autofluorescence) and codon optimized and mutated luciferases have been \ndeveloped making optical imaging more sensitive and offering the possibility to \nuse dual gene reporters. Apart from new „smart gene reporters“ there has also \nbeen a great development in injectable near infrared fluorescent (NIRF) probes, \nespecially for tumour detection. These NIRF probes can either be targeted or \nenzyme-cleavable. These new developments has opened up the possibility to \napply NIRF imaging in the clinic especially to image tumour tissue and to identify \nsentinel lymph nodes during operation. The assessment of the tumour-free margin \nduring cancer surgery is critical to completely remove the tumour and improve \nthe prognosis of the patient. By injecting a tumour specific NIRF probe, tumour \ntissue and local metastases can be visualised in real-time during operation using \na dedicated NIRF camera system. We now already use NIRF imaging in the clinic \nto detect the sentinel lymph node (SLN) in several types of cancers. In the current \npresentation preclinical and clinical applications of NIRF imaging in image-guided \nsurgery will be discussed. \nLearning Objectives:\n1. To understand the principle of near infrared optical imaging.\n2. To learn about the strengths and limitations of optical imaging.\n3. To understand the principle of activatable probes.\n4. To identify indications for its use in preclinical and clinical research as well \nas in clinical routine.\nA‑470\t 08:58 \nUltrasound providing molecular imaging \nM. Palmowski; Aachen/DE (mpalmowski@ukaachen.de) \nTargeted ultrasound contrast agents have opened up the door for molecular \nimaging with sonography. These contrast agents, which consist of encapsulated \ngas microbubbles, are coated with antibodies or specific ligands. Injected into \nthe circulation, microbubbles are retained in diseased tissue where they can be \ndetected and quantified by different approaches such as “semiquantitative 2-D” \nor “quantitative 3-D” imaging techniques. Due to their size, microbubbles behave \nsimilar to red blood cells and remain within the intravascular space. Therefore, \nthe disease process must be characterised by specific molecular changes on the \nsurface of the endothelial cells to be assessable by ultrasound. Several angio -\ngenic markers such as VEGFR2, αvβ3-integrins, ICAM-1 and VCAM are known \nto be overexpressed by the endothelium in neoplastic, inflammatory and vascular \ndiseases. Thus, molecular ultrasound imaging seems perfectly suited to detect \nthese markers and monitor changes which might occur during treatment response \nor disease progression. Today, targeted ultrasound contrast agents are becoming \na routinely used preclinical tool and the first application of specific microbubbles in \na clinical scenario is expected for the near future. This talk will introduce into the \nprinciples of molecular imaging with ultrasound. Based on recent studies, basics of \ntumour biology, potential endovascular targets, synthesis of molecular probes and \ndifferent imaging approaches for a preclinical and clinical application of molecular \nultrasound will be discussed. \nLearning Objectives:\n1. To learn about potential targets and indications for molecular ultrasound \nimaging of tumour angiogenesis.\n2. To understand the principle of target-specific ultrasound contrast agents.\n3. To learn about different MB detection techniques and about the requirements \non ultrasound hardware.\nA‑471\t 09:21 \nMR in molecular imaging \nE.A. Schellenberger; Berlin/DE (eyk.schellenberger@charite.de) \nA summary about the advantages, problems and challenges of USPIO-based lymph \nnode diagnostics are given. Examples of clinical cell tracking are demonstrated. \nThe contrast mechanisms of paramagnetic and superparamagnetic contrast agents \nand their use for the design of non-targeted, targeted and activatable MR imaging \nprobes are explained. The function of different designs of activatable MR-probes \n\nPostgraduate.Educational.Programme\nS120\n A B C D E F G H\n(helium or xenon), oxygen-enhancement or other technologies. All of these might \nalso provide quantitative read-outs for disease and/or therapy monitoring. \nLearning Objectives:\n1. To learn how CT and other imaging methods can be used to examine the \nstructure-function relationship in SAD.\n2. To review the state-of-the-art imaging methods that can provide information \nabout disease extent, disease activity and global and regional lung function \nin patients with SAD.\n3. To become familiar with the current use and the future developments of \nthese techniques.\nPanel discussion: \nSigns of small airways disease can be seen on CT but when and why do \nthey really matter? 09:44\nSigns of small airways disease are a frequent finding on CT especially when \nexpiratory scans are performed in addition to inspiratory scans. When should we \nreport these changes? Are they always important, do they perhaps predict the \ndevelopment of more severe disease, or are there cases where they have little \ninfluence on diagnosis and therapy? When should an expiratory scan be performed? \n08:30 - 10:00 Room F1 \nAbdominal and Gastrointestinal \nRC 1501 \nRectal cancer imaging: all you need to know \nModerator:\nG. Brown; Sutton/UK \nA‑476\t 08:30 \nChairman’s introduction \nG. Brown; Sutton/UK (gina.brown@rmh.nhs.uk) \nCareful preoperative staging and preoperative using high-resolution MRI together \nwith preoperative multidisciplinary team discussion has been shown to reduce \nmargin involvement by tumour from 30% to < 5% by identification of patients that \nrequire more radical preoperative therapy and surgery. The detailed demonstra -\ntion of preoperative prognostic factors also recognises patients on imaging that \nare not at risk of local recurrence and therefore the avoidance of unnecessary \npreoperative therapy in a proportion of patients. The use of EUS can help in the \nassessment of early stage flat lesions suitable for local excision and is a powerful \ncomplementary tool. PET-CT is crucial for the preoperative work up of patients \nundergoing radical procedures such as metastatectomy. Follow-up for colorectal \ncancer patients at high risk for developing recurrent disease is now well established, \nand the emergence of specialised multidisciplinary teams, combined with a range \nof treatment options for recurrent disease has improved curative resection rates \nfollowing metastatectomy and pelvic recurrence surgery. Radiologists with a solid \nunderstanding of not only the pathological manifestations of primary and recurrent \nrectal cancer but also the treatment options available play a key role in enabling \nthe appropriate selection of patients - increasing overall cure rates and reducing \ntreatment-related morbidity. This refresher course aims to provide radiologists \nwith an understanding of local staging of rectal cancer, the assessment of recur-\nrent disease, and assessing response to treatment. The course will highlight how \nimaging underpins the key preoperative decisions for surgical and oncological \ntreatment planning in rectal cancer. \nA‑477\t 08:38 \nA. Staging with US and CT \nA. Maier; Vienna/AT (andrea.maier@meduniwien.ac.at) \nFor rectal cancer surgery a variety of alternative operations are currently pos-\nsible. Furthermore, there is an increasing trend towards treating patients with \nradiotherapy before surgery. The choice of operation and the decision whether \nto employ radiotherapy is based on preoperative staging. In patients with primary \nrectal cancer accurate assessment of tumour extent and the presence or absence \nof lymph node invasion are factors for determining prognosis and risk of tumour \nrecurrence. Endorectal ultrasound (EUS) is effective for T-staging. It has been \nrecommended as the investigation of choice in the selection of potentially curative \nlocal excision. Lymph node staging by this method is less precise than tumour \nstaging. Initial reports of the use of CT for tumour staging were encouraging. \nStudies which compare CT with EUS staging consistently show the latter to be \nmore accurate for both tumour stage and lymph node stage. Thus, the usefulness \nby the speakers at the end of the session. At the other end of the clinical and \nimaging spectrum to obliterative bronchiolitis is exudative small airways disease, \ntypified by (Japanese) diffuse panbronchiolitis. The exudative bronchiolitides are \ncharacterised by direct signs on HRCT, notably a tree-in-bud pattern. While this \nis a readily appreciated and specific sign, other diseases that mimic this HRCT \nfinding will be discussed. Bronchiectasis of variable severity is a usual accompani-\nment to both obliterative and exudative bronchiolitis and the relationship between \nlarge and small airways disease will be explored. The instances in which HRCT \nfindings of obliterative and exudative bronchiolitis co-exist are relatively few, and \nthe differential diagnosis for this situation will be considered. In practice, HRCT \nwill often show signs of bronchiolitis (whether obliterative or exudative) limited to \na segment or even subsegment, and the interpretation of the clinical significance \nof such a chance finding is sometimes a difficult judgement. \nLearning Objectives:\n1. To become familiar with the direct and indirect signs of small airway \ninvolvement on CT.\n2. To know how to correlate these signs with the pathological changes.\n3. To understand the differential diagnosis with other diseases that can show \nsimilar CT findings.\nA‑474\t 08:58 \nFrom pattern to diagnosis \nC. Beigelman; Paris/FR \nVarious schemes of classification of SAD have been proposed according to clinical, \npathologic or imaging criteria that are confusing. An optimal approach, mainly based \non CT analysis of direct and indirect features, usually allows the recognition of the \ntwo main types of SAD, namely inflammatory/exudative and fibrotic/constrictive/\nobliterative bronchiolitis. A miscellaneous group that corresponds to bronchiolar \ninvolvement in diverse diffuse lung diseases may also be individualised. Direct signs \nof SAD that refer to direct visualisation of diseased bronchioles strongly suggest \ninflammatory bronchiolitis. They mainly consist in centrilobular nodules with tree \nin bud appearance. Conversely, indirect signs mainly represented by mosaic at-\ntenuation, air trapping, bronchial wall thickening and dilation characterise fibrotic \nbronchiolitis. Volumetric acquisition, performed a dose reaching that obtained \nwith classical HRCT protocols, may be of interest in several ways. Particularly, \nmaximum intensity projection tool may facilitate the recognition of the tree in bud \npattern. The minimum intensity projection mode may optimise the recognition of \nthe mosaic attenuation pattern requiring an appropriate contrast resolution, as \nwell as the analysis of proximal airways. Expiratory CT, optimally performed on a \ndynamic mode, may be useful in some conditions at a dose equivalent to around 2 \nchest x-rays. A combination of post-processing tools from a volumetric acquisition \nperformed with carefully chosen parameters might therefore appear useful in the \nevaluation of SAD. Furthermore, additional co-existing findings such as ground glass \nopacity or other features of interstitial pneumonias may be detected. Their analysis \nmay help to recognise the cause of SAD in addition to clinical data. \nLearning Objectives:\n1. To learn about the different types of SAD and to become familiar with the \nterminology used to describe them.\n2. To understand how CT can help to classify these different types of SAD.\n3. To learn how CT can contribute to the specific diagnosis.\nA‑475\t 09:21 \nBeyond morphology \nH.-U. Kauczor; Heidelberg/DE (Hans‑Ulrich.Kauczor@med.uni‑heidelberg.de) \nStructural changes associated with SAD are difficult to depict directly on CT. Indirect \nsigns of SAD, such as mosaic attenuation on an inspiratory scan and/or air trapping on \nan expiratory scan, are common findings. They nicely illustrate the structure-function \nrelationship between obstruction or expiratory collapse of the small airways and the \nsubsequent effects on ventilation (local hyperinflation) and perfusion (hypoxic vaso-\nconstriction). These “functional” signs are thought to be more sensitive than the direct \nvisualisation of the underlying structural changes. Careful interpretation and software \ntools help to generate data about disease extent as well as global and regional lung \nfunction. Beyond paired inspiratory-expiratory CT scanning, dynamic expiratory cine \nas well as perfusion and ventilation imaging on the basis of both, CT and MRI, can \nbe applied to increase sensitivity, specificity and accuracy of the diagnosis of SAD. \nSome of them are ready for routine clinical use, such as dynamic expiratory cine \nCT, cine MRI during continuous breathing as well as gadolinium-enhanced perfusion \nMRI. Future developments in the fields of CT and MRI will provide novel technical \napproaches for functional imaging of SAD. These will include novel applications of dual \nenergy/spectral CT using iodine-enhancement for perfusion and xenon-enhancement \nfor ventilation enhancement as well as ventilation MRI using hyperpolarised gases \n\nMonday\nPostgraduate.Educational.Programme\nA\n S121\nCB D E F G H\nafter apparently curative chemoradiation. The potential contribution of newer tech-\nniques (including perfusion CT, diffusion-weighted MR, PET CT, USPIO-enhanced \nMR for lymph node imaging etc) will be discussed. \n08:30 - 10:00 Room G/H \nNeuro \nRC 1511 \nEpilepsy \nModerator: \nB. Gómez‑Ansón; Barcelona/ES \nA‑480\t 08:30 \nChairman’s introduction \nB. Gómez-Ansón; Barcelona/ES (bgomeza@santpau.cat) \nIntractable epilepsy is a common and relevant medical condition, where imaging \nhas made a tremendous impact. Neuoradiology (MRI) has improved diagnosis in \npatients with epilepsy, making it possible to recognise underlying pathologies that \nmay have different, curative treatment options. This is the case of hippocampal \nsclerosis, and of abnormalities of cortical development, conditions with very different \ntreatment options, and prognosis. In addition, MRI has added in the recognition and \ncharacterisation of neoplasms in the context of epilepsy. Finally, neuroradiology has \ndemonstrated to be a valuable tool for surgical treatment of patients with epilepsy. \nNew MR techniques add anatomical detail and more precise risk assessment of \npostsurgical deficits, thus providing important information for patients´management. \nIn this RC, a general insight of imaging in epilepsy, including indications, protocols, \nand the most common neuroradiological conditions to be identified, will be covered. \nParticular interest will be given to tumours as a cause of epilepsy, and to their more \nrelevant neuroradiological aspects. Finally, the contributions of different imaging \ntechniques in the specific context of epilepsy surgery will be reviewed. \nSession Objectives:\n1. To get a general insight of imaging in epilepsy.\n2. To understand how neuroradiology improves the diagnosis and management \nof patients with tumours and epilepsy.\n3. To learn about the contribution of imaging in the context of surgery for \nintractable epilepsy.\nA‑481\t 08:35 \nA. Tumour as a cause of epilepsy \nM. Stajgis; Poznan/PL (stajgis@o2.pl) \nBrain tumours are a common cause of epilepsy more often in adults, less in children. \nTumours detected in patients with chronic epilepsy are predominantly located in the \nbrain cortex area, affecting the temporal lobe most often. Any benign or malignant \nbrain tumour can be responsible for seizures, but some are more frequently as-\nsociated with epileptic symptoms. Low-grade astrocytomas, oligodendrogliomas, \ngangliomas, dysembryoplastic neuroepithelial tumours (DNETs) and glioblastomas \nmultiforme are the tumours significantly often presenting with seizures in adult \npopulation. Brain tumour-related epileptogenesis in not fully understood yet, but \none can list a number of factors playing an important role in this process, including: \ndisruption of physiological neuronal structure, tumour affection on the release of \nneurotransmitters and abnormal electrical activity of the brain. Different imaging \ntechniques are widely used for evaluation for neoplasms in epileptic patients. CT \nis reserved for acute conditions, one must remember to exclude other possible \naetiologies of seizures like haemorrhage, trauma or inherited malformations. \nMRI remains the gold standard in imaging investigation of patients with epilepsy. \nConventional pre- and post-contrast SE sequences are mandatory to perform in \nevery subject. Newer and more sophisticated techniques such as diffusion-weighted \nimaging (DWI), functional studies (fMRI), spectroscopy (MRS) and PET are helpful \nin qualification for surgery and preoperative functional mapping. \nLearning Objectives:\n1. To be aware of the common neoplasms that may cause epilepsy.\n2. To understand why and how a neoplasm can cause epilepsy.\n3. To be familiar with different imaging techniques for evaluating for neoplasms \nin epilepsy patients.\nof CT for rectal cancer is disappointing. Accurate assessment of local spread can \nonly be achieved in advanced tumours. The value of CT as an investigation tool \nfor staging rectal cancer has to be seen in the detection of distant metastases. \nNew approaches with perfusion technique may lead to an increased relevance of \nCT in the preoperative assessment of rectal cancer. \nLearning Objectives:\n1. To describe the technique of endorectal ultrasound illustrated with both \nnormal and abnormal findings.\n2. To discuss the role of endorectal ultrasound in rectal cancer staging.\n3. To describe state-of-the-art CT techniques for local staging of rectal cancer.\n4. To discuss the role of optimised CT techniques in rectal cancer staging.\nA‑478\t 09:00 \nB. Staging with MRI \nL.C.O. Blomqvist; Stockholm/SE (lennart.k.blomqvist@ki.se) \nMRI has become established as the modality of choice for preoperative local staging of \nrectal cancer. The most important general advantages of MRI compared to other cross-\nsectional imaging modalities are the soft tissue contrast resolution between the propria \nmuscle layer of the rectum and the perirectal fat, the ability to visualise the different pelvic \ncompartments including the visceral pelvic (mesorectal) fascia and the surrounding \ntissues in the pelvis. High resolution T2-weighted sequences sagittal, transaxial and \nperpendicular to the tumour is the basic standard for morphological evaluation of the \ntumour, the distance of the tumour to the anal verge and for evaluation of extramural \nextension and the distance to the circumferential resection margin. Presence of other \nadverse features such as extramural venous invasion and local lymph node metastases \nis also noted. The MR-images are ideally demonstrated by the radiologist in a local \nmultidisciplinary conference to make sure that the information is used to select the best \npossible treatment for the patient. When neo-adjuvant treatment is administered, MRI \nis usually performed both before and after treatment to assess treatment response. \nWhen planning surgery, both the pre- as well as the post-treatment images should be \navailable for surgical planning. Finally in this lecture, the potential benefits of 3 T com-\npared to 1.5 T for pre-operative imaging of rectal cancer as well as the present role of \nadditional techniques, such as diffusion-weighted imaging (DWI) and specific contrast \nagents that have been evaluated for assessment of rectal cancer will be addressed. \nLearning Objectives:\n1. To describe optimised MR techniques for rectal cancer staging.\n2. To understand the role of the radiologist in the context of the multidisciplinary \nassessment and correct triaging of patients with rectal cancer.\n3. To discuss the follow-up of patients post neoadjuvant chemoradiation.\n4. To discuss the potential impact of modern MR imaging techniques in \nimproving rectal cancer staging (3 Tesla, diffusion-weighted MR, USPIO-\nenhanced MRI for lymph node imaging etc).\nA‑479\t 09:22 \nC. Monitoring therapy and detection of local recurrence \nR.G.H. Beets-Tan; Maastricht/NL (r.beets.tan@mumc.nl) \nLocally recurrent rectal cancer is the main concern after rectal cancer surgery and \nhas long been regarded as a rarely curable disease. Patients were treated palliatively, \nand subsequent median survival was 14 months and the 5-year survival rate was 5%. \nHowever, during the past 20-30 years, more patients were considered candidates for \ncurative treatment due to better treatment options. Patients with distant recurrences \nfrom colorectal cancer, especially those in the liver or lung, have improved chances for \ncure with better imaging, better surgery and alternative minimal invasive treatment. In \nthe follow-up after colorectal cancer surgery it is thus important to detect recurrences \nat an early stage. Besides CEA, imaging is often used as a surveillance tool. It is still \nunclear which is the most cost-efficient (imaging) tool for monitoring distant and local \nrecurrences. This lecture aims at providing the evidence for surveillance by imaging \nand reviewing the guidelines for the detection of recurrences after colorectal cancer \nsurgery. It will also discuss the role of MRI for establishing resectability of locally \nrecurrent rectal cancer and the imaging patterns and features of recurrent disease. \nLearning Objectives:\n1. To understand the evidence base for follow-up after treatment of primary \nrectal cancer.\n2. To review the guidelines for imaging of local recurrence and distant disease.\n3. To understand the patterns of recurrent disease.\nPanel discussion: \nWhat are the clinicians really expecting from us: the main questions/\nanswers 09:44\nThe chairperson and speakers will discuss an integrated approach to the imaging of \nrectal cancer based on the range of currently available techniques and therapeutic \noptions. The use of imaging in post treatment patients will be discussed along with \nthe potential for MRI to triage and follow-up patients in whom surgery is withheld \n\nPostgraduate.Educational.Programme\nS122\n A B C D E F G H\n08:30 - 10:00 Room I/K \nCardiac \nRC 1503 \nImaging advanced stages of ischaemic heart \ndisease \nModerator: \nJ.‑N. Dacher; Rouen/FR \nA‑484\t 08:30 \nA. CT: angiography, function and perfusion \nG. Feuchtner; Innsbruck/AT (Gudrun.Feuchtner@i‑med.ac.at) \nMultislice coronary computed tomography angiography (CTA) is an accurate tool in \nthe non-invasive work-up of patients with suspected coronary artery disease (CAD). \nIts strength comprises a high sensitivity in detecting coronary stenosis > 50% and \nan excellent negative predictive value. The stringent limitation of CTA lies in its \nconfinement to anatomic grading of coronary stenosis and a lack of information \nregarding whether a stenosis causes reversible myocardial ischaemia indicating \nthe need for coronary revascularisation. Recently published data in animals and \nhumans indicate that myocardial computed tomography perfusion (CTP) imaging \nis feasible, promising and accurate. The advantage of CTA is the comprehensive \nevaluation of coronary arteries and myocardial perfusion defects from the same \ndatasets, which permits both visualisation of coronary anatomy and physiology. \nFurther, CT provides information about regional and global myocardial function. The \naim of this course is to understand basic principles of CT perfusion and functional \nimaging, to learn \"how-to\" perform CTP and comprehensive CTA/CTP scans, to \nreview current scientific evidence and to discuss potential clinical applications. \nLearning Objectives:\n1. To review the performance of CT in CAD.\n2. To understand the role of functional assessment and how it can help in \nreaching the correct diagnosis.\n3. To review the current data supporting the use of CTA perfusion.\nA‑485\t 09:00 \nB. MR perfusion imaging: how much quantification do we need? \nL. Natale; Rome/IT (lnatale@rm.unicatt.it) \nNuclear medicine tests (SPECT and PET), MRI and more recently MDCT have been \ninvolved in myocardial perfusion imaging. In clinical practice, perfusion analysis is \nroutinely performed with qualitative or semiquantitative assessment, both based \non relative evaluation of uptake or enhancement of myocardium, considering a \nremote region as normal. However, the assumption of part of myocardium as \nnormal can be wrong and cause false negatives. Absolute quantification has been \nintroduced mostly with PET perfusion imaging (water, ammonia and rubidium), \nbut its incremental value for the clinical decision making has not been widely \ninvestigated. More recently, MR perfusion imaging has been used for quantitative \nanalysis with different technical approach. There are some clinical scenarios where \nquantification can change the clinical interpretation: 1. multivessel coronary artery \ndisease (CAD), 2. balanced multivessel CAD, 3. exclusion of CAD in symptomatic \npatients, 4. microvascular disease, 5. revascularised patients. However, there are \nstill some limitations in the use of absolute quantification: first, the setting of cut-\noff value for normal or abnormal perfusion; second, some clinical situations, such \nas heart failure patients, where perfusion is reduced and heterogeneous. Finally, \nstudies concerning the prognostic value and the cost-effectiveness are needed. \nLearning Objectives:\n1. To review the different quantification techniques and indices available.\n2. To become familiar with the strengths and limitations of the various \nquantification techniques.\n3. To understand the current and future role of MR perfusion imaging in risk \nstratification of patients with CAD.\nA‑486\t 09:30 \nC. Imaging patients after bypass surgery \nK.-F. Kreitner; Mainz/DE (kreitner@radiologie.klinik.uni‑mainz.de) \nBesides drug therapy, the mainstays in the treatment of coronary heart disease \n(CHD) are interventional therapy and coronary bypass surgery. The need to image \ncoronary bypass grafts is based on their limited lifetime: the occlusion rate at 10 \nyears ranges between 5 and 15% for arterial, and between 40 and 50% for venous \nA‑482\t 08:58 \nB. Non-neoplastic causes of epilepsy \nM.A. Papathanasiou; Athens/GR (matpapath@hotmail.com) \nEpilepsy is a common disorder with a prevalence of up to 1% in the general \npopulation. Epilepsies are broadly classified into generalized and focal. Though \nmost generalised seizures are controlled pharmaceutically, 30% of focal seizures \nare medically intractable. In this subset of patients, the overall sensitivity of MRI \nin identifying responsible substrates is approximately 80%. The purpose of neu-\nroimaging in epilepsy patients is to identify underlying structural abnormalities that \nrequire specific treatment (usually surgical) and to aid in formulating a syndromic \nor aetiologic diagnosis. In this presentation imaging findings of the most common \nnon-neoplastic lesions responsible for focal epilepsy, namely: a. hippocampal \nsclerosis, b. malformations of cortical development, c. vascular abnormalities and \ne. gliosis, will be discussed along with their differential diagnosis and pertinent \nimaging pitfalls. Since routine MR imaging is suboptimal in identifying epileptogenic \nsubstrates, imaging should be tailored accordingly. Hippocampal sclerosis, the \nmost common cause of mesial temporal lobe epilepsy, is best demonstrated when \nthe temporal lobes are imaged with thin sections in coronal plane perpendicular \nto the longitudinal axis of the hippocampus. Inversion recovery sequences best \ndemonstrate morphology and volume loss in the hippocampus, mammilary body \nand fornix. T2 and FLAIR images best demonstrate the increased signal due to \ngliosis. For malformations of cortical development FLAIR is useful in assessing \nhyperintense signal. T1 gradient volume sequences can demonstrate subtle devel-\nopmental malformations. Finally, because many epileptogenic lesions are subtle \nand easily overlooked, a systematic diagnostic approach to MRI interpretation in \nthe clinical setting of epilepsy is helpful and will be discussed. \nLearning Objectives:\n1. To learn the characteristics of non-neoplastic causes of epilepsy.\n2. To learn the characteristic neuroimaging findings that may be useful in \nestablishing differential diagnoses.\n3. To be aware of differences in diagnosis depending on age.\nA‑483\t 09:21 \nC. Multimodality epilepsy protocol \nL. Stenberg; Lund/SE (lars.stenberg@med.lu.se) \nEpilepsy surgery is an effective and safe therapy for selected patients with intrac-\ntable localisation-related epilepsy. When morphological MRI fails to reveal focal, \nstructural pathology (e.g. tumour, dysplasia, etc). as the putative aetiology for the \nseizures, other modalities may be taken into account. In the absence of structural \npathology it is essential to identify the epileptogenic zone as exactly as possible \nin order to (a) increase the chance of a good outcome (reduction or termination of \nseizures) and (b) limit post-surgical sequelae. This lecture will cover some modali-\nties that may add valuable information in this process. The need to individualise the \npre-surgical evaluation and the concept of a multimodality epilepsy protocol will be \ndiscussed. The main focus will be on SPECT (single-photon-emission computed \ntomography), functional MRI, PET (positron-emission tomography) and the added \nvalue of co-registration on morphological MRI (e.g. SISCOM). Briefly, ictal SPECT \nmay help to identify focal areas of hyperperfusion (ictal zones). Functional MRI is \nused for several reasons. One is to determine language laterality (dominant hemi-\nsphere); another is to localise eloquent cortical structures to aid the planning of the \nsurgical approach. PET may detect hypometabolic areas corresponding to areas \ninvolved in epilepsy. MRS (magnetic resonance spectroscopy), MEG (magnetoen-\ncephalography) and intradural EEG-registration and stimulation will be mentioned. \nLearning Objectives:\n1. To understand which different modalities can be used in diagnosing epilepsy.\n2. To learn the protocols of different modalities.\n3. To consolidate the best neuroimaging protocols for evaluating different forms \nof epilepsy.\nPanel discussion: \nImaging epilepsy? 09:44\nThe term epilepsy covers a wide spectrum of symptoms and underlying etiologies. \nAn essential part of the work-up of patients with epilepsy includes the radiological \nexamination. In recent years more sophisticated methods radiological methods have \nemerged and the discussion will focus on how these new advanced techniques \nmay help finding underlying causes and be of help in the pre-surgical work-up. \n\nMonday\nPostgraduate.Educational.Programme\nA\n S123\nCB D E F G H\nA‑489\t 08:58 \nExcellence in teleradiology: key issues in workflow management \nJ. Schillebeeckx; Bonheiden/BE (jan.schillebeeckx@imelda.be) \nThe healthcare market is undergoing significant change. The market is evolving from \na provider centric to a patient centric model, requiring relevant data to converge at \npatient level in a timely and structured fashion. The push towards setting up col-\nlaborative networks for radiology is strong in most European countries. The most \nimportant challenge for teleradiology is to ensure that it develops in a manner that \nbenefits patient care and ensures overall patient safety, and does not in any way \nreduce the quality of radiology services provided to the citizen. Therefore, these \ncollaborative networks require more than just IT infrastructure with IT support. But \nas important is case management, workflow management and the administrative \nand management support that provides all the stakeholders with operational, \nanalytical and statistical QA reports. Through a centrally operated hub, the radiol-\nogy workflow is optimised to ensure throughput of cases, involving radiologists in \nthe network, with the difference that only the services are provided by the Hub to \nthe network, not the medical acts, which remain in the hands of the radiologists. \nLearning Objectives:\n1. To learn about the technical needs of a teleradiology infrastructure adapted \nto a distributed environment.\n2. To understand that teleradiology involves much more than just technology. \nOptimising the workflow and time management are also important.\n3. To appreciate how creating collaborative networks can improve the efficiency \nof radiology procedures and bring improved work/life balance to radiologists.\nA‑490\t 09:21 \nDedicated solutions for specific clinical scenarios \nH. Billing; Barcelona/ES (hb@telemedicineclinic.com) \nTo make teleradiology an integrated part of clinical radiology, it must change from \nbeing a provider of radiology reports into a close collaboration with the client \nradiology department. There are many different aspects on workflow in a clinical \nsetting and the teleradiology service should adapt to these specific needs in order \nto make a seamless collaboration. However, there are advantages with the global \naspects of teleradiology that could improve diagnostic accuracy and efficiency in \nthe clinical setting that should be woven into the collaboration. \nLearning Objectives:\n1. To understand the need for close communication between remote radiologists \nand local clinicians. Different clinical scenarios need different solutions.\n2. To be aware of the need for local adaptation of service vs. the advantages of \nglobal solutions.\n3. To appreciate that there are specific workflow needs for different kinds of \nclinical work.\nPanel discussion: \nTo what extent has teleradiology demonstrated it can improve radiological \nservices? 09:44\nT eleradiology services have developed substantially over the last few years from limited \nuse between hospitals and tertiary care centres for second opinions and patient transfer \nto the international provision of reporting services. There is no doubt that teleradiology \nprovides a valuable service in some circumstances, but it also has a number of inherent \nlimitations regarding the proper provision of imaging services to the patient and therefore \nmay increase risks for the patient. We will highlight the problems that have arisen and \nreiterate key parts of the guidelines which were developed for the benefit of patient care. \n08:30 - 10:00 Room N/O \nHead and Neck \nRC 1508 \nCommon pains in the head and neck \nModerator: \nK. Hrabák; Budapest/HU \nA‑491\t 08:30 \nA. Salivary colic \nT. Beale; London/UK (timothy.beale@royalfree.nhs.uk) \nThis lecture will demonstrate a multimodality approach to the imaging of salivary \ncolic. The relevant US and MRI salivary anatomy will be highlighted and the ultra-\nsound, computed tomography and magnetic resonance appearances of salivary \ngrafts. respectively. Graft sclerosis develops in 38% of nonoccluded venous bypass \nvessels after 5 years and in 75% after 10 years. This sclerosis causes more than \n50% luminal narrowing in approximately half of the affected vessels. Non-invasive \nimaging of coronary bypass grafts by MD-CT require information about the opera-\ntive procedure. With the increasing implementation of 64slice CT scanners and \nbeyond, it is possible to scan the heart and the full anatomic extent of grafts with \nsub-millimeter slice-thickness within a single breath-hold. When analysing the grafts, \nthree graft segments should be assessed: the origin or proximal anastomosis, the \nbody of the graft and the cardiac anastomosis, either single or sequential. Recent \nstudies have shown that graft patency and the presence of significant graft stenosis \ncan be assessed with an accuracy of 100% using most recent MD-CT technology \n(256/320 slice CT or dual source CT). The assessment of native coronaries with \nrespect to the progression of CAD may still be problematic in cases with severe \ncalcifications of the native coronary arteries. In these cases, MR perfusion imaging \nin combination with Cine and late gadolinium enhancement (LGE) imaging may \nbe helpful in detecting newly developed, stress-induced myocardial ischaemia. \nLearning Objectives:\n1. To review the indications of CTA for bypass graft assessment.\n2. To understand the clinical impact of CTA in this subgroup of patients.\n3. To elucidate possible indications for MR imaging in patients after bypass \ngrafting.\n08:30 - 10:00 Room L/M \nProfessional Challenges Session \nPC 15 \nTeleradiology: for better or for worse \nModerator: \nL. Donoso; Barcelona/ES \nA‑487\t 08:30 \nChairman’s introduction \nL. Donoso; Barcelona/ES (ldonoso@clinic.ub.es) \nTeleradiology services have developed substantially over the last few years from \nlimited use between hospitals and tertiary care centres for second opinions and \npatient transfer to the international provision of reporting services There is no doubt \nthat teleradiology provides a valuable service in some circumstances, but it also has \na number of inherent limitations regarding the proper provision of imaging services \nto the patient and therefore may increase risks for the patient. We will highlight the \nproblems that have arisen and to reiterate key parts of the guidelines which were \ndeveloped for the benefit of patient care. \nSession Objectives:\n1. To learn about the e-health regulatory initiatives at the European level.\n2. To understand the importance of proper workflow management.\n3. To become familiar with different scenarios in which teleradiology can be used.\n4. To appreciate the implications for patient care of using teleradiology.\nA‑488\t 08:35 \nAre we safeguarding patients’ rights? \nD. Caramella; Pisa/IT (davide.caramella@med.unipi.it) \nIt is now well understood that teleradiology cannot be considered just as ‘telere -\nporting’, i.e. the simple interpretations of images remotely acquired and sent as a \nmessage in the bottle. Teleradiology procedures, being medical acts, must ensure \nthe full involvement of the interpreting radiologist in all phases of the well established \npractice of diagnostic imaging: appropriateness check, personalised acquisition \nprotocols, access to clinical history and prior imaging examinations, communica-\ntion with referring physician and patient. Any obstacle that teleradiology causes to \nthese activities may put our patients at risk (and therefore may expose us at liability \nsuits). The presentation will describe the organisational as well as technological \nremedies for reducing such risk. \nLearning Objectives:\n1. To appreciate that radiological procedures are medical acts, not just \nreporting.\n2. To understand the difference between locally delivered radiological services \nand teleradiology.\n3. To recognise potential risks for the patients when using teleradiology.\n4. To learn about the strategies for reducing such risks.\n\nPostgraduate.Educational.Programme\nS124\n A B C D E F G H\n08:30 - 10:00 Room P \nPhysics in Radiology \nRC 1513 \nSimulations make us understand x-ray imaging \nModerators: \nK. Bacher; Gent/BE \nS. Barter; Cambridge/UK \nA‑494\t 08:30 \nA. Monte Carlo simulations of x-ray tubes and x-ray spectra \nM. Koutalonis; London/UK (Manthos.Koutalonis@bartsandthelondon.nhs.uk) \nFor several decades, Monte Carlo simulation has been recognised as a powerful \ntechnique to simulate the transport of radiation in media, as well as to provide \nsolutions for calculations too complex for classical approaches. Several general \npurpose codes and databases providing particle interaction cross-sections have \nbeen developed, and with the increase in computing power, simulation has become \nmore and more popular within the field of medical imaging. Using Monte Carlo \nsimulation methods, the different steps involved in the formation of a medical \nimage can be analysed in detail, and the whole system optimised. A topic that \nhas deserved particular attention in the past is the simulation of x-ray tubes and \nx-ray spectra, which is the first step in the simulation of a medical imaging system. \nWhen simulating an x-ray tube, various complex phenomena need to be taken into \naccount, such as the electron multiple scattering, bremsstrahlung interactions, \ncharacteristic x-rays emitted from the K-shell and Auger electrons emitted during \na photon interaction. Together with the simulation of the target material and the \nfiltration of the x-ray beam through permanent (e.g. a Be window) and added \nfiltration (e.g. Al, Mo, Rh, Ag, etc)., this technique can lead to a good estimation \nof the emitted x-ray spectrum, a task which is hard to achieve with experimental \nmethods. This review will provide an overview of the basic knowledge necessary \nto start the simulation of an x-ray tube as well as of how to accelerate the calcula-\ntions. Emphasis will be given to mammographic x-ray tubes. \nLearning Objectives:\n1. To understand the basics of Monte Carlo simulations of x-ray tubes and \nx-ray spectra.\n2. To learn why and how to start a Monte Carlo software platform.\n3. To learn how to accelerate Monte Carlo calculations.\nA‑495\t 09:00 \nB. Monte Carlo simulations of virtual patients (anthropomorphic \nphantoms) \nP.R. Bakic; Philadelphia, PA/US (Predrag.Bakic@uphs.upenn.edu) \nBreast cancer screening and diagnostic imaging, as all clinical imaging, are increas-\ningly multimodality. A number of new imaging modalities have been developed, \nincluding digital breast tomosynthesis and dedicated breast CT. They have shown \npromise in early studies; however, their technological complexity present obstacle \nfor optimisation. The ultimate technology tests are clinical trials, which are, however, \nchallenging, particularly for breast cancer screening, as large studies are needed \ndue to the small number of detected lesions. Clinical trials are costly, long, and \nthey involve repeated exposure of women to radiation. As an alternative, we have \nbeen developing virtual clinical trials, based upon our virtual breast phantoms and \nsimulation of phantom images. This talk will describe the development of anthro-\npomorphic computer breast phantoms, and illustrate their use in the analysis of \nphantom digital mammography and digital breast tomosynthesis images. Different \ncurrently used phantom designs will be compared in terms of their flexibility and \nrealism. Specific phantom requirements related to different imaging modalities will \nbe emphasised. The role of phantoms in tissue-specific analysis of the radiation \ndose during mammography will be discussed. In addition to the anthropomorphic \nphantoms for breast imaging, the use of virtual patients in various clinical imaging \ndisciplines will also be illustrated. \nLearning Objectives:\n1. To learn about requirements for anthropomorphic phantoms (virtual \npatients).\n2. To understand the value of anthropomorphic phantoms for breast imaging.\n3. To compare advantages and disadvantages of several types of \nanthropomorphic phantoms.\n4. To learn how to estimate typical patient doses from simulations with virtual \nphantoms.\ncolic will be shown and techniques for optimising the imaging of salivary colic given. \nThe use of US, CT, MRI, and both MRI and conventional sialography in the imaging \nof salivary colic will be discussed. The role of interventional sialography and mini-\nmally invasive techniques in benign salivary gland obstruction will be demonstrated. \nLearning Objectives:\n1. To review the role of imaging in the evaluation of salivary colic.\n2. To understand the advantages and limitations of the different available \nimaging techniques.\n3. To become familiar with MR sialography technique and how it compares with \nconventional sialography.\n4. To learn the indications and limitations of interventional sialography.\nA‑492\t 09:00 \nB. Trigeminal neuralgia \nB.F. Schuknecht; Zurich/CH (image‑solution@ggaweb.ch) \nTrigeminal neuralgia is defined as recurrent episodes of lancinating pain most \ncommon in the second (V 2) or third division (V 3) of the trigeminal nerve. The \npathogenesis is a neurovascular conflict by an artery or vein associated with focal \ndemyelination of sensory fibers at the glia-Schwann cell junction. Apposition of \ndemyelinated fibers induces abnormal generation and transmission of impulses. \nMR Imaging is based on high-resolution 3D sequences: CISS/Fiesta/3D T2Space \nwith coronal and sagittal oblique MPR and a 3D TOF intracranial sequence with \naxial and coronal thin MIP reconstruction to delineate the course of vessels along \nthe trigeminal nerve form the pons, and glia Schwann cell junction to the Gasse-\nrian ganglion. The brainstem and brain are assessed by T2, Flair and 3D isotropic \nGd-enhanced T1 sequences; the viscerocranium is examined by a noncontrast \nand coronal T1 Gd fat suppressed sequence. Analysis of images is focussed on \nrecognition of displacement and distortion of the proximal trigeminal nerve by the \nSCA, rarely by the AICA, BA or petrosal, pontomesencephalic or peduncular vein. \nCorrelation of the circumferential site of distortion at the root entry zone with the \nsomatopic representation of fibres increases the, in general, low specificity of the \nneurovascular contact. Ruling our compressive tumours, neoplastic infiltration, \ninflammation or demyelination and delineating a neurovascular conflict stratifies \npatients for potential microvascular decompression in case of failure of medication. \nLearning Objectives:\n1. To review the critical diagnostic criteria and pathophysiology of trigeminal \nneuralgia.\n2. To learn how to tailor an MR imaging exam.\n3. To become familiar with the most common causes.\n4. To understand the value of imaging in patient management.\nA‑493\t 09:30 \nC. Painful swallowing \nM. Becker; Geneva/CH (minerva.becker@hcuge.ch) \nThe purpose of this lecture is to provide an overview of the key imaging features of \npainful swallowing with or without associated mucosal pathology. In the presence of \na mucosal lesion, painful swallowing is most often caused by infectious, neoplastic \nor traumatic lesions of the pharynx itself, whereas in the absence of mucosal altera-\ntions, painful swallowing is the result of functional disorders (dysfunction of the \ncricopharyngeus muscle), infectious, inflammatory or neoplastic diseases affecting \nadjacent neck spaces (retropharyngeal and paraphyrngeal space), neurologic \nimpairment (glossopharyngeal neuralgia), carotidodynia and Eagle’s syndrome. \nThe indications for CT, MRI, US and videofluoroscopy will be reviewed and their \nrespective role in the detection and precise description of the underlying cause. \nMajor emphasis will be put on how to report the findings in a comprehensive way. \nLearning Objectives:\n1. To recognise the most common causes of painful swallowing in patients with \na normal pharynx at clinical examination.\n2. To review the role of different imaging techniques in the diagnosis and \ntreatment of painful swallowing.\n3. To review the key imaging techniques in the diagnosis and treatment of \npainful swallowing.\n4. To review the key imaging features of the most common causes of painful \nswallowing as seen with the respective imaging techniques.\n\nMonday\nPostgraduate.Educational.Programme\nA\n S125\nCB D E F G H\nThe typical HRCT features of interstitial lung disease are ground-glass opacity, \nconsolidation, pulmonary nodules, tree-in but sign, bronchiolar wall thickening, \nmucoid impaction, air trapping, septal thickening, mosaic perfusion and honey \ncombing. Most frequent diseases in children to be dealt with are bronchiectasis, \ncystic fibrosis, asthma, constrictive bronchiolitis, bronchiolitis obliterans and extrinsic \nallergic alveolitis and they will be demonstrated with use of a systematic approach. \nLearning Objectives:\n1. To understand the role of chest CT.\n2. To learn about the typical CT findings of the interstitial lung disease.\n3. To become familiar with the most frequent diseases and learn about a \nsystematic approach.\nA‑499\t 09:30 \nC. MRI of the chest in children \nM.U. Puderbach; Heidelberg/DE (m.puderbach@dkfz.de) \nDiseases of the respiratory system are of great importance in paediatrics. Early \ndetection and follow -up of infectious, congenital and environmental diseases in \nyoung patients is crucial for adequate treatment and improved outcome. Here, \nimaging techniques play an indispensable role. In the past the interest was focused \non morphological aspects of pulmonary tissue. Here, computed tomography (CT) \nserves as the gold standard. In the course of the development of MRI, MR imaging of \nthe lung played a subordinate role. This was caused by several technical problems: \n1. low signal to noise ratio because of low proton density of the lung, 2. artefacts \nbecause of cardiac and breathing motion, 3. susceptibility artefacts because of air-\nsoft tissue transition. Despite these inherent difficulties of MRI of the lung, significant \nprogress has been made recently. Although spatial resolution is lower than at CT, \nMRI allows for the visualisation of the lung parenchyma using ultra-short echo time \n(TE). Furthermore, MRI has the advantages to evaluate different tissue aspects \n(T1w, T2w, fat suppression) and to improve lesion characterisation. In addition, \nMRI is capable to assess lung function, e.g. perfusion, angiography, ventilation \nand respiratory mechanics. Using up to date scanner systems a complete study \nof the chest including morphological and functional imaging can be performed in \nless than 30 minutes. Especially diseases that go along with pulmonary structure \naugmentation and/or involve vascular structures can be studied by MRI. \nLearning Objectives:\n1. To learn about MR techniques available for chest imaging in children.\n2. To learn about specific clinical scenarios where MRI is helpful.\n3. To understand the strengths and weaknesses of chest MRI with the help of \ncase-based illustrations.\n10:30 - 12:00 Room B \nInteractive Teaching Session \nE³ 1620 \nCommon radiological problems: cognitive decline \nand dementia \nA‑500\t 10:30 \nCommon radiological problems: cognitive decline and dementia \nB. Gómez-Ansón1, F. Barkhof2; 1Barcelona/ES, 2Amsterdam/NL \n(bgomeza@santpau.cat) \nWith advances in healthcare and age, the prevalence of dementia increases ex-\nponentially, with ~20% of subjects over 85 years becoming demented. While the \nguidelines differ by country, many recommend imaging at least once during the \nwork-up of patients suspected of dementia. Beyond exclusion of surgically treatable \ndisorders (e.g. tumour, subdural haematoma or hydrocephalus), imaging can now \nbe used to positively determine the underlying disorder (e.g. hippocampal atrophy \nin Alzheimer‘s disease). While MRI is the modality of choice, multislice CT with \nmultiplanar reformats provides a robust and quick alternative to assess general \ncortical atrophy, hippocampal atrophy and vascular pathology. SPECT and PET \nshould be reserved for second line investigation, e.g. suspicion of frontotemporal \nlobar degeneration (FLTD) lacking characteristic atrophy on structural imaging. The \nadvent of amyloid imaging using PIB-PET provides a future tool to secure a diag-\nnosis of Alzheimer through molecular imaging, but its value over CSF examination \nneeds to be determined. Increasing insights are being gained into the aetiology, \nclinical features and imaging findings in other neurodegenerative diseases, e.g. \nLewy-body dementia. Structural imaging plays an essential role in establishing the \ndiagnosis of vascular dementia (VaD), and cases of mixed dementia. Serial MRI is \nA‑496\t 09:30 \nC. Monte Carlo simulations of x-ray detectors and x-ray images \nK. Smans, H. Bosmans; Leuven/BE (kristien.smans@gmail.com) \nDuring the lecture we will present and validate methods to simulate radiographic \nimages with the Monte Carlo software MCNP/MCNPX in a time efficient way. We \nwill start the lecture by introducing three image detector models that can be used in \nMCNP/MCNPX. The first detector model that will be presented is the standard semi-\ndeterministic radiography tally, which has been used in previous image simulation \nstudies. Furthermore, we will present two alternative stochastic detector models: a \nperfect energy integrating detector and a detector based on the energy absorbed \nin the detector material. The image detector models will be validated by compar-\ning calculated scatter-to-primary ratios (SPRs) with published and experimentally \nacquired SPR values. Subsequently, we will introduce a method to modify the im-\nages, generated with the MCNP/MCNPX image detector models, for the physical \ncharacteristics of a computed radiography (CR) imaging systems. The method \npresented in this lecture takes into account the signal intensity variations due to \nthe heel effect along the anode-cathode axis, the spatial resolution characteristics \nof the imaging system and the various sources of image noise. To demonstrate \nthe accuracy of our model we will compare the threshold-contrast detectability \nin simulated and experimentally acquired images of a contrast-detail phantom. \nLearning Objectives:\n1. To learn basic methods for simulating imaging detectors.\n2. To learn how to simulate x-ray images.\n3. To learn how to validate Monte Carlo simulations of an x-ray imaging system.\n08:30 - 10:00 Room Q \nPaediatric \nRC 1512 \nChest imaging: what to use and when to use it \nModerator: \nM. Raissaki; Iraklion/GR \nA‑497\t 08:30 \nA. Thoracic trauma and foreign body inhalation \nM.L. Lobo; Lisbon/PT (mluisalobo@gmail.com) \nThoracic trauma in children is most commonly seen in a polytrauma context, and \nis associated with significant morbidity and mortality. Blunt trauma accounts for the \nmajority of cases, often resultant from motor vehicle accident and pedestrian crash. \nCommon thoracic injuries include pulmonary contusion, rib fractures, pneumothorax \nand haemothorax. Diaphragmatic and mediastinal injuries, such as aortic rupture and \ntracheobrocheal tear, are rare but potentially life threatening. Different patterns of injury \nare seen in children due to anatomical and physiological differences, and these should \nbe recognised. Chest radiography is the first and most important imaging modality. \nMDCT allows accurate diagnosis for most traumatic injuries, and is usually performed \nfor severe chest and/or polytrauma. Adapted paediatric protocols are essential. Foreign \nbody inhalation is a common paediatric domestic accident, with potential serious or even \nfatal consequences. Clinical history is the key for the diagnosis. With a definite history, \nbronchoscopy is the modality of choice for both diagnosis and treatment. However, in \nmany cases the aspiration event is not witnessed and the diagnosis is often delayed \nor overlooked. The majority of aspirated foreign bodies are non-opaque and imaging \nfindings largely result from complete or incomplete airway obstruction. Chest radiog-\nraphy is the first imaging modality. Expiratory films (or lateral decubitus or fluoroscopy) \nare very useful to demonstrate air-trapping. Chest MDCT offer excellent details of the \ntracheobronchial tree and pulmonary parenchyma, and is usually reserved for more \ncomplex cases and/or long-standing foreign bodies. \nLearning Objectives:\n1. To become familiar with lesions observed in thoracic trauma.\n2. To learn about strategies for imaging.\n3. To become familiar with the classical and atypical signs of foreign body \ninhalation.\nA‑498\t 09:00 \nB. Infiltrative diseases of the chest \nG. Staatz; Mainz/DE (staatz@radiologie.klinik.uni‑mainz.de) \nHigh-resolution CT of the chest is the imaging technique of choice for the evaluation \nof most infiltrative diseases of the chest. In children dose-adapted protocols should \nbe used and recommendations for suitable protocols will be given in the course. \n\nPostgraduate.Educational.Programme\nS126\n A B C D E F G H\nA‑503\t 14:45 \nB. Mediastinal mass \nJ. Vilar; Valencia/ES (vilarjlu@gmail.com) \nThe mediastinum is a region of the thorax that separates both lungs and com-\nmunicates with the neck and the abdomen. These two anatomic features are very \nimportant to understand the behaviour of some diseases and their radiological \nmanifestations. Most asymptomatic mediastinal masses are benign, while clinical \nsymptoms might raise the possibility of a malignant lesion. Imaging plays a very \nimportant role, especially CT and MRI. In the presence of a mediastinal mass we \nmust ask ourselves two questions: 1. Where is the mass located? The classic \ndivisions of the mediastinum in compartments remains very useful, because it \nnarrows the differential diagnosis. 2. Is the lesion cystic or solid? Pure mediastinal \ncysts are benign and their characterisation depends on their location. Thymic cyst \n(anterior mediastinum), bronchogenic and duplication cysts (middle mediastinum) \nand menyngoceles (posterior mediastinum). Solid lesions may be benign or \nmalignant while some lesions may have a cystic component. Solid lesions of the \nanterior mediastinum are usually thymomas, germ cell tumours or lymphomas. In \nthe middle mediastinum most masses are of lymphatic origin but we should also \ninclude aortic or oesophageal pathology. Intrathoracic thyroid usually follows the \ntrachea and thus is situated in the upper-middle mediastinum although posterior \nand anterior extensions may occur. In the posterior mediastinum most masses \nare of neural origin. There are some locations that will typically indicate specific \ndiagnosis or a narrow differential. Such is the case of the cardiophrenic angle \nmasses, juxtadiaphragmatic lesions and thoracic inlet pathology. \nLearning Objectives:\n1. To learn how to detect and characterise a pulmonary nodule.\n2. To learn how to detect and characterise a mediastinal mass.\n3. To learn how to apply adequate protocols according to the clinical situation.\n14:00 - 15:30 Room C \nInteractive Teaching Session \nE³ 1720b \nColorectal cancer: what the radiologist must report \nA‑504\t 14:00 \nColorectal cancer: what the radiologist must report \nR.G.H. Beets-Tan1, C. Hoeffel2; 1Maastricht/NL, 2Reims/FR \n(r.beets.tan@mumc.nl) \nColorectal cancer is common. Approximately 280,000 new cases occur each year \nin the 500 million population of the 27 states which comprise the EU. After lung, \nit is the second commonest cause of cancer death resulting in approximately \n140,000 deaths per annum. These relatively high mortality figures are a reflection \nof the fact that the disease is often advanced at the time of presentation. Efforts to \nreduce mortality, therefore centre on early detection as well as accurate staging. \nThe latter is particularly important in rectal cancer-the commonest site for colonic \ncancer. Detection depends on presentation, which is often protean or non-existent; \nhence, the introduction of screening programs. Typical diagnostic tools include the \nbarium oenema, optical colonoscopy and CT colonography. The limitations of the \nbarium enema have been exposed by optical colonoscopy and it can no longer be \nadvocated in this role. CT colonography, however, rivals optical colonoscopy in the \ndetection of polyps and tumours, although of course has no therapeutic potential. \nMajor advances in the treatment of rectal cancer include total mesorectal excision \n(TME) of the rectum as well as neo-adjuvant therapies such as chemo-radiation. \nTheir use depends on highly accurate staging of the primary disease, which can \nonly be achieved by MR examination, although of course CT or PET/CT is required \nfor the assessment of more distant metastatic disease. Finally, once treated, it is \nessential that these patients are followed-up; usually by a regime of colonoscopy \nand CT. These issues will be discussed in an interactive lecture. \nLearning Objectives:\n1. To review the genetic and environmental factors predisposing to colorectal \ncancer and to consider the significance of colorectal cancer in overall health \nterms.\n2. To understand the rationale of screening and to discuss the role of CT \ncolonography and its relation to other screening tests such as FOB test and \ncolonoscopy.\n3. To learn the principles and rationale for accurate preoperative imaging of \nrectal cancer.\nvery sensitive to the degenerative process underlying neurodegenerative disorders, \nproviding insights into their pathogenesis and offers a possibility to determine the \neffects of putative new treatments in randomised clinical trials. \nLearning Objectives:\n1. To learn about the usefulness of imaging in patients with dementia.\n2. To be able to approach conventional CT and MRI examinations for patients \nwith cognitive decline and dementia.\n3. To become familiar with the most common types of dementia and their \ncharacteristic imaging findings.\n4. To appreciate the role of imaging in early diagnosis of dementia and in \ndifferentiating the vascular and neurodegenerative disease dementia.\n5. To understand the indications for SPECT and PET in dementia.\n12:30 - 13:30 Room Z \nThe Beauty of Basic Knowledge: Interpretation of the Chest \nRadiograph \nMC 21E \nDecreased opacity of the lung(s) \nA‑501\t 12:30 \nDecreased opacity of the lung(s) \nJ. Cáceres; Barcelona/ES (josecac@gmail.com) \nDecreased opacity of the lung may be a bilateral or unilateral process. If unilateral, it \nmay involve an entire lung, a lobe or a segment. Faulty radiological technique must \nalways be excluded. The most common cause of unilateral decreased opacity is a \nprevious mastectomy. Bilateral decreased opacity occurs in COPD and asthma. It \nis also caused by decreased blood flow in the lung/s. Expiratory films separate the \ntrue lung causes from all the others, by demonstrating air trapping. \nLearning Objectives:\n1. To learn useful signs to recognise emphysema.\n2. To evaluate unilateral hyperlucent lung.\n3. To evaluate localised areas of increased lucency.\n14:00 - 15:30 Room B \nInteractive Teaching Session \nE³ 1720a \nCommon radiological problems: incidental chest \nlesions \nA‑502\t 14:00 \nA. Solitary pulmonary nodule \nE. Castañer; Sabadell/ES (ecastaner@tauli.cat) \nPulmonary nodules are spherical radiographic opacities (solid and subsolid) that \nmeasure up to 30 mm in diameter. Extremely common in clinical practice, pulmo-\nnary nodules, especially small ones under 1  cm in diameter, are a challenge to \nmanage. It is important to identify malignant nodules because they are potentially \ncurable. The first step in assessing a pulmonary nodule on a chest radiograph \nis to determine that it is indeed a lung nodule rather than a pleural or chest wall \nabnormality. It is essential to review images from previous examinations, because \na solid nodule that remains stable for at least 2 years is probably benign. Topics \ndiscussed in this talk include the importance of nodule size, growth rate, margin \nmorphology, density (solid, ground-glass and part solid), calcifications or fatty com-\nponents within the nodules, the significance of cavitations or bubble-like densities, \nenhancement patterns at dynamic contrast-enhanced CT, and findings on positron \nemission tomography (PET). The talk also covers the current guidelines for the \nmanagement of incidentally detected nodules (solid and subsolid). \nLearning Objectives:\n1. To learn how to detect and characterise a pulmonary nodule.\n2. To learn how to detect and characterise a mediastinal mass.\n3. To learn how to apply adequate protocols according to the clinical situation.\n\nMonday\nPostgraduate.Educational.Programme\nA\n S127\nCB D E F G H\nadenomatous polyposis with prior history of abdominal surgery is highly suggestive \nof mesenteric fibromatosis. \nLearning Objectives:\n1. To review the imaging modalities used in the diagnosis of various solid \nperitoneal and mesenteric masses.\n2. To learn about differential diagnostic clues.\n3. To become familiar with radiological-pathologic correlations.\nA‑507\t 16:30 \nB. Imaging of cystic mesenteric or omental masses \nC. Stoupis; Maennedorf/CH (c.stoupis@spitalmaennedorf.ch) \nThis presentation has the purpose to familiarise radiologists with the spectrum of \nmesenteric and omental cystic masses, demonstrating the additional correlation \nwith the underlying pathology. Cystic masses of the mesentery or omentum are not \ncommon lesions; however, radiologists should be aware of these entities as well \nas with other cystic lesion of the abdomen. Important tool for the diagnosis is to \ndetermine the organ from which the mass originates. Common types of mesenteric \nand cystic masses include lymphangioma, enteric duplication cyst, enteric cyst, \nmesothelial cyst and non-pancreatic pseudocyst. Other entities such as cystic \nmesothelioma, cystic spindle cell tumour and cystic teratoma could be located in \nthe mesentery also. Due to the overlap in the imaging features, not always the final \ndiagnosis could be reached by imaging only and therefore histologic examination \nis necessary to establish the diagnosis. However, it is important for the radiologist \nto define the cystic nature of the mass and demonstrate the potential mesenteric \nor omental origin, targeting to the correct differential diagnosis of the cystic lesion. \nLearning Objectives:\n1. To review the imaging findings of cystic mesenteric or omental masses.\n2. To learn to correlate imaging findings with the underlying pathology.\n3. To appreciate the accuracy of imaging modalities and difficulties in \ndifferential diagnosis.\nA‑508\t 17:00 \nC. Patterns of peritoneal carcinomatosis \nP.K. Prassopoulos; Alexandroupolis/GR (pprasopo@med.duth.gr) \nCancer cells from intraabdominal neoplasms, carried by peritoneal fluid throughout \nthe abdominal cavity, result in widespread metastases in the form of implants, the so-\ncalled peritoneal carcinomatosis. The location of implants development is governed \nmostly by peritoneal fluid circulation and by specific anatomic pathways formed \nby peritoneal reflections. The most common sites where the peritoneal fluid may \ntemporarily arrested facilitating implantation of cancer cells include cul-de-sac, distal \nsmall bowel mesentery, right paracolic gutter, posterior sub-hepatic space, greater \nomentum and sub-phrenic spaces. The role of imaging is to disclose the presence \nand extent of the disease - i.e. fundamental in candidates for cytoreductive sur-\ngery - to monitor response to treatment and to reveal recurrences. MDCT with thin \ncollimation and i.v. contrast material supplemented by multiplanar reconstructions \nis the primary imaging modality for the investigation of peritoneal carcinomatosis. \nAscitis, contrast enhanced smooth, nodular, or plaque-like peritoneal thickening, \nperitoneal nodules, plaques or masses, rounded, ill-defined soft-tissue or cystic \nmesenteric masses, mesenteric fixation with increased attenuation values and \nthickening, irregular soft-tissue permeation of omental fat or confluent solid omental \nmasses are the most frequent CT findings of peritoneal carcinomatosis. CT has a \nsensitivity and specificity between 85 and 95%, depending on the size/location of \nimplants and examination protocol used. MR imaging employing a post- gadolin-\nium-enhanced 3d FLASH sequence with fat saturation may alternatively be used \nand it is advantageous in cases of diffused layered type of peritoneal/mesenteric \ninvolvement. Diffusion MRI may be of value in post-treatment imaging evaluation. \nLearning Objectives:\n1. To learn about the various imaging findings of peritoneal carcinomatosis.\n2. To learn about the accuracy of different imaging modalities in disease staging.\n3. To appreciate the role of imaging techniques in the evaluation of response \nto treatment.\n16:00 - 17:30 Room B \nInteractive Teaching Session \nE³ 1820 \nFemale pelvic infections: what the radiologist must \nreport \nA‑505\t 16:00 \nFemale pelvic infections: what the radiologist must report \nJ.A. Spencer1, R. Forstner2; 1Leeds/UK, 2Salzburg/AT \n(johnaspencer50@hotmail.com) \nMost episodes of infection within the female pelvic organs are simply diagnosed on \nclinical grounds and resolve over time with or without antibiotic therapy. Infection \nwhich drains spontaneously usually resolves with these simple measures. Infection \ntrapped within the female pelvic organs results in pyometra and/or tuboovarian \nabscess. These complications may require imaging. More severe infections may \ndischarge internally with the development of a pelvic abscess or dissemination to \nthe peritoneal cavity. Chronic infection may result in fibrosis with stricture forma-\ntion in the female pelvic organs or the adjacent bowel, bladder and ureters. This \ninvolvement may result in lower GI or urinary tract symptoms. Other secondary \neffects include lymphadenopathy which can be cystic/necrotic and venous throm-\nbosis with iliac and/or ascending ovarian vein thrombosis. Factors predisposing to \ncomplicated infection include: recurrent infections, previous surgery/radiotherapy, \nintrauterine devices, instrumentation, immunocompromise. US is the first line imag-\ning test, ideally from the transvaginal route. This may be poorly tolerated by women \nwith severe infection/pelvic peritonitis. MR imaging is useful for sonographically \nindeterminate pelvic masses. Women with pelvic or generalised peritonitis may \nbe suspected to have appendicitis or diverticulitis. Diagnosis may therefore arise \nfrom emergency CT. Both US and CT are used for aspiration or drainage of pelvic \ninfections. A variety of endocavitary and percutaneous approaches are available. \nLearning Objectives:\n1. To become familiar with the clinical spectrum of infection and inflammation of \nthe female genital tract.\n2. To understand their pathways of spread.\n3. To recognise typical imaging findings of pelvic inflammatory disease and \npelvic abscesses and the role of image-guided intervention.\n4. To consider the appearances of unusual infections and the differential \ndiagnosis of female pelvic infections.\n16:00 - 17:30 Room C \nAbdominal and Gastrointestinal \nRC 1801 \nPeritoneum and mesentery \nModerator: \nF.‑T. Fork; Malmö/SE \nA‑506\t 16:00 \nA. Primary solid peritoneal and mesenteric tumours \nM. Zins; Paris/FR (mzins@hpsj.fr) \nPrimary solid tumours of the peritoneum and mesentery occur much less frequently \nthan metastatic disease in the same location. However, these rare primary neo-\nplasms (peritoneal mesothelioma, primary peritoneal serous carcinoma, desmo-\nplastic small round cell tumour, mesenchymal tumours, mesenteric fibromatosis \nor mesenteric desmoid tumour, mesenteric sarcoma, etc.) are often first detected \nat CT and should be considered in the absence of a known primary organ-based \nmalignancy. CT appearance combined with patient's relevant clinical and demo-\ngraphic data can help narrow the differential diagnosis for a primary peritoneal or \nmesenteric tumour in many cases; Diffuse sheetlike thickening of the peritoneum \nand stellate appearance of the mesentery at CT or MRI are suggestive of primary \nmalignant mesothelioma in older men with high level of asbestos exposure. Ab-\nsence of an ovarian mass is mandatory in suggesting the diagnosis of primary \nperitoneal serous carcinoma in a post-menopausal woman. Desmoplastic small \nround cell tumour occurs in young men and often presents with a large primary \nperitoneal mass with calcification. A solid mesenteric mass at CT or MRI, regard-\nless of its pre- and post-contrast appearance, occurring in a patient with familial \n\nPostgraduate.Educational.Programme\nS128\n A B C D E F G H\nLearning Objectives:\n1. To understand newer techniques with micro catheters, drug-eluting beads, \nrotational angiography and flat panel CT.\n2. To understand the technique and results of TACE and RF ablation of \ncolorectal metastases.\n3. To understand the technique and results of interventional treatment of \nendocrine tumour metastases.\nA‑511\t 16:21 \nEmbolisation of HCC with drug eluting beads \nK. Malagari; Athens/GR (kmalag@otenet.gr) \nDrug eluting beads have proved predictable pharmacokinetics and achievement \nof higher doses of the chemotherapeutic, prolonged contact time with cancer cells. \nIn addition, research data today have shown response, and tolerance benefit of \ndrug eluting beads compared to conventional chemoembolisation for the more \nadvanced subgroup of BCLC - class B patients. For diameters larger than 100 μm \nDC Bead loaded with doxorubicin have proven to be more effective with respect to \nlocal response, recurrence rates and time to progression (TTP) compared to bland \nembolisation with similar diameters. In this session results of studies on DC Bead \nloaded with doxorubicin for the treatment of HCC will be discussed, and guidelines \nfor optimal clinical use will be presented. \nLearning Objectives:\n1. To appreciate the difference between conventional TACE and TACE with \ndrug eluting beads.\n2. To understand the technique and experimental results.\n3. To learn about the results of clinical trials in HCC.\nA‑512\t 16:39 \nSelective internal radiotherapy \nJ.I. Bilbao; Pamplona/ES (jibilbao@unav.es) \nSelective internal radiotherapy, also called radioembolisation (RE), consists in \nthe delivery of beta-radiation to liver tumours using microspheres loaded with \nyttrium-90 (Y90) that are injected into the hepatic artery or its branches. Y90 is a \npure beta-emitting radioisotope, with a limited tissue penetration (average: 2.5 mm \nand maximal: 11 mm) and a half life of 64 hours. Y90 can be either incorporated or \nlabelled into glass or resin microspheres (25 µm). Once the particles are infused \ninto the hepatic artery, they travel to the distal tumoural arterioles, from where the \nbeta-emissions from the isotope irradiate the tumour. With traditional external beam \nradiation, doses are limited to 30-40 Gray (Gy) due to the risk of radiation-induced \nliver disease that may occur with higher doses. With RE, tumours can receive a \nhigher dose of radiation due to their preferentially arterial vascularisation and a \nhigher tolerance of the non-tumoural liver parenchyma to this form of radiation. \nRE has shown an encouraging antitumoural activity with a good safety profile in \npatients with hepatocellular carcinoma, even in the presence of portal vein throm-\nbosis or invasion. Local tumour growth control is achieved in the majority of patients \nalthough response rates using volumetric criteria are achieved in only 20-40% of \npatients. In liver-predominant unresectable metastases, there is promising evidence \nthat RE combined with systemic chemotherapy significantly extends the time to \nprogression of liver metastases and increases objective response rates as well as \nenabling patients to receive systemic chemotherapy for a longer period of time. \nLearning Objectives:\n1. To learn about the technique, legal and safety requirements in the cathlab.\n2. To understand the diagnostic and interventional procedures before \nradioembolisation.\n3. To learn about the results of clinical trials in HCC and liver metastases.\nA‑513\t 16:57 \nCombined therapies before and after ablation \nR. Lencioni; Pisa/IT (lencioni@med.unipi.it) \nImage-guided RFA is currently established as the standard of care for patients \nwith early-stage HCC when transplantation or resection is precluded. However, \nhistologic data from liver specimens of patients who underwent RFA as bridge \ntreatment for transplantation showed that the rate of complete tumour eradication \nis highly dependent on the size and the presence of large abutting vessels. Com-\nbined percutaneous-transcatheter approaches that aim at increasing the ablation \nvolume by minimising heat loss due to perfusion-mediated tissue cooling have \nbeen developed, using either a balloon catheter occlusion of the tumour arterial \nsupply at the time of the RFA or by performing a prior TACE. Experimental stud-\nies in animal tumour models have shown that lowering the temperature threshold \nat which cell death occurs by combining sublethal heating with  cell exposure to \n16:00 - 17:30 Room D1 \nSpecial Focus Session \nSF 18a \nTransarterial treatment of liver tumours: major \nadvances \nModerator: \nJ. Lammer; Vienna/AT \nA‑509\t 16:00 \nChairman’s introduction \nJ. Lammer; Vienna/AT (Johannes.Lammer@akhwien.at) \nHepatocellular carcinoma (HCC) is an increasingly common tumour with a poor \nprognosis and limited systemic treatment options; approximately 80% of patients \ndie within a year of the diagnosis. In men, it is the fifth most common cancer \nworldwide and the third leading cause of cancer-related death. The Barcelona \nClinic Liver Cancer (BCLC) tumour staging is considered the most conceptually \nuseful in HCC. It includes the clinical performance of the patient, the stage of the \nliver cirrhosis and of the tumour, and includes treatment options. In stage A (early \nstage) ablation therapy (radiofrequency, laser, cryotherapy and electroporation), \nliver resection and transplantation are the treatment options of choice. In stage B \n(intermediate stage) transarterial chemoembolisation (TACE, precision TACE with \ndrug eluting beads) or radioembolisation with yttrium-90 microsphere brachytherapy \nare the treatment options. For stage C (advanced stage) systemic therapy with \nsorafenib is recommended. In patients with metastatic disease confined to the liver \nsurgery is first choice treatment. However, if surgery is not indicated and systemic \nchemotherapy failed tumour ablation with radiofrequency, laser, cryotherapy and \nelectroporation, TACE and radioembolisation are further treatment options. Tumours \nmost commonly treated by ablation, TACE and radioembolisation are metastases \nof colorectal and breast cancer, melanoma of the skin and retina. The purpose \nof the special focus session is to highlight the treatment which can be offered by \nintervention radiology. \nSession Objectives:\n1. To understand the treatment options.\n2. To understand BCLC staging of HCC.\n3. To review the accepted indications of TACE and tumour ablation.\nA‑510\t 16:03 \nAdvances in chemoembolisation of liver metastases \nM.A. Funovics; Vienna/AT (martin@funovics.com) \nTrans-arterial chemoembolisation takes advantage of the largely portal vascu -\nlarisation of liver tissue, while metastatic tissue is supplied almost exclusively \nby hepatic arteries. The benefit of intra-arterial application of chemotherapeutic \ndrugs is proportional to the first pass extraction of the drug by the target tissue \nand inversely proportional to the body clearance of the drug. These figures vary \ngreatly with different chemical properties of the drug. Intratumoural drug con -\ncentration after transarterial application (compared to intravenous application) is \napproximately 20x for THP-adriamycine, 5x - 10x for 5 FU, 6x - 8x for mitomycine, \n4x for cisplatin or oxaliplatin, and 2x for doxorubicin. Several trials support supe-\nriority of intraarterial 5 FU over i.v. application in response rate, and partly with a \nmoderate survival benefit. However, with the advent of novel chemotherapeutics \n(mainly oxalyplatin, irinotecan), response rates of i.v. chemotherapy approached \nthe results after i.a. 5 FU. More recently, i.a. oxaliplatin has shown a 45% response \nrate in a multicenter trial on non-responders to i.v. oxalyplatin. Also, combinations \nof i.a. oxalyplatin and i.v. 5 FU and cetuximab have achieved promising response \nrates as first line therapy. Even though intraarterial chemoembolisation alone can \nachieve promising response rates, the actual survival benefits are limited to date. \nAlso, the beneficial effect of additional embolization (over conventional arterial \ninjection) remains largely unproven for a large number of different embolisation \nagents in hepatic metastases. In an attempt to further increase tumour uptake, \nchemotherapeutic agents (anthracyclines and irinotecan) have been electrostatically \ncoupled to microspheres. Irinotecan-eluting microspheres have been untilized in \nthe treatment of CRC metastases in smaller case series. Due to the high paren -\nchymal drug uptake, appropriate medications to mitigate postembolization side \neffects need to be emphasised. While the initial response rates were over 60% \n(according to EASL), tumour progression was observed within 6 months in the \nmajority of responders, suggesting potential stimulation of angiogenesis at the \ntumour boarders. Potentially, adjuvant antiangiogenic treatment can provide an \noveradditive effect in these patients. \n\nMonday\nPostgraduate.Educational.Programme\nA\n S129\nCB D E F G H\nLearning Objectives:\n1. To become familiar with the basic principles of diagnosing bone tumours.\n2. To learn how to determine the biological activity of bone neoplasms and \ntumour-like lesions on the basis of radiographic findings.\n3. To understand the role of CT and MRI in the diagnosis of bone tumours.\n4. To recognise imaging patterns on the basis of radiologic-pathologic \ncorrelation.\nA‑516\t 16:28 \nB. Staging and intervention \nS. James; Birmingham/UK (steven.james@roh.nhs.uk) \nPrimary bone tumours require both local staging and the identification of distant \nmetastases to guide management. MR imaging is the modality of choice to \ndetermine local disease extent and allows excellent depiction of intra- and extra-\nosseous disease. Chest CT enables pulmonary metastases to be identified and \nbone scintigraphy allows evaluation of the presence of bone metastases. The \nroles of whole body MRI and PET/CT in the staging of bone tumours will also be \ndiscussed. Whilst imaging may allow a narrow differential diagnosis to be reached, \nhistological confirmation of the nature of the lesion is required pre-operatively to plan \nappropriate treatment. Image-guided biopsy may be performed using fluoroscopy, \nCT, MRI and occasionally ultrasound guidance. The relative values of each of these \ntechniques will be covered. Percutaneous therapies are increasingly being utilised \nin the treatment of a number of primary bone tumours. Radiofrequency ablation \nis the method of choice for osteoid osteoma and is now used in the treatment \nof chondroblastoma. Alternatives include microwave therapy, cryotherapy and \nsclerotherapy. These percutaneous techniques may also be used for local disease \ncontrol where disease recurrence is encountered. \nLearning Objectives:\n1. To understand the role of radiographs, MRI, CT and bone scintigraphy in the \nstaging of primary bone tumours.\n2. To appreciate the principles and techniques of percutaneous bone biopsy.\n3. To be aware of the indications, technique and outcome of percutaneous \ntherapies in the treatment of bone tumours.\nA‑517\t 16:51 \nC. New techniques (including DWI) \nS. Pans; Leuven/BE (Steven.Pans@uz.kuleuven.ac.be) \nMagnetic resonance imaging (MRI) has evolved to become the most important \ndiagnostic method for local staging of primary bone tumours and for detecting \npostoperative tumour relapse. It allows accurate preoperative staging of local \ntumour extent and helps to obtain adequate safety margins. MRI is a noninvasive \ntechnique that can be used to obtain information regarding tumour vascularisation, \nmetabolism, and pathophysiology, and allows early assessment of therapeutic \neffects of cancer drugs. One approach is dynamic contrast-enhanced (DCE) MRI, \nwhich measures tumour vascular characteristics after administration of a contrast \nmedium. MRI enhanced with small-molecular-weight contrast agents is extensively \nused in the clinic to differentiate benign from malignant lesions, as well as to moni-\ntor tumour microvascular characteristics during treatment. Diffusion-weighted MRI \n(DWI) is a more recent technique and it allows noninvasive characterisation of \nbiologic tissues based on the random microscopic motion of water proton mea-\nsurement. Several studies have shown that DWI allows early detection of tumour \nresponse to chemotherapy. The use of water diffusion is a surrogate marker used \nto distinguish highly cellular regions of tumour from acellular and necrotic regions. \nWhole body diffusion-weighted sequence (WB DWI) is a new promising technique \nfeasible to evaluate multifocal disease. DWI has revealed great potential in the \nevaluation of patients with cancer or benign disease, as it supplies both quantita-\ntive and qualitative information of the whole body. This presentation will focus on \nthe potential role of DWI in combination of DCE MRI in bone tumours as well as \non the possibilities of WB DWI. \nLearning Objectives:\n1. To learn about new techniques in the diagnosis and follow-up of bone \ntumours.\n2. To appreciate the integration of DWI in whole-body MRI.\n3. To become familiar with diffusion-weighted imaging in bone tumours.\nPanel discussion: \nWhat is the clinical impact of advanced imaging, and when should what \nkind of advanced/sophisticated imaging be used? 17:14\nIn this integrated refresher course, the impact of basic and advanced imaging on \nthe entire process, from diagnosis to treatment of bone tumours, will be addressed. \nDiagnosis is based on understanding the imaging features from a histopathologic \nchemotherapeutic agents is an attractive alternate strategy to increase tumour \nnecrosis. The efficacy of a combination therapy, including RFA plus the intraarterial \nadministration of drug-eluting beads has been recently demonstrated, while the \nuse of intravenously administered, thermally sensitive drug carriers is currently \nbeing explored. Despite the advances in local treatment, the long-term outcome \nof treated patients remains unsatisfactory because new tumours emerge in about \n80% of the cases within 5 years. Clinical trials evaluating the usefulness of adjuvant \nmolecular targeted therapies with anti-angiogenic and anti-proliferative activity in \npreventing early recurrence after successful ablation are ongoing. \nLearning Objectives:\n1. To understand the pros and cons of TACE before and/or after tumour \nablation.\n2. To understand the technique of a combined approach.\n3. To learn about indications and results.\nPanel discussion: \nWhich treatment option is the best for the various stages of \ndisease? 17:15\nIn early HCC (BCLC A) tumour ablation is a curative treatment option. In intermedi-\nate stage HCC (BCLC B) TACE or radioembolisation are the treatment options. \nInterventional treatment of advanced HCC is under debate. Borderline cases \nshould be discussed. In patients with liver metastases tumour ablation and TACE \nwith drug eluting beads offer new options for patients after unsuccessful first line \nchemotherapy. The place of interventional therapy will be discussed. \n16:00 - 17:30 Room E1 \nMusculoskeletal \nRC 1810 \nBone tumours \nModerator \nJ.L. Bloem; Leiden/NL \nA‑514\t 16:00 \nChairman’s introduction \nJ.L. Bloem; Leiden/NL (j.l.bloem@lumc.nl) \nIn this integrated refresher course, the impact of basic and advanced imaging on \nthe entire process from diagnosis to treatment of bone tumours will be addressed. \nDiagnosis is based on understanding the imaging features from a histopathologic \nperspective. Staging, biopsy and image-guided treatment require an integration of \nimaging findings with basic knowledge of surgical-oncological principles, as well \nas skills. Can technically driven development of advanced MR techniques change \nhow we diagnose, monitor therapy and determine prognosis. Techniques and \nprocedures that improve patient outcome in a cost-effective way will be identified \nbased on 3 presentations and a panel discussion. \nA‑515\t 16:05 \nA. Diagnosis: from radiographs to MRI \nK. Wörtler; Munich/DE (woertler@roe.med.tum.de) \nThe diagnosis of a bone tumour is based on clinical findings, the age of the patient, \nthe location of the lesion, its radiologic appearance, and, if imaging does not al-\nlow for a specific diagnosis, its histopathologic features. Radiography remains the \ninitial imaging modality for evaluation of the localisation of the lesion with respect \nto the longitudinal and axial planes of the involved bone, for the depiction of matrix \nmineralisations, and for estimation of biologic activity by analysing the patterns of \nbone destruction and periosteal response. CT can add „radiographic“ information \nparticularly in regions of complex skeletal anatomy such as the spine, pelvis and \nshoulder girdle. MR imaging has classically been used to determine the local extent \nof a bone tumour (local staging). In addition to radiography and/or CT, it can at \ntimes also be valuable in establishing the differential diagnosis, especially in cystic \nbone lesions and cartilaginous tumours. Whole-body applications have recently \ngained importance in demonstrating the presence and extent of bone (marrow) \ninvolvement in benign and malignant systemic/polyostotic tumourous diseases. This \ncourse reviews the basic principles of diagnosing bone tumours in a multimodality \napproach (with an emphasis on conventional radiography). The different steps of \nmorphologic analysis as well as the advantages and disadvantages of the individual \nimaging techniques are illustrated on the basis of pathologically confirmed cases. \n\nPostgraduate.Educational.Programme\nS130\n A B C D E F G H\nreview: (1) the biological rationale for using perfusion imaging in brain tumours, (2) \nmethods available for the imaging of microvascular structure and function in brain \ntumours. We will discuss the relevant advantages and disadvantages of T1 versus \nT2 weighted acquisition strategies. (3) A detailed review of methods for dynamic \ncontrast enhanced imaging and its analysis, (4) a review of current evidence for \nclinical application focusing on: (a) distinguishing abscess from tumour, (b) distin-\nguishing tumour types, (c) distinguishing glioblastoma from solitary metastases, (d) \npredicting grade, histological subtype and prognosis in glioblastoma, (e) monitoring \nradiotherapy and predicting radiotherapy response, (f) applications in clinical trials \nof novel therapeutic agents, particularly antiangiogenic agents. \nLearning Objectives:\n1. To understand the different methods available for perfusion imaging of brain \ntumours and their advantages and disadvantages.\n2. To understand the clinical uses of perfusion imaging in neuro-oncology.\n3. To understand the benefits of perfusion imaging in clinical trials of novel \ntherapeutic agents.\n4. To get an insight into the potential advances in perfusion imaging as they \nrelate to neuro-oncology.\nA‑521\t 16:51 \nStroke and vascular diseases \nJ. Vymazal, J. Keller, A. Rulseh, J. Tintera; Prague/CZ \n(Josef.Vymazal@homolka.cz) \nEarly diagnosis and treatment of acute stroke is crucial for a favourable prognosis. \nWhile non-contrast MRI is much more sensitive to ischaemia in comparison with \nnon-contrast CT, perfusion studies make both techniques comparable. Ultrafast CT \nscanners cover most of the brain with perfusion imaging; the scanning is faster and \nquality imaging results depend less on patient co-operation than in MRI. However, \nMRI enables diffusion imaging adding more specific information to the diagnostic \nprocess. Because of the short time window to eventual vascular intervention, in \nmany institutions CT is the technique of choice. Besides depiction of hyperacute \nstroke by means of diffusion weighted imaging, MRI has the advantage of perform-\ning a contrast agent-free perfusion study using a promising new technique called \narterial spin labelling (ASL). Thus, an MRI perfusion study can be performed even in \npatients with impaired renal functions where iodine and gadolinium-based contrast \nagents may be dangerous. \nLearning Objectives:\n1. To understand the role of perfusion imaging in the management of acute \nstroke.\n2. To be able to distinguish the advantages and disadvantages of CT vs MRI in \nperfusion imaging.\n3. To develop insight into the use of non-contrast arterial spin labelling \ntechnique in vascular diseases.\nPanel discussion: \nGuidelines, recommendations, hints and tips to get more from perfusion \nimaging in CNS pathologies 17:14\nPerfusion imaging is an emerging non-invasive tool that enables evaluation of brain \nfunction via assessment of various hemodynamic measurements such as cerebral \nblood volume, cerebral blood flow, and mean transit time. These techniques have \nbecome important clinical tools in the diagnosis and treatment of patients with \nCNS disorders via evaluation of brain tissue during cerebrovascular diseases, non-\ninvasive histopathologic assessment of tumours, evaluation of neurodegenerative \nconditions and assessment of the effects of drugs. \n16:00 - 17:30 Room G/H \nNeuro \nRC 1811 \nSpinal cord \nModerator: \nM. Muto; Naples/IT \nA‑522\t 16:00 \nA. Myelitis vs myelopathy \nM. Gallucci; L’Aquila/IT (massimo.gallucci@cc.univaq.it) \nThe term myelopathy indicates every generic form of pathological involvement of \nthe spinal cord. Under this definition, even the category of myelitis is enclosed. \nNonetheless, usually the term myelitis is restricted to inflammatory forms that \ninvolve a segmental extension of the spinal cord: the so-called “transverse myeli-\ntis”. Symptoms are not specific for aetiology in most cases, and MRI is the most \nperspective. Staging, biopsy and image-guided treatment require an integration of \nimaging findings with basic knowledge of surgical-oncological principles, as well as \nskills. Techniques and procedures that improve patient outcome in a cost-effective \nway will be identified, based on three presentations and a panel discussion. Can \ntechnically-driven development of advanced MR techniques change how we \ndiagnose and monitor therapy, and determine prognosis? \n16:00 - 17:30 Room F2 \nSpecial Focus Session \nSF 18b \nBrain perfusion made easy: CT/MR? \nModerator: \nE.T. Tali; Ankara/TR \nA‑518\t 16:00 \nChairman’s introduction \nE.T. Tali; Ankara/TR (turgut.tali@gmail.com) \nPerfusion imaging is helpful to analyse and assist in judging the biological behaviour \n(especially haemodynamic features) of central nervous system diseases. Qualita-\ntive and quantitative information can be obtained to evaluate pathoanatomical \nstructures and pathophysiological changes of the lesions. Cerebral blood flow \n(CBF), cerebral blood volume (CBV), mean transient time (MTT), permeability \nsurface (PS), regional blood volume, microvascular permeability measurements \nand more information can be obtained for the diagnosis and differential diagnosis \nof the diseases. Advantages and disadvantages of the CT perfusion imaging (CTP) \nand magnetic resonance perfusion imaging (MRP) in the different diseases will be \nevaluated in detail. Hints and tips for the better applications and postprocessing \nwill also be discussed. \nSession Objectives:\n1. To become familiar with perfusion imaging techniques.\n2. To become familiar with the benefits of perfusion imaging.\n3. To learn about the potential applications.\nA‑519\t 16:05 \nTechniques for CT and MR, post-processing, radiation \nR.A. Meuli; Lausanne/CH (reto.meuli@chuv.ch) \nBrain perfusion can be assessed by CT and MR. For CT, two major techniques \nare used. First, Xenon CT is an equilibrium technique based on a freely diffusible \ntracer. First pass of iodinated contrast injected intravenously is a second method, \nmore widely available. Both methods are proven to be robust and quantitative, \nthanks to the linear relationship between contrast concentration and x-ray attenu-\nation. For the CT methods, concern regarding x-ray doses delivered to the patients \nneed to be addressed. MR is also able to assess brain perfusion using the first \npass of gadolinium based contrast agent injected intravenously. This method has \nto be considered as a semi-quantitative because of the non linear relationship \nbetween contrast concentration and MR signal changes. Arterial spin labeling \nis another MR method assessing brain perfusion without injection of contrast. In \nsuch case, the blood flow in the carotids is magnetically labelled by an external \nradiofrequency pulse and observed during its first pass through the brain. Each \nof this various CT and MR techniques have advantages and limits that will be il-\nlustrated and summarised. \nLearning Objectives:\n1. To understand and compare the different techniques for brain perfusion \nimaging.\n2. To learn about the methods of acquisition and post-processing of brain \nperfusion by first pass of contrast agent for CT and MR.\n3. To learn about non contrast MR methods (arterial spin labelling).\nA‑520\t 16:28 \nBrain tumours \nA. Jackson; Manchester/UK (Alan.Jackson@manchester.ac.uk) \nThis presentation will discuss the current ‘state of the art’ in the use of perfusion \nimaging techniques in neuro-oncology. The term “perfusion imaging” is commonly \nused but is in fact a misnomer since perfusion and blood flow are not the only imag-\ning biomarkers of microvascular structure and function in common use. Indeed, in \noncological applications measurements of proportional blood volume, endothelial \ncapillary permeability or vessel size can be of equal or greater importance. We will \n\nMonday\nPostgraduate.Educational.Programme\nA\n S131\nCB D E F G H\nLearning Objectives:\n1. To understand the pathophysiology of spinal vascular anomalies.\n2. To learn the key imaging findings in different vascular diseases of the spinal \ncord.\n3. To consolidate the best neuroimaging protocols and comprehend the \nconcepts of CTA, MRA and angiography in evaluation of spinal vascular \ndiseases.\n16:00 - 17:30 Room I/K \nChest \nRC 1804 \nThe new faces of pulmonary infection \nModerator: \nB. Feragalli; Chieti/IT \nA‑525\t 16:00 \nA. Aspergillosis in the immunocompromised patient \nS.J. Copley; London/UK (suecopley@hotmail.com) \nAspergillus is a genus of around 200 fungi (moulds) which are ubiquitous in the \nenvironment. The common species affecting humans are A. fumigatus, A. flavus, \nA. niger and A. terreus. Aspergillus fumigatus is exceptional among microorgan -\nisms in being both a primary and opportunistic pathogen as well as a major al-\nlergen. Reproduction is by spore formation which is prolific and therefore human \nrespiratory tract exposure is almost constant. The spectrum of aspergillus infec-\ntion includes aspergilloma (mycetoma), chronic pulmonary aspergillosis, chronic \nnecrotising pulmonary aspergillosis (subacute invasive, chronic airway invasive), \ninvasive pulmonary aspergillosis (angioinvasive, non-angioinvasive including acute \ntracheobronchitis, exudative bronchiolitis and bronchopneumonia), and allergic \ndisease (allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric \ngranulomatosis). Immunocompromised individuals are particularly susceptible \nto invasive aspergillosis. The risk factors for invasive aspergillosis include: pro-\nfound neutropenia, haematopoietic stem cell transplant recipients, solid organ \ntransplantation, potent immunosupressive therapy, prolonged corticosteroid use \nand AIDS. Invasive aspergillosis can be further subdivided into angioinvasive and \nnon-angioinvasive forms. The imaging features of angioinvasive aspergillosis are \ncharacterised on CT by nodules with a ‘halo’ of surrounding ground glass opacity \ndue to alveolar haemorrhage. In the context of neutrophil recovery, nodules may \ndemonstrate cavitation. Airway invasive aspergillosis may manifest as areas of \nconsolidation (bronchopneumonia), nodular ‘tree-in-bud’ densities on CT (exudative \nbronchiolitis), or an acute tracheobronchitis with large airway thickening. \nLearning Objectives:\n1. To review the epidemiology and clinical settings of aspergillosis.\n2. To understand the role of imaging in immunocompromised patients.\n3. To understand radiological findings of pulmonary aspergillosis.\nA‑526\t 16:30 \nB. The changing patterns of pulmonary tuberculosis \nW.F.M. De Wever; Leuven/BE (walter.dewever@uzleuven.be) \nTuberculosis (TB) is an airborne infectious disease caused by Mycobacterium \ntuberculosis and is a major cause of morbidity and mortality. Worldwide, there were \n9.4 million new TB cases in 2008 and more than two billion people were infected \nwith TB bacilli. The estimated global incidence rate fell to 139 cases per 100.000. \nFalling rates are stabilising in Europe. Tuberculosis is developing new faces due \nto changes in host cellular immunity, such as HIV infection, immunosuppressive \ntherapy, malignancy and due to multi-drug resistance. Chest radiography plays a \nmajor role in screening, diagnosis, and response to treatment of patients with TB; \nhowever, radiographs may be normal or show only mild or nonspecific findings in \nactive disease. CT and high-resolution CT (HRCT) are more sensitive than chest \nradiography in the detection and characterisation of parenchymal disease, small \nfoci of cavitation, mediastinal lymphadenopathy, and pleural complications. Based \non these findings, HRCT is useful in determining disease activity and plays also an \nimportant role in the management of TB. Radiological manifestations of primary \ntuberculosis are lymph node enlargement, airspace consolidation and pleural ef-\nfusion. The most common findings of post-primary tuberculosis are centrilobular \nnodules, branching linear and nodular opacities, patchy or lobular areas of con-\nsolidation, and cavitation. Miliary tuberculosis results from acute haematogenous \ndissemination of TB bacilli in lungs and other organs and CT-findings consist of \ninnumerable small nodules randomly distributed throughout both lungs. Airway \ntuberculosis is characterised by circumferential wall thickening and luminal nar-\nrowing, with involvement of a long segment of the bronchi. \nsensitive diagnostic tool. Radiological semiotics are always useful and often very \nspecific in addressing the diagnosis: some fundamental concepts include the \npeculiar pattern of vasogenic oedema, which, in opposition to what happens in \nthe brain, tends to involve the central grey more than the peripheral white matter. \nDistribution pattern of the lesion can also often address to aetiological diagnosis. \nIn fact, lesions selectively involving posterior or lateral columns, asymmetrically, \nand sparing the central grey matter, are more typical expression of demyelinating-\ninflammatory diseases (multiple sclerosis, ADEM, Devic’s disease, LES, Behcet’s \ndisease), while selective and symmetrical involvement of both posterior columns, \nextended for more than 2 myelomers, and possibly associated with involvement of \nlateral columns, is typical expression of combined sclerosis (B12 vitamin deficit). \nIschaemic lesions are also usually symmetrical, but they involve both grey and \nwhite matter, extending to the anterior two-third of the cord, or, sometimes, remain \nlimited to the central grey matter. On the other hand, selective involvement of the \nanterior horns is typical of poliomyelitis. \nLearning Objectives:\n1. To learn to differentiate between myelitis and myelopathy.\n2. To learn the imaging patterns of myelitis and myelopathy.\n3. To consolidate knowledge of the best neuroimaging protocols for evaluating \npatients with suspected myelitis and myelopathy.\nA‑523\t 16:30 \nB. Spinal intradural tumours \nJ.W.M. Van Goethem, C. Venstermans, F. De Belder, L. van den Hauwe, \nP.M. Parizel; Antwerp/BE (johan.vangoethem@ua.ac.be) \nSpinal tumours are uncommon lesions and affect only a minority of the population. \nHowever, these lesions can cause significant morbidity in terms of limb dysfunc-\ntion and can be associated with mortality as well. In establishing the differential \ndiagnosis for a spinal lesion, location is the most important feature. MR imaging, \nwhich plays the central role in the imaging of spinal tumours, easily allows tumours \nto be classified as extradural, intradural-extramedullary or intramedullary. Although \nthis classification is somewhat of an oversimplification, since lesions can reside \nin several compartments, it is very useful in tumour characterisation. In general, \nextradural lesions are the most common (60% of all spinal tumours), with the \nmajority of lesions originating from the vertebrae. Intradural tumours are rare, \nand the majority is extramedullary (30% of all spinal tumours), with meningiomas, \nnerve sheath tumours (schwannomas and neurofibromas) and drop metastases \nbeing the most frequent. Intramedullary tumours are uncommon spinal tumours \n(10% of all spinal tumours), and occur most often in the cervical spinal cord. Astro-\ncytomas and ependymomas comprise the majority of the intramedullary tumours, \nwith ependymomas occurring with about double the frequency of astrocytomas. \nLearning Objectives:\n1. To review the most common spinal cord tumours.\n2. To learn the key imaging findings in different spinal cord neoplasm.\n3. To understand how to create the optimal MR imaging protocol for \npreoperative planning of spinal cord tumours.\nA‑524\t 17:00 \nC. Vascular disorders of the spinal cord \nR.J. Nijenhuis1, T. Krings2, M. Mull3, A.K. Thron3, J.T. Wilmink1, W.H. Backes1; \n1Maastricht/NL, 2T oronto, ON/CA, 3Aachen/DE (nijenhuis@rad.unimaas.nl) \nVascular spinal cord malformations are rare entities with unspecific neurological \npresentations leading often to a late diagnosis. Delay in diagnosis can be hazardous \nto patient outcome as these abnormalities can lead to paraparesis if not treated \nproperly. Apart from confirming the presence of a vascular spinal cord malforma-\ntion, the lesion also has to be classified to a specific subtype as this determines \nthe choice of therapy. The vascular spinal cord lesions can be differentiated in pial \nand dural arteriovenous shunting lesions depending on the vessels feeding the \nshunt. Pial arteriovenous malformations are supplied by arteries normally feed-\ning the neural tissue. Dural arteriovenous fistulae (DAVF) are the most common \nencountered vascular spinal cord lesions and are supplied by radiculomenigeal \narteries. MRI is the modality that should be used first to identify the vascular lesion \nand rule out other potential differential diagnosis (e.g. tumour, ischaemia, myelitis \nand degenerative disease). When a vascular spinal cord malformation is suggested \non MRI, catheter angiography has to be performed to classify the vascular lesion. \nRecently, non-invasive imaging techniques such as MR and CT angiography have \nbe used to depict the origin level of the vascular lesion. Especially, for localising \nthe level of a DAVF they have proven to have additional value in reducing catheter \nangiography examination time by guiding the interventionalist to a specific region. In \nmost cases the treatment of vascular spinal cord malformations will be endovascular \nwith a combined or surgical approach in selected cases. \n\nPostgraduate.Educational.Programme\nS132\n A B C D E F G H\nA‑529\t 16:05 \nA. Expected changes after treatment \nR. Hermans; Leuven/BE (Robert.Hermans@uzleuven.be) \nEarly stage head and neck cancer can be cured by surgery or radiotherapy. The \nchoice depends on the functional and cosmetic result to be expected, tumour histol-\nogy, patient’s condition and preference, and institutional policy. In advanced lesions, \nnowadays concomitant chemoradiotherapy is offered, with surgery reserved for \nsalvage. A relatively high locoregional control rate can be obtained, at the expense \nof acute and late toxic side effects, and a higher incidence of treatment complica-\ntions. On post-therapeutic imaging studies, treatment-induced tissue changes are \noften visible; these changes should not be misinterpreted as evidence of persis-\ntent or recurrent tumour, or treatment complication. After radiotherapy, the visible \nchanges depend on the radiation dose and rate, the irradiated tissue volume, and \nthe time elapsed since the end of treatment. Basically, thickening of the laryngeal \nand pharyngeal walls, increased attenuation of fat planes, postirradiation sialad -\nenitis, lymphatic tissue atrophy, and retropharyngeal oedema will be seen. These \nirradiation-induced tissue changes usually appear symmetrical. The acute effects \nof radiotherapy occur during or immediately after treatment, and usually settle \nspontaneously. Complications of radiotherapy are usually seen months to years \nafter the end of treatment. The limits of surgery are determined by safeguarding \ncritical functions and maintaining a cosmetically acceptable appearance. Exten-\nsive resections are possible by the use of various reconstructive materials. Most \nsurgical complications occur early after treatment, and are dealt with on a clinical \nbasis. Imaging may be required, for example, in case of a postoperative collection, \nfor fistula detection and follow-up, or to confirm flap failure because of necrosis. \nLearning Objectives:\n1. To learn about the current treatment options in head and neck cancer.\n2. To understand the expected tissue changes on imaging studies after \nradiotherapy for head and neck cancer.\n3. To appreciate the expected imaging findings after surgery for head and neck \ncancer.\nA‑530\t 16:28 \nB. Surveillance imaging, tumour recurrence and treatment complications \nA.D. King; Hong Kong/CN (king2015@cuhk.edu.hk) \nThere is no clear consensus regarding optimal time points for surveillance, but \nclinical assessments are more frequent in year 1 and are performed over at \nleast 2-3 years, during which time most locoregional failures and second primary \ntumours are detected. Ideally for imaging surveillance at least one post-treatment \nbaseline head and neck scan (MRI/CT) should be performed at 3-6 months, and \noften closer surveillance is desirable. Candidates for salvage surgery after (chemo)\nradiotherapy undergo a post-treatment scan at 6-8 weeks, followed by regular \nscans (4-6 months in year 1; 6-12 months thereafter, the exact time period being \ntailored to the patient). A residual mass after (chemo)radiotherapy may be caused \nby cancer, benign treatment mass (BTM), or both. In the later post-treatment period \nresidual/recurrent cancer (homogeneous moderately contrast-enhancing expansile \nmass of intermediate T2 signal) can be distinguished from a BTM (retracted/straight \nedged non-enhancing fibrotic scar tissue of low T1 and T2 signal). Earlier stages are \nmore problematic when both cancer and BTMs form expansile masses of marked/\nmoderate contrast-enhancement and high/ moderate T2 signal. This limitation \nhas focused attention on functional imaging techniques. 18 F FDG-PET has a high \nnegative predictive value for cancer at ≥ 3 months. Functional MR techniques are \nshowing promise for even earlier post-treatment assessment using DWI, MRS \nand DCE. The delayed effects of treatment cause a wide range of complications. \nOsteoradionecrosis, chondronecrosis, muscle denervation, inflammatory polyps \nand radiation-induced tumours may to be mistaken for tumour recurrence. Features \nof these treatment-induced complications will be illustrated. \nLearning Objectives:\n1. To become familiar with the ideal time points for follow-up.\n2. To become familiar with morphological and functional changes occurring \nwith tumour recurrence.\n3. To understand treatment complications and to differentiate them from tumour \nrecurrence.\nA‑531\t 16:51 \nC. Predicting outcome after radiation therapy in head and neck cancer: \nwhat is evidence-based? \nR. Maroldi; Brescia/IT (maroldi@med.unibs.it) \nThe most recent advances of radiotherapy techniques are characterised by the \nincreased precision with which the radiation energy is released to the target, the \nreduced collateral damage to adjacent non-neoplastic tissues, and the synergic \nLearning Objectives:\n1. To review the current demographics of pulmonary tuberculosis in Europe.\n2. To understand the role of imaging in patients with tuberculosis.\n3. To understand radiological findings of pulmonary tuberculosis.\nA‑527\t 17:00 \nC. Emerging viral infections \nC.J. Herold; Vienna/AT (Christian.Herold@meduniwien.ac.at) \nViral agents are part of the spectrum of organisms which cause community acquired \npneumonias. Furthermore, they are thought to function as a trigger for bacterial \ninfections in the hospital or health care setting. In addition, viruses play a significant \nrole as causative agents for infections in the immunocompromized host. Within \nthe last years, outbreaks of viral infections have challenged regional, national and \neven global health care systems, have effected thousands of individuals and have \nresulted in significant morbidity and mortality. Most of the involved viral agents \nrepresented emerging organisms with an unpredictable impact on individual and \nsociety health. The radiologic community has learned several lessons from the \ndocumented outbreaks, and radiologists around the world have contributed to the \nearly diagnosis of the disease, the monitoring of its course, and the documenta -\ntion of complications as well as of response to therapy. Thus, imaging plays an \nimportant role in the diagnosis and management of these patients. In this course, \nepidemiologic aspects, patho-physiology and clinical features of emerging viral \ninfections will be presented. In addition, their radiologic features and the role of \nradiology in diagnosis and management will be discussed. Attendees will learn how \nto understand, recognize, report and follow patients with emerging viral infections. \nLearning Objectives:\n1. To review the epidemiology and etiology of viral infections.\n2. To become familiar with radiological patterns of different viral pneumonias \nand pulmonary infections.\n3. To understand the role of imaging in patients suspected of having viral \ninfections.\n16:00 - 17:30 Room N/O \nHead and Neck \nRC 1808 \nManagement of the post-treatment head and neck: a \ndiagnostic dilemma \nModerator:\nR. Maroldi; Brescia/IT \nA‑528\t 16:00 \nChairman’s introduction \nR. Maroldi; Brescia/IT (maroldi@med.unibs.it) \nMajor changes in the treatment of head and neck neoplasms encompass the \nadvances of endoscopic-based surgical techniques, mainly for nasosinusal and \nlaryngeal tumours, and the application of sophisticated radiation therapy techniques, \ncombined with chemotherapy. As most tumours arise from the mucosa of the upper \naero-digestive tract, clinical surveillance is necessary to detect superficial recur-\nrences, while morphological and ‘functional’ imaging techniques are indispensable \nto detect subclinical extra-mucosal and nodal recurrences. How can imaging \ntechniques discriminate recurrence, inflammation, necrosis or scar? Key points \ninclude the knowledge of the normal appearance of tissues (morphology and sig-\nnals) on CT, MRI, and PET-CT after surgery and chemo-radiotherapy. Specifically, \nwhen non-surgical treatment has been used, that means to become familiar with \nthe expected changes both of tumour and adjacent tissues. Morphology-based \nimaging techniques are often inadequate to discriminate small recurrences from \nvascularised scar tissue (enhancing). CT or MRI do require to be integrated by \ninformation provided by functional-based imaging techniques, FDG-PET-CT being \nthe most established. Recently, a great interest among radiologists is focused on \nthe application of DCE-CT or DCE-MRI and DWI-MRI in the follow-up of head and \nneck neoplasms. In fact, several studies have credited these techniques for provid-\ning functional information about tissues (perfusion, water exchange) that help to \ndiscriminate scar from recurrences. Obviously, the horizon pursued is to combine \nmorphology and functional data in a single examination. Though clearly promising, \nthese new techniques share significant limitations, like the reproducibility of CT and \nMR-based functional results, their introduction and feasibility in the day practice. \n\nMonday\nPostgraduate.Educational.Programme\nA\n S133\nCB D E F G H\nA‑533\t 16:30 \nB. Dual energy CT and time resolved CT \nK. Nikolaou; Munich/DE (konstantin.nikolaou@med.uni‑muenchen.de) \nToday, CT angiography (CTA) is considered as a safe, non-invasive and well-\nestablished procedure for vascular imaging. Modern multi-slice CT technology \nallows for coverage of larger vascular territories - even the whole body - in just \nseveral seconds. Further technical improvements such as wide detectors of up \nto 16 cm width or moving table techniques are making new applications possible, \nsuch as perfusion imaging, or time-resolved CT angiography. Especially with the \nmoving table technique (the so-called „shuttle-mode“), vascular territories of up to \n50 cm can be covered in a dynamic fashion, which can be helpful in the diagnosis \nof aortic dissections or peripheral vascular occlusive disease. On the other side, \nradiation exposure has to be maintained within a reasonable range applying these \nrepeated acquisition modes. Another interesting field opening new options in CTA \nis dual energy CT (DECT). A number of technical setups may allow for spectral \nCT imaging, such as systems with two tubes (dual source CT), CT systems with \nswitching kV modes or with special detectors. In vascular applications, DECT is \nespecially helpful for automated bone removal, plaque removal, and potentially \nfor „perfusion“ imaging (iodine mapping). In this course, the basics of modern CT \nangiography will be highlighted, with a special focus on new applications such as \ntime-resolved CTA and dual energy CTA. \nLearning Objectives:\n1. To learn the basic principles of dual energy CT and time resolved CT and its \nadvantages for vascular imaging.\n2. To review imaging protocols, results and radiation exposure aspects.\n3. To learn about future developments and advantages in comparison with \nMRA.\nA‑534\t 17:00 \nC. Flat panel CT (C-arm CT) \nH. Rousseau; T oulouse/FR (rousseau.h@chu‑toulouse.fr) \nAngio-3D with digital flat-panel detector has recently been adapted for use with \nC-arm systems and provides a higher detector quantum efficiency (DQE) than \nconventional detectors based on II camera. This configuration represents the next \ngeneration of imaging technology available in the interventional radiology suite and \nis predicted to be the platform for many of the three-dimensional (3D) roadmapping \nand navigational tools that will emerge in parallel with its integration. It provides \nprojection radiography, fluoroscopy, digital subtraction angiography, and volumetric \ncomputed tomography (CT) capabilities with the ability for immediate multiplanar \npost-treatment assessment in a single patient setup, within the interventional suite. \nSuch capabilities allow the interventionalist to perform intraprocedural volumetric \nimaging without the need for patient transportation. The clinical benefits of 2D an-\ngiography with these new systems have been assessed in the fields of cardiology \nand interventional radiology. These key features alone may translate to a reduction \nin the use of iodinated contrast media, a decrease in the radiation dose to the pa-\ntient and operator, and an increase in the safety and performance of interventional \nprocedures. Proper use of this new technology requires an understanding of both \nits capabilities and limitations. This article provides an overview of the potential \nof this new technology. \nLearning Objectives:\n1. To learn the basic principles of flat panel CT.\n2. To review imaging protocols, results and radiation exposure aspects.\n3. To become familiar with the most common applications.\neffect of chemo-radiotherapy. As the treatment planning becomes progressively \n‘tailored’, strong predictive factors for the individual tumour arising in a specific \npatient have to be identified. These factors would ideally provide a quantitative \nassessment of the risks of both relapsing (in the primary, nodal or distant sites) \nand developing treatment-related (early or late) complications. Predictors are \nrelated to tumour’s characteristics (biology, metabolism, site, volume and spread) \nand to patient’s overall clinical conditions. Imaging-based predictive factors have \nbeen founded upon morphological findings (2D, volume) until the development \nof new techniques, which analyse ‘functional’ parameters like FDG-PET-CT, the \nmost established, and perfusion-CT or DWI-MRI. Evidence of level A has been \nprovided on the impact of negative predictive value of FDG-PET-CT in ruling out \nresidual disease, whilst there is no clear data regarding the role of pre-treatment \nintensity of glucose metabolism (SUV) in predicting the outcome after radiotherapy. \nThis limitation can be addressed to the enrolment of tumours arising in various \nsites in the head and neck. A major disadvantage common not only in PET stud-\nies but also in most DCE and DWI-MRI studies. Perfusion-CT and DWI-MR are \npromising techniques, as they provide information about neo-angiogenesis and \nwater-flow in submicroscopic tissue compartments. However, these techniques \nstill require randomised trials and confirmation studies about the reproducibility \nof their interesting results. \nLearning Objectives:\n1. To become familiar with the prognostic significance of MR imaging-\ndetermined tumour parameters.\n2. To become familiar with the prognostic significance of CT imaging-\ndetermined tumour parameters.\n3. To discuss what is evidence-based, including future perspectives.\nPanel discussion: \nRecurrence, inflammation, necrosis or scar: is imaging useful? 17:14\nIn the follow-up after minimal invasive surgical techniques or chemo-radiation, a \nmajor limitation of standard morphological imaging is the differentiation of the highly \nvascularised scar tissue (enhancing, with mass effect) from persistent or recurrent \nneoplasm. Is it time for integrating standard imaging with the functional information \nprovided by DWI and/or CT or MR perfusion techniques? Which evidence level are \nwe at presently? Is it now feasible in daily practice? \n16:00 - 17:30 Room P \nVascular \nRC 1815 \nAdvances in vascular imaging \nModerator: \nP.M.T. Pattynama; Gouda/NL \nA‑532\t 16:00 \nA. Vascular imaging at 3 T \nH. Hoppe; Berne/CH (hanno.hoppe@web.de) \nThree-Tesla MRI scanners offer an increased signal and contrast for MR-angi -\nography (MRA) compared to 1.5-Tesla machines. MRA can be performed within \na shorter time enabling the acquisition of temporally resolved three-dimensional \ndatasets with high spatial resolution. Due to high signal and contrast the dose \nof gadolinium may be reduced. Furthermore, novel imaging protocols for MRA \nat 3.0-Tesla with intravasal contrast agents and prolonged enhancement during \nhigh-spatial-resolution steady-state enable new possibilities for angiography of \nthe upper and lower extremities including veins and vessels below the knee, spi-\nnal arteries, vascular malformations, and double-gated angiography of coronary \narteries and bypass vessels to compensate for the complex cardiac motion pat-\ntern. A 3.0-Tesla MRI system equipped with a matrix coil system allows for whole \nbody MRA with continuous table movement, which is an applicable technique for \nimaging peripheral vessels without the need for planning different steps and field \nof view positioning, thereby considerably reducing the examination time. Phase \ncontrast magnetic resonance angiography may develop into an important, non-\ninvasive method for obtaining quantitative information on blood flow. In addition, \nnon-enhanced three-dimensional MR angiography using turbo spin echo (TSE) \nimaging with non-selective refocusing pulses may be a promising imaging technique \nfor vascular imaging in patients with renal insufficiency. \nLearning Objectives:\n1. To learn the major advantages of vascular imaging at 3 T.\n2. To become familiar with imaging protocols for vascular imaging.\n3. To learn about future developments.\n\nPostgraduate.Educational.Programme\nS134\n A B C D E F G H\nA‑537\t 16:28 \nB. Intraoperative imaging for surgeons \nA. Pietrabissa; Pisa/IT (andrea.pietrabissa@gmail.com) \nThe advent of minimally invasive surgery has made even more important the \nplace of preoperative imaging assessment of patients selected for this type of \nsurgery. In fact, the loss of tactile feed-back and the bi-dimensional intraopera -\ntive vision have limited the capability of surgeons to assess extent and anatomic \nrelationship of a given disease, particularly cancer. Preoperative planning can be \nfurther enhanced by the use of 3D models of the target anatomy, derived from CT \nscan dataset. In addition, dedicated technology can be implemented to introduce \nmixed reality environments in the operative room. Using 3D helmets with built-in \nmicrocameras, the surgeons’ view of the operative field can be fused with the \npreoperative 3D anatomy of the patient. Localiser should be used, either infrared \nbased or electromagnetic. The last step would be intraoperative navigation. This \noffers special problems to be addressed, due to organ shifting and soft tissue in \nthe setting of abdominal surgery. \nLearning Objectives:\n1. To understand why surgeons will need more intraoperative guidance.\n2. To learn about the role of robotics and augmented reality for the general \nsurgeon.\n3. To become familiar with patient-specific simulation.\n4. To appreciate the place of surgical training and credentialing.\nA‑538\t 16:51 \nC. Images and models for CAS \nH.U. Lemke; Berlin/DE (hulemke@cars‑int.org) \nThe appropriate use of information and communication technology (ICT) and as-\nsociated systems is considered by many experts as a significant contribution to \nimprove workflow and quality of care in clinical settings. A conceptual design and \nprototypical implementation of such an infrastructure, i.e. a therapy Imaging and \nmodel management system (TIMMS) will be introduced as a solution to a patient-\nspecific medicine. A TIMMS is an information technology concept and framework \nfor the collection, organisation, and utilisation of medical information from sources \nsuch as the electronic medical record, PACS, etc. TIMMS was originally designed \nas a surgical assist system, but has many general medical uses as well, including \nall forms of model-guided medicine and may therefore be generalised to a medi-\ncal information and model management system. The architectural framework and \na number of individual ICT components of a TIMMS have been realised. These \ninclude standardised interfaces for communication of patient-specific and workflow \nmodels, thereby creating a unified environment for the input and output of data, \nincluding the representation and display of information and images, as well as the \nelectromechanical control of interventional and navigational devices. In conclu -\nsion, the patient-specific model (PSM) is the central construct for a patient within \na personalised medicine environment in order to provide a clinician with a real-time \nrepresentation of critical information about the patient. The required information \nconcerning the patient for model-guided therapy is extracted by TIMMS agents \nand assembled within the framework of an active PSM and workflow manage -\nment system. \nLearning Objectives:\n1. To become familiar with the problem of integration of image information for \nknowledge models of patients.\n2. To become familiar with the concept of ‘from image-guided to model-guided \nsurgery’.\n3. To learn about selected examples from ENT, neuro- and cardiovascular \nsurgery.\n4. To learn about IT infrastructures and standards for enabling image-guided \nand model-guided surgery.\nPanel discussion: \nThe take-home points 17:14\n1. Image sharing in teleradiology\n2. Surgical workflow\n3. Image and model-guided surgery\n4. Patient-specific model \n16:00 - 17:30 Room Q \nComputer Applications \nRC 1805 \nImage sharing \nModerator: \nD. Caramella; Pisa/IT \nA‑535\t 16:00 \nChairman’s introduction \nD. Caramella; Pisa/IT \nThe introduction of picture archiving and communication systems (PACS), through a \nmuch more effective image sharing, has dramatically changed the role of radiology \nboth within the hospital and on a geographic perspective. Historically, the latter has \nbecome apparent first with the early implementation of teleradiology applications. \nPhysicians and the general public have understood that digital images can be read, \nprocessed, and stored independently on the site of production. Therefore, telecon-\nsultation and telereporting activities have been carried out among medical users, and \ngeneric users have learnt to include radiological images in their own on-line personal \nhealth records. Only later the full potentialities of multidisciplinary image sharing \nwithin the hospital have been discovered, and now it is increasingly common to see \nadvanced integration between radiologists and surgeons for planning and guiding \nsurgical interventions. During this session, the lecturers - exceptionally expert in \ntheir respective fields - will give insights into image sharing: from the geographical \napplications (teleradiology) to the hospital-based applications, with specific reference \nto the support to surgeons (intraoperative guidance and model-guided surgery). \nSession Objectives:\n1. To become familiar with models of PACS and imaging networks.\n2. To understand the evolution of teleradiology.\n3. To understand the utilisation of general public communication tools.\nA‑536\t 16:05 \nA. Image data beyond radiology: new techniques \nF.H. Barneveld Binkhuysen1, E.R. Ranschaert2; 1Soest/NL, \n2’s‑Hertogenbosch/NL (ranschaert@telenet.be) \nMedical imaging is part of a changing medical environment, a changing patient envi-\nronment and consequently a new medical world. In the recent decennium one of the \nmost important changes in radiology is the conversion from analogue to digital. In no \ntime medical images have become interchangeable through the digital highway and \ncould be post-processed in a different location. Teleradiology has become a reality \nsince then. We have seen the maturation of commercial international teleradiology \ncompanies offering a wide portfolio of services. Another aspect is the availability \nof image data for all medical specialties beyond radiology and beyond the regular \nmedical disciplines. An increasing number of surgical or oncological specialties and \neven pharmaceutical companies increasingly use image data to prepare a strategy \nfor operative procedures, to choose the right therapy, to decide which prosthesis to \nthe best to use, for follow-up or for post-processing purposes. They are supported \nby many new techniques and software. An increasing number of medical computer \napplications such as complex navigation and visualisation tools based upon digital \nimages is already in clinical use or under development. Another trend is the increasing \ninterest in E-health and telemedicine in Europe, also among European policy makers. \nNow we see mobile health that brings care directly into the patient environment. The \npurpose of this presentation is to give a comprehensive overview of and insight into \nthese new developments and to create awareness among radiologists of the increas-\ning importance of integration of medical imaging in a multidisciplinary environment. \nLearning Objectives:\n1. To review remote consultation.\n2. To review second/expert reading.\n3. To understand image data beyond radiology.\n4. To understand communication, visualisation and navigation.","source_license":"CC-BY-4.0","license_restricted":false}